Strategy #1: Educate all parents and children on why to stay away from sugary snacks

ABOUT

Problem Statement

Decrease the number of no shows and increase the number of kept appointments.

Aim / Overall Goal / Desired Result

Garrett County Dental Care Center will reduce the clinic no show rate 50% by June 01, 2022.

Change Idea

Dental hygienists and assistants will utilize contact methods such as cell and home phone calls, email, text messaging, and post cards to reach patients and parents regarding scheduled appointments at least two weeks in advance for a timely notice in case of needing to reschedule due to conflict.

PDSA Objective

The clinic will utilize different contact methods such as text and email to keep patients and parents on track and on time for operative or recall appointments.

PDSA Cycle Number: 1

Estimated PDSA Implementation Timeline

From 2021-07-14 to 2022-04-01

What questions do you want answered for this change?

Will the clinic see a decrease in the number of no shows? Will the clinic see an increase in kept appoinments?

PLAN

Predict what will happen when this test is carried out:

By taking further contact methods the clinic will see an increase in patient response as well as arrival rate.

List the tasks needed to set-up this change: (Please include the person responsible, when the task is to be completed, and where the task is to be completed for each task.)

Sending postcards in advance will remind patients early enough to cancel if needed. Inquiring email addresses from patient's if they would need to be reached via email. Follow up with patients that missed appointments with a "sorry we missed you" letter.

Related Improvement Measure:

10) Number of Patients receiving fluoride application

DO

Describe what happened when you ran the test:

The post cards and reminder phone calls have been very helpful as far as getting reminders out early enough to give patient's plenty of notice if they need to cancel. Some people are not willing to give out email addressed. We started sending out text message reminders in September. We are hoping that the text reminders will also improve out no show rate. Since we started sending post cards in the beginning of September, we have cut our no show rate by half. The clinic elected to keep sending post cards two weeks early we have gotten good response with that.

STUDY

Describe the measured results, and how they compared to the predictions:

At the end of August and beginning of September we cut our no show rate 50%, but the no show rate seems to be fluctuating by different weeks. It seems like by the end of each month the no shows increase daily. I would not say that the no show rate is high at this point it is still lower than expected because we are still seeing a lot of patients daily. For the month of October we had a total of 35 no shows out of 254 people seen.

ACT

Describe what modifications in the plan will be made for the next cycle from what you learned:

We are going to try harder to reach people the day before appointments. The office currently uses and automated system that gives us feedback on who was reached and who could not be reach by the phone numbers they provide. The clinic will try using emergency contacts as well as reach any responsible parties to confirm they are coming to the scheduled appointment.

ABOUT

Problem Statement

Decreasing the amount of emergencies left unscheduled in a business week.

Aim / Overall Goal / Desired Result

Increasing the amount of emergencies that can be seen within 2 business days.

Change Idea

By allowing emergency hold spaces in our schedule 2 days a week will that benefit the amount of pain patients we can see in a business week?

PDSA Objective

Our priority would be to try to get patients seen before there dental procedure becomes an emergency.

PDSA Cycle Number: 1

Estimated PDSA Implementation Timeline

From 2022-04-05 to 2022-11-01

What questions do you want answered for this change?

Will this help with keeping dental emergencies out the the emergency room?   Will blocking space in the schedule benefit the amount of time it takes to get a person in?    Do certain days of the week determine the amount of emergencies called?

PLAN

Predict what will happen when this test is carried out:

By holding appointments in our schedule this will allow us to get priority dental patients in within the business week verses scheduling them out to when we have availability.

List the tasks needed to set-up this change: (Please include the person responsible, when the task is to be completed, and where the task is to be completed for each task.)

Reserving appointments a month in advance includes scheduling staff (Macey, Amy, Regan, and McKenzie).  

Related Improvement Measure:

3) Number of dental emergencies presenting at GRMC ER.

DO

Describe what happened when you ran the test:

After implementing priority holds in the schedule 2 days a week it has helped us reduce the amount of emergencies left unscheduled within a business week. We are filling most of the hold appointment by Monday morning which isn't benefiting us towards the end of the week.  We do continue to put patient's on the cancellation list and work them in as we have cancels and no shows for appointments. No one in the area is taking new patients nor are they accepting adult medicaid. We are operating with limited staff right now that has prevented our clinic from accepting new patients. Our policy procedure states that if a patient is new and experiencing a true dental emergency they are to be worked into the schedule if time allows.  

STUDY

Describe the measured results, and how they compared to the predictions:

We have been able to get the majority of people that call in, in pain, within the week. We are currently not taking new patients due to staffing issues so this has resulted in us turning some away. Patients in pain that are new; we are stilling trying to work in as well. Our priority is to get our our established patients seen.  In some cases patients are not as flexible and need a certain time. Our hold appointments are only certain times so this results in people still waiting for the time slot they need when it becomes available.

ACT

Describe what modifications in the plan will be made for the next cycle from what you learned:

The office has notice that we do receive more emergency calls on Monday's and Tuesday's. We also have noticed we get several calls on Thursday morning's. Since we are no open on Fridays we have been leaving holds on Thursday afternoons as well to get those people in before the weekend. When we originally implemented this cycle we had additional staff since then we have lost a hygienist. We are going to continue this to make sure data is not skewed. As a clinic we have decided to only leave open appointments for emergencies Monday afternoon and Thursday afternoon because those our our busiest days in the clinic. We have noticed that leaving holds daily is not working in our favor because there has been appointments left open instead of filled and because of these open appointments we don't have a high volume of patients on out cancellation list.   The changes we will make for next cycle is to put holds on the schedule Monday-Thursday at least one daily that way we can get everyone in that has called in pain. If we have not filled the hold appointments by the end of prior business day we will fill the hold appointment with someone off the cancel list. Typically these people are already scheduled and just need a sooner appointment. This will help keep production up. As a clinic we have decided to not continue to do held appointment every day of the week and only doing Monday and Thursday afternoon because that is the clinics most busiest clinic days. When implementing the held appointments daily we have been unable to fill appointments leaving the clinic production down. We will still make emergency appointments priority and get them in within the business week.

ABOUT

Problem Statement

Patient compliance with fluoride application.

Aim / Overall Goal / Desired Result

Increase patient compliance with fluoride application.

Change Idea

By educating patients, parents, and guardians on fluoride misconception we hope to increase fluoride applications.

PDSA Objective

To increase delivery and documentation of dental varnish.

PDSA Cycle Number: 1

Estimated PDSA Implementation Timeline

From 2022-11-01 to 2023-06-30

What questions do you want answered for this change?

What is the number one reason patients decline fluoride application? With fluoride now being a covered service through Medicaid for adult and children, will that also help with increased fluoride application?  

PLAN

Predict what will happen when this test is carried out:

The clinic predicts that we will have better patient compliance with fluoride once we begin educating patients, parents, and guardians more on the benefits of fluoride application.

List the tasks needed to set-up this change: (Please include the person responsible, when the task is to be completed, and where the task is to be completed for each task.)

McKenzie and Jason will provide fluoride to patients during a routine appointment or for general sensitivity. Amy, Regan, and myself can provide parents and patients with information about fluoride including the history and benefits  

Related Improvement Measure:

10) Number of Patients receiving fluoride application

DO

Describe what happened when you ran the test:

Parents are still denying for children because parents have it applied at PCP. Children do not like the way fluoride makes their teeth feel. Some parents still deem its unsafe for their children mostly in Amish Mennonite families. Fluoride is now a covered service under adult Medicaid. Adults still assume that since it is in their water and in their toothpaste that they do not need any additional fluoride. Other adults are still denying it because they can't drink anything hot for 30 minutes and they can not take it with them because is it a prescription.  

STUDY

Describe the measured results, and how they compared to the predictions:

Patient compliance has been fluctuating December was a slow month of only applying 28 fluoride applications, January increased to 49 applications, and as of February we are on track to be comparable to  January at 29 applications as of 02/16/2023. This project data will steadily increase due to it now being a covered service with adult Medicaid. We have steadily seen in increase in adults patient with fluoride after the start of the new year. We have even had many adult patients ask us for fluoride treatments. Since my last update with fluoride uses February was very successful with 50 applications and March at 48. Our office is averaging at  50 applications per month. This is very good

ACT

Describe what modifications in the plan will be made for the next cycle from what you learned:

Overall patient compliance with fluoride has been going very well. We have had a steady increase in patient compliance over the last few months and we hope that will continue. The number one reason patients/parent deny fluoride application is parents believe fluoride varnish is not healthful for there children. Mostly the others was because patients do not like the feeling of it. Medicaid has not denied a single treatment which is great news! We have found that most private insurance will not pay for fluoride over the age of 14. There will always be controversy with fluoride. At the beginning of this project I was not hopeful that we would see much patient compliance with fluoride because of the constant controversy. Data shows that at the start of the project 21% of our patients were receiving fluoride monthly. At the close of the project 26% of our patient monthly are receiving fluoride treatments. We did not put a target percent on this project because we new we just wanted to see an increase even if it wasn't much of an increase. We will continue to advocate fluoride for our patients for good oral health.