Sedation architectonics

Successful sedation dentistry begins with proper scheduling. Here's how you can maximize appointment efficiency and profitability.

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Successful sedation dentistry begins with proper scheduling. Here's how you can maximize appointment efficiency and profitability.

by Anthony S. Feck, DMD, DDOCS

For more on this topic, go to www.dentaleconomics.com and search using the following key words: sedation dentistry, Dr. Anthony Feck, DOCS, scheduling.

Incorporating sedation dentistry can have an enormously positive effect on your practice, not the least of which involves making a significant impact on the health and well-being of your patients. But the potential doesn't end there. This emerging new standard for treating anxious dental patients can substantially improve your dental business, resulting in more new patients, as well as more profitability per patient. Click here to view chart,

As with any tool, knowing how to best use sedation systems to your advantage will determine just how positive the results will be for your practice. This article addresses the best and most effective ways to schedule sedation candidates in order to maximize appointment efficiency and profitability.

Sedation patients are different from the start

The first thing we must understand when scheduling sedation candidates is that these individuals are unique in many ways and our approach to treatment planning and scheduling needs to reflect those differences. There are specific procedures and techniques that should be followed to ensure successful and efficient sedation treatment — and it all begins with the very first phone call to your office.

It is important to know who these individuals are. You determine this by asking when the caller's last visit to your office was. When you have confirmed they are a new patient, you should ask them how they found out about your practice. If they came by way of any marketing method used to attract sedation candidates, you can assume they are inquiring about sedation. You then simply ask them, "It sounds as if you're interested in sedation. Is that correct?"

Once you find out you are dealing with a sedation candidate, your team member answering the phone should go into "sedation mode." These patients require compassion, empathy, and understanding. They need to feel safe and understood, and most importantly of all, they don't want to be judged. They need to know that they will be made completely and totally comfortable prior to any dental procedure and they must be spoken to in a manner that conveys this.

How effectively your business office team has handled the call is determined by whether or not the patient schedules their first appointment. The next step in sedation scheduling is getting the patient to show up for their appointment. This is more likely to occur if the appointment is made within a week after their first call. Encouraging the patient to bring a close family member or friend with them is another "pearl" to ensuring they keep their initial appointment.

Additionally, the patient's companion will help support the dental team, encourage the patient to move forward with treatment, and the patient will feel confident and reassured in the care they are going to receive.

Case acceptance

Once the business office team has connected with the patient and the appointment is made and honored, it then becomes the responsibility of the entire team to gain case acceptance. Here again, it is important to understand that sedation candidates have different motivations.

Whereas a nonsedation patient is often most concerned about money, a sedation patient, while not indifferent to cost, is motivated most by comfort, followed by reduction in the number of appointments required to complete their treatment.

Case acceptance starts as soon as a patient is greeted in the reception area. Be sure to congratulate them on having the courage to make and keep their appointment. Empathize with them. Be careful not to give these patients more information than they need to make a decision. This will only confuse and threaten them.

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They do not want to know all of the nitty-gritty details about their treatment — only that they will be anxiety-free and pain-free during their procedure. If they ask for more information, you can supply it; otherwise, less is more.

They also want to be reassured that all of their treatment can be completed in one appointment, which is usually unlikely. You can, however, emphasize that with sedation dentistry treatment can be accomplished in significantly fewer visits.

Also keep in mind that a separate treatment planning presentation is often necessary due to the complexities of many of these cases, but time is of the essence here. These patients want to come in as few times as necessary, so when possible, arriving at a treatment plan during their initial visit increases case acceptance.

Scheduling guidelines

When it comes to scheduling sedation appointments, keep the following guidelines in mind:

You should never sedate a patient during their first (sedation consult) appointment. Forms have to be signed, a companion determined and made available, a detailed health history taken, a sedation work-up performed, including researching any drug interactions, and occasionally, communication with the patient's physician. Lastly, prepayment needs to be obtained.

Sedation patients are best scheduled in the morning. They tend to be more relaxed at that time of day versus the afternoon or evening. It also makes it easier for them to be NPO (without food or liquids) for six hours prior to their appointment because much of that time takes place while they are asleep the night before.

Because so much dentistry can be accomplished during a sedation appointment (it is not uncommon for appointments to average four to six hours in length), you will likely have to block out time in your schedule in advance in order to be able to schedule them within a week or two of case acceptance. Waiting any longer can be problematic from the standpoint of buyer's remorse and/or taking care of the urgent needs sedation patients often have, such as pain and infection.

Sedation appointments are extremely productive, so there is no need to schedule a lot of patients around these appointments. Still, you can schedule another patient during the induction time (typically one hour in duration), as long as you have a qualified team member to monitor the patient. You can also take breaks during the appointment when assistant or hygiene procedures are taking place. These breaks in your treatment of the patient can also be used to see another patient somewhere else in the office if your state or province's regulations permit it.

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You only schedule one sedation patient at a time. You need to be able to give a sedation patient all of your attention in the unlikely circumstance something unexpected should occur. For this reason, you should never take responsibility for two sedation appointments at the same time. If there are multiple dentists in the practice qualified to perform sedation services, then there can be multiple sedation appointments, but again, only one sedation patient per dentist at a time.

The abbreviated initial sedation visit

Occasionally, the patient needs to be sedated before a comprehensive treatment plan is formulated. This may be due to the patient being too sensitive and/or too anxious to tolerate an examination. Or it may be due to emergency needs of the patient that must be dealt with immediately. After a thorough medical evaluation is taken and any drug interactions researched, the remainder of the pre-sedation work-up is performed and the patient scheduled as soon as possible for a sedation appointment where a thorough exam can be performed. After this appointment, the patient can return for a formal treatment plan presentation.

Pre-sedation work-up

Certain procedures must be performed prior to the initial sedation treatment. Baseline vitals such as blood pressure, heart rate, and oxygen saturation percentages should be measured and recorded. The pre- and postoperative instructions should be reviewed and the patient's signature obtained indicating they understand and intend to comply. Once the patient has had an opportunity to review the consent form and ask any questions they may have, written consent is obtained. Finally, the name and contact information of the patient's companion for the day of the sedation appointment is acquired.

Allow for extra time in your schedule and plan for the unexpected

With a "typical" patient, when you encounter something unexpected (e.g., mesial pulp horn during the crown preparation on tooth No. 30), you simply sit them upright and discuss with them their options. You can have a frank discussion with them, recommend treatment, make financial arrangements, and move forward with the new treatment plan.

During a sedation appointment, if you run into the unexpected, you can't sit patients up, talk to them, and get permission. They have an altered state of consciousness and cannot be held accountable for any type of consent they may give while under the influence of a drug you have administered.

You have, however, obtained consent to change the treatment plan if, in your professional judgment, it is in the best interest of the patient. Nevertheless, any treatment not planned, given consent for, and not paid for in advance should be performed at no charge. Yes, free of charge. If you have not diagnosed the condition, and have not been paid for it, go ahead and do it for free.

You're probably thinking that this is crazy, giving your dentistry away, and eliminating your profit. However, profitability from sedation appointments is so much higher than regular appointments that it allows for this occasional situation to occur without hurting practice profitability.

Besides, it's the right thing to do for the patient and it's not likely to happen. Why? Because you plan for the unforeseen in your initial estimate.

When creating a treatment plan for a sedation patient, plan for the most unlikely circumstances in your estimates — but do not over-treat. Include any procedures for events or procedures you may likely run into, and, if in the end you did not have to perform them, you simply issue the patient a refund.

Sedation appointments should always be paid for in advance, by at least two weeks. This is done for a couple of reasons.

One, because prepayment serves as insurance for the large amount of time you have set aside in your schedule to treat the patient. If they have paid in advance, you can almost guarantee that they are going to show up.

And two, because it makes the process that much simpler. Imagine two scenarios. You have just completed treatment on Mrs. Jones. You can call her the next day and say:

"Mrs. Jones, you were a great patient, and everything went as planned except for one thing. We ran into an unexpected root canal that we had to do and we went ahead and did it. If you could drop a check tomorrow, we'll be square." Or, "Mrs. Jones, you were a wonderful patient. Everything went as planned, except for one thing. We didn't end up having to do that root canal we had planned. Everything is going to be fine and we've already dropped a check in the mail to reimburse you for it."

Keep in mind that sedation treatment requires a considerable investment in training, equipment, and time on behalf of the dental team. Because sedation treatment involves an induction period for the medication to take effect, make sure you charge a fee for the sedation. Charge for sedation what you would normally produce in your operatory during that hour. For the rest of the appointment, charge your normal fees.

If you accept insurance reimbursement, then at least have the patient pay for their estimated portion of the treatment two weeks in advance. In order for many patients to accept a complete treatment plan, you need to provide alternate payment options. CareCredit is a great tool to assist in securing case acceptance. Have a second source as well.

Key points to remember:

  • Plan your schedule to allow for extra treatment time if needed
  • Plan for unlikely circumstances but do not over-treat
  • Make sure you are paid in advance and include a fee for the sedation

The test sedation appointment

A test sedation appointment is a relatively short appointment (two to three hours) designed to determine the patient's susceptibility to the effects of oral conscious sedation when it is in doubt. In cases where a patient has a specific medical condition — for example, liver disease, obesity, a history of drug abuse, or is on a multitude of prescription medications — it is highly beneficial to schedule a test appointment.

This two- to three-hour appointment includes induction period, dental procedures such as hygiene, and emergency or palliative care if needed. A regular sedation fee should be charged along with any procedures performed during the test sedation appointment.

Conclusion

A successful sedation experience is the culmination of proper patient assessment, choosing the appropriate protocol, intraoperative monitoring, postoperative follow-up, as well as specialized scheduling and careful patient management. When given special consideration for their unique needs, treating the sedation patient can be predictable, effective, safe, and extremely rewarding.

Dr. Anthony S. Feck is a nationally recognized sedation and cosmetic dentist, mentor, author, and educator. He resides in Lexington, Ky., and has been in private practice since 1983. Dr. Feck is the co-founder of Sunrise Dental Solutions (www.SunriseDentalSolutions.com), a consulting firm that helps manage dental practices. He serves as the Dean of Faculty for the Dental Organization for Continuing Sedation Education (www.DOCSeducation.com). He can be reached via e-mail at DrFeck@DOCSeducation.com.

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