Returning to Your Practice: A How-To for Operating Under COVID

When the first cases of the novel coronavirus, COVID-19, appeared in North America, so little was known that our reactions across the board were simultaneously ad-hoc and very limited. Since our social distancing and restricted measures began, our lives have radically changed in many ways. Only a handful of businesses in most towns and cities were prepared to carry on, despite several industries like oral care being in a strong position with their experience preparing and working in sterile environments. Despite the abundance of precaution that dental offices exercise every day, it became clear that risks of transmission and the likelihood of becoming a vector, were too high, and practices were temporarily shuttered.

While not everywhere in North America is even remotely out of the woods, many practices are being given the opportunity to return to the office. Even as some dentists and office managers start to see their business return, they’re far from returning to the ways their business once operated. As restrictions begin to lift and patients’ lives start to expand outside of their own home, being prepared to safely operate and address your patients’ concerns is more important than ever. Understanding the ins and outs of that process, and being able to deliver peace of mind, is now paramount to your practice’s reputation, and bottom line.

Before we get into it, it needs to be said that not every step or measure we outline will be right for your office. Depending on your region, current staffing, or even the building that houses your practice, you may find our recommendations impossible to complete. Always consult with your local college or health authority, and take the time to make sure you get up and running safely, after all – we’re in this together.

Getting the Word Out

While people may not have had access to concerts, they’ve still been eating every day. As our mouths have been hard at work on loaves of sourdough and experimental concoctions, scores of people have developed tooth decay, cavities, and plaque buildup. Even if the dentist isn’t everyone’s number one destination, as we enter our second and third phases of reopening, plenty of your patients are already mentally lined up to address their aches and pain.

Think carefully about how your new routine will impact your business. How many patients will you see in a day? How many breaks will staff get with increased sterilization and cleaning time? Starting slowly with a handful of new patients is the perfect way to get a feel for how you’ll operate under these conditions moving forward.

However you come to your conclusion, you’ll need to reach out to your patient base about opening again, along with transparency and expectations around treatment processes. A polished email that provides your intended availability and any limits on conducted procedures can easily be sent out using practice management software.

On the off chance that you are taking appointments across a provincial, state, and even country border, remember the recommendations for local travel. This could involve putting a pause on notifying those from the other side of your nearest boundary, or only letting your patients in the local city know about your ability to give a great cleaning.

Making an Appointment

Depending on the system that you currently use to manage the day-to-day operations of your practice, you may see appointment requests fly in over email, phone, or SMS text message. While plenty may be overdue for a cleaning, focusing on those with necessary or emergency cases will be imperative. 

Your pre-COVID booking process was a simple exchange, searching for a time that fits your patient’s schedule. Now those same patients will need to recognize that part of getting their time in your chair, will involve identifying their own risks.

No matter how a patient tries to make their appointment, it’s in yours, theirs, and everyone’s best interest that you address their recent history and health. With the right practice management software, you’ll have the option of securely collecting this info online and ahead of time. Confirming in writing is the best way of obtaining a statement, but there are a few questions you’ll need to consider as part of the qualification process:

  1. Have they tested positive for COVID-19?
  2. Have they, or someone they are in contact with, traveled outside of the country/province/state in the past 14 days?
  3. Have they been sick within the past 14 days?
  4. Have they been in self-isolation or quarantine?
  5. Are they experiencing a persistent cough, sore throat, nausea, headache, or fever?

These questions are vital to not just preventing further spread, but ensuring that you and your staff are safe and can continue to care for others.

Obviously, not every one of your patients may be honest with you, whether that’s a reluctance to admit the seriousness of the pandemic or desperation to receive treatment. It’s important to be clear because of this. Coming down with a runny nose during pollen season shouldn’t be perceived as a reason to be denied care. Your patients need to know that you’re invested in their health, but a two-week delay in that care may be necessary to ensure the health of your community – and theirs. Screening your patients before the day of appointment allows you to flag any questionnaire responses that might need follow-up.

Along with your brief questionnaire, consider sending expectations and requirements. This is one occasion where an itemized list ahead of time will go an infinitely long way towards making the experience as smooth as possible. If your patients know what to expect when they show up, it’ll speed the process up dramatically. 

The Check-In and the Check-Up

With you and your staff’s time more finite than ever, it’ll be important to establish clear guidelines for confirming an appointment. A no-show at this stage is more devastating than ever, so consider revising your current standards. 48-72 hours before the appointment is a great time to request or provide confirmation. Let’s say your previous process was sending out a reminder over text the morning of an afternoon appointment. Getting full confirmation at least 24 hours in advance may now be the only way they can hold their spot in line. By making responses or confirmations a requirement for the appointment, you’re further reducing your risk that all your staff’s hard work will be for nothing.

Once they arrive for their appointment, make sure they understand the need to wait outside, or in their vehicle. Any last-minute adjustments, prep, or final reviews should take place during this brief window, as to limit indoor exposure. In the meantime, you can use this window to text or email over their records and ask for a quick review. Even though handing over a clipboard is a time-honored tradition of the waiting room, every single thing a patient touches or handles is a possible transmission source. It’s important to stay focused on the necessities of a visit in these times – swapping pens to confirm an address or changed phone number won’t cut it. 2-way texting, patient portals, and online payments can help walk your patient through the same processes they’d encounter in your waiting room, all while maintaining a safe, contact-free experience. Remember, you have a direct line to them through their smartphone, and any updates can be confirmed verbally during an appointment before being added to their patient records, including updates to their insurance.

Your front desk has confirmed that the patient’s info hasn’t changed, and there are no signs of illness or infection – it’s finally time to provide excellent care! After your hygienist and/or dentist are adorned in PPE and they’ve confirmed that all the tools they need are present and ready for use, you can send out the welcome message. Over text or phone call, your patient is informed that they can enter the office, along with any particular instructions unique to your residence. Keeping in mind attempts to limit what is touched, having their main route cleared with doors held open provides a path directly to the chair. Once they’re situated, you can go over any updates they provided to their records from a safe distance of 6 feet or 2 meters.

Now, with all of the logistics and administration out of the way, you and your team will be ready for the procedure to take place. As you work through the cavities and bonding, the dental work you’ve always delivered with care will be very similar to what you remember, even behind a face shield and N95.

After the procedure is wrapped and recontouring is complete, your patient will be ready to leave the office. If you haven’t collected insurance and billing info ahead of time, you can easily do so through email, text, or over the phone. Regardless of the circumstances, a patient that has finished receiving their care should head for the exit as quickly as possible.

Cleaning Up

After your patient is officially out of the office, you’ll actually have a little time to yourself. With current WHO and CDC guidelines, waiting 15 minutes before cleanup means that you’re giving time for all airborne particulates to settle. This waiting period is extra important for practices inside older or poorly ventilated buildings. Making sure that nothing is in the air before you sterilize and prepare for your next visit is a cornerstone of stopping this disease while staying open as a business.

The cleanup process will be thorough, regardless of how long an appointment went on for. The typical sterilization process for tools now extends to your chair (and definitely the armrests), controls for a TV or other distraction device in your office, and everything within a 6-foot vicinity. In the event your practice still relies on paper records, you’ll need to consider how they’ll be protected from risk, or how they’ll be isolated or cleaned. If you’re already working a paperless dental practice, don’t forget to wipe down your keyboard.

Cross-contamination will also be a point of attention. If your office has previously gotten by without a dental assistant, you’ll need to think about the keypads, touchscreens, and drawer handles that could have been within grasp over the last hour or two. It may be beneficial to your office to put strict guidelines on the services that you provide. Going above and beyond the outlined procedures from appointments may no longer be an option, even if something unexpected is discovered. Ultimately, it’s up to you how well prepared for possible treatments you want to be, or if you operate under the expectation of one-appointment, one-treatment. You and your care teams have big decisions to make, but safety and making sure that all staff is comfortable and confident will keep you in control.

Rinse and Repeat

Once your thorough cleanup is complete, it’ll be time to check in with your next patient, who is hopefully waiting patiently outside your clinic. The steps you take during this process can feel overwhelming or even excessive, especially if your region is only just starting to reopen, or saw relatively low case volume. For the time being, this is simply what providing safe health care is going to look like.

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Taking any type of shortcut, regardless of your local COVID-19 status is a risk that simply isn’t worth it. Outbreaks among patients or staff quickly handicaps your production capabilities, and eats away at the credibility of your practice when it comes to offering great oral care. Take the time, be thorough, and your patient’s loyalty and confidence will only grow.