Dental diversion plan eases burden in busy EDs

By Joanna Lyford, Senior medwireNews Reporter

Hospital emergency departments (ED) may benefit from having a diversion plan in place to deal with dental patients, say US researchers writing in the Journal of Oral and Maxillofacial Surgery.

They warn that the current trend for dental patients to seek care in the ED "may contribute to an already overcrowded and overburdened situation." In a pilot study of the diversion plan, management of dental patients in the ED fell by more than half.

Daniel Laskin (Virginia Commonwealth University, Richmond, USA) and colleagues first used the ICD-9 diagnosis codes for dental complaints to characterize patients visiting the ED of a large metropolitan level I trauma center between 2007 and 2009.

Of a total of 173,648 ED visits, 4.3% were dental-related, the authors report.

Two-thirds of patients had tooth-related ailments and treatment typically entailed an analgesic and an antibiotic. Nevertheless, the estimated total cost of these visits was US$ 1.2 million (€ 916,206).

Based on this information, Laskin et al developed a pilot program to divert these patients from the ED to a special urgent dental care clinic in the hospital's Oral and Maxillofacial Surgery (OMS) department.

Diversion occurred after triage had determined it was not a serious problem. Treatment in the OMS usually involved either an oral surgical procedure or a prescription for pain medication.

In the year prior to initiation of the pilot program, a total of 2618 patients with dental problems were managed in the ED.

This decreased to 1249 - a 52.3% drop - during the first year of the pilot program, Laskin and co-authors report.

Furthermore, the number of dental patients with two or more visits to the ED also declined considerably, from 353 to 119 - a 66.3% drop.

Based on their analysis, the researchers conclude that the pilot diversion program was successful and could be expanded to other specialties and centers in order to help relieve overcrowding and long waiting times in the ED.

They write: "It also provides a framework for initiating a similar program in other services such as otolaryngology, ophthalmology, and dermatology, in which patients who present to the ED with minor problems may be treated more efficiently in the outpatient clinic."

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