Emergency Dental Care Triage: Role of Telephone Triage in Patient Management

Introduction

Due to the lockdown as a result of the COVID-19 pandemic effective March 23, 2020, the emphasis on oral health care shifted from routine dental care to urgent care only. Urgent dental care centers (UDCs) were established at short notice to receive patients with dental emergencies.

King’s College Hospital’s emergency service was previously a walk-in service, where patients queued for an appointment, but in August 2019 it became an appointment service in response to patient feedback, with 40 appointments available and the first 40 patients calling to receive an appointment. This service saw approximately 200 patients per week from across London.

This call service became a UDC center during the pandemic, with a telephone triage system developed to identify patients requiring emergency dental care and invite them for an in-person consultation. The path was established to minimize unnecessary passage through the hospital and help maintain social distancing rules, thereby reducing the potential for virus transmission.

The center was led by an oral surgeon and had staff from the restorative, pediatrics, orthodontics, and special care dentistry departments. There was no staff shortage as all routine clinics were cancelled. During the periods in which data were collected, NHS consultants provided telephone triage using seven telephones. Triage was performed daily from 8 am to 4 pm, Monday to Friday.

As described in the chief dental officer (CDO) readiness letter, emergency conditions that met acceptance criteria for a clinical evaluation included serious and life-threatening conditions, as well as uncontrollable pain, swelling, and trauma.

Patients involved in trauma and those with swollen faces were invited to send photographs to an NHS email address, and in situations where there was any doubt over the phone, the photographs helped confirm whether to invite the patient for an assessment clinic.

The doctors involved also gave advice on painkillers and how to deal with non-urgent problems, as well as prescribing antibiotics when necessary. Patients who were to be seen for clinical evaluation were also classified by vulnerability and possible infection with COVID-19 so that they could be seen in clearly identified and separate areas of the hospital.

Background

Due to the COVID-19 pandemic, effective March 23, 2020, the routine dental director stopped routine dental treatment, with an emphasis on urgent dental care only.

Aim

To evaluate the activities of the emergency service in a second-level Urgent Dental Care (UDC) center during the COVID-19 pandemic.

Materials and methods

The total number of patients seen was recorded from March 30 to June 20, 2020. The effectiveness of telephone triage and the suitability of patients invited for clinical evaluation were evaluated over a two-week period.

Results

The number of calls to the UDC center was highest during the first few weeks, with up to 249 per day. The most frequently provided emergency treatments included extractions and pulp removals.

Discussion

As other UDC centers opened, the number of calls decreased and patients were directed to a UDC closer to where they lived.

Key lessons learned are:

Communication should be improved and consistent information disseminated to UDC centres, dental professionals and 111. With improved leadership from government representatives, patient information about these services should be kept up to date and clear so that patients can search adequate and timely help in the case of a dental emergency

During the first weeks of the COVID-19 lockdown, there were not enough UDC centers open, causing some patients to travel long distances, often by public transport. In the event of new spikes or subsequent pandemics, it is important that there is sufficient local service provision to reduce the risk of virus transmission and improve access to care.

Certain conditions were and can be easily managed over the telephone, negating the need for the patient to travel for a face-to-face consultation.

All data collection was done on paper, which was inefficient, so moving to electronic collection would improve efficiency and allow some doctors to work from home.

The use of ’Attend Anywhere’ virtual video conferencing software could allow video consultations to reduce patient influx, while allowing doctors to address the patient backlog that has arisen due to the cancellation of elective services. This requires the availability of sufficient rooms to maintain confidentiality.

Effort should be made to collect data on whether patients are registered with a dentist, their normal dental attendance record and their deprivation status, as this may be important as dental public health attempts to address oral health inequalities in the United Kingdom.