VCU School of Dentistry Urgent Care Clinic increases access to emergency dental care

Author: Joan Tupons and John Wallace

Nataja Bailey couldn't take it anymore. She had a deep hole in her molar and pain radiated from her jaw, causing headaches. She contacted several dentists, but they wouldn't accept her insurance. Finally, she found the Urgent Care Clinic at the Virginia Commonwealth University School of Dentistry online and was grateful when she called and was told she could be seen right away.

“The pain started in 2022, but I didn't like going to the dentist, so I kept putting it off. The cavities were so bad, I thought the tooth was cracked and needed to be extracted,” Bailey said. “After the examination, they said it could be saved and scheduled me for a root canal later in the afternoon.”

The school’s urgent care clinic opened in 2017 under the leadership of former VCU School of Dentistry Dean David Sarrett, DMD, to meet the region’s critical need for emergency oral health care, and now school administration is refocusing its efforts on improving its operations as Serve as many people as possible.

“For years, there have been queues outside the school every day before it opened. The clinic operates on a first-come, first-served basis and sources say if you don't arrive early, you may not be seen,” said.

During his first few months on the job, Lockhart wanted to get the perspective of patients waiting in line early in the morning. He started going out, asking questions and listening to their problems.

“Our goal is to see every patient on the same day. Our team started focusing on the patient experience within our services and honed the way we register patients and refer them to the school’s various specialty clinics,” Lockhart explain.

Dentists instruct students while working with patients.

David Sarrett, M.D., instructs a third-year dental student to secure a patient's loose crown. (Virginia Commonwealth University School of Dentistry)

“Now, the vast majority of patients are seen on the same day. If there are complications or other reasons that cannot be scheduled, they will be prioritized for the next day.

Lockhart said the contributions of urgent care clinic director Conway Upsher, DDS, and clinic manager Angela Carter are critical to improving urgent patient care and enhancing the patient experience.

Last year, the clinic's outpatient volume increased by 43%. The numbers are growing due to similar concerns about the operation of school specialty clinics.

“We changed the registration process to pre-triage patients,” said Donnie Parris, director of patient business services at VCU Dental Care. “Staff will refer them to clinics or oral surgery. Capacity is also being increased.

For example, the school's oral and facial surgery clinic more than doubled its caseload by improving its triage process.

“Last July alone, surgical cases increased 166%,” Lockhart said.

Linking education to improved access to care

For some Virginians who are underinsured, low-income, or simply have insurance that some dentists don’t accept, getting timely and regular dental care can be a challenge.

“The last time I went to the dentist was in 2016 to have my wisdom teeth removed,” Bailey said. “I got a screening appointment at the student clinic, so I wanted to start coming regularly.”

The Virginia Commonwealth University School of Dentistry is the largest provider of oral health care services to Medicaid patients. Since Virginia expanded adult Medicaid dental benefits in July 2021, demand for school services has increased significantly. For many patients, the urgent care clinic is their first interaction with the school.

“The experience of treating patients in the urgent care clinic is different than the experience we had in the predoctoral clinic,” said Sana Habib, a fourth-year dental student. “Here, we see patients coming in in quick succession rather than the longer scheduled appointments in pre-doctoral medicine.”

Sarrett, now an adjunct faculty member, supervises fourth-year dental students every Wednesday who work for the clinic during their required two-week rotations. He believes the fast-paced clinic is a great learning opportunity for students.

Sometimes, when the clinic is busy, he will go to the school's predoctoral clinic and rope in third-year students to help.

A group of students and dental clinic faculty.

(Left to right: Clayton Jackson; Lyda Sypawka; Conway Upshur, Urgent Care Clinic Director; Angela Carter, Urgent Care Clinic Manager; Hoordad Sharif; Aufia Zhowandai) (Virginia Commonwealth University School of Dentistry)

“Urgent care clinics emphasize the importance of following a systematic protocol and developing an evidence-based treatment plan,” Sarrett said. “Patients often present with pain and we want to help them as quickly as possible. However, it is important that students' treatment plans are based on a thorough assessment and not jump to conclusions that result in unnecessary care.”

Sarrett also emphasized the importance of being compassionate and understanding when it comes to the challenges some patients face when accessing oral health care.

“Many Medicaid patients are not fully aware of their benefits,” Habib said. “There are other factors, such as work or family responsibilities, that prevent people from receiving care.”

Lyndon Cooper, DDS, Ph.D., dean of the School of Dentistry, said the school’s services are considered an important “safety net” for patients who have difficulty accessing dental care.

“Treatment of emergency patients is an important learning opportunity to gain the experience needed to become a well-rounded professional,” Cooper said. “At Virginia Commonwealth University, we focus on how to operate as efficiently as possible to serve the community. huge demand.”

Supervised training and experience providing care in school clinics and external rotation sites are key to VCU’s reputation for graduating highly skilled providers, Cooper said.

“Ninety-seven percent of our students pass the board exam on the first try. The main difference between seeing a student dentist and a faculty dentist is not the quality of care, but the time required,” he said. “We believe we are training some of the best new dentists in the country.”

Get an appointment for dental emergencies more easily

In many cases, people go to the emergency room instead of the dentist's office for dental problems. These patients often take medications to treat infection or pain and are referred to an oral surgeon or other specialist.

To help make those connections, the clinic is piloting a novel scheduling system that prioritizes care for patients who need immediate attention.

The school's information technology team worked with electronic health records provider Axium to develop a QR code and mobile app for clinic prioritization. If successful in this area, it may be rolled out to other clinics on campus.

“This new technology will allow patients to make appointments at their convenience. Confirmations can be sent and received via text message and email, and if they are an existing patient, all of their medical records will be automatically made available to their provider,” Locke Hart said. “It will change the way we care for patients throughout the building.”

Self-service check-in will mark the person as an urgent care patient and immediately place them in a queue. As Lockhart said, patients no longer have to queue outside because they can make appointments at home.

It takes an effort from the entire team, from everyone in the building, to ensure patients receive care when they need it most. Lockhart said the work being done to streamline the process reflects patient needs and makes the urgent care clinic a “truly community-oriented facility.”

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