Dentists and Covid-19: The current health emergency has made dental practices face an important truth: there is a need to change the way they provide their services, introducing telephone triage into the process. What if the solution comes through a video?
The continuing Covid-19 emergency is changing and will change the way we do things for a long time to come. Even the simplest actions will be radically changed to ensure the safety of all citizens. Just think of the many social distancing measures that are still under discussion and which will have a major impact on many aspects of the economy, from tourism to retail and transport, both public and private.
Of all of them, one area that must not be forgotten is that of personal care: medical practices, specialist clinics, and so on. When we talk about doctors who are victims of the Coronavirus, all too often we forget that it is not only those who work daily in Covid wards and in the various resuscitations who are sensitive.
In addition to the many medical professionals who directly treat patients with Covid-19, there is also a large number of health professionals in other fields who routinely deal with patients and, therefore, put themselves at risk. Doctors in medical practices of all kinds need to be able to guarantee the maximum continuity of all services to patients without jeopardizing the health of the professionals themselves.
But how can this be achieved, given that direct contact between doctor and patient is practically inevitable?
Intervene beforehand to be safer afterwards
Even if there is no substitute for direct contact when it comes to certain activities, there is potential for innovation with other activities. One of these is the preliminary phase, i.e. when the patient has not yet arrived at the facility. When practices can ensure that patients arrive safely, the risk of infection is significantly reduced. But what does this translate into in concrete terms?
One solution is remote triage.
Before we explore this solution in detail, let’s start by providing some definitions. According to the Treccani Encyclopaedia, the term “triage” refers to the method of immediate assessment and selection used to prioritize treatment when there are many patients, or when there is an extra-hospital emergency and the severity of the patient’s clinical condition has to be assessed.
In other words, it is a process based on monitoring the patient’s vital signs by experienced nursing staff specifically trained to assess the patient’s symptoms, identifying life-threatening conditions, and, consequently, to assign a code of severity in order to prioritize examination. Usually, this type of procedure takes place inside the facility.
In general, triage activity is divided into three different phases.
- The first phase, reception, is where data such as vital statistics is collected on the patient.
- Next, the patient is assigned a specific code according to the severity of the situation; from here on, the actual sorting takes place.
- In the third and final phase, the patient is monitored to periodically assess the suitability of the assigned code, based on the level of severity identified in phase two.
How Covid-19 changes triage
As part of the assessment, healthcare staff must carry out a series of operations in close contact with the patient. In order to avoid or reduce this type of contact, in Italy, the national health service provided direction for doctors to perform triage over the phone (salute.gov.it). The Ministry of Health website advised professionals to increase their availability via telephone to patients with flu-like symptoms in order to avoid bringing patients who were ill into the practice.
This approach, which at the time was limited to family doctors, has also been adopted by other categories of health professionals, such as dentists, over time.
A few days ago, the national association of Italian dentists (ANDI) issued a document of guidance for dental clinic activities during the new phase 2 of the pandemic, since a large number of dental visits were cancelled or delayed as a result of the emergency (insalutenews.it).
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It should be pointed out that this type of information is not only intended to manage an emergency and therefore to regulate access, but also to enable professional services to be carried out safely. For this reason, the same indications have a much wider application than the simple telephone triage. Let’s start from the top.
The first phase is that of telephone triage, where the professional has a fundamental role because he must be able to understand the patient’s situation and make the right decision. As Dr. Mario Bussi, head of Otolaryngology at San Raffaele Hospital in Milan and President of the Italian Society of Otolaryngology and Head and Neck Surgery (SIOeChCF), said, “The direct relationship is fundamental: the doctor must also dissuade all patients who can do without the visit, giving advice to resolve the situation, at least temporarily, at home.”
But how should this triage take place?
The structure is that of the telephone questionnaire, in which some questions are asked to understand the patient’s situation. Questions include those to understand if the patient has travelled to high-risk areas in the last 14 days, if he has come into contact with people in quarantine or if he has had symptoms such as fever, conjunctivitis, breathing difficulties, diarrhoea, or flu-like symptoms over the last 14 days.
If even one of these questions is answered in the affirmative, the examination should be postponed to a safer period, during which the patient should be monitored by telephone to see how his condition develops.
Also, in this case, it is interesting to observe what has been established for the dental sector, in particular by the AIO, the Italian Dental Association, which recently published a guide of practices to avoid the spread of contagion, taking its cue from the indications previously provided by ANDI and the national association of dentists.
Among the various provisions, there is one concerning the waiting room, which must essentially disappear. For this reason, it is advisable to organize appointments to avoid having more than one person in the waiting room at a time. This also reduces the “risk” of patients touching objects or surfaces inside the practice.
For the same reason, operators inside the facility are instructed on the use and disposal of PPE (personal protective equipment, such as gloves, masks, and headgear) and instructed to wear them for as long as they are inside the practice, also for performing administrative functions. In this sense, effort may also be required from the patients themselves. Once inside, patients must have their temperature checked. They must also be provided disposable protective materials and a disposable bag in which to place all their belongings; the patient must take this bag with them after the appointment.
Digital transformation can also contribute
The key to the entire procedure is telephone triage, the proper completion of which is the very premise of all subsequent measures, which depend on being able to identify if a patient has potentially been affected by Covid-19. As a result, this procedure is of fundamental importance.
However, such responsibility is certainly not easy to manage, especially at a time when working schedules are reduced and when employees are under increased stress. Is there a way to avoid putting the “weight” of triage on professionals without sacrificing the reliability of the result?
One answer could come from digital transformation through the implementation of solutions related to telemedicine.
An example comes to us from the United States. The case in question involves Google, who has developed resources to answer questions from Americans about the epidemic, offering data and insights, safety tips, and information about testing. With the Alphabet company Verily, it has created Project Baseline, an effort to expand access to testing and screening for Covid-19. According to the website, it is a connected and secure solution to support individuals from screening through testing and receipt of their test results, which is done under physician direction. Unlike a simple digital screener, this connected solution enables follow-up with individuals who are screened for future testing based on changes in screening criteria. The program is currently operating in California but has plans to expand to other states.
Triage becomes video (customizable)
Although in our country there is still no Google equivalent that has invested in such a project in Italy, there are equally interesting alternative solutions.
The personalized videos made available by Doxee offers one potential solution. Doxee Pvideo® is product that brings out the richness hidden in customer data, transforming it into personalized, interactive video experiences. With it, it is possible to create individual videos based on the data of each recipient. This means that each user, or in this case, each patient, can be reached by a video where all the elements (from graphics, to text, to audio) are perfectly tailored to the viewer and their unique situation.
The video could be sent a few days before the appointment, reminding the patient about the appointment and inviting them to fill out a short questionnaire similar to the one made by phone.
This is possible because Doxee’s personalized videos offer a personalized narration through the Dynamic Storyboard, a function that allows you to show or hide individual scenes according to the recipient’s profile, adapting the narration to their characteristics.
Among other things, Doxee Pvideo® makes it possible to integrate interactive tools that allow the user to perform different actions from within the video. This would make it possible to transform the telephone triage into a digital triage, within the context of appealing visual content.
Innovative communication of this type—which is simultaneously effective and engaging—offers another advantage: It can help improve the relationship with patients. The personalization features make patients feel understood and this leads them to have greater confidence in the practice and its commitment to providing them with a safe and tailored service.
This, of course, has a positive impact on the reputation of the practice and, as a result, on its ability to attract new clients and build loyalty. Another advantage of videos as a communication mechanism is that it makes communications trackable, which saves time on the administrative side.
And that’s not all. The greater traceability offered by this tool is a key aspect, since it allows you to monitor all your patients, creating a real database of information that you can constantly update, to the benefit of the health of operators and patients and the safety of your workplace.