COMMENTARIES
and morbidity in varied health care settings.1-3 We congratulate Dr. Tokede and colleagues for their efforts toward successful implementation of checklists in dental care settings. Studies such as theirs that document the effects of checklists are critical and will go a long way in attaining “buy in” from the end users of such checklists (dentists, support staff, practice managers, etc.). Sivaraman Prakasam, BDS, MSD, PhD Clinical Assistant Professor Department of Periodontics and Allied Dental Health School of Dentistry Indiana University Indianapolis 1. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA; Safe Surgery Saves Lives Investigators and Study Group. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 2010;251(5):976-980. 2. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360(5):491-499. 3. Semel ME, Resch S, Haynes AB, et al. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Aff (Millwood) 2010;29(9):1593-1599.
DENTAL CARE IN EMERGENCY DEPARTMENTS
Dr. Allareddy and colleagues’ article, “Hospital-Based Emergency Department Visits Involving Dental Conditions: Profile and Predictors of Poor Outcomes and Resource Utilization” (JADA 2014;145[4]:331-337), is a well-written analysis of the problem of dental conditions being treated in an emergency department. Did the authors find any emergency departments that provided definitive dental care by a dentist? I would be curious to see the statistics for the percentage of dental patients of the total patients seen, the mean cost, the outcomes and the percentage of repeat visits by a dental patient in these facilities. It also would be interesting to see the change in the percentage of total patients seen in the emergency department who are dental patients after definitive dental care became available in the 698
JADA 145(7)
http://jada.ada.org
emergency department. We are reminded often in the literature of the high cost of providing dental care by nondentists in a nondental facility. At what point does it become cost-effective to place a dentist and a dental facility in the emergency department? What is the dollar cost that will prompt hospitals to take action and do something definitive about the problem? What is being done to train dentists to function in an emergency department environment? Thank you. Lawrence J. Tepe, DDS Cincinnati
Authors’ response: We thank Dr. Tepe for his interest in our article and for several insightful comments made about the article. During the study period (2008 to 2010), patients with dental-related conditions made close to 1 percent of all emergency department (ED) visits in the entire United States. The mean ED charge per dental-related visit was $760 (inflation adjusted to year 2010 dollar value). The overall mean ED charge per visit in the United States for all conditions was $2,060 in 2010. One reason why dental ED visits incurred lower charges compared with all other ED visits is that for most of the dental-related ED visits, no definitive care was provided beyond prescribing medications. The Nationwide Emergency Department Sample (NEDS) data set that was used for our study does not provide information about repeat visits. The NEDS data set does not provide identifying information about patients, which precludes us from identifying patients who visit hospital EDs repeatedly and their discharge status after the ED visit. Dr. Tepe posed an interesting question: At what point does it become cost-effective to place a dentist and dental facility in the ED? We do not have an answer for this thoughtprovoking question at this time. Our research team currently is in the process of designing and conducting a cost-effectiveness study on having
a dentist on the hospital team. We hope to come up with an answer to Dr. Tepe’s question soon. What has been shown conclusively to date is that close to 90 percent of dental-related ED visits result in no dental procedure, and most treatments are related to prescription medication.1,2 In an earlier report, we showed that there has been an increasing trend toward dentalrelated hospitalizations in the United States.3 All these findings mandate that dentists should be integrated into hospital teams.4 But at what point this approach becomes costeffective currently is unknown. Veerasathpurush Allareddy, BDS, MBA, MHA, PhD, MMSc Associate Professor Department of Orthodontics College of Dentistry and Dental Clinics The University of Iowa Iowa City Sankeerth Rampa, MBA, MPH Graduate Student School of Rural Public Health Texas A&M University Health Science Center College Station Min Kyeong Lee, DMD Advanced Graduate Student Department of Developmental Biology Harvard School of Dental Medicine Boston Veerajalandhar Allareddy, MD, MBA Assistant Professor Department of Pediatric Critical Care School of Medicine Case Western Reserve University Cleveland Romesh P. Nalliah, BDS Instructor Office of Global and Community Health Harvard School of Dental Medicine Boston 1. McCormick AP, Abubaker AO, Laskin DM, Gonzales MS, Garland S. Reducing the burden of dental patients on the busy hospital emergency department. J Oral Maxillofac Surg 2013;71(3):475-478. 2. Tulip DE, Palmer NO. A retrospective investigation of the clinical management of patients attending an out of hours dental clinic in Merseyside under the new NHS dental contract. Br Dent J 2008;205(12):659-664. 3. Allareddy V, Kim MK, Kim S, et al. Hospitalizations primarily attributed to dental conditions in the United States in 2008. Oral Surg Oral Med Oral Pathol Oral Radiol
July 2014
Copyright © 2014 American Dental Association. All Rights Reserved.
and morbidity in varied health care settings.1-3 We congratulate Dr. Tokede and colleagues for their efforts toward successful implementation of checklists in dental care settings. Studies such as theirs that document the effects of checklists are critical and will go a long way in attaining “buy in” from the end users of such checklists (dentists, support staff, practice managers, etc.). Sivaraman Prakasam, BDS, MSD, PhD Clinical Assistant Professor Department of Periodontics and Allied Dental Health School of Dentistry Indiana University Indianapolis 1. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA; Safe Surgery Saves Lives Investigators and Study Group. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 2010;251(5):976-980. 2. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360(5):491-499. 3. Semel ME, Resch S, Haynes AB, et al. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Aff (Millwood) 2010;29(9):1593-1599.
DENTAL CARE IN EMERGENCY DEPARTMENTS
Dr. Allareddy and colleagues’ article, “Hospital-Based Emergency Department Visits Involving Dental Conditions: Profile and Predictors of Poor Outcomes and Resource Utilization” (JADA 2014;145[4]:331-337), is a well-written analysis of the problem of dental conditions being treated in an emergency department. Did the authors find any emergency departments that provided definitive dental care by a dentist? I would be curious to see the statistics for the percentage of dental patients of the total patients seen, the mean cost, the outcomes and the percentage of repeat visits by a dental patient in these facilities. It also would be interesting to see the change in the percentage of total patients seen in the emergency department who are dental patients after definitive dental care became available in the 698
JADA 145(7)
http://jada.ada.org
emergency department. We are reminded often in the literature of the high cost of providing dental care by nondentists in a nondental facility. At what point does it become cost-effective to place a dentist and a dental facility in the emergency department? What is the dollar cost that will prompt hospitals to take action and do something definitive about the problem? What is being done to train dentists to function in an emergency department environment? Thank you. Lawrence J. Tepe, DDS Cincinnati
Authors’ response: We thank Dr. Tepe for his interest in our article and for several insightful comments made about the article. During the study period (2008 to 2010), patients with dental-related conditions made close to 1 percent of all emergency department (ED) visits in the entire United States. The mean ED charge per dental-related visit was $760 (inflation adjusted to year 2010 dollar value). The overall mean ED charge per visit in the United States for all conditions was $2,060 in 2010. One reason why dental ED visits incurred lower charges compared with all other ED visits is that for most of the dental-related ED visits, no definitive care was provided beyond prescribing medications. The Nationwide Emergency Department Sample (NEDS) data set that was used for our study does not provide information about repeat visits. The NEDS data set does not provide identifying information about patients, which precludes us from identifying patients who visit hospital EDs repeatedly and their discharge status after the ED visit. Dr. Tepe posed an interesting question: At what point does it become cost-effective to place a dentist and dental facility in the ED? We do not have an answer for this thoughtprovoking question at this time. Our research team currently is in the process of designing and conducting a cost-effectiveness study on having
a dentist on the hospital team. We hope to come up with an answer to Dr. Tepe’s question soon. What has been shown conclusively to date is that close to 90 percent of dental-related ED visits result in no dental procedure, and most treatments are related to prescription medication.1,2 In an earlier report, we showed that there has been an increasing trend toward dentalrelated hospitalizations in the United States.3 All these findings mandate that dentists should be integrated into hospital teams.4 But at what point this approach becomes costeffective currently is unknown. Veerasathpurush Allareddy, BDS, MBA, MHA, PhD, MMSc Associate Professor Department of Orthodontics College of Dentistry and Dental Clinics The University of Iowa Iowa City Sankeerth Rampa, MBA, MPH Graduate Student School of Rural Public Health Texas A&M University Health Science Center College Station Min Kyeong Lee, DMD Advanced Graduate Student Department of Developmental Biology Harvard School of Dental Medicine Boston Veerajalandhar Allareddy, MD, MBA Assistant Professor Department of Pediatric Critical Care School of Medicine Case Western Reserve University Cleveland Romesh P. Nalliah, BDS Instructor Office of Global and Community Health Harvard School of Dental Medicine Boston 1. McCormick AP, Abubaker AO, Laskin DM, Gonzales MS, Garland S. Reducing the burden of dental patients on the busy hospital emergency department. J Oral Maxillofac Surg 2013;71(3):475-478. 2. Tulip DE, Palmer NO. A retrospective investigation of the clinical management of patients attending an out of hours dental clinic in Merseyside under the new NHS dental contract. Br Dent J 2008;205(12):659-664. 3. Allareddy V, Kim MK, Kim S, et al. Hospitalizations primarily attributed to dental conditions in the United States in 2008. Oral Surg Oral Med Oral Pathol Oral Radiol
July 2014
Copyright © 2014 American Dental Association. All Rights Reserved.
