Appointment Control Policy

Subject:  Appointment Control
Effective Date:  October 1992
Revision Dates:  January 2002, August 2016

Purpose

To outline patient expectations for making and keeping dental appointments at the School of Dentistry.

General Policy

The School of Dentistry is committed to providing quality care for dental patients as well as providing a successful clinical education for students.  Dental students are in the process of learning to apply didactic knowledge in a clinical setting and are closely supervised by faculty. Accordingly, dental care in an academic setting is expected to take longer than in a private dental office.

To best maximize the limited clinic time available to students, the School requires that all patients sign an agreement as a commitment to this educational and clinical partnership. Patients must make an effort to remain available for appointments of varying lengths during their course of treatment over the academic quarter. Missed appointments or late arrivals could have a negative impact on the care process and the education of the student. Loss of clinic time can delay patient treatment and may slow a student in completing his or her educational program.

Patients who fail to meet their responsibilities in making and keeping dental appointments may have their care discontinued at the School of Dentistry.

Implementation

I. Appointment Management Protocol

A. Distribution of Guidelines

To establish the School’s expectations regarding dental appointments, all new patients of the School of Dentistry must sign the Care Agreement (see Appendix A) and are given a copy of the Patient Rights and Responsibilities brochure (see Appendix B)

B. Appointment Frequency and Duration

1. Patients should plan to spend as much as one 3-hour, regular (non-emergency) appointment every three weeks during a quarter once treatment has begun.
2. If a patient is unable to come frequently and stay for lengthy appointments, he/she will not be admitted to or allowed to continue in the School of Dentistry care programs.
3. This requirement can be waived at the discretion of the Department Chair or the Associate Dean for Clinical Services if unique patient circumstances arise which would prohibit compliance and the education of the student would not be inhibited.

C. Treatment Delay

1. Active patients admitted may be granted a delay of treatment which exceeds three months (an academic quarter) under the following conditions:
   1. The patient has demonstrated compliance with the appointment policy in the past.
   2. The delay is not detrimental to the patient’s health.
   3. The delay is approved by the Office of Clinical Services (OCS).
   4. The delay is documented in the patient’s dental record in both the contact notes in the electronic patient record and in a letter to the patient confirming the requested delay.

2. A patient who has been admitted to the Pediatric Dentistry clinical program is not eligible for a delay of treatment status unless extenuating circumstances are the cause of the treatment delay. Such requests shall be reviewed on a case-by-case basis by the department chair or designee.

D. Keeping Appointments

1. Appointment Cancellation

1. An appointment cancellation is defined as notice being given to the care provider by the patient at least 24 hours before the appointment that he/she cannot meet that arranged appointment.
2. Patients who cancel three appointments in a calendar year are subject to the discontinuance of care by the school.

2. Broken Appointment Protocol

A broken appointment is defined as failure to give the care provider notice 24 hours prior to a previously scheduled appointment that he/she cannot meet that arranged appointment.

Documentation of Broken Appointments
The care provider is responsible for documentation of cancellations and broken appointments in axiUm. The documentation shall include:

a. Cancellations

When a patient contacts the school to cancel an appointment, the appointment status is changed in axiUm from ‘active’ to ‘cancelled.’ AxiUm logs the date, time and user that updated the appointment status. Staff making the update will select the time frame and/or reason the patient cancelled the appointment. A supporting contact note is added to document details of the cancellation.

b. Broken Appointments

The axiUm appointment status must be updated to “failed” for patients who did not come to their appointment. This change must occur before the end of the appointment day and should be completed by the person(s) responsible for maintaining the clinic’s schedule.

Note: Only documented missed appointments shall be considered in the disposition of the continuation of care for a patient.

E. Disciplinary Actions

1. The following actions will be implemented unless special exception is made by the appropriate Department Chair, or designee:
   • Comprehensive care patients who break three appointments per year are subject to the discontinuance of care by the school unless special exception is made by the appropriate Department Chair or designee.
   • Endodontic, limited care patients who fail an initial endodontic appointment are discontinued following the failure of that appointment.
   • Endodontic patients who break two appointments may be discontinued from care in the Endodontic department.

III. Care Discontinuance Protocol

A formal protocol is used for managing the warning to patients and possible discontinuance of patient care.

A. Warning Letter

1. A patient who has three cancellations within a year documented in the patient record, or one broken (no-show) appointment within a year shall be sent a warning letter (see Appendix C) reminding them of the appointment obligation they agreed to and the consequences of non-compliance.
2. A copy of the letter is scanned in the patient record and a contact note is made in axiUm. Departments that manage their own patient pools are responsible for this correspondence and documentation.
3. OCS is responsible for Student Clinic patients upon notification by either the scheduling staff, care providers or supervising faculty.

B. Discontinuance of Care Letter

The discontinuance of the care of a patient constitutes the legal severance of the doctor/patient relationship and is subject to provisions of the Dental Practice Act (WAC 246-817-380).

4. Failure to make and keep appointments constitutes justification for severing the relationship as long as the patient is appropriately notified in writing.
5. All discontinuance letters (see template in Appendix D) shall be managed by the Manager of Patient Relations in accordance with the law and the risk management policies of the School of Dentistry.
6. .Departments that manage their own discontinuance protocol shall submit a written description of the protocol and form letters to the Manager of Patient Relations for approval. The basis for approval must meet state law and University policy.

Appendices:           

Appendix A, Care Agreement

Appendix B, Patient Rights & Responsibilities Brochure

Appendix C, First Missed Appointment Warning Letter

Appendix D, Second Missed Appointment Warning Letter

Appendix E, Discontinuance Letter

Dean of UW SOD:

Joel Berg, Dean of the UW School of Dentistry

 

APPENDIX A
Care Agreement (PDF)

APPENDIX B
Patient Rights & Responsibilities Brochure (PDF)

APPENDIX C

First Missed Appointment Warning Letter

 Today’s Date

 

Patient Name
Patient Address
Chart #:

Dear Patient Name,

Our records indicate that you missed your appointment on [Missed Appointment Date]. Please call 206-616-6996 and we will be happy to schedule another appointment for you.

We request that you provide us with at least 24-hour notice if you must change/cancel your appointment. This courtesy allows us to schedule another patient who is also in need of dental care.

As a reminder, 3 missed or cancelled appointments may result in dismissal from the School of Dentistry.

We are committed to providing you with the best care possible. We look forward to seeing you at your next appointment. If you have any questions, please call us at 206-221-0778.

Sincerely,

 

Patient Services
UW School of Dentistry

 

APPENDIX D

Second Missed Appointment Warning Letter

Today’s Date

 

Patient Name,
Patient Address

Chart #:

Dear Patient Name,

Our records indicate that you missed your appointments on Date of First MA and Date of Second MA.

As stated in the previous letter we sent you, 3 missed or cancelled appointments may result in dismissal from the School of Dentistry.

We request that you provide us with at least 24-hour notice if you must change/cancel your appointment. This courtesy allows us to schedule another patient who is also in need of dental care.

Please call 206-616-6996 and we will be happy to schedule another appointment for you.

We are committed to providing you with the best care possible. We look forward to seeing you at your next appointment. If you have any questions, please call us at 206-221-0778.

Sincerely,

 

Patient Services
UW School of Dentistry

 

APPENDIX E

Discontinuance Letter

 

Today’s Date

 

Patient Name
Address

Chart #:

Dear Patient Name,

Our records indicate that you have failed and/or cancelled three scheduled dental appointments on (enter dates here).

In order for us to manage our patient’s dental needs appropriately and provide the necessary clinical experience for our students, we require our patients to be available for their scheduled appointments.

We regret to inform you that your care at the University of Washington, School of Dentistry has been discontinued effective (30 days from today’s date).  We will provide emergency dental services only during this 30-day period. To schedule an appointment, please call Dental Urgent Care at 206-543-5850.

We recommend that you seek care immediately to avoid future damage to your teeth and/or supporting bone. Please contact your local dental society, which has a referral service to assist you in finding a new dentist who can meet your needs.

For a copy of your complete dental record, please contact our Patient Records Office at 206-543-7049 and they will provide a copy of your patient records, upon receiving your written authorization, for a nominal fee.

We wish you success with your new dentist.

Sincerely,

 

Patient Services
UW School of Dentistry