Dental Malpractice risk management : The tip: plan to follow up missed or Cancelled appointments

The Risk :

  A missed or cancelled appointment, and the failure of a practice to follow up with or
contact the patient, may result in a serious delay in diagnosis or treatment and a subsequent
risk of liability for the provider.

 The Recommendation:

  A pro-active system to follow up with patients about missed or cancelled appointments
allows a dentist to promptly assess and respond to clinical situations, thereby maintaining continuity of patient care.

1. Develop policies and procedures in your practice for following up with patients who have missed or cancelled appointments.

2. Dentists should be made aware of any patients who have missed or cancelled appointments. The staff should inform the dentist(s) of these patients at the end of the day and have each patient’s record ready for the dentist’s review.

3. The dentist should assess the clinical importance of the appointment, the severity of the patient’s condition, dental practices are not required to obtain accreditation for OBS unless the dentist is also a physician. If a dentist who is not also a physician contracts with an anesthesiologist to provide services, the anesthesiologist can work in that dental practice without being in violation of the OBS statute. However, if the dentist is an M.D. or D.O. who practices OBS, then the site must be accredited. Otherwise, the anesthesiologist
may risk allegations of professional misconduct by OPMC by continuing to practice at that office after July 14, 2009. and the risk(s) associated with the missed or cancelled appointment.

4. A reminder telephone call should be placed to the patient. The time and date of the telephone call and the content of the message or conversation must be documented in the patient’s record.

5. A telephone call from the dentist may be indicated for patients at higher  risk. The dentist should emphasize the importance of follow-up care and the risks inherent in failing to obtain it. This telephone conversation must also be documented in the patient’s record.

6. If there is no response from the patient, or the patient develops a pattern of not keeping or missing appointments, a letter should be mailed to the patient to advise him/ her of the risk of non-compliance.
The letter should be sent two ways:
1) certified mail, return receipt requested.
2) first class mail, with a certificate of mailing purchased from the US Post Office. A copy of the letter and any documents returned by the Post Office should be maintained in the patient’s chart.

7. All efforts to contact the patient, either by telephone or letter, must be documented in the patient’s record.
This provides written evidence that the patient was clearly made aware of the importance of continuing care.

8. Educate your staff about patient follow-up policies and procedures in your practice. Conduct periodic record reviews to determine staff compliance and to evaluate the effectiveness of the processes you have implemented.

9. Continued failure of patients to keep appointments may be deemed non-compliance with treatment. Consideration should be given to discharging the patient from your practice since patient non-compliance
may increase the risk of liability. The attorneys at Fager & Amsler, LLP are available to assist you to determine how and when to properly discontinue your dentist-patient relationship due to patient non-compliance.