A Communication Toolkit Increased Quality of Care for Long-term Care (LTC) Residents at a Dental Surgical Center

Long-term care (LTC) residents have complex medical histories and decreased access to dental care, which leads to unmet dental needs and poor health outcomes. This complex and underserved population often requires general anesthesia for dental care. Also, limited communication between LTC and treating facilities frequently leads to missed opportunities to provide dental care. Local Problem: For a small surgical center and one dental provider, poor communication between LTC facilities and the surgical center led to preventable case cancellations due to improper anesthesia preparation. LTC resident case cancellations are costly, and delays dental care for the resident. Methods: This quality improvement project aimed to decrease case cancellations by improving communication processes during a 4-week pilot project. Pre-intervention case cancellation rates were calculated using a retrospective 12-month chart review to determine preventable and nonpreventable cases. Communication barriers were identified between the surgical center, dental office, and LTC facilities. A communication toolkit was developed and implemented to address communication barriers. All users were individually educated on how to use the toolkit. Post-intervention, case cancellation rates were calculated and categorized into "preventable" and "not preventable." Post-intervention interviews were conducted to determine the feasibility, usability, and satisfaction of the toolkit for the surgical center, the LTC facilities, and the dentist. Interventions: The communication toolkit included a preoperative patient assessment form and processes, a medication reconciliation form, an updated patient history and anesthesia record, an updated postoperative order and discharge instructions, a communication handoff and preoperative order form, a postoperative communication handoff form, and a nothing by mouth sign for facility use. Results: Pre- and post-cancellation rates showed no changes post-intervention and a higher percentage of preventable case cancellations post-intervention. Overall feasibility, usability, and satisfaction of the toolkit were high across all users, with increased communication between the surgical center and the LTC facilities. Conclusion: Although there was no change in cancellation rates, and most cases were preventable, the project was deemed successful, with high satisfaction with the toolkit use and increased perception of communication between the surgical center and the LTC facilities. The plan is to modify the toolkit as per feedback, continue its use, and refine the processes as needed. Further implementation will occur in all LTC facilities and for all adult patients seen at the surgical center. Additional fine-tuning will increase efficiency processes and expand services to more clients needing dental surgical care.