Do you debrief?

When we introduce the “Patient Debrief” to teams, their first response is, “We already do that.” And to a certain degree they absolutely do part of it!

Typically, we see that hygienists always give patients oral hygiene instructions before during and after the prophy. Assistants give patients post-op instructions, often while removing instruments from the tray, lowering the dental chair and removing the patient’s napkin. How much of the information do you think the patient retains while all of this other activity is taking place? It’s no wonder that the patients develop “patient amnesia” and don’t retain a thing you said during the walk from the operatory to the front desk.

There is so much to be gained from a structured, focused Patient Debrief that truly takes only 2-3 minutes to complete. A formal debrief offers so much more than just giving patients follow-up instructions on the fly. The benefits include relationship building and better informed patients- resulting in fewer call backs because patients didn’t hear or understand the instructions. Another benefit is higher levels of patient commitment to future appointments resulting in reduced numbers of cancellations and no-shows. Are all of these potential benefits worth spending an additional few minutes with each patient? You decide.

New Patterns

Picture this scene. At the end of the hygiene or restorative appointment, leaving the patient’s napkin in place, the team member who will dismiss the patient says, “Before I escort you to the front desk, I would like to give you some important information.” This lets the patient know that the appointment is not over yet.

Even though this assistant or hygienist is concerned about getting the room turned over and seating the next patient, it’s vital that she or he must not appear rushed. This patient deserves full attention and a thorough debrief, which includes the opportunity to ask questions or express any concerns.

The 7 Ws

In this example, we will highlight an assistant conducting the patient debrief after a crown preparation. The assistant lowers the dental chair and sits the patient up. Pulling her chair close to the patient and facing him with complete, focused attention, the Patient Debrief begins using these seven Ws.

WHAT was done today (brief description of the procedure/s): “Mr. Johnson, today Dr. Barrows prepared your upper left molar for a crown by shaping your tooth and placing a post in it to support your new crown. We then took impressions for our lab to use in making your new crown. You now have a temporary crown on your tooth until you return to get your permanent crown.”

WHAT the patient can expect (includes post-op instructions/oral hygiene instructions): “You should not have discomfort with your tooth since the nerve was removed when you had root canal therapy. The tissue around your tooth may be a bit sore. Several warm salt water rinses each day for a few days will help. Take care not to bite down on hard things while you have your temporary crown because that can cause it to break. Brush carefully and pull the floss out from between your teeth rather than pulling up on it as that could dislodge your temporary crown. If, for any reason, your temporary crown comes off, please call our office right away so that we can arrange to either re-cement it or make a new one depending on its condition.”

WHAT is next and WHO the patient will see (restorative appointment or hygiene visit with Dr. or Hygienist): “At your next appointment, Dr. Barrows plans to fit and adjust your new crown. If it meets his clinical and aesthetic expectations, he will cement it. This will take only about 30-40 minutes.”

WHEN the patient needs to return: “It takes our lab about 2-3 weeks to make your custom crown and return it to us. Mary will set up your next appointment when I escort you to the front desk.”

WHY it’s important to keep this appointment as scheduled: “So that your tissue stays in good condition and your temporary crown is removed in a timely manner, it is very important to keep your next appointment as scheduled.”

“WHAT questions may I answer for you?” It’s important to ask an open-ended question with the assumption that the patient is expected to have questions. Be sure to thoroughly answer any and all questions or concerns before you escort the patient to the front desk.

Consistency counts

This structure should be followed consistently by all team members who dismiss patients-including the doctor. Create a one-page flow chart using the format in the example above. Place these pages in plastic sleeves and put one in each operatory. By using this flow chart, the Patient Debrief will flow smoothly, nothing will be omitted and “patient amnesia” will practically disappear.

Schedule a staff meeting to practice the art of the Patient Debrief. First, each team member needs to create a scenario and plug that into the format of the Debrief. Pair off and go into the operatories. One team member will be the patient and the other team member will be the assistant or hygienist delivering the Patient Debrief. Use the flow chart so you won’t leave anything out. The Doctor can play himself or herself, because the time will come when it flows more smoothly for the Doctor to do the Patient Debrief, e.g., when the procedure/s or post-op instructions are more complex.

Once you have completed the first scenario, switch roles so the other team member gets to practice. Now you each have had a practice session. For even more practice and better results, switch partners and do another practice using another scenario.

Now, watch the benefits of a thorough Patient Debrief unfold. Better informed patients will make fewer call backs for information and you’ll see more patient commitment to keeping appointments because the importance of doing that has been communicated and stressed. Most importantly, patients will feel cared for and valued and will appreciate the time you spent with them. You will treasure the art of the Patient Debrief because of all the benefits it provides to patients and your practice.
 

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