Emergency

Emergency Clinic Patient Flow | Course Information | Attendance Policy

​Clinical Director of Emergency: Dr. Woo
Administrative Coordinator: Liz Concepcion

Emergency Clinic Patient Flow

1. Patient signs emergency consent (INTESC).

  • INTESC can be found under patient consent forms.
  • EM is the source code, not your GP#.

2. Faculty verbal start check upon completion of INTESC and full medical history. (A treatment plan consisting of charged office visit, radiographs taken, and today’s proposed treatment will be created at upon diagnosis. It will be approved by faculty/patient at that time.)

  • Check if diabetic (check if controlled – medication, most recent meal, etc.)
    • If in doubt, get glucometer from dispensary
  • BP 180/110 CUT OFF
  • HIV patient with no lab documentation: take them to Tina’s office

3. Clinical Exam

  • Axium emergency worksheets (EMGREC) are used to gather data
    • Fill out Subjective, Objective, and Diagnosis and Treatment Planning tabs
      • Pulpal diagnosis:
        • Normal pulp, reversible pulpitis, symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis, previously treated, previously initiated therapy
      • Periapical diagnosis:
        • Normal apical tissues, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, chronic apical abscess (sinus tract), condensing osteitis
    • Chart perio findings in the perio chart (pocket depths, furcation, mobility)
    • Discuss the proposed radiographs/special tests with faculty (after you have formed a working diagnosis through examination)
      • PANORAMIC radiograph and CONE BEAM require a treatment plan approved by faculty and patient to schedule with radiology

4. Take necessary radiographs. Inform patient they are incurring costs when we take radiographs.

5. Review radiographs, objective/special tests, consultation.

6. Form a Diagnosis

7. Obtain necessary consultations/referrals.

  • Endodontics
    • Endo faculty will determine whether a case needs to be referred to a resident
    • If DDS student case:
      • Indicate DDS case in EMGREC form
      • Proceed with scheduling endodontic treatment
    • If resident case:
      • Indicate resident case in EMGREC form
      • Email Zandro and Erica Rincon with the referral
        • Include pt’s name, chart #, tooth requiring treatment, and endo faculty who approved the referral
      • Inform the pt that the Endo department will contact them within a two week period
  • Oral Surgery
    • Complete OS tab of General Referral form
    • You do not need to treatment plan extractions. This will be completed by Oral Surgery.

8. Treatment Plan

  • What is the final treatment procedure plan (code) based on the diagnosis? Enter the treatment procedure code and codes for radiographs taken.
  • Faculty approves/swipes the treatment plan. Pt signs the treatment plan.
    • Commonly used codes:
      • Diagnosis: Pain/Altered Sensation
      • D9430 – Visit for Observation (Charge)
        • ​Examination with diagnosis
        • Observation ONLY
        • May include prescribing, reappointing, and/or referral to Oral Surgery
        • *Requires documentation
      • D9460 – No Charge Office Visit (RARE)
        • Very few of these in emergency clinic
        • Active Patients of Record assigned to students
        • Most common
        • Temporaries (re-cement & remake)
        • Tooth in progress
        • Denture adjustment (usually less than 1 year post-delivery)
        • *Requires documentation
      • D9110 – Palliative (emergency) treatment of dental pain
        • Considered a “hands on” visit
        • Minor procedure performed to alleviate acute symptoms of pain/discomfort
        • Generally meant to ease symptoms without curing the underlying problem – NOT DEFINITIVE TREATMENT
        • E.g. temporary filling, perio related, smoothing sharp tooth
        • *Requires documentation
      • D3221 – Pulpal Debridement
        • If this is done at the Emergency appointment, insure to print out RCT instructions below, have the patient sign it, scan the document into their chart, and give it to the patient before they leave.
      • Radiograph codes:
        • D0220 – First Periapical
        • D0230 – Additional Periapical
        • D0270 – Bitewing, single
        • D0330 – Panoramic
  • For endo treatment: sign Post Root Canal Necessary Treatment consent (ENPRCT)

9. Get financial approval (with PCC or cashier) and get P* removed before starting any procedure.

10. Documentation – SOAP Note (Axium template)
EMERGENCY VISIT #___
List faculty (ER and specialists) you worked with
EMERGENCY VISIT #___

FACULTY:

S:
CC:
HPI:
Pain Scale (0 – 10):
Med Hx:
Meds:
Allergies:

O:
Vitals:  BP:  Pulse:
Hard tissue findings:
Soft tissue findings:
Perio findings:
Endo findings:

Radiographs taken:

A:
Diagnoses:

P:
Procedure/Plan:
DWP:

Loader Loading…
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [51.62 KB]

Loader Loading…
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [167.77 KB]

Loader Loading…
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [291.75 KB]

Loader Loading…
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [173.75 KB]

RCT Patient Instructions

Loader Loading…
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [67.31 KB]

Information About COH 368 Emergency Clinic

Module overview
This module focuses on basic guidelines and protocols of emergency clinic.  It includes online self-paced study and class huddle.  You will first study foundational concepts at your own pace out of the class and then be prepared to come to the Monday morning huddle when we will discuss the key concepts covered in the online presentation and clarify misconception.

Learning objectives
1. To get familiar with important emergency clinic protocols.
2. To be prepared to see patients in the rotation.

Out of the class
1. Review the “3rd year emergency clinic rotation presentation 2018-2019”. (Download or view below)
2. Take the protocol quiz on Canvas. Click on the quiz title within this module.
Due: Sunday at 3 pm before your rotation starts the following week.
Important notice:

  • Failure to take the quiz will NOT allow you to treat emergency patients in the rotation.
  • I will review your quiz answers online after the quiz is due and identify questions to be discussed and clarified in the class huddle the following week.

​Class huddle
1. Q&A
2. Discuss  and clarify difficult concepts
3. Emergency rotation knowledge pre-test (self-assessment; Non-graded).  This will allow me to identify where you may need specific guidance. review_lecture_emergency_clinic_2019-20.pptx File Size: 2089 kb File Type: pptx Download File

Attendance Policy

The FULL FIVE DAY attendance and the first morning huddle is mandatory and absences must come through Academic Affairs.  The attendance policy for the Emergency Clinic course is firm as we are committed to rendering care to patients who are in pain and we expect students to take this professional obligation seriously.

We have minimal capacity to offer make up sessions, due to the limited amount of assigned Emergency chairs in the Main Clinic.  Therefore, absence from this rotation creates a number of complications and is detrimental for emergent patient care.  Since the Emergency clinic operates throughout the year, quarter breaks are the only time for make up sessions under rare circumstances.

If you are ill, you must find a classmate to substitute for you.

Discretionary day use is not permitted during Emergency rotations.  Any absence, regardless of reason (including illness, national boards, conference attendance, vacations, etc) will result in a 5 point grade deduction from the student’s final course grade in COH 368, for each day of absence.  All absences are reported to Academic Affairs as well as to the student’s Group Practice Leader.

On a case by case basis, we will consider waiving this point deduction exclusively for the following two situations:

1)  In the case of illness, a letter is provided by the student from their treating physician stating that the student was not well enough to provide patient care on specific dates, including the date that they were examined and/or treated the student. This letter must be submitted by the student within 24 hours after the absence of the student.

2)  A student who has a residency interview when they were scheduled in the Emergency Clinic. This documentation should include the specific dates and times of the interview and must confirm the fact that alternate dates/times were not made available to the student by the residency program. This documentation must be provided as soon as the student is aware of the schedule conflict with a minimum of 1 week prior to the affected rotation.

Please note that waiver of the point deduction is not guaranteed and will not be considered without the specified documentation.  Any falsification of documentation is an ethical violation and will be pursued accordingly.

Any absences must be made up during the quarter break and/or at times determined by the student’s group practice coordinator in agreement with the Emergency Director. Any absence will result in an INC grade (which averages into the student’s GPA as a D grade) which will remain on the student’s record until final rotation grades are submitted, assuming that the missed time is made up by that time (end of Autumn Quarter).

Consideration of student requests to switch entire rotations with a classmate within their group practice, once approved by the student’s GPL and the Main Clinic administration can be an option but please note that this is rarely possible due to the complexity of the larger school rotation schedule. Requests to switch for a portion of the rotation are not considered.

We strongly encourage students to volunteer during the quarter breaks, as this greatly enhances their critical thinking and diagnostic skills in treating emergency cases. Please note that when you sign up, the attendance policy firmly applies. If you are absent for any reason, you will be required to make up this time at the next available break.