Creating healthy smiles

In recent years, Sydney Dental Hospital (SDH) and Oral Health Services (OHS) has experienced an increase in waiting times for general dental treatment, which has led to a significant backlog, negative impacts patient health outcomes, and increased numbers of emergency presentations. In response to a high number of complaints from patients looking to access dental care, SDH & OHS undertook an analysis to identify inefficiencies.

The analysis revealed that only 45% of the demand for general dental appointments could be met in-house, with the remaining 55% managed through Oral Health Fee for Service Scheme (OHFFSS) vouchers. These vouchers are used with private oral health service providers as an adjunct to in-house treatment to manage patients within the recommended time set by NSW Ministry of Health.

The NSW Health Priority Oral Health Program (POHP) policy provides directions for waitlisting and managing general dental patients. Within the Policy, Code C is a treatment waiting list for medically compromised patients which defines only certain medical conditions having higher priority as they impact oral health. In July 2023, SDH and OHS reviewed the Code C waitlist of 1729 patients in Community Oral Health Clinics and identified a proportion of patients who did not meet the Code C criteria. As a result, patients are incorrectly prioritised impacting other patients on the waiting list.

Reducing backlog in general dental treatment

The Creating Healthy Smiles project aims to address the backlog and inefficiencies in the general dental treatment waiting list at SDH & OHS, by redesigning triage processes, improving appointment booking systems and enhancing discharge protocols. The project looks to ensure prompt access to dental care, a reduction in patient complaints and improved clinical outcomes. This initiative will help patients waiting for urgent and non-urgent dental care, improving their overall health and quality of life. By December 2024, the Creating Healthy Smiles project aims to:

• Increase the general dental patient treatment capacity/demand ratio (excluding vouchers) from 23.3% to 45% per month (currently 33% in June 2024)
• Decrease the number of incorrectly placed patients on Code C waiting list by 20% from 1729 in July 2023 to 1383 (currently 1394 in June 2024)
• Reduce patient complaints relating to access to care by 25% from 20 complaints per month in July 2023 to 15 (currently 8 in June 2024)

Redesigning the triage process

The project leads undertook thorough diagnostics, mapping of processes and engaged with key stakeholders. The team identified three solutions:

• Improve workflows and training for the Centralised Oral Health Intake & Information Services staff to ensure accurate and consistent triaging of patients as per Priority Oral Health Program (POHP) criteria. Dental students will manage additional urgent appointments to enhance capacity.
• Educate clinicians on proper discharge protocols to ensure timely removal of patients from the system post-treatment to allow spots for new patients. Improve clinician understanding of POHP Code C criteria to correctly waitlist patients.
• Introduce new roster templates and telehealth pre-appointment processes to optimise the use of clinical time and reduce waiting periods.

The project team is closely monitoring these changes, with audits and continuous feedback mechanisms in place to measure their effectiveness. In December 2023, SDH & OHS were meeting 23.3% of the demand. This increased to 33% in May 2024, with an aim to meet 45% of the demand by December 2024.

Initial outcomes have shown an improvement in utilisation of clinical time to manage demand for general dental treatment and an increase in patient satisfaction. The project team will conduct further formal evaluation to measure long-term impacts on patient outcomes and system efficiency.

View this project's poster from the Centre for Healthcare Redesign graduation August 2024.

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