Fall 2002 Practice Management Diary

"Efficiency"

by Gerald Nelson, DDS

Dr. Anoop Sondhi recently spoke to the UCSF Alumni, residents, faculty and new orthodontic graduates. Dr. Sondhi’s stimulating presentation included a discussion of efficiency — the number of appointments required to treat a case.

Efficiency as a standard has value so long as treatment achieves an excellent finish and provides a quality service experience for the patient family.

Every clinical appointment requires a series of tasks apart from the patient’s actual adjustment—making the appointment; a reminder phone call; checking in the patient; seating the patient; preparing the instruments; hygiene evaluation; making chart entries; making new appointments; clearing away the instruments; sanitizing the chair, lights and unit; processing and sterilizing the instruments; and replacing instruments in inventory.

This is a significant series of steps. When your protocol requires five more clinical appointments than necessary—for every patient—much time is wasted.

The following are a few of Dr Sondhi’s suggestions for reducing office visits:

• Strive for consistent bracket position—We all develop our own method for placing an appliance that will straighten the teeth with minimal archwire bends, thus fewer adjustment appointments.
  
  Dr. Sondhi recommends indirect bonding, a technique used by fewer than 15% of clinicians. Direct bonding usually necessitates a reset appointment.
  
  Adjust your appliance prescription in response to avoid repeated problems—e.g., for excess lingual crown torque on lower molars, reduce the torque in the prescription; for extruded upper second molar cusp, weld the bracket on the occlusal margin; and for excess distal tip of upper first molars, reduce the tip in the prescription.
• Adjust appointment interval to expected tooth movement—Nickel titanium wires have a long range, and, thus, will apply effective forces for many weeks (approximately 8–10).
• Steel wires allow detail adjustments, but have a short effective range (approximately three weeks). Instead of a standard appointment interval, relate it to the expected range of movement.
• Make the appointment count—Once you have your patient in the office, take every possible appropriate action—avoid putting off adjustments, resets, etc. until the next visit.
• Consolidate work appointments—The basic protocol is three work appointments: first, to place all appliances; second, to reset all misplaced brackets as identified by an xray and visual inspection; and third, to remove the appliances.
  
  All other visits are for routine adjustments. Although a treatment plan may require additional phases, such as maxillary expansion, a headgear phase, or exposing an impaction, just removing one appointment from every patient’s treatment program can liberate hours of time in your schedule.

(PDF version)*