Screening All Patients . . . A Winning Strategy Initialize patient discussions of possible symptoms and problems. By Marty R. Lipsey, DDS
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hen we speak to Dentists who are interested in starting or growing their Dental Sleep Medicine practice, one of the most frequent initial questions we hear is “How can we get patients from medical doctors or local sleep centers?” While we certainly have ideas on how to develop these referrals, we would strongly suggest that every dental practice first develops a program to screen all patients of record and all new general patients for Sleep Disordered Breathing. In most dental practices snoring and other sleep disordered breathing problems are never discussed. We have found that your existing and new patients will welcome the idea of your screening for sleep health. When you put systems in place to do this, you will find that you not only open the door to find that you probably have a multitude of CPAP intolerant patients right within your practice, but also patients that should be referred to a sleep specialist or the appropriate medical professional for further evaluation and diagnosis. The added benefit here is that you also can start to build a referral relationship with your medical counterparts. You will, as well, begin to hear many stories of patient’s family members that are in need of evaluation for SDB. This is the perfect opportunity to invite those family members to become general patients of the practice. So you see, these screening systems are not only a way to grow your sleep practice, but your general practice and relationships in the medical community as well. The most important rule of implementing a screening program for
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sleep health is to screen every patient. Using a patient’s occasional mention of snoring or excessive daytime sleepiness to trigger your sleep screening is really no system at all. The best way to determine if your patients are candidates for sleep therapy is to screen every one. Even before you put the screening programs in place, make sure that every member of your team is educated. Your team cannot successfully educate your patients and help them to commit to any treatment or referral until they understand the problem, the solutions and the way to get there. Dental sleep medicine is a unique area of your practice and requires that you take the time to have your entire team on board. We often speak about helping everyone on the team to develop the medical mindset that is necessary to discuss and deal with these problems. Make sure that this is part of your program! If you have a new patient packet that you mail out to your new general patients, introduce the idea that you are screening for sleep health at the initial telephone contact and include the appropriate screening forms in your new patient packet. Some ideas of what to include are the Epworth Sleepiness Scale, the Fatigue Sleepiness Scale and Bed Partner Screening forms. For your recare patients, make sure that the hygienist or dental assistant has a standardized routine, with questions and checklist, so that every recare patient appointment follows your protocol in terms of screening for SDB. Our philosophy is that initial screening is just that - initial discussion of possible symptoms and problems that lead to a subsequent initial sleep consultation
appointment. The sleep screening at a new patient exam or recare appointment should lead to the offer of a followup initial sleep consultation. It is at the subsequent appointment where the situation is discussed and evaluated in more detail. Trying to do too much at screening time may lead to; (1) delays in treating other scheduled patients for the day, (2) rushing or incompletely explaining all the details of the sleep problem(s) and treatment options, and/ or (3) discouraging the patient from scheduling the proper and complete sleep consultation appointment because you have given them the impression that it may be secondary to their dental treatment or that you are really not focused on their sleep health, The bottom line is that attempting to do too much at the initial sleep screening shortcuts the patient in terms of fully analyzing the problem and providing the patient with all necessary information. Proper sleep screening is structured so that it introduces the critical initial information and is also a segue to the complete and subsequent sleep consultation appointment. In this manner, it is a win-win situation. The follow-up initial sleep consultation is really the appropriate time to do a more thorough evaluation, using your pharyngometer and other tools to gather information and to discuss the situation in greater detail. This is the dedicated sleep appointment where you have scheduled time to be more thorough. You now have the appropriate setting to help the patient understand the treatment options and will be more likely to have the patient commit to the next appropriate step in treatment or evaluation. Implementing a fully organized and across the board screening routine is the key to get to the initial sleep consultation appointment and a winning strategy for your dental sleep medicine practice!