Virtual clinics in paediatric dentistry

Abstract

During the COVID-19 pandemic, the National Health Service (NHS) had to adapt and innovate in ways to provide clinical care. A traditional healthcare model, where patients travel to a clinical building for their care, or a clinician travelled to the patients' home, was not possible. Instead, many Trusts established or expanded virtual ways of providing care; the patient and clinician connect remotely, via telephone, video call, or written communication.

Beyond the pandemic, virtual clinics and wards have become a routine part of NHS healthcare, with benefits for patients, staff, and the environment.¹

Dental procedures cannot be carried out virtually, so in this paper we refer to appointments that are for assessment, treatment planning, or review. In the speciality of paediatric dentistry, where patients have rapidly evolving dentitions and undergo rapid change, there is a high need for these types of appointments.

The aim of this paper is to highlight different formats of virtual clinics that are relevant to the field of paediatric dentistry, using example cases and quality improvement data from the virtual clinics at the Eastman Dental Hospital.

Virtual clinics can take many forms, and the value of different clinic types may depend on the case-mix for each paediatric dentistry service. All virtual clinics can be conducted in a clinical room, in a non-clinical room, or remotely.

For any appointment or interaction, appropriate patient documentation will need to be completed, such as clinical notes, letters, requesting follow up appointments, coding, and recording the referral-to-treat outcome. The authors also suggest asking parents to send in patient photographs in advance of a virtual clinic, as this aids the diagnostic value of the appointment.

For the sake of simplicity, the term ‘parent’ is used to refer to the adult most likely to accompany the patient and have parental responsibility. This is not the case for every patient, and so the term ‘parent’ should be substituted with the appropriate adult(s) for each child or young person.

Virtual working can have benefits for patients, parents, and staff. They are also associated with less costs both financially and environmentally. Admittedly, except for A&G, they require a similar amount of time as face-to-face appointments.

When planning a virtual clinic, a clear standard operating procedure should be written, and all stakeholders included to identify the important issues to be managed. This could include personnel, funding, administrative support, as well as the physical location and hardware required to run the virtual service. Each part of the pathway should be assessed from referrer to clinician to hospital capacity. The virtual service must fit in with the existing clinical service, recognising the clinical and administrative time needed.

Once this is in place, then clear guidance should be produced so that all stakeholders understand the aims, objectives, limitations, and outcomes from the service. In the same way as trained nursing staff are required to deliver a face-to-face clinic, trained administrative staff are required to prepare, book, and process virtual clinics.

Initial or pilot clinics with reduced patient numbers are an effective way to “test” the new standard operating procedure, and then make changes as necessary for the individual service needs. This requires input from all stakeholders, and training of all involved staff.

Below are some of the main considerations for any paediatric dentistry service considering virtual working.

Throughout this paper, quality improvement examples have been given. For virtual clinics, as with any type of service design or development, QI methodology should be designed to evaluate success of the virtual clinic, and drive changes.

Table 2 demonstrates some useful quality improvement tools and outcomes that can be employed for virtual clinics.

Virtual clinics have a role in paediatric dentistry for assessments, treatment planning, and reviews. When planned properly, they can be used to benefit patients, families, staff, costs, and the environment. There are lots of different formats to virtual clinics, and like any emerging service, they can be evaluated and progressed via quality improvement methodology.