Running Clinical Reports by Andrea Cook

Our patients and their parents are judging us on many levels. Most of these reasons are not related to teeth, their smile or how accurate their bite is. They assume that they will get a beautiful smile when they trust you with their child’s or their own orthodontic treatment. The areas that matter most to them are:
  • Are they seen on time for their appointments?
  • Is your office in a convenient location?
  • Are all your employees friendly?
  • Does your office provide good communication?
  • Is their treatment completed on time?
  • Does your office have convenient office hours?
  • Do they experience few emergencies?

Most orthodontic offices run daily and monthly financial and administrative reports to measure growth, monetary tracking and other practice monitors. Running a set of clinical reports on a monthly basis will allow you to evaluate your treatment, your clinicians and your schedule. Running these reports will only help the practice if the information is accurate and reviewed.

Ask yourself these questions:
  • Is your clinic running on time? Are your patients being seen on time?
  • Are your clinicians consistently able to complete procedures in the allotted time?
  • Are your estimated completion dates being met?
  • Is your percentage of emergency visits at an acceptable level?

Many times I work with offices that have a “feeling” of what is happening in their office. Were your answers based on your feelings or one person’s perspective? Or were they based on actual facts and accurate information? You can more accurately provide answers by running your monthly clinical reports. Actual times and accurate data will give you a better perspective on which to base your decisions. The clinical reports I recommend running monthly are your emergency tracking report, patient flow report, patients beyond ECD (estimated completion date) and treatment efficiency monitors. Once you have this information, you can answer the questions listed based on what is truly happening in your clinic rather than assumptions.

Emergency Tracking Report
If proper coding is used consistently, a report of all emergency visit codes will give you insight into possible areas of concern. There might be two codes used to track this information – one for patients who call into the office with breakage or a problem and schedule an emergency appointment, and the second for breakage found at the chair during a scheduled appointment. Each of these gives a different view of the areas of concerns to address. If the number of emergencies is very high, this will most often lead to extended treatment times as well as the reduction of the per visit fee. This report might reflect the need for clinical training, bonding protocol review and other areas of improvement for the clinic.

The number of emergencies seen in a practice should average five percent or less. If your report shows that number to be higher than desired, it is time to provide training and put consistent protocols in place to reduce this number. Consistency in the clinic is a key factor in the reduction of emergencies. It is critical to make sure clinical protocols are developed and consistently delivered by each clinician. As I work with clinical teams to reduce bond failures, I will ask about their bonding protocol. I am typically assured that the practice has strict protocols and all team members know and follow them. A portion of my first day in an office during a clinical consult is spent observing the team as it delivers patient care with a full schedule. The number of inconsistencies I observe are often reflected in the rate of bond failures; the higher number of inconsistencies, the higher number of bond failures.

For multi-office practices, I also look at the number of emergencies based on percentages per office. One office might have a higher number due to the equipment in that location. Is the compressor functioning well? Are the air/water lines allowing water to come through when you are drying the teeth during a bonding procedure? Is the ambient light allowing the adhesive to start to set prior to the doctor arriving at the chair?

If the number of emergencies is higher than acceptable it is necessary to dig deeper to get some true information to evaluate. The computer reports will tell us which clinician saw the patient for the emergency visit, not the clinician who is responsible for the additional appointment. To fully evaluate each emergency or repair appointment, a paper trail is needed. Gathering the following information will help determine areas for improvement:
  • Which office was the patient seen in at his or her last visit?
  • Which clinician saw the patient?
  • Was it a loose bracket, band, wire poke or other problem?
  • Which tooth – for loose bands and brackets?
  • Which bracket – for offices using a variety of brackets?
  • Was the adhesive on the tooth, bracket or both?
  • Date and type of bond – for offices using direct and indirect?
  • Was it a wire poke or wire slide? Once we have this information we can make some educated decisions about solutions.


Patient Flow Reports
One of the ways our patients judge us is by being seen on time for their appointments. This means seating each patient on time as well as finishing each procedure on time. The patient flow report will give us that information if the team is checking the patient in and out on time. We can track this back to which procedures are taking longer than our schedule is designed for. This report can also be tracked by clinician, which pinpoints which members of the team might need more training. Many times I find that a clinician is unaware of the actual time he or she is taking for procedures. Having actual data will be much more helpful than “you are always running behind.” Give the clinician some real numbers that can give him or her a goal for improvement.

This report will only track the total time a patient is in a chair. It will not account for time that is spent waiting for the doctor to come to the chair. Assuming that the clinician just needs to speed up and get more efficient in the procedure might not be an accurate solution. It might be due to the doctor time in the schedule not being accurate or in the correct place in the procedure.

Your patient flow report will allow you to evaluate your clinicians as well as your procedures. Do all clinicians need extra time for specific procedures? It might be time to review the timings for your procedures. Have you changed bracket systems, bonding protocols or treatment applications? If so, the schedule might not reflect correct time for these new procedures. If one clinician is not able to consistently complete a specific procedure in the scheduled time, additional training might be needed. It could be helpful to have a clinician who is able to complete the procedure in time work with those who cannot. Making sure each clinician is prepared for the doctor when he or she comes to the chair, has good chairside organization (all adhesives, extra instruments, disposable items, etc.) and is fully trained will allow him or her to move through the appointment most efficiently.

Patients Beyond ECD
Having a high number of patients beyond their estimated completion date can be a huge struggle for many practices. Getting this number down to an acceptable level of five percent or less of your patients will help you meet your financial goals and free up a clogged schedule. The morning huddle is a good time to have these patients brought to everyone’s attention. The clinicians who see those patients can evaluate their treatment and compliance and help get them back on track.

The tracking report for patients beyond their estimated completion date should also be reviewed on a monthly basis. Are there financial concerns involved with these patients? Patient compliance issues? A set protocol should be developed to allow the team to address these patients. The estimated completion date should be reviewed and adjusted if there are missed appointments, compliance issues or treatment changes that are extending treatment. If the estimated completion date cannot be met, I recommend a scheduled consultation with the patient and parent to discuss the treatment options.

If compliance is the reason for not meeting the estimated completion date, it might be time to discuss options. Are there fixed forces that can be used to remove patient compliance from the treatment? Is it in the patient’s best interest to discontinue treatment?

Treatment Efficiency Monitors
This report will tell you how many procedures are completed during a patient’s treatment. It will include all scheduled procedures that are completed and all emergency visits. In order for a practice to be financially sound we must look at treatment from this perspective. When we tie this to the treatment fee, this will help us determine if our financial goals are being met. If the per visit fee is not at an acceptable level we can look at options. One of the biggest contributors to a case that is not financially sound or profitable is the high number of emergency visits. With consistency and training, this situation can be greatly reduced.

There are other options that might help your office decrease the number of visits in a patient’s treatment. The first is making sure that each appointment is as efficient as possible. Each appointment must make the necessary progress to move the patient through treatment in a timely manner. Would moving to a self-ligating bracket allow you to extend the weeks between visits? If repositioning too many brackets is adding visits it might be beneficial to look at indirect bonding or computerized treatment planning to achieve more accurate bracket placement.

In order to fully evaluate treatment times I monitor not only the total treatment time in months but include number of procedures and number of emergencies. If your computer system does not include enough information to fully evaluate treatment I would recommend using a treatment efficiency monitor that is filled out at each patient’s deband appointment. This monitor will track the type of treatment, total treatment time, the number of appointments and the financial outcome of the case.

Now that you have accurate information to base your responses on, I ask you to answer those same questions again. The key to a successful practice is meeting the needs of the patients. Once we understand their needs, we can use this information to make sure we are not only meeting their needs but also excelling at every level. Running your clinical reports is the first step. Using this information to improve your practice and your team will take you to the next level of clinical excellence! I challenge you all to get there!

Author's Bio
Andrea Cook bases training systems on practical knowledge gained through 20 years chairside experience. Andrea works as a clinical consultant and trainer for premier orthodontic offices across the country. Since effectively training clinical team members is a critical portion to the advancement of clinical productivity and profitability, Andrea works with teams to increase efficiency, improve communication and guide the office to a new level of excellence. For more information, contact Andrea Cook at 253-332-3376 or andrea@andreacookconsulting.com. You can also visit her Web site at www.andreacookconsulting.com.

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