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Case Study – Rapid Response to Patient Safety During Pandemic

Swift updates made to operational and medical protocols allowed Kids Care Dental & Orthodontics to safely see patients during the COVID-19 pandemic, while other dental practices remained closed.

Patients come first. This simple statement is the guiding principle behind Kids Care Dental & Orthodontics’ everyday operations. The COVID-19 pandemic tested yet reinforced that philosophy ten-fold. When other dental practices shuttered operations in the spring of 2020, Kids Care was able to quickly adjust protocols and operations to ensure patient services could continue. How? Early awareness and preparation.

Early Awareness Leads to Preparation

Before 2019 ended, Kids Care Dental & Orthodontics’ Chief Compliance Officer Angel Tobar was monitoring information about a new respiratory virus in China; what we now know as COVID-19. He began talking to vendors to identify potential supply issues of personal protective equipment (PPE) items.

“We were working with vendors at the end of December 2019 to gauge the temperature on what would be high-demand items, specifically N95 masks, surgical level 3 masks, and disposable gowns,” said Tobar.

By March 2020, he had successfully increased the organization’s ordering capacity for PPE to ensure Kids Care always had an adequate supply to care for patients. So, in the early days of California’s response to COVID-19, when many area dental offices were halting operations because of a lack of PPE, Kids Care was able to remain open and focus new safety protocols to serve patients in the safest manner possible.

Preparedness Prevails

As part of its regular operations, Kids Care develops emergency plans. Before COVID-19, those plans focused on patient care during wildfires and other natural disasters, as well as treating patients who have aerosol transmitted diseases, such as tuberculosis.

Drawing from existing plans, especially the aerosol transmitted disease program, a multidisciplinary team of Kids Care staff began to develop procedures to screen and treat patients while also protecting and preserving the health of patients and staff. The response included:

  • identifying which locations would become regional hubs
  • triaging patient concerns
  • screening patients and staff for COVID-19
  • creating a system to easily flag appointments to be rescheduled and rank appointments by severity
  • launching teledentistry

A Pandemic Playbook

Kids Care worked quickly and tailored its crisis preparedness to specifically meet the needs of ever-changing pandemic care. Essentially, it developed a “pandemic playbook” for the entire dental group because nothing else existed at the time. The playbook provided guidance for every aspect of the business and patient care—how to disinfect between patients, how to doff a mask, everything that would need to happen in the course of a day.

“It was great to see how ahead we really were with our protocols,” explained Tobar, noting the

Rapid Switch to COVID Operations

In order to serve patients safely, Kids Care shifted patient care from its 20 community locations to five regional hubs and focused on urgent care. This model allowed for services within a short driving distance from patients, while offering in-person appointments only to patients with urgent needs.

For patients unsure whether their dental needs were urgent, Kids Care implemented teledentistry within 72 hours of switching to emergency care only. Using a video conference platform and DocuSign for consent, providers were able to talk with patients and/or their parents about dental issues and symptoms to assess and identify which patients needed to be seen in office, and whose care could be managed at home.

For Kids Care’s most vulnerable patients (e.g., patients who are very young, have chronic underlying conditions, who have infections, etc.), the surgery center team managed care in partnered hospital locations. As hospitals became increasingly full, space was held for Kids Care only if they could bring their own PPE. Because of its due diligence early on with supply chain vendors, this was not a problem for Kids Care providers.

Across the board, Kids Care updated provider PPE requirements, viewing recommendations from the World Health Organization, the Centers for Disease Control and Prevention, and the American Dental Association as requirements to keep patients safe.

“Our north star was always going to be what is best for the health, safety and well-being of our teammates and for our patients,” said Janet Widmann, president and chief executive officer.

Following the best safety advice, Kids Care offices began requiring staff to wear N95 masks instead of surgical masks, the standard protection in dentistry pre-COVID. The upgrade to N95 masks required staff to undergo fit testing to ensure the N95s could be worn properly. All staff, approximately 300 employees, were able to undergo this testing within one week.

Switching PPE requirements for a large dental practice came with significant cost impacts. Before the coronavirus outbreak, Kids Care was paying $0.08 per surgical mask. Of course, N95 masks cost more than surgical masks. When in short supply, the cost was $12.50 each.

“We never compromised. We were always going to follow the most effective recommendation, even if that translated into significant increased costs. The safety of our patients and staff are paramount,” said Enrique Figueroa, vice president of operations.

 Safety Success

In just a little longer than six months—May 1 to Nov. 30—Kids Care saw more than 100,000 patients, nearly 200,000 people (since pediatric patients have an adult accompany them), and there have been zero COVID transmissions—patient to provider, provider to patient, and teammate to teammate. Of those 100,000 patient visits, 93% of them were high risk, aerosol-generating visits. To further preserve health and well-being, Kids Care made a multimillion-dollar investment and added medical grade HVACs to all 20 practice locations.

The biggest success factor in keeping COVID-19 cases out of Kids Care is its screening process. Patients and parents/guardians attending appointments are screened twice for COVID-19 symptoms. The first screening is conducted at the time of scheduling; the second occurs three hours before the appointment time. Patients and parents have expressed, on surveys, their trust in Kids Care to keep them safe. They are comfortable coming in for dental treatments, even more comfortable than visiting a pediatrician’s office.

Community Partners

Kids Care Dental & Orthodontics also is committed to serving the communities where its patients live. While only having a quarter of office locations open, Kids Care offered its closed spaces to area hospitals to use to help however they were needed. Kids Care staff impacted by smaller patient volumes looked into volunteer opportunities to help hospitals whose employees were already stretched thin—actions the Kids Care executive team fully supported and encouraged.

David Trent, M.D., D.D.S., chief medical officer, when talking with other dentists says, “You have a lot of knowledge that could be useful to hospitals as cases surge. Start to ask yourself, how would you be able to help? Are you ready, willing, and able to answer that call if necessary?”

As California braces for the impact of the second wave of cases in late 2020 and imposes new shelter in place orders, Kids Care will once again volunteer time and space to aid hospitals and other frontline workers. Additionally, Kids Care is working to help change state legislation, working with the governor’s office and the California Dental Association to authorize dental offices to serve as testing facilities and to aide with vaccine distribution, once it becomes available to the general public. To help reduce community spread of COVID-19, Kids Care joined Healthy Davis Together, a project lead by the City of Davis and UC Davis to provide no cost COVID-19 testing for asymptomatic people.

“Dentists already have these skills, and are ready and able to help,” says Dr. Trent. “We are hopeful legislation will change to allow us to help more, as other health professionals–like pharmacists—have successfully made changes and taken on bigger roles.”

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