How should you prepare to re-open your dental clinic?

Businesses across the world have been significantly impacted by the sudden need to forcefully shut down what we know to be our ‘normal’ lives. Unlike many businesses, however, dental clinics in the UK have been left in the dark about when and how they should re-open their doors to patients.

Though the guidance or lack thereof is hugely vague, that does not mean you should wait for word from the powers that be to put a plan in place. While you sit and ride out the storm of COVID-19, your competitors already have their wheels in motion, ready to swipe your patients at the first opportunity.

Dental problems have not gone away during these times of isolation. Clinics around the country have been triaging emergency patients as best they can. Nonetheless, there will undoubtedly be a stream of patients desperate for treatment once you are given the go-ahead to provide it.

Stepping into a new world

As we gradually remerge from the Coronavirus induced lockdown and try to resume normality, the virus still and could likely plague us forever. How then can you prepare to open your dental clinic in a Coronavirus affected environment?

The tips we share below are our recommendations of areas to consider when planning your re-opening strategy. With the individuality of each practice, and depending on the impact of the virus in your area, you will need to come up with a tailored plan to suit your situation. We hope that our suggestions make for a good starting point and perhaps provide you with some ideas you may not have thought to prepare previously.

Check with authorities & assess your situation

• Stay up to date with the guidance from the relevant governing bodies. The BDA’s Live Updates is a useful hub for up to date information on the developments in dentistry.
• Check online for resources and checklists provided for dentistry. As we learn more about how to deal with the virus in day to day life, the publication of these will increase.
• While re-opening may be allowed, that doesn’t necessarily mean it is safe for you to do so. What is the infection rate like in your area? What is the demographic of your patient base? Are your staff fit and healthy enough for the task, and does your clinic layout allow for enough space between people inside? If you aren’t confident opening is the right choice, do not feel pressured into doing so.

Organise your team

• Before you can re-open, you need to ensure your dental team are up to the challenge. Clinicians and employees who are unwell, have been exposed to the virus, or who have any form of immune deficiency might not be able to return to work for a while.
• With the staggered return of children to schools, make sure that those who have children have appropriate childcare.
• Be sure to communicate with your team, confirm their availability and address any concerns they raise.
• Initially, you will want as few staff in the clinic as possible. After assessing their availability, decide who will work when and what tasks they will be responsible for. Jobs roles will vary and change to allow for patient intake and office cleaning.
• Discuss the new operating schedule, patient intake procedures and other adaptations with the team.
• Distribute their confirmed schedule and responsibilities, ideally via a cloud-based system to avoid touch points on printed schedules. Making sure everyone is on the same page will help things run smoothly when you open your doors.
• Keep health and safety procedures top of mind by discussing them in your daily meetings. Regularly remind your team of the importance of enforcing hygiene practices with patients.
• Partake in new courses where available. Training workshops for relevant topics like mask fitting are becoming increasingly available. Where possible, have your team trained in the latest procedures to increase patient and staff safety.

Confirm your dental practice is fit to open

• For those practices who decided to divert calls to triage emergencies from home, it may have been some time since you visited your clinic in the flesh. Inspect the physical location before opening to make sure it is good to go. You never know what may have gone awry while you were away.
• Are the utilities working? Are the phone line and internet still connected? Is your security system still in operation? Can you take payments on your POS machine and is the contactless function working as expected? Is your dental equipment in the best shape for when it is required?
• Bear in mind that you may need to reposition some items and equipment to help enforce social distancing.

Prepare your inventory

• It is common knowledge that face masks and other items of PPE are in short supply on a global scale. This is a situation that may not be rectified for some time. Have you got access to the PPE required to operate? Can you ensure a steady supply of this stock? Don’t waste the effort and cost you will outlay to open, only to have to reclose due to a shortage of supply.
• Touch base with your general suppliers of all other items required to operate. How have they faired throughout the lockdown period? Don’t just assume they will be available and stocked when you’re ready to return to the practice.
• Consider the move to manual instruments for your procedures. Manual hand scalers, for example, are an excellent option to limit spray. Better yet, the disposable alternatives greatly reduce the risk of cross-infection.
• Have a procedure in place when taking deliveries. Accept these outside the clinic and sanitise them prior to opening.

Modify your practice

• Where face to face communication cannot be avoided, install perspex panels or ‘germ-guards’ along the reception desk.
• Clearly mark out social distancing recommendations.
• Use ‘dry fogging’ machines that will decontaminate the surgery between each patient to ensure a safe virus-free environment.
• Decontaminate communal areas prior to opening the practice, at lunchtime and at the end of the day.
• Use video and phone consultations whenever possible.
• Remove all non-essential items such as newspapers, magazines, brochures, display models, and even small toys in the children’s area of the waiting room.

Heightened infection control

• Thorough sanitation is no longer limited to clinical instruments and spaces. These meticulous standards must now extend to the reception area, restrooms and offices. Don’t forget about door handles, countertops, and other high touch areas.
• Ensure all staff have additional PPE when in surgery.
• Designate hand sanitiser stations in reception areas and throughout the practice to encourage hand hygiene.

Move to online communications

• Where possible, introduce a contactless experience in your clinic. Consider what could now be sent and received by email and text message to patients such as appointment times, reminders and offers.
• When you need information from the patient, consider setting up forms that can be sent electronically, filled out online and returned electronically before their appointment. Think of what you can do to minimise the touching of pens, paper, and devices in the clinic.
• Move to E-consultations to deal with patients off-site where possible and install WhatsApp or Facebook Messenger widgets on your website to help handle queries.
• Don’t forget to have a plan B for patients who do not have access to or do not feel comfortable using online means of communication. Consider what you can do by phone or if perhaps a drop off/postal service could alleviate clinic contact more effectively for them.

Notices on display

• Remind team members of new protocols by posting signage near clocks, in break rooms and restrooms.
• For patients, having useful reminders shown outside the clinic can help to reinforce the behaviour you wish for them to adopt upon entry. These could be reminders to go home if they are feeling sick, to leave non-essential items inside the reception area, or to call reception for clearance prior to entry.
• Have signs on display throughout the practice reminding people about physical distancing. Consider adding marker points on the floor from the entry to the procedure room, so patients know how far to stand away from team members.
• If you have a separate entry/exit point, make sure these are clearly displayed.

Managing expectations

• PPE can be daunting and frightening to those who aren’t used to it, especially children. Remember to sound happy and friendly to patients who enter the clinic to help them relax. Remind them that it is you still underneath all the apparel and explain why you use the PPE and how it keeps everyone safe.
• Inform patients of all changes. Update your appointment scheduling and reminder procedures to notify them of any new policies, so nothing is a surprise to them. Better still, consider creating a patient walkthrough video of your practice to show them exactly how things will work once they are there.
• Call patients prior to their appointments to run through your clinics’ procedures.

Changing the treatment process

• Adapt your treatments to reduce risk where possible—for example, using a rubber dam to contain all aerosol spray. You could also consider allocating a dental assistant to each dental hygienist to help them use a high-volume ejector for hygiene procedures.

Staff screening and safety measures

• Designate a daily health screening area for your team and log all results taken each day.
• Minimise staff interaction within the practice.

Patient pre-appointment process

• Adapt your appointment confirmation process. This could involve explaining new safety policies over the phone when confirming appointments with patients. This would also be a good time to check if the patient has any symptoms of the virus.
• Provide efficient PPE at the door for the patient to put on prior to entry.
• Request that all patients thoroughly brush their teeth just before arrival.
• Ask that they wash their hands for 20 seconds before leaving home.
• Complete a pre-appointment screening process either via phone or via online form.
• Ask that patient wait in their vehicle or outside the practice until they are called in by the office team, once the previous patient is gone and sanitation is complete.

Patient during the appointment process

• Modify the patient check-in process. The office team must speak with them over the phone and clear them before they can enter the practice.
• Consider allocating a member of the team to greet the patient and escort them through to the treatment room, ensuring they follow the required protocol.
• Enforce the use of hand sanitiser and PPE.
• Take their temperature prior to entry.
• Ask that they use a Betadine anti-viral throat spray and rinse with a specific mouthwash.
• Complete a screening process questionnaire.

Patient post-appointment process

• Upon completion of the dental service, notify the patients’ guardian or parent by phone to come to the exit.
• Request that the patient uses hand sanitiser when leaving the office.
• Hand-off the patient to their parent or guardian outside the office.
• If a payment is required before leaving, take this by card and contactless where possible.
• Organise a follow-up appointment at the time of payment or via electronic communications after they leave the clinic.

Shifting appointment structure

• Add at least an extra 20-30 minutes per patient, per procedure to allow for enough time to manage the patient through the new process and perform the proper cleaning ritual.
• Ensure appointments allow for social distancing by staggering patients. Perhaps start with one patient at a time and just a few patients per day. You can increase this as you become more adept to the new process and when the restrictions ease accordingly.
• Perhaps initially consider limiting services to those with the lowest risk of catching the virus.

Limiting clinic access

• Restrict clinic entry strictly to patients. Spouses, friends, caregivers and parents must wait outside. Patients can be assisted/accompanied to the door then handed off to one of the dental team outside the practice.

End of day process for the dental team

• Request that team members remove their disposable lab coat before removing their gloves.
• Permit them to bring a change of clothing to change into and request that they properly store their workplace garments in a plastic bag to be washed when they return home.
• Enforce that they wash their hands with soap and water for at least 45 seconds after disposing of their PPE.

Update your marketing

• The essential element of your marketing right now is keeping your patients up to date with everything that they need to know. They need to know that you are open, what you have done to make things safe for them while you were closed and why they should come back. Consider sending these messages across multiple communication channels such as email, leaflets posted to homes, text messages, social media and online advertising to ensure they are all aware you are back in business.
• Building trust with your patient base is more important than ever now. Make sure you are promoting your updated office hours and available services offered so that patients can find accurate and current information. Don’t forget to tell them about new services that have been adopted, such as e-consultations. Promoting these changes on your website, social media and Google My Business listing is a great place to start.
• Provide detailed information on your website that explains the safety precautions you are taking. This could be in the form of blogs, dedicated patient information pages or popups.
• Ensure you are optimising any new content for SEO to be in the best position to catch the attention of patients old and new.

Monitor the situation and adapt

• Be flexible in your approach to all of this. The situation with the virus changes day by day and depending on whether we see a steady decline or waves in infection rates will determine how your clinic can operate. Keep an eye on supply availability, the level of the Coronavirus infection in your area and if your safety procedures are still deemed appropriate. When restrictions ease, you will be able to look into increasing patient numbers in your clinic, but only do so when guidance allows for it and if you are comfortable making the changes.

If you would like any help in organising your re-opening strategy and communicating this with your patients, contact our team today.

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