Hospitalizing Patients lor Dental Care
Deciding 011 hospitatization. The vast majority of patients needing routine dental care, induding oral and maxillofacial surgery, can be safely managed in the dental office. However, occasionally some patients require that dental care be provided in a hospital or surgery cener environment. A patient may be better treated in a hospitalstttng for several reasons. One of the most common reasons is behavioral management. Patients unable to cooperate (e.g., because of mental retardation), unwilling to cooperate e.g., uncontrollable children), or who refuse dental care while awake can be deeply sedated or placed under general anesthesia; this allows routine dental care to be delivered to these individuals quickly and safely. An operating room setting for dental treatment may also be necessaryfor the physically handicapped patient who is either unable to gain access to a dental office or is unable to remain relatively motionless during .procedures.’An operating room is also often needed to provide dental care for patients with high-risk medical conditions, such as patients requiring care that cannot be delayed until t_he medical condition is alleviated or
improved, or patients requiring emergency dental care shortly after a serious myocardial infarction (MI). In somecases a patient’s physician may be able to provide guidance as to the safety of office-based dental care. A final reason for planning a procedure in an operating room facility is for patients in whom acceptable local anesthesiacannot be attained, such as those requiring care on teeth in an area of severe infection. Usually these patients are best referred to an oral and maxillofacial surgeon, but
hospitalization may be an alternative if the dentist feels capable of managing the surgical problem. Day surgery facilities. In the past, operating room acilities were available only In hospitals, and patients
had to be admitted the day before dental surgery and remain in the hospital until the dentist believed discharge was indicated (commonly 1 to 2 days postoperatively).However, changes have occurred’ in methods of
delivering operating room care. Free-standing or hospitalbased
surgical centers now exist that offer staffed operating and recovery rooms and anesthesiologists for patients not needing preoperative or postoperative hospitalization. Many hospitals also offer the use of their operating room and staff, without requiring hospital admission. A
dentist may find that many patients unable to be cared for in the dental office can be effectively treated in daysurgery facilities without hospitalization. reoperative patient evaluation. Once the decision to
use an operating room facility has been made, several steps must be taken before the operation. The operating room staff must’be contacted and the operating time scheduled. Most facilities need some biographic information about the patient, the reason for the procedure, the procedure planned, who will perform the procedure, how long the operating room will be in use, the type of anesthesia required (i.e., sedation only or general anesthesia), and whether special equipment will be required. A hospitalbased operating room must also know if the patient will be admitted; patients to be admitted must have a room reservation made and an estimated length of stay.
All operating room facilities require that a medical history and physical examination be performed before the operation. See Chapter 1 for guidelines for recording the history and physical examination results in the medical record. This recording can be performed either by the patient’s physician before the day of the operation or, in some facilities, by the anesthesiologist during the preanesthetic consultation. Most facilities also require thatany medically indicated laboratory tests, radiographs, or
electrocardiograms be done at a time proximate’ to the surgery. Requirements vary from place to place, but the _usual minimal testing necessary is a hematocrit. “Doctor’s orders” communicate patient care instructions to nurses and other hospital staff members. The dentist’s orders should be accurate. clearly written, and comprehensive.
Preoperative orders are necessary for patients being admitted to a hospital or scheduled to be ti:eated in an operating room setting without hospital admission. Orders are best written by the dentist but may be given to nurses over the telephone (dentists must eventually sign
telephone orders). An example of adrnissron and preoperative
orders is given in Fig. 31-4. Before surgery the operating dentist should place a note in the patient’s record that briefly describes the nature of the patient’s medical and dental problems and the expected operating room and hospital course. The hospital staff can then use this note to familiarize themselves with the patient’s general condition and reason for admission (Fig. 31-5).