Recommendations:

A pro-active system to follow up with patients about missed or cancelled appointments allows a dentist to promptly assess and respond to clinical situations, thereby maintaining continuity of patient care.

1. Develop policies and procedures in your practice for following up with patients who have missed or cancelled appointments.
2. Dentists should be made aware of any patients who have missed or cancelled appointments. The staff should inform the dentist(s) of these patients at the end of the day and have each patient’s record ready for the dentist’s review.
3. The dentist should assess the clinical importance of the appointment, the severity of the patient’s condition, and the risk(s) associated with the missed or cancelled appointment.
4. A reminder telephone call should be placed to the patient. The time and date of the telephone call and the content of the message or conversation must be documented in the patient’s record.
5. A telephone call from the dentist may be indicated for patients at higher risk. The dentist should emphasize the importance of follow-up care and the risks inherent in failing to obtain it. This telephone conversation must also be documented in the patient’s record.
6. If there is no response from the patient, or the patient develops a pattern of not keeping or missing appointments, a letter should be mailed to the patient to advise him/her of the risk of non-compliance. The letter should be sent two ways: 1) Certified mail, return receipt requested, and 2) first class mail, with a certificate of mailing purchased from the US Post Office. A copy of the letter and any documents returned by the Post Office should be maintained in the patient’s chart.
7. All efforts to contact the patient, either by telephone or letter, must be documented in the patient’s record. This provides written evidence that the patient was clearly made aware of the importance of continuing care.
8. Educate your staff about patient follow-up policies and procedures in your practice. Conduct periodic record reviews to determine staff compliance and to evaluate the effectiveness of the processes you have implemented.
9. Continued failure of patients to keep appointments may be deemed non-compliance with treatment.

Consideration should be given to discharging the patient from your practice since patient non-compliance may increase the risk of liability. The attorneys at Fager Amsler Keller & Schoppmann, LLP are available to assist you to determine how and when to properly discontinue your dentist-patient relationship due to patient non-compliance.

Recommendations:

1. Referring dentists should develop a method for determining whether a consultation has been completed and if a written report has been received.
2. As a matter of standard office policy, all consultation reports must be reviewed by a dentist, initialed, and dated prior to being filed in the patient’s dental record.
3. Office follow-up procedures should provide for easy identification of a patient’s noncompliance with the recommendation for a referral, such as when a written report has not been received from the consultant.
4. If a patient has been non-compliant in obtaining the recommended referral/consultation, follow-up with the patient is necessary. Your discussion with the patient should include reinforcement of the necessity and reason for the referral/consultation, as well as documentation in the patient’s dental record of all attempts to contact the patient and obtain compliance.
5. If a written report from the consultant is not received in a timely manner, you should contact the consultant to determine whether a written report has been generated.
6. Consulting dentists should routinely send written reports to referring dentists in a timely manner. These reports should include:
   1. findings;
   2. recommendations, including interventions and the delineation of the dentist responsible for treatment; and
   3. follow-up of abnormal test results, including incidental findings.
7. To promote effective communication, the consultant should contact the referring dentist about any patients who fail to keep appointments. Dental record documentation should reflect the missed appointment, as well as notification of the referring dentist.
8. Telephone conversations between referring and consulting dentists are important when clarification of the contents of a report is necessary. Timely contact must be made when an urgent or emergent clinical finding is identified. These conversations must also be documented in the patient’s dental record.