Dental nurse triage of patients with dental emergencies

Objectives: To pilot assess triage as a cost effective and safe method of ensuring emergencies are seen in regards to clinical need and not in the time in which they arrive in Kings’ College Dental Hospital (London). Methods: Dental nurses underwent a period of training and calibration to triage patients presenting to the primary/acute dental care clinic into four categories 1: Immediate, 2: Urgent, 3: Routine, 4: Non urgent. These criteria were developed by the investigators based on the time critical nature as well as the severity of the dental emergency. Patients in the pilot were then seen in the order of clinical priority as opposed to the routine first come first seen. Each patient was also triaged by an experienced dentist to look for agreement between the dentists and nurses. Results: There was agreement between the dental nurse and the dentist in 84.9% of the 139 subjects. Of the 15% where there was disagreement between the dentist and the dental nurse, in half of the cases the nurse had given a higher triage category than the dentist and in the other half the dentist had given a higher triage category than the nurse.  The average waiting times (minutes, Mean±SD) for each category were Category 1 n=20 (15%) 22.4±15.4, Category 2 n=17 (13%) 22.9±15.4, Category 3 n=86 (67%) 42.4±42.5, Category 4, n=6 (5%) 38.8±23.1. Conclusion: This pilot data shows good agreement (P<0.05) between the dental nurses and the dentists in triaging dental emergencies using standardised criteria. The wait for emergencies such as facial trauma and avulsed teeth was lower than for routine dental emergencies such as dental pain. Further studies are in progress to develop a sustainable and cost-effective model of introducing nurse led triage to improve the care pathway of dental emergencies.