Dentist Peer Review: A Practical Way to Improve Quality

One of the challenges of group practice is to keep all dentists providing similar high quality care. It’s true in dentistry “you’re only as strong as your weakest link” – or to put it a bit harshly, “one bad apple ruins the bunch.” For dentists that practice in groups, using an internal peer review process is a wonderful way to maintain quality.

My practice conducts an internal peer review process every six months. We evaluate three teams:

  • General dentists
  • Hygienists
  • Dental assistants (CDAs and EFDAs)

The sentiment of our peer review process is to encourage all our dentists and staff to treat each case as if it were going to be on display for a full review, to consider our clinical philosophy on a variety of procedures, and to improve our documentation to protect against malpractice claims. By including coaching comments, it also gives our providers a review of their strengths and opportunities for improvement.

For our general dentists, we review the following procedures:

  • Emergency exam
  • Comprehensive exam
  • Formal treatment plan
  • Endo
  • TMJ
  • Crown/bridge
  • Oral surgery
  • Amalgam
  • Composite
  • Complete denture
  • Partial denture
  • IV sedation
  • Implant

Our hygienists review:

  • Regular recall – adult
  • Regular recall – child
  • STM
  • New patient adult
  • New patient child
  • Emergency
  • Sealants
  • Pano
  • CMX

Our assistants review:

  • Emergency
  • New client adult
  • Sealants
  • Pano
  • CMX
  • Amalgam (EFDAs)
  • Composite (EFDAs)

We have a page of specific criteria for each of these procedures. The criteria ask the reviewer to rate (1 excellent, 2 accceptable, 3 needs redone/repaired) several items that should be present for that procedure. For example, on our Emergencies criteria page – the dentist/staff are checking to see was the emergency form filled out? Was an intraoral camera photo taken? Were tests run? Was treatment provided? Was documentation thorough/accurate? Were medications given? Was post op follow up completed? Was the chart organized?  Each of these criteria questions receives a rating and an average is calculated to determine the final for this procedure.

This process is repeated for each procedure. Each provider rates the other providers – so our 3 general dentists each rate the other two (knowing they also are being rated). Same for our 3 hygienists. Same for our 3 upper level assistants and 2 EFDAs. To avoid ‘the fox guarding the hen house’, our secretary team runs peer review and selects patients at random. Once the ratings are completed then the original provider receives his/her charts and ratings back for review.

For Dentrix users, selecting random patients for peer review is a piece of cake. We run this report from the Office Manager, Letters, Continuing Care – then create a report where you select the procedure code (for emergencies we’re using D9110 and D0140) with dates selected for the last 6 months. The only data you’ll need is the patient name, and perhaps a last visit name – which makes the chart easier to find. You’ll select Create/Merge and then Create Data File Only (we’re not sending letters – just finding names for peer review). Once Dentrix finishes this report, just copy and paste into Excel and then if there are 100 people listed – just choose at random to find a patient for each procedure.

At the next dentist or team meeting, peer review is reviewed in the group. Usually one person at a time discussed his/her ratings and coaching comments at a time. This is a good time to ask for suggestions – how are you getting intraoral photos taken consistently? Or, perhaps explain why this one patient was unique and why you missed a criteria. With the right spirit of helping each other improve (and avoid malpractice), this is a positive meeting that helps everyone on the team continue to provide consistent quality. It builds trust between the providers – when one is on vacation, she can trust the other provider will provide similar quality care to “her” patients.

We share these ratings in our annual Strategic Planning meeting. We also have used the criteria as a weekly review in our assistant team – walking through each criteria step for a procedure as a quality review for the team and explaining the value of each step. If you’re working in a group practice – even just 2 dentists or 2 hygienists – you can see the value of performing a peer review process. This could be your new year’s resolution and goal for your practice – one practical way to meet a goal of improving quality care to your patients. Feel free to email me with questions/comments about implementing a peer review process in your office.

For more ideas to improve the business-side of your dental practice:

AUTHOR: Jill Nesbitt
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