Oral Surgery - Updates from Vyomesh Bhatt
Chair, Managed Clinical Network for Oral Surgery in Essex
Chair, Clinical Triage for Oral Surgery in East Anglia
We are finding an increasing no of referrals for simple extractions related to patients on newer anticoagulants or anti resorptive medication.
There is no evidence that outcomes are any different in these groups when managed in L3 or L1/L2 as long as guidance attached is followed.
As long as the tooth/teeth in question meet the surgical criteria to to be completed for extraction in L1 then the procedure should proceed with the appropriate cautions and any recommended follow up organised.
Any L1 extractions sent via FDS to be done in L2/L3 for reasons that they are on anticoagulants or anti-resorptives will be rejected.
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Maxillofacial Referrals
It is inappropriate to send a patient to Southend ED for maxillofacial attention without duly communicating with the on call team based at Broomfield 24/7.
The communication below is from the MSE NHS Foundation Trust :
Yesterday we had a patient referred from Southend ED due to post-op bleeding. The patient is a long term Warfarin user who was undergoing extractions in a Tier 2 services. Unable to achieve haemostasis the dental surgeon directed the patient to Southend ED with a letter to see Maxfax. He spent hours in Southend and then self transferred to Broomfield by which time he had stopped bleeding was given supportive measures and discharged.
There are a number of GDPs sending patients to ED with letters which are classed as direct referrals, without prior conversation with the oncall team. Some referrals are not appropriate and had a short conversation been had before hand with the oncall team appropriate advice would be given or direction to Broomfield directly. Also it would stop some of the confrontations DCTs are having with ED when they are called and told “the patient they accepted has arrived” when they have no idea who the patient is. Appreciate there may be times when a GDP maybe unable to get through on the bleep calls, but this is not frequent.
I wonder whether it would be beneficial to circulate some comms with the LDC to cascade to GDPs to “remind” them of the appropriate referral pathway (and professional courtesy) into our oncall service. This would ensure patients are being seen in the right place at the right time. It also puts DCTs in a better position as ED are more collaborative when we can say “yes we know the patient, can they have bloods OPG, analgesia etc. and be sent to E321”
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Kind regards,
Clint Foreman
(Asst. Sec. Essex LDC)