HCM 491 Module 2 Problem Definition Short Paper Example

Same Tooth, Next Month: Defining the Emergency Department Dental Visit Problem at Marlow Regional Hospital

[Student Name]

Southern New Hampshire University

HCM 491: Health Sciences Capstone

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Same Tooth, Next Month: Defining the Emergency Department Dental Visit Problem at Marlow Regional Hospital

Everyone in Marlow Regional Hospital's emergency department knows the toothache patient. Few people know how many there are, who they are or why they keep coming back. A capstone proposal built on impressions risks solving the wrong problem. This paper uses one year of hospital data to size the problem, compares it with national research, examines the policy setting, traces causes and ends with a formal problem statement that later modules will address.

Data Sources

The ED director approved a de-identified extract of all visits in fiscal year 2025 with a primary diagnosis in the ICD-10 range for diseases of the oral cavity, K00 through K14, excluding injuries. The extract includes age, payer, arrival time, length of stay, prescriptions, disposition and any return visit within twelve months. The finance office supplied average direct cost per visit by diagnosis group. Free-text comments from 60 patient experience surveys completed by dental visitors add patients' own explanations.

How Many and Who

The ED recorded 1,452 dental visits, 3.1% of its 47,000 visits. Seven in ten patients were aged 18 to 44. Payer mix differed sharply from the ED overall: 29% were uninsured and 35% had Medicaid, compared with 11% and 27% for all ED visits. Only 24% had commercial insurance. Table 1 summarizes the profile.

Table 1. Profile of ED Dental Visits, Fiscal Year 2025

Note. Hospital data extract; percentages rounded.

When They Come

More than half of dental visits began between 5 PM and 7 AM or on weekends, when no dental office in the county is open. Monday mornings were also busy, suggesting patients waited through the weekend and gave up on getting a same-day dental appointment. Arrival patterns matter because any solution that depends only on daytime referrals will miss most of the patients.

Repeat Visits

About 36% of dental patients returned to the ED for a dental problem within twelve months. A small group drove much of the volume: 112 patients had three or more dental visits and accounted for 410 visits, more than a quarter of the total. Many of these patients carried the same diagnosis code each time, indicating the same untreated problem. This concentration suggests that a targeted approach for frequent visitors could reduce volume faster than a general campaign.

What Happens in the ED

The median length of stay for a dental visit was 2.4 hours. Antibiotics were prescribed at 58% of visits and opioids at 31%, down from 49% before a 2023 prescribing guideline. Only 6% received a local anesthetic nerve block, which can relieve pain for hours without an opioid. Discharge instructions were a generic sheet advising follow-up with a dentist, with no clinic name or phone number. Twenty-nine visits ended in admission for facial infection, at an average direct cost of about $9,800 each.

What It Costs

At an average direct cost of $390 per treat-and-release visit, dental visits cost the hospital about $555,000 in fiscal 2025, plus roughly $284,000 for the 29 admissions. Payments covered about 38% of those costs. Beyond money, each dental visit occupies a treatment space for more than two hours in an ED where the median wait to see a clinician reached 47 minutes last winter.

Comparing With National Data

Marlow's figures sit close to national patterns. Sun et al. (2015) found in Oregon that dental problems made up about 2.5% of ED visits, cost hospitals about $402 per visit and were strongly associated with lacking insurance or having Medicaid, and that more than half of visits ended with opioid and antibiotic prescriptions. Marlow's opioid rate is lower, reflecting its guideline, but its antibiotic rate is similar. Lee et al. (2012) showed that the heaviest growth in ED dental use nationally came among younger working-age adults and people without coverage, the same groups that dominate Marlow's data.

The Policy Setting

The state's Medicaid program covers adult dental care only for emergency extractions, not fillings, root canals or routine exams. Singhal et al. (2015) studied California after it eliminated most adult Medicaid dental coverage and found that ED visits for dental conditions and their costs rose afterward. Marlow's high Medicaid share suggests a similar dynamic: patients with coverage for emergencies but not prevention wait until pain forces them to the only door that is always open.

Root Cause Analysis

A fishbone diagram, built with two ED nurses, a social worker and the dental clinic's manager, grouped causes into five categories. Table 2 summarizes them. The causes the hospital can influence most directly are in the process category: no referral link, generic instructions and infrequent nerve blocks.

Table 2. Fishbone Summary of Causes

Note. Developed by the author with ED and dental clinic staff.

Five Whys for Repeat Visits

Why do patients return? Because the tooth is still diseased. Why is it still diseased? Because they did not see a dentist after the ED visit. Why not? Because the only affordable clinic had no opening for weeks and they did not know how to get one. Why did they not know? Because the ED gives no clinic name, number or appointment. Why not? Because no agreement exists between the hospital and the clinic. The chain ends at a gap the hospital can close.

What Patients Say

Survey comments echo the analysis. Several patients wrote that they called dental offices and could not get in, that they did not know a sliding-fee clinic existed or that the ED was the only place open when the pain became unbearable. One wrote, "They told me to see a dentist like I hadn't tried." These comments point to the missing link between the ED and affordable dental care as much as to cost itself.

Problem Statement

In fiscal 2025, Marlow Regional Hospital's emergency department handled 1,452 visits for nontraumatic dental problems, 36% of which led to a repeat dental visit within twelve months, at an unreimbursed direct cost of more than $500,000. Patients, mostly uninsured or on Medicaid, leave without a dental appointment because no referral pathway connects the ED with the community's affordable dental clinic, and ED treatment relies on antibiotics and prescriptions rather than local pain control.

Scope

The capstone will focus on the part of the problem the hospital can change: the referral link, discharge process and ED pain management. It will not attempt to change Medicaid policy, though it will note where advocacy could help. Children are excluded, since pediatric dental coverage differs and the numbers are small.

Conclusion

Local data show a concentrated, costly and largely preventable problem that matches national patterns. The root causes point to a missing referral pathway and gaps in ED pain management, both within the hospital's reach. Module Three will review what research says about closing that gap.

References

Lee, H. H., Lewis, C. W., Saltzman, B., & Starks, H. (2012). Visiting the emergency department for dental problems: Trends in utilization, 2001 to 2008. American Journal of Public Health, 102(11), e77-e83. https://doi.org/10.2105/AJPH.2012.300965

Singhal, A., Caplan, D. J., Jones, M. P., Momany, E. T., Kuthy, R. A., Buresh, C. T., Isman, R., & Damiano, P. C. (2015). Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs. Health Affairs, 34(5), 749-756. https://doi.org/10.1377/hlthaff.2014.1358

Sun, B. C., Chi, D. L., Schwarz, E., Milgrom, P., Yagapen, A., Malveau, S., Chen, Z., Chan, B., Danner, S., Owen, E., Morton, V., & Lowe, R. A. (2015). Emergency department visits for nontraumatic dental problems: A mixed-methods study. American Journal of Public Health, 105(5), 947-955. https://doi.org/10.2105/AJPH.2014.302398