RED ALERT: Uncontrolled Bleeding

As a long time practitioner with a focus on special needs patients, I have run the gamut when it comes to dealing with patient medical histories. Systematically breaking down complex ones into manageable issues helps determine if I need to modify my standard procedures, and this is so important in providing safe, effective care. This requires a specific focus on conditions that result in a susceptibility to infection, a tendency for uncontrolled bleeding, or unstable disease. The first article in this series focused on susceptibility to infection, but this second article will focus on a risk for uncontrolled bleeding.

Conditions related to uncontrolled bleeding are well known to clinicians. They usually involve a patient reporting specific medical conditions (e.g. liver disease) or particular kinds of medications taken (e.g. anticoagulants). When one of these medical history conditions are present, I know to have a heightened concern for the possibility of uncontrolled bleeding and that I may need to modify my care accordingly.  For example, if my patient is taking coumadin and has an INR of greater than 3.5  they might need to stop the coumadin medication for a few days before undergoing care.

How can my software help me in this situation?

As I said, my task is to identify the possibility of uncontrolled bleeding and if I need to modify care. If my software can auto-analyze my patient’s medical history and point out the risk, I’ll know from the very beginning how to prepare to treat my patient. Instead of manually unearthing this from the patient history, it is immediately presented to me.

For those who use our online patient registration system, they have these notices on their list of patients to indicate if (or if not) the patient has a disease correlated to susceptibility to infection.


The  “H”  which stands for hemostasis, might be one of three colors. Grey, Green, or Red.

Grey is the color for when then history has not been completed.

Green means that there are no known risks for uncontrolled bleeding.

Red  means caution because something in the patient’s history should be evaluated regarding the potential for uncontrolled bleeding.

How is it determined that the “H” should be red?

The medical history questionnaire and follow up questions inquires into areas such as:  anticoagulant medication, cancer therapy, bleeding disorder, or liver disease. It also asks if patients have been warned by their physician of possible uncontrolled bleeding.

ePatient’s Pre-Clinical Analysis then automatically examines the information to determine if any of these conditions are present. If one of them is, the alert is turned red which gives me a heads up when reviewing the medical history.

Of course these alerts don’t replace my judgment as a clinician, but they absolutely help me to better make those judgments.

Offices using this system learn to pay attention to these alert colors in the patient list and more quickly get a sense about the the primary concerns when evaluating patients for care. This connection between dental software and clinical awareness allows a systematic analysis of patients’ medical histories to inform dentists about potential barriers to giving great care.


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