So Far in This Series…
In Part 1, we discussed ADA and Section 504 requirements and what dental practices must do to provide equal access to patients with disabilities.
In Part 2, we talked about OSHA, ergonomics, workplace injuries, and why patient transfers can create significant risk for your team.
Now we’re getting to the question everybody eventually asks:
“Okay, Tink… what do we actually do?”
Fair question.
But before we talk about moving patients, I want to share something I’ve learned over the years.
Most transfer injuries don’t happen because someone didn’t know a transfer technique.
They happen because someone skipped an assessment.
Or rushed.
Or assumed.
Or failed to communicate.
The transfer itself is usually the final step.
The real safety decisions happen before anyone ever touches the patient.
That’s why this article isn’t really about moving patients.
It’s about making good decisions before you move patients.
The Most Important Transfer Happens Before the Transfer
If I could teach dental teams only one thing, it would be this:
Slow down.
The safest transfer is usually the one that was planned.
Before anyone stands, pivots, assists, or moves, answer five simple questions.
1. Can the Patient Stand?
Yes?
No?
Maybe?
If you’re not sure, don’t guess.
Ask the patient.
2. Can the Patient Bear Weight?
Fully?
Partially?
Not at all?
This changes everything.
3. How Do They Normally Transfer?
This may be the most important question in the entire article.
Many patients have been transferring safely for years.
They know what works.
They know what doesn’t.
Listen carefully.
The patient is often the most experienced person in the room.
4. How Much Help Is Needed?
Can they transfer independently?
Do they usually need assistance?
Do they normally use equipment?
Do they have a caregiver who routinely assists?
Never assume.
Ask.
5. Is the Environment Ready?
Before you begin:
✓ Wheelchair brakes locked
✓ Footrests moved out of the way
✓ Pathway clear
✓ Dental chair positioned appropriately
✓ Team members ready
✓ Equipment available
Only then should you proceed.
A Lesson I Learned the Hard Way
Years ago, I watched a team prepare to transfer a patient.
Everyone was focused on the mechanics.
Who was standing where.
Who was helping.
Who was going to support the patient.
Nobody asked a simple question:
“Do you normally have trouble standing?”
Turns out they did.
A lot.
The patient’s legs buckled almost immediately.
Thankfully nobody was seriously injured.
But it reinforced a lesson I’ve never forgotten:
Patients often tell us exactly what we need to know.
If we take the time to ask.
Scenario #1: The Independent Transfer
Some patients don’t need physical assistance.
They simply need:
• Time
• Space
• Stability
• Clear communication
Your role is usually supervision and support.
What Good Teams Do
✓ Position the dental chair appropriately
✓ Lock wheelchair brakes
✓ Remove obstacles
✓ Stay nearby
✓ Provide clear instructions
What Good Teams Don’t Do
✗ Rush the patient
✗ Walk away
✗ Assume today will be exactly like the last visit
I’ve seen patients who transferred independently for years suddenly become weak, dizzy, or unstable.
Never assume.
Scenario #2: The Assisted Transfer
This is probably the most common situation in dentistry.
The patient can usually:
✓ Stand
✓ Bear some weight
✓ Pivot
But needs assistance.
The biggest mistake I see?
Everyone focuses on strength.
The answer is usually communication.
Before the Transfer
Determine:
• Who is leading
• Who is assisting
• What the patient needs
• What the plan is
During the Transfer
One person should lead communication.
Simple commands work best.
Examples:
• “We’re going to help you stand.”
• “On three.”
• “We’re turning toward the chair.”
• “We’re going to sit down slowly.”
Short.
Predictable.
Clear.
Patients who know what’s happening tend to move more predictably.
Predictable movement is safer movement.
Scenario #3: The Patient Who Cannot Safely Transfer Independently
Some patients require substantial assistance.
Some require specialized equipment.
Some may be better served in a facility with resources your office simply doesn’t have.
And that’s okay.
The goal is not proving you can transfer every patient.
The goal is providing care safely.
Potential options may include:
• Additional assistance
• Alternative positioning
• Treatment in the wheelchair when clinically appropriate
• Referral to a better-equipped setting when necessary
Good judgment is never a compliance violation.
Poor judgment often becomes one.
Sometimes the Best Transfer Is No Transfer
Read that again.
Sometimes the best transfer is no transfer.
If:
✓ The patient cannot safely bear weight
✓ Staff are not adequately trained
✓ Sufficient assistance is unavailable
✓ Equipment is unavailable
✓ The environment is unsafe
✓ The patient is experiencing a medical issue
Then stop.
Reassess.
Consider alternatives.
Because nobody gets bonus points for attempting an unsafe transfer.
The Four Most Dangerous Words During a Transfer
I’ve heard them.
You’ve probably heard them.
Maybe you’ve even said them.
“I’ve got them. Don’t worry.”
Sometimes those are the last words spoken before somebody gets hurt (I’ve been there and done that. I don’t recommend it).
The moment a patient begins losing balance, human nature takes over.
We reach.
In a panic, they reach.
We twist.
We overextend.
We sacrifice our own body mechanics trying to save the situation.
That’s how one injury becomes two.
A better approach is:
• Stop.
• Stabilize.
• Reassess.
No dental procedure is important enough to justify injuring a patient or a team member.
What Good Dental Teams Do Differently
The safest dental teams aren’t necessarily the strongest.
They have better habits.
Good Teams
✓ Ask how the patient normally transfers
✓ Clear pathways beforehand
✓ Assign roles before movement begins
✓ Communicate throughout the transfer
✓ Know when to stop
✓ Document what happened
Struggling Teams
✗ Wing it
✗ Assume
✗ Rush
✗ Change the plan halfway through
✗ Hope everything works out
Hope is not a transfer strategy.
Communication: The Secret Ingredient Nobody Talks About
Want to know what separates smooth transfers from chaotic transfers?
Communication.
Not strength.
Not equipment.
Not experience.
Communication.
Everyone should know:
• What’s happening
• Who’s leading
• When movement will occur
• What the patient should expect
Patients who understand what’s happening tend to feel safer.
And safer patients move more predictably.
We’ll dive much deeper into communication in Part 4 because honestly, it may be the most important skill in this entire series.
Documentation: Your Future Self Will Thank You
Chart as if you’re describing the event to a risk manager.
Because someday you might be.
Document:
• Mobility status
• Patient preferences
• Assistance provided
• Staff involved
• Equipment used
• Accommodations provided
• Any complications
• Patient response
Example:
“Patient arrived via wheelchair. Reports partial weight-bearing status and prefers assisted transfer. Transfer completed with assistance from two team members. No complications observed. Patient tolerated transfer well.”
Simple.
Professional.
Defensible.
Think of documentation as a gift to future-you.
Because six months from now, future-you won’t remember every detail.
Your chart will.
The Toothcop’s Take
In Part 2, I shared one of the worst memories of my career—the day a patient transfer went wrong and both the patient and my partner were injured.
That experience taught me something I’ll never forget.
Transfers are rarely won with strength.
They’re won with preparation.
By now you’ve probably noticed a theme throughout this series.
The safest dental offices aren’t the offices with the most equipment.
They’re the offices with the best processes.
They assess.
They communicate.
They plan.
They document.
And they don’t let pride make decisions.
One of the smartest things a dental team can say is:
“This transfer isn’t safe for us to perform.”
That’s not failure.
That’s professionalism.
Because at the end of the day, nobody wins when a patient gets hurt.
And nobody wins when a team member gets hurt trying to prevent it.
The goal isn’t proving what you can do.
The goal is making sure everyone gets home safely.
Coming Next: Part 4
We’ve talked about the law.
We’ve talked about OSHA.
We’ve talked about transfer safety.
Now we’re going to discuss the one thing that ties all of it together:
Communication.
Because many disability-related complaints aren’t about ramps, transfers, or equipment.
They’re about how people are treated.
And honestly?
That’s where some of the most important lessons in this entire series live.
’til next time, remember to always tell the Tooth, the whole Tooth, and nothing but the Tooth!
— Duane “The Toothcop” Tinker