Who should be doing admission appointments?

RE: Who should be doing admission appointments?

Sarah Keir — Mon, 11 Jun 2018 10:15:59 GMT

Tim, I agree that lack of ownership of cases is one of the big issues. It is the same in ops/investigations and consultations.

RE: Who should be doing admission appointments?

Tim Browning — Mon, 11 Jun 2018 09:23:21 GMT

In multi vet charity hospitals that I am familiar with there were often issues around vets booking ops where other vets would end up doing, as presented with a list on their ops day or session, where often vet had not admitted animal as well.

They would then often dispute the need for a vicious Rottweiler to have a wart removed or feel uncomfortable with skill levels needed for other procedures. There was always this issue of what the booking vet had said about risks and outcomes as 'informed consent' depends on the communication levels and opinions of the booking vet.

So in my place I instigated a system of 'internal referral'. The ideal was to book ops to yourself but this wasn't always possible where many part timers, holidays and emergencies etc. Otherwise the vet would find an operating vet available and ask nicely if they could or would do it and discuss what they had communicated to the owner. The new operating vet was accepting responsibility for outcomes and aftercare and would be then 'their case'. I didn't like vets wandering around saying 'its not my case' and attempting to avoid ownership of the problem.

This might take time but avoided a lot of hassle on the day of the op, helped develop teamwork and vet stress overall. If a resolution couldn't be found the senior vet would have to intervene, but it was meant to be self regulating as much as possible.

RE: Who should be doing admission appointments?

Beats — Sun, 10 Jun 2018 21:22:30 GMT

[quote user="Michael Woodhouse"]Quite happy you wheeling me in an anaesthetised animal with a post it note attached![/quote]

... as long as you're not then asked to discharge the patient

... and your investigation, treatment or surgery was not what you would have personally recommended

"so now he's castrated he'll stop barking, won't he?"

RE: Who should be doing admission appointments?

Michael Woodhouse — Sun, 10 Jun 2018 20:00:38 GMT

[quote user="Beats"] don't like doing procedures unless i've met and spoken to the owner myself (and I find a physical meeting far preferable to a phonecall), generally.[/quote]

I hate dealing with people. Quite happy you wheeling me in an anaesthetised animal with a post it note attached!

[to be clear that's not how we work]

We are mixed so sometimes vets out doing early calls. I really don't see an issue with lay staff taking animals in, but it's maybe a culture specific to our type of practice.

RE: Who should be doing admission appointments?

Sarah Keir — Sat, 09 Jun 2018 22:39:53 GMT

Beats I don't think I am a control freak but neither do I know my colleagues well having started a new job only a month or so ago.

RE: Who should be doing admission appointments?

Beats — Fri, 08 Jun 2018 22:57:53 GMT

[quote user="Sarah Keir"]May be I should explain more. I work in a multi-vet practice and it is most often not the vet that booked in the procedure who does it and I am finding some have not seem seen for several months before coming in for the procedure. And what about the 'routine' neuterings that haven't seen a vet since their puppy vaccinations.[/quote]

I don't like doing procedures unless i've met and spoken to the owner myself (and I find a physical meeting far preferable to a phonecall), generally. I do think it depends a bit on where you work and the folks you work with and how well you know them / trust their judgement etc etc.

I would generally not want to castrate a dog without knowing why the castration has been requested, for instance.

Also, I find it very hard to provide estimates for what someone else will then be doing or vice versa.

I like to treat and follow-up the same cases myself.

I often wish to premed anxious patients on admission, I want to decide what to premed them with.

I am clearly a control freak! [You may be too?]

RE: Who should be doing admission appointments?

Nicola Cole — Fri, 08 Jun 2018 21:19:07 GMT

If it’s not seen a vet for a few months then usually pre-op check with vet prior to surgery day then nurse admit. Or vet admit on morning of op. I’m happy with either.

RE: Who should be doing admission appointments?

David Mills — Fri, 08 Jun 2018 20:49:16 GMT

[quote user="Sarah Keir"]

May be I should explain more. I work in a multi-vet practice and it is most often not the vet that booked in the procedure who does it and I am finding some have not seem seen for several months before coming in for the procedure. And what about the 'routine' neuterings that haven't seen a vet since their puppy vaccinations.

[/quote]

Yes, same with us, rarely the vet who booked in is the one doing procedure. Our lead time on ops is around 2 weeks though, and if there's a long time such as over 6 weeks then we'd get them in for a health check before surgery.

[quote user="Gillian Mostyn"]being booked during a consultation, but what about booking over the phone when the animal hasn't been seen for a while?[/quote]

We don't book over the phone, if they um and er about it over weeks then it's another consult before booking. [quote user="Gillian Mostyn"] I do understand that if you're admitting 10 animals to many vets, different systems need to be put in place.[/quote]

Yes, it partly is a numbers thing. We admit about 12 a day, so it doesn't make financial sense for a vet to see every one in when it's likely been seen a week or so.before by a vet.

Re booking ops after initial puppy vacc, same applies, we will see for a consult first. These things are great for nurses clinics to ensure the animal is healthy and the op can go ahead.

We don't have receptionists admitting ops.

RE: Who should be doing admission appointments?

Sarah Keir — Fri, 08 Jun 2018 20:31:40 GMT

RE: Who should be doing admission appointments?

Gillian Mostyn — Fri, 08 Jun 2018 18:42:25 GMT

[quote user="David Mills"]All consent forms are signed at time of booking, and ops explained at that point. We find that the information goes in better at that point rather than on the morning of the op.[/quote]

That sounds great if the op is being booked during a consultation, but what about booking over the phone when the animal hasn't been seen for a while?

There isn't going to be a one size fits all solution. I work on my own (with one RVN, one SVN and an ANA) and will therefore be doing all the ops myself. Thus it isn't onerous for me or the RVN to admit, and as a local, client friendly practice, I like it that way. I do understand that if you're admitting 10 animals to many vets, different systems need to be put in place. I do think that, at some point, a clinical staff member should be having the conversation about the procedure and risks, but it matters very little when that actually happens.

I don't personally think receptionists, regardless of length of service, should carry that responsibility.

RE: Who should be doing admission appointments?

David Mills — Fri, 08 Jun 2018 18:35:33 GMT

[quote user="Martin Atkinson"]

I'm struggling to think of an occasion when a patient has been admitted for surgery and it hasn't had a pre-op check at which I would have explained all the potential risks, compliations and possible additional costs. The consent forms then say there is a risk for any procedure/anaesthetic including death. They can then just be admitted by lay staff who are primed to ask if there is any change since they were last seen and call me if they are concerned.

That said my lay staff are a girl with 7 years experience who I would wager is as good as most of the rest of your trained VNs and one who is expected to qualify next month with flying colours as she has excelled throughout her course and was good enough before she even started it!

[/quote]

Similar here.

All consent forms are signed at time of booking, and ops explained at that point. We find that the information goes in better at that point rather than on the morning of the op. The vet operating can then exam pre premed if they so wish.

RE: Who should be doing admission appointments?

Martin Atkinson — Fri, 08 Jun 2018 13:16:11 GMT

[quote user="Gillian Mostyn"]When I've had any medical procedures done, the doctor/surgeon has been the one to discuss it with me.[/quote].....and the admissions nurse, and the anaesthetist, and the theatre nurse, and Uncle Tom Cobley - it all becomes a bit repetitive but I guess too many have gone tits up for them to take a chance.

RE: Who should be doing admission appointments?

Gillian Mostyn — Fri, 08 Jun 2018 12:43:43 GMT

Horses for courses.

Every practice is different. All I know is that I'm sure my clients would prefer to hand over their much loved pet to someone who takes the time to discuss the procedure and and relevant risks. I really don't think a cursory glance at a consent form, handed to them by a receptionist, before their pet is taken away would be very reassuring at all. It is easy to forget just how worried a lot of these clients are, and a chat with one of the clinical staff who will actually be doing /helping with the procedure seems an obvious service we can provide.

When I've had any medical procedures done, the doctor/surgeon has been the one to discuss it with me.

But then we do provide very good customer service.

RE: Who should be doing admission appointments?

Martin Atkinson — Fri, 08 Jun 2018 11:38:41 GMT

RE: Who should be doing admission appointments?

Sarah Keir — Thu, 07 Jun 2018 22:52:24 GMT

Clive Ansell the missing things on admission is the other reason I am very uncomfortable with non-clinical staff performing admissions. The patients are not getting a clinical exam on admission; I clinical exam patients that I am assigned to operate/investigate that day.

RE: Who should be doing admission appointments?

Clive Ansell — Thu, 07 Jun 2018 15:48:55 GMT

[quote user="Jill Butterworth"]I am under the impression the the RCVS is becoming a lot hotter on true informed consent [/quote]

what is true informed consent, and how can one gauge how informed a client is?

I had a few last week; some had left the shared family brain cell at home, and just stand there saying "yeah, yeah" and will sign anything they are given. Too thick to be informed really.

RE: Who should be doing admission appointments?

Clive Ansell — Thu, 07 Jun 2018 15:40:36 GMT

I think all admissions should be carried out by vets or RVN's/VN's, and should receive a clinical examination in front of, and discussion with the client.

I seem to have had a run lately where patients are admitted by reception staff and I have discovered things not previously recorded in the notes, so have had to contact clients prior to proceeding; examples are routine neuters with heart murmurs, retained deciduous teeth, umbilical hernias, and cryptorchidism. In some of the cases these things had been discussed, but not entered in to clinical notes (somewhat embarrassing).

It is sometimes more difficult as a locum, as it is impossible to know what has or has not been discussed, along with incomplete clinical notes. Certainly with more complex cases, I prefer to admit them myself if I've not seen them before.

RE: Who should be doing admission appointments?

Jill Butterworth — Thu, 07 Jun 2018 12:20:12 GMT

[quote user="Sarah Keir"] I feel torn between 'wasting time' calling the owner and going through informed consent (and correcting the estimate etc) and just getting on with it but risking it back firing.[/quote]

I am under the impression the the RCVS is becoming a lot hotter on true informed consent and the risks being explained fully. If you have had to had surgery yourself recently, you may well have had a consultant list accidental bowel damage, colostomy bags etc nonchalantly as he hands you the pen...

Some clients can't emotionally cope with that amount of detailed discussion of risk, but I always throw something in like, 'complications are very rare, but can happen', to highlight what risk actually means.

I personally prefer to discuss risks on a different day to the surgery (we used to do pre spay checks to look for lactation etc) so could go through the pros and cons fully, record the discussion on the clinical notes, and prefer a nurse to go through the consent form again (admittedly brief) on the day.

I find a highly nervous client can affect my objectivity when I operate and I just prefer to crack on and get into the 'zone'.

RE: Who should be doing admission appointments?

Edward Jones — Thu, 07 Jun 2018 11:30:34 GMT

Somebody needs to properly discuss anaesthetic and complication risk for every procedure. It can be done by a nurse, but admission is not a trivial task at all.

RE: Who should be doing admission appointments?

Julie Innes — Thu, 07 Jun 2018 08:46:43 GMT

Qualified nursing staff do them here- usually whoever will be monitoring the anaesthetic carries out a full clinical exam, weighs the animal and goes through the consent form thoroughly with the owner. Any issues or queries I am here. If I, or one of the other vets, want to chat to the owner we come in to do so, or telephone them the night before/ morning of.

I get the nurses to actually read out the consent form, and explain to the owner what each part means- if asked to read and sign it, most owners will just sign, I know I do

RE: Who should be doing admission appointments?

Gillian Mostyn — Thu, 07 Jun 2018 07:26:04 GMT

We would always have clinical staff (usually vet or RVN) admit an animal. I can't see how a receptionist could do the necessary pre-admit examination (they all get at least a basic TPR etc) or answer any questions regarding the procedure.

RE: Who should be doing admission appointments?

Michael Woodhouse — Thu, 07 Jun 2018 00:55:17 GMT

I have no problem lay staff admitting patients for relatively routine procedures, or even more complex things that have been seen recently, and discussed with a vet. If it was something with high risk then I'd want the operating surgeon to discuss things where possible.

The limit of our discussion of risk is reading the statement from the consent form that says something along the lines of: "I understand all anaesthetics and surgical procedures have an inherent degree of risk" and I will invite any questions from the owner. I'd have a more in depth conversation if we were something complex.

If the estimate is wrong then obviously you need to speak to the owner (unless over-estimated then they get a nice surprise). If the owner needs specific warnings then speak to them (going home with a drain, need cage rest). Otherwise I think you are wasting time! Going into in depth discussion over the risk of death and wound breakdown in something straightforward is unnecessary and creates additional worry IMO.

Don't ever forget that when the vet rings when you have their dog they immediately think the worst!