Arranging shifts: busy hospital with own OOH

RE: Arranging shifts: busy hospital with own OOH

Evelyn Barbour-Hill — Fri, 31 Aug 2018 12:34:58 GMT

[quote user="James Dunne"] I think a lot of our decisions are influenced by the pressure we can be under at times. And as disciplined as we make ourselves, human thinking seems to be altered by the 'what if..' situation[/quote]

RE: Arranging shifts: busy hospital with own OOH

James Dunne — Fri, 31 Aug 2018 08:04:48 GMT

We can get things wrong both ways - either by doing too much [exlapping when nothing's there] or too little [not exlapping 'cause we aren't sure and then finding out too late]. My last foreign body was one I could feel clearly and took a radiograph to confirm my suspicions - nothing obvious on x-ray!! I was under ferocious pressure on a busy Saturday so ex lapped during 'lunch break' and found a rubber disc-shaped object slicing through the jejunum. That dog is doing brilliantly. Equally I can remember a few where I was sure that something was there [between clinical and diagnostics] and not finding anything. I think a lot of our decisions are influenced by the pressure we can be under at times. And as disciplined as we make ourselves, human thinking seems to be altered by the 'what if..' situation - I guess so long as our intent is genuine, our competence is reasonable and we document our reasons for doing X at the time, we should be okay. Whatever system you work under, be it open surgery, 10 minute appointments, 15 minute etc, you can end up in the deep end because of circumstances [unexpected staff shortages, a run of unreasonable clients, walk-in emergencies etc etc]. It sounds though that it in the OP situation, the system is set up to almost allow constant pressure [AND is short staffed at present]- it needs adjusting.

RE: Arranging shifts: busy hospital with own OOH

David Mills — Wed, 29 Aug 2018 21:47:36 GMT

According to the VDS one of the biggest sources of complaints is foreign bodies being "missed" by clinical exam alone. Although it is not negligent to make a misdiagnosis on the basis of the information available at that time, it is food for thought.

RE: Arranging shifts: busy hospital with own OOH

Joyce Whitehead — Wed, 29 Aug 2018 21:34:00 GMT

Ive just disagreed with you Anthony so want to say why. I’m also a dinovet being qualified 35 years. And yes clinical exam will often tell you of a foreign body. What it won’t do is tell you there definitely is not one. Fabric, gastric foreign bodies etc, fat Labradors. I’d say more often than not they are not palpable. So yes we will admit to investigate. As I would have done 35years ago too. fair enough I may scan as well as xray if I’m suspicious.

But we do not do this with every vomiting dog. And please please stop implying that in the “good old days“everything got better just with a jab and good wishes. They didn’t. I can remember animals not surviving surgery as it had been left too long.

So now you will say well in my day we just ex lapped everything. And that can be a valid option. Just not every time. I think your retrospective glasses can be a bit rosy. And can maybe contribute to young vets thinking they don’t do things as well as they should.

RE: Arranging shifts: busy hospital with own OOH

Anthony Todd — Wed, 29 Aug 2018 19:56:53 GMT

[quote user="Robin Grimmer"]Could well be a foreign body though.[/quote]

[groan] Yes, sure it could be, but it's amazing what you can diagnose when you feel the abdomen, and I'm sure you'd have done that.........although I got much more sensitive with practice.........

It used to be part of the "clinical exam but, I suppose, it's better to X-ray as an extra...........

How many KFC corncobs will you miss with your X-rays and ultrasounds and barium meals and blood tests and barium meals and re-Xrays etc................

RE: Arranging shifts: busy hospital with own OOH

Gillian Mostyn — Wed, 29 Aug 2018 19:53:12 GMT

[quote user="SER"]Long days but four day weeks and usually our day off is after the night on duty. [/quote]

[quote user="SER"]If you work part of weekend you have an extra day off[/quote]

No, I'm sorry but this is unacceptable. If you've got a busy OOH caseload, as you say you do, then the day after a night on call really isn't a day off. It will be spent sleeping.

Might be worth you working out the hourly rate your vets are working for (including OOH time) and see if it seems reasonable? You might find they are pretty poorly paid!

As far as your rota..as has been said, ask your staff! But I would also say get your consultations down to 10 minutes, with regular breaks, which will increase capacity. It is difficult when you're short staffed though.

Being controversial...is the workload spread equally at the moment? Do all vets step up and help other people if they have an unexpected gap? If the ops list is quiet, will that vet help with consultations? You seem to have lots of vets....are they all working equally effectively?

RE: Arranging shifts: busy hospital with own OOH

Gillian Mostyn — Wed, 29 Aug 2018 19:45:08 GMT

[quote user="David Mills"]Maybe they just don't work for everyone. There is an art to 10 minute consults, as I'm sure there is to 15 minute consults. Still, I've no idea what people talk about or even do in terms of examining the animal for that length of time[/quote]

Couldn't agree more.

RE: Arranging shifts: busy hospital with own OOH

David Mills — Wed, 29 Aug 2018 17:52:35 GMT

[quote user="Dinu Catilina"]I find 10 minute consults to be conveyor belt work with little satisfaction and poor communication.[/quote]

Maybe they just don't work for everyone. There is an art to 10 minute consults, as I'm sure there is to 15 minute consults. Still, I've no idea what people talk about or even do in terms of examining the animal for that length of time, the only conceivable thing to me is if booking in an op, PTS, or complex medical case none of which are that common in a full day, and can be mitigated by vets not doing things that can be delegated to others.

Some experienced, good vets do struggle enormously with time efficiency in consults, and with typing succinct notes, it bemuses me.

RE: Arranging shifts: busy hospital with own OOH

Robin Grimmer — Wed, 29 Aug 2018 17:09:09 GMT

[quote user="Anthony Todd"]

I mean your vomiting 2yo dog could conceivably be in early stage renal failure but 99 times out of 98 etc. etc.

[/quote]

Could well be a foreign body though.

RE: Arranging shifts: busy hospital with own OOH

Anthony Todd — Wed, 29 Aug 2018 15:14:47 GMT

[quote user="Michael Woodhouse"]We run open surgeries and I sometimes time how long people are taking, only 1 out of the 4 of us averages over 10 mins. That's a full range of undifferentiated 1st opinion work, some of it a nurse could do.[/quote]

I really would like to see some comparison of a "long" "comprehensive" consult, or even a "consultation" [pedant's corner, if I ever heard one], and a short problem fixing or comeback, symptom relieving approach.

I mean your vomiting 2yo dog could conceivably be in early stage renal failure but 99 times out of 98 etc. etc.

RE: Arranging shifts: busy hospital with own OOH

Iain Richards — Wed, 29 Aug 2018 08:59:43 GMT

Agree with the suggestion to increase fees to afford another vet/nurse. Finish at 7pm too and consult from 9. If you are a good practice, folk will make the time to come.

RE: Arranging shifts: busy hospital with own OOH

Alistair Graham-Evans — Wed, 29 Aug 2018 05:51:16 GMT

If you are that busy and have difficulty finding staff I would consider increased fees to allow changes to provide a more pleasant working day. I am happy to be corrected but if everyone is flat out then the clients will see that and feel they are processed rather than listened to, things will be missed, errors will be made and empty positions will remain empty.

You may find that with higher fees then you can have better adaptable rostering, better continuity of care giving more work satisfaction. Ask your staff what they would prefer - some may prefer a 5 day week with shorter days. You may even be surprised by the amount of increased work generated from longer consults and happier staff.

Eg During a routine consultation a knackered vet is running late and knows they have several in patients to treat and a hectic late shift. They find a lump which may be a lipoma but feels atypical. They may get the client to make another appointment ( which they may or may not do ) or assume it’s a lipoma a hurriedly tell the owner not to worry. If the same vet was happy and relaxed and not rushed they could do an FNA on the spot and not miss the mast cell tumour. They could chat a bit with the client, try and allay their concerns and arrange work up and excision of the tumour later in the week - they could arrange to do this themselves and develop a better working relationship with the owner. The owner is pleased, the dog is cured, a diagnosis is not missed, more income is generated for the clinic and the vet’s friend who is burnt out in a neighbouring clinic hears what a nice place it is to work and applies for a vacant position.

Happy days

If you are scared to make changes you will work harder achieving less and long for the end of the day rather than looking forward to the next. If you lose some clients because you increase fees you are probably still better off. If your clinic is that busy and successful you should have the resources to change for the better!

PS Our standard appointment time is 20 minutes

RE: Arranging shifts: busy hospital with own OOH

Michael Woodhouse — Wed, 29 Aug 2018 02:05:34 GMT

[quote user="Dinu Catilina"]I find 10 minute consults to be conveyor belt work with little satisfaction and poor communication.[/quote]

I'd argue the opposite - you have lest time so your communication needs to be better.

We run open surgeries and I sometimes time how long people are taking, only 1 out of the 4 of us averages over 10 mins. That's a full range of undifferentiated 1st opinion work, some of it a nurse could do.

RE: Arranging shifts: busy hospital with own OOH

Evelyn Barbour-Hill — Wed, 29 Aug 2018 01:20:32 GMT

[quote user="David Mills"]Have you considered that clients value a short consult?[/quote]

Yes, I considered that hypothesis for about ten seconds.

But then I do consultations, not "consults".

RE: Arranging shifts: busy hospital with own OOH

Dinu Catilina — Wed, 29 Aug 2018 00:21:49 GMT

[quote user="David Mills"]Have you considered that clients value a short consult?[/quote]

Some do but many value a detailed consult without rushing things.

[quote user="David Mills"] I don't do lists or more than 2 problems per consult. Does anyone?! [/quote]

I do. So many times even, anal glands, or a ear infection, or a nail clip. I don't feel I can ask a value client to leave as their time is up and book another appointment.

I worked both 10 and 15 minute consults and I don't run behind. I find 10 minute consults to be conveyor belt work with little satisfaction and poor communication.

RE: Arranging shifts: busy hospital with own OOH

David Mills — Wed, 29 Aug 2018 00:01:27 GMT

[quote user="Evelyn Barbour-Hill"]i've no idea how you can do a proper consultation in ten minutes.[/quote]

Just get a bit more efficient I suppose.

Have you considered that clients value a short consult?

[quote user="Evelyn Barbour-Hill"]"Sorry, Mrs. Bloggs, time's up, please make another appointment so we can try to make progress with Binky's problems, off you go and don't forget to pay a full consultation fee at the desk"[/quote]

Pretty much. I don't do lists or more than 2 problems per consult. Does anyone?!

RE: Arranging shifts: busy hospital with own OOH

Evelyn Barbour-Hill — Tue, 28 Aug 2018 23:39:07 GMT

[quote user="David Mills"]Cut consulting times and build in breaks. That consulting day shift sounds horrific.[/quote]

It does indeed – and being pushed with 10-minute appointments would make it worse.

[quote user="David Mills"] I've no idea what people talk about for 15 minutes in consults. [/quote]

i've no idea how you can do a proper consultation in ten minutes.

What do you do if you haven't finished in nine and a half minutes and you've got twenty-two more appointments lined up without a break? "Sorry, Mrs. Bloggs, time's up, please make another appointment so we can try to make progress with Binky's problems, off you go and don't forget to pay a full consultation fee at the desk"

RE: Arranging shifts: busy hospital with own OOH

David Mills — Tue, 28 Aug 2018 22:08:12 GMT

[quote user="Jill Butterworth"]Ask your staff. They will come up with a better solution that you could ever impose ;)[/quote]

This.

Other thoughts.

Cut consulting times and build in breaks. That consulting day shift sounds horrific. I've no idea what people talk about for 15 minutes in consults.

Cut the hospital vets consulting out completely. It's silly having them do an hour at the end of the day.

Build in more flexibility to accommodate walk ins and manage walk in expectations through reception and rvn triage. I sincerely doubt that any of these 6 or 7 per day are dire life or death emergencies.

Do you really need to be open til 8pm? If so, could you charge more for evening consults like a dentist does?

RE: Arranging shifts: busy hospital with own OOH

Jill Butterworth — Tue, 28 Aug 2018 21:55:59 GMT

Ask your staff. They will come up with a better solution that you could ever impose ;)

RE: Arranging shifts: busy hospital with own OOH

Sara Ramsey — Tue, 28 Aug 2018 21:33:20 GMT

[quote user="Jill Butterworth"]

[quote user="SER"]Long days but four day weeks and usually our day off is after the night on duty.[/quote]

Isn't that a recovery day..?

Not really. We do work 40 hour weeks just over four days. If you work part of weekend you have an extra day off

[/quote]

RE: Arranging shifts: busy hospital with own OOH

Sara Ramsey — Tue, 28 Aug 2018 21:31:41 GMT

[quote user="Robin Grimmer"]

I sure as hell wouldn't want to work those hours or conditions! Maybe why you are short staffed as Jill says.

It's not ideal which is why we want change it. It's a fabulous team, supportive management, well equipped and brilliant nurses.

How would you suggest in patients and emergencies might be better managed? I really curious as to how other similar practiced make it work....we can't be the only hospital with ooh set up

[/quote]

RE: Arranging shifts: busy hospital with own OOH

Jill Butterworth — Tue, 28 Aug 2018 21:31:38 GMT

[quote user="SER"]Long days but four day weeks and usually our day off is after the night on duty.[/quote]

Isn't that a recovery day..?

RE: Arranging shifts: busy hospital with own OOH

Robin Grimmer — Tue, 28 Aug 2018 21:14:41 GMT

I sure as hell wouldn't want to work those hours or conditions! Maybe why you are short staffed as Jill says.

RE: Arranging shifts: busy hospital with own OOH

Michael Woodhouse — Tue, 28 Aug 2018 21:07:19 GMT

Knock the 15 min appointments down to 10 mins? Can do 90% of things in 10 mins and you've just gained (23*15 - 23*10) nearly 2 hours a day. Book a double slot for PTS or 2nd opinion.

Agree with using nurses for everything they possibly can do.

RE: Arranging shifts: busy hospital with own OOH

Sara Ramsey — Tue, 28 Aug 2018 20:57:16 GMT

[quote user="Silvia Maldonado"]

I should understand there is no OOH vet on site, and the late vet has to deal with appointments plus any emergency that may be referred from any of the other practices, is that so?

[/quote]that is correct. We are busy but not busy enough to employ night vets yet...even if we could find some!