Working in emergency and critical care

Re: Working in emergency and critical care

Jenny Babington — Mon, 29 Mar 2010 11:19:52 GMT

Hi Clive,

My apologies for the delay in responding, I have been on annual leave for a couple of weeks.

House visits are certainly not impossible for us - I carried out 3 myself during the year I was Senior Vet at Witham and obviously we have to assess each request and the possible H&S aspects individually at the time. However your questions are valid and obviously it's difficult to devise a policy that covers every single possible scenario- guess that's where common sense also comes in!

If you want to chat through how we'd support our vets in this or other scenarios, please feel free to give me a call directly on 07973 960798 or email me at jenny.babington@vets-now.com and I can discuss in more detail offline.

Thanks,

Jenny.

Re: Working in emergency and critical care

Clive Ansell — Fri, 12 Mar 2010 17:42:05 GMT

Hi Jenny,

Thats good where the host practices can and are willing to do that. One of the Vets Now clinics which I worked was hosted by the PDSA, and they were very reluctant to take on cases of private clients through the day. Other, not Vets Now, clinics are unmanned through the day which makes transport essential and non negotiable.

Home visits must still be very difficult or impossible, how do you leave the clinic and comply with H&S if there are only 2 of you there? what if there is no taxi firm willing to help?, many asian taxi drivers will not take animals. Do you now have a second vet on call rota? if not what if nobody can or will help?

Re: Working in emergency and critical care

Jenny Babington — Fri, 12 Mar 2010 16:13:05 GMT

Hi Clive,

With very ill or injured animals (for example a GDV seen overnight which has come off the table at 7am) we have a arrangement with our hosting sites for the patient to be able to stay there during the day and been treated on our behalf by the host practice who will then invoice Vets Now for anything they do during the day so the owner only receives one invoice.

We also contact the animal’s Member Practice in the morning first to let them know we have their patient at the clinic. I was senior vet for Vets Now Witham for a year and in that time we would have maybe one patient every couple of months where in our opinion it could not be moved so these cases are not that frequent.

Ultimately the vet treating the case (either Vets Now clinician sending case back to own practice or Member Practice vet wanting to send a transfer case in) must make a clinical decision as to whether that animal is stable enough to be transported and we do not transport very unstable patients.

For stable patient transfers we use the owners mainly for transport, occasionally the Member Practice may carry out the transfers if they have an ambulance but this is rare. As a Phipps mentioned in an earlier post, we aimed to roll out ambulances across all our clinics however this project had to be stopped after launching the first 6 ambulances as we just couldn’t get owners to use them enough with the majority still preferring to come in and collect the pet themselves.

Re home visits, we have a very detailed home visit policy that follows RCVS guidance and have internal written guidelines for all our staff on how to handle house call requests, and a decision making process for them to follow to help decide if a visit is necessary. Some of our clinics do have ambulances, and others have pet taxis in the area who can often help. In areas with no ambulance or pet taxi there are often normal taxi firms who will carry animals that we recommend. Some of our clinics have staff who don’t mind being called when they’re not on shift and who will come in to help if we need to go out so we tackle it in various different ways in each area depending on the resources of that particular area.

We have also recently created a toolkit of handouts which we’re about to launch that our Member Practices can give to owners ahead of time concerning house visits and what is and isn’t possible OOH and the likely costs involved to allow us to support our Member Practices in communicating this to their clients as per RCVS Guidance so they are aware ahead of time what to expect.

Re: Working in emergency and critical care

Louise Buckley — Fri, 12 Mar 2010 14:39:59 GMT

[quote user="Jenny Babington"]

Hi – as a Vets Now employee and someone who loves working in ECC care, have been reading all the posts with interest. They certainly highlight a lot of the challenges associated with OOH care! Just wanted to make the comment that Vets Now is committed both to training and giving great clinical care as well as to supporting our member practices and own staff. We have policies covering a lot of the issues raised all written with RCVS guidance in mind – anyone who wants more info / has any questions please feel free to ask me J

[/quote]

Exactly. I just about to type similar to this. I'd be the last person to argue that Vets Now are perfect as I don't believe that they (or any other practice) are perfect - can anybody really claim to work at the perfect practice??? - and obviously some areas of emergency medicine can be a particular challenge e.g. transportation of sick animals but they do have protocols in place for these situations. I have worked for Vets Now on and off now since 2003 - both as a locum, as a fulltime manager and as a part time nurse and have worked in a number of their clinics - Lincoln, Sheffield, Nottingham, Derby, Hull, Edinburgh and Glasgow so I have seen how cases are managed in various different clinics.

It is certainly not simply a case of just kicking anything out the door at 7.30am irrespective of how sick the animal is and I have to say that I resent the implication that that is what we do! If there is a feeling that we do do that then I think I would not be the only member of staff who would upset to be perceived in that way. I can think of enough cases where we have stayed back late precisely because a patient wasn't well enough to travel and alternative measures needed to be taken.

In cases where the animal is genuinely too sick to transport there was always an arrangement made with the host practice that we hand the animal over to their care until Vets Now staff came back on shift. I have seen this occur on numerous occasions. I am not arguing that the transportation situation is always perfect (but neither is having a vet working OOH when they have been working all day - both can be discussed in terms of animal welfare implications) but I am saying that when it is really necessary provision can be made and, in my experience, has been.

Re: Working in emergency and critical care

Hannah Wynne Richards — Fri, 12 Mar 2010 11:31:59 GMT

Transport and home visits were my main areas of dissatisfaction with Vets Now, and ultimately, why I left them

Wynne

Re: Working in emergency and critical care

Clive Ansell — Fri, 12 Mar 2010 11:08:54 GMT

Jenny. How do get around the issues of transporting very ill or injured animals to/from user practices? I have worked (not since 2003 I admit) for Vets-Now on occasions as a locum, but there was never a protocol in place to deal with it. In the 3 clinics I worked, none had a vehicle. I have always got round it using local taxi firms, animal ambulances, but what if none are available?

Similar question regarding OOH home visits. The RCVS and many in the profession feel, wrongly in my view, that we should be able to provide home visits 24/7.

Re: Working in emergency and critical care

Jenny Babington — Fri, 12 Mar 2010 10:54:52 GMT

Re: Working in emergency and critical care

Vikki Halliday LLB — Tue, 02 Mar 2010 22:46:29 GMT

[quote user="Evelyn Barbour-Hill"]

We Members sometimes need to remember that. And some people in Belgravia House need to be reminded too.

[/quote]

Couldn't agree more, especially as we are as a profession rarely asked for our views on how practical and sensible these "rules" are.

I have come to the conclusion that Belgravia House are the voice of the few, paid for by the many.

And again I fully expect to be shot down in flames for making such comments, but hey, is the object of this forum not to provoke healthy debate?

Re: Working in emergency and critical care

Evelyn Barbour-Hill — Tue, 02 Mar 2010 22:24:48 GMT

[quote user="Clive Ansell"]

[quote user="Hannah Wynne Richards"]

Clive I checked Annex 1 of the Gto PC, and noted the following points :

Practice policies to exclude domiciliary visits are not acceptable

Wynne

[/quote]

Seems like a typical RCVS woolly, vague, non specific, meaningless statement. does it mean we should/shouldn't/can/can't/can if we want too carry out home visits.

[/quote]

With sympathy and respect, and without holding any brief for Belgravia House: this is not an Act of Parliament written in immense detail to avoid loopholes, nor is it a rule written in minutely prescriptive detail so that the lumpen need not tax their brains. It is a Guide, a Guide to Professional Conduct.

With the law you have to obey the letter and the spirit is irrelevant, so people are constantly looking for loopholes. With a code of professional conduct you think for yourself and obey the spirit.

We Members sometimes need to remember that. And some people in Belgravia House need to be reminded too.

Re: Working in emergency and critical care

Glen McIntosh — Tue, 02 Mar 2010 13:22:00 GMT

[quote user="Hannah Wynne Richards"]I checked the latest Gto PC last night, and was dissappointed to find that the requirement for practices to transport animals to and from OOH providers seems to have been dropped.[/quote]

No, it is still there, just a little hard to find, it is in section 2D, "Maintaining Practice Standards", here it is:

"14. Where it is necessary and appropriate to transfer an animal between the primary practice and an out-of-hours emergency service provider or vice versa, the responsibility is that of the veterinary practices involved, not the client. Normally, the practice from which the animal is transferred is responsible for the transfer or arranging the transfer."

[quote user="Hannah Wynne Richards"]Transporting animals-Read the Guide to Professional Conduct, and you'll find it UNEQUIVOCALLY states that it is the veterinary surgeon's responsibility. I agree that neither emplyed veterinary surgeons, or nurses, should be expected to use their own cars, but if Vets Now can't provide a service STRICTLY obeying the Gto PC, they shouldn't be doing it at all.[/quote]

When read in the context of the full subsection of the guide "Continuity of care" paragraphs 9 - 15, I am not convinced that it is so unequivocal. Every paragraph in this subsection (apart from paragraph 14) that refers to transportation between practices is referring to critically ill animals. Here is the link:

http://www.rcvs.org.uk/Templates/Internal.asp?NodeID=92570&int1stParentNodeID=89642

I would agree that getting owners to transport critically ill animals is wrong, and Vets Now policy is to handover the care of animals unfit for transport to the day practice that Vets Now works out of.

But for animals that are fit for transport there are many good reasons for sending the animal back to it's usual veterinary practice for ongoing care. In this situation, I cannot see that transporting the animal back to its usual vets in the back of a pet taxi or ambulance results in any improvement in the care of the animal in comparison to transportation by the owner. So it then becomes a matter of owner convenience, not animal welfare.

We had use of an ambulance and driver for transfers between our clinic and member practices for about 6 months. It was very convenient for us - we no longer had to arrange and wait (occasionally hours) for owners to pick up their animals, but I can honestly say that it made no difference to the quality of care of the animal. We charged the clients for this service. I believe that the majority of clients preferred this service but some did not, and insisted on transferring their animal themselves. Ultimately, the ambulance service was not financially viable and was stopped. We were disappointed but the vast majority of owners were happy to transfer their animals, just like before the ambulance service arrived, apart from very occasional grumbling about inconvenience (which, oddly enough, replaced, almost exactly, the very occasional grumbling about the charge for the ambulance transfer - so no change in net client grumbling levels).

Now, I would argue that in an ideal world the best thing from the point of view of the sick (but fit for transport) animal is not to be transfered to and fro at all. But in the real world, where, by neccessity, most ooh's clinics are situated in non-referral/non-specialist daytime practices where no greater level of clinical care can be provided in comparison to the animals usual veterinary practice, a strong case can be made that there are genuine advantages to the animal and the client from transfer back to their usual practice in the "sick but fit for transport" scenario. And the iron clad assurance to member/feeder practices that these types of cases will be transferred back to them as soon as possible is one of the practical and political compromises that, through overcoming the fear of client supercession to local competition, has allowed for the evolution of OOH practices like Vets Now and others, to the greater benefit of pets, clients and vets.

And I believe that the RCVS recognises and accepts the above argument (or something similar) and the above interpretation (or something similar) of paragraph 14 of section 2D of the GtPC. It is my understanding that Vets Now animal transfer protocols (like all their other relevant clinical protocols - including house visits) have been examined and approved by the RCVS, and all Vets Now clinics are certified as tier 2 emergency service providers by the PSS.

In practice, a strict adherence to paragraph 14, as you have advocated, might preclude the operation of OOH clinics such as Vets Now and others. And that would be a shame because, when taken out of context, as I have argued above, this paragraph does nothing to improve clinical care or safeguard animal welfare. I suspect the bulk of the profession, the RCVS and the vast majority of clients who, in my experience, have been grateful for the availability of dedicated OOH clinics, would rather continue to allow the operation of dedicated OOH clinics and take a more contextual interpretation of this paragraph, than not.

Re: Working in emergency and critical care

Clive Ansell — Tue, 02 Mar 2010 12:46:44 GMT

[quote user="Hannah Wynne Richards"]

I checked the latest Gto PC last night, and was disappointed to find that the requirement for practices to transport animals to and from OOH providers seems to have been dropped. Is this a case of RCVS bowing to pressure from an organisation too large to discipline ??????????????????????? If so, I am very, very sad.

Wynne

[/quote]

I agree it is a retrograde step, there needs to be specific guidance on this.

[quote user="Hannah Wynne Richards"]

Clive I checked Annex 1 of the Gto PC, and noted the following points :

Practice policies to exclude domiciliary visits are not acceptable

Wynne

[/quote]

Seems like a typical RCVS woolly, vague, non specific, meaningless statement. does it mean we should/shouldn't/can/can't/can if we want too carry out home visits. If it is mandatory, what happens when there is no practice vehicle (I sometimes travel to some of my work by train or bicycle, and I don't transport animals in my private car)? ; what happens if there is no time in the daily schedule or not enough staff (common occurrence in a one man practice with too few nurses); what happens if it is 1830 on a double booked Friday evening and all staff finish at 1900?. The infrastructure is not there to be able to carry out home visits at anytime, on any day, at short notice.

[quote user="Hannah Wynne Richards"]

In -patient care

Before leaving an animal at a practice, the owner, keeper, or carer must be made aware of the level of supervision that will be provided to the animal, INCLUDING THE LEVEL OF SUPERVISION DURING AN OVERNIGHT STAY.Different levels of care arise in differing circumstances.

Wynne

[/quote]

I always make people aware of overnight care (or lack of). I never like keeping animals in overnight in unmanned premises unchecked for 13-14 hours, but that's the way it is sometimes. I always advise transfer to the OOH facility, but many decline on grounds of cost. If staying on the premises or close by I will pop in and check cases, but it is on the basis that the premises is unmanned and it is not full on hospital care.

one practice I work is not allowed to keep animals overnight as part of their lease agreement because of residential flats above. That can cause problems at time because clients that can't/won't pay for ooh clinic care have to take sick/post op animals home.

Re: Working in emergency and critical care

Hannah Wynne Richards — Tue, 02 Mar 2010 10:46:32 GMT

Clive I agree that this dog might not have survived, even if it had ben seen earlier-on the other hand the telephone advice might have meant that the "window of opportunity " had been lost. I think the reason I am so angry, is that I have a policy of NOT giving telephone advice. It's always easier to forgive if one thinks "There but for the grace of God, go I "

Wynne

Re: Working in emergency and critical care

Hannah Wynne Richards — Tue, 02 Mar 2010 10:21:26 GMT

I checked the latest Gto PC last night, and was dissappointed to find that the requirement for practices to transport animals to and from OOH providers seems to have been dropped. Is this a case of RCVS bowing to pressure from an organisation too large to discipline ??????????????????????? If so, I am very, very sad.

Clive I checked Annex 1 of the Gto PC, and noted the following points :

10 Veterinary surgeons must be aware of the difficulties created by :

a)making clinical judgements without examining the animal-

and must be able to justify a decision that the needs of the animal will not be adversely affected should treatment be delayed

11 Practice policies to exclude domicilary visits are not acceptable

In -patient care

Jane will know what I am referring to when I draw particular attention to

b)post-operative recovery

c)RTAs and some orthopaedic procedures

Referral practices

7 Referral practices must provide 24 hour availability in all their specialities, or they must, by prior arrangement, direct referring veterinary surgeons to an alternative source of appropriate assistance. Appropriate post-operative, or in-patient care must be provided by the referral veterinary surgeon, or by another veterinary surgeon with SIMILAR EXPERTISE (and at a practice with similar facilities )unless agreed otherwise with the client and provided the welfare of the patient is not compromised

Clive The practice I now use to help me when I am off-duty will shortly obtain hospital status

Wynne

Re: Working in emergency and critical care

Gareth Dowdeswell — Tue, 02 Mar 2010 10:00:35 GMT

[quote user="Clive Ansell"]

I tend to agree with you, but in practice it rarely happens. As I say I work occasionally in 4 ooh clinics, none of which have a vehicle, or the means or infrastructure in place to transport sick animals. I sometimes use a local pet ambulance service which is run by a VN, that works OK, other than that it is the client or a taxi.

I don't know what the answer is?? maybe referral of sick cases to larger hospital status practices that can hospitalise 24/7? maybe user practices collecting animals themselves?. It is something that partners, directors, practice owners and managers need to address.

[/quote]

We use an out of hours clinic about 30 min drive away from us. It's the closest one to us, and it's also used by all but 1 of the practices in our town. We do have a pet ambulance, so can transport animals to and from if necessary. We do, however, charge for mileage and the time taken for a member of staff to do this. Does anyone else have a similar arrangement, and do they charge for it? Is it the case that insurance won't pay for transporting animals?

Re: Working in emergency and critical care

Clive Ansell — Mon, 01 Mar 2010 22:33:04 GMT

[quote user="Hannah Wynne Richards"]

Clive Re telephone advice. Another case which was a major factor in me deciding to leave Vets Now was an elderly dog which seemed fine when the owners went out on a Saturday morning. It had vomited by the time they returned, and I had just "switched over " They immediately phoned Vets Now, and, instead of being asked to bring the dog in (which is what they expected -and they could always refuse if they were mean-which they were not )they were told to withhold food for 24 hours. The dog's vomiting continued, so the owners phoned again, late that evening . The dog was then examined, and an anti-emetic injected. Vomiting continued, so the dog was examined again on Sunday morning. Biochemistry was done, revealing severe renal failure, and IVFT started. Finally, the still very unwell dog was discharged to an upset owner on Monday morning. This dog eventually died.

It is , of course, impossible to know whether the original cause of vomiting was renal failure, or whether it was due to some other cause (bloods weren't done on Sat ), and renal failure only intervened as a consequence of dehydration. I don't claim to be infallible, and even if the original cause had been renal failure, I might also have mussed it, and merely injected anti-emetic. Alternatively, as I have made clear already, the dog might not have been suffering from renal failure AT THAT TIME The difference between the treatment I would have given , and that which was given, is that I would never have given telephone advice without examination of a vomiting dog. I have, in the past, had problems with both assistants and nurses doing this, and it has always led to a major falling out. Some might say this is a typical bosses attitude, so as to get another consultation fee, but in this instance, although it is Vets Now's coffers , not mine that would have benefitted, it was still a very major factor in my decision to leave them

I might have injected an anti-emetic in early afternoon, and, if dehydration, consequent to vomiting was the cause of renal failure, it might have been avoided. Alternatively, even if I had missed renal failure, the contnued vomiting following an anti-emetic would have become apparent much earlier. IVFT would have been started some 12 hours earlier, and the dog might have been saved.

Wynne

[/quote]

I guess It is impossible to know whether this dog would have survived or not and if any earlier intervention would have made any difference. I would not always see a dog that has vomited just once, but would advise it being seen if ill, old or if the vomiting was continuous. Depending on clinical exam I may or may not have ran bloods and/or IVFT at the first appointment. Given this was an older dog, I probably would have.

[quote user="Hannah Wynne Richards"]

My opinion (and that of Royal College ) about discharging sick animals to owners is already crystal clear

Wynne

[/quote]

Re: Working in emergency and critical care

Hannah Wynne Richards — Mon, 01 Mar 2010 19:18:35 GMT

Adi and Toby. You 2, like Jane sound like the sort of people I would be happy to entrust my OOH care to

It is , of course, impossible to know whether the original cause of vomiting was renal failure, or whether it was due to some other cause (bloods weren't done on Sat ), and renal failure only intervened as a consequence of dehydration. I don't claim to be infallible, and even if the original cause had been renal failure, I might also have mussed it, and merely injected anti-emetic. Alternatively, as I have made clear already, the dog might not have been suffering from renal failure AT THAT TIME The difference between the treatment I would have given , and that which was given, is that I would never have given telephone advice without examination of a vomiting dog. I have, in the past, had problems with both assistants and nurses doing this, and it has always led to a major falling out. Some might say this is a typical bosses attitude, so as to get anothr consultation fee, but in this instance, although it is Vets Now's coffers , not mine that would have benefitted, it was still a very major factor in my decision to leave them

My opinion (and that of Royal College ) about discharging sick animals to owners is already crystal clear

I do agree with you, Clive that referral centres should look after their own cases

Wynne

Re: Working in emergency and critical care

Clive Ansell — Mon, 01 Mar 2010 09:07:49 GMT

[quote user="Hannah Wynne Richards"]

Clive I won't say I never offer telephone advice, but I do so very,very rarely.I have to be thoroughly familiar with the animal, and both know and trust the owner. My standard reply to requests for telephone advice is "I can't possibly comment without seeing the animal " If the owner doesn't want to pay a consultation fee, I am blunt "You wouldn't phone a solicitor, or accountant expecting FOC telephone advice, so what on earth makes you think you can do so with a veterinary SURGEON ?"-emphasis on surgeon !!!!!!!!!!!!!!.My attitude is that if I guess wrongly, it's my fault, if the owners are too mean to pay a consultation fee, it's their fault.

Wynne

[/quote]

I will give ooh telephone advice, depending on the case. For example a young otherwise healthy dog that has diarrhoea does not need to be rushed to an OOH clinic at midnight, the advice to starve overnight and contact your own practice tomorrow is entirely appropriate. Of course if the owners are worried, or wish to be seen, then I would see them. Again a young dog that has had a small seizure and is now back to normal does not need to be rushed to ER for a midnight investigation.

I don't know any that do, but I do think think OOH clinics could charge for OOH advice by means of a premium rate telephone line. We must be the only profession that gives free professional advice at 3am. I recently had a 15 minute telephone conversation with my account to seek his advice, the £30 bill arrived the next day - and that was 2pm, not midnight!

[quote user="Hannah Wynne Richards"]

Transporting animals-Read the Guide to Professional Conduct, and you'll find it UNEQUIVOCALLY states that it is the veterinary surgeon's responsibility. I agree that neither emplyed veterinary surgeons, or nurses, should be expected to use their own cars, but if Vets Now can't provide a service STRICTLY obeying the Gto PC, they shouldn't be doing it at all.

Where house visits are concerned, the safety of the veterinary surgeon is paramount, but again the Gto PC is absolutely clear-a blanket ban on home visits is not permissible. A case that particularly annoyed me, was an elderly widow (late 70s )living alone. Her dog weighed 30/35kg, and was collapsed. Vets Now refused to visit.

Wynne

[/quote]

There are many practices and OOH clinics that don't meet this requirement I'm afraid. Of the 4 OOH clinics I work in, none have a vehicle or a specific arrangement with a transport provider, it is left to the vet and VN on the floor to sort it out. As I said in a previous post, one had an ambulance and driver, but it was discontinued because it was not financially viable.

One of the clinics has a back up on call vet that will do ooh home visits if needed, although they are almost never called up on. They us their own vehicles and most will not transport animals, but will carry out an ooh pts and bring the body back.

I sympathise with your elderly widow, but ooh home visits from most ooh clinics are almost impossible, although I have done them on the odd occasion. There are usually only 2 staff members, hospitalised cases, no vehicle, and of course the premises cannot be left unattended, what would happen if a critical case died because nobody was there? I would have worked with the elderly lady to try and find a way of getting her and her dog to the clinic if a visit were not possible. I think expectations regarding ooh visits should be looked at, it often is just not feasible, and cannot be compared to NHS ambulance service.

Clients need to take responsibility too, if someone owns a 30-35Kg dog they should have a means of transporting their animal if needed, be that with a friend, relative, or a local taxi firm. It is not reasonable that they just blame the veterinary profession for being unable to visit their home at 3am at 15 minutes notice.

[quote user="Hannah Wynne Richards"]

Where that particular referral clinic is concerned, the post-op supervision (or lack of ) is the reason I won't refer to them, and tell owners why I think it would be better for them to travel further. Again , looking at the Gto PC,do they make it crystal clear to owners that if the animal isn't well enough to go home, it is left in an empty building, with only one check ? I would imagine most owners would say "If he's not well enough to come home, he's certainly not well enough to be left alone " !!!!!!!!!!!!!!!!!!!!!!!!!!!!

Wynne

[/quote]

Shouldn't referral centres and their clinicians look after their own cases. One of the ooh clinics I work used to accept cases from a feline medicine referral centre at weekends, I was never happy with the arrangement as there was often no way of contacting the referral clinician if a complication arose.

Re: Working in emergency and critical care

Toby Birch — Mon, 01 Mar 2010 01:41:11 GMT

[quote user="Adi Nell"]

While it may be emergency care only, the vets must take ownership of the cases they're dealing with, not just say "it was on the plan I inherited." We're very strict about every animal having a full clinical exam by the night vet (in addition to the full clinical by the day vet) which allows the night vet to get a feel for the case and interpret his/her instructions from the day staff more completely. You don't need to employ a vet to give injections at set times or to keep drips running, you need them to use their judgement and clinical experience and add value to the cases they're in charge of!

[/quote]

Absolutely. I also work OOH (for a private provider) and yes we alter plans when we have to. It very much depends on the case but often we are faced with large amounts of case details and poor hand-overs. We are lucky to normally have the time to go back over these, complete a thorough clinical exam and if necessary fill in pieces of history. I would like to think that member practices are paying for more than just our babysitting skills. As said above vets are not needed to follow instructions and I firmly believe that the team is better than the individual. A fresh pair of eyes might spot something that has been missed. We don't always tell the owner and just add notes for the benefit of the member practice.

Another thing that I have an issue with is that 'emergencies only happen at night'. ECC is a fast moving world and it takes a lot of effort to try and keep up with the CPD. Often cases are time-consuming and if, through out training we can improve patients' chances by altering treatment plans then I for one sleep more soundly when I get home.

I agree there are several types of people who work OOH. Those who are actually interested in ECC and those who think it is an easy job. I take huge amounts of pride and responsibility in what I do. At the same time I believe that a lot of information is missed by not performing thorough clinical exams and performing cheap basic tests as some vets automatically head for the comfort zone of IVFT/bloods and radiographs without actually asking themselves what are they actually looking for and why.

I am leaving OOH and returning to days. Several reasons for this but one being that I want to try and further 24hr ECC (I am going to work for a practice that also runs its own OOH). People think we are there only for emergencies and forget about the critical care part. While there are only a handful of practices within the UK that can provide true critical care facilities I am sure a great many things can be improved within normal working hours if the correct balance can be found. I am sure that many smaller practices would relish being able to transfer cases early to people that are interested in managing them rather than not being able to offer what they might like to due to evening surgery or because it is not cost effective for them to have the equipment. We most easily become good at what we enjoy and I don't believe jack of all trades, master of none is so easily justifiable these days. As long as each practice educates their clients about what they offer and any veterinary surgeon presents the management options to the client the decsion is ultimately the client's and that must be respected in which practice they choose or how they opt to have their pet treated.

Re: Working in emergency and critical care

Adi Nell — Sun, 28 Feb 2010 19:52:14 GMT

[quote user="Clive Ansell"] there are a few colleagues who run endless and sometimes unnecessary tests and investigations, when they could quite safely be carried out the following day or week at the user practice[/quote]

One of our guiding principles is to do the emergency work only, leaving the rest for the feeder clinic. We actively seek to return animals to their practices of origin once the emergency care is completed.

[quote user="Clive Ansell"]

I wanted all the staff to be actively contributing to patient care, not just babysitting.

[/quote]

Re: Working in emergency and critical care

Hannah Wynne Richards — Sun, 28 Feb 2010 15:39:32 GMT

In addition to the telephone calls from the practice that did it's own OOH,I would often have clients turning up at 9 am, saying "We phoned your OOH service, and they told us to bring him to you in the morning. We've been so worried, we stayed up all night with him "If I ask "Did they refuse to see you ?", the answer would be "Not exactly, but they obviously didn't want to, and we didn't want to force them at that hour "I had a notice in my waiting room, saying that Vets Now was actually staffed all night, but not everyone reads notices, and most of my clients are nice, polite, people. I also know that if someone has always been willing to pay for proper treatment in the past, then avoiding the OOH fee would be highly uncharacteristic, especially if the animal is insured, so I'm inclined to believe their account.

Hanna. One of the advantages of a small practice is that I don't have animals hospitalised so often that it becomes an onerous burden- and I have clients who will pay sufficiently for both my RVN and I to do it willingly when required-I don't expect my nurses to stay in the practice for nothing-I pay time and a half, plus a call-out fee

Jane I agree there are 2 types of people who want to do OOH work-I remember you, and you were one of the good ones. My experiences recently have been baby-sitting types, so I voted with my feet, and left.

Wynne

Re: Working in emergency and critical care

Clive Ansell — Sat, 27 Feb 2010 19:36:52 GMT

[quote user="Jane Dunnett"]

I've found there tend to be 2 types of people who want to go into OOH work: those who genuinely enjoy the challenge of working on their own, have a great work-ethic and a real willingness to improve their skills and those who see OOH as an easy ride - effectively babysitting cases without actively trying to further their work-up (the "as long as it doesn't die then I've done my job" attitude) and seeing the bare minimum of calls while sleeping for most of the night. There are, of course a few who fall between the two extremes.

[/quote]

I would like to think that I am one of the few who fall in the middle. Of course, it is up to the vet on the floor to make the call, but I think it has to be a balance between providing a good or acceptable standard of care, and not doing too much which annoys user practices and takes away their work and their revenue, or interferes with their case management.

It has to be said, that there are a few colleagues who run endless and sometimes unnecessary tests and investigations, when they could quite safely be carried out the following day or week at the user practice; routine and T4 blood tests, routine ecg's, even lameness work ups etc. And, there are others who have lost the sense of reality and just want to play ER because they are "emergency and critical care vets" things like "every animal must go on IVFT, have blood gases, and must be TPR'd every 2 hours" regardless of whether or not it is needed.

[quote user="Jane Dunnett"]

I wanted all the staff to be actively contributing to patient care, not just babysitting.

[/quote]

In what way?

Re: Working in emergency and critical care

kirsty — Sat, 27 Feb 2010 14:29:29 GMT

have a look at this -- from front page of vet times on this subject

http://www.justiceforted.com/

Re: Working in emergency and critical care

Gillian Mostyn — Fri, 26 Feb 2010 21:59:52 GMT

We have been pretty happy with our OOH provider. Apart from the few inevitable glitches, they do a good job and using them has made a massive difference to our work-life balance.

I have to say though that as the service is run by a local first opinion clinic, they do keep animals in until they are fit to travel - meaning there aren't the transporting issues others have had. We also care for our own in-patients (unless they are critical).

I do find their costs are high - I think they would run a full blood screen on a teddy bear if it got dropped in reception - but I can't begrudge them their fees - I wouldn't want to do it!

Re: Working in emergency and critical care

jd2008 — Fri, 26 Feb 2010 19:40:03 GMT

I've worked on both sides of the fence. I'm now in the same position as Adi - we both manage 24 hour centres for the same group and employ dedicated night vets/nurses to care for our case, cases from our satellite branches and OOH for referring practices.

Prior to this I worked for Vets Now, in fact (you may remember Wynne) I was the senior vet for the Swansea clinic when it first started.

There's never going to be complete cohesion between OOH providers and referring clinics but a lot of the success (or otherwise) will boil down to 2 factors: 1) the quality and commitment of the OOH staff and 2) effective and ongoing communication with give and take on both sides.

I left Vets Now for a variety of reasons. I believed the company's idea and vision was great but I was frustrated that I wasn't "on the same page" as most of the other staff members I was working with. I wanted the checks for the referral clinic to be more frequent but was shouted down by others. I wanted all the staff to be actively contributing to patient care, not just babysitting.

I do believe delegating OOH work away from day staff is the way forward. Hours worked and the intensity of work nowadays mean that it simply isn't reasonable to expect a vet to provide adequate care doing a night shift on top of a full day shift - no-one benefits. Having centres where a sick patient can stay until it is fit enough for transport is infinitely more preferable than shipping a patient out at 8am because the OOH service is shutting up shop until evening rolls round again. (that was another aspect of the swansea work that i didn't feel comfortable with)

Jane

Re: Working in emergency and critical care

Hanna Bennett — Fri, 26 Feb 2010 18:55:12 GMT

[quote user="Hannah Wynne Richards"]James. If I have an animal on a drip, either I or my RVN will stay in the practice.[/quote]

Eeek - i'd never leave the building - we very rarely have no inpatients, and almost always they are on fluids. We have drip pumps, wonderful inventions. Would love to have the building staffed at night but not an option (yet....)