Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Kate Richardson — Mon, 03 Oct 2011 13:49:44 GMT

[quote user="Stephen Courtney"]

How did you go about setting them up Is this nurse-driven or vet driven? how do you decide what to do? We are all aware of weight clinics where nurses use all the goodies and advice provided by various food companies. how about other clinics such as geriatrics - something i think has considerable merit, though i feel this is an area that should be covered by vets rather than nurses on their own.

I'm not sure how much scope there would be for say chemo clinics, unless your practice does a lot of this stuff, and even then I'd feel a little uncomfortable delegating to a nurse. same with diabetes.

Regarding having such lectures presented at congress, would you as a vet go...or would you send your nurses?

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The weight/behaviour clinics were set up prior to me joining the practice. Dental/geriatric clinics were started later. I was very keen to set up cat geri clinics, as geriatric medicine is one of my passions, and the aim was to try to get more cats in for regular checks to detect old age disease early as we all know how well cats like to hide the fact they are ill and therefore be in a position to either treat or manage these conditions better, rather than seeing cats when they reach end stage disease or are more chronically ill. I sat down with the nurse and we discussed how we would like to run them, and what they should entail, and what the nurse felt comfortable with until we found a format that we both agreed on. They involve a weight check, general history paying attention to appetite and drinking changes, changes in urination/defaecation patterns/locations, behaviour changes, mobility changes, blood pressure check, and and urine analysis if possible. Essentially they are for cats that are perceived by their owners to be well. If the owners ring up for a geri clinic appointment and state on the phone that the cats is intermittently vomiting or has obvious weight loss, they are booked to see a vet, not the nurse. I started by doing an evening talk for clients on old age disease in cats, to try to get across the thought that old age itself wasn't a disease, but there were diseases of old age. So many people just see changes and put it down to 'I thought he was just getting old' and assume that there is nothing that can be done, so the aim was to change this concept and educate our clients. The meeting was very well attended and I had a lot of positive feedback. People also don't want their cat 'messed about with' so we aimed to change this perception as well and educate on some of the simple things that can make a huge difference to their cats's quality and often quantity of life. The biggest problem I have is getting the other vets to remember to recommend the clinics to all elderly cats they see for boosters, so that they come back in 6 months for a free check up, and then getting the owners to remember to come back in 6 months. We are currently setting up a reminder system for this, so that should help. The other problem is that owners often don't like taking their cat to the vet anyway as it causes stress to both owners and the cat, so its finding a way to encourage this as well by having cat only sessions etc. The nurse consultation is very relaxed, the cats are allowed to wander around the room, and because they have more time, they relax better, so the owners have a more pleasant experience as well which all helps. But it takes time for this to filter through to clients unfortunately. I think once we can get our clients perception of old age changed, then the clinics will do better, but I think we need to re-iterate the point again and again and again until it gets through.

I agree chemo clinics and diabetes clinics are no-nos in my book, other than checking the blood glucose or urine glucose on patients at risk, and this does happen in the weight clinics/geri clinics particularly if the right questions are asked regarding drinking habits and having a nurse who is on the ball in this respect! and we have detected some diabetes cases early in this way. And dietary advice for chemo patients may be helpful, but I don't thinka clinic per say would be necessary.

I think lectures on setting up clinics will only be attended by people who are keen and have the enthusiasm to do so, be they vets or nurses. I think they need a team of vet(s) and nurse(s) to make them work successfully. If the vets just say, yes yes run along and do a clinic if that will make you happy, then the nurse will not feel she has the support and back upo she needs to make them work. Yes I would go if I felt there would be something I could learn on how to promote these clinics and encourage uptake, but I would equally happy for my nurse to go and bring me feedback.

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Stephen Courtney — Mon, 03 Oct 2011 08:15:24 GMT

[quote user="Gareth C."]

I spoke, with a VN as well, at BSAVA congress 2008 and 2010 on dental and geriatric clinics respectively in the nurses masterclasses. They were very well attended (fully/ oversubscribed) so there was a need / appetite for them. Its also not a new thing for BSAVA to be doing, but I guess repeating things for a new audience is a good thing. I've still got the lectures...

[/quote]

Seems you are one of the folk I'm looking for then! I tried to message you through the website but not sure it got through - could you contact me on hound.doc99@gmail.com? Thanks for your input!

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Gareth C. — Sun, 02 Oct 2011 23:00:29 GMT

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Rob Loxley — Sun, 02 Oct 2011 22:56:38 GMT

[quote user="plantagenet"]I must be being thick here, but I never saw the point of 'clinics' - we just see clients and their animals for what they need to be seen for as near their convenience as possible. [/quote]

Does having named 'clinics' conflict with doing this? You can have nurses running 'weight clinics' but these can be at flexible times. You can have vets offering 'pre-travel advice clinics' but at flexible times.

IME, most of the time, people bring their animals in when they are perceived to be unwell or for vaccination, and a lot of the 'clinics' are maybe trying to offer something to attract clients in for other reasons (be that puppy party, adolescent healthchecks, post-dental checkups, weight management, worming or 'wellness' clinics), hopefully to the benefit of the animal, client and practice.

We recently have started vet-run 'Senior Pet Clinics' and indeed clients are seen when they want (during consulting hours). From my experience of setting these up, calling them a 'clinic' - rather that just being a vet appointment - is a good way to focus the team and client's minds on a particular target area, helps with advertising and marketing a succinct concept, maybe with bundling introductory discounts/incentives/offers and allows focussing on developing a new area of opportunity (in this case 'well'-senior-pet checks). If we just said, for instance, "shouldn't we try and see more older animals to see if they have early renal failure before they are presented end-stage" without developing a structure to achieve this I think we'd have had less impact.

I think the target audience & subject is wide, from the business/marketing/PR of why/how to set up such clinics to the practicalities of what might be useful for the detailed running of both nurse-run and vet-run clinics.

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

CatherineThomas — Sun, 02 Oct 2011 21:32:45 GMT

We tried doing a geriatric cat clinic with the nurses. The idea was that the nurse would do a basic history and examination and note down their findings, such as weight, body condition score etc. They also discussed signs of pain. They would measure blood pressure and do a urine dipstick and SG if the owner could bring in a urine sample. Everything was writtin down on a sheet which was then checked by a vet. If the vet felt that there was anything on there to be worried about they would call the owner and suggest they bring the cat back for a consultation with a vet. The nurse appointment was free but if they had to see a vet it would be charged for as normal.

Letters were sent out to all of the clients with cats over a certain age to advertise the clinics. Unfortunately the take up wasn't that good. There were a few really old cats with several problems that had obviously been going on for a while which ended up being pts. I think there were a few in which we picked up early stages of renal failure or arthritis.

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Stephen Courtney — Sat, 01 Oct 2011 21:41:01 GMT

Thanks for the input - i don't mean to deride clinics run by nurses at all, and am aware that many practices use them.

Regarding having such lectures presented at congress, would you as a vet go...or would you send your nurses?

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Kate Richardson — Sat, 01 Oct 2011 16:02:37 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"] and I think clients often open up more to a nurse, instead of being in 'awe' of the vet, and not wanting to bother us with what they perceive to be minor issues, but they feel they can 'bother' the nurse with it.[/quote]

Not always. I guess it depends on the client, the nurse, and the vet. Above all the vet.

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Absolutely. Certainly with regards to feeding habits, I often find they confess all those extra titbits more to the nurse than to me! Or maybe its just that after being asked again, they decide to come clean?

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"]Same with dental clinics. If they need dental treatment, then that is arranged, but with early problems that management can assist with and prevent future problems, again pointed in the direction of the clinics and also for post operative care and ongoing prophylaxis.[/quote]

The trouble is, this involves diagnosis by the nurse (strictly speaking, illegal, but let us not get back in to that debate). There is no problem with the nurse arranging dental treatment which is unnecessary, as the veterinary surgeon who is going to do the procedure (it is going to be a veterinary surgeon, isn't it?) will see that treatment is unnecessary. There would be a big problem with the nurse deciding that treatment was not necessary.

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I probably didn't make myself clear here. If they see the vet, and dental treatment is deemed necessary, then the vet arranges this. If no immediate dental treatment is necessary, but prophylaxis is required, then they are booked for the dental clinic.

Our nurse does NOT arrange dental treatments; if she thinks it may be necessary, then she either gets a vet to assess the mouth there and then if a vet is available and treatment is arranged if deemed necessary, or she will make an appointment with a vet to assess and book treatment if necessary. The nurse who does our clinics is superb and I totally trust her to request a vets attention if necessary- more often than not she is overly worried about something, but is totally aware of her limitations and wants a vet to say, no its fine, and will not make that decision herself.

So it comes down to choosing the right nurse for the job.

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Evelyn Barbour-Hill — Sat, 01 Oct 2011 15:23:46 GMT

Not always. I guess it depends on the client, the nurse, and the vet. Above all the vet.

Getting into detailed points here:

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Kate Richardson — Sat, 01 Oct 2011 15:08:09 GMT

I disagree. I feel clinics are very beneficial to both clients and the practice. They create a sense of involvement of the nursing team, and done well they really work. They do need to 'right' person for the job though.

One of our nurses runs our clinics. We provide weight, dental, adolescent health checks (6months old), behaviour and geriatric clinics. She does a far better job of getting animals to lose weight successfully than any of us vets can, mainly I believe because there is consistency of seeing the same person and she has the interest and enthusiasm to promote success. If I was to spend the same amount of time that she does discussing weight loss plans, then I would be here all day. The way it usually works is the vet will advise the owner that their pet is overweight and recommend a suitable diet, I usually send them away with a bag of the appropriate diet, get them going on it and then book them to come back and see the nurse in 2-3 weeks to reweigh and discuss their progress. Same with dental clinics. If they need dental treatment, then that is arranged, but with early problems that management can assist with and prevent future problems, again pointed in the direction of the clinics and also for post operative care and ongoing prophylaxis. She does not do a lot of behavioural work, and is limited to 'minor' problems, and will refer to a behaviour specialist if she feels this is more appropriate. If she feels a vets involvement is necessary she will consult one of us. We offer a health check for adolescents at 6months of age to discuss behaviour, parasite control, and neutering, sometimes these are with the vet, sometimes these are with the nurse. Again, she spends more time with them than I do, and goes through everything in far more detail than I can as she has more time allotted to her. This bonds the clients to the practice, they love talking about their pet, and I think clients often open up more to a nurse, instead of being in 'awe' of the vet, and not wanting to bother us with what they perceive to be minor issues, but they feel they can 'bother' the nurse with it.

Geriatric clinics are something we have started more recently, and have had a poorer uptake, mainly I believe due to lack of promotion by the vets unfortunately. But I have plans to improve this as I am really passionate about the oldies, especially cats, and really want to encourage people to approach us when their animal is older and showing signs of problems, and being more aware of the signs (or lack of outward signs) that cats in particular show. In essence to change people's attitudes to understand that old age itself is not a disease, and that we can lots to maintain good quality and quantity of life, but lets pick things up early.

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

Stephen Courtney — Thu, 29 Sep 2011 22:38:44 GMT

I have to agree on this one. I always get the feeling they are a cynical attempt to give nurses 'something professional to do' On the whole in our practice we do have a couple of successful so called clinics at the main hospital, but when out in smaller branches invariably the enthusiasm fizzles and the vet ends up doing them.

However this is what i have been asked to look into. I have some ideas on physiotherapy for DJDs and post orthopaedic op cases, and some ideas for a couple of other clinics, but i really cannot see how any practice is going to need guidance on setting up clinics on a large-scale and formal basis. I can't see many people having enough demand for this in terms of case load.

I do appreciate all comments however, I need something to take back even if it is in the negative!

Re: Setting Up Clinics - Discussion and Advice for BSAVA Congress 2013

plantagenet — Thu, 29 Sep 2011 08:22:05 GMT

I must be being thick here, but I never saw the point of 'clinics' - we just see clients and their animals for what they need to be seen for as near their convenience as possible.

I have the same attitude to myself an the dr - if I want to see a nurse or a dr to have anything from a vaccination to a problem, I want to go when it suits, possibly for both at once.

Perhaps its a big practice thing, perhaps it just sounds up to date?