Although I worked a 14-hour ER shift last night––definitely not my normal gig––I actually feel pretty great this morning. Energized, even. This fact, along with a few great comments filed under yesterday’s entry, inspired me to put together this post on how to know if your animal ER offers what you need when things go all wrong with your pets in the off-hours.
Though I’ve always loved ER work and have plenty of experience doing it (at least four years’ worth), it’s been years since I put in time on the overnight shift.
I tend to think of it as a young vet’s job, something you do when you have the energy and the high drive for hard-hitting work. But it’s also true that some people are just built for this job––the high stress, the long hours, the rush that comes with the kind of successes only life-and-death emergencies can provide.
Not that it’s all life and death, mind you. It’s also the midnight diarrheas, just-got-into-garbage cases, facial swellings from tooth root abscesses, can’t-sleep-because-she’s-scratching patients and sudden limpings that can easily wait a couple of days for cruciate ligament surgery.
Some of these were in evidence last night, but I also saw a hit-by-car in need of chest tubes, post-op orthopedic cases requiring careful pain management, and one heavy-duty, seriously critical seizure case.
Loved it. Too bad my lifestyle isn’t exactly conducive to this kind of career any longer.
In between emergencies, however, I did get to thinking about what makes a great animal ER run well...and what makes some falter. So I figured that even if I can’t work ER all the time, I CAN work to make my favorite ER even better by writing a letter detailing where they do things beautifully...and where they need improvement. Because even the best place can stand a little criticism, right?
To that end, here’s a ten-point checklist of what YOU, the pet owner needs from a great ER and, consequently, what a great ER needs to offer.
#1 Staff attitude and skills
A caring, knowledgeable staff (whose work ethic and positive interpersonal skills are tops) is THE MOST important element for a successful after-hours hospital. To achieve this you need a well-paid staff granted humane hours and cozy working conditions.
#2 Staff numbers
Frankly, any ER that doesn’t have a minimum of two technicians (preferably licensed or certified) and one doctor at all times (not on call, but actually there all night) isn’t always capable of doing your pet justice.
#3 Sleep policy
If the staff and doc are allowed to sleep...things will slip. I promise.
#4 Access to specialists
An ER run by a criticalist (veterinary critical care specialist) is the best, but a speciality hospital with internists and surgeons on call (or at least accessible by phone) is pretty fantastic, too. This way, pets that need them can be transferred to specialists first thing in the morning.
#5 Open 24 hours
ERs that are open only after hours are not set up for truly critical cases. I think of these more along the lines of “urgent care” facilities.
#6 Seamlessness of operations
ERs that rent space from specialty operations or general practices (a common setup) are somewhat hampered by their ability to offer comprehensive care seamlessly. Clients can be confused by the need for double paperwork and double billing and patient care can sometimes fall in between the cracks.
#7 Equipment
An animal emergency facility needs better equipment than what most hospitals have to offer. The critical nature of ER patients mean that digital X-rays, rapid, reliable blood testing equipment and a perfectly appointed OR (among other key tools) can make the difference between life and death.
This also includes backup generators and an evacuation safe location. Here in storm-prone Miami it makes a difference––a big difference. The last thing you want is a place that can’t handle a power outage or proves flood-prone just when you need its services most.
#8 Excellent record-keeping
Digitized records mean that everything is in one place for seamless transition to the next shift or to your regular veterinarian. ER hospitals that communicate well with general practitioners make for the best patient care possible in both short and long terms. In the best cases, overnight-working ER vets hang around until regular hospitals open to communicate personally by telephone with referring vets.
#9 Regular staff
Is your after-hours place staffed by ER professionals or by just any old vet in need of a few extra bucks on her off hours? You definitely want a place that prides itself on its staff’s consistency and specific expertise. And this is not just about the vets. The entire staff should be specifically ER-enabled and accustomed to working with the ER vets as a team.
#10 Reasonable prices and payment alternatives
You can’t work your veterinary magic unless people can afford to pay for your services. Working hard to pare down estimates, a willingness to provide step-wise care and offering options like the CareCredit payment alternative (essentially a veterinary credit card) definitely takes extra work...but means that more patients can access the care they need.
***
While my letter is bound to be much more detailed, these ten points are a great starting point. But I know you have more suggestions sourced from your own personal experiences. Help me out and offer them up below.
Add Comment23 Comments
I learn from and enjoy every post on Dolittler but this post is especially valuable, and I've posted a link to twitter at http://www.twitter.com/geekaren to share with friends. Fortunately, my preferred pet ER has the qualities Dr Khuli has listed and I'm very grateful for that. This post is also a great reminder about the importance of identifying a pet ER *before* an emergency arises, if one lives in an area where there are multiple pet ERs.
karen September 12th, 2009 11:30:45 AM
I definitely agree with point #5. I reall Really REALLY hate the "emergency" hospitals that are only open from 6pm to 7am. There could not be a worse business model for treating critically ill patients. These hours require that a sick pet be discharged early in the morning -often before their regular veterinarian is open for business. That means that sick patients who are in no shape to be transported in the first place could be in veterinary limbo for a few hours before being re-hospitalized. Doctors who own these clinics sell it from the standpoint of "We won't 'steal' your patients like the big referral hospitals do!" What a load of bs! I don't care about patients being stolen -I care about continuity of care and putting the patient first. 24/7 is the only way to go if that's an option in your town. I am blessed to have several 24 hour emergency services within a 10 mile radius.
Dennis Leon, DVM September 12th, 2009 11:38:37 AM
I think the point about an ER's sleep policy is really interesting. It's certainly something I haven't considered when touring emergency facilities and, with a cat that gets into EVERYTHING, I've been in more emergency overnight facilities than I care to count. Thankfully, the ones I've been in have been great with super-supportive staff who are willing to take that extra step to make sure we're taken care of.
Jane - Petfinder.com Blog September 12th, 2009 12:39:43 PM
I couldn't agree more with your first point. I would add that it's important to treat every case like an emergency, most especially if the client calls in ahead of time (like we're told to do) with something like a suspected bloat. Because to the client, it is an emergecy, or else they wouldn't be there. There's nothing worse than hurrying an animal in that's in obvious distress then seeing the staff move as slow as molasses, seemingly not taking the potential emergency seriously. I also hate the assumption that paying is going to be an issue. If that's the deal-breaking concern before caring for the animal, ask for the credit card to pay for diagnostics when the person walks in the door. Certainly for things as routine as bloodwork, rads and exams a pricelist could be kept in the reception area.
Can you tell I had a bad experience? I still call ahead (although i wonder what good it does), but now I walk in with my credit card in hand and ask for what I want (bloodwork, x-rays, exam) and state quite clearly what I think is wrong with my dog. I think it helps that I'm now an established paying customer, but I still thank my lucky stars that what we thought was bloat was a non-surgical obstruction, albeit one that presented with most of the symptoms of bloat. The three times I've been to the ER vet since have been cases that simply could not wait until morning or Monday, not drop-everything emergencies and I've been treated very well. I also had a very good experience with an animal ER in another city prior to moving to this one.
Deanna September 12th, 2009 01:23:42 PM
Well, being a cat owner, I think there is more to it. Bo has been to the ERfive times. All except for the last time were at a newer facility - an ER that also does speciality surgery. The place was wonderful - even though there were dogs, it was quiet and seemed very clean. (We normally go to a cat-only clinic.) Bo went there for his exploratory surgery initially, and then his incision had to be reopened on Christmas 2007, and then the final follow-up. I noticed when I brought Bo there he was very curious and seemed ready to investigate. His final visit was this last Christmas after vomiting non-stop. They didn't really do anything but watch him and keep him on IV drip since his last vomit was just before we left the house (of course, we didn't know that), and we had already given him meds. We were very pleased with this facility.
The last time was just a couple weeks ago on a Sunday. We woke up and Bo was limping on one of his front paws. As it turned out, it wasnt anything serious. We called the old ER only to find out their number was forwarded and that they no longer do ER work. I'm sure that is the economy at work - what a time to open a new facility just a year or so before the economy tanks. So, off to an older place. While the staff and vet were fine, the facility itself was awful for a cat. Bo, who usually growls at even us when he is at the vets, hid in a corner or borrowed his head into us. This place was so noisy I could not believe it. Even though we were waiting in the exam room, we could hear everything in this clinic. The non-stop dog noise, children noise, and this bellthat went off 7 or 8 timesevery 3-4 minutes. On top of it, there was dog hair all over the floor which made me worried that Bo would come home with fleas (luckily he did not). While I understand the place is older, it just did not seem very clean. I will say the prices were much cheaper than the other ER, and their ER vet fee was actually cheaper than our regular vet. I would have been willing to pay more for a cleaner and quieter place. We have decided that our cats will need to be extremely sick for us to ever take this ER ever again. Although I don't really care much for this beinga Hill's brochure, I would have been happy to hand them this brochure if I had one in hand:
http://www.hillspet.com/media/Research/PublicationFeatures/cliniciansBrief/assets/en/CB_PracticeMgmt_HillsFelineFriendlyBroc_v25_Final.pdf
Jenny
Jenny September 12th, 2009 02:51:26 PM
I live near a university vet teaching hospital so have wonderful ER facilities (with great staff and resources) available 24/7.
However, several years ago when my 7 year old cat threw a blood clot at 6:00am and I took her to the "urgent care" facility (closest to me), they stabilized her and I had to transport her to my "regular" vet (they were getting ready to close). When his day was through, I had to transport her back to the urgent care facility. I wish I had had my head on straight and taken her directly to the university vet clinic, but I didn't. I've regretted that decision many times. I wonder if she would have had a chance somewhere else with continuous care and better resources . . . although I know that a saddle thrombis is often fatal.
The urgent care facility has since gone to a 24/7 clinic in a new building with better resources available. I still go to the vet clinic at the university, though, since three of my cats are special needs (two cardiac plus one CRF/IBD/liver) and they all see specialists there.
I agree that staff attitudes and skills are at the top of my list! However, it's important to me that the clinic have the resources to do the treatments that are necessary.
dottie September 12th, 2009 02:53:36 PM
It is also impotant to know which emergency clinics will treat exotic species. I have rabbits and do like to know where I can take them if I need to. Not all vets can or know how to treat anything that is not a cat or dog. It can be hard enough to find a good exotics vet for regular care, let alone and ER.
I love my rabbit vet. Even though they are more expensive than other exotic vets in the city, they are close to where I live, only treat exotics (now barking dogs to stress an already stressed rabbit), know what they are doing and are friendly. Unfortunetly, they are not open 24/7. I did recently have to get staples removed form a rabbit I recently got (staples were from a spay. Who uses staples on a rabbit spay in a question I can't answer). My regualr vet doesn't use staples, so they were not able to remove them. I was directed to an emergency clinic near by that was able to do it. This clinic is also the clinic that the regualr vet refers thier after hours emergencies too, so they do treat exotics.
I did not know that this emergency clinic sees exotics before I went. If I had needed an exotic vet after hours, I probably would have has to go a lot further to one that I know does.
It will do my rabbits no good to go to a clinic that can't treat them properly.
Kate M September 12th, 2009 03:58:03 PM
Excellent blog and one that should be repeated! Thank you.
Barb A./NH September 12th, 2009 04:35:46 PM
I am fortunate to live 5 minutes from one of the best Emergency Clinics in the country from what I have heard. They are not cheap, but in a true emergency, I am not concerned about that. They also have specialty clinics and I took one of my rescues there for an echocardiogram a few weeks ago. That test plus bloodwork was just under $400, which we thought was very reasonable. They did give our rescue a discount. They are open 24 -7 and have staff doctors and technicians. I feel very fortunate to have such an amazing facility so close. We also have a great University emergency clinic in the same town. Yup, Columbus, Ohio is a good place to be if you have a pet emergency.
Robinsdogs September 12th, 2009 08:48:28 PM
The closest emergency clinic to me is 2 hours away. In my area after hours emergencies get handed to the vet on call for your own vet hospital. If you don't have an established vet be prepared to call around as some won't agree to see non-clients in the middle of the night. (to many getting stiffed hasn't helped the feeling of goodwill) I am so glad I don't work for their answering service!
http://k-9solutionsdogtraininginc.blogspot.com
Marie September 12th, 2009 10:54:01 PM
I'm happy to hear your ER shift was interesting and not exhausting.
To see a checklist for a great ER is very helpful.
One of the things I've also been very grateful for is the abiltiy to call the 24 hour hospital at any time to check on how my pet is doing. When it's 2am and you can't sleep because you're still thinking about something you thought about when you left at 10pm, it's nice to know the staff will take your call and give you a status report.
Just an Owner September 12th, 2009 11:42:08 PM
Robinsdogs, I agree, Columbus OH is a good place to have a pet emergency. (Great large animal vets in the area too.) I'm unfortunately familiar with MedVet and OSU and highly recommend both.
Deanna September 13th, 2009 06:42:39 PM
Do all e-vets have a triage system in place? My emergency vet has a separate emergency line from the normal line (urgent and appointments), so that if they're busy and your pet is actively bleeding, you can go to the head of the line.
I also really like that they have two separate waiting areas for dogs and cats after checking in. (I wait in the cat area with my bird b/c cats are generally in carriers while dogs generally are not.)
zandperl September 18th, 2009 08:28:29 PM
Find Cheap ugg bailey boots?UGG boots On Sale,Enjoy free shipping + bargain sale now!UGG Classic Short,100% Authentic UGG Australia Boots!ALL of UGG Classic Cardy are the cheapest and best for you!Enjoy yourself of shoping in Find Cheap Sheepskin UGG New Boots IN Ecwarm Boots.com!
UGG Classic Cardy November 11th, 2009 04:36:00 AM
<a href="oris'>http://www.cartierwatches.us/Oris/">oris replica</a>
<a href="DeWitt'>http://www.iwcwatches.us/DeWitt/">DeWitt replica</a>
Rolex GMT (watches) replica November 11th, 2009 12:42:17 PM
UGG Classic Cardy
Discount Uggs Boots On Sale
Ugg Classic Tall Boots
Ugg Boots Cheap
Ugg New Styles
ugg boots on link November 13th, 2009 10:12:47 AM
omega watch for sale
omega watch for sale November 13th, 2009 11:44:50 PM
<p><a href="http://www.uggsmvp.com/">ugg boots sale</a>，<a href="http://www.uggsmvp.com/">ugg boots</a>，<a href="http://www.uggsmvp.com/">cheap ugg boots</a>，<a href="http://www.uggsmvp.com/">discount ugg boots</a>，<a href="http://www.uggsmvp.com/ugg-classic-cardy-c-12.html">Ugg Classic Cardy</a>，<a href="http://www.uggsmvp.com/ugg-classic-tall-c-16.html" target="_blank">UGG Classic boots</a>, <a href="http://www.uggsmvp.com/ugg-classic-short-c-15.html">UGG Classic Short</a>，<a href="http://www.uggsmvp.com/ugg-classic-tall-c-16.html">UGG Classic Tall</a>，<a href="http://www.uggsmvp.com/black-ugg-boots-5815-classic-tall-p-41.html">Classic tall black uggs</a>，<a href="http://www.uggsmvp.com/ugg-classic-mini-c-14.html">ugg classic mini boots</a>，<a href="http://www.uggsmvp.com/ugg-rainier-c-20.html">UGG Rainier Boots</a>，<a href="http://www.uggsmvp.com/ugg-bailey-button-c-2.html">bailey ugg boots</a>，<a href="http://www.uggsmvp.com/ugg-nightfall-c-19.html">UGG Nightfall</a>，<a href="http://www.uggsmvp.com/ugg-persephone-sandal-c-32.html">UGG Persephone Sandal</a>，<a href="http://www.uggsmvp.com/purple-ugg-tasmina-p-99.html">Purple Ugg Tasmina</a>，<a href="http://www.uggsmvp.com/ugg-mens-layback-slipper-c30.html">UGG Layback Slipper</a>，<a href="http://www.uggsmvp.com/ugg-ascot-slippers-c-4.html">UGG Ascot Men's Sand Slippers</a>，<a href="http://www.uggsmvp.com/black-ugg-boots-5815-classic-tall-p-41.html">ugg 5815</a>，<a href="http://www.uggsmvp.com/black-ugg-boots-5819-classic-cardy-p-19.html">ugg 5819</a></p>
ugg boots sale November 14th, 2009 02:57:38 AM
Glashutte watch for sale
Glashutte watch for sale November 15th, 2009 08:28:12 PM
Ten ways to know if your animal ER has got the goods Kerja Keras Adalah Energi Kita. Sudah sepatutnya kita Berusaha dengan dengan kerja keras agar energi yang kita hasilkan dapat berdaya guna bagi diri sendiri dan orang lain. Itu untuk Mengembalikan Jati Diri Bangsa
http://www.khai.yehia.org
Kerja Keras November 17th, 2009 10:18:11 AM
http://www.cheapgoodssale.com
china wholeshoe November 18th, 2009 11:07:47 AM
Rado watches Tag Heuer watches Tudor watches U-boat watches Vacheron Constantin watches
Rado watches November 19th, 2009 08:45:11 AM
Rado watch for sale
Bell & Ross watches
Breguet watches
Breitling watches
Cartier watches
Patek Philippe watch for sale November 20th, 2009 10:06:11 AM
Add Commment