Benefits and challenges in round-the- clock care - Veterinary Practice
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InFocus

Benefits and challenges in round-the- clock care

Guy Carter & Richard Leonard, who run two of Medivet’s six 24-hour and emergency centres – Guy in Watford and Richard in Hendon – discuss best practice in continuous care

MEDIVET has six 24-hour
continuous care and emergency
centres, which are central to our
hub-and-spoke model. These
centres provide their surrounding
practices with the technology,
equipment, expertise and support
to deal with more complicated cases
and emergencies.

Patients are
transferred to and from
our satellite practices to
the main centres, usually
in our ambulances.
The way the system
works also supports the professional
development of our staff – both vets
and nurses.

We introduced 24-hour continuous
care into our partnership over two
decades ago – it’s embedded in our
work and is central to our business
model. Before this, we often found
ourselves in a stop-start scenario with
animals left alone overnight or at
weekends. This was unacceptable to us in terms of patient outcomes and
animal welfare – diabetic patients, in
particular, need constant monitoring,
and round-the-clock care is vital in
cases of gastric torsion.

Over the past 20 years, as we’ve
developed and re ned our in-house
OOH provision, we’ve seen greatly improved outcomes in both patient
survival and in speed of recovery.
Patients can stay at our 24-hour centres
until they are ready to be discharged,
reducing the number of journeys they
have to make. Because the patients are
in the continuous care of our team of vets and nurses, we can get to the
bottom of cases more quickly and are
able to work cases up better.

We’ve had to develop an
infrastructure to ensure this works,
not least of which is our integrated
computer system. This gives all our
vets access to the full patient history
and is regularly and continuously
updated.

Of course, staf ng is one of the
most challenging aspects of 24-hour
care. Like most 24-hour providers, we
have teams of night vets and nurses
who work week-long shifts followed by
a week off. We try to ensure there is at
least one experienced vet on this team
at all times.

This is backed up by a robust on-call
system. A vet and a nurse are on stand-
by for each 24-hour centre – not only
to cover members of staff who are ill,
but also to provide support in more
complicated cases or for home visits.
In addition, we have a second on-call
team, often our senior partners, who
can be contacted if a problem arises.

One of the biggest challenges for
us as leaders of 24-hour care lies in
processing cases and co-ordinating the
team of people involved in each case,
from surgeons to vets with expertise in
medicine or imaging, to our in-house
laboratory for blood tests, cytology
and so on. A vital part of that team are
our veterinary nurses, who carry out much of the work, doing x-rays,
putting up drips, monitoring
anaesthetics, etc.

Another issue is
communication with clients.
This is something we spend a
lot of our time doing! There
may be up to four vets looking
after a patient, especially
following weekend admissions.
We aim to have one lead vet
communicating with the client,
while other staff, especially vet
nurses, provide updates on progress
and arrange owner hospital visits.

This is to ensure continuity
in the information that is being
communicated to the client, and helps
cement a relationship of trust with
the clinician. Attention to detail is an
important part of maintaining good
relations: clients can become upset
about a missing collar or favourite toy
even if the case goes well.

Our investment in continuous care
has led not only to improved outcomes
and recovery rates for our patients,
but has also provided professional
bene ts for our staff. While we make
use of external referral centres when
we need to, being able to refer in-
house and expecting our vets to retain
involvement with those cases adds to
their clinical knowledge and capability,
leading to improved job satisfaction.

We invest heavily in the professional
development of all our staff and as
a result there are a large number of
certificate holders or vets working
towards gaining further qualifications
across our group.

In addition, many of our vets have
special interests and experience in
chosen areas of practice: one, for
example, does MRIs and spinal surgery
(Richard), while another has a special
interest in rabbit medicine (Guy);
our partner
Gareth Richardson
carries out hip
replacements, and
so on.

We have high-quality ultrasound scanning at all
our main centres, we do endoscopy,
laparoscopic surgery and are about to
install a CT scanner alongside our MRI
scanner at our Hendon centre. These
skills and facilities are available to all
the branches in the catchment area of
each continuous care and emergency
centre – the spokes to our main hubs
– and they are also used by a growing
number of practices outside our
partnership.

The model we have developed allows
vets in our feeder practices to remain
involved in cases. They can carry
out the work themselves at our main
centres, or work under the supervision
of our more experienced vets, often
improving their clinical skills by
learning from colleagues who have
more advanced skills.

We expect branch vets to maintain
contact with individual cases and their
owners throughout. This provides the
continuity of care many clients expect
and, from a professional point of view,
it’s a more satisfying way of working
for vets who like to see cases through
to their conclusion.

The provision of 24-hour care is a
lynchpin of our business, and we have
plans to expand it. Clients now expect
to be offered round-the-clock care for
their pets, and we anticipate demand for this level of
care increasing in
the future. It is so
deeply embedded
in the way we do
things, we can’t
imagine working
in any other way.

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