The world and vets’ working lives have changed hugely over the last few decades. But one thing that hasn’t changed is the fact that our patients are very inconsiderate in choosing which day and at what time they get ill, and how ill they get. They are also very inconsiderate in choosing if they are ill enough to be admitted and recovering to a point that they can be sent home. This presents us with a plethora of issues. The problem can be boiled down to the question: What do we do with the inpatients?
I have worked in different practices that have at various times employed most of the common systems. The management of inpatients can be a source of stress to vets in practices. We just want to do the best for our patients and have to work within the system in which we find ourselves. Or failing that, effect a change.
The best system for the patients is to keep them in the same premises and have round-the-clock nursing and access to vets. Many practices leave patients in unattended premises with the duty vet making intermittent checks (which can now be improved by using Wi-Fi-enabled cam-eras). In this system, we don’t have to move ill animals (usually twice in a 24-hour period) or shoo them out of the door at closing time. However, there are inherent disadvantages with intermittent monitoring. Intermittent checks are also used in practices that outsource out of hours provision and move some patients but leave some in-house. The cost difference to owners is significant. The going rate for overnight hospitalisation at an out of hours clinic for pets is currently about £200 per night. For uninsured pets, that is a huge cost.
Most vets will strive for “gold standard” care. This is a phrase I use intentionally as it is so widely used by vets and is what we all feel we should aim for. However, the “gold standard” cannot always be achieved. If you don’t work in a 24-hour staffed practice with out of hours vet and nursing provision in-house, then you need to find a workable solution. Patient selection is important: who really needs to be kept in? Pets would certainly rather be at home with their owners than in a cage listening to various beeping noises all night.
If you have ever watched a cat on a drip spending the day hiding under its bedding in a cage, it would be hard to argue that sending it home for the night wouldn’t have its advantages.
Another version of the “gold standard” concept is to compare vet practices to our human counterparts in the NHS. I live in a rural area, with two large market towns and a lot of sea, coast and moorland. If you take our nearest 24-hour A & E human hospital and the 24-hour vet hospital two miles from it, the comparisons are interesting. Let’s cast an approximately two-hour journey time circle round them. You would find about six 24-hour vet clinics with 24-hour vet service guaranteeing a 30-minute journey from phone call to seeing a vet. In the same two-hour circle, you would find just one 24-hour hospital, backed up by ambulances but still up to two hours to drive to. Five of the vets have vet nurse and vet cover on site and one new practice would send you an hour to their out of hours clinic.
In human care, once you get to the hospital, you would be triaged and can expect the usual four-hour wait. Last time I was there, my son (then a toddler) had had a pyrexic fit. He was very pyrexic and we were kept in a cubicle for two hours; no one offered him even a glass of water. Human inpatient care is stretched – you may even end up on a trolley.
We need to be realistic about what we can provide. We need to be sensible about what can be done, and about what is genuinely best for the client and pet, not just what we think some notion of “gold standard” may be. Doing your own out of hours as a practice will actually make things easier. This was brought home to us when dealing with a holidaymaker and their sick dog. The consult was at the end of the day and the dog clearly needed to be admitted. The owner asked, “Where do we have to take him?” Our vet asked what on earth she meant. She was expecting to load up her own dog (on a drip) into her car, drive it somewhere new then reverse that process in the morning. “He will stay here,” our vet said, “and be looked after by us.” The client nearly wept with relief and gratitude.