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Coming in from the curb: When (and how) to let clients back inside

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As states continue to relax social distancing requirements across the country, many clients are anxious to get back in the exam room with their pets during appointments. And many hospitals, due to safety concerns, are just as anxious to keep them out. How will you decide when—and, perhaps more importantly, how—to let clients back inside your hospital?

NEWStat spoke to owners and staff at several AAHA-accredited hospitals to find out where they stood on the issue.

Ashley Forrester, CVPM, practice manager at Cumming Veterinary Clinic in Cumming, Georgia, inspired this story when she asked her AAHA colleagues at other hospitals via the AAHA-Accredited Members Facebook page if anyone had surveyed clients to see how they felt about coming back inside.

Forrester never actually sent out a survey herself, but after relaying her colleagues’ Facebook feedback to her hospital’s owner, they decided to hold off on letting clients back inside and focus on staff safety concerns. “We plan to continue curbside service through the end of June and are considering having clients back in the building after the July 4th weekend,” she says, adding that they’ll continue to offer curbside service as an option through the end of the year.

Margaret Rucker, DVM, owner of Southwest Virginia Veterinary Services in Lebanon, Virginia, and past-president of AAHA (1998–1999) didn’t do a survey, either, but she did start allowing one person per pet into her hospital two weeks ago—and only if they wore a mask. About half the clients who had booked appointments took her up on it that first week, but the second week, nearly all opted to don a mask and came inside.

As of yesterday, Rucker says, all clients wear their own masks, and technicians escort them inside and check their temperature at the front desk. Once the visit’s over, they’re escorted back to check out or are checked out in the room, and then outside. “No one is allowed to enter the building without an escort, and no one can come in and loiter or wait in the reception area,” Rucker says. “And only one person per pet is allowed.” The one exception is euthanasia, when several family members are allowed to grieve together in the comfort room.

Christen Lynch, practice manager at Animal Hospital of Rowlett and Diagnostic Center in Rowlett, Texas, said their clients would love for them to return from curbside to inside visits. “But we’re not willing to do so at this time,” she says, citing, like Forrester, concerns for staff safety. Lynch says she didn’t bother with a client survey “because I already know their feedback would overwhelmingly tell us that they want to be back in the building with their pets.” If you’re willing to allow that, she says, “then I think a survey is a great idea.”

Lynch says her hospital will go back to their prepandemic hours in July, but plan to remain curbside until at least August. “We’re watching the Dallas County [COVID-19 monitoring report] and it’s not down enough yet for us to feel comfortable moving away from curbside.” Nevertheless, they have a plan in place to let masked clients back in: “Clients will get their temperature checked at the door, they’ll be escorted inside directly to an exam room, we’ll limit the number of clients in the room, and have lines on the ground where they must stand to stay six feet from staff,” she says. They also bought Plexiglas to separate benches in the seating area in the event they ever have clients waiting inside. “And we’ll continue to offer curbside forever for those who like it.

Lauren Dell, DVM, owner of the Cat Vet of Hebron in Hebron, Kentucky, surveyed her staff, not her clients: she put a whiteboard in the breakroom for staff to write down suggestions about protocols for letting clients back in. “So far, [suggestions include] getting wrist bands for the front door key, making storyboards featuring our [cat mascot] to explain the state safety guidelines, and having our website company make a slideshow of the storyboards [to email] with appointment reminders.” Dell will start letting clients back inside on July 1.

One hospital owner in the Denver metro area who asked to remain anonymous told NEWStat she wouldn’t survey clients: “This is one area where I don’t think the clients’ desires should be a deciding factor. I say this as a practice owner who understands this may alienate some clients and lead to loss of revenue. There are a number of reasons we’re continuing curbside, and much of that decision is based on things clients have no understanding of—lack of PPE for [staff], the impossibility of maintaining social distance in a small practice, the liability for employers if an employee gets sick or gets a client sick, etc. [Clients] don’t know enough about [how things work behind the scenes] to have a say about this.”

Despite that, she says her hospital is considering ways to let people back in soon, but for her the biggest difficulty is scale: Her hospital is a one-doctor practice with fewer than five employees. “It’s not physically possible for us to keep a six-foot distance in exam rooms or the lobby area,” she said. “I’m most concerned about people congregating around the front desk. Even if people come in, we’ll still have to take the pets to the back to have enough working room and distance from clients, so it’s easier to just have them stay outside for now.”

Another concern: her hospital is a part of Denver, which is considered a COVID-19 hot spot, with several recent outbreaks at nearby businesses. When those numbers go down and the governing bodies give the go-ahead, she’ll start thinking about letting clients back inside. But she says that could be a while. “We’re not out of the woods yet.”

Rebecca May, practice manager at Town ’N’ Country Animal Hospital in Burlington, North Carolina, said they started surveying clients about coming back inside two weeks ago.

The response was pretty evenly split, with 49% voting to come inside as long as they were masked and observed social distancing measures and 51% opting to stay curbside to limit their exposure. With client desires split down the middle, May says her hospital decided to try catering to both groups.

“We’re only doing [in-hospital visits] with exams, euthanasia, [and] basically things where we believe there’s going to be some conversation between the veterinarian and the client that the client benefits from, ” she told NEWStat. “That means no coming inside if clients are just dropping off pets for boarding, or a bath, or a heartworm test. We wanted to limit our staff’s exposure in situations where there was no benefit in face-to-face communication.”

May says the in-hospital visits are going well, although occasionally clients try to bend the rules. One of those rules is one person per pet, and that person has to be masked. “One woman came in last week after agreeing to the conditions in writing: she’d come in alone and masked. Instead, she showed up with her three children and nobody had a mask.” Needless to say, they weren’t allowed in.

Although May says you can’t please everyone, Town ’N’ Country seems to be coming close. “We had older immunosuppressed clients say, ‘If you let clients in the building, I’m going to have to find another veterinarian because I won’t feel safe,’” she says. “And we’ve had healthy clients say, ‘This is ridiculous. You need to let everybody in.’ Doing it this way, we’re able to accommodate clients who don’t feel safe and want to stay in their car.”

And what about clients who are adamant about coming in with their pet?

“As long as they play by our safety rules,” May says, “we can accommodate them, too.”

Photo credit: © iStock/olrat