The unintentional casualty of overwhelmed general practices: Your local ER


Most practices are experiencing a major uptick in business. But the boom in general practices is cascading—onto emergency practices.

Many ERs are finding they’re seeing cases that general practices would normally handle, but haven’t been able to because they were either closed or limited in the kind of care they could provide.

Max Rinaldi, DVM, medical director at AAHA-accredited Emergency Veterinary Hospital in Springfield, Oregon, calls their caseload “unprecedented. I’ve been doing this for eight years and I’ve never seen it like this.” He estimates their caseload is up 40% over this time last year, and he credits the boom in overflow to general practices: “As they become more stretched, things that aren’t necessarily huge emergencies, but still need to be seen within a reasonable period of time, end up coming to our door.”

With local hospitals booked out several weeks in advance, Rinaldi says, “We’re seeing a lot more of the routine stuff.” A lot of which consists of dermatology cases, hot spots, flea infestations, and general dentistry.

But they don’t turn anyone away.

“We can get [patients] started, but we don’t carry a lot of the products that general practices do,” Rinaldi says. When a client shows up with a dog who has a hot spot, “We tell them, ‘We’re going to see you and we’re going to do X, Y, and Z; then you need to schedule an appointment with your regular veterinarian. They can pick up where we leave off and design a longer-term treatment plan because they have the supplies and they’re able to do that follow up in a way we can’t.’”

“It stretches our capabilities quite a bit,” he says. “It takes some creativity.”

When clients call their usual practice and want to be seen right away for nonemergency issues, the hospitals may tell them, “I can’t see you today, but there’s an ER a block and half away. They’ll sort you out and fax your records over when they’re done.” Rinaldi says that’s something they always had to deal with to a degree, but it’s really ramped up during the pandemic.

The ER doesn’t take appointments, which bumps up wait times, too. Rinaldi says about one-third of their clients call ahead, but the rest just show up in the parking lot.

On busy days, wait times are anywhere from two to eight hours. Rinaldi says that’s partly because the rules of triage apply. “If your dog has an ear infection, you’re probably going to wait a lot longer than a dog who got hit by a car.”

But he says there’s a silver lining.

“We’ve found, somewhat paradoxically, that since we’re not allowing clients in the hospital, we’re actually a lot more efficient.” Because they’re doing curbside only, Rinaldi says they don’t have to wait for an exam room to open up, or take time moving the patient and client into a room, or have them talk to a technician before a doctor can see them. “It takes a couple of steps out of that process. It’s much more streamlined and efficient.” But he adds, “I don’t know that that’s going to continue long term once the pandemic is behind us.”

Pat Kennedy-Arrington, DVM, owner and hospital director at AAHA-accredited Jefferson Animal Hospital in Louisville, Kentucky, says her ER is seeing similar waiting times to Rinaldi’s, but hasn’t experienced the same streamlining benefits from the curbside service they’ve been doing since mid-March. “We’re seeing clients who had never been here before,” she says. “It takes half an hour just to fill out the preliminary paperwork.” In April, May, and June, wait times were four to six hours.

She did see the overflow effect. “People had been going to their regular veterinarian for years. Now their pet was vomiting or having a seizure, [but] their regular veterinarian was telling them ‘We’re booked up and can’t see you for another four to six weeks.’ [So] they’re just kind of showing up here.”

Often, it’s something simple, like a torn toenail. “We’d look at it, we’d tell them, ‘Your pet is stable, you don’t need to wait six hours. Go home, call your veterinarian; try to get an appointment. But their veterinarians weren’t taking appointments, they were too backed up.”

“We were getting killed,” Kennedy-Arrington says. Complicating the issue was the fact that her hospital also does wellness care, so they were taking some appointments. “If [people] were able to make an appointment, we tried to get them in, but even then, we told them we’re [primarily] an emergency hospital.”

Meaning they might have to wait. Maybe for a long time.

Weekends are even worse. In Louisville, she says, no regular hospital is open after noon on Saturday. “Our Saturdays are crazy; our Sundays are crazy.” She has four doctors on duty in staggered, 12-hour shifts, and they can still barely keep up with the caseload. “Last Sunday, the doctor scheduled until 2 a.m. was there until 6.”

And the minor issues are coming in alongside the big stuff. Kennedy-Arrington reads aloud from an intake sheet from the night before, ticking off cases that came through the door: “Vomiting; diarrhea, bloody; big dog/little dog; infected eye; hurt leg; hit by a car; hit by a car; small laceration; vomiting; diarrhea, bloody; saddle thrombosis; possible bloat; vaginal bleeding; tail laceration; possible rat poison ingestion . . .” On and on and on it goes.

Jefferson Animal Hospital is seeing a parvo spike, as well. “In the last couple of months, we’ve seen an unbelievable number of parvo cases,” she says. “We have a whole separate ward for parvo.”

Kennedy-Arrington says they sort of saw the parvo crisis coming and tried to be proactive: Back at the start of the pandemic, “We’d make appointments for puppies to make sure they got their parvo vaccinations.” And they weren’t just proactive about parvo. “We’d make sure we got spays in. We were trying to make allowances.”

Five months later, her practice is still totally swamped. “A week ago Sunday was probably the busiest Sunday we’ve ever had in the 40-year history of the practice,” Kennedy-Arrington says. The log shows 14 emergencies between 10 a.m. and 1 p.m. By noon, they were already two hours behind. That night, two doctors were on during the overnight shift. Between midnight and 6 a.m., 10 cases came in.

On a typical day, they’ll have anywhere from 12 to 14 people out in the parking lot waiting to be seen. Up to three hours may go by before a doctor’s free to even assess the patient because the hospital takes the most difficult cases first.

Kennedy-Arrington acknowledges that things are likely to get worse before they get better: She’d just gotten off the phone with a local general practice veterinarian who has three locations. They told her they had to close one completely due to a staff COVID exposure.

She says general practice veterinarians are getting creamed with cases coming from other general practice veterinarians who say they can’t get clients in for weeks. And not just for vaccines: “These are pets having seizures, pets [with] lacerations.”

“It’s just crazy,” she says. “And the other emergency hospitals are just as busy.” Regular hospitals are doing the best they can, she says, but if somebody shows up in their parking lot, they have to wait. Or they come to Jefferson Animal Hospital. “We’re telling everyone on the phone, you may have a four- to six-hour wait because we’re doing the critical stuff first. But then they keep calling every half hour, asking, ‘How much longer, how much longer?’”

Still, Kennedy-Arrington manages to keep her sense of humor with impatient clients: “Well,” she says wryly, “if you wouldn’t call so often . . .”

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