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Why ERs are so busy: An ER vet explains cluster periods -- Part I

Where do worried pet owners go when they can’t see their regular vet? Since curbside started, many are going to the nearest emergency hospital—whether it’s an emergency or not.

After earning her DVM from the University of Tennessee in 2010, Kaihla Parker did a short stint in general practice before realizing that emergency medicine was her true calling. For the last decade she’s worked as an emergency room clinician at AAHA-accredited Animal Emergency and Specialty Hospital, a state-of-the-art, 24/7 emergency specialty hospital in Knoxville, Tennessee, and in that time, she’s seen it all.

She recently sat down with NEWStat to talk about why ERs have been so busy during COVID—and how anxious pet owners are contributing to those especially chaotic moments she calls “cluster periods.”*

*This interview has been edited and condensed.

NEWStat: What tend to be the busiest times for a 24/7? Is it ever predictable?

KP: Busy periods often match up to pet owners’ schedules, so after work between 5:00 and 7:00 pm we start seeing a lot of cases come in. Weekend mornings are another busy time because people wake up and realize something happened to their pet overnight. Pretty much all day Saturday afternoon and Sunday.  

NEWStat: So, whereabouts do cluster periods come up? 

KP: They can happen anytime, but in my experience they do happen during those busy time frames, so you can sometimes predict it, but not always. 

NEWStat: And what is a cluster period?

KP: It’s just an overwhelming number of cases that come in all at the same time, more than you could possibly manage efficiently depending on how many doctors you have, and that number is going to be different for every hospital.

NEWStat: So, cluster periods are, by their nature, sort of unpredictable. 

KP: Yes, and hard to manage.

NEWStat: What’s getting missed during cluster periods? 

KP: There are a lot of things that are consistently getting missed, and again each practice is going to be a little bit different. But essentially, they sometimes miss doing a full physical examination on a pet. And charges get missed a lot across the board. Anything from take-home medications and discharge instructions, to paper records the customer brought in. Just about anything tangible can get lost in the shuffle.  

NEWStat: It sounds like it can get pretty crazy. 

KP: Yes, it’s extremely chaotic. 

NEWStat: How many cases per DVM is reasonable at one time? 

KP: In my experience, you can really only efficiently manage up to three cases at one time. After that, once you take on that fourth case, everything just kind of goes out the window. And again, that number is going to be different for every doctor. But in in my experience, trying to manage three cases at once is as efficient as I can possibly be. And a lot of it depends on the type of patient, whether they’re going to need a lot of diagnostics or not, how many technicians you have to support the procedures that need to be done. There are a lot of variables.

NEWStat: Owners are complaining about having to wait hours and hours in ERs. Why is it so much worse than it used to be?

KP: Nonemergencies. [During COVID] we’ve seen this huge influx of nonemergency patients that are not typically the type of patient that we would see historically in an ER. So, now in addition to seeing traumas like pets hit by cars, or pets who’ve consumed toxins, common emergencies like that, we’re also seeing things like skin infections, ear infections, even patients with fleas. Or pets who’d been limping at home, but now they’re fine, but the owner is worried and just wants to get them checked out.  

NEWStat: So, ERs are seeing a lot of cases in which owners would normally schedule an appointment, but they don’t want to wait a month—they want to be seen right away? 

KP: Exactly. And it seems like there’s no deterrent. They don’t care what the cost is. They don’t care if they have to wait. Many pet owners are willing to just sit there and wait to be seen.

Others wait for a while and then change their minds. Sometimes they wait 20 or 30 minutes and they see all these other emergencies come in, and they realize that their pet is probably bottom of the list, and so they leave.

NEWStat: How is that affecting your caseload, especially during cluster periods?

KP: Our caseload has gotten very crazy. Historically one to two doctors would see maybe 15 to 20 patients in an eight-hour period. Now we’re sometimes seeing 40 or 50 in the same time frame.

NEWStat: Is there any way to thin out those nonemergency patients?

KP: Sometimes, if it’s clearly not an emergency, we’ll have a technician go up and look at the pet and have a conversation with the owner to just kind of assure them that their pet’s OK, and that they’re probably OK to wait for primary care.

But I’ve also done examinations at no charge on some animals just to confirm that they’re OK and then I have a technician communicate that to the owner so they feel OK about waiting to see their primary care vet.

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