Emergency Measures on the Fly: Veterinary Hospitals Make the Best of a Stressful Situation

You probably have an emergency plan in case your hospital suffers a natural disaster. But few could have anticipated all of the extraordinary situations that have to be dealt with during the COVID-19 pandemic. From how to manage the stress to how to work with clients and colleagues while being socially distanced, new ways of operating have appeared.

by Maureen Blaney Flietner

As this article was being written, the novel coronavirus known as COVID-19 is sweeping the globe. Current estimates show that the United States has seen approximately 130,000 deaths and Canada nearly 9,000 deaths, with a world death toll at some 530,000. The drumbeat of social distancing and proper washing of hands is relentless.

While many states are beginning to open up, only “essential” businesses have been in operation, and veterinary practices are among them. But it’s definitely not business as usual. In many cases, veterinary practices still have limited services and hours. Practices have learned to innovate and tweak protocols.

During this time, several in the field made the time to answer questions for Trends, providing a glimpse of how they are coping.

Working in the Epicenter

While the first US case of COVID-19 is believed to have appeared on the West Coast, New York City quickly became the epicenter. At Westside Veterinary Center, an AAHA-accredited hospital on the Upper West Side of Manhattan, the practice has been operating with a crew of 30, a 40% drop from its usual workforce.

“No one has been sick enough to be tested and those not feeling well are not coming in,” said office manager Crystal Ortiz. “We normally have 10 veterinarians. A few senior veterinarians left for their homes outside the city and about 4 other veterinarians rotate in each day.”

The nursing staff remains at full strength. Several nonmedical staff members concerned because they must take mass transit to work chose to stay home. One veterinarian just initiated televisits with two clients.

Westside has reduced its hours and is not taking appointments for routine care. However, sick pets are still being seen.

“We do not allow clients inside the building, and since we are in New York City, we have no parking lot. Instead, clients are asked to hand off their pet for treatment at the front door and then to either wait out front or return later. We typically have one or two clients, five at the most, spaced apart outside. Medications and food also are handed off at the door. Clients pay with credit cards over the phone,” said Ortiz.

A sign on the door of Four Seasons Veterinary Specialists in Loveland, Colorado, instructs clients on proper social distancing procedures.

”We focus on different areas of wellbeing at different times in our lives depending on our priorities.“
—COURTNEY HUBRECHT, HOSPITAL DIRECTOR,
FOUR SEASONS VETERINARY SPECIALISTS

Letting Technology Shine

Four Seasons Veterinary Specialists, an AAHA-accredited referral hospital in Loveland, Colorado, started changing its procedures at the beginning of March, according to hospital director Courtney Hubrecht.

“Early on, we predicted our biggest risk was the loss of doctors and staff to quarantine or illness, so we took measures,” she explained. The hospital followed the COVID-19 guidelines provided by the US Centers for Disease Control and Prevention (CDC) and the AVMA to help staff feel as comfortable and safe as possible. Those at a higher risk per the CDC were given the option to stay home.

The hospital has found that its use of technology has made it easier to work remotely and to keep in contact, as well as providing the opportunity to bring levity to a trying situation.

To limit the number of staff at the hospital, its IT team equipped a few specialists, the administrative team, and a few client care staffers to answer incoming calls and to access the hospital’s electronic medical records system from their homes. Several apps including Zoom, TeleVet, and FaceTime are used and a virtual private network was set up.

“We still reach out to one another via phone, text messaging, and email,” Hubrecht said. “To help reduce stress and add some fun, we document our journey through pictures of group video calls, including posing a la The Brady Bunch opening theme. We use the VetBloom platform to communicate with staff, including sections on fun things to do while quarantined and positive feedback from clients and staff.”

The hospital, which had just started to offer telemedicine, has seen its use rise dramatically.

“We’ve had many success stories with telemedicine, especially with our internal medicine and oncology departments,” Hubrecht explained. “One benefit is that we can see patients in their home environment, which can provide invaluable information. Governor Jared Polis has issued an executive order to provide temporary suspension of requirements related to telehealth, which will open up even more opportunities.“

An online pharmacy was implemented so that clients can get needed pet supplies without leaving their homes. DocuSign is used to send consent forms and estimates for client signatures.

Curbside pickup for pets has begun with clients calling when they arrive. While less than ideal, said Hubrecht, it has gone well partly because of the implementation of a parking system. It involves cones, chalk numbers, and parking spot documentation within Instinct, the hospital’s digital whiteboard system, to clearly match patients to owners’ vehicles and to ensure social distancing while talking to clients in the lot.

While most clients appreciate the new rules, “there have been rare occasions where empowering your team to feel comfortable in politely and appropriately redirecting the client, for the safety of all, is valuable,” said Hubrecht.

Understanding how difficult it is for clients to not accompany their animals, hospital staff share pictures and videos of pets while they are in their care. In turn, the hospital is feeling the love from its local community. Volunteers are making face masks for hospital staff, and a local distillery donated hand sanitizer.

One challenge has been enforcing the guidelines during heightened emotional situations, such as having to limit access into the building during euthanasias or not being able to offer a hug to a grieving client or coworker.

“Some euthanasias are being performed outside, where grassy areas and the sounds of spring still provide a comfortable environment. We also have portable sound machines and privacy screens to offer as an option as well.

“Although we look forward to a return to normalcy when clients can be inside and we can share space more easily,” said Hubrecht, “our coronavirus precautions/protocols remain fluid so that we can react as things evolve in the county and state.”

Four Seasons Veterinary Specialists client care communication liaison Ilona G.

Finding What Works

In Kentucky, Darren Taul, DVM, owner of AAHA-accredited Animal Hospital of Danville and past president of AAHA, reported that while operations were getting “better day by day,” he noted that “every time you change something, something can pop up that needs to be tweaked.”

One example was when clients were asked to remain in the parking lot.

“We have a staff member obtain patient history by telephone then go out to bring the pet inside. What we didn’t realize is that calling each client to discuss the visit or diagnostics needed makes our phone lines busy all the time, so people couldn’t call in.”

Taul said the practice was working to remedy the situation by using text messaging and “providing virtual room visits though FaceTime or Google Duo so clients can be ‘in the exam room.’ We can have both visual and voice communication, thus freeing up limited phone lines. Not every client chooses ‘virtual visits,’ so we still tie up phone lines quite often.”

With the practice’s stringent cleaning protocols, staff have not asked for any time off because of worries about the virus, Taul noted. And while everyone understands that people would always prefer to be with their pets during visits, clients are taking it in stride.

The practice has everything it needs . . . for the most part.

“We are experiencing some shipping delays in prescription dog food. It has not been as timely as usual, and we need IV extension sets, but the order is still ‘in process.’ We have not been told when we will get them. But that one is a minimal problem. It just helps us conserve IV lines.”

Masks—but not surgical masks—are in high demand. Because of his connection to the local hospice organization—he was its former chair and board member—Taul was asked and was able to solicit donations from local veterinary hospitals, noting, “We can mitigate our risk and human contact. They can’t.”

What is Taul’s take on it so far?

“We are learning as we put each protocol in place that literally no one has done this before. But there’s never anything we can’t get through.”

Four Seasons Veterinary Specialists oncologist Erica Faulhaber, DVM, MS.

Supporting Each Other

Conejo Valley Veterinary Hospital, an AAHA-accredited 24-hour referral hospital in Thousand Oaks, California, is providing emergency pet care, but decisions on what cases will be seen is evolving. It also temporarily closed its boarding, doggie day camp, and bathing services.

“We furloughed our boarding staff and have certain high-risk individuals [who] are furloughed for their safety,” noted Jason Sweitzer, DVM, RVT, associate veterinarian.

“Supplies of personal protective equipment are running very low. We are curbside-only. Our attempt at separated lobby-only at night has been discontinued. However, we do allow two clients into our comfort room for euthanasia to support their emotional needs as we try to restrict transmission risks. We place an IVC first with an extension set and do all paperwork over the phone before we bring the client and pet into the comfort room before euthanizing.

“Anyone with any respiratory signs must have someone else bring in their pet. We are using FaceTime, video, and picture texts for visiting of hospitalized patients. Some doctors have been called off, but the number of urgent care and full emergencies has required us to have most of our doctors still available to care for sick and injured pets.”

The staff has been handling paperwork online and accepting payment by phone. Numbering the parking spots helped ease the stress of everyone needing to know vehicle makes and models. But interaction in the lot and how medications are delivered continues to be tweaked.

With an already high-stress job, the addition of a pandemic ratchets up the risks. Conejo Valley is supporting staff members and doctors staying home and offers resources online and through the corporations it works with. As a board member of Not One More Vet, Sweitzer said the hospital has seen many participate and receive care through the peer-to-peer support of those groups.

The hospital—a 24-veterinarian practice with up to 150 employees at full staffing—has created an atmosphere in which people support each other and watch out for each other’s needs, said Sweitzer. He brought in 20 cloth masks for staff members, another staff member is making cloth masks, and 50 more masks were due to arrive soon.

As intern director and extern coordinator, Sweitzer noted that while most schools have stopped externships, “our interns have risen to the challenge, stepped up, and done an amazing job during such a stressful time.”

He urged other hospitals to remember to put themselves first.

“It is difficult to not immediately try to address the clients’ concerns first and then figure out your own needs, but ideally, you should figure out how to address you and your staff’s needs and then figure out how to operate the business within those confines.

“We can all pull together to overcome a stressful event by activating our stress systems. However . . . this is a prolonged stress and will wear down all of our reserves. People will be pushed to the breaking point, not by one single thing, but by the constant barrage of little things that keep us shifting and not being able to truly settle into a new normal. I subscribe to the idea paraphrased from Richard Branson: ‘Take care of your employees and they will take care of your clients.’”

Four Seasons Veterinary Specialists radiologist Amy Felumlee, DVM, MS, (left), and Denise S., LVT, the radiology department lead technician.

Finding Relief

How do relief veterinarians fit into this? Cindy Trice, DVM, founder of Relief Rover (reliefrover.com), an online platform for stakeholders, reported that she is seeing jobs disappear and opportunities arise.

Some practices with reduced hours and services are canceling the shifts of their relief veterinarians. Relief veterinarians with contracts are wondering whether they should enforce or waive the contracts under these extreme circumstances.

Some relief veterinarians are having to cancel shifts because of children out of school or concerns about COVID-19 safety since practices vary on protocols.

Trice said she believes there will be more opportunities for relief veterinarians who want to work. In the past, people who felt sick might have gone to work anyway, but now they feel uncomfortable doing that, and some practices are short staffed, she explained. In addition, more older doctors may decide to stay home, or those who live with someone who has an underlying condition may decide not to take a chance.

“We still need each other. We need to maintain respectful, professional relationships with each other. And,” she reminded, “relief veterinarians also are cross-pollinators,” informing those practices about what is working well at other hospitals.

Maureen Blaney Flietner is an award-winning freelance writer living in Wisconsin.

 

Photo credits: ©AAHA/Robin Taylor, photos courtesy of Jen Lowry and Tara Britt (Four Seasons Veterinary Specialists)

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