Case Management

As the hospital staff is growing, and with the presence of interns, NEC has developed the following guidelines for hospital inpatient case management. The goals of these guidelines are to improve client communications, case-by-case management and overall flow of the hospital.

Primary vet

Each inpatient case will have a primary vet in charge

  • The primary vet will have the following responsibilities:
    1. Client communications
      • ALL CLIENT COMMUNCIATION MUST BE RECORDED IN THE RECORD
      • Please do NOT just write “client called.” There needs to be detailed summary of what was discussed, plan and prognosis if applicable.
    2. Case management
      • All direction on the case will be discussed and ultimately decided by the primary vet.
      • Available in hours and after hours for case update/discussion
    3. Day-to-day treatment plans
      • These need to be completed prior to the on call vet coming on duty at 5pm
    4. Ensuring invoice is up-to-date and correct
    5. Ensuring client details are up-to-date on invoice.
      • There is a note category called “bill update”
      • Please use this category when the client is updated on the state of the account as it make it easy to see when the history is scanned.
    6. Medical record, assessment, vet report (Every inpatient is REQUIRED to have a vet report written before discharge.) all should be completed on the day or within 24 hours of admission/surgery/examination if late in the day.
    7. Discharge communications and follow-up.

How the primary vet will be assigned during regular hours

How the primary vet will be assigned after hours:

  • Weekday or Weekend On Call Vet:
    • Primary vet for new emergency patients from 5 pm to 8 am, or from 5 pm Friday to 8 am Monday.
    • Advice can be sought from PT or LG or MW, depending on the case, if needed.
    • Attending vet for inpatient overnight treatments which should not be changed without consulting the primary vet on the case.
    • If there are major changes, the primary vet on the case should be called.
  • 8am following weekday morning or 8am on Monday morning the case is transferred to the appropriate Primary vet (see above).
  • After hours Client communication
    • New admissions: responsibility of the admitting on call vet
    • In hospital cases: responsibility of the primary vet to inform the owner of the new on call vet to communicate *or*
    • Advise the client that no communication will occur over the weekend/holiday unless there is a change in the status of the case.
    • If a client visits and the ON CALL VET is NOT the primary vet then the details of any discussion with the client MUST be put in the record. This is essential so the primary vet and the on call vet do not tell the client different things or give a different prognosis for the case.
  • Transfer rounds MUST happen before the end of each day between primary vet on the case and on call vet. Even if it’s a brief text “my patients don’t need anything overnight”.

Treatments

  • EVERYONE is required to help with inpatient treatments if at the clinic. Remember, our work hours are until 6pm now as most have a 4-day work week. You need to be here until 6 unless approved by Kristen. It is a good time to catch up on call backs, records, reports etc if not much on.
  • Interns will take over this responsibility as they acquire competence.
  • Treatments need to done at the appropriate time and not changed unless there is a discussion with the Primary vet on the case.
  • Treatments need to ticked off in your own name, this means both vets and nurses.

Rounds

Daily morning routines:

  • 8:30am rounds:
    • All in-hospital staff (vets + nurses) to attend.
    • Alert by text, email or yelling prior to start.
    • Updates to be discussed and used to formulate a plan for the day (inpatient procedures, surgeries, which nurses to help with what etc.)
    • These rounds will be quick, 5-10 minutes.
    • This is also a great time to get each others’ opinions on cases, discuss cases as a group – fresh eyes can be crucial to tough cases sometimes!

Brief Afternoon Rounds:

  • These are very quick rounds between vets in hospital and vet on call.
  • If vet on call is not at hospital, it is the responsibility of the vets with cases in hospital to call on call vet with updates or any treatments that need to happen overnight.
  • This can be a brief text if nothing significant to report. But some sort of communication MUST occur between primary vets and vet on call.

Reports

Reports should be written for the following procedures with an interpretation and a plan:

  • All Imaging other than routine reproductive scanning
    • Tendon scans
    • Radiographs of any region
    • Endoscopy
    • Dynamic Scope
    • Ultrasound of chest or abdomen (may be incorporated into procedural report)
    • Cardiac examinations
  • Surgery of any kind including minor procedures.
  • PPE where radiographs are involved
    • REMEMBER: PT must always be consulted when xrays are taken for PPE!!!
    • These are the cases vets get sued over so a specialist opinion is part of the price!!!
  • Vetnostics or In-house pathology as these require an interpretation specific to the client’s horse.
    • Ie ACTH result:  original lab result plus report plus what does it mean and a plan…
    • Progesterones
    • Viral testing
    • Respiratory Washes/Body fluid analysis (an interpretation will be provided by KT).
    • Joint fluid analysis (this can be incorporated into the procedure report.
  • Procedural Report: Any diagnostic work up that is complex
    • Lameness that is not straight forward
    • Medical cases
    • Post-op of surgical cases which are prolonged (may require many reports)

 

Communication between vets and nurses is the key to having a smooth-running hospital.  Communication between vets and clients is the key to having a successful practice.