Prep Your Staff For Critical Care

There’s more to emergencies than a quick response time.

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For your staff members, emergency medicine is a fragile blend of critical care and client care. With every case, they must balance the immediate medical needs of the pet with the strong emotional needs of the pet owner. From the location of certain drugs or equipment to the protocols that are followed, it is essential that emergency procedures are consistent, almost second nature, so that your staff can handle the unpredictable character of a distraught client.

Assign Roles and Responsibilities

"What works best for us is to assign a certain job to each person involved in an emergency," said Allison Gross, DVM, an emergency and surgery clinician at Friendship Hospital for Animals in Washington, D.C. "For example, I try to have one person in charge of intubating and breathing for a patient, one person in charge of getting venous access, one person getting the drugs and fluids we will need, and one person recording everything."

Dr. Gross said the team tries to schedule these positions at the beginning of a shift, but often they are assigned on the spot as an emergency comes in. Off-the-cuff assignments aren't a problem, as long as your staff is cross-trained and each member has a solid understanding of what each role entails.
At Baring Boulevard Veterinary Hospital in Sparks, Nev., each of the positions needed to be filled in the worst-case scenario of cardiac arrest has a specific name, such as team leader, ventilator and go-fer, according to Bob Baker, DVM, director of medical services.

"Let your staff know exactly what you expect them to do prior to an emergency. If people know their roles, they will perform better," Dr. Baker said.

Remain Calm

Emotions are contagious, so you'll want to have methods of re-establishing calm in the clinic during an emergency, beginning with the lead veterinarian. "Don't panic. Confident doctors will inspire confidence in their staff," Baker said.

"We teach the staff to remain calm. Being calm and reassuring the client that we are working with the pet immediately is important," said Jeff Rothstein, DVM, MBA, the president and owner of Progressive Pet Animal Hospitals and Management Group (a group of five hospitals in Southeastern Michigan). Before beginning work on the patient, Dr. Rothstein instructs staff to bring emergency patients back to the treatment area immediately. "It also keeps the rest of the hospital calm since we are somewhat removed from the rest of the hospital," Rothstein said. Once staff members complete a brief overview of the situation and relax the pet owner, they can return to reception to complete any necessary paperwork.

Not only will a calm attitude among the ranks reassure the client, it helps improve communication and therefore the pet's treatment. If stressed, staff members may hear instructions but not necessarily understand them. Communication should be clear and deliberate. "If we all just jump in, then an important step may get overlooked," Gross said.

Listen to the Client

Train your staff members to truly listen to the client—not just to learn how the case is presenting itself, but also to let the pet owner know they care.
"I believe the most important thing—aside from getting any pertinent historical information—is to ask, 'What happened?' and then listen," Baker said.

"The receptionist or an exam room assistant will usually stay with the client, seeing if they need anything, tissues, water, etc.," Baker said. "Asking the client if there is anyone [friend or family] they would like to call and giving them private access to a phone can be helpful." Work with your staff to develop a clear policy on allowing (or prohibiting) pet owners in the treatment area, even if the policy is determined case by case based on established circumstances.

"It really depends on the presentation," Baker said. "As long as pet owners do not interfere with the care of the patient, I personally do not mind them being there. I think in some situations, it can be helpful to the client to see we are doing everything possible for their loved one. Also, some owners are able to provide important history relevant to the presentation that guides diagnosis and treatment."

"Owners are always welcome to be on hand," said Peter H. Eeg, DVM, owner of Poolesville Veterinary Clinic, LLC in Poolesville, Md. "We treat the owner like a child's parent. They should be able to watch as long as they are not out of control."

Encourage your staff to be flexible. Some pet owners will want to talk to a staff member constantly, whereas others may want to be left alone in a quiet room.

Provide Information

No matter what the outcome of an emergency case, a pet owner will best remember how he or she was treated. Besides the medical responsibilities taken on by you and your staff, you'll want to assign the role of "communicator"—the person (or people) who keeps the pet owner informed of the pet's status.

"What works best for me is to make my initial assessment of the patient, then let the technicians know what needs to be done (oxygen, IV catheter/fluids, etc.). I am then free to talk to the owners about what I think is going on, what needs to be done and my best guess at the prognosis while the technicians get started on stabilization procedures," Gross said.

Rothstein will also send a doctor to see the client as soon as possible, with other staff keeping the client updated in the meantime. "The receptionists are also trained to provide comfort and answer concerns of the owner as best they can, or they may get a more appropriate staff member to help them," Rothstein said.

No Surprises

No matter how many emergencies your staff has seen, emergency training should be ongoing. Make continuing education, in-house seminars and hands-on equipment training available to your staff at least semiannually, Rothstein recommended. Also set aside time for full-scale role playing–possibly the best emergency training method. "Mock emergencies are a must so that you are prepared when the time does arise," said Pam Fettig, assistant manager of the surgery department at Angell Memorial Animal Hospital in Boston. "There are many people who need to be involved and different roles that need to be filled in an instant." Rothstein said it is essential for staff to be familiar with emergency care equipment and drug dosages.

"We have posted in the treatment/surgery area protocols for emergency care, correct procedure for CPR, and drug dosages for emergency drugs. Role playing is important because it puts this training into play," Rothstein said. It also allows you to identify your staff members' strong points and deficiencies. Gross uses roll playing to assign staff to positions that maximize their strengths and to create opportunities to develop new skills, "so everyone can be prepared when an emergency comes in."

Angela Davids is a freelance writer based in Baltimore and is a regular contributor to Veterinary Practice News.

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