5 ways to work smarter

Chaos. That's your first thought as you glance around your practice. Lisa's trying to explain Max's home dental care while Max enthusiastically greets his distracted owner. Carrie can't find the special diet Rex needs, and Mrs. Smith is calling to check up on Butterball but no one can find the patient record. And you can't wait until the clocks strikes 6 p.m. so you can finally sit down already.

There's an easier way to work, whether you're a staff of one or 100. Let's look at five of your top efficiency issues and examine some tools and advice for practices of all sizes.

1. Managing inventory

CHALLENGE: Recording, tracking, and ordering prescription medication and supplies

SOLUTION: Use your inventory tracking program in your practice management software, and visually review your stored supplies to track the inventory in front of you, says Pam Stevenson, CVPM, a consultant with Veterinary Results Management in Durham, N.C. Also take advantage of the inventory management services your distributor offers, she says.

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Start by creating a protocol for when to place product orders. For profitability, your inventory should turn five to seven times a year. A strong relationship with a distributor and some savvy negotiating with your representative will earn you the best service and pricing. There's little cost savings in chasing the best prices of the week.

And dedicating space to a central storage area is worthwhile, Stevenson says. When you store supplies in a single location, you're less likely to order the wrong amount, and it's easier to track what you've got. An organized central storage area can save hundreds or thousands of dollars a year. If you don't have a central space to devote to supplies, group the full supply of an item in one place.

If you're a small practice and you don't use software, consider this tip: Find a centralized location where you can hang a list that tracks the medication and supplies the practice needs to reorder. When you take the last of an item, add it to the list. This tells your inventory manager what she needs to reorder.

And make sure your inventory manager understands how you use all medication and supplies, says Caitlin Rivers, a Firstline Editorial Advisory Board member. Rivers, a veterinary assistant and inventory and special projects coordinator at Metzger Animal Hospital in State College, Pa., says it also helps if your inventory manager understands the practices' trends for using specific products.

In larger practices, it's a good idea to assign one team member to order and track the practice's use of each category of supplies, such as medication or housekeeping products, says Nancy Potter, a Firstline board member and the practice manager at Olathe Animal Hospital in Olathe, Kan. This helps distribute the workload of an otherwise overwhelming task in a large practice.

A bonus: When you devote a team member to one category of supplies, he or she learns more about those products. For example, the team member responsible for pet food can track when new prescription diets are available and any promotions the distributor offers.

2. Tracking hospitalized patients

CHALLENGE: Tracking patient care and communicating patient information to team members and clients

SOLUTION: To help effectively track your team's care of hospitalized patients, consider these tips:

• Assign pets to team members at the beginning of a shift so they can follow pets' care and provide owners detailed updates. Then tell clients when they drop off their pet who will monitor the pet's care so clients know who to ask for when they call for updates.

• Use forms to document the care the pet receives and the supplies you use to perform those services during the pet's stay. For example, you'll use patient treatment forms to chart patients' activity, such as walks, fluids in and out, and blood pressure—especially for patients receiving intravenous fluids. Then you'll use the forms to document charges, bill clients accurately, and bridge the communication gap shift changes can cause.

• Make rounds. In a small practice, making rounds means reviewing what's going on in the practice, such as which team member is leaving her shift early, and monitoring hospitalized patients.

In a large practice, you may use doctors' and technicians' rounds. Doctors' rounds should focus on the pet's prognosis and plan. For example, the doctor may explain the diagnosis and prescribed treatment and solicit input from other doctors. Technicians' rounds should focus on carrying out doctors' orders and monitoring pets' emotional state. To make the technician's job easier, doctors should include technicians in their rounds. This way, technicians learn first-hand the diagnosis and treatment plan the doctor recommends.

• Input care into patients' records. The best person to enter charges and update patient records is someone who participated in the rounds or helped provide the patient's care, such as a medical records specialist or a technician. It's important to update the records during or immediately following rounds. While the doctor should call owners of hospitalized patients once a day to update them on their pet's condition, these clients are likely calling the practice more, and updated medical records will allow any team member to answer pet owners' questions.

This is also a good time to enter and verify charges for the corresponding invoice. The care you've provided is fresh in your mind and you're more likely to accurately capture all treatment, lab work, and medication administered.

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3. Updating patient records

CHALLENGE: Maintaining complete medical records by documenting lab results, communication with clients, services clients request, and other critical data

SOLUTION: Team members should document their care using standard abbreviations when they perform a service or speak to a client. Then they should sign the record electronically or manually with the month, day, and year. This includes all treatments, diagnostics, and conversations regarding the patient, including those with clients, pathologists, and specialists. Following this protocol helps the whole team understand and track patients' care. "We know who's talked to the client, because our software requires each team member to log in and it attributes changes to the user," says Susan Harr, the practice manager at Cloverleaf Animal Hospital in Westfield Center, Ohio.

A smaller team means it's more difficult to maintain complete patient records when a team member's out sick or on vacation. So use a checklist to capture all related activity for the records. This way it's easier to catch up when you're fully staffed.

Some practices designate bins to track the activities and the status of patients' records, including pet owners the doctor needs to call. The team at Cloverleaf Animal Hospital uses a bin to collect lab work team members need to record in patient files. They've also designated an area where doctors and technicians can complete patient records.

This is also critical in larger practices, where the volume of records and number of people who work on them increases the chances you'll miss information or misplace records. "Any time you spend searching for medical records is time away from client service and patient care," Stevenson says.

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4. Avoiding missed charges

CHALLENGE: Capturing services rendered for inpatient and outpatient visits

SOLUTION: Devote one or more team members to managing medical records and capturing fees. Pam Weakley, a Firstline board member and the practice manager at Dickman Road Veterinary Clinic in Battle Creek, Mich., explains why this step is important: At her practice, doctors used to work from memory to create invoices for clients on the day of the pet's discharge. And instead of itemizing the drugs the team administered, the doctors would add a general medication line item and attach a price much lower than the actual cost.

"We couldn't believe the difference in bills once we took the responsibility out of doctors' hands and put it in the hands of our technicians, who provide most of the day-to-day care," Weakley says. Average invoices for hospitalized patients once ranged from $150 to $175. When technicians started invoicing, the average increased to $200 or more. "We were amazed how many charges we used to miss. And clients never flinched at the higher bills. With the itemized invoice, they see exactly where their money goes," Weakley says.

If you're a small practice, it may not be possible to devote one team member to this role full-time. So managing medical records and capturing fees should be one of the responsibilities on the daily checklist the team works together to complete. The person who performs the care will mark the charges on the travel sheet. Then the receptionist will compare the travel sheet or medical record with the corresponding invoice to make sure you capture all charges.

If you're a large practice, you may be able to support a full-time team member to manage medical records and capture fees. Most often, the office administrator, a technician, or a senior receptionist fills this role, but any team member can assume these responsibilities. She must understand basic hospital finances and be able to review travel sheets and medical records and know what aspects of the care are billable, Stevenson says.

This team member will compare medical records with the corresponding invoices and look for missed charges so she can educate the rest of the team about the services or products that are most often forgotten. She should also examine patient records for other opportunities to continue pets' care. For example, she should note pending recommendations as well as examine breed and age and list preventive care and diagnostics the doctor might recommend.

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5. Streamlining discharge appointments

CHALLENGE: Ensuring thorough, effective discharge visits, including scheduling return and follow-up appointments and communicating care with clients

SOLUTION: Schedule the discharge appointment at drop-off or during the post-surgery or treatment call. And make sure the team knows when to expect clients so their pet's ready when the owners arrive.

Then consider pre-discharge appointments to shorten in-person visits. The team e-mails or faxes clients a discharge summary relaying everything you would—and still can—address in the discharge visit, including home care instructions and even the payment due. Clients review the summary and then the doctor or discharge team member calls clients to answer any questions. This can limit the in-person visit to payment and picking up the pet and reduce congestion at the front desk. If clients prefer traditional discharge appointments, they can discuss the discharge summary they received earlier at their in-person discharge visit.

It's key pets stay out of sight until their owners have checked out to minimize distractions, Stevenson says. She recommends team members wait until the receptionist signals she's finished with the checkout process.

Weakley agrees. "Once clients see their pet, we lose 'em. The dogs are thrilled to see their owners, and vice versa. You can actually watch clients shut down and stop listening to what we're saying," she says.

To speed up less involved visits that don't require discharge instructions or an explanation from the doctor, such as grooming or boarding visits, consider an express checkout option. When clients arrive, a team member retrieves the pet and waits for the receptionist's signal. Clients leave their credit card information and signature on file and sign an agreement that gives the practice permission to automatically charge the credit card according to the terms of the agreement. Then, if the pet requires a follow-up appointment, team members contact the client later by e-mail or phone. Of course, you'll only extend this option to established clients who visit often.

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If you're a small practice, assign discharge duties to team members whenever possible. This allows the doctor to concentrate on medical care and team members to focus on client and patient service.

If you have more doctors or longer business hours, there's a chance the doctor assigned to the patient's case has left for the day or hasn't arrived yet when the pet is discharged. So consider pre-discharge appointments that allow clients to speak with the doctor during the follow-up phone call, and let team members discharge pets.

Implementing these specific protocols will help improve your efficiency, and educating team members and enforcing high standards can address these common practice problems from the top down, Stevenson says. When you share information and everyone completely understands their responsibilities and they're held accountable, you're poised to deliver consistent, professional client service and patient care.