Doing more with less: working more effectively–part 2 (Proceedings)

What Does it Mean to Work "Smarter"? (cont'd)

15. Take advantage of the individuals who want to volunteer in your practice.

     • Let them take care of:

     • Plants

     • Laundry

     • Exercising pets

     • TLC post-op

     • Cleaning cages

     • Sweeping hair in the middle of the day

     • Greeting clients and pets

     • Overseeing a client hospitality center

16. Use readily available organizational aids like:

     • In/out board

     • File organizers

     • Flip signs for exam room doors to indicate occupancy

     • Drawer organizers

     • Mail boxes for all staff

     • Lockers for team members

     • Cabinet for extra office supplies

     • Dry marker boards — inpatient needs, medications for patients, surgery patients and their procedures

     • Cage cards

     • Patient ID necklaces

     • Cage caddies

17. Drug/fluid dosing tables

There are so many calculations to be made during a typical day in a veterinary practice — antibiotic doses, fluid flow rates, anaesthetic and analgesic doses. Every time someone makes a calculation there is a chance for a mistake. Unfortunately, even a small miscalculation can spell disaster for an animal patient.

For commonly used medications — e.g. anaesthetic agents, CRI drugs, euthanasia drugs — consider creating files in Microsoft Excel that show volume doses of drugs in 0.2 # increments. Having these doses pre-calculated eliminates an important risk for miscalculation.

Place the printed materials into page protectors in a 3 – ring binder in a central location in the treatment area. Make two notebooks if you need to. The key is to make it easy for everyone to do things absolutely correctly.

18. Label drawers & cabinets in your treatment area.

Precious minutes can be wasted looking for what you need to assist a patient. It will take only a short time to up-shift the organization of the treatment area to make it much more "user friendly". The timesavings will make the time investment in labeling well worth the effort. Use drawer organizers wherever possible to facilitate finding what you need.

19. Use laminated erasable travel sheets.

Most veterinary software companies have travel sheets programmed into them. Travel sheets have columns of the practice's service codes (without fees) on them for the nurses and veterinarians to circle. All services that are rendered are circled on the sheet for the receptionist to enter by simply glancing at the form. Either laminate the sheet or place it into a plastic page protector. Then use overhead projector pens for marking.

20. Save time with patient report cards and other no-carbon-required forms.

Patient report cards are a terrific time-saver in the exam room. Two pages, no carbon required, write once and everything is recorded for the medical record and for the client. There are multiple report card options out there, so find one that fits your style or create your own by composite. Include body "maps" for showing vaccine injections as well as marking tumors and other lesions. Record what the client is feeding the pet, your findings, and your recommendations.

Consent forms and discharge orders are additional examples of a great use for 2-page no-carbon-required forms in a busy practice. These allow you to write once and provide both the client and the practice with a copy of this important information.

21. Print two copies of your prescription labels — one for the amber vial and one for the medical record.

Be certain to check the pharmacy law in your particular state, but in most states the details of a prescription must be recorded in the medical record as well as on the label for the medication container. The prescription details for the medical record should include the medication, strength, quantity, dosing size and interval, as well as route of administration. Rather than writing all those details in the record by hand (or by dictation and subsequent transcription), how much easier is it simply to print a second copy of the label and place it into the hard copy of the record?

There are several advantages to using an extra prescription label this way, including huge timesaving for team members, as well as increased accuracy in the recording of medications in the chart.

22. Place "Special Diet" stickers on the fronts of medical records.

When nutrition is an important part of your practice, your team members will make specific nutritional recommendations to clients. Once you convert clients to using the specific product you recommend, make it easy on all parties to remember what food that is. The special diet sticker allows you to record the particular product on the front of the medical record for all to see. When the client comes in and can't remember what the label looks like, any member of the team can simply look on the folder and remind them.

Stickers on the records save everyone time. Heartworm stickers record the date of the most recent heartworm test and the type and strength of the pet's heartworm prevention. Use stickers for insured pets, microchipped pets, to indicate whether the pet is male or female, as well as particularly medical conditions — diabetes, chronic renal failure, hypothyroidism, etc.

23. Create checklists of topics to be covered during examinations.

Standardize the client education experience in the examination room by creating checklists of topics that support team members and doctors will follow. These lists will vary depending upon the profile of the particular patient. It streamlines the client's time in the exam room, streamlines the doctor's and veterinary nurse's time, and ensures that important subjects will not fall through the cracks.

24. Regularly scheduled call-back times

Few things are bigger time wasters than playing "phone tag" with clients, vendors, and other veterinarians. Create a time slot (or two) each and every day for your veterinarians to spend uninterrupted time making their necessary callbacks. You will need to be a bit flexible in order to accommodate those clients who cannot be available at the proposed time. So be it. For the most part, you will find that scheduled callback times work very well.

25. Assign one person to be in charge of:

Inventory — Ordering drugs and supplies should not be a doctor duty.

Surgery/pack prep — Surgery packs need to be prepared precisely as the doctors desire. Sterilized packs, drapes, and instruments need to be rotated on a regular basis and re-sterilized as needed. While all the nurses and treatment staff need to know how to process pack prep supplies, give a single person the authority and responsibility to ensure that it all works smoothly.

Log books — Your x-ray log, anaesthesia log, internal laboratory log, external laboratory log, etc. need to be completed and kept up to date. Assign specific individuals to be in charge of each of the logs for the practice. Have these team members review the logs with you periodically.

26. Train clients to call ahead for prescription refills.

Every veterinary practice has patients on chronic use medications — Rimadyl, phenobarbital, thyroid replacement hormone, etc. One option is for the client simply to show up and ask for a refill, never mind what might be going on in the hospital at that time. This means that some member of the team must drop what he or she is doing in order to fill the prescription. Otherwise the client must sit around and wait to get medications. Often we are taking a team member away from a client and patient who have a scheduled appointment and should be able to count on the doctor and nurse's uninterrupted time and attention. It is much easier on all parties to have clients call ahead for their prescription refills.

This saves the clients time. They make a call and find out when the medication will be ready, allowing them to schedule their own time more efficiently and pick the medication up when it is convenient for them.

This saves the receptionists time. They can review the medical record, the refill requested, the strength, and the dosing interval over the phone with the client. If there are any discrepancies, they may then review the chart with the doctor to clarify what should be happening with the pet's medication. The receptionist can do this legwork at his or her convenience, and not with the client waiting in the reception area.

This saves the doctors time. If there is a problem with a medication or if information needs to be clarified before the prescription is refilled, the doctors are not being interrupted during regularly scheduled appointments.

This saves the veterinary nurses time. They are generally the ones to prepare medications. If clients call ahead for prescription refills, the nurses can schedule their own time in order to get medications ready — around their existing time commitments.

27. Create and use call back flags in the practice software for contacting clients and maximizing compliance.

"Recheck, recall, remind" are the "3-R's" of increasing client traffic. Recalls are a great way to keep clients on task with medications that must be given, laboratory tests that must be done, and maximizing compliance for scheduled follow-ups, to cite but a few examples.

The cards are filled out at the time of the decision that there must be follow-up. The client information, date for the call, and reason for the call back is listed. The card then goes into a card file for the appropriate month. These can also be logged via computer. One use of call back cards in our practice is to provide courtesy calls to our clients who request them for giving HeartGard every month. This simple task gives us an opportunity to dramatically increase our clients' compliance with heartworm prevention.

28. Use a centrally posted Year-at-a-Glance calendar for scheduling staff absences, CE training, etc.

Get your team involved in scheduling their time away from the clinic by posting a large Year-at-a-Glance calendar in a central location. Use a fine-point permanent marker to mark team members' times to attend CE training, take personal days, and go on vacation. Time away needs to be cleared through the appropriate individual, but a posted calendar allows every team member to see easily what times have already been assigned. The calendar also provides gentle reminders of those times when team members will need to help each other out when they will be short-handed.