Treatment room quarterback (Proceedings)

Have you ever stopped to think about how organized (or disorganized) the treatment area in your hospital truly is? Has an animal ever been admitted into the hospital for a procedure but you didn't realize that it was there until the owner came by to pick it up? How about having that dog in for a dental prophy/polish, and after everything went smoothly and the dog is already fully recovered from anesthesia, you discover that the dog's owner also wanted you to remove that little growth on the belly? Or, how often have you had to fight with a nasty cat (you know the one which makes you wonder why you ever went into this field in the first place), coax it into the induction box (getting thoroughly clawed up in the process), anesthetize it, perform whatever minor procedure it came in for, then, after it has recovered (and hopefully you have too) and is back in its cage you realize that it was also due for its vaccines? Well, don't feel too badly because these things have happened in all of our practices at one time or another. Naturally the larger and busier practices experience these problems even more often.

I'm sure you've all heard the expression that "too many cooks spoil the broth?" This is exactly why these mistakes happen in most veterinary hospitals–there are simply too many people in charge and there's either too much, or not enough, overlap. What happens to a patient and the patient file in your hospital when the pet is brought back to be admitted? Is the procedure different if the animal is admitted by a doctor than if it is brought in as a drop-off? Who, or better yet, how many different people are allowed to place admitted patient records in the file rack? If more than one person has this responsibility, you are looking for trouble! Think about who is allowed to re-file a book pulled off of a shelf in a library–certainly not you!

I discovered a great and simple solution to this problem that has plagued many veterinary hospitals for years, and I refer to it as the Treatment Area List Person. This "person" is sort of like the director or manager of the hospital's main treatment area. In a busy practice it is definitely a full-time position and should be filled by someone who has a lot of technician experience. This person handles every file that comes through the back of the hospital–whether it belongs to an animal being admitted for hospitalization, surgery, grooming, or boarding, or even if the file is being brought back for a medication refill. Our list person sits by a computer in our main treatment room just adjacent to our file rack and our large erasable "treatment board." To the right of the computer terminal is our "in" box, where all records are placed in order to be "processed" by our list person. Except for those files which have already been processed and are already in the appropriate location in the file rack, the list person is the only person who is allowed to place a newly admitted file into the rack–and that includes you, the doctors!

Now, let's go through the "mechanics" of this position. Naturally, as the name implies, the list person has to have a "list" on which to process all the files. We consider our list the daily "instruction manual" as it lets us know every animal in our hospital and why they are in. Every single service that needs to be performed on that animal will be on that list. In fact, any animal may appear on the list more than once depending on what services are to be performed, if you are using a "treatment category" based list, or multiple categories can be listed after a particular pet's name if you elect to use a "name" based list. The list categories are: Dr. Exam, Tx, Surgery/Anesthesia, Minor Procedures (dentals, minor surgeries, etc.), Vaccines, Lab, X-rays, Bathing/Grooming, and Tech Exam/Treatments. The list person not only makes the entries, but also organizes the surgeries, cross references the procedures in case an animal is in for many different reasons, writes down any treatments or special instructions on the treatment board, then files the record in the file rack in the appropriate location. Our file rack is divided into sections for boarding, bathing/grooming, surgery, minor procedures, hospitalization (main ward, cat ward, and isolation), and home. The list person also coordinates the surgeries with the doctors so we can plan our anesthesias and the technician schedules. It is important to note that any time a doctor or a technician takes a file out of the file rack to make any change in treatment or case management plans, that file must go back into the "in" box with a note that changes have been made, or be handed in person to the list person to let him or her know of the changes.

The last responsibility of the list person is preparing the patient files for discharge. This includes entering all the services and charges into the computer, preparing any medications and discharge instructions, and coordinating the discharge with the front office. Any late pick-ups also need to go through the list person to make sure that all meds and instructions will be ready.

Now that you have a better understanding of the "list" and the "list person" let's go through a typical day to illustrate a working example. The first thing the list person does in the morning is to start on the day's list. He or she first goes through all the records in the file rack (remember, these animals are all in from the night before as no new records can be processed by anyone else), enters them onto the "list," rechecks their entries on the treatment board, and if they will be going home, will prepare the file for discharge. As this is being done, animals are coming into the hospital either by drop-off or by a doctor admission, so the "in" box is filling up with new files. One by one the list person processes these new files appropriately then places them in the correct section in the file rack. He/she double checks the computer on each file for vaccine dates, and anytime an animal is in for any anesthetic procedure, also checks the file to make sure there is nothing else that animal may need to have done while under anesthesia. For surgery cases, the list person is responsible to make sure the patient's cage cards have an NPO sticker on them. By late morning the list is usually completed and the days' tasks coordinated so the list person's attention shifts to preparing records for hospitalization (ward assignment, medication/treatment instructions, diet instructions etc.) or discharge (charges, medications, discharge instructions).

It should be very clear now why the problems that we used to experience are now a thing of the past. We no longer "miss" patients because their files have to go to only one place–the "in" box, for processing by only one person–the "list person." Since the list person reviews each file and is aware of every change or addition to a treatment plan, we no longer miss those little "add-on" procedures when animals are anesthetized. And lastly, since the list person checks the vaccine status on each patient and coordinates all of the procedures due on any one patient, those very nasty cats or dogs get everything done to them that is due or necessary while they are under, or at least recovering from, anesthesia–and not once they've completely recovered.

We have a very busy three doctor practice where we see on average over 70 cases a day, and with the list person in operation everything goes smoothly, efficiently, and timely with little to no mistakes. This is a great way to organize the treatment area of your hospital, keep you and your doctors happier, and help make life easier for everyone!