Small Animal Small Animal Emergency & Critical Emergency & Critical

Care Medicine Care Medicine

Maureen McMichael, DVMMaureen McMichael, DVMDiplomate ACVECCDiplomate ACVECC

Texas A&M UniversityTexas A&M University

Emergency & Critical Care Emergency & Critical Care

Proposal - Independent SAECC Proposal - Independent SAECC Service - 2002Service - 2002

Three phasesThree phases Physical space/curriculum/consultingPhysical space/curriculum/consulting Emergency receiving serviceEmergency receiving service Critical Care serviceCritical Care service

Phase IPhase IPhysical SpacePhysical Space

Design and build new 3,000 sq ft ICUDesign and build new 3,000 sq ft ICU Old ICU too smallOld ICU too small

Need for ICU protocolsNeed for ICU protocols Need for critical care monitoring Need for critical care monitoring Need for POC testingNeed for POC testing Need for ECC in curriculumNeed for ECC in curriculum

Phase IIPhase IIEmergency Receiving ServiceEmergency Receiving Service

Receive all incoming emergency casesReceive all incoming emergency cases Transfer all stable cases to appropriate Transfer all stable cases to appropriate

service the following weekdayservice the following weekday ECC student rotation with didactic roundsECC student rotation with didactic rounds ECC student manual ECC student manual

Phase IIPhase IIEmergency Receiving ServiceEmergency Receiving Service

BenefitsBenefits Students – ER rotation, rounds, sleepStudents – ER rotation, rounds, sleep Interns & ResidentsInterns & Residents Clinical Services – IM, surgery, oncoClinical Services – IM, surgery, onco Local VeterinariansLocal Veterinarians Local ClientsLocal Clients Hospital IncomeHospital Income

Phase IIIPhase IIICritical Care ServiceCritical Care Service

Separate CC service that takes trauma, Separate CC service that takes trauma, toxins and all critical case transferstoxins and all critical case transfers

Separate student rotationSeparate student rotation Residents and interns – experience with Residents and interns – experience with

complex critical casescomplex critical cases

Phase IIIPhase IIICritical Care ServiceCritical Care Service

BenefitsBenefits Students – CC rotation, roundsStudents – CC rotation, rounds Interns & ResidentsInterns & Residents Clinical Services – relieve caseload Clinical Services – relieve caseload Local Veterinarians – case continuityLocal Veterinarians – case continuity

Resources NeededResources Needed

Full Plan – implement in stagesFull Plan – implement in stages 4-5 ECC faculty (2-3 ER, 2-3 CC) 4-5 ECC faculty (2-3 ER, 2-3 CC) 3 ECC residents3 ECC residents 1 dedicated ECC intern1 dedicated ECC intern Continued rotation – house officers Continued rotation – house officers 6 Students (3 day and 3 night)6 Students (3 day and 3 night)

Where Are We Now?Where Are We Now?

Physical SpacePhysical Space ICU protocols, POC testing, etc.ICU protocols, POC testing, etc. CurriculumCurriculum

Emergency Receiving ServiceEmergency Receiving Service Critical Care ServiceCritical Care Service

Phase IPhase IPhysical Space Physical Space

Old ICU New ICU

New ICU – 3,000 sq ftNew ICU – 3,000 sq ft

Phase IPhase IPhysical SpacePhysical Space

EquipmentEquipment VentilatorVentilator Monitoring equipmentMonitoring equipment PyxisPyxis

ProtocolsProtocols For technicians, for internsFor technicians, for interns

Phase IPhase IPhysical SpacePhysical Space

CPCR protocolsCPCR protocols Constant rate Constant rate

infusions – infusions – analgesiaanalgesia

Phase IPhase IPhysical SpacePhysical Space

ICU treatment ICU treatment sheets – prompts sheets – prompts for studentsfor students

Emergency drug Emergency drug dosages – every dosages – every animalanimal

Phase IPhase IPhysical SpacePhysical Space

Point of care Point of care testingtesting

Rapid results – 1 Rapid results – 1 minute, 14 testsminute, 14 tests

Blood gas – Blood gas – teaching, patient teaching, patient care care

Phase IPhase ICurriculumCurriculum

First year CPCR, Respiratory physiology First year CPCR, Respiratory physiology laboratorieslaboratories

22ndnd year – CPCR lecture, labs year – CPCR lecture, labs 33rdrd year – Clinical Skills lab year – Clinical Skills lab 33rdrd year – 5 didactic ECC lectures year – 5 didactic ECC lectures 44thth year – ER rotation year – ER rotation ER student rotation manual ER student rotation manual

Phase IIPhase IIEmergency Receiving ServiceEmergency Receiving Service

mid-October 2004mid-October 2004 No marketing No marketing

outside local outside local BVVMA BVVMA

Case load up Case load up significantlysignificantly

ER income up ER income up significantlysignificantly

ER Cases and Fee RevenueER Cases and Fee Revenue

YearYear OctOct NovNov DecDec JanJan

ER ER caseloadcaseload

20032003 164164 164164 204204 107107

20042004 212212 275275 344344 232232

ChangeChange +48+48 +111+111 +140+140 +125+125

ER FeeER Fee 20032003 12,28312,283 12,27712,277 15,26915,269 7,2507,250

20042004 15,91215,912 20,66220,662 25,83425,834 17,21717,217

ChangeChange +3,629+3,629 +8,385+8,385 +10,565+10,565 +9,967+9,967

Phase IIPhase IIEmergency Receiving ServiceEmergency Receiving Service

Marketing PotentialMarketing Potential ER MagnetsER Magnets RDVM phoneRDVM phone Advertising/PRAdvertising/PR ECC RDVM conferenceECC RDVM conference Ross studentsRoss students

Where Are We?Where Are We?

Phase I – CompletedPhase I – Completed Phase II – Very successful – growth Phase II – Very successful – growth

potentialpotential Phase III – If ER continues to grow - Phase III – If ER continues to grow -

need a CC serviceneed a CC service Resources??????Resources??????

Davis Davis

ERER

MSU MSU

ERER

TuftsTufts

ERER

ER ER cases/yrcases/yr

15001500 40004000 90009000

ECC ECC facultyfaculty

33 33 66

ECC ECC residentsresidents

44 1/31/3 99

ECC ECC internsinterns

-- 22 55

ECC ECC DVMsDVMs

33 -- --

Resources NeededResources Needed

Davis Davis ERER

MSU MSU

ERER

Tufts Tufts

ERERTAMU TAMU ERER

ER ER cases/yrcases/yr

15001500 40004000 90009000 36003600

ECC ECC facultyfaculty

33 33 6/76/7 11

ECC ECC residentsresidents

44 1/31/3 99 00

ECC ECC internsinterns

-- 22 55 00

ECC ECC DVMsDVMs

33 -- -- 00