Preanesthetic Testing Why Mandatory Makes Sense 2004 IDEXX

Preanesthetic Testing: Why Mandatory Makes Sense © 2004 IDEXX Laboratories, Inc. All rights reserved. 2423 -00 (2) 1

Overview—Preanesthetic Testing • Why test? • Why make testing mandatory? • How to implement a program in your clinic 2

Why preanesthetic testing? 3

Why Test? Pets are at risk “For a 12 -test profile, approximately 46% of all clinically normal animals will have at least one abnormal test result. ” Alan Rebar, DVM, Ph. D, DACVP and Fred Metzger, DVM, DABVP There are hidden abnormalities in one out of every two patients of all ages. Rebar A, Metzger F. Clinical pathology for small-animal practitioners: Interpreting the hemogram. Vet Med CE Advisor. 1996. 4

Why Test? Updated research: importance of testing Study 1 • 11% delay of surgery • 84% compliance in first 6 months (optional) • Only 2 clients objected in last 18 months (mandatory) Study 2—Program Mandatory • 10. 1% delayed surgery • 21% changed anesthetic approach or delayed procedure All in apparently healthy animals of all ages. 1. Irwin J. Preanesthetic program can be standard in delivery of quality care. DVM Newsmagazine. November 1998. 2. Irwin J. Do tests first: Presurgical blood work may eliminate a variety of surprises. DVM In Focus. November 2003. 5

It’s Quality Medicine Why Test? Sulphur Springs Veterinary Clinic, Irwin Study 1996– 1998 Diagnoses and Conditions Total Portosystemic shunts 2 Diabetes mellitus 3 Kidney disease 6 Liver disease 5 Anemia 6 Thrombocytopenia 4 Hypokalemia 18 Hyperadrenocorticism 1 Hyperthyroidism 2 Hypothyroidism 6 FIV/Fe. LV 4 FIP 2 n = 542 Irwin J. Preanesthetic program can be standard in delivery of quality care. DVM Newsmagazine. November 1998. 6

It’s Quality Medicine Why Test? Sulphur Springs Veterinary Clinic, Irwin Study 2003 Abnormalities Total ALT increased 11 ALKP increased 18 BUN increased or decreased 16 Creatinine increased 5 Glucose increased or decreased 7 Total Protein increased or decreased 11 Sodium increased or decreased 18 Potassium increased or decreased 16 Chloride increased or decreased 11 Neutrophils increased or decreased 9 Hct decreased 12 Lymphocytes increased or decreased 10 T 4 increased or decreased 15 n = 128 Irwin J. Do tests first: Presurgical blood work may eliminate a variety of surprises. DVM In Focus. November 2003. 7

Why Test? Wouldn’t you want it done for you? • Determine full health picture of pet— physical exam alone is not comprehensive • Choose appropriate anesthetic agent and ensure rapid recovery • Provide baseline data • Provide peace of mind to client and staff 8

Puppies and kittens are equally at risk Why Test? “Preanesthetic screening is imperative for puppies and kittens. Most often the preanesthetic diagnostic screening is the first comprehensive look we have at the pet’s health. It is at that time we can assess the pet for common breedspecific ailments, as well as gather solid baseline data for the future health care of the pet. ” Ernest Ward, Jr. , DVM Seaside Animal Care Calabash, NC 9

When you test,

Why make preanesthetic testing mandatory? 11

Why make it mandatory? “We don’t ask clients what type of anesthetic to use, we recommend what’s right for their pets—we’re the experts. So why should we offer them a choice of blood work? ” Fred Metzger, DVM, DABVP Dr. Fred Metzger, Metzger Animal Hospital, State College, PA 12

Why make it mandatory? It makes workflow easier Reception • Faster registration/drop-off • Simplified process—no forms Technician • Uniform policy for lab work • Eliminates “this one wants testing, this one doesn’t” Doctor • No more convincing • More time to focus on the patient work-up Clinic • Higher standard of care, better service, increased client loyalty • Creates comfort in client discussions clinic-wide 13

Why make it mandatory? Your clients want it Pet parents look to you for advice on what’s right • 78% of dog owners and 71% of cat owners say veterinarians are their primary source of information 1 Clients won’t leave you • In his first 18 months of mandatory preanesthetic testing, Dr. Irwin only had two clients object to it. 2 1. Ralston Purina. The state of the American pet: A study among pet owners. October, 2000: 53. 2. Irwin J. Preanesthetic program can be standard in delivery of quality care. DVM Newsmagazine. November 1998. 14

How to implement preanesthetic testing in your practice 15

How to implement Tips for success • • • Follow the protocol Involve the entire staff Use the tools Communicate with your clients Believe in what you’re doing 16

Staff roles How to implement Everyone plays a part 17

How to implement OK, it’s mandatory… what do I test? • Age-specific testing • Additional tests based on specific animal • Get the whole picture—chemistry, hematology, electrolytes, etc. • Plasma for efficiency 18

Conversations with clients How to implement Puppy/Kitten visit Discuss preanesthetic testing—clinic policy, gravity of anesthesia, need for testing, baseline data New client call back Make recommendations about how best to choose a clinic—including clinic tour, Web site visit and asking about preanesthetic testing, pain management, etc. Older pet, existing client Discuss procedure—advances in veterinary medicine, the gravity of the pending procedure, risks, etc. 19

How to implement Tools Client Materials • Client brochure • Good News pad • Results printout Clinic Tools • Run Preanesthetic Testing stickers • Discussion guides • Common objections 20

How to implement Always communicate with your clients Preanesthetic testing is important… • • • Pets can’t talk Human connection Standard of care for all pets Gravity of procedure Baseline data 21

Summary—Preanesthetic Testing is important • Pets are at risk • Considered a standard of care Make testing mandatory • Clients want it • Easier workflow Implementation • Involve the entire staff • Communicate with your clients 22

How to implement Good Luck! • Work as a team to gain momentum in the program. • Success will leave you confident in knowing that you offered each pet the best care possible. 23

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How to implement Run plasma to increase efficiency • Vet. Test and Vet. Lyte both run plasma • Results in 8 minutes, you can quickly let owners know if their pets are ready for surgery “Customers are 2 times more likely to agree to follow recommendations when presented with written lab work. ” Jim Irwin, DVM Sulphur Springs Animal Hospital 25