Appointment Work Flow
What time do rounds happen?
9-10 a.m.; sometimes 4 p.m. in the afternoon
What documents does EVERY appointment need?
- Hx + PE document
- PHC walkout summary
When do you sign up for these?
Weekly on Thursday
How would you reduce stress in a patient you are about to examine?
- Bring all items into room that you need
- Minimize entry/exit
- NO SCRUFFING
- Lots of treats!
- Towels/Feliway for kitties
What must you NEVER do to a feline patient?
Scruff them! (if you feel the need to do this, ask for help)
How many students should sign up for an appointment? When does this sign-up occur?
Daily around 4 p.m.; 2 students per appointment
Where do you write/input the history and physical exam?
Type directly into PE/hx form while taking hx from owner and performing physical exam; can get student buddy to be a scribe!
How many students per case? What about Tuesdays?
2 students per case; 3 on Tuesdays if we have enough students
What are the core vaccines for dogs and cats?
Dogs: Rabies + DHPP
Cats: Rabies, FVRCP, FeLV for kittens
What do you need to sign up for today?
- Apts (today and tomorrow)
- Procedures for the week
- Journal club
- Case presentations
- Lab call-backs (on the call-back board)
What do we use to make estimates?
Quick estimate sheet + our technicians
Where does the TPR go?
In the TPR section (heart button)
What has to get approved and set up before procedure day? What other documents do you need?
- Anesthesia plan
- Anesthesia induction station in treatment area
- ER drug sheet (on ELC)
- Anesthesia check list
- Recovery sheet
Who do we test for heartworm disease and when?
Dogs: Yearly if on prevention routinely; q6mo if gaps in prevention or change in meds
Cats: Not needed if healthy; test if clinical/indicated on x-rays
What else must you complete while on block?
- Communications peer review
- Fear free certificate
Describe the timeline of an appointment (how long should each step take)?
First 10 min: notify your tech that P is here; put P and O into exam room
10-20 min: Take a history; tech to get TPR, weight; start collecting blood/urine samples PRN
20-30 min: PE
30-35 min: Collect your thoughts; present to doctor
35 min: Dr. to do exam; finalize plan with O
45 min: Perform treatments/diagnostics with technician assistance; dismiss O
Write the assessment for the following patient:
- 5 yo FS doodle with an ear infection; you did an ear cytology, gave Claro, and instructed the owner to recheck in 3 weeks
- Otitis externa - yeast and cocci seen on cytology; Claro applied AU; recheck in 3 weeks
Describe the flow the morning of a procedure.
- Intake patient b/w 7:30-8
- Confirm: recent history and medications, what blood work you are performing that morning, any other additions to the procedure/estimate needed
- Perform PE yourself and then with Dr.
- Update procedure technician on what all needs to be done
- Tech to pre-med while you're in rounds
What wellness care should this patient receive? Can they get a 3-year rabies this year? What about next year?
7 yo FS DSH. Indoor/outdoor. Last vaccinated for Rabies at 4 yo. Has never received an FVRCP. Not recently FeLV/FIV tested.
- This year: 1-year Rabies vaccine, FVRCP vaccine today and in 3 weeks (also could be 1-year), FeLV vaccine today and again in 3 weeks, FeLV/FIV test, offer BW, UA, T4
- Next year: 3-year Rabies, 3-year FVRCP, 1-year FeLV, FeLV/FIV test, BW/UA/T4
What time do you need to arrive in the mornings?
7:30 a.m.
...Even if you don't have a drop-off appointment yourself, there may be early-morning add-ons or your classmates may need help
Describe overall appointment flow from beginning to end.
- Notify tech of appointment's arrival
- Gather the chart, choose/set up an exam room
- Press "record" button to record your intake + fill out clip board by exam room
- Place O and P in room - get history, PE, etc.
- His "stop recording" button
- Present case to Dr.; come up with plan
- Execute plan
Write the assessment for the following patient:
- 10 yo FS DSH presenting for vomiting; the client declined advanced diagnostics today, but you suspect IBD; you started the patient on steroid therapy and a hydrolyzed diet and instructed the owner to recheck in 2 weeks
- Vomiting - r/o IBD vs. lymphoma vs. other; started prednisolone + Purina HA today; recheck exam, symptoms, NSAID/lytes panel in 2 weeks; pursue abdominal ultrasound if no improvement
Practice asking for a CPR status.
Practice with group :)
For puppy and kitten vaccines, what is the single most important factor in determining how many DHPP/FVRCP boosters to give?
Explain why.
The animal's age
Puppies: Must receive at least 2 DHPP's after the age of 12 weeks, regardless of number of boosters received already
Kittens: Must receive at least 2 FVRCP's after 12 weeks, and ideally another booster at 20 weeks
Window of susceptibility due to waning maternal antibodies
Professionalism: wild card
- Attire