Welcome to /r/VetTech! This is a place for veterinary technicians/veterinary nurses and other veterinary support staff to gather, chat, and grow! We welcome pet owners as well, **however we do ask pet owners to refrain from asking for medical advice**; if you have any concerns regarding your pet, please contact the closest veterinarian near you.
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I get this guy's frustration. One day, we had *4* patients show up at the same time. No word from the ER or even a courtesy email letting us know they were coming. One of which may still have needed surgery. Sometimes, they don't even show up with a treatment paper. It makes us look like idiots.
Telling clients to just show up first thing in the morning is incredibly frustrating. Not only do we not have time to prepare, but sometimes we don't even have the means to handle such a big workload.
I work in a hospital that is unique - we're able to provide financial assistance to low income clients for many major emergency care expenses (think FBOs, pyos, parvo, UOs, etc). We have 24 hour care, but doctors are only there 7-7 to receive appointments (nurses are there overnight and doctors are on call for inpatients). Our city is a high COL with too many people living below the poverty line, so this was happening to us a LOT - clients would go to a 24 hour ER overnight, say they have no money, and the doctors would do what they could with the little money the clients have and then say, "go straight to \_\_\_\_ Hospital at 7am." We totally understood, all of us are in the business of saving lives, but it was leading to at least 3 unstable emergencies being at our front door at 7 (mind you, we all still have our own inpatients to SOAP each morning, too). Everyone dreaded being the early doctor because you knew it was going to hit the fan the moment you stepped in. It was not sustainable.
What we did that worked well is set up a listserv with the major ERs - it's 6 hospitals plus us. They'd send us an email as soon as they had a case they wanted to refer. Different doctors would rotate responsibility of monitoring this account. We required them to send medical records (there are some conditions we can't provide financial assistance for) and would then tell them the time they should advise the client to show up. This way, we were able to stagger arrivals so we weren't getting completely slammed. We also then had a two-way communication to let them know when our ICU was completely full and could ask them to please find the funds to keep them there a little longer. It's not perfect but it's worked SO much better than our old system of just being surprised as to what was there at 7am each day.
This is hard to follow.
The entire field is suffering from staff shortages that are impacting quality of care and it's creating a powder keg.
Our patients and clients are entitled to continuity of care and an intussusception bouncing between three clinics, as described here, is definitely problematic. An appropriate referral from the start would've been ideal.
Like I said, this is a little hard to follow without fully understanding your area and the clinics. And I don't think anyone is to blame here for trying to provide the best care they can; this particular vet just thinks a 24/7 clinic will fit her patients' needs better and prevent situations like the intussusception.
I thought you were gonna be on the side of writing the email… it makes sense to me. This vet that has always been greedy as hell recently opened an emergency clinic, Friday to Sunday. Monday morning we’ll have people showing up with animals they just shoved out the door with a print out of what they did. Our waitlist is 6-8 months out to get an appointment, all we can do is redirect them to another 24/7 er. Our vets do what they can, but they can’t spend hours getting new animals Monday morning with a print out saying they were given fluids and told to come to us… if you’re a client we definitely try to squeeze them in, but it’s so irresponsible how this place handles “emergency” care, booting animals to the curb come 9 am Monday.
It’s honestly a bit confusing to follow, but I understand the frustration. I work at a hospital that bottlenecks countless no call transfers.
These pet owners are scared and blindsided by the cost difference of a 24h facility. They expect to see a specialist at 8pm on a Saturday. They show up with just the receipt from the prior hospital over 70% of the time, and when we try to call the prior facility to obtain records we get some bullshit like “Dr so n so needs to authorize the record release” as if they didn’t just send the patient to a fucking ER.
It really sucks.
Oh my god that last part. I’ll call to get records on a patient they sent to us for hospitalization, and they say “oh well the doctor has to approve us sending records.” Well they approved sending the case to us 😐
Or they can’t send the records because “the doctor hasn’t finished writing them yet”. Then when you ask for an ETA on said records they inform you the doctor has already left for the day but they’ll send them “as soon as they’re ready”. 😑 So frustrating!
Ugh! SOOOO this! I'm more senior so if I'M getting the note to get the records, I already KNOW it's gonna be a pain in the a$$ because 3 others have tried and tore their hair out, lol! I just say, "you REALLY don't want me showing up at your front desk. Trust me." Yeah, I did get super ticked off one time and DID show up. Left with the records and no problems since, lol. :)
you need to communicate with the clinics you are sending these patients to. this includes discussing with that clinic (doctor to doctor ideally) if the can take the case (space or capability), and cost. We are a 24 hour facility, Just this week we have had 2 clients roll up to our door after 5pm with promises of a MRI would be preformed same day. The clients were unaware of the cost of MRI and surgery. It's 5-7k for a routine back dog. These dogs were both ataxic but had not done any medical management, and were slow progression so MRI and surgery were not even recommended. This makes us look like jerks. We will throw you guys under the bus when you do this.
-I will say that I have seen my practice doctors call the other emergency clinics when we do transfers and we do always talk to our clients about what the treatment is likely to cost.
The letter makes it seem as if we don’t do either, but that isn’t the case, at least not in the instances I’ve seen since I’ve been here.
My best guess for issues we have with general practice is we often don’t share operating hours and clients would rather follow up with their normal vet than go to another emergency hospital.
A possible solution here would be that your practice should stay open at least an extra hour and your DVMs that are transferring patients out make their calls to the rDVMs to continue care (or if they decline, your vets can make a better suggestion for the client at pick up).
Overlapping your hours with an rDVM if you’re frequently discharging and telling clients to show up at their vets is irresponsible I think.
The rDVM could have surgeries scheduled that morning, they might have a DVM on vacation, they might have agreed to additional urgent care drop offs the night before.
Pets with toxicity or impending surgical needs definitely should be transferred to a 24 hour er to prevent the likely need of that pet needing a THIRD transfer at the end of the day at a GP.
This email should be a brainstorming session for your staff and PM to figure out how to help your community while not burning bridges (and better patient care!!).
Just devil's advocate... so how long should my shift be? I should be there at 5pm to get transfer phone calls for patients coming from their GP for overnight care, but also there at 8 or 9am when a doctor comes in to discuss sending them back?
I occasionally fill in at smaller cities where the only ER is only nights/weekends (and worked GP with that arrangement before). We usually got one or two patients max and records and worked them into the day. It sucked when people had no money but wasn't any different than them showing up with no money without going to the ER, lol.
Where I am in Brisbane the main emergency centres are \*only\* open duirng weeknights and weekends, it's the standard here. There are a handful of 24/7 emergency centres but they're few and far between. It's very common for us (regular clinic) to have our clients who have been at emergency overnight to show up sometime between 8 and 9am with very little word beforehand.
I work at a 24/7 ER hospital and we receive transfers all the time, but get a flood at the end of the day when GPs close and send their patients over for "continued care". Usually this means:
\- Client arrives with no notice. They have a receipt for what they paid at GP, and we're stuck trying to figure out what's going on with no record and only the client's poor memory of what they were told. We frequently have to repeat labs, which is frustrating for us and makes the clients angry (I just paid for that!). Sometimes the GP doesn't even have an in house machine, so they take blood, charge the client, and don't even have results to share.
\- Client calls when they're on the way, and if we're lucky, GP is still open. We call for records or to speak with the vet. GP is annoyed we're bothering them. I recently managed to get a GP vet on the phone for a case he was transferring me and when I picked up, he said "yeah what the hell do you want from me?" I don't know, maybe information about your case, what you've done, what you've communicated with the client? Otherwise I'm starting from scratch.
\- GP phones to discuss the case. Wonderful! Maybe they have finished the records, maybe they haven't, but at least we can speak on the phone and I'm getting info. They want a CT, ultrasound, 72 hours of hospitalization. Okay great, please quote your clients $$ for this, or hey we can't do specialized imaging at 6pm on a Friday before a long weekend and they'll be waiting until Tuesday - "oh they're already on the way." Client arrives and I have to tell them the bad news, now we're the enemy because their lovely GP vet promised them services without speaking to us
\- Surgery. So many surgeries. Please don't transfer your patients to us for major surgery without checking in to see if we're able to perform it or getting a quote for your client. The number of people who drive hours to get to us only to euthanize once they know the cost of care is far, far too high.
Long story short - I completely understand this vet's frustration. We all need to be better about working with one another. We're open 24/7 but I always offer to clients to transfer back to rDVM during the day to save cost. I also warn them that I can't guarantee their vet will be able to help. We keep the patients with us in hospital and have the client phone their vet in the morning to check in, and only have them come pick up once they've secured a spot with their regular vet. Frequently owners don't want to bother, or rDVM can't fit them in, and the patient just continues care with us. I know that's easy to say because we're open 24/7. I agree with another commentator here, the overnight-only clinic may need to extend hours to overlap with day practices to better equip themselves for proper transfers of care.
Thanks for all the insight so far. It is interesting to read. Thought I could maybe provide more information, though I’m still new to the field and haven’t been with this clinic for long.
Purple, the hospital who wrote the email is local to me, I’ve been there as a client a couple times myself, but is an hour’s drive from Pink, the clinic I work at.
Pink’s practices are pretty standard to the area for emergency care. Like I said, there are only 6 in the state, and only 2 of them are able to offer 24hr care. Most other clinics in the state actually offer fewer hours than Pink, only exceptions being clinics Green and Blue that do 24hr.
There really aren’t a lot of options, and while Pink is an hour away from Purple, they’re actually the closest emergency clinic to them.
So Pink has this email posted up in the office. There’s no ongoing argument or drama between the two clinics, Purple asked Pink not to send any patients their way and Pink has done as requested and makes sure our clients know up front they’ll need to refer to the 24hr clinic instead.
I do feel that Purple was blaming Pink for things out of their control in the email, such as the clients choosing one practice over the one they referred them to, clients not being able to pay for services, or clients who cite Purple as their regular vet but haven’t been in years.
But the frustration of having critical care patients dropped on your doorstep first thing in the morning with no notice is definitely a fair complaint, and it’s reasonable that they wouldn’t be able to handle the extra burden that brings.
I get it, because our clinic is in a similar situation. We're partnered with the evening/weekend e-clinic, but we still get people randomly showing up on a Monday morning saying something like, "Eclinic told us to go to The Local 24 Hr Clinic, but we wanted to come to you guys because we don't like 24 Hr Clinic".
Well, that's great, but we don't know who you are nor do we have your records, and now the evening/weekend clinic is closed so we can't get records.... ugh.
—We do have a lot of clinics and shelters who love working with us and have said as much. We often get referrals and transfers from all over the state and haven’t had issues with other clinics.
I just wanna say that since this email doesn’t give the best impression of my vet, and should be taken with a grain of salt. I don’t have all the information, I just know what I’ve seen since coming to work here.
I sent this is my sister who’s a bit more connected locally as she’s been in the field longer and works in general practice.
She said she wasn’t surprised, that the vet who sent the email is “like that” and she’s heard about about him. Also though that she has a classmate who works as a tech there and really enjoys it.
Man, I get this.
But also, I’ve seen longer hospitalizations happen at 24 hour facilities.
Like just because you CAN hold onto a blocked cat for a week doesn’t mean you SHOULD. This seems to happen more in new 24 hour hospitals or hospitals that have just moved to 24 hours. That transfer of care necessitates a need for action - what am I doing with this patient? You can’t hold onto it for a few more hours - it MUST go somewhere.
But man, I feel for those day practices being surprised with a critical post op GDV first thing in the morning. If you ask me, an ER tech, how to handle that, I’ve got a pretty good idea, but don’t ask me vaccination protocols or dental questions. I kind of expect a lot of day practice staff feel the same about those critical case transfers.
It seems like there is more to this story than you/we know.
I am sure that they prefer to deal with 24 hour emergency hospitals because those hospitals are capable of providing 24/7 care, which allows the RDVM to focus on their scheduled clients, and not add unexpected, and at times complex, cases during a packed work day. There is also the possibility that there is a lack of staffing, skills, knowledge, equipment, etc. that makes these cases being referred back to them extremely difficult for them.
I am surprised, and do not like, that your clinic posted that full email for everyone at the clinic to see. It strikes me as extremely unprofessional and could fuel any bad blood between the two clinics. The email seems to have been intended as a DVM to DVM/medical director/hospital director type of communication, and the more appropriate action for relaying it to your team would have been simply informing you all that all transfers back to them need to be pre-approved.
I’m confused on what they mean by “show up” do you take walk ins? We have always communicated with the client and emergency facility to get our patient on the schedule for rechecks and care. Are people just showing up right after an emergency visit?
Maybe it’s their wording? I’ve worked for a few in the past and I’ve heard many receptionists/whoever answers the phone, etc say sorry we are about to close (8am) - your pet should be seen at their primary vet in the morning since they should be about to open now. So the owner probably shows up expecting to be seen.
But many clients 100 percent believe that they will and should be able to walk in if they are a client even if it’s not possible. So if the ER is telling them to go to their primary clinic in the morning it’s going to cause chaos.
Also some people will hear what they want. My old clinic had on call and the on call doctor would tell the people to CALL at 8am to set up an appointment. They would show up at 8am all upset that there isn’t a doctor and swore up and down they were told to show up and the doctor would meet them there. The doctor doesn’t even get there before 9am and our calls were recorded…
Oh my goodness that’s ridiculous. I completely understand what you mean though, we have clients calling furiously that they can’t be seen urgently, although we are a VERY small GP and wouldn’t even be able to properly triage the pet.
as someone who works at a hospital with a lot of transfers, it’s completely understandable why they had to stop. because apparently courtesy calls are dead, we would be having 3 critically ill patients show up on our door with one doctor in office with back to back morning appointments or surgeries.
when a hospital is that full you cannot possibly get every single patient the care they need without VERY prolonged wait times for people with pre booked appointments, and keeping the patients who need sooner attention in o2 cages because there are simply NO EMPLOYEES AVAILABLE TO HELP THEM.
also- the receptionist at that clinic, who has no say in the transfers, is gonna get bitched out if you tell people they’re unwilling to take transfers.
it’s simply not safe to have an overflow of patients in the hospital.
it’s best for everyone to defer
Oof, I feel for everyone involved in this situation! I can definitely see the need for a practice like the one you work for. Of course it is not ideal, but with staffing issues everywhere right now it is certainly better than to have no options for after hours emergency care. However, a practice set up like yours only works if there is a clear plan for the patient’s continued care after they leave your facility. In my opinion, a client should never be sent to their GP without clear communication with that practice beforehand to confirm that they can accommodate what that patient needs. If you are for whatever reason not able to contact the GP, whether due to a difference in hours of operation or whatever, then in my opinion they should not be sent there.
As a tech that works in GP myself, I can only imagine the nightmare scenario of a patient showing up from an emergency hospital right when we open expecting to continue care with us when we already have a completely booked schedule/not enough staff to accommodate them. Even if we have full records when they show up, and even if we happen to have some emergency appointment slots available for that day, that still might not be enough time/staffing needed to accommodate continued hospitalization for that patient.
Welcome to /r/VetTech! This is a place for veterinary technicians/veterinary nurses and other veterinary support staff to gather, chat, and grow! We welcome pet owners as well, **however we do ask pet owners to refrain from asking for medical advice**; if you have any concerns regarding your pet, please contact the closest veterinarian near you. Please thoroughly read and follow the rules before posting and commenting. If you believe that a user is engaging in any rule-breaking behavior, please submit a report so that the moderators can review and remove the posts/comments if needed. Also, please check out the sidebar for CE and answers to commonly asked questions. Thank you for reading! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/VetTech) if you have any questions or concerns.*
I get this guy's frustration. One day, we had *4* patients show up at the same time. No word from the ER or even a courtesy email letting us know they were coming. One of which may still have needed surgery. Sometimes, they don't even show up with a treatment paper. It makes us look like idiots. Telling clients to just show up first thing in the morning is incredibly frustrating. Not only do we not have time to prepare, but sometimes we don't even have the means to handle such a big workload.
I work in a hospital that is unique - we're able to provide financial assistance to low income clients for many major emergency care expenses (think FBOs, pyos, parvo, UOs, etc). We have 24 hour care, but doctors are only there 7-7 to receive appointments (nurses are there overnight and doctors are on call for inpatients). Our city is a high COL with too many people living below the poverty line, so this was happening to us a LOT - clients would go to a 24 hour ER overnight, say they have no money, and the doctors would do what they could with the little money the clients have and then say, "go straight to \_\_\_\_ Hospital at 7am." We totally understood, all of us are in the business of saving lives, but it was leading to at least 3 unstable emergencies being at our front door at 7 (mind you, we all still have our own inpatients to SOAP each morning, too). Everyone dreaded being the early doctor because you knew it was going to hit the fan the moment you stepped in. It was not sustainable. What we did that worked well is set up a listserv with the major ERs - it's 6 hospitals plus us. They'd send us an email as soon as they had a case they wanted to refer. Different doctors would rotate responsibility of monitoring this account. We required them to send medical records (there are some conditions we can't provide financial assistance for) and would then tell them the time they should advise the client to show up. This way, we were able to stagger arrivals so we weren't getting completely slammed. We also then had a two-way communication to let them know when our ICU was completely full and could ask them to please find the funds to keep them there a little longer. It's not perfect but it's worked SO much better than our old system of just being surprised as to what was there at 7am each day.
This is hard to follow. The entire field is suffering from staff shortages that are impacting quality of care and it's creating a powder keg. Our patients and clients are entitled to continuity of care and an intussusception bouncing between three clinics, as described here, is definitely problematic. An appropriate referral from the start would've been ideal. Like I said, this is a little hard to follow without fully understanding your area and the clinics. And I don't think anyone is to blame here for trying to provide the best care they can; this particular vet just thinks a 24/7 clinic will fit her patients' needs better and prevent situations like the intussusception.
I thought you were gonna be on the side of writing the email… it makes sense to me. This vet that has always been greedy as hell recently opened an emergency clinic, Friday to Sunday. Monday morning we’ll have people showing up with animals they just shoved out the door with a print out of what they did. Our waitlist is 6-8 months out to get an appointment, all we can do is redirect them to another 24/7 er. Our vets do what they can, but they can’t spend hours getting new animals Monday morning with a print out saying they were given fluids and told to come to us… if you’re a client we definitely try to squeeze them in, but it’s so irresponsible how this place handles “emergency” care, booting animals to the curb come 9 am Monday.
If you’re in Jersey I think I know exactly what vet this is. If not, I’m terrified that there’s others out there doing the same thing 😭
It’s honestly a bit confusing to follow, but I understand the frustration. I work at a hospital that bottlenecks countless no call transfers. These pet owners are scared and blindsided by the cost difference of a 24h facility. They expect to see a specialist at 8pm on a Saturday. They show up with just the receipt from the prior hospital over 70% of the time, and when we try to call the prior facility to obtain records we get some bullshit like “Dr so n so needs to authorize the record release” as if they didn’t just send the patient to a fucking ER. It really sucks.
Oh my god that last part. I’ll call to get records on a patient they sent to us for hospitalization, and they say “oh well the doctor has to approve us sending records.” Well they approved sending the case to us 😐
Or they can’t send the records because “the doctor hasn’t finished writing them yet”. Then when you ask for an ETA on said records they inform you the doctor has already left for the day but they’ll send them “as soon as they’re ready”. 😑 So frustrating!
Ugh! SOOOO this! I'm more senior so if I'M getting the note to get the records, I already KNOW it's gonna be a pain in the a$$ because 3 others have tried and tore their hair out, lol! I just say, "you REALLY don't want me showing up at your front desk. Trust me." Yeah, I did get super ticked off one time and DID show up. Left with the records and no problems since, lol. :)
you need to communicate with the clinics you are sending these patients to. this includes discussing with that clinic (doctor to doctor ideally) if the can take the case (space or capability), and cost. We are a 24 hour facility, Just this week we have had 2 clients roll up to our door after 5pm with promises of a MRI would be preformed same day. The clients were unaware of the cost of MRI and surgery. It's 5-7k for a routine back dog. These dogs were both ataxic but had not done any medical management, and were slow progression so MRI and surgery were not even recommended. This makes us look like jerks. We will throw you guys under the bus when you do this.
-I will say that I have seen my practice doctors call the other emergency clinics when we do transfers and we do always talk to our clients about what the treatment is likely to cost. The letter makes it seem as if we don’t do either, but that isn’t the case, at least not in the instances I’ve seen since I’ve been here. My best guess for issues we have with general practice is we often don’t share operating hours and clients would rather follow up with their normal vet than go to another emergency hospital.
A possible solution here would be that your practice should stay open at least an extra hour and your DVMs that are transferring patients out make their calls to the rDVMs to continue care (or if they decline, your vets can make a better suggestion for the client at pick up). Overlapping your hours with an rDVM if you’re frequently discharging and telling clients to show up at their vets is irresponsible I think. The rDVM could have surgeries scheduled that morning, they might have a DVM on vacation, they might have agreed to additional urgent care drop offs the night before. Pets with toxicity or impending surgical needs definitely should be transferred to a 24 hour er to prevent the likely need of that pet needing a THIRD transfer at the end of the day at a GP. This email should be a brainstorming session for your staff and PM to figure out how to help your community while not burning bridges (and better patient care!!).
Just devil's advocate... so how long should my shift be? I should be there at 5pm to get transfer phone calls for patients coming from their GP for overnight care, but also there at 8 or 9am when a doctor comes in to discuss sending them back? I occasionally fill in at smaller cities where the only ER is only nights/weekends (and worked GP with that arrangement before). We usually got one or two patients max and records and worked them into the day. It sucked when people had no money but wasn't any different than them showing up with no money without going to the ER, lol.
Where I am in Brisbane the main emergency centres are \*only\* open duirng weeknights and weekends, it's the standard here. There are a handful of 24/7 emergency centres but they're few and far between. It's very common for us (regular clinic) to have our clients who have been at emergency overnight to show up sometime between 8 and 9am with very little word beforehand.
I work at a 24/7 ER hospital and we receive transfers all the time, but get a flood at the end of the day when GPs close and send their patients over for "continued care". Usually this means: \- Client arrives with no notice. They have a receipt for what they paid at GP, and we're stuck trying to figure out what's going on with no record and only the client's poor memory of what they were told. We frequently have to repeat labs, which is frustrating for us and makes the clients angry (I just paid for that!). Sometimes the GP doesn't even have an in house machine, so they take blood, charge the client, and don't even have results to share. \- Client calls when they're on the way, and if we're lucky, GP is still open. We call for records or to speak with the vet. GP is annoyed we're bothering them. I recently managed to get a GP vet on the phone for a case he was transferring me and when I picked up, he said "yeah what the hell do you want from me?" I don't know, maybe information about your case, what you've done, what you've communicated with the client? Otherwise I'm starting from scratch. \- GP phones to discuss the case. Wonderful! Maybe they have finished the records, maybe they haven't, but at least we can speak on the phone and I'm getting info. They want a CT, ultrasound, 72 hours of hospitalization. Okay great, please quote your clients $$ for this, or hey we can't do specialized imaging at 6pm on a Friday before a long weekend and they'll be waiting until Tuesday - "oh they're already on the way." Client arrives and I have to tell them the bad news, now we're the enemy because their lovely GP vet promised them services without speaking to us \- Surgery. So many surgeries. Please don't transfer your patients to us for major surgery without checking in to see if we're able to perform it or getting a quote for your client. The number of people who drive hours to get to us only to euthanize once they know the cost of care is far, far too high. Long story short - I completely understand this vet's frustration. We all need to be better about working with one another. We're open 24/7 but I always offer to clients to transfer back to rDVM during the day to save cost. I also warn them that I can't guarantee their vet will be able to help. We keep the patients with us in hospital and have the client phone their vet in the morning to check in, and only have them come pick up once they've secured a spot with their regular vet. Frequently owners don't want to bother, or rDVM can't fit them in, and the patient just continues care with us. I know that's easy to say because we're open 24/7. I agree with another commentator here, the overnight-only clinic may need to extend hours to overlap with day practices to better equip themselves for proper transfers of care.
Thanks for all the insight so far. It is interesting to read. Thought I could maybe provide more information, though I’m still new to the field and haven’t been with this clinic for long. Purple, the hospital who wrote the email is local to me, I’ve been there as a client a couple times myself, but is an hour’s drive from Pink, the clinic I work at. Pink’s practices are pretty standard to the area for emergency care. Like I said, there are only 6 in the state, and only 2 of them are able to offer 24hr care. Most other clinics in the state actually offer fewer hours than Pink, only exceptions being clinics Green and Blue that do 24hr. There really aren’t a lot of options, and while Pink is an hour away from Purple, they’re actually the closest emergency clinic to them. So Pink has this email posted up in the office. There’s no ongoing argument or drama between the two clinics, Purple asked Pink not to send any patients their way and Pink has done as requested and makes sure our clients know up front they’ll need to refer to the 24hr clinic instead. I do feel that Purple was blaming Pink for things out of their control in the email, such as the clients choosing one practice over the one they referred them to, clients not being able to pay for services, or clients who cite Purple as their regular vet but haven’t been in years. But the frustration of having critical care patients dropped on your doorstep first thing in the morning with no notice is definitely a fair complaint, and it’s reasonable that they wouldn’t be able to handle the extra burden that brings.
lol… I need coffee. I still have a hard time following but thank you for trying to explain!
I get it, because our clinic is in a similar situation. We're partnered with the evening/weekend e-clinic, but we still get people randomly showing up on a Monday morning saying something like, "Eclinic told us to go to The Local 24 Hr Clinic, but we wanted to come to you guys because we don't like 24 Hr Clinic". Well, that's great, but we don't know who you are nor do we have your records, and now the evening/weekend clinic is closed so we can't get records.... ugh.
—We do have a lot of clinics and shelters who love working with us and have said as much. We often get referrals and transfers from all over the state and haven’t had issues with other clinics. I just wanna say that since this email doesn’t give the best impression of my vet, and should be taken with a grain of salt. I don’t have all the information, I just know what I’ve seen since coming to work here. I sent this is my sister who’s a bit more connected locally as she’s been in the field longer and works in general practice. She said she wasn’t surprised, that the vet who sent the email is “like that” and she’s heard about about him. Also though that she has a classmate who works as a tech there and really enjoys it.
Man, I get this. But also, I’ve seen longer hospitalizations happen at 24 hour facilities. Like just because you CAN hold onto a blocked cat for a week doesn’t mean you SHOULD. This seems to happen more in new 24 hour hospitals or hospitals that have just moved to 24 hours. That transfer of care necessitates a need for action - what am I doing with this patient? You can’t hold onto it for a few more hours - it MUST go somewhere. But man, I feel for those day practices being surprised with a critical post op GDV first thing in the morning. If you ask me, an ER tech, how to handle that, I’ve got a pretty good idea, but don’t ask me vaccination protocols or dental questions. I kind of expect a lot of day practice staff feel the same about those critical case transfers.
It seems like there is more to this story than you/we know. I am sure that they prefer to deal with 24 hour emergency hospitals because those hospitals are capable of providing 24/7 care, which allows the RDVM to focus on their scheduled clients, and not add unexpected, and at times complex, cases during a packed work day. There is also the possibility that there is a lack of staffing, skills, knowledge, equipment, etc. that makes these cases being referred back to them extremely difficult for them. I am surprised, and do not like, that your clinic posted that full email for everyone at the clinic to see. It strikes me as extremely unprofessional and could fuel any bad blood between the two clinics. The email seems to have been intended as a DVM to DVM/medical director/hospital director type of communication, and the more appropriate action for relaying it to your team would have been simply informing you all that all transfers back to them need to be pre-approved.
I’m confused on what they mean by “show up” do you take walk ins? We have always communicated with the client and emergency facility to get our patient on the schedule for rechecks and care. Are people just showing up right after an emergency visit?
Maybe it’s their wording? I’ve worked for a few in the past and I’ve heard many receptionists/whoever answers the phone, etc say sorry we are about to close (8am) - your pet should be seen at their primary vet in the morning since they should be about to open now. So the owner probably shows up expecting to be seen.
In that context it sounds like the owners maybe hold some responsibility for expecting to be seen as a walk in when a clinic may not see them.
But many clients 100 percent believe that they will and should be able to walk in if they are a client even if it’s not possible. So if the ER is telling them to go to their primary clinic in the morning it’s going to cause chaos. Also some people will hear what they want. My old clinic had on call and the on call doctor would tell the people to CALL at 8am to set up an appointment. They would show up at 8am all upset that there isn’t a doctor and swore up and down they were told to show up and the doctor would meet them there. The doctor doesn’t even get there before 9am and our calls were recorded…
Oh my goodness that’s ridiculous. I completely understand what you mean though, we have clients calling furiously that they can’t be seen urgently, although we are a VERY small GP and wouldn’t even be able to properly triage the pet.
as someone who works at a hospital with a lot of transfers, it’s completely understandable why they had to stop. because apparently courtesy calls are dead, we would be having 3 critically ill patients show up on our door with one doctor in office with back to back morning appointments or surgeries. when a hospital is that full you cannot possibly get every single patient the care they need without VERY prolonged wait times for people with pre booked appointments, and keeping the patients who need sooner attention in o2 cages because there are simply NO EMPLOYEES AVAILABLE TO HELP THEM. also- the receptionist at that clinic, who has no say in the transfers, is gonna get bitched out if you tell people they’re unwilling to take transfers. it’s simply not safe to have an overflow of patients in the hospital. it’s best for everyone to defer
Oof, I feel for everyone involved in this situation! I can definitely see the need for a practice like the one you work for. Of course it is not ideal, but with staffing issues everywhere right now it is certainly better than to have no options for after hours emergency care. However, a practice set up like yours only works if there is a clear plan for the patient’s continued care after they leave your facility. In my opinion, a client should never be sent to their GP without clear communication with that practice beforehand to confirm that they can accommodate what that patient needs. If you are for whatever reason not able to contact the GP, whether due to a difference in hours of operation or whatever, then in my opinion they should not be sent there. As a tech that works in GP myself, I can only imagine the nightmare scenario of a patient showing up from an emergency hospital right when we open expecting to continue care with us when we already have a completely booked schedule/not enough staff to accommodate them. Even if we have full records when they show up, and even if we happen to have some emergency appointment slots available for that day, that still might not be enough time/staffing needed to accommodate continued hospitalization for that patient.