Small Animal
Small Animal
Emergency & Critical
Emergency & Critical
Care Medicine
Care Medicine
Maureen McMichael, DVM Maureen McMichael, DVM Diplomate ACVECC Diplomate ACVECC Texas A&M University Texas A&M UniversityEmergency & Critical Care
Emergency & Critical Care
Proposal - Independent SAECC
Proposal - Independent SAECC
Service - 2002
Service - 2002
Three phases
Three phases
Physical space/curriculum/consultingPhysical space/curriculum/consulting Emergency receiving serviceEmergency receiving service
Phase I
Phase I
Physical Space
Physical 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
Phase II
Phase II
Emergency Receiving Service
Emergency 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 weekday service the following weekday
ECC student rotation with didactic roundsECC student rotation with didactic rounds ECC student manual ECC student manual
Phase II
Phase II
Emergency Receiving Service
Emergency 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
Phase III
Phase III
Critical Care Service
Critical Care Service
Separate CC service that takes trauma, Separate CC service that takes trauma,
toxins and all critical case transfers toxins and all critical case transfers
Separate student rotationSeparate student rotation
Residents and interns – experience with Residents and interns – experience with
complex critical cases complex critical cases
Phase III
Phase III
Critical Care Service
Critical 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 Needed
Resources 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 Space
Physical Space
ICU protocols, POC testing, etc.
ICU protocols, POC testing, etc.
Curriculum
Curriculum
Emergency Receiving Service
Emergency Receiving Service
Critical Care Service
Critical Care Service
Phase I
Phase I
Physical Space
Physical Space
New ICU – 3,000 sq ft
New ICU – 3,000 sq ft
Phase I
Phase I
Physical Space
Physical Space
Equipment
Equipment
VentilatorVentilator Monitoring equipmentMonitoring equipment PyxisPyxis
Protocols
Protocols
Phase I
Phase I
Physical Space
Physical Space
CPCR protocols
CPCR protocols
Constant rate
Constant rate
infusions –
infusions –
analgesia
Phase I
Phase I
Physical Space
Physical Space
ICU treatment
ICU treatment
sheets – prompts
sheets – prompts
for students
for students
Emergency drug
Emergency drug
dosages – every
dosages – every
animal
Phase I
Phase I
Physical Space
Physical Space
Point of care
Point of care
testing
testing
Rapid results – 1
Rapid results – 1
minute, 14 tests
minute, 14 tests
Blood gas –
Blood gas –
teaching, patient
teaching, patient
care
Phase I
Phase I
Curriculum
Curriculum
First year CPCR, Respiratory physiology First year CPCR, Respiratory physiology
laboratories laboratories
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
Phase II
Phase II
Emergency Receiving Service
Emergency Receiving Service
mid-October 2004mid-October 2004 No marketing No marketing outside local outside local BVVMA BVVMA
Case load up Case load up
significantly significantly
ER income up ER income up
significantly significantly
ER Cases and Fee Revenue
ER Cases and Fee Revenue
Year
Year OctOct NovNov DecDec JanJan
ER ER caseload caseload 20032003 164164 164164 204204 107107 2004 2004 212212 275275 344344 232232 Change Change +48+48 +111+111 +140+140 +125+125 ER Fee ER Fee 20032003 12,28312,283 12,27712,277 15,26915,269 7,2507,250 2004 2004 15,91215,912 20,66220,662 25,83425,834 17,21717,217 Change Change +3,629+3,629 +8,385+8,385 +10,565+10,565 +9,967+9,967
Phase II
Phase II
Emergency Receiving Service
Emergency Receiving Service
Marketing Potential
Marketing 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 – Completed
Phase I – Completed
Phase II – Very successful – growth
Phase II – Very successful – growth
potential
potential
Phase III – If ER continues to grow -
Phase III – If ER continues to grow -
need a CC service
need a CC service
Davis Davis ER ER MSU MSU ER ER Tufts Tufts ER ER ER ER cases/yr cases/yr 15001500 40004000 90009000 ECC ECC faculty faculty 33 33 66 ECC ECC residents residents 44 1/31/3 99 ECC ECC interns interns -- 22 55 ECC ECC DVMs DVMs 33 -- -
-Resources Needed
Resources Needed
Davis Davis
ER
ER MSU ERMSU ER Tufts ERTufts ER TAMU ERTAMU ER ER ER cases/yr cases/yr 15001500 40004000 90009000 36003600 ECC ECC faculty faculty 33 33 6/76/7 11 ECC ECC residents residents 44 1/31/3 99 00 ECC ECC interns interns -- 22 55 00 ECC ECC DVMs DVMs 33 -- -- 00