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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 University

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Emergency & 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

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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

(4)

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

(5)

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

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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

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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

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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)

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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

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Phase I

Phase I

Physical Space

Physical Space

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New ICU – 3,000 sq ft

New ICU – 3,000 sq ft

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Phase I

Phase I

Physical Space

Physical Space

Equipment

Equipment

 VentilatorVentilator

 Monitoring equipmentMonitoring equipment  PyxisPyxis

Protocols

Protocols

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Phase I

Phase I

Physical Space

Physical Space

CPCR protocols

CPCR protocols

Constant rate

Constant rate

infusions –

infusions –

analgesia

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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

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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

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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

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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

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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

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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

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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

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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

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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

(23)

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