Download - Emergency and Critical Care Medicine
Small Animal Small Animal Emergency & Critical Emergency & Critical
Care Medicine Care Medicine
Maureen McMichael, DVMMaureen McMichael, DVMDiplomate ACVECCDiplomate ACVECC
Texas A&M UniversityTexas A&M University
Emergency & Critical Care Emergency & Critical Care
Proposal - Independent SAECC Proposal - Independent SAECC Service - 2002Service - 2002
Three phasesThree phases Physical space/curriculum/consultingPhysical space/curriculum/consulting Emergency receiving serviceEmergency receiving service Critical Care serviceCritical Care service
Phase IPhase IPhysical SpacePhysical 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 Need for ECC in curriculumNeed for ECC in curriculum
Phase IIPhase IIEmergency Receiving ServiceEmergency 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 weekdayservice the following weekday ECC student rotation with didactic roundsECC student rotation with didactic rounds ECC student manual ECC student manual
Phase IIPhase IIEmergency Receiving ServiceEmergency 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 Hospital IncomeHospital Income
Phase IIIPhase IIICritical Care ServiceCritical Care Service
Separate CC service that takes trauma, Separate CC service that takes trauma, toxins and all critical case transferstoxins and all critical case transfers
Separate student rotationSeparate student rotation Residents and interns – experience with Residents and interns – experience with
complex critical casescomplex critical cases
Phase IIIPhase IIICritical Care ServiceCritical 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 NeededResources 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 SpacePhysical Space ICU protocols, POC testing, etc.ICU protocols, POC testing, etc. CurriculumCurriculum
Emergency Receiving ServiceEmergency Receiving Service Critical Care ServiceCritical Care Service
Phase IPhase IPhysical Space Physical Space
Old ICU New ICU
New ICU – 3,000 sq ftNew ICU – 3,000 sq ft
Phase IPhase IPhysical SpacePhysical Space
EquipmentEquipment VentilatorVentilator Monitoring equipmentMonitoring equipment PyxisPyxis
ProtocolsProtocols For technicians, for internsFor technicians, for interns
Phase IPhase IPhysical SpacePhysical Space
CPCR protocolsCPCR protocols Constant rate Constant rate
infusions – infusions – analgesiaanalgesia
Phase IPhase IPhysical SpacePhysical Space
ICU treatment ICU treatment sheets – prompts sheets – prompts for studentsfor students
Emergency drug Emergency drug dosages – every dosages – every animalanimal
Phase IPhase IPhysical SpacePhysical Space
Point of care Point of care testingtesting
Rapid results – 1 Rapid results – 1 minute, 14 testsminute, 14 tests
Blood gas – Blood gas – teaching, patient teaching, patient care care
Phase IPhase ICurriculumCurriculum
First year CPCR, Respiratory physiology First year CPCR, Respiratory physiology laboratorieslaboratories
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 ER student rotation manual ER student rotation manual
Phase IIPhase IIEmergency Receiving ServiceEmergency Receiving Service
mid-October 2004mid-October 2004 No marketing No marketing
outside local outside local BVVMA BVVMA
Case load up Case load up significantlysignificantly
ER income up ER income up significantlysignificantly
ER Cases and Fee RevenueER Cases and Fee Revenue
YearYear OctOct NovNov DecDec JanJan
ER ER caseloadcaseload
20032003 164164 164164 204204 107107
20042004 212212 275275 344344 232232
ChangeChange +48+48 +111+111 +140+140 +125+125
ER FeeER Fee 20032003 12,28312,283 12,27712,277 15,26915,269 7,2507,250
20042004 15,91215,912 20,66220,662 25,83425,834 17,21717,217
ChangeChange +3,629+3,629 +8,385+8,385 +10,565+10,565 +9,967+9,967
Phase IIPhase IIEmergency Receiving ServiceEmergency Receiving Service
Marketing PotentialMarketing 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 – CompletedPhase I – Completed Phase II – Very successful – growth Phase II – Very successful – growth
potentialpotential Phase III – If ER continues to grow - Phase III – If ER continues to grow -
need a CC serviceneed a CC service Resources??????Resources??????
Davis Davis
ERER
MSU MSU
ERER
TuftsTufts
ERER
ER ER cases/yrcases/yr
15001500 40004000 90009000
ECC ECC facultyfaculty
33 33 66
ECC ECC residentsresidents
44 1/31/3 99
ECC ECC internsinterns
-- 22 55
ECC ECC DVMsDVMs
33 -- --
Resources NeededResources Needed
Davis Davis ERER
MSU MSU
ERER
Tufts Tufts
ERERTAMU TAMU ERER
ER ER cases/yrcases/yr
15001500 40004000 90009000 36003600
ECC ECC facultyfaculty
33 33 6/76/7 11
ECC ECC residentsresidents
44 1/31/3 99 00
ECC ECC internsinterns
-- 22 55 00
ECC ECC DVMsDVMs
33 -- -- 00