Golden Age of Vet Med?

[DVMDream]

Back in the 'old' days (man things are changing fast) of seeing things on ER overnight and turfing them back to their GP for care during the day .... we got contacted by a corporate practice who flat-out said "we can't take care of sick patients. please do not send our clients back to us. keep them hospitalized there."

Nowadays that's really more the norm. The only ones I transfer back to their GP are when the client insists on it because they love their GP or cost or whatever. But as a rule, when I hospitalize something, I just plan to keep it until it discharges to home care or croaks.

The only reason I hate the back and forth between ER and GP is because of the breakdown in patient care and the stress to the patient from constant shuttling back and forth. You have them at one place overnight, then back to GP in AM, then back to ER at night and so on. I have seen many times the communication fall apart. The client gets frustrated. The records are horrible because half our in the ER computer and the other half faxed over (maybe if you are lucky from GP) and overall things just lost in the shuffle.

That is why I always preferred that if anything needed multi-day hospitalization it just stay in one spot until stable, then have the GP take back over its care at that time.

I had a horrid renal failure case on ER once that majorly fell through the cracks because of the back/forth arrangement and no one really paying any attention to the big picture. Either the other ER docs or the GP doctor. I had to be the "bad person" that after tracking down all the labwork over the prior 3 days of back/forth discovered that its renal values were increasing despite fluid diuresis, that no one knew if the dog had produced any urine recently or when was the last time it urinated, that no one realized the dog was whiter than ****ing snow and had a PCV of around 9% and an abdominal fluid wave. ER was under the impression they were to just babysit on fluids overnight and GP kept doing more of the same and everyone just kept rechecking values but not adding in any further diagnostics. So I got to call up the owner and be all ... your dog needs to be euthanized. No one had a serious talk with these people, because they had seen upwards of 7 doctors by that point.

So, that is why, when it comes to something that needs multiple days in hospital, I feel like, if possible, one clinic, one location, one record system, same lab machines and hopefully only a few different doctors over the few days on ER rotation. If not possible, financially, or otherwise, I totally get why the back and forth happens, but yeah, I do feel patient care sometimes takes a hit with back and forth.

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[Trilt]

Back in the 'old' days (man things are changing fast) of seeing things on ER overnight and turfing them back to their GP for care during the day .... we got contacted by a corporate practice who flat-out said "we can't take care of sick patients. please do not send our clients back to us. keep them hospitalized there."

Nowadays that's really more the norm. The only ones I transfer back to their GP are when the client insists on it because they love their GP or cost or whatever. But as a rule, when I hospitalize something, I just plan to keep it until it discharges to home care or croaks.

Our local ER literally switched from "old days" style to being 24/7 over the last year or so. As a referrer, I feel pros and cons.

We recently had an A+ client with her dog there for five days for FB surgery and post-op aspiration pneumonia (bulldogs ugh) and had no idea until she called US wanting to have an intense quality of life discussion. They usually fax over updates but it's fallen by the wayside with COVID craziness. That sucked.

But the upside is that I am not particularly sure my GP could have saved that dog, and his KCS-atopic-can't-breathe-despite-airway-surgery-did-I-mention-both-knees-have-been-repaired ass came in for an ear infection last week, so there's that.

I can't even imagine back and forth from GP to ER and what a nightmare it must be for continuity of care. In the "old days" once we got them we just tended to keep'em at the GP.

 

[itsrocky]

Currently practicing with one e clinic that practices in the “good old days”. They triage, figure out who they are clients of, and send them to us if applicable and the patient needs continued care. To my knowledge, they wouldn’t take patients back in for hospitalization subsequent nights, but I’ve never tried. There’s one hospital I know of in the area that has 24 hour monitoring, but they also aren’t an emergency clinic. So if I wanted to hospitalize something to the best standard of care, I’d send them there and of course I always offer it and record if they say no. But it is very expensive and largely inaccessible to most of backwoods north Louisiana, so I’m documenting that a lot. I’ve hospitalized a lot of things that would have benefited by 24 hour care, which sucks to have hanging over your head, but there’s been no choice. I enjoy the challenges that brings honestly, but I also hate that I have to turn away things that need oxygen because I don’t have an oxygen tent, then they can’t afford to go to the speciality place, so I tend to lose a lot of those cases.

 

[itsrocky]

But yeah, I still think I prefer that to shuttling a mutual patient back and forth.