The Emergency Service at Hope has the privilege of seeing a wide range of complex and challenging cases, many of which come in as referrals or direct transfers from our general practice colleagues. We do our best to communicate thoroughly and frequently, both before and after a patient has been transferred, to ensure efficient and effective care throughout an acute or chronic disease process. With that in mind, questions often arise as to who does what and when in terms of both diagnostics and treatments.
Before a case is transferred, we find great value in having one of our emergency doctors speak with the primary veterinarian to discuss progression to date and the reason for the transfer. This enables us to gather as much information as possible and to relay any relevant expectations to the owner prior to their arrival. In the course of a busy day on either end, this direct line of communication is not always feasible, and when timing or availability are at a premium, we often have one of our nurses speak with the referring practice. The most important things we can communicate up front include available specialties, schedules, and expected costs based on the information available at the time. As with most hospitals, this information is subject to change, so with a quick phone call we can keep everyone up to date and manage expectations.
Although the stat triage is an exhilarating experience, it’s certainly more fun to work up a case when it arrives in as stable condition as possible. This often means providing initial treatment prior to transfer. If there is a reasonable suspicion of a condition and there is an immediate treatment that may improve survival to discharge, it should be administered. This would certainly include things like IV fluids, analgesia, sedation, diuretics, oxygen therapy, bronchodilators, and in some cases, antibiotics. This would also include certain procedures, such as thoracocentesis, or passage of an indwelling urinary catheter in a sick, obstructed cat. There are only a few cases when previous treatments are a measurable hindrance to ongoing diagnostics and care. Some examples that come to mind are the administration of long-acting steroids and antibiotics.
In terms of actual materials to send over with a client, the list is shorter. Medical records and relevant radiographs are always appreciated. As a matter of biosecurity, we typically will not make use of any IV fluids or IV medications that the patient has received while hospitalized at a referring facility. Additionally, in the interest of avoiding spurious lab errors due to delayed sample testing, we will typically pull our own blood and urine samples once a patient arrives, so no need to send over most bodily fluids.
Naturally, every patient, owner, and day of the week is different. We are always happy to discuss the details of any case prior to transfer to help determine what makes sense in terms of division of labor. As our own Emergency Department continues to grow, we look forward to the opportunity to continue to coordinate care with our talented colleagues in general practice in the best interests of all of our mutual patients.
Melissa Ogg, VMD
Emergency Veterinarian at Hope Veterinary Specialists