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PreanestheticTesting:

© 2004 IDEXX Laboratories, Inc. All rights reserved. 2423-00 (2)

Why Mandatory Makes Sense

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Overview—Preanesthetic Testing• Why test?

• Why make testing mandatory?

• How to implement a program in your clinic

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Why preanesthetic

testing?

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“For a 12-test profile, approximately 46% of all clinically normal animals will have at least one abnormal test result.”

Alan Rebar, DVM, PhD, DACVP and Fred Metzger, DVM, DABVP

There are hidden abnormalities in one out of every two patients of all ages.

Rebar A, Metzger F. Clinical pathology for small-animal practitioners: Interpreting the hemogram.Vet Med CE Advisor. 1996.

Why Test?

Pets are at risk

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Updated research: importance of testing

Study1

• 11% delay of surgery

• 84% compliance in first 6 months (optional)

• Only 2 clients objected in last 18 months (mandatory)

Study2—Program Mandatory• 10.1% delayed surgery

• 21% changed anesthetic approach or delayed procedure

All in apparently healthy animals of all ages.

1. Irwin J. Preanesthetic program can be standard in delivery of quality care. DVM Newsmagazine. November 1998.

2. Irwin J. Do tests first: Presurgical blood work may eliminate a variety of surprises. DVM In Focus. November 2003.

Why Test?

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Irwin J. Preanesthetic program can be standard in delivery of quality care. DVM Newsmagazine. November 1998.

Diagnoses

and Conditions Total

Portosystemic shunts 2

Diabetes mellitus 3

Kidney disease 6

Liver disease 5

Anemia 6

Thrombocytopenia 4

Hypokalemia 18

Hyperadrenocorticism 1

Hyperthyroidism 2

Hypothyroidism 6

FIV/FeLV 4

FIP 2n = 542

Why Test?

It’s Quality MedicineSulphur Springs Veterinary Clinic, Irwin Study 1996–1998

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It’s Quality MedicineSulphur Springs Veterinary Clinic, Irwin Study 2003

Irwin J. Do tests first: Presurgical blood work may eliminate a variety of surprises. DVM In Focus. November 2003.

Abnormalities Total

ALT increased 11

ALKP increased 18

BUN increased or decreased 16

Creatinine increased 5

Glucose increased or decreased 7

Total Protein increased or decreased 11

Sodium increased or decreased 18

Potassium increased or decreased 16

Chloride increased or decreased 11

Neutrophils increased or decreased 9

Hct decreased 12

Lymphocytes increased or decreased 10

T4 increased or decreased 15

n = 128

Why Test?

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Wouldn’t you want it done for you?• Determine full health picture of pet—

physical exam alone is not comprehensive

• Choose appropriate anesthetic agent and ensure rapid recovery

• Provide baseline data

• Provide peace of mind to client and staff

Why Test?

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Puppies and kittens are equally at risk“Preanesthetic screening is imperative for puppies and kittens. Most often the preanesthetic diagnostic screening is the first comprehensive look we have at the pet’s health. It is at that time we can assess the pet for common breed-specific ailments, as well as gather solid baseline data for the future health care of the pet.”

Ernest Ward, Jr., DVMSeaside Animal Care

Calabash, NC

Why Test?

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When you test,

everyone wins“Performing… preanesthesia lab testing is an essential step for providing good medical care and maintaining client trust, as well as avoiding stressful situations for the doctor and staff.”

Jim Irwin, DVM

Irwin J. Do tests first: Presurgical blood work may eliminate a variety of surprises. DVM In Focus. November 2003.

Why Test?

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Why makepreanesthetic testing mandatory?

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“We don’t ask clients what type of anesthetic to use, we recommend what’s right for their pets—we’re the experts. So why should we offer them a choice of blood work?”

Fred Metzger, DVM, DABVP

Dr. Fred Metzger, Metzger Animal Hospital, State College, PA

Why make it mandatory?

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It makes workflow easierReception

• Faster registration/drop-off• Simplified process—no forms

Technician • Uniform policy for lab work • Eliminates “this one wants testing, this one doesn’t”

Doctor• No more convincing• More time to focus on the patient work-up

Clinic• Higher standard of care, better service, increased client loyalty• Creates comfort in client discussions clinic-wide

Why make it mandatory?

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Your clients want itPet parents look to you for advice on what’s right

• 78% of dog owners and 71% of cat owners say veterinarians are their primary source of information1

Clients won’t leave you

• In his first 18 months of mandatory preanesthetic testing, Dr. Irwin only had two clients object to it.2

1. Ralston Purina. The state of the American pet: A study among pet owners. October, 2000:53.

2. Irwin J. Preanesthetic program can be standard in delivery of quality care. DVM Newsmagazine. November 1998.

Why make it mandatory?

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How to implement preanesthetic testing in your practice

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Tips for success• Follow the protocol

• Involve the entire staff

• Use the tools

• Communicate with your clients

• Believe in what you’re doing

How to implement

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Staff roles Everyone plays a part

How to implement

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OK, it’s mandatory…what do I test?• Age-specific testing

• Additional tests based on specific animal

• Get the whole picture—chemistry, hematology, electrolytes, etc.

• Plasma for efficiency

How to implement

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Conversations with clientsPuppy/Kitten visit

Discuss preanesthetic testing—clinic policy, gravity of anesthesia, need for testing, baseline data

New client call back

Make recommendations about how best to choose a clinic—including clinic tour, Web site visit and asking about preanesthetic testing, pain management, etc.

Older pet, existing client

Discuss procedure—advances in veterinary medicine, the gravity of the pending procedure, risks, etc.

How to implement

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ToolsClient Materials• Client brochure

• Good News pad

• Results printout

Clinic Tools• Run Preanesthetic

Testing stickers

• Discussion guides

• Common objections

How to implement

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Always communicate with your clients

• Pets can’t talk

• Human connection

• Standard of care for all pets

• Gravity of procedure

• Baseline data

Preanesthetic testing is important…

How to implement

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Summary—Preanesthetic TestingTesting is important • Pets are at risk• Considered a standard of care

Make testing mandatory • Clients want it• Easier workflow

Implementation• Involve the entire staff• Communicate with

your clients

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Good Luck!• Work as a team to gain

momentum in the program.

• Success will leave you confident in knowing that you offered each pet the best care possible.

How to implement

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Run plasma to increase efficiency• VetTest and VetLyte both run plasma

• Results in 8 minutes, you can quickly let owners know if their pets are ready for surgery

“Customers are 2 times more likely to agree to follow recommendations when presented with written lab work.”

Jim Irwin, DVMSulphur Springs Animal Hospital

VetTest TimeSerum 1. Allow sample to clot 20 minutes

2. Spin Sample in Statspin 2 minutes3. Sample run=6 minutes 6 minutes

Plasma 1. Heparinize Whole blood2. Immediately Centrifuge in Statspin 2 minutes3. Sample run=6 minutes 6 minutes

How to implement