If the pet is not awake, it is easier to detect and diagnose dental issues. A distraught technician explained her hospital schedules 14 dental procedures per day, and she’s worried about her health. After four procedures in a row, her arm goes numb. The technician sought advice from conference speaker Mary L. Berg, BS, LATG, RVT, VTS (dentistry) of Beyond the Crown Veterinary Education in Lawrence, Kan., and author of Dental Radiographs Made Easy and Companion Animal Dentistry for Veterinary Technicians. Avoid overcrowding dental schedules, which can put patient and technician health at risk. “If a practice wants to embrace dentistry, they can’t schedule eight or more per day because they will do poor procedures,” advises Berg. “Take time to look for disease, take radiographs, and address problems.” Teams can be more efficient with smart scheduling and setting clients’ expectations. Here’s expert advice: Budget enough time Rushing to complete procedures can leave some disease untreated, Berg warns. Create scheduling guidelines for client service representatives (CSRs) and other employees who book procedures. Berg shares estimated procedure times based on the stage of periodontal disease. Procedure times are “table time” from induction to the start of recovery, and include taking radiographs and performing some extractions. Patient preparation and recovery time are additional. Multiple and/or difficult extractions also will increase times. Stage 1 procedure: 1 hour Stage 2 procedure: 1 to 1 ½ hours Stage 3 procedure: 2 to 2 ½ hours Stage 4 procedure: 3 hours Let’s say the dental team will perform procedures from 9 a.m. to 1 p.m. for four hours of procedure time. The team could do four Stage 1 procedures, two Stage 2 procedures, or one Stage 1 and one Stage 4 procedure. Berg advises limiting to two Stage 3 or 4 procedures per day. If the procedure will require more than three hours, consider staging care, Berg suggests. The first procedure is a dental cleaning while the second is oral surgery about a week later. Debra Bohnke, DVM, and medical director of Cimarron Animal Hospital in Tucson, Ariz., explains in her blog staging dental treatments also spreads out expenses for clients. “Seventy-five percent of dogs and cats have more dental disease than can be detected when pets are awake because they don’t let anyone do a thorough 360-degree tooth-by-tooth examination while they are awake,” Dr. Bohnke writes. During the first procedure, Bohnke calls the client to explain any additional treatments and extractions. She discusses doing everything at once or delaying care along with an appropriate timeline based on the severity of disease. If staged care is performed within the time specified, Cimarron Animal Hospital offers an $85 credit toward the second anesthesia. Assign a dental team Use two to three technicians and assistants based on your staffing levels, Berg advises. An anesthesia technician does hands-on patient monitoring and watches electronic monitoring equipment. “Don’t rely on electronic monitors only,” Berg warns. Periodically use a stethoscope as a double check. The second teammate is a dental technician who performs the procedure. An optional third member is a veterinary assistant who completes an oral examination, takes full mouth dental radiographs, and performs the procedure. Additionally, a fourth member (also veterinary assistant) can be available to assist the dental technician with charting and radiographs. Set the order based on doctor availability Do not schedule an orthopedic surgery at the same time as a Stage 4 dental procedure, which will require the doctor’s time simultaneously. Veterinarians will perform most oral surgeries. Consult your state board of veterinary medicine on which duties technicians and veterinary assistants may or may not perform, including extractions. A smart scheduling approach is to have the doctor performing a spay, neuter, or shorter surgery while the dental team is doing Stage 3 and 4 procedures. Set client expectations Clients at VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York in Buffalo, N.Y., get an admission process sheet upon scheduling. Instructions explain what to do or not do 10 days before the pet’s procedure, the day before, what to bring, and what to expect on procedure day. The admission process sheet tells clients they will get pre-admission calls the day prior, which will last 10 minutes. Hospital manager Holly Monroe says a triage technician calls clients with CSRs as backup. Questions are prepopulated in electronic medical records based on the type of procedure and patient history. All clients are asked if pets have taken any medication within 24 hours, including NSAIDs, fish oil, or aspirin; any issues to be aware of before procedures; who will bring the pet; confirm vaccines are up to date; and discuss any additional services. A client with a diabetic pet will be asked about the brand of insulin, how much is given, when the last dose was administered, when the pet will eat, and when the next insulin dose will be due. Clients receive individual treatment plans and anesthetic consents by email or through the MyVCA app, which allows digital signatures. The admission process sheet and preadmission calls have cut surgical and dental check-in times in half. “This has helped the admission process in so many ways,” says Monroe. “We can admit six to seven clients smoothly and quickly. Medical records are more thorough. Every staff member is asking consistent questions. We have fewer no-shows. It’s been a huge deal for us. The more communication you have with your clients, the better.” Clients also pay 75 percent of the treatment plan upon booking. Have preoperative appointments Suffolk Veterinary Group Animal Wellness & Laser Surgery Center in Selden, N.Y., created preoperative appointments to avoid surprises on surgery days. “Our veterinarian was tired of not knowing what type of surgery he was walking into that day,” explains practice manager Nicole Carucci-Winkler, LVT. New clients would call, schedule surgery, and drop off patients. “We would have no idea who these people were, who patients were, and what, if any, contraindications to surgery there might be,” says Carucci-Winkler. “A canine neuter could be a five-pound Yorkie with a portal-systemic liver shunt. You want to know about the shunt prior to surgery, not the morning of surgery. No human doctor would do surgery on a patient without a preoperative appointment. Why should a veterinarian be required to?” Preoperative appointments are with a veterinarian and licensed veterinary technician (LVT). Before the preoperative appointment, the LVT contacts the referring or previous veterinarian for medical records, reviews and audits patient history, checks vaccination status, and writes a case summary for the veterinarian. The doctor examines the patient to establish a veterinary-client-patient relationship (VCPR), which is required by state law and the American Veterinary Medical Association (AVMA). “Introducing the LVT as part of the surgical team helps build clients’ trust and educates the public about who an LVT is and the importance of his or her role in veterinary medicine,” Carucci-Winkler says. During the preoperative appointment, 10 to 14 days before the procedure, the doctor and technician explain the procedure, fees, third-party financing, and expected outcomes along with possible complications and post-operative care. The technician collects blood and urine samples to send to its reference lab. You don’t want abnormal results the morning of the procedure, such as the patient with a portal-systemic shunt, Carucci-Winkler explains. “You don’t want to call the client while she’s at work or otherwise occupied and tell her you’re cancelling surgery because blood work indicates the patient needs additional diagnostics before you would put it under anesthesia,” she says. Preoperative appointments let the team choose appropriate dates and times based on the type of procedure. Clients sign treatment plans and anesthetic consents in advance. When patients are admitted for procedures, clients just sign to acknowledge they are admitting the patient and confirm contact information for today. Talk with your team about ways to streamline admissions, budget procedure time, and set clear expectations for clients. You and your clients deserve smooth, efficient check-ins. Wendy S. Myers, CVJ, has been training veterinary teams for 22 years as owner of Communication Solutions for Veterinarians. She teaches teams to become confident communicators, so more pet owners say yes to medical care. You may reach her at wmyers@csvets.com or www.csvets.com.
