Basic Animal Restraint

Hello everyone,

I wanted to create a place where you can regularly go to view some basic k9 and feline restraint techniques.  Thanks to my good friends at Animal Medical in New City, we have the following pictures.

Correct approach towards a canine in the waiting area.

In the above photo, you can see a wary dog.  Notice how it's banked next to the owner's leg.  By approaching the pet from the side, rather than directly on, Jill is less confrontational to a frightened patient that could very likely bite.  She allows her hand to remain at her side where the k9 can investigate on it's own terms.

In the photo below, see a response that is very natural to us, but very confrontational to the dog.  It is our natural instinct to want to stand over small dogs and put our faces into theirs for a closer, more intimate look.  To the dog, this is frightening, aggressive and confrontational.  While people understand that we are only being nice, dogs do not.  Never bend over a strange dog and look at it directly in the eyes.   Our patients in our lobby are frightened and outside of their element.  A bite is very likely, regardless of the patient's 'normal' temperament.

Remember that cats feel safer in the lobby if placed on something higher up, (like the bench you are sitting on...but make sure the carrier is squarely situated so that it doesn't fall off).  For more information on great tips to keep cats calm during the transportation process to the veterinarian and while they wait at our practice, shoot me an email to sit in our live restraint class.

Once cats are in the practice, it's best to allow them to come out of their carriers on their own terms.  In many cases, cats may remain couched inside, a common sign of fear.  To reduce stress, it's best to remove the top portion of the carrier in order to have access to the cat  rather than reaching in and pulling the cat out.  In some cases, the cat can be 'dumped' out of the carrier onto the table, but again, this can be stressful for the patient and alarming for the owner to see.  Use a calm voice at all times.  Remember that any time you reach into a carrier to pull a cat out, you risk a scratch or a bite.

In this picture, a fractious or aggressive cat is prepared for restraint.  The carrier top has been removed and the veterinarian has slipped a heavy town over the bottom portion of the carrier.  With his hands restraining the head of the patient through the towel, he'll use the insides of both arms to squeeze the entire patient's body and lift it from the carrier onto the table.

When taking canine patients out of a cage, it's important to remember to keep your hands and body outside of the cage as best as you can.  K9's may think of the cage as a safe retreat from the frightening environment they see through the bars and may become aggressive towards anyone that tries to take them out of their 'safe' spot to pull them into the scary world.  For this reason, we always use a lead to guide dogs from their kennel.

 Notice the gentle lead that the technician is preparing to slip over the patient's head shown in the background.

With her body safely on the outside of the cage, the technician holds the gentle lead open for the patient to 'walk into'.  Once the lead is around the patient's neck, the technician can escort the patient out of the cage.  Remember, if you are going to walk patients outside, you must always have TWO leads on the patient in case one of them should slip off.

Lateral Recumbancy is a basic position for both dogs and cats.  In the photo below, a technician firmly (but not painfully) scruffs the skin in the back of this cat's neck, while grasping both of it's back legs with the other free hand.

Note how the technician can use the inside of his right arm to push ventrally against the cat's body forcing it if necessary to stretch out more.  This prevents the cat from contacting the the technician's left hand (or the hand of the other technician or doctor).  The left hand has an index finger in between the two rear legs for a more secure, comfortable restraint.  In this photo, the tail of the cat remains behind the restrainer's hand, but in cases, where a cat may move about, the technician can include it in the grasp of the left hand.

Here's the same restraint technique being used on a patient for a saphenous blood draw.

Notice how the tail and the right leg of the patient are being held in the technician's right hand while at the same time she applies gentle pressure to the inside of the patient's left leg.  This pressure make blood pool in the saphenous vein, increasing it's size and allowing the veterinarian to better see where to introduce the needle for the blood draw.

The below photo demonstrates lateral recumbancy in a dog.  It's a slightly different hold.  We don't scruff dogs, rather we use the weight of arms to keep them lying on their side, while the hands holding the table-side legs prevent the patient from getting up.

Though this shows a feline patient, here is the technique we use to place a dog in lateral recumbancy

With the k9 patient pressed into your body, grasp the legs closest to you from the far side of the patient.  While keeping the patient's body close to yours, gently pull the inside legs out from beneath the patient and away from your body.  The torso of the patient should gently slide down you own body to rest easily against the table surface.

In this case, the technician can use his hands and arms to apply pressure to the dog's body and keep them from moving too much.  The hands on the table-side legs, prevent the patient from standing up.  Again, this technique is used on dogs, not cats.  We just happened to have a very gentle cat handy for the demonstration :)

Ventral recumbancy refers to the stomach portion of the patient being in contact with the table.  We also sometimes refer to this as sitting or lying sternal.  Below is an example of feline patient being held in ventral recumbancy for a cephalic blood draw.  The same hold can be used on dogs.  Notice that Sandy is using her entire body to securely restrain and envelope the patient.  This reduces movement and believe it or not, stress.  Animals often respond favorably to secure contact.  The patient looks as though it is being held very hard.  In reality, it is being held securely and comfortably.  Sandy's left hand is preventing the patient from biting the doctor, but it's in no way hurting or choking the patient.  She is using her right hand to grasp, rotate and 'hold off' the cephalic vein that is located on the inside or medial side of a cat and a dog's front legs.

This is Dorsal recumbancy in both a cat and a dog.  Below shows the same positioning if it is necessary to scruff the feline patient.

Like before, this technician is using the inside of his right arm to press against the dorsal surface of the patient.  This arches the patient's back and prevents the patient from striking the restrainer's left hand with its front paws.

Here is another view of ventral positioning that can be used in both a dog or a cat.  An index finger between the front legs makes for a more secure and comfortable restraint for the patient.  If this patient were being positioned for a jugular blood draw, the technician would move his third and fourth fingers of his right hand out of the way and arch the patient's neck towards the phlebotomist.  The jugular vein is found both on the left and the right of the patient's neck, just lateral of the trachea.  When positioning a patient for a jugular stick, listen to the phlebotomist's instructions on which way to adjust the patient's head so that the jugular vein can be visualized.

These last photos show how a cat can be returned to it's carrier.  In most cases, a frightened cat will gladly return to the safe confines of hits carrier.  Simply open up the door to the carrier and allow the patient to walk (or run) in.

You can see that this patient however is reluctant and is bracing itself against entry.  To fight with a cat like this only risks more stress for the cat and a potential scratch or bite to the handler.  Instead, try lowering the patient into the carrier as shown.

I hope all of you have found this helpful.  Please send me some comments if you would like additional holding techniques photographed and explained.   Remember to BE SAFE!!!!!  IT'S IN EVERYONE'S BEST INTEREST.

Restraint and Emergency Coming UP!

Hello all!  Just a quick reminder that I’ll be doing an online class titled Restraint and Animal Safety this coming Wednesday, April 27^th at 1pm.  This class discusses the importance of safety as well as the costs involved with work related accidents.  We’ll show several pictures of feline and canine restraint designed to keep patient and handler safe.   We’ll also be doing another class titled Emergency!  on May 17^th which teaches the assistant and client care specialists how to quickly assess a patient’s emergency status, how to handle emergency phone calls and the basic physiological signs patients exhibit when in an emergency crisis.   Still unannounced is a class on the common diagnostic tests we perform in the hospital, how patients need to be prepared for them and what they are telling the veterinarian.  This will be sometime in May, we just haven’t set a date.  As always, current clients of Halow Consulting attend classes free of charge while outside hospitals may attend for 35 dollars per hospital.  Please contact Bash at bash@halowconsulting.com for more information.  Have a wonderful Spring Break everyone!!!

The NYSAVT Spring Conference is a success!!!

Take a look at the turn out for the NYSAVT spring conference!   Held at the beautiful Beaver Hollow Lodge in Javit Center, NY, this great CE event was a knock-out-of-the park success. 

I worked with some of the LVT-Managers and  extra-interested LVT’s in the group going over veterinary financial management information.  We worked for 3 hours in the facility’s well appointed board room.  Because our group was small, we had some great interaction and really had a chance to dig into the material.  Thank you so much NYSAVT for a wonderful time!

Now for the drama part of the story.  The event was held on April 16^th, but on April 15^th, my computer crashed!  No worries, I had the presentation on a thumb drive and one of the organizers was happy to loan me her computer…which wouldn’t boot the show.  No problem, the conference center provided me with a computer…that crashed during the presentation…No problem, one of the NYSAVT board members loaned me her computer…which went off twice because of the storm-related power outage…No problem we rebooted it so we could continue with the presentation which was interrupted by an announcement, “Does anyone own a blue car with license plate number…it’s an emergency (see the emergency below)”

Big problem.  The wind had blown over a tree which went crashing into one of the attendee's car!   I continued with the lecture, before we were interrupted again.  “Does anyone own a Toyota Tacoma with license plate”….YES, I DO.  MY GOD, WHAT’S WRONG?  (See below what was wrong)

This big tree was ready to continue breaking and slam down on a couple of cars (mine included) parked underneath.  No problem, I moved the car.

Despite all the mishaps, our group stayed ½ hour past our finish time, exchanging ideas and talking.  I hope to stay in touch with all my new colleagues!  Thanks again, NYSAVT.  Even gale force winds couldn't dampen the spirit of this group!

Sip and read

Happy Monday morning fellow managers!  Who needs another cup of coffee?   Go on, you know you want it.  

While you sip that, I want to go over some upcoming events that you may not be aware of.

#1  The NY State Association of Veterinary Technicians is having their Spring Seminar this coming weekend.  I’ll be doing 2 hours of lecture, so if you feel like a day trip to Java, NY (that’s the city in NY, not the Jacob Javitz Center in NYC), head on up.  Should be a great conference with a great group of people.  For more information go to http://www.nysavt.org/seminar2011

#2  Not to be outdone or upstaged, another group of great people (led by the indomitable Tracy Turner, CVT), the New Jersey Veterinary Technician Association will be holding their annual conference, Sunday, April 17^th.  Please take a look at their website, http://www.njvta.com/, for more information.  Over the past three years, this group of inspired and dedicated technicians have really pulled the State’s veterinary nursing together and done an excellent job at improving the care we provide our pets and the awareness of the industry within the state.

#3  Have I harped enough about the May 19^th event at Redbank with Karyn Gavzer?  And for the love of god, take 20 seconds and do the survey at http://www.surveymonkey.com/s/FKCHXQP.  We’re going to use the information to illustrate some points about where we are as a group with our human resources.  Strictly anonymous, so go ahead and let her rip.

#4  What about the online classes?  You don’t want to treat your receptionists and assistants to a fast little learning session with the Halow?  This is not your regular CE, but an integrated approach to turn education into superior service, the endorsement of your practices and increased awareness of the value of veterinary services.  Give it a whirl.  Next one is Tuesday, April 11^th at 1pm on diarrhea (no wisecracks, please).  Send me an email at bash@halowconsulting.com if you would like an invitation to this live webinar.

Ahhhh $%^&, my dog has diarrhea!

Diarrhea!

How many calls do we get each week regarding diarrhea?  Is your staff prepared as well as it can be to answer your client’s concerns and can they intelligently and convincing encourage the client to book an appointment?

I have an upcoming, live webinar, Diarrhea in the Companion Animal, scheduled for April 12^th at 1pm. Invite your team to learn how the body’s digestive tract should work, what goes wrong when a patient has diarrhea, the many causes of diarrhea, and what each veterinarian does when examining and diagnosing a case of diarrhea.  We’ll talk about the benefits of an examination and the words we should use when encouraging a client to book an appointment for this illness.  Attendees will also get a copy of a phone script to use as well as a flow sheet when triaging cases over the phone.   Please send me the email addresses of those in your practice that you would like to attend.   Current clients of Halow Consulting enjoy this webinar free of charge.  Other clinics contact me for information on how your entire team can attend!

As a reminder, we will be REPEATING the lecture on Endoparasites at 3pm also on April 12^th.  Attendees will leave understanding the common parasites we find in our routine screenings, the medications we use to treat the infections, and the strong need for regular endoparasite testing.   Handouts are also available to all attendees. 

They Call It Christmas City

Hey Everyone,

Great news!

My partner, Robin Stankowski and I will be working with a soon-to-be-opened animal hospital in Bethlehem, Pa.  Can I start out with Bethlehem…anyone ever been there?   I don’t know if you’re like me, but I was thinking rust belt, steel town, row houses…like that…NOT SO AT ALL.  It’s really beautiful actually…beautiful houses; nice planned parks…the community seems civilized and alive with momentum.  Something I wasn’t expecting.  Also, for you gamblers out there, they have a casino.  A big one.  So pack up the car and day trip it to Bethlehem. 

Robin, a resident of Bethlehem, says that Christmas City is popular alternative to the city's formal name.

Anyway, back to the animal hospital.  They’re setting it up in a former bank!  In fact, one of the exam rooms/office is going to be in the original vault.   You know, I’m an old I Love Lucy buff, and you can’t imagine the Mr. Mooney high-jinx that was going through my mind when I saw that vault:

 

Vault Scene:  Mrs. Pierpont is our most demanding client.  Her prize poodle, Perfume, wanders into the vault when I’m not looking.  I accidentally lean on the door, locking this poor dog in with no means of escape.  “Oh Mr. Mooney!!!!”

Alright, I’ll knock it off.  Anyway, the owner and I worked out a plan to move forward and I’m very excited.  One of the things we’re all committed to doing is keeping a journal of our progress.  A veterinary hospital from the loan-closing date to grand opening, from Bank of America to Bank of Cages, from FDIC to SOAP.  It should be a great way to reflect back on this very important and exciting time.  So keep a look out here for more information on how we come along.  Also, we're going to be relying heavily on our already strong relationships with our vendors for ways to keep our expenses as low as they can be.  We'll be sure to share some of the cost savings strategies we hear about.

See that window?  That used to be the drive up.  Can you see that little canister right in front of it...that was that thing you put your deposit in that got sucked into the tube.  Cool, right?

Take care everyone and I look forward to talking to you soon!

Great Night at the 'Ole Veterinary Referral Center

Well hats off to the Stacey Simpson-Camelli of Antech, Amy Shields and the entire team at Animal Critical Care and Specialty Group of Malvern, Pa for hosting our discussion Financial Oversight and Pricing for the Busy Practice Manager.  What a terrific evening we all had discussing our pricing, markups and Key Performance Indicators with fellow colleagues from around the south east part of Pa. 

Take a look at this facility, would you? 

You know I’m a big stickler for service…well VRC seems to have it down.  When I entered their lobby, every Client Care Service person looked up and smiled and gave me a hearty hello.  Signs were already in place directing attendees to the conference room and once there, we were all treated to a delicious catered meal.

Okay, so I should have had everyone pose…

Thanks to all who expressed an interest in a stronger Pennsylvania State coalition of managers.  And how great was it that Dr. Ron Kraft, Secretary Treasurer of the PVMA was there to tell us about the New Membership Category for managers through their organization?  I’ll be sure to follow up with Dr. K in the upcoming weeks and contact all who expressed interest in our group to see what venues we can use to bring us together better.  I’ll also reach out to Dr. Mary Bryant and Deborah Harvey of Vetstreet.  I have a feeling that between these very supportive industry veterans, we’ll be able to come up with some great resources to make our jobs more enjoyable and successful.   Anyone else have an idea on who we should contact or a direction in which they would like to see us move forward?

I had lots of inquiries about the formulas I discussed as well as my online classes.  I’ve listed these on a separate blog page to make it easier for you print out and have on hand.  Also, check out the live online classes that I’ll be offering in the month of April.  These are 40 minutes long…just enough time before things start melting down and you everyone has to go back to their prospective posts.  Here’s a breakdown of how the classes work.

1.  Send me an email that you are interested in having your staff attend.  I need one email address for each terminal that you plan on using.  Please note that your staff members can log in from home too.  There is no additional cost, just an honor system that you are paying for your staff alone and no other practice.

2.  I’ll send you a link to make a payment of 35 dollars through Paypal.  Make the payment and you’ll receive an invitation-link for each of the email addresses you sent to me.  Remember 35 dollars buys your entire staff access to the webinar.

3.  Log onto the webinar at the designated time, sit back and watch.  Ask any questions you like during the live broadcast either by raising your hand, speaking or typing me text in a private chat window.

4.  At the end of the class, each participant will receive great, user-friendly handouts that can be placed into your training manual or that can be the start of one you have yet to create!

5.  Remember, these are excellent classes for Client Services and Assistants alike.  They not only train the medicine, but they train the language we should use when talking with our clients.  They are designed to make a direct impact on your patient and client care and consequently improve your bottom line.

Common KPI's and other tools for Financial Oversight

Common Key Performance Ratios and other tools for Veterinary Practice Financial Oversight

Return on Sales= Net Profit/ Gross Sales

Net Operating Income= Money left over from Gross Sales after all reasonable expenses have been paid.

Average Invoice=  Gross revenue in a period/# of invoices in the same period

Average Client Invoice= Gross revenue in a period/ # of clients seen in the same period

Average Patient Invoice= Gross revenue in a period/# of patients seen in the same period.

Client Retention= Active Clients previous period+ new clients this period- active clients this period= # of clients lost (you may wish to increase the active search for clients ‘this period’ to be 18 months to account for stragglers)

New Client Retention=  New Clients seen last period and this period – New clients seen last period

Value of a lost client= avg # of pets per owner X avg transaction X avg # of visits per client X # of years client owns pets X number of friends client may refer over the life time of a pet

Financial Terms Defined: 

Gross Revenue:  Total Income for a practice (found at the top of the Profit and Loss Statement)

COGS:  Cost of Goods Sold.  These are your variable expenses or all of the expenses that change proportionately depending on the amount of business you do.  COGS for a health practice should be 18-22%.  Aim for 14-18 % if you are a hospital with a small staff and a straight- forward case load, but even larger practices should not exceed 22%.  Referral hospitals often have a much higher COGS.

Gross Profit:  Money left over after you take out the COGS

Expenses:  Listed after the COGS in the Profit and Loss.  These are a practice’s fixed and semi-fixed expenses.  The biggest expense in this section of the profit loss is payroll.

Net Profit:  The amount of revenue left over after all the COGS and the Fixed and Semi Fixed expenses have been removed.

Pricing:

Pricing Calculator=

Fixed Costs per minute + Semi Fixed Costs per minute+ Minutes it takes to do a service+ material/lab/radiological costs to do the service+ desired markup = price

Formulas to determine markup:

If you are looking for a mark up on cost the formula is

Cost+ (Desired Markup X Costs)= Final Price

If you are looking for a mark up on final price the formula is

Costs + (Desired Mark up X Final Price)= Final Price

If you are paying doctors on production and want to include your doctor production costs in the final price the formula is:

Costs + ((Desired Mark Up + Doctor Production) X Final Price)= Final Price

April Calendar of Continuing Education

Hey Everyone, here is the Continuing Education Class Calendar for April 2011

Here's how you do it:  For an invitation to this live webinar, send an email to bash@halowconsulting.com and provide a list of those members of your team who will be attending. One email per terminal please, so if you have more than one employee at one desktop, you only need to provide one email address of one of the attendees who will be at that terminal.  Once we receive your note, you will be provided with a link to make a 35 dollar payment to PayPal.  This payment covers all the members of your team and there is no limit on the number from one hospital that can attend.  Once we receive payment, we’ll provide you with an electronic invite to use when signing onto the class.  If you have additional questions, send us an email at the above address.   We look forward to seeing you there!

April 12^th, 1pm  Diarrhea in Dogs and Cats.  This class gives receptionists and veterinary assistants a solid understanding of the common reason pets get diarrhea.  We spend a great deal of time explaining why a visit to a veterinarian for diarrhea cases is important and how it can save both the pet and the owner a lot of needless discomfort and concern.  This class comes with a great triage sheet that team members can use on the phone to assist in booking the appointment and explaining the need for a visit.

April 12^th, 3pm  Endoparasites.  With so many of us sending out fecal samples to laboratories and seeing an increase in positives, it’s important for all of our team members to know about the endoparasites we are identifying.  This class is not just the medicine behind the parasite, however; but handouts on the common medications we use to treat infections as well as information our team members can share with clients to convince owners to take precautionary steps against infection.

April 27^th, 1pm  Restraint for the Receptionist and Assistant.  This class, complete with photos, discusses safety measures all of us should use when working with animals.  We cover basic interaction with our patients in the lobby, removing patients from and placing them into carriers, restraining patients for catheters and blood draws, restraining patients for examinations, and removing patients from cages.   We also discuss the tools we have at our practices to keep us safe and how best to use them.