Small Animal Emergency & Critical Care Medicine Maureen McMichael, DVM Diplomate ACVECC Texas A&M University

Emergency & Critical Care Proposal - Independent SAECC Service - 2002 Three phases Physical space/curriculum/consulting Emergency receiving service Critical Care service

Phase I Physical Space Design and build new 3,000 sq ft ICU Old ICU too small Need for ICU protocols Need for critical care monitoring Need for POC testing Need for ECC in curriculum

Phase II Emergency Receiving Service Receive all incoming emergency cases Transfer all stable cases to appropriate service the following weekday ECC student rotation with didactic rounds ECC student manual

Phase II Emergency Receiving Service Benefits Students – ER rotation, rounds, sleep Interns & Residents Clinical Services – IM, surgery, onco Local Veterinarians Local Clients Hospital Income

Phase III Critical Care Service Separate CC service that takes trauma, toxins and all critical case transfers Separate student rotation Residents and interns – experience with complex critical cases

Phase III Critical Care Service Benefits Students – CC rotation, rounds Interns & Residents Clinical Services – relieve caseload Local Veterinarians – case continuity

Resources Needed Full Plan – implement in stages 4-5 ECC faculty (2-3 ER, 2-3 CC) 3 ECC residents 1 dedicated ECC intern Continued rotation – house officers 6 Students (3 day and 3 night)

Where Are We Now? Physical Space ICU protocols, POC testing, etc. Curriculum Emergency Receiving Service Critical Care Service

Phase I Physical Space New ICU Old ICU

New ICU – 3,000 sq ft

Phase I Physical Space Equipment Protocols Ventilator Monitoring equipment Pyxis Protocols For technicians, for interns

Phase I Physical Space CPCR protocols Constant rate infusions – analgesia

Phase I Physical Space ICU treatment sheets – prompts for students Emergency drug dosages – every animal

Phase I Physical Space Point of care testing Rapid results – 1 minute, 14 tests Blood gas – teaching, patient care

Phase I Curriculum First year CPCR, Respiratory physiology laboratories 2nd year – CPCR lecture, labs 3rd year – Clinical Skills lab 3rd year – 5 didactic ECC lectures 4th year – ER rotation ER student rotation manual

Phase II Emergency Receiving Service mid-October 2004 No marketing outside local BVVMA Case load up significantly ER income up significantly

ER Cases and Fee Revenue Year Oct Nov Dec Jan ER caseload 2003 164 204 107 2004 212 275 344 232 Change +48 +111 +140 +125 ER Fee 12,283 12,277 15,269 7,250 15,912 20,662 25,834 17,217 +3,629 +8,385 +10,565 +9,967

Phase II Emergency Receiving Service Marketing Potential ER Magnets RDVM phone Advertising/PR ECC RDVM conference Ross students

Where Are We? Phase I – Completed Phase II – Very successful – growth potential Phase III – If ER continues to grow - need a CC service Resources??????

Resources Needed Davis ER MSU Tufts ER cases/yr 1500 4000 9000 ECC faculty 3 6 ECC residents 4 1/3 9 ECC interns - 2 5 ECC DVMs

TAMU ER 3600 1 Davis ER MSU ER Tufts ER cases/yr 1500 4000 9000 ECC faculty 3 6/7 1 ECC residents 4 1/3 9 ECC interns - 2 5 ECC DVMs