1. 1 Preanesthetic Testing: © 2004 IDEXX Laboratories, Inc. All rights reserved. 2423-00 (2) Why Mandatory Makes Sense

2. 2 Overview—Preanesthetic Testing Why test? Why make testing mandatory? How to implement a program in your clinic

3. 3 Why preanesthetic testing?

4. 4 “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

5. 5 Updated research: importance of testing Study 1 11% delay of surgery 84% compliance in first 6 months (optional) Only 2 clients objected in last 18 months (mandatory) Study 2 —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?

6. 6 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 Hypokalemia18 Hyperadrenocorticism 1 Hyperthyroidism 2 Hypothyroidism 6 FIV/FeLV 4 FIP 2 n = 542 Why Test? It’s Quality Medicine Sulphur Springs Veterinary Clinic, Irwin Study 1996–1998

7. 7 It’s Quality Medicine Sulphur 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. AbnormalitiesTotal ALTincreased11 ALKPincreased18 BUNincreased or decreased16 Creatinineincreased 5 Glucoseincreased or decreased 7 Total Proteinincreased or decreased11 Sodiumincreased or decreased18 Potassiumincreased or decreased16 Chlorideincreased or decreased11 Neutrophilsincreased or decreased 9 Hctdecreased12 Lymphocytesincreased or decreased10 T4T4 increased or decreased15 n = 128 Why Test?

8. 8 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?

9. 9 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., DVM Seaside Animal Care Calabash, NC Why Test?

10. 10 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?

11. 11 Why make preanesthetic testing mandatory?

12. 12 “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?

13. 13 It makes workflow easier Reception 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?

14. 14 Your clients want it Pet 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 information 1 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?

15. 15 How to implement preanesthetic testing in your practice

16. 16 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

17. 17 Staff roles Everyone plays a part How to implement

18. 18 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

19. 19 Conversations with clients Puppy/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

20. 20 Tools Client Materials Client brochure Good News pad Results printout Clinic Tools Run Preanesthetic Testing stickers Discussion guides Common objections How to implement

21. 21 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

22. 22 Summary—Preanesthetic Testing Testing 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

23. 23 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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25. 25 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, DVM Sulphur Springs Animal Hospital How to implement