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Logistics and efficiency on a surgery day (Proceedings)

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Aug 01, 2011

Running a high volume spay neuter operation requires much more than having efficient surgeons. Everything about the operation from scheduling appointments and intake of patients to discharge of patients after surgery must be organized and run efficiently. A chain is only as strong as its weakest link and a spay/neuter operation is only as efficient as its slowest component. While this presentation describes the operations of a high volume spay neuter clinic the concepts presented here can easily be transferred to any spay neuter function.

What are the tasks?

The obvious

     • Scheduling appointments
     • Intake of cases
     • Patient assessment
     • Patient induction
     • Presurgical prep
     • Anesthetic management
     • Surgery
     • Anesthetic recovery
     • Post-operative evaluation
     • Patient discharge
     • Maintaining medical records

Behind the scenes

     • Cleaning surgery suite(s), prep room(s), recovery area, cages/runs etc
     • Preparing surgery packs
     • Restocking
     • Ordering supplies

Appointments

To run efficiently any spay neuter program needs to run on an appointment only basis. The program must have a system to determine how many of each type of surgery can be performed in any given day. This decision must be based on the financial targets of the organization as well as the capacity of the system based on veterinary surgeon's skills, technical assistance available, hours of operation, and available facilities. In our spay neuter program we use a point system with adult dog spays counting 5 points, puppy spays counting 4 points, cat spays counting 3 points, adult dog castrations 2 points, and puppy and cat castrations 0 points. We can easily handle 70 points a day and this is with veterinary students performing a majority of the surgeries. Each program will have to determine its own ideal system and then strive to operate at maximum capacity. It is wise to anticipate up to a 5% no show rate and up to a 5% decline for surgery rate. To operate at maximum capacity, therefore, appointments are scheduled up to 110% of maximum. Occasionally you will get "burned" by this overbooking, but not often.

Intake of cases

To function effectively the program must have specific drop off and pick up time for patients. Staggering patient arrivals and discharges through the day is extremely disruptive and interferes greatly with efficient operations. Humane Alliance schedules all arrivals to occur between 8 am and 9 am and all discharges at 7:30 am the next morning except for surgeries on Fridays. For Friday surgeries discharges are at 5 pm the same day. Universal appointment and discharge times allow you to efficiently schedule personnel for the day and gives the veterinarians the opportunity to evaluate all patients before starting surgery.

Ideally, an office representative greets the clients, initiates the paperwork, and collect fees. The client and patient are then directed to a veterinary technician who confirms that the patient has been held off food for the appropriate time period, obtains a medical history and determines any obvious medical concerns.

Patient assessment

All patients must receive a physical examination by a licensed veterinarian. Ideally, the veterinarian who will be performing the surgery conducts this exam. The results of the examination, coupled with the medical history, are used to make the final determination as to whether or not to perform the surgery. All females should be examined for the presence of a spay scar; all males examined for the presence of testicles. It is up to the clinic/veterinarian to determine what medical conditions would disqualify a patient from surgery at that time, but every effort should be made not to anesthetize an animal that has already been spayed or neutered.