Utilizing CVTs to Improve Efficiency

By Kate Boatright, VMD

As a doctor, when was the last time you drew blood on a patient? Placed an IV catheter? Restrained a patient for radiographs? If these are things you’re doing on a regular basis, you may not be fully leveraging your support staff. With the high caseloads experienced in practices, maximizing efficiency can improve patient outcomes, reduce staff stress, and increase staff satisfaction, retention, and practice revenue.

What Can Your Technicians Do?

The easier question to answer is what they can’t do. Based on the Pennsylvania Veterinary Regulations, credentialed veterinary technicians, also known as veterinary nurses, and veterinary assistants are only prohibited from doing five things: perform surgery, diagnose, prognose, prescribe, and attest to health status.1

What tasks they can do in the clinic depends on the level of veterinary supervision provided. The PA Regulations define three levels of supervision: indirect, direct, and immediate. Only credentialed veterinary technicians—which I will refer to as CVTs or veterinary nurses for the purpose of this article—can operate under indirect supervision. This means the veterinarian does not have to be on site but has given written or oral instructions for a case they are managing. This can include administering vaccinations and injectable medication, placing IV catheters, performing diagnostic imaging, and applying bandages.

Both CVTs and assistants can operate under direct supervision. Direct supervision means the veterinarian “is on the premises and quickly available to assist.”2 Some duties performed by unlicensed veterinary assistants must be performed under immediate supervision, which requires the veterinarian to be in both visible and audible range. CVTs are never required to operate under immediate supervision. The administration of anesthesia, establishing an airway, and performing basic and advanced life support can be done under direct supervision by CVTs but require immediate supervision for noncredentialed staff. Both can perform dental prophylaxis under direct supervision.

How CVTs Can Improve Efficiency in Practice

CVTs are a vastly underutilized resource in veterinary clinics. These highly trained professionals are required to complete a 2- to 4-year AVMA-accredited program, pass a national licensing examination, and maintain their license through continuing education. Individuals who pursue this education want to apply their skills and knowledge.

Here are some ways that CVTs can be utilized in practice:

• Perform patient diagnostics, including all sample collection for urine and blood specimens.

• Place intravenous catheters for hospitalized patients, surgery, and euthanasia.

• Perform in-hospital treatments and administer medications, including after-hours care or when the veterinarian is not in the clinic, provided there are clear written instructions.

• Induce, monitor, and recover patients from anesthesia.

• Place bandages on postoperative patients or perform bandage changes for ongoing care with veterinarian assessing healing progress.

• Schedule technician appointments for nail trims, ear cleaning, anal gland expression, suture removal, vaccination

boosters, and laboratory tests. Ensure that these are occurring within a valid veterinary-client-patient relationship (VCPR).

• Take a leading role in client communication, including answering basic medical questions, triaging patients, and assisting with call backs for outpatient test results once the veterinarian has reviewed them.

• Play a central role in client education, including preventive care, management of chronic disease, surgical discharges, and teaching clients to perform at-home treatments from the administration of oral medication to injections.

Just as the veterinarian should prioritize performing tasks that only they are qualified to do, CVTs should be given the ability to focus on tasks they can perform under less veterinary supervision than their unlicensed colleagues. This will improve efficiency and maximize job satisfaction for these individuals.

Example Appointment: A Team Approach

Poppy, a 10-year-old female spayed Shih Tzu, arrives for her annual wellness appointment. She is greeted and checked in by the client service representative (CSR) at the front desk. A few minutes later, a veterinary assistant leads her to the examination room, records weight and temperature, gathers a history, and reviews the vaccinations and preventive care items for which she is due. The veterinarian performs a physical examination with the help of the assistant and discusses Poppy’s dental disease with her owner. The veterinarian recommends that Poppy be scheduled for a Comprehensive Oral Health Assessment and Treatment (COHAT) and recommends a senior laboratory panel be sent out as a preoperative screen.

While the assistant restrains Poppy for sample collection for the laboratory testing and vaccine administration by a CVT, the veterinarian is free to work on medical records, review other patient test results, perform the next examination, or speak to a concerned owner by phone. Before Poppy leaves, the CVT reviews the estimate for the COHAT with Poppy’s owner and answers questions about anesthesia preparation. The assistant or a CSR can complete the appointment by scheduling the procedure and checking out Poppy and her owner.

When the laboratory results arrive the next day, the veterinarian reviews them. Finding only a mild elevation in the ALP, the vet outlines recommendations and passes a message to the nursing team to call and discuss the results with the owner.

Team Players

Every member of the veterinary team plays an essential role in ensuring smooth operations in the hospital and maximizing each client and patient experience. By narrowing job duties of each position to the tasks that are specific to that position, clinics will improve efficiency and revenue. This is not to say that a veterinarian will never draw blood or restrain for a radiograph. Nor does it mean a CVT will never restrain a pet during an examination, clean a kennel, or answer a phone. What it means is that each member of the clinic team will have the time to focus on their primary job duties, allowing others to do the same.

References:

1 49 Pa. Code § 31.31. Full text available at https://bit.ly/PA-CodeChapter31

2 49 Pa. Code § 31.1. Full text available at https://bit.ly/PA-CodeChapter31

About the Author: Kate Boatright, VMD, is a 2013 graduate of the University of Pennsylvania, and is an associate veterinarian, freelance speaker and author in western Pennsylvania. She is actively involved in the AVMA House of Delegates as well as the current Vice President of the Pennsylvania Veterinary Medical Association. She is a former national officer of the Veterinary Business Management Association. She can be reached at Hello@WritetheBoat.com or visit WritetheBoat. com for more information.