5 Ways to Improve Relationships Between GP and ER Clinics

It’s 4:30 pm on Friday, and you are a mere 30 minutes from closing for the weekend. Your appointments are winding down when the phone rings. Mrs. Smith has just come home and found that her dog Snickers has vomited multiple times. Your client service representative comes to you seeking advice. She has already advised Mrs. Smith that she should seek emergency care, but the two closest ER clinics to your practice are not accepting any non-critical patients for the remainder of the night. The next nearest hospital is an hour away and projects a 6-8 hour wait for stable patients, which Mrs. Smith is not happy about. What do you do?

This situation has become an all-toocommon reality in practices across Pennsylvania—and the country—over the past year. General practices are booking weeks to months out. Emergency clinics are overwhelmed with their normal emergency caseload and additional medical cases that can’t find a GP appointment. It seems no one has the time or resources to keep up with the demand. I have worked in both emergency and general practice during the pandemic. I have seen both sides of the issue, and I understand the frustration on both sides. As a general practitioner, it used to be a comfort to know that emergency clinics were available to care for my patients on my off-hours. I also had a place to send my critical pets or those who needed more care than I could provide. But now those options are limited.

Emergency clinics have been faced with the difficult decision to limit patient intake, reduce their hours, or discontinue emergency services altogether in an effort to protect their staff from burnout and ensure they maintain the resources necessary to provide adequate care to their inpatients. I have the utmost respect for the management teams who have had to make these difficult decisions. No one wants to turn away patients or make them wait in their car for most of the night, but it is our current reality at all levels of practice.

How did we end up here? It’s a complicated answer with many moving pieces that we’ve been debating for a while now. We can continue to have these debates, or we can start to find solutions. On a recent episode of the Cone of Shame podcast, David Liss, MBA, CVPM, RVT, VTS, summarized the state of our profession perfectly: “It’s no one’s fault, but it’s everyone’s problem.”1

We aren’t going to solve case backlogs, staffing shortages, and decreased efficiency overnight.2 But there are things we can do in our local communities to best serve our clients and patients while protecting the physical and mental health of our valuable staff members.

By Kate Boatright, VMD

1. Client Education

There are increasing news reports and social media posts about the state of our profession that are helping to spread

continued from page 17

awareness, but we can do more at the clinic level. GP clinics can educate their clients through social media, signage at the clinic, and one-on-one conversations when referring to emergency clinics. Key points to include in client education are:

• Expectations for wait times at the emergency clinic. Advise clients that their pet will be assessed at arrival.

If they are waiting, that’s a good thing—their pet is stable.

• Costs of ER care and prognosis. Too often ER clinics receive clients who cannot afford care and make the decision for economic euthanasia or leave without treatment. When possible, providing estimates and an honest prognosis to clients before they head to the ER can save time and heartbreak. Many clients would rather make the decision to euthanize with a staff and doctor they are familiar with than a stranger at an emergency clinic.

• Understanding a true pet emergency and distinguishing what can wait for

GP availability.

• Preventive care to minimize the need for urgent visits (i.e., spay to prevent pyometra, vaccination to prevent parvovirus).

• Being proactive if pets are showing early signs of illness to schedule an appointment sooner rather than later before it becomes an urgent matter.

2. Set Boundaries with Clients

While most of our clients are pleasant, patient people, we all have stories about the demanding, entitled clients who make everyone cringe. Why do we tolerate and continue to reward bad behavior? If all clinics started implementing and enforcing zero tolerance policies for clients who are abusive toward our staff, become demanding when we are not able to fill a medication or return a phone call within the hour, or show up late and no show to their appointments, we would begin to reduce that behavior overall.

3. Eliminate the “Us Versus Them” Way of Thinking

It is imperative that we form partnerships between clinics in our local communities. There are more than enough clients to go around. If we are unable to see a client, offering them a recommendation to another local clinic will not decimate our business. Reach out to clinics in your area to establish relationships.

Relationships are especially important between ER and GP clinics. Keeping open communication between GPs and our ER and specialty hospital partners is key to preventing resentment from growing. Find out what the communication preferences are of your local ER and try to respect them.

If you’re in GP, a call is often appreciated to make sure the ER can take your patient before sending them. Make sure to send records, and if the ER doctor has time, ask if they want a quick case summary over the phone.

4. GPs: Get Comfortable with Basic Stabilization

We need to work together and not expect our emergency colleagues to take care of everything. A patient may need to travel hours to reach an open ER, so we need to do some stabilization. Get comfortable with basic emergency assessment and procedures like chest taps, IV fluid boluses, and unblocking cats. Don’t be afraid to give a dose of pain meds for that hit-by-car patient or a dose of furosemide for the patient in heart failure. When in doubt, call the local ER clinic and ask what you can do for the patient in front of you before you transfer them.

5. ERs: Be Ready to Answer Some Questions

If you want your GP colleagues to help with managing some of these cases, you’ll need to be available to answer questions and advise them. You are the experts. Keep the lines of communication open. Provide tips and CE to your local colleagues. If you’ve got time, take the phone call to talk your GP colleague through the case, give an estimate, or confirm your availability (or lack thereof).

Some GPs are afraid of calling their local ERs because of previous experiences where they were brushed aside or felt they were being judged for their handling of a case. We need to repair these relationships by taking the time to have a conversation and understand the limitations that GPs have in available medications and equipment. Let’s work together instead of against each other.

References:

1 Roark A. The new bad blood between GPs and ERs (Episode 90). Cone of Shame [Audio Podcast]. First aired July 22, 2021. Accessed October 25, 2021.

2 Salois M and Golab G. Are we in a veterinary workforce crisis? Understanding our reality can guide us to a solution. Available at bit.ly/3EFyL61. Accessed November 8, 2021.

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.