Managing the Surgical Patient's Journey Through the Hospital

Daniel Brockman, BVSc CertVR, CertSAO, DACVS, DECVS, Royal Veterinary College

Alison Young, DAVN (Surgery), VTS (Surgery), RVN, Royal Veterinary College

Surgery, Soft Tissue|May 2018|Web-Exclusive

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Managing the Surgical Patient's Journey Through the Hospital

Introduction

Surgery is frequently performed in small animal practice with operations ranging from routine elective sterilization procedures to complex urgent or emergency procedures. In order to manage the surgical patient in an optimal way, the clinical team will need to be in command of every aspect of the animal’s management. This process begins with an accurate diagnosis whenever this is possible and includes carefully considered conversation with the animal’s owner so as to gain informed consent for the intended procedure. In addition, sufficiently detailed communication with those involved with the in-hospital care needs of the animal must take place so that the nursing and surgical teams can deliver preoperative, intra-operative, and postoperative care that is both thorough and tailored to that animal’s needs. Finally, the home-care requirements and any follow-up appointments will need to be explained to the animal’s owner at the time of discharge, so that the ongoing recovery can be carefully managed and any complications identified quickly and addressed appropriately. From a medical perspective, an accurate diagnosis and selection of the appropriate surgical procedure are critical, as is the proficient performance of anesthesia and the surgical procedure as well as careful, postoperative care. The true foundation of a successful patient journey, however, is in the way communications surrounding the treatment happen, and the detail they contain.


Part 1: Prior to and Upon Admission

Owner Communication

Discussing the Procedure

Prior to admission of the animal, the veterinarian should make it clear to the owners, in lay terms, what procedure(s) are going to be performed on their pet, what the intended outcome should be, what potential unintended outcomes or complications may occur (ie, the hazards of such an intervention), and the time gap until the next communication about their pet’s progress.

Informed Consent

Ideally, all owners should then provide their informed consent to the procedure, in the form of a signed “consent” form that identifies the animal and owner, names the planned surgical procedure, contains an estimate of cost, and mentions the more common potential complications. Prior to admission, the animal should be fitted with a temporary identification collar.

Preoperative Patient Preparation

History Taking

The acquisition of a complete medical history from the pet owner is essential. For healthy animals undergoing elective surgery such as sterilization, this serves to ensure that the animal is suitably “ready”; so, vaccination history, worming history, and recent feeding history must be established at admission. For sick animals, this is the first step to learn what might be wrong and will inform subsequent investigations and diagnostic tests. Although this can be time consuming, careful attention to the historical features of disease can yield massive benefits in terms of definition and refinement of the “problem list” and organ system involvement.

Physical Examination

The surgeon should perform a complete physical examination of the patient prior to all nonemergent surgery. Aspects of the examination that should be emphasized include:

  • Overall state of mentation and mobility
  • Body condition score
  • Mucous membrane color and capillary refill time 
  • Oral examination
  • Superficial palpation of the neck, thorax, abdomen, and limbs
  • Arterial pulse rate and quality
  • Peripheral lymph node palpation
  • Abdominal palpation
  • Auscultation of the thoracic cavity heart sounds, rhythm, and lung sounds
  • Examination of external genitalia
  • Rectal examination

References

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