Should Taking Blood Pressure Be Part of Routine Care?

You sit patiently in the waiting room until a nurse calls your name. You follow him or her back to an examination room where, as part of the routine examination, he or she measures your height and weight, takes a brief medical history, reviews your current medications, and takes your temperature and blood pressure (BP) before leaving you to wait for the physician.

This is not a description of a veterinary patient experience—it is a human patient experience. The difference? When it comes to veterinary patient care, BP is seldom included in a routine preventive physical examination.

Veterinary professionals may shy away from making BP readings routine because they do not want to create extra stress for patients, take more time in the examination room, or maintain extra equipment, but cases do exist where it is warranted.

For example, using more screening tools such as BP checks and urinalyses may be warranted for geriatric patients as part of a preventive care protocol. Patients with conditions that predispose them to hypertension (eg, renal disease, hyperthyroidism, cardiac disease) also benefit from routine screening and monitoring. Clients may readily accept these recommendations because they are accustomed to having their own BP taken on a routine basis.

Implementing additional tests as part of the practice’s routine examination is a conscious choice. The AAHA Senior Care Guidelines for Dogs and Cats recommend routine blood pressure monitoring for hyperthyroidism, chronic renal failure, and heart disease.¹ If the choice is made to include BP testing, then a protocol should be created, the team should be trained as the standard is implemented, and reminders should be put in to place so that patients will return as needed for their progress examinations and monitoring.

Developing New Protocols

Using the addition of BP measurement to senior routine care as an example, once the decision has been made, the next step is to write a clear and concise protocol. Protocols bring clarity to the team so that everyone understands what needs to be done, who will do it, and when it is to be done.

When discussing the key elements of the protocol, ask the following questions:

• Why is BP assessment being added as a new routine senior care protocol? Team members will need to understand so they can explain the reason to clients.

• What needs to be done when BP assessment becomes part of the practice’s routine senior care (eg, more equipment, more accessible equipment, team training)?

• Who is going to take the BP during routine senior appointments? Will this require assistance? If yes, from whom?

• At what point in the appointment will the BP be assessed and recorded in the medical record?

Use the answers to write the protocol. Distribute the new protocol to the team, preferably at a team meeting where questions can be asked and answered and everyone will be on the same page.

Setting Reminders

Specific reminders should be attached to senior physical examination codes to prompt clients to bring their pet back to the practice in the timeframe dictated by the senior preventive standards of care set in the new protocol. Contact the practice management software provider if assistance is needed.

Training & Implementation

After the new protocol has been written and accepted, use team meetings to conduct additional training. With veterinary nurses and veterinarians who are proficient at obtaining BP acting as coaches, team members should work in small groups to practice obtaining BP from stable, noncritical patients. Patients who have been admitted for drop-off appointments are ideal because they may need their BP obtained as part of the new protocol and are not constrained by a limited appointment time. The training should take no more than 15 to 20 minutes when experienced team members are part of the practice team. When every necessary team member is trained, set a date for launching the new protocol.

To Charge or Not to Charge?

This is the big question: Should the practice charge for assessing BP as part of routine senior care? According to Benchmarks 2017: A Study of Well-Managed Practices, the median price charged for BP evaluation as a diagnostic is $38.² The same study found that 80% of practices included BP monitoring during a dental prophy but only 34% of those practices included a fee for the monitoring, with the median fee being $30.³

In these examples, BP is viewed as a diagnostic or a monitoring tool rather than a vital sign obtained during routine senior care. If the leap is made from ignoring BP as part of routine senior care to including it as a routine vital sign, the author suggests client experience and expectation should be considered and no separate fee should be charged. With that in mind, the bigger question is, Is the practice charging appropriately for physical examinations?

Median examination fees for Well-Managed Practices include the following⁴:

• Physical examinations    $54

• Preventive care/wellness examinations    $52

• Comprehensive/extended examinations    $67

• Senior examinations    $54

The median senior examination fee of $54 does not include obtaining a routine BP, which would most likely extend the examination, for which the median fee is $67.⁴ If the practice does choose to expand the senior preventive care standards, the fee should include the extra time and be in line with the median comprehensive/extended examination.

Conclusion

BP measurement is an important diagnostic tool that can aid veterinarians in maintaining and improving quality of life for pets that are aging, prone to breed-specific medical conditions, or have certain medical conditions. If the practice decides to include routine BP testing, then review the examination fees to ensure the charges are appropriate and that they take into account the team’s time, knowledge, and expertise. Ensure the team understands the value of the physical examination and everything that is included so they can embrace the new protocol and confidently communicate the value to clients.

This article originally appeared in the October 2018 issue of Veterinary Team Brief.