Costs of care: Does every pet need an IV catheter?

Costs of care: Does every pet need an IV catheter?

Striking a balance between staff comfort and overhead cost is key in your veterinary hospital's protocol plan.
May 24, 2017

(’ve all had that sinking feeling when comparing overhead costs with what you charge for phone-shopped services. It is the bane of the practice owner’s existence—finding the balance between what’s the gold standard and what you can actually afford.

My new associate and I have been working on our protocols. She hasn’t been out of veterinary school nearly as long as I have and hasn’t had the opportunity to look that careful overhead balance in the eye like I do every day. Her view is firmly on patient welfare, which is, of course, the most paramount of concerns for us all.

So my associate thinks that every patient—even the ones coming in for quick elective surgeries—must have an intravenous (IV) catheter as a minimum standard of care. I used to offer catheterization as an option on every surgery, but many people phone shop these services and we often failed to mention it on the phone. Then clients would think that we were nickel and diming them when they dropped their pets off.

This feeling is not something that I can afford to risk. The clients tell their friends and post online that they felt like we were ripping them off—or they just decline it and everything goes fine and they think it was not necessary anyway. This issue is reputation management.

I cannot afford to just eat the cost of all this in an already stripped-down procedure. But, of course, if a patient did have something go wrong and you didn't have IV access, things could get even worse. So what should we do?

Negotiating the right balance

I think that the answer lies in a balance. At my hospital, we're creating a hospital-wide protocol to serve as a guide so everyone feels safe. Here are some things that we've looked at and found helpful along the way.

First, find out exactly what the IV catheter will cost you in materials and time. Factor in the cost of the catheter and the port with tape and flush. Allow additional costs for mistakes that require more than one catheter. Estimate how long it will take for a team member to insert the catheter as well (you should already know your overhead cost per minute).

Now, look at the cost that will be added to your procedure total and decide if it is something that you can add onto the client cost or should only offer as an option. Don’t forget that your team is already offering lots of options and might appreciate it just being included.

If you truly cannot afford to add it to the client cost, consider making a flowchart to guide you and your team to consistent care every time. Maybe take into account the surgery type and length, patient parameters and potential risk.

Also decide where you will draw the line. For example, one of my colleagues says that any pet more than 7 years old gets an IV catheter no matter what. Find out what makes you—and your associates—comfortable.

Client communication caveat

If you do decide to include an IV catheter as an option, be careful about team training so that everyone is comfortable with how to pitch it. At the end of the day, you want healthy, happy patients and a healthy, happy bottom line.

Response to article Costs of care: Does every pet need an IV

The article entitled Costs of care: Does every pet need an IV catheter, stirs up an old debate about balancing patient care and the clinics bottomline. It puts me in mind of a line from Jurassic Park "just because you could does not mean you should" (paraphrasing).
Just my opinion but if we allow clients to drive the quality of the medicine we practice then we start to alter that quality for good or bad to meet their expectations, who is the professional in the room the veterinarian or the client. When placing any pet or person under general anesthesia there are physiological changes that start from the moment a premedication/anesthetic drug is given. An IV catheter provides the rapid access and life line for when those changes become detrimental to the health of the patient. Offering that or even monitoring those parameters as optional sends the wrong message to clients. How do you justify if that "healthy" kitten or puppy's heart rate drops, or the blood pressure is dangerously low and you can not access a vein efficiently.
The last surgery you or your child had, was an IV catheter or other life saving devices/monitoring optional.
If clients are price shopping and blogging about the cost of veterinary care they really have only themselves to blame for the increasing expenses. They create the demand for more complex care, politicians cater to unreasonable, knee jerk agendas and the general public has become more litigious and less responsible for their own role in their pets care. Which brings me back to who is the professional with years of training in various science based topics, has spent vast sums of money, time and sacrifices to be able to provide the best medical advice and advocate for those without a voice, its not John Q Public.
Perhaps as a profession we need to work more on public campaigns that better promote what pet care is about and how we provide a level of care that parallels that of human medicine. The Human-Pet bond is getting stronger everyday, I wonder what would happen if the AVMA invested in a commercial during the Super Bowl or March Madness and compared an Ovariohysterectomy in a pet to a person
(obviously respectfully). All the organs are in the same location, still need a sterile field, monitoring vital signs, anesthetic machine, pain management etc.
Devaluing what we do may not be the way to go especially with more consolidation of practices and corporately owned there could come a time clients will write that clinic "ABC does not care about my pet they don't even put a catheter in....."
I often speak with clients who are afraid to place their pet under anesthesia for elective procedures but when the process is explained with all the attention to detail and monitoring, safeguards that are in place they become more comfortable about moving forward.

As consumers we all want respect, quality service, convenience, and affordability. Just think of business's that tried to improve their "bottom line" by cutting corners vs those who educated their clientele as to the benefits and "why" behind the cost. Why should veterinary medicine be any different.