The Benefits of a Client-Focused Team-Based Approach

Veterinary teams work best when they work together to deliver high quality pet healthcare. The team-based approach can greatly improve the pet health outcomes and increase client satisfaction. In the veterinary practice setting, team-based healthcare utilises at least 2 healthcare providers, usually a veterinarian and technician or nurse who work collaboratively with clients to accomplish the shared goal or high quality care. The role of the veterinarian is to cure and the role of the nurse or technician is to care. The sharing of responsibilities has many benefits including reduced complaints due to miscommunication, reduced home care complications, improved compliance to treatment plans.

Benefits of a team-based approach

Practice benefits	Reduced overtime and costs Reduced complications and readmissions Increased accessibility of services and knowledge for clients Improved finances Improved client satisfaction
Team benefits	More efficient patient care Enhance communication Improved job satisfaction Greater role clarity Less client confusion and complaints
Client benefits	Enhanced satisfaction Better acceptance of treatment plans Better compliance Less medical error
Patient benefits	Better health outcomes Less negative outcomes

Implementing a team-based approach

When a veterinarian must rely upon information and action from another team member, it is important that there are systems in place to avoid inefficiencies and errors.

This includes:

• Having the team on board with the goal to maximise pet healthcare by partnering with the client
  
• Working with clients to provide a positive experience
  
• Delivering high quality care
  
• Building and strengthening relationships
  
• Developing the teams skills to deliver their tasks
  
• Supporting the team with the tools to deliver their rasks

Individual team roles

Veterinarian

Provide and maintain and trusting relationship with the client Respond to the initial presentation Determine diagnosis and prognosis Complex decision making Taking responsibility for the treatment plan Implementing the treatment plan Client education

Assistant (Nurse or Technician)

Before the consultation, conduct initial assessment Following the consultation, evaluate the client’s understanding Provide medications and review the label with them. Share medication information sheets so the client is fully aware of storage requirements, dose rates, administration and potential side effects Provide supporting home care information e.g. videos Evaluate progress with follow up phone calls and nurse or technician consultations

The 4 stage of clinical care

The team-based approach to clinical care can be divided into 4 stages.
Stage 1: Data gathering - assistant or veterinarian
Stage 2: Analysis of data and pertinent physical exam - veterinarian
Stage 3: Decision making and development of a plan - veterinarian
Stage 4: Implementation of the plan and patient education - assistant

Stage 1: Data gathering - assistant or veterinarian

A. CURRENT PATIENT HISTORY
The patient history forms the most important aspect of the clinical examination with 90% of the diagnosis determine from it. The patient history can be obtained via digital online forms and health assessments or can be asked verbally by the assistant prior to the consultation to help keep the veterinarian on time.

Questions relating to the patient history should include: Onset of symptoms – When did the problem start? Description of symptoms – Constant vs. intermittent Duration – How long does the symptom last? Intensity – Mild, moderate, severe? Frequency – Does it occur daily, weekly? History – Is this the first episode, or has it occurred before? Accompanying symptoms – Do any other symptoms accompany this symptom? Precipitating/alleviating factors – What makes it better or worse? Progression of the symptom – Is it getting better or worse?

B. PAST MEDICAL HISTORY

• Review current medication list.
  
• Determine if client is compliant with medication schedule
  
• Discuss the need for a prescription refill
  
• Ask about medication side effects
  
• Encourage the client to bring in medications at the next visit
  
• Collect the results of any recently completed diagnostic tests, lab results including heartworm tests, fecal tests etc.
  
• Make note of discussions in the medical record

C. BREED PREDISPOSITIONS AND ALLERGIES

• Review and update breed predispositions.
  
• Review and update allergy history.

D. REVIEW OF BODILY FUNCTIONS/SYSTEMS

• Review all appropriate bodily systems and perform vital signs.

E. PREVENTIVE CARE UPDATE

• Ask briefly about the last vaccination, parasiticides, fecal examination, heartworm test etc.
  
• Recommend and document appropriate preventive care plan.

Stage 2: Analysis of data and pertinent physical exam - Veterinarian

• Veterinarian greets the client and patient and obtains verbally from the assistant all the information already gathered.
  
• Veterinarian reviews the patient history received, asks further questions and adds to information as necessary.
  
• Veterinarian performs physical exam and documents findings in the medical record.

Stage 3: Decision making and development of a plan - Veterinarian

• Veterinarian writes down differentials and plan.
  
• Veterinarian updates problem list in the electronic medical record.
  
• Records any tests and when they are needed.
  
• Veterinarian reviews the impressions and plans with the client and then politely exits.
  
• Veterinarian make notes or verbal recommendations and the need for supporting information to be shared with client.

Stage 4: Implementation of the plan and patient education - Assistant

• Document the treatment plan of the Veterinarian into a digital summary. The plan includes tests and labs, medications added, medications discontinued, suggested lifestyle pr nutrition changes, and date expected to return to clinic.
  
• Make any bookings are made for tests or treatments.
  
• Document any treatments or tests refused by the patient, along with the patient's understanding of potential for poor outcome.
  
• Provide client education concerning disease process, medications, tests ordered or lifestyle or nutrition changes that the vet has noted in the medical record.
  
• Explain matters of referral process or obtaining external laboratory test results.
  
• Provide all medications and review them with client. Provide medication information sheets that outline storage, dose rate, how to administer and potential side effects.
  
• Remind patient to call if necessary and to schedule any recommended return visits.
  
• Close the visit kindly and ask client to wait in the waiting room or to go home until the pet can be discharged and take the patient for appropriate area to take bloods, radiographs etc
  
• Contact pet owner with update and when to pick up the pet.
  
• At discharge, as if the client has any further questions and give them an update on when the test results will be in.