Ace the Test
How advances in in-house diagnostics are improving veterinary care and freeing up time for the healthcare team
Despite the fact that the American Animal Hospital Association identified compliance as one of the biggest challenges veterinarians face back in 2002, it remains an issue nearly two decades later. Even the best recommendations for treatment and preventive care fall flat if they are not properly carried out. The challenge lies in getting clients to say “yes.”
Quickly identifying problems can be key to getting that OK.
Today’s veterinarians have the luxury of many tools previously unavailable, ranging from full in-house laboratories to the latest labor-saving computer applications to help with various office tasks and medical interpretations. While there is still work to be done in order to offer the highest level of care, these diagnostic technologies and product advances give veterinary healthcare teams an important head start.
“One challenge has been getting veterinarians to use their in-house diagnostic equipment,” says Dennis M. McCurnin, DVM, MS, DACVS, former president of the Western Veterinary Conference and a Louisiana State University School of Veterinary Medicine professor emeritus of surgery. “Some veterinarians have diagnostic equipment but have gotten into the habit of sending most of the lab work to an outside lab, including fecal exams,” he says. “They should be utilizing their veterinary technicians to run these tests in-house.”
Doing so produces results more quickly and less expensively, he says.
Dr. McCurnin maintains that proper use of such equipment would provide test results while the client and patient are still on-site, increasing the likelihood of the client agreeing to treatment, which improves the patient’s health.
And leveraging the skills of certified veterinary technicians/nurses to perform the tests will increase their engagement with the practice and help reduce turnover, Dr. McCurnin says. In fact, he believes that if the profession would properly use veterinary nurses, there would be far less talk of a veterinarian shortage.
“Many people believe we have a shortage of DVMs, but my feeling is we’d have too many if we were to start using support staff — meaning veterinary technicians — properly in practice,” Dr. McCurnin says. “We are the only profession that is still trying to run outpatient visits using one room per veterinarian with just the DVM, owner and patient,” he says. “All other professions utilize multiple exam rooms and support staff to see multiple patients per hour.”
If some practitioners already have the equipment, why aren’t they using it more?
“I’m not sure, but the answer might be they do not have enough credentialed technicians, or they don’t know what technicians are capable of doing in the lab,” says Dr. McCurnin. “Maybe they believe it is more efficient to send everything out, or maybe they don’t trust the results from their own lab.
“But who do you think runs these tests at the veterinary reference lab? Yes, credentialed veterinary technicians. The modern in-practice veterinary lab equipment today is very reliable, and the results are comparable to a reference lab.”
Robin Downing, DVM, MS, DAAPM, DACVSMR, agrees that practitioners should utilize in-clinic laboratories rather than rely fully on reference labs. She is director of the Downing Center for Veterinary Pain management in Windsor, Colorado.
“When a patient presents to us with a medical issue, there is only so much we can figure out with a physical examination,” says Dr. Downing. “A complete examination means looking both inside and outside of that pet’s body. Whether the pet is vomiting, having diarrhea, experiencing a fever, emitting an unusual aroma, experiencing pain, or some combination of these, we have a bioethical obligation to both the patient and the pet owner to get to an accurate diagnosis as quickly and as reliably as possible.
“For instance, if I am faced with a vomiting dog with diarrhea, my client is pretty frantic to get to the bottom of things,” she says. “If that same patient is clinically dehydrated and will benefit from IV fluid therapy, I certainly need to know many things that cannot be determined from the exam — even simple things like just what fluids will be the best fit, what (if anything) should be added, what degree of dehydration is the patient experiencing, and what level of renal compromise might be present. These are all questions that must be answered accurately if we are doing our jobs. If I have to rely on an outside reference lab for relevant data for this example, my patient can be seriously compromised before I have the answers I need. I installed my first in-house lab in 1995. We didn’t have very sophisticated technology in those days. We have upgraded over the years, and not one day goes by that my lab equipment goes unused.
“I could not practice without it, and neither should any of my colleagues.”
Robin Brogdon, MA, of BluePrints Veterinary Management Group, says digital cytology is an important way to bring diagnostics in-house.
“It allows veterinarians to take tissue samples, send them through the cloud, and within one hour a pathologist has read the sample and gets the report back to the veterinarian,” she says.
“This allows the clinician to begin treatment while the patient is still in the office,” she says. “It’s challenging for a client to wait, particularly in emergent cases. This technology expedites diagnosis and treatment. Some pet owners probably wouldn’t treat at all if they have to wait.”
Brogdon says the digital cytology company provides a scanning microscope, camera, and program to digitize slides and send images through the cloud. An international network of pathologists is on standby, so a pathologist in New Zealand, for instance, can read a slide in real time and have the report to the U.S. veterinarian within an hour.
Diane Johnson, DVM, owns Animal Emergency Hospital Volusia, a 24/7 emergency clinic in Ormond Beach, Florida. She has used digital cytology for more than two years.
She also offers this service to her referring DVMs, allowing them to bring their slides to her to be submitted.
”We get the pathology back almost immediately,” Dr. Johnson says. “This aspect has been sorely lacking in the veterinary industry. At first, our referring vets were unsure of what we were offering, but now it’s very common to immediately be able to give them a quick idea of what’s going on.”
Dr. Johnson uses the digital cytology technology with abdominal ultrasounds, fine needle aspirates or possible lymphomas.
“It gives us a significant level of confidence that we’re proceeding in the right direction,” Dr. Johnson says.
“If we did it the old way, as most practices do, we’d send in the sample to a reference lab and when we get a report back in a day or more, we need to get the owner and patient back in to treat, or even to decide whether to treat. The patient’s care is greatly diminished. With digital cytology, we have a greater likelihood of getting the client’s go-ahead right then.”
The public today is more educated and capable than ever, she notes.
“Owners are demanding knowledge and opportunity, and sometimes a delay in working something up slows the process. I’m thankful for our more educated public. Health care becomes a shared experience, instead of being all my responsibility.
“We have an onsite lab, bloodwork, ultrasound and radiographs, but this added component made a difference in how we handle cases. It’s an exciting aspect of veterinary medicine overall.”
Her hospital is the only 24-hour critical care facility in Florida’s Volusia County. She has found that offering the service to referring DVMs is another way to support area colleagues.
Sometimes they send a slide, she says, but 90% of the time they send the case to her facility. “It’s additional revenue for us, but it’s been a strong collaboration-building process.
“Anything we can do to add to the financial stability of our organization is something I’m thankful for,” Dr. Johnson says. “Digital cytology enhances the quality of what we’re doing. Pets get their best chance to find out what’s going on and get on the other side of it. And we’ve found it to be a reputation builder.
“We practice quality medicine, and have quality diagnostics. We advocate for patients, but digital cytology also helps us attract additional team members.”
Artificial intelligence radiography is part science, part art, says Seth Wallack, DVM, DACVR, founder and CEO of the Veterinary Imaging Center of San Diego.
“It takes a radiologist’s experience and puts it into a computer to interpret radiographs, similar to how a radiology group interprets radiographs themselves,” he says. “It transfers knowledge.”
It is built on the experience of veterinary radiologists.
“The more common a case, the smarter AI is,” Dr. Wallack says. “In a rare case that is hardly ever seen, AI will not be very good. There’s always a little bit of interpretive error. But as time goes on, it will exceed above what a radiologist can be.”
With the veterinary community’s dearth of board-certified radiologists, AI has an important role to play. “Our huge shortage of board-certified radiologists is not getting better any time soon,” Dr. Wallack says. “When they pulled radiologists out of universities and into practice, it caused a decline in the number of radiology programs, so now there’s less training for students, fewer residencies. AI helps level out the caseload.”
AI is an adjunct, not a replacement for the human, Dr. Wallack says. The veterinarian performs the first read, and AI offers a second opinion within minutes.
“If the clinician still has questions after getting the AI report, they have the backup of the teleradiology group.”
In the veterinary world, the technology is fairly new.
“On the human side, it started in 2015,” Dr. Wallack says. “My company rolled it out in 2017. … There’s still a lot of learning, even on the human side. There are continual advancements.”
He says the technology is not expensive. At the base level, which is up to 500 radiograph reads, it’s less than a dollar per read. The technology provides a report in a five-minute turnaround. It allows veterinarians to budget better, and with the quick results, owners are more likely to agree to recommendations, says veterinary consultant Cathy Levendoski, the principal of ActionPoint Marketing.
“What we’ve found is a 30% increase in diagnostics recommended,” Dr. Wallack says. “It’s good for the pet and for the veterinarian — especially those who might be less comfortable reading rads.”
“AI means faster treatment and better care for the pet,” Levendoski says. “It improves workflow, and provides better revenue for the veterinarian because they get results while the owner is still in the office, which means better compliance.
“And at the end of the day, the veterinarian isn’t writing up reports. They get home sooner, and that’s huge for the veterinarian.”
Upgrading to a suite of new analyzers boosts a veterinary team’s efficiency and client service.
Greenfield Animal Hospital in Saratoga County, New York, recommends and strongly believes in annual bloodwork for every pet, especially seniors. Preanesthetic testing is also important, with the doctors performing a number of surgeries every week. And, of course, when sick pets come in, a diagnostic profile is often the first step to pinpointing what’s wrong and what to do next.
Yet the hospital had outgrown its previous method of in-house laboratory testing — a system that was slow, outdated and often unreliable, says Hospital Operations Manager Ashley Cotner. The team’s busy schedule and increased demand for fast and accurate results ultimately led to the decision to switch to a new diagnostic suite, one that included in-house hematology, chemistry, urine sediment and coagulation analyzers.
Once the team decided to make a change, things happened fast. The transition from the former diagnostic equipment to the new suite was quick and effective and the staff was fully trained by manufacturer representatives within a few hours, Cotner says.
And the hospital team couldn’t be happier about the new tools available to them.
“The process by which we now achieve results for our patients’ diagnostic testing is faster and more reliable,” Cotner says. “Many of the new in-house tests were priced similarly as our previous ones; however, a few needed to be increased to maintain the same profit margin.”
Cotner says clients were understanding of the fee increases, reporting that they appreciated the added value after staff members communicated the advantages and capabilities of the new equipment. The hospital runs more efficiently with the new diagnostic analyzers, and team members are finally able to rely on the practice’s equipment to work quickly and effectively.
“Fewer errors and the elimination of untrustworthy or suspicious results have made for a much better workflow,” Cotner says.
With the increased efficiency, reduced need to rerun tests or send them to reference labs and enhanced ease of use, Cotner says the new diagnostic suite has had a positive impact on Greenfield Animal Hospital’s bottom line, team member and doctor morale, and client satisfaction.
“The team has been able to reduce clients’ wait time for diagnostics, which makes for a more favorable experience all around,” Cotner says. “Most importantly, our patients are treated more accurately and promptly through more dependable and efficient in-house testing.”
By Kristi Fender