When Avah, a 7-year-old golden retriever, started crying out in pain and doing the downward-dog stretch excessively, her owner feared the worst and took Avah to her primary veterinarian, where the team determined she was suffering from an intestinal blockage, pancreatitis and bloat. The gas and bloating were severe, and her stomach was at risk of flipping, so the veterinarian recommended that Avah go to Veterinary Emergency Group (VEG) for 24-hour care.
After working as a veterinary receptionist for more than four years, Avah’s owner, Hannah Harden, expected VEG to be like any other emergency veterinary hospital. “I figured it would be a drop-off-your-dog-and-we’ll-call-you sort of place,” she said. “But when I walked inside, I was completely blown away.”
What Harden saw at the Alpharetta, Georgia, hospital was a large, open room with exam tables scattered throughout. Doctors and veterinary nurses were attending to dogs and cats as the owners stood comforting their pets and speaking with the medical teams. Computers and desks were in the middle of the space, kennels along the perimeter, and doors to the surgical suites, X-ray and private exam rooms toward the back. Surprisingly, some pet owners lounged in beanbag-like chairs next to kennels, while others were inside kennels with their housed pets.
Avah and her owner, Hannah Harden.
“I walked in and felt like they were my best friends,” Harden said of the practice team. “It was the craziest feeling. They took us in right away, we went straight to a doctor, straight to a scale, and they got to work on her.”
Throughout the three days Avah spent at VEG, Harden worked remotely from inside Avah’s kennel, staying next to her while she recovered. The pair were separated only once — Avah was in surgery — but even then, Harden watched through the surgical suite window.
“I felt like I had an out-of-body experience. They were working on dogs on the tables in front of me, there were owners in there, and it just felt homey. I thought, ‘Wow, someone really gets it,’” Harden said.
As a pet owner, Harden loved the open, collaborative and transparent feel of the VEG hospital and being able to stay at Avah’s side.
But how do veterinary professionals feel about open hospitals and doing their work while pet owners observe and sometimes assist? Is it the future of veterinary hospital design? Should the profession stop taking pets “to the back” and separating them from their owners?
A Practice Owner’s Perspective
“Oh, my God! He’s breathing like an asthmatic cat!” was what David Bessler, VMD, the founder and CEO of Veterinary Emergency Group, yelled before racing his 3-year-old son to the ER.
Bursting through the waiting room door, Dr. Bessler shouted, “My son can’t breathe!” and dismissed the paperwork the ER staff tried to hand him. The medical team attempted to put a pulse ox on the little boy, who panicked, not wanting anything to do with the people trying to poke and prod him.
“They let me hold him, but he still freaked out when they tried to put the pulse ox on him again. So, I asked them to let me put it on his finger,”
Dr. Bessler recalled. “First, I put it on my finger and showed him that it wouldn’t hurt, and then he easily let me put it on his finger.”
Dr. Bessler’s son suffered a minor asthma attack that day, but the ER visit got Dr. Bessler, who had worked as an emergency veterinarian since 2003, to think about how veterinary emergency hospitals operated.
“I was trying to imagine what would have happened if they insisted on taking him from me — maybe into another room — and wouldn’t let me hold him and explain things to him,” Dr. Bessler said.
The experience contributed to his vision to revolutionize emergency veterinary medicine through a “holistic, radically open experience for the caregiver, customer and patient,” he said.
In 2014, after years of practicing “open” medicine and allowing owners to go to the back with their pets during his emergency shifts, Dr. Bessler founded Veterinary Emergency Group.
“We started by doing things in an open way. Then, we started changing our hospitals to match our behavior,” Dr. Bessler said. “One person who worked for one of our early architects naively asked on a conference call if the exam rooms needed to be in the front. His boss sort of yelled at him and said, ‘Of course, they need to be in the front!’ And we said, ‘Actually, let’s try them in the back.’ That’s how great things happen — one person breaks out of their legacy thinking.”
VEG now has 32 hospitals operating in 11 states.
“Emergency is hard,” Dr. Bessler said. “It’s physically challenging. It’s emotionally challenging. There’s blood, guts and crying. But there’s also heroism and life-altering meaningful moments for everyone involved. The more people can see what we do, the better.”
A Veterinarian’s Perspective
Whether you’re trying to parallel-park a car, prepare a masterpiece in the kitchen or draw blood from a fractious cat, having someone watching your every move can be nerve-racking. But most “VEGgies” — what VEG employees call themselves — love working in an open environment, side by side with pet owners.
“I know of only three or four people out of 2,000 who tried it and didn’t like it. And some people don’t join VEG because of their fears and assumptions,” Dr. Bessler said.
Tannetje Crocker, DVM, loves working at VEG’s Dallas location.
“When you separate people and their pets, it can be traumatic,” the ER veterinarian said. “But when you integrate clients into the process from the beginning, you start the communication right away, and you start showing them the value of what you’re doing.”
Dr. Crocker is often asked about the legal risks of having pet owners in the treatment area. What if an owner is scratched or bitten?
“You need to communicate how involved an owner can or can’t be — if they can or can’t help hold the pet,” she said. “It’s also about assessing the situation and ensuring the veterinary team is properly trained.
“When I’m examining pets, when we’re doing a fair majority of our diagnostics, owners are either holding their pets or petting their pets. They’re right there. There’s a way to do it, but when you work from a place of thinking of all the negative things that could happen, you lose sight of all the positive benefits of involving pet owners.”
Dr. Crocker believes that keeping pets with their people helps keep the human-animal bond top of mind for the veterinary team.
“Seeing clients with their pets and realizing how important this is for them makes me want to work harder and be a better veterinarian,” she said.
A Veterinary Nurse’s Perspective
Jenneth Zettler, CVT, FFCP, LSHC-S, got her start in veterinary medicine in 2007 as a veterinary assistant. For the past year, she’s worked as the veterinary nursing development coordinator at Veterinary Emergency Group Denver. She wishes the open-concept floor plan was more prevalent at primary care and specialty practices.
“I don’t know where the idea of wanting to help animals but not wanting to connect with people came from,” Zettler said. “Pets come with a person attached to them. Being around people — talking with them and hearing their stories — brings us back to the roots of why we do what we do.”
She sees many pros to the open-concept veterinary hospital, but one of the most significant changes she’s noticed is more client satisfaction.
“Our clients appreciate knowing what’s going on because they aren’t stuck in a sterile room wondering, ‘Is my pet OK? Are they just back there in a cage alone?’” Zettler said. “We have an open-door policy. Pet owners visit anytime. They spend the night with their pets. They help us with walks. Sometimes, we’ll ask if they want to hold their pet during treatment.
“It’s hard to understand the value of something if you don’t see it for yourself,” she said. “With the open concept, clients see everything. They see decisions being made. They’re so much nicer because they see how busy we are and all the work we’ve put into what we do.”
Improved and more efficient communication is another benefit of the open-concept design. For example, veterinary nurses often play the middle person in client communication, but an open design removes the literal barrier between the team in the treatment area and the client in the exam room.
“We don’t have to convey information from the doctor, who’s seeing the pet, to the client, who’s in the exam room waiting, and go back and forth and play telephone,” Zettler said. “The doctor’s there, the pet’s there, the pet owner’s there. So, we’re all able to work together.”
What About Client Privacy?
Any open-concept hospital should incorporate options for pet owners who desire privacy and those who’d rather not watch medical procedures.
All VEG facilities have at least one private exam room. In addition, some place privacy screens around tables in the open area in case clients don’t want to watch other medical emergencies or don’t want other people to see their pets’ emergency care. But, according to Dr. Crocker, most clients appreciate the openness.
“I recently came out of a surgery, and one of the patients I’d been managing all day coded,” Dr. Crocker said. “The owner was distraught and sobbing on the floor, and other clients came over and held the woman and took care of her, showing so much compassion for her while our team worked on her dog.”
The dog didn’t survive, but after witnessing the medical team’s efforts, its owner was grateful that everyone worked so hard and did everything they could.
“In society, we try to push aside trauma and the difficult things that can happen,” Dr. Crocker said. “But sometimes, just addressing those head-on and acknowledging that ‘This is really horrible and tough, but we’re here to support you’ is a lot more valuable.”
Dr. Bessler had another perspective.
“I was visiting our VEG in Chicago’s South Loop, and one of our nurses told me about a client who didn’t want to leave when her dog was ready for discharge because she was enjoying watching the emergencies,” he said. “I heard the same thing about a client who asked if she could stay because she was in the middle of a comforting conversation with an elderly woman whose dog was in surgery. She wanted to stay with her until the dog was out of surgery.”
How to Do It
Creating an open-concept hospital that integrates pet owners into the visit requires a culture and mindset shift but not necessarily a complete remodel. Here are four ideas.
1. Do more in the exam room.
Blood draws, nail trims, vaccinations, anal gland expressions and more can be performed in the exam room with the pet owner present.
“The goal is almost to over-communicate with pet owners,” Dr. Crocker said. “We want to keep owners and their pets together as much as possible. If you need to do an ultrasound, bring the ultrasound into the exam room.”
2. Bring pet owners to the back.
When you can’t do something in the exam room, invite the owner into the treatment area so you can explain what’s going to happen and show where it’s going to take place. For example, if a pet will be hospitalized, show the owner where the pet will stay. Owners will appreciate the transparency.
3. Keep pet owners engaged when they aren’t present.
“I couldn’t stay the night with Avah because I had to go home to take care of my other dog, but I loved that I could call and talk to a doctor immediately if I needed anything,” Harden said. “When I woke up in the morning, I would have a text on my phone with a picture of Avah and a message explaining how she was doing. That was so refreshing.”
Dr. Crocker agreed. “Do as much as you possibly can with the pet owner present, and when they aren’t, send a lot of pictures and videos,” she said.
4. Make it appear open.
Becky Gasser, the director of design at BDA Architecture, said veterinary practices can create visually open spaces without eliminating interior walls.
“We’ve seen some practices wanting to create more visual openness but not necessarily take away the entire physical barrier between the medical spaces and exam rooms or client areas,” Gasser said. “That’s typically done with glass.”
For example, 1st Pet Veterinary Centers in Chandler, Arizona, visually opened its exam rooms by incorporating double-sided fish tanks.
“You get some privacy, which is nice in those exam rooms, but you don’t feel completely isolated and alone,” Gasser said of what 1st Pet did. “You can see the people outside through the fish tank, and they can see you, so it’s riding that fine line of privacy and that open, visual connection.”
Double-sided fish tanks visually open up the space at 1st Pet Veterinary Centers in Chandler, Arizona.
THE PROS AND CONS
Here’s a glimpse at both sides of the idea of keeping pets and their owners together during a veterinary visit.
The benefits:
- Stress and anxiety are reduced for pets and owners when they stay together.
- Clients are happier and more loyal. When they witness the hard work firsthand, they generally treat the veterinary team with more respect and understanding.
- Because clients are happier and their pets experience less stress and anxiety, the veterinary team enjoys better job satisfaction.
- Communication between doctors, veterinary nurses and pet owners is easier and more efficient.
- Clients are more likely to see the value in a service they’re paying for if they witness it, which could reduce the frequency of uncomfortable cost-of-care conversations.
- An open-concept design makes practices feel bigger architecturally. They are also brighter and tend to have more natural light permeating the space.
The downsides:
- The back of a veterinary hospital can be quite noisy because of staff conversations, barking dogs and more. Consider the acoustics and what you might not want clients to hear in your open practice.
- Watching medical procedures isn’t everyone’s cup of tea, so be sure to have private spaces available for difficult or end-of-life cases, unsocialized pets, and clients who prefer some separation.
MAKE YOURSELF AT HOME
Inviting clients into your treatment rooms might sound horrifying, but Veterinary Emergency Group has no regrets. Carla Alves, the director of content marketing and communications, said VEG teams make a client’s stay with a pet as comfortable as possible. “There are no rules,” she said. “We always find a way to say yes.”
Some ways VEG accommodates pet owners include:
- Clients can sleep near a pet’s cage on a VEG-supplied cot or in a personal sleeping bag.
- Some VEG locations have a “resting room” with a bed.
- Each VEG hospital has a stocked kitchen and pantry with plenty of snacks and beverages. Alves said many clients go out to eat or order meals to be delivered.
- Clients can use the hospital’s showers.
But what about antsy clients who make themselves too comfortable and wander around or touch the equipment?
“We have never had an issue with a client not respecting the environment,” Alves said. “On the contrary, they have huge respect for what our team does and do their best to show appreciation. They have always stayed out of the way when we are working on other pets, and we have even had clients go beyond that and provide support and comfort to other pet owners.”