Clinical Connections  –  Summer 2020

RVC Emergency and Critical Care During COVID Crisis

The RVC Small Animal Hospital was no different to veterinary practices across the UK (and many other countries), with the day-to-day working of the hospital being completely re-evaluated daily in the wake of the COVID-19 epidemic. 

Following the government announcement and RCVS and BVA guidance, we cancelled all routine appointments and started seeing urgent and emergency cases only. This meant that the Emergency Referrals, Critical Care, first opinion out-of-hours, Ophthalmology and Neurology and Neurosurgery services were seeing almost all the cases presenting to the hospital. 

Our students, who are present for 48 weeks a year in the hospital, were released from clinical duties the week prior to the lockdown, and changes were needed to keep staff and clients as safe as possible, whilst still delivering high standards of care.

We rapidly implemented new protocols so clients would not to have to enter the hospital. Clients remained in their cars while their pet was taken into the hospital for triage and full assessment. Owners therefore had to say goodbye to them upon admission, which could be difficult for them as they didn’t know what the full plan for their pet was at that point. History taking over the phone was fairly simple, but online consent forms were more of a challenge and we had to go through several iterations before we found a system that really worked. We worried about owners without mobile phones, but actually this transpired not to be much of an issue.

However, we had other challenges we didn’t anticipate, such as owners needing the toilet after a long journey. Before the full government lockdown was implemented, some owners felt our actions were overzealous, but as the severity of the situation became more obvious to everyone, this became much less common.  Inside the hospital things were changing too. Our caseload was obviously hugely decreased due to the lack of non-urgent appointments, but emergency referrals were also lower than usual. We were unsure if this was due to owners not wanting to travel for referral or because they were worried about finances, or perhaps a combination of both. 

A major change for us was not having undergraduate veterinary medicine and veterinary nurse students in the hospital. Everyone who works here has a passion for teaching, so this felt like a major loss. Our usually buzzing Intensive Care Unit (ICU) and Emergency Room (ER) were therefore very quiet compared to our usual standards. But still, we needed to work and care for our patients effectively and this is essentially impossible without close contact between members of staff.

We did our utmost to minimise time spent in close proximity and we changed to virtual rounds and took breaks separately, spending as little time as necessary together. This was hard. Vets and vet nurses are caring and social people and our ECC department has a strong team ethos. We are friends as well as colleagues and we want to spend time together. We tried to make sure people still felt cared for and appreciated, but the hospital certainly seemed like a very different place. We also felt that we needed to support the practices that referred to us and those that used us as a first opinion out-of-hours provider, recognising that financially and emotionally this is a very stressful time.

We are always happy to provide emergency advice 24 hours a day, seven days a week and we hope this was even more helpful during this period, when many vets would have been working without the usual support of their colleagues in their practices.  We tried to be flexible, increasing our hours of cover of first opinion out-of-hours care and providing support for those practices’ cases that needed extra care. We also were able to help the NHS a little by offering our mechanical ventilators and continuous renal replacement therapy machine to them.

Working in a frequently changing and challenging environment is something that our ECC team do, however these are normally patient and hospital factors rather than global. We have massively increased our internal communication with all other teams, daily conversations about resources and staff shortages. We implemented daily changes to our processes and standard operating procedures, whilst maintaining staff and patient safety. What we actioned one day needed a new plan the next, as evidence and advice filtered through, so we made the best plan for each day, knowing full well we didn’t have the answers.

As with all our colleagues throughout the globe, we’ve been trying to cope and provide the best service we can at this time. We all really want to get back to normal service, obviously because we love what we do, but mostly because that should mean the COVID 19 pandemic is coming under control.

Contributor: Karen Humm, Senior Lecturer in Small Animal Emergency and Critical Caew nd Co-Head of the Emergency Referral and Critical Care Services

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