2017 December - After hours care of patients or “Who will look after my pet when you are closed?”
Veterinarians discuss many issues when animals are admitted to their hospital but phone calls to the Board office suggest they often overlook covering the issue of “what happens after hours”. Veterinarians may think the clients know what arrangements are in place but it’s wrong to assume the client knows what your practice offers after hours.
There are very specific clauses of the Veterinary practitioners code of professional conduct (Code) that indicate aspects of a veterinary practitioner’s responsibility in this circumstance, including clause 2 (Welfare of animals must be considered), and clauses 5 (Utilisation of skills of colleagues), 6 (Professional conduct), 7 (Informed consent), 8 (Availability to care for animal), and 9 (Referrals and second opinions).
It is essential that all veterinary practitioners in NSW are familiar with the Code, which is Schedule 2 of the Veterinary Practice Regulation 2013 that addends the Veterinary Practice Act 2003. The Code is available under Resources (Legislation) on the Board’s website.
It has long been a commonly accepted practice within the veterinary profession for animals to be hospitalised after hours, most often not fully supervised. There is no argument that many animals have benefited enormously from such hospitalisation.
There is a vast range of medical and surgical conditions where after hours hospitalisation will play a key part in treatment or recovery. These range from simple convenience situations to critical care cases where movement of the animal may pose significant risk.
There is no blanket rule as to what is right in cases of hospitalisation after a veterinary hospital is closed. Each case is affected by factors unique to that case, and several options may represent appropriate levels of care. The veterinary practitioner must make that judgement.
Clearly the Board is not seeking after hours supervision in all veterinary hospitals and recognises that even in quite large regional centres there may be no dedicated after hours or emergency veterinary hospital.
It should be noted that complaints tend to arise when clients find there were options in major centres that they were not informed about.
The client has a right to be fully informed. You should consider discussing, when appropriate, the benefits that the specific form of after hours hospitalisation may provide to the animal and client, the level of supervision that will or could be provided during hospitalisation, the various other options available, and the costs of these various options.
It is the veterinarian’s responsibility to ensure the client’s right to be fully informed is satisfied.
Options may include (but are not limited to):
- no supervision – animal left unattended
- minimal supervision – scheduled supervised visits by veterinary or nursing staff during the hospitalisation period
- constant supervision – veterinary or nursing staff to provide constant supervision throughout the hospitalisation period
- referral to another facility e.g. an after hours emergency centre
- client taking the animal home to provide supervision.
Discussion and agreement to any of these options and the associated costs constitutes informed consent, and should be noted in the medical record.
Once the client has been informed of the hospitalisation option(s) available to them at the practice, and has given their informed consent, the registered veterinary practitioner is responsible for ensuring the conditions of the chosen option are met.
If for unforeseen reasons the chosen option can no longer be met, then a new round of communication and choice must be initiated. Please don’t assume that, “I thought the client knew that nobody would monitor the animal during the night”.
As veterinarians we are dealing with a more sophisticated and knowledgeable general public, with higher and higher expectations. The major consequence of this change is the imposition of higher standards of communication on veterinarians - a challenge our profession meets admirably in almost all circumstances!