By Vickie DeHamer:
Emergency room wait times are significantly shorter, but there are still things pet parents can do to avoid a long wait in the ER
We have great news. Emergency wait times have finally gone back to normal! But “normal” ER wait times can still be long, and waiting for your pet to be seen is still stressful.
At Pet Emergency & Specialty Center of Marin, we are happy to report that our ER wait times for stable patients have gone from a staggering 6-8+ hours/”criticals only” to a much more sustainable 1-2 hours for stable patients. What a relief that we – veterinary staff and pet parents alike, because we endured it together – have made it through the past three years of the high-patient/low-staff gridlock that were the hallmarks of peak pandemic times.
We could end this blog here and just be grateful. (And we certainly are!)
But even with the pandemic stressors receding, we feel this is actually the perfect time to talk about emergency wait times. To break it down in a real way, with real, common-sense advice. To give our pet parents the tools and knowledge to navigate their emergency visits better. We hope to demystify the process, and take some of the unknowns out of the equation.
Because we know that an original quote of one hour can turn into three, and then four, and as you sit in our lobby and see patients being taken to the back, you might rightfully wonder, “why am I still here?”
While there is no magic fix to ensure you won’t ever have to wait at an ER, there are things you can do to lessen the frustration and uncertainty of an emergency room visit.
Here are five ways to avoid a long wait in our veterinary emergency room.
- Avoid cluster periods
Not surprisingly, busy times in the ER mirror people’s schedules. Weeknights after work and weekends tend to be our busiest times because pet parents are home and primary care vets are closed. If at all possible, avoid coming to the ER with non-emergent problems (more on that later) during these peak times.
Weeknights from 5 to 7: As the end of the business day approaches, and pet parents come home from work to find their limping cats or itchy dogs, and their regular vet offices are closing for the day, they understandably head into the ER for help.
If you find yourself in this situation, call your regular vet office for advice. Most regular vet hospitals are open just late enough to catch them before they leave, so they can help you decide if you should head into the ER. They know your pet: her history, age, last blood work results. They can give more educated advice over the phone than an ER hospital not equipped with the same history. Can they make an appointment in the next few days? Is your pet eating, drinking and otherwise acting normal? Maybe you can wait for an appointment.
If you’re not sure, please do come down to the ER. One of our medical team members will triage your pet, listen to what’s been happening, take your pet’s vitals and let you know the estimated wait time to be seen.
Weekends: Pet parents working all week may have been too busy to take their dogs with ear infections to their primary vet, or didn’t notice their cat’s weepy eye until Saturday morning. Maybe a Sunday hike turned into a foxtail up their dog’s nose.
Calling the ER ahead of arrival can help. While our staff can’t diagnose your pet over the phone or predict how our wait times will ebb and flow with the comings and goings of critical and non-critical patients, they can let you know if you can reasonably wait and call us in a few hours when we’ve worked through the backlog. We are open 24/7/365, so sitting in the comfort of your home to monitor your pet and calling us back for updated wait times is never a problem.
- Avoid not having a regular veterinarian
So many of our pet parents coming through our ER doors do not have primary veterinarians. Maybe they’ve just moved, or have a brand new puppy, or have a cat who “never needed to go to the vet before.” For whatever reason, they are now solely dependent upon an emergency room for the healthcare of their pet.
This is not a good situation to be in, because emergency rooms are not designed to deliver primary care to pets. Emergency rooms are designed to help pets experiencing emergencies. (And before you say that no primary vets are accepting new patients, read our sidebar!)
Having a regular veterinarian (rDVM) is worth the time and effort. Scheduling yearly exams, vaccines, dental work, spays/neuters and preventative care keeps you and your pet out of our emergency room. Many rDVMs will catch major disease processes during yearly checkups before they become an emergency. They’ll hear a heart murmur and begin a medication regimen before your pet has heart failure. They’ll answer your call at 5:30 pm when you walk into a diarrhea maelstrom in your kitchen and give you advice (and perhaps a last-minute anti-diarrheal medication) to tide you over until they can see you for an appointment.
For pet parents worried about cost, it’s significantly less expensive to pay for yearly exams and occasional maintenance visits with your rDVM than to use emergency rooms for veterinary care. Emergency room prices are higher for a good reason – to pay for specialized equipment and round-the-clock staff and doctors. But rDVMs don’t have to pay for those things. Their staff is asleep (hopefully!) at two in the morning. Not only will you save money, but heartache and time as well.
- Avoid using the ER for non-emergent problems
We know it’s hard to know what is an emergency and what is not. We always want you to come down to be checked if you are not sure.
But to give you some insight into what emergency rooms prioritize, it is truly the critical, life-and-death cases that we will see first. Examples are HBCs (hit-by-cars), toxin ingestions, trouble breathing, GDV (bloat), saddle thrombus, heart failure, diabetic crisis. These patients show up suddenly, without warning, and demand all of our time and resources.
We also prioritize euthanasia and quality of life assessments. When pet parents make the decision that their pet is suffering, and can’t wait for an appointment with their regular veterinarian, the emergency room is there for them to offer humane euthanasia 24-hours a day. We take that responsibility seriously and do prioritize euthanasia and quality of life patients over other stable patients waiting to be seen.
Some examples or urgent (but not emergent) cases include ear infections, skin infections (hot spots), flea infestations, limping, foxtails and diarrhea. These cases are tough because it is often true they need to be seen soon but the patients are stable enough to wait behind our critical cases. These are the people who end up waiting in our ER the longest, and these are the people we want to help the most avoid any unnecessary, long ER waits in the future.
If your pet is having an urgent, but not emergent, health issue, we recommend calling your primary veterinarian first, getting their advice and appointment availability.
We are also thrilled to offer urgent care appointments at PESCM. Currently, Dr. Ben Otten sees patients Mondays through Fridays. Call us for current availability. In fact, calling ahead is an excellent idea for urgent issues, since we can possibly schedule you an urgent care appointment and you can avoid an ER visit entirely.
- Avoid not understanding the ER process
Our triage process is straightforward but prone to many delays as we continuously prioritize what is happening in the hospital. The prioritizing and re-prioritizing of cases never stops in an ER.
From a client’s point of view, you just see the receptionists up front, and nurses coming in and out of the lobby to ferry patients. You see pets being taken back, (pets who have arrived after you, by the way! Why are they being helped first?) We encourage our clients to ask what is happening at any given time, but want to outline the steps so you have some context.
Triage: a medical team member will speak with you shortly after arrival, assess if your pet is stable or critical and give you an estimated wait time to speak with a doctor. Your pet is taken to the treatment room for vitals and sometimes kept with us for monitoring, or returned to you to wait if monitoring is not necessary or you prefer to wait with your pet. (Yes, you can ask for your pet back while you wait!)
Exam: The doctor will examine your pet in the treatment room and have a conversation with you about recommended diagnostics, treatments and medications. This is your opportunity to ask questions and explore all of your options with the doctor. This conversation may happen in person, in an exam room, or on the phone. Post-pandemic we have made every effort to return to in-person exams and do so at every opportunity. Our doctors want to see their clients’ faces and make that connection! It is highly dependent on what patients the doctor is overseeing and how the doctor can most efficiently accomplish all of her competing priorities at once. But it is not always possible given our ER caseload.
Estimate: Staff will present you with a cost estimate and collect a deposit. (Why do we collect a deposit? Because, unfortunately, some clients aren’t prone to pay for things after they have been completed, simply because there is no longer a pressing need for them to do so. To keep doing business, and keep our ER doors open, we need to collect payments upfront. This is not because we are heartless, or “only care about money.” This is just to ensure we can present costs transparently to owners and collect payment for our services.)
Treatment: We begin treatments once staff is free to do them. We prioritize treatments similarly to how we prioritize cases – who is suffering the most urgent need gets tended to first.
Diagnostics: If your pet needs diagnostics, you’ll need to wait for those to be completed, or you may be sent home to wait if we anticipate it taking a long time. We may need to wait for enough staff to be available to perform a particular diagnostic, or a particular doctor to be available for specialized diagnostics like ultrasound.
Discharge prep: Once we have been able to complete all of the diagnostics your doctor ordered (blood work, x-rays, etc.) and treatments (fluid therapy, injections, etc.) we will finalize your invoice, prepare any take-home medications and wait for the doctor to finish writing your discharge notes.
Discharge: Invoice finalized and paid, medications and discharges in hand, we will bring your pet back out to you and go over at-home care and follow-up recommendations.
What can slow down all these steps? In a word, so many things.
At any point in this seven-step process, critical patients may have continued to arrive, demanding our staff’s immediate attention and slowing things down. Or hospitalized patients may have experienced complications, demanding our staff’s immediate attention and slowing things down.
We aren’t taking longer than we said we’d take three hours ago, when we went over your estimate and took your deposit because we are being inefficient, or don’t value your time, or don’t care about your pet. We are taking longer because unforeseen events have arised, and we needed to pivot, make a new plan, and adjust. We likely were too busy to call you to let you know that a hit-by-car came in and needed immediate surgery, taking two of our nurses off the treatment floor.
We recommend that you ask our staff for updates, frequently and unapologetically. Ask the receptionist or call from home to see what is going on. We will tell you, to the best of our ability, how much longer we think it may take. We just ask in return that you are understanding and patient, giving us the benefit of the doubt that we are trying our best to complete your pet’s emergency visit as efficiently and compassionately as possible.
- Avoid having unrealistic expectations
This is the toughest part to talk about. But we’ve gotten this far, so let’s do it!
As much as we take responsibility as an emergency room to staff our hospital appropriately, have the most cutting-edge diagnostic equipment, a dedicated roster of qualified emergency and specialty doctors, a clean and functional hospital, a team of compassionate staff – we also need our clients’ cooperation and understanding when they have to wait.
It’s difficult when clients come in with the mindset that we are not trying our best when things don’t live up to their expectations. We have clients whose patience runs thin, and they yell at our staff. We’ve had occasional clients throw things and threaten us. In a field that has a 3.5x risk of staff dying by suicide than the general population, staff who are leaving the veterinary field for human medicine in droves for less stress and better pay, we truly need clients who are patient, communicate respectfully and understand their emergency room journey. And if they don’t, simply ask rather than assume the worst.
If the pandemic taught us anything, it was that kindness is way more useful in a crisis than anger and blame. And while the crisis of Covid-19 has lessened, crisis management is a constant in a veterinary emergency room, and for our staff to manage those crises requires just as much kindness.
We thank you for that in advance. And remember – we are here for you and your pets day or night, 7 days a week, 365 days a year.