A ‘day’ in the life of an OOH small animal vet

Written by: Emma Simpson
Published on: 1 Jul 2022
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Simpson image For every job advert promising “no OOH”, an out‑of‑hours rota is filled by vets and nurses who step into the breach.

While a stalwart and hardy few are able and willing to weather the on-call rota alongside a daytime role, increasingly the unsociable hours in the 24‑hour cycle have become the remit of the exclusively OOH vet service.

In centres across the UK, OOH vets and RVNs man the telephones, care for inpatients and handle all and any emergencies arising in our small animal patients from the early evening until the popular working day begins 12 to 14 hours later.

Upholding the requirement in the RCVS Code of Professional Conduct for Veterinary Surgeons that all vets provide 24‑hour emergency care, OOH veterinary teams give the day teams a chance to clock off for the evening while still facilitating a high standard of care for all the patients who need it.

From my experience, it is an unpredictable, fascinating and privileged position, which nonetheless exacts an inescapable toll from those who dare to enter it.

Welcome to my day (or should that be night?) as an OOH vet.

Up to speed

I work in a first opinion veterinary hospital with a substantial inpatient caseload.

My first goal on arriving – having greeted the day team, of course – is to get up to speed with all the inpatient cases and start to formulate a plan for each patient overnight. Catching up with the inpatient vet is a great chance for an edifying clinical discussion – as well as getting the low‑down on which patients like snuggles the best.

Although the handover period is relatively short, this is a key moment of team solidarity, as well as a prime opportunity for me – as a largely sole-charge vet – to learn from my experienced colleagues. Very often the day vets will also have had in‑depth discussions with the clients whose animals are in the hospital, so will be able to convey key details, such as the client’s personal outlook on welfare priorities, personal circumstances that may impact compliance after discharge and what budget we are working within.

With both night nurses also up to speed on the nursing front and the vet handover complete, day team members head home and, hopefully, are able to relax in the knowledge the night team has taken responsibility for all the patients overnight.

New cases

The next phase of the evening – if we can be said to have a schedule – is the arrival of cases transferred from the branches and affiliated day practices.

Most of these patients are brought across by the owners. Although the transferring vet will have already formed a plan and conveyed details about the planned hospitalisation, I find it valuable to meet the owners and discuss their pet’s condition with them directly.

It takes a certain level of trust to leave a much-loved pet overnight in the care of a vet practice you may never have visited before, so I hope getting the chance to meet either myself or our wonderful nurses helps dispel some of the anxieties surrounding the experience.

The transfer admission consultation is also a great opportunity for expectation management and answering some of the new questions that inevitably develop on the journey between the practices.

Occurring either concurrently with transfers – or, ideally, after they have been completed – are the emergency consultations. These OOH appointments are liable to occur at any time through the night according to demand, but typically, early evening sees back-to-back appointments.

Many of these consultations are simply alleviating owners’ concerns before they head to bed, or giving some minor treatment – such as antiemesis or analgesia – to assist animals in settling for the night, with daytime follow-up recommended as necessary.

However, among the plethora of consultations are some clinically definitive emergencies that require urgent treatment. Dogs arrive having disagreed with other dogs on the evening walk, male cats with blocked urethras catching their owner’s attention after work, and deep-chested dogs – having been too energetic in the garden after dinner – showing up with gastric volvulus.

Beyond these classic examples are a myriad of other emergencies, in surprising and varied circumstances, all contributing to the fascination of the job. Just the number of different items dogs will voluntarily swallow could fill a book.

Supporting owners

OOH owners are typically stressed – and sometimes in quite severe emotional shock – yet, for the genuine emergencies, they are required to understand the relevant medical science and make decisions with significant time pressure. Consultation communication skills have never been so important.

An emergency and critical care (ECC) vet is constantly treading the fine line between conveying concise medical information and showing suitable empathy for what is frequently a traumatic situation. Ultimately, owners need support in a making a decision that is suitable for their personal circumstances and the individual animal, and which hopefully they will feel comfortable with in hindsight.

The high emotional stakes are frequently compounded by lack of sleep and lack of time to prepare on the owner’s part. Where possible, I extend the consultation time to prevent unnecessary rush – dealing with other patients, where appropriate, in the meantime.

In the truly unsociable hours of the morning, the only time pressure is often the condition of the patient. It is a privileged experience as a vet to be able to give this level of attention to a client and their pet in a moment of crisis.

Planning

Time management as an OOH vet depends on adapting to the changing priorities as the calls come in, new cases arrive and inpatients destabilise.

If possible, the night team will sit down early in the shift, over coffee, to touch base on what procedures are planned for the following 13 hours and establish a loose ranking of urgency. This ranking and plan are subject to constant review. The nursing team plays a crucial role in monitoring the inpatients and will flag up cases requiring urgent veterinary reassessment.

One perk of working in a sizeable hospital is the availability of equipment to allow targeted monitoring alongside the regular temperature, pulse rate and respiration rate assessed by the nursing team – lactate monitors, blood pressure monitors, and blood gas and biochemistry machines generate rapid evidence to guide the triage and monitoring process.

Constant communication, both in the form of written inpatient records and verbal notes to each other, is vital for enabling our small team of three to provide the high-quality care to each patient we collectively aspire to provide.

Workload patterns

If the night shift has a pattern, it is often that the early hours are less populated with telephone calls and consultations than the evening. Surgical and investigative procedures are started as soon as reasonably possible, with the early hours being when some of the less urgent procedures can be completed.

I individually assess all the inpatients, and we aim to allow patients that can safely be left to sleep a few undisturbed hours. Unstable patients obviously can’t be afforded such luxury, but where sleep is likely to play a key part in speed of recovery, capitalising on the relatively calmer environment of the early hours seems to be very much in the patient’s interest. Taking advantage of the comparative tranquillity of dawn, I tend to write my notes, do some clinical reading on my most complex cases and generally decompress.

Handover to day team

Handover to the day team signals the end of the night shift. Usually, our patients from external practices stay on site for the duration of their hospitalisation, so I introduce the day team to these patients and any others that have arrived from consultations during the night.

Again, running through the cases with the inpatient vets is a welcome opportunity to merge ideas and discuss the plans for each patient going forward.

Finally, about 14 hours after my shift started, I am able to head home for a few hours’ rest before starting over again.

With a 7-on-14-off working pattern, my working life as a night vet is intense, but the time off allows for some real decompression after the week of shifts are completed. Working this number of shifts in a row also enables significant case continuity, which is both beneficial to the patients and a great means of developing my veterinary expertise. It is a thoroughly stimulating role, if unpredictable and frequently exhausting.

Working in ECC allows me to focus on the most critical of patients, and make a notable difference to patients and their owners in those times when every minute counts.

Prioritising both patient care and the welfare of our daytime colleagues, the OOH service upholds the standard of practice to facilitate the high-quality 24‑hour service our clients have come to expect.