Social ward rounds

We’re used to the concept of ward rounds – a way of communicating information about our patients – and know they improve standards and success rates.

But is something missing? Do you consider the owner’s situation and the financial aspects of the patient’s care in that ward round? Should the ward round cover these at the same time as the medical aspect? Or should it be discussed separately?

Having spent some time dealing with client complaints and bad debts, I’ve found too many people – vets, nurses, receptionists and clients included – haven’t always communicated as well as they could have. Too often, complaints are down to poor communication:

• We didn’t know the 40kg dog had to go down steps to the garden after cruciate surgery.
• The dog walker didn’t know about bandage care.
• The receptionist didn’t know about the payment plan.
• The client didn’t realise how important the physio was.
• The owner couldn’t make regular bandage change appointments.

All are an important part of the patient and client journey with us, and need to be reviewed as part of the path to healing patients.

How do we do it?

In the human field these are called “social ward rounds”. Once the medical review of the patient has been carried out, the social or holistic aspects of care are considered and debated, and further plans made. These are noted in evidence-based medicine as crucial to providing a high standard of care across health care providers.

As in the veterinary industry, few patients are now diagnosed and cured by one small team. We need to communicate. We’re not talking about extending medical rounds to do this, but starting a new communication pathway. We already pass on information a client has told us, but in an informal way. How do we ensure we are putting together a care plan the owner can achieve? Ensure they can give the medication the patient goes home with, and can make the follow-up appointments to help the wound heal.

Social ward rounds need information to be collated and contact with the owner. However, it doesn’t need to be a vet that does this contact – another health care professional always does this in human care, giving the client a named contact to speak to. We already do this in many cases, but – for example – a short discussion after the vet has made his or her morning call to the owner with an overnight update, to see how the owner is and what the next step is, needn’t take long out of your day and really helps.

To help deal with the financial side, I developed a plan where I would wait until after ward rounds to speak to the vet in charge of any cases where the client had raised financial issues. It kept it discreet, but started communication.

As we know, clients often feel more comfortable talking to nurses rather than vets. They can feel, when talking to the vet, they don’t want to admit they can’t tablet their cat or give the dog ear drops, and this spills over into how much they can afford. Many owners worry they will look like they don’t or can’t care for their pet, when the opposite is true. They have come to the vets for help, so are streets ahead of many owners.

How do you record this?

We know disputes over fees are some of the most common complaints vets receive, so it’s important to note what you have discussed. Is it a direct claim? What are the financial limitations? Is a payment plan needed? Vets and nurses need to know this for treatment plans, but, importantly, receptionists need to know as well.

When a client comes to collect his or her pet, they need to know what and how they are paying – and they only know that if they’ve been told. There’s nothing worse for both receptionist and client if the client is asked to settle a bill that has already been discussed and plans made.

How can we sort this? I introduced a system of financial notes for the pet’s notes. Some people already did this, but others didn’t. If a patient is in for a few days, it’s quite hard to scroll back and find these notes.

Each computer system has snazzy ways of making “special” notes, but a simple way exists. We already used a way of making notes for insurance claims by prefixing the note with ###, so for financial notes I suggested we use %%%. I did consider £££, but as clients can see your notes it didn’t look that professional.

This made notes on finance easy to find for all staff and promoted the importance of making them. It helps that our computer system also notes the bill at the time of making any notes, but it means a vet or nurse in a hurry could put %%% to confirm they had updated the client on the bill for that day.

While this isn’t going to solve all issues we have with a client’s bill, it is a step in the right direction for communicating with the client and each other.

While social ward rounds will not be needed for every patient, they are a useful tool to promote good communication with everyone involved in the patient’s care.