Referrals through CritiCare:
Betsy Dayrell-Hart, VMD
DACVIM (Neurology) and
Matthew Antkowiak, DVM

What exactly happens to my Patient?
At SouthPaws, we strive for specialist accessibility.  Often times when a veterinarian calls with a referral, we are able to fit that patient in as an outpatient appointment.  When a specialist's schedule does not allow additional outpatient appointments, the patient is seen through the ICU/emergency room (CritiCare) where the specialist is able to consult on the case, usually that same day.

When a patient is seen through the CritiCare department, what actually happens?  First, there is triage where the animal is assessed for stability.  Following triage, an ICU/ER doctor assesses the patient.  If a patient is stable and has been referred by their veterinarian for a specific specialist, the specialist is notified when the animal is in the hospital, and the ICU doctor and the specialist work together to generate a plan.  This plan may include further diagnostics the specialist deems necessary to perform a more complete consultation. If the animal is not stable, the owner is informed of the clinical situation and treatment is initiated immediately. The actual consultation occurs when the specialist has a cancellation, in between appointments or after their appointments for the day are completed.  The owner is contacted directly by the specialist following the consultation, as is the referring veterinarian, and a treatment/diagnostic plan is agreed upon.  The ICU clinician is also informed and further diagnostics and therapy are initiated at that time. If the patient is admitted during the day, it may be transferred to the specialty service or if critical care is needed, it may remain in the ICU unit.  If it is admitted at night, it will be transferred to the appropriate service the next day following morning rounds.

Morning rounds are held in the ICU unit daily at 8 AM. A representative from each specialty at SouthPaws attends and a discussion of each patient's history, exams, test results and clinical progress occurs.  A
radiologist, internist, surgeon, and neurologist are present to discuss the case with the CritiCare doctors. Often, constructive debate occurs and may result in changes in diagnostics or treatment plans.  Morning
rounds can expedite treatment or needed diagnostics through specialist interaction, as opposed to individual interaction during a consultation.

For example:  A patient, who we shall refer to as "Max", is referred to CritiCare for an abdominal ultrasound and a consultation with the internal medicine service.   Max is a 7-year-old MN Sheltie with a history of vomiting and a suspect abdominal mass is seen on abdominal radiographs.  Max arrives at 7pm and is triaged as stable.  He is seen by an ICU doctor who assesses him as being 5% dehydrated with an uncomfortable abdomen.  Max is hospitalized overnight on IV fluids and gastric protectants.  A CBC and Profile are completed at the referring veterinarian's request.

At morning rounds, our radiologist reviews the radiographs, notes a mild loss of detail in the cranial abdomen, confirms the presence of a mid-abdominal mass and suspects sublumbar lymph node enlargement.  The
internist and the neurologist discuss the lab work and note subtle changes in the leukogram that may be consistent with leukemia.  Max has an ultrasound at 10am. Lymphadenopathy and pancreatitis are confirmed.  A fine needle aspirate is performed and the oncologist
confirms lymphoma.  The transfer is completed to the oncologist who informs both the owner and the referring veterinarian of the diagnosis and a plan is formulated for treatment.

This may seem like a dry description of a standard case.  However, at second glance, 4 different specialists have collaborated on a patient that was referred for a single service. These interactions between specialists may not be evident to the owner or the referring veterinarian, but they are an everyday occurrence at SouthPaws.

When a patient is referred to CritiCare at SouthPaws, it is standard for more than one specialist to lend an opinion.  Specialists are "informally" consulted on a daily basis allowing a merging of intellects, which ultimately leads to thorough patient care and improved referral satisfaction.