Category: Technology

No veterinary team manager starts out with the intention of forcing their clinic into a socially precarious position. But over time, due to both pre-existent and self-perpetuated conditions, a certain miasma settles in. Let us examine the foundations of such cases to determine the best way to tear their structure down.

Life and Death

Death roams the halls of every kind of hospital, from pediatric to geriatric. But directly playing the agent of Death, as veterinarians do, is a whole other kind of trauma. Active or “aggressive” euthanasia (and dysthanasia) is a regular occurrence in veterinary hospitals. And it carries an emotional toll for both parent and vet when deciding to put an animal down. Deliberately taking the life of a beloved animal because of suffering, behavioral issues, or even financial insufficiency is not easy. Especially not for someone who cares deeply for animals, as many veterinarians do.

High Demand, Low Supply

The precipitous trend of animal adoption in the developed world is inadequately matched by the output of veterinary students. It doesn’t help that the cost of quality veterinary education ranges from $200,000 to well over $400,000 in the U.S. alone. The result is understaffed veterinary care centers where the practice manager is the beggar, not the chooser. This makes enforcing rules of conduct a tight rope to walk. What are you going to do? Fire your team’s only experienced veterinary technician for being mean to the intern a few times?

Elitist Expectations

Ever watched the first episode of Grey’s Anatomy? Right out the door, we get to hear the menacing monologue droning on in the background. “The 7 years you spend here as a surgical resident will be the best and worst of your life,” it says, “You will be pushed to the breaking point. Look around you. Say hello to your competition. Eight of you will switch to an easier specialty. Five of you will crack under the pressure. Two of you will be asked to leave. This is your arena.” Internet personality, Doctor Mike, remarked that this sounded more like the Hunger Games than Grey’s Anatomy. Unfortunately, though, this dramatized version of the surgical experience sounds all too familiar.

A similar belief is perpetuated in the veterinary community. That those who endure the extreme workloads and rigorous training are worthy of respect and advancement. Commitment, it is called. Tolerance. Capacity to bear the veterinarian yoke.

And out of this bud, The Hazing blooms

For most in the medical field, the word hazing requires no definition. If you haven’t experienced hazing, then are you even a true veterinarian at all? (Let us be clear, that was said ironically). Why does this happen? Because the new hire is viewed as an added burden instead of a potential source of respite. Like leeches that will suck the energy of their attendings, hanging heavily off of their shoulders like sloths. 

Hazing is not necessarily the blatant, outright egg-throwing ritual you remember from Initiation Day. Often, it is deliberate maliciousness, sabotage, ostracism, and passive-aggression shown towards new initiates. Essentially, they’re put through the grinder to determine whether they’re durable enough. It isn’t always that extreme, of course. Sometimes the intern is simply abandoned to “learn on their feet” … till they walk out with blisters and bad memories. Or they survive, in which case: hurray! Another grim, sardonic, brutal addition to the bunch.

Needless to say, hazing is unhealthy and yields nothing that could not be accomplished by better means. In fact, it exacerbates the problem, driving away future hires and dooming the practice to perpetual staff-shortage.

Janus, the two-faced Client

The client can, sadly, play the dual role of angel and demon in the veterinary clinic. They are affectionate and considerate toward their pets but do not always extend this behavior to their animals’ caretakers. As Shawn McVey, MA, MSW, CEO of Pathway (Veterinary Management), quips, “People come to us with beer budgets and champagne expectations for their animals,” They use their intense bond with animals as an excuse to vent their emotions inappropriately. And this can weigh heavily on veterinarians.

Institutional Ignorance

You don’t really need an optician to help you read the writing on the wall. Often, what’s going on is clear as day to everyone in the team. But sometimes, the veterinary manager is either overwhelmed or embittered by the attitudes of the team. They are usually busy with efficiency optimization, inventory management, and the practical HR functions. So weighed down are they, that they neither can nor wish to face this particularly nasty dragon.

The Culmination

The stress of all these elements combine to turn the clinic into a pressure cooker, with the veterinarians inside slowly, but inevitably falling apart.

We have an idiom where I come from: “Jab tak chal raha hai, chalne de”. It means as long as a system is going, let it go. And sometimes this means you keep on going till its gone. A rather grim thought, when we consider that we’re talking about human beings here, not just the practice. Around 70% of veterinarians have lost a colleague to suicide, according to a survey done last year. Worse, the suicide rate among veterinarians is 4 times that of the general population [1].

If these stark stats sound like something you want to address, then learn how to recognize the symptoms here.

Also join us in our upcoming webinar to learn strategies for preventing, negating, and managing these circumstances in your clinic

We cannot emphasize enough how important the environment around and mindset within a team affects the functionality of its members. There is no case that is too far gone.

[1] Stoewen DL. Suicide in veterinary medicine: let’s talk about it. Can Vet J. 2015 Jan;56(1):89-92. PMID: 25565722; PMCID: PMC4266064.

Ever walked into a really messy space and thought, “How do people function within such mess?” Of course, the answer is simple: it isn’t “messy” in their eyes, it’s normal. The same can be said of the state of most organizations. What outsiders may label as unhealthy patterns would be dismissed as the standard by employees. They have grown so accustomed to their ways that it’s the status quo.  

And that’s almost inevitable, right? Employees don’t always have the resources or influence to change their entire workplace. But the real danger arises when the practice manager gets lulled into that same sense of complacency. The kind that desensitizes them to the putrid milieu of social illness pervasive in the clinic. It is, therefore, important that ­­­you as a veterinary manager know the symptoms of this danger in order to better combat it.  

In our last article, we addressed the ugly truth of toxicity in veterinary culture. Here we will endeavor to help you identify the trademarks of this condition. And in our webinar, we will give you the necessary tools to lop that ugly head straight off!

Veterinary Silence Speaks the Loudest

Veterinary hospitals are rarely ever quiet spaces. The irate animals’ yelps and hisses, the mechanical whirring of the equipment, the tingle and jangle of supplies, medical items, and medication being shifted around – all keep the peace at bay for sure. There is chaos, there is commotion, and there are cantankerous clients.

But there is a different kind of silence that thrives within this disorderly system. It lives off of passive aggression, bitterness, cold-shouldering, issue-avoidance, and neglect. We cannot express how much offence is the direct offspring of miscommunications. Each member must feel comfortable voicing their concerns, opinions, and ideas. But that’s easier said than done. The practice of holding team meetings, brainstorming sessions, and sticking slogans to the wall won’t do the trick in-and-of itself. Intention is what breathes life into these practices. When you implement these as steps to a goal of creating a Cohesive vet team culture – that’s when these become meaningful. That’s when you see an improvement in morale.

In the meantime, do the following if you want to run your team into the ground

• Shrug off your people’s voices, suggestions, and concerns.
• Ignore genuine attempts to find solutions.
• Don’t appreciate or reciprocate good intentions from your new veterinary teammates.
• Don’t clearly communicate changes or reasons for changes.
• Make decisions about the team without warning or consulting the team members.
• Make decisions that clearly only benefit one person (you).
• Acquire minions that report each other’s failures, weaknesses, and dysfunctions to their overlord (you).
• Why be honest with your veterinary team when you can just put up facades and make excuses?
• Give shout-outs to outperformers who clearly function by overworking and bully others to alleviate their stress.
• Feed off of people’s fear.
• Be a psychopath.
• Eat children.

As a result, you will: 

• Isolate new recruits, making them feel unwelcome.
• Stifle the flow of ideas and positive conversations.
• Help doubts to grow by silencing their expression.
• Rub dirt into wounds to help them fester into resentment.
• Ensure that all relationships are built on the foundations of cynicism and distrust.

If that’s not your style, then it is crucial to establish clear lines of communication to promote a supportive and inclusive work environment in your veterinary clinic.

And the Award Goes To…

Wait a minute. Before you start dishing out credit and bonuses, consider your motives. Consider the purpose. Do you do this because it’s a convention? Is it because that other clinic five miles north of you does it? Is it even having any effect in the long term?

Acknowledgements come in many forms and with many reasons. There is recognition for high-performance or contribution to the team or for finding creative solutions or client retention rates. But remember that true appreciation is both a courtesy and a message. What do we mean by the latter? Well, if you’re rewarding individuals, then that promotes a competitive spirit. If you instead make a rule that if the team accomplishes a quota of tasks then they get a surprise, that promotes team collaboration. This can be in the form of an outing, a fun activity like an escape room, or a shared prize. It should be some boon they may have been asking for since a while; something that they all can use and cherish, or a symbol of teamwork. Such as a mascot.

Dodging Responsibilities

Speaking of acknowledgements, let’s acknowledge that burnout is a serious issue and mustn’t be taken lightly. We encourage veterinary managers to draw the line for their clinical workers before they reach the point of no return. But there’s a difference between drawing boundaries to preserve one’s own wellbeing and shirking duties under the guise of exhaustion. The latter can signal indifference to the plight of desperate animals and fellow veterinarians. If there’s one thing that veterinarians understand, it’s empathy. And a seemingly insensitive teammate will attract coldness and bitterness from their coworkers and clients alike.

Often disputes and hostilities are borne from the refusal to help in a time of crisis. Rejecting small, non-stressful tasks such as answering calls, cleaning kennels, holding animals, or filling prescriptions can really be unwise. The way to manage such attitudes is to assess the capability of an individual in that role prior to hiring. Make it clear by outlining responsibilities and setting expectations right from the start. Also make your good intentions obvious from the start. There is no formula for how much work a veterinarian can or cannot do. Some people have a lower endurance. They may have disabilities, chronic illnesses, debilitating fatigue, or any other myriad of issues to combat with. Keep an eye out for veterinarians who seem at their wits ends. If you spot someone showing clear signs of exhaustion, even if they’re not acknowledging it, tell them to get some rest. This may be difficult and seem counterintuitive, but it will highlight to your team, especially new recruits, that their wellbeing surpasses the bottom line in terms of priorities.

Being a Group, not a Team

Group members feel like they are pulled together for administrative purposes. Members focus on themselves because they’re not sufficiently involved in the execution of organizational goals. Members are instructed and not asked their opinion on the best approach. Members often distrust the motives of superiors and co-workers. It’s each man for himself. Disagreement is considered non-supportive. Conflicts arise and remain unresolved by supervisors or superiors until the wound has festered. Personal motivation is seen as irrelevant and non-vital to the running of the business and therefore unaddressed.

If that sounded dreary to read, imagine how oppressive an environment it must be to work in.

Now teams on the other hand understand interdependence and mutual support. In a team, your goal is everyone’s goal. You work to meet the goal of the organization and the organization aids in your career goals. Whether that be research, further education, or social initiates, everyone takes interest and gets involved.

Teammates feel a sense of ownership. Commitment is borne of having established the groundrules, set the boundaries, and chosen goals themselves. Team leaders encourage participation and collaboration to find solutions. They stimulate honest and open communication, and absorb questions, ideas, and feelings. Conflict is natural and should be seen as an opportunity for growth, ideation, and creativity.

As a manager, a great first step is to figure out the personal goals and career objectives each member has. Sit down with them and draft resolutions, commitments, find out their aims and desires. Find out what they care about, what initiative they’re part of. Offer them support in the completion of those. Have the team be involved in supporting that plan.

For starters to any business, inventory management can seem like simply stacking crates and stocking closets. But these inconspicuous expenses can very quickly build up, cutting into your profit margin with you none the wiser. Typically, between 12% to 15% of the overall practice income can be consumed by inventory costs.

Inventory management encompasses:

• counting inaccuracies or damage,
• managing product shortages,
• ensuring adequate availability,
• priority ordering based on relevant parameters,
• making timely payments and maintaining good cash flow,
• meticulous expiration date monitoring,
• verifying the accuracy of inventory reports,
• maintaining professional relationship with distributors
• minimizing inventory loss due to theft
• and much more

If this list alone is making your eyes blur over, then imagine how big of a migraine you’ll have when you look at the endless lists of stock that’s propagating in your storeroom. That is, unless you have a clear-cut system to collect, categorize and analyze the

The appropriate inventory management system is clearly vital in a veterinary hospital. Whether setting up a clinic, refreshing your practice, or adding new wings or care outlets, this article will be your guide to organizing your inventory in an efficient and intuitive manner.

What Constitutes Veterinary Inventory?

The variety and complexity of inventory will vary from small, privately owned clinic to vast veterinary hospital chains. It also depends on whether the practice is specialized or generalized. However, the overall veterinary purchases fall into two main categories: High-value assets and Supplies and Instruments.

High-Value Assets

These consist of the larger, more expensive machinery, equipment, and even technological devices that are used to operate the former. The availability and functionality of these assets is vital to the performance of your clinic and treatment of your patients. They depreciate in value, requiring regular maintenance to last in the long-term.

Image by Konstantin Kolosov from Pixabay 

• Medical machinery, such as heart rate and oxygen saturation monitors, centrifuges, autoclaves, x-ray machines, ultrasound machines, etc.
• Technology, such as laptops, printers, 3D printers, tablets, credit-card processors, patient monitors, etc.

Supplies and Instruments

This inventory is also dependent on the kind and extent of service you offer, but generally include the day to day tools, materials, and medicine that is required to complete procedures, aid your caregivers, and supply your clients directly. These should have a high turnover, and are meant to last in the short term, especially since some have an expiry date. 

Image by Hans from Pixabay 

• Medical supplies such as vaccines, antibiotics, anti-anxiety and anti-parasite medications, flea and tick products. ointments, shampoos.
• First-aid, safety, and surgical supplies, like cones, gauze, tick tweezers, self-adhesive tape, alcohol swabs, syringes, exam gloves, surgical masks, scissors, retractors, forceps, and elevators.
• Retail products and merchandise such as collars, leashes, pet clothing, pet food, treats, shopping bags, heated or insulated beds.
• Grooming supplies, including brushes and combs, scissors, nail-trimmers and clippers, ointments, wipes, shampoo, and cute accessories
• Office supplies for receptionists, veterinarians and general office staff.

Why should I care about Inventory Management?

We know that in many small-scale practices, the practice owner is the practice manager. Or the practice manager is the Operations, Finance, HR, and Marketing departments all wrapped up in one. So there just isn’t enough time to look into every single aspect of the business in minute detail. As a result, you may be used to slight losses here and there. But when it comes to inventory, you’d be feeding a massive portion of your profits to inefficiencies and oversights.

Wouldn’t it be tragic if you chose to ignore this seemingly complicated, but essential portion of the management when the simple solution was right at your feet all along? There are certain weaknesses and inventory costs that almost any service provider incurs. In order to minimize wastages and maximize profits, however, inventory must be meticulously organized and monitored.

Shortages

Sales from Inventory constitute a significant proportion of the revenue in a veterinary hospital. Having regular shortages can result in disgruntled clients who are likely to search for alternative supply sources. “ These outages can lead your clients to the conclusion that perhaps big box stores and your online competitors are more reliable.

Stock-outs can also result in delays in treatment, which may affect patient care. Unlike other businesses, a veterinary clinic deals with life-and-death situations, the treatment of which often cannot be delayed. Not having the required materials to handle an emergency is a serious red mark against your performance and reliability. It is a of immense priority to have functional inventory management workflows to prevent shortages.

Surplus

An excessive amount of stock can, conversely, indicate operational inefficiency as it means your hospital has excess working capital. To put it simply, your assets are lying idle and of course, that has an opportunity cost: increased holding costs.

Holding costs are one of two indirect costs in inventory management. They include the facility and utility costs of insulating temperature sensitive items like medication and vaccines. They also include the costs of installing CCTVs, paying insurance premiums, and other maintenance costs. Holding costs can represent as much as 15% of the unit expenses. And they can become cumbersome as the practice expands.

Labor Costs

The 5 Rs of Inventory Management are: recognize, react, reorder, receive, and restock.

This involves forecasting what items will be needed by which date based on current sales and usage. A purchase order is then compiled and placed. Before the fresh goods arrive, the old stock must be repositioned to make place for the new. Once the inventory is received, it must be stacked and stored. The supplies must be portioned according to requirements and then transported to the different departments and each item restocked in the right cabinet, drawer, closet, and shelf.

All this must be coordinated and overseen in a precise manner. For small practices, this may require one store-room and one worker. For a veterinary hospital with multiple wings, it can involve pallet trolleys, forklifts and many workers. Remember that up to 20% of the unit costs go to labor. In other words, a practice can incur $0.20 on every dollar spent on inventory on paying labor.

Within the hospital, the role of veterinarians is to focus on their clients and help their patients, not be tied up doing manual labor. Having to leave the exam room in search of instruments during a 10 minute checkup can really negatively impact patient experience.

Practice Value

As we discussed at the onset of this article, inventory costs can have significant impacts on profit. As the ratio

The higher your proportion of spending on inventory to revenue, the lower your practice profits fall. Let’s say your inventory to revenue ratio is 30% instead of 20%, you are spending an additional 10 cents for every dollar earned. Implementing strategies to lower inventory costs, which we will discuss further along, will directly improve your bottom line.

But what does that have to do with your practice’s value?

A practice’s worth is usually a multiple of its profit. Practices can be offered between 6 to 12 times their adjusted net revenue. Simplified, every dollar of savings is worth between 6 and 12 dollars in practice value.

Now, hopefully, you understand why all this is essential to the running of your care center.

Great, now let’s talk about the fundamentals you need to grasp to start directing your inventory is an effective manner!

It’s Elementary, my Dear Veterinarians

Yes, we know this phrase was not coined by Arthur Conan Doyle. But these are the basic building blocks of veterinary inventory management. 

Of course, you could skip to the shortcuts and solutions straight away, of course. But it would be ideal to have a rock solid foundational understanding of certain concepts, calculations, and distinctions. That way, you could really appreciate the tips, tactics, and strategies we will outline further on. 

Understanding Pricing Formulas: Markup, Margin, and Multiples of Cost

The financial stage of the inventory cycle is often the most daunting one. But remember that this is what determines the survival of your entire enterprise. Be bold and courageous as you traverse this realm: the fate of your veterinary clinic hangs in the balance.

We’re kidding; inventory finance is Grade 7 math easy. It’s all about percentages:

Markup

Markup is Price-Cost/Cost (M= P-C/C).

Cross-multiply to make P the subject (or let us do it for you): P= C (1+M)

Let’s say your markup percentage is 20% and your original cost is $100, then

Price = 100(1+0.2) or 100(1.2), which gives us $120.

Markup is quite literally the additional amount you are charging beyond the cost to make a profit. For Markup, cost the base, while for Margin, Price is the base.

Margin

Margin is Price-Cost/Price (M= P-C/P).

Cross-multiply to make P the subject (or don’t; it’s already done): P = C/1-M

If your Margin is 20% and your original Cost is $100, then

Price = 100/1-0.2, or 100/0.8, which gives us $125.

Basically, margin is the ratio of profit to revenue or how much more you’re selling the product for as compared to its cost. Remember, margin is the percentage by which the original cost is lower than the price, NOT the other way around. 

Multiples of Cost

Now most lab tests that require expensive machinery and equipment are charged at up to 4 or 5 multiples of their cost. This may seem simple enough but some inventory software calls for entering a percentage, not a number. Just remember that if something has doubled, it has been multiplies by 2 but the percentage increase is 100%. If it is multiplied by 3, the percentage increase is 200%. If it is multiplied by 4, the percentage increase is 300% and so on.

Performance Evaluation

Inventory is akin to a living, expanding cycle. As a business expands, the quantity and diversity of items entering and leaving will grow. And with it, the number of blind spots, the number of discrepancies between reports and reality, the number of expiries, the risk of theft, destruction, shortages, and mis-location all grow.

This means that you must employ evolving techniques to assess the performance and flow of inventory through the veterinary business. Otherwise, you stand to face more losses, both to revenue and to reputation. Here are some of the basics – blood tests, if you will – for veterinary inventory management:

Average Inventory

Average inventory shows you the worth of average inventory held during a particular period. This is found by totaling the value of inventory at the beginning and end of the month and dividing it by two. Keep in mind that the cost of the goods at purchase must be used here, not the sale price.

This is because the sale price may change based on the promotions running at any particular time and will not be always consistent with the margin that is generally applied, whereas the cost of the goods is a well-recorded number.

Inventory Turnover Rate

Inventory turnover rate measures the number of times your stock has been refreshed within a time period. To calculate it, you divide the total spending on your inventory for the year by the average value of the inventory. If we know that the average value of CPV-2 vaccine held during a month was $350 and that $2100 was spent on CPV-2 that year, then the turnover of CPV-2 vaccine was six.

This provides you an idea of how healthy your sales are. If your turnover is unusually low, this may be a symptom of overstocking. It will inform you that there are wastages in the form of expired medications or holding costs. If your turnover is unnaturally high, it may indicate a different form of wastage entirely. Staff may be utilizing more supplies than necessary or theft may be occurring.

Checking each item or set of items separately can also show you which items are underperforming. Therefore, you can take steps to remedy this issue. You can also determine the order quantity and frequency of each product. But calculating the individual turnover rate of each item individually can be tedious and time consuming. The right inventory management system would be able to provide performance comparisons and make astute recommendations.

Accuracy of Demand Forecast

As the name suggests, demand forecasting has to do with using past and current demand to predict future demand. Obviously, this can be a game-changer, enabling you to order in a manner that optimizes revenue while minimizing holding and labor costs.

It can also be used in the execution of strategic purchase and pricing decisions based on seasonal spikes in demand for specific services.

Forecast accuracy refers to how closely a forecast aligns with actual demand. As we discussed, the types of items that need stocking within the hospital are variable. Hence, forecasting is a crucial, but complicated component of your evaluations. Between medical supplies and patient medications, different categories of inventory will be subject to various criteria and follow distinct cycles. And the ability to both track these separate categories and analyze trends within them is no small task.

You would need a highly flexible and agile inventory forecaster to accumulate data from multiple sources, including historical and real-time usage figures on active and inactive clients, appointments, cancellations, etc.

Basically, these measures act as a test by helping in the diagnosis of your inventory system. 

Lead Time and Pipeline Inventory

Lead Time is a concept mostly used in the manufacturing industry. It denotes the time between the onset and completion of a project or portion of the process. When it comes to a veterinary practice, it would mainly be used to measure Material Lead Time. Material Lead Time is the time it takes the supplier to complete the order from the initial order placement date.

This is important as it is used to measure the Pipeline Inventory. Products en route to the clinic are refers to in this manner. While on the way, goods are considered part of the standard inventory despite not physically being present within the storeroom. You get a more complete overview of total cash tied up in inventory by including the pipeline inventory. Furthermore, this allows you to pre-sell medications to manage the high demands.

Pipeline inventory is calculated as Lead Time * Demand Rate. Say your lead time is 4 weeks at 50 units a week. You would need to order 200 units each time to maintain consistent inventory levels.

Categorize Inventory according to the 80/20 Rule

Identify the top-selling and fastest-moving inventory which generates a majority of the revenue. Then prioritize these items in terms of affordability, availability, and convenience. For ease, use structured, color-coded methods of product distinction, ranging from critical to dormant. Finally, ensure that those medications and supplies are always on hand and easily within reach of your staff.

This can prove advantageous in minimizing shrinkage (loss of inventory due to theft, inaccurate unit measurement, and damage). Additionally, it can reduce waste from expired items and enhance reorder frequency.

Do keep in mind that not all inventory in the veterinary hospital will move the same way. Remember that inventory and service items are two separate categories and should be treated as such. Usually it is understood that tangible objects are inventory and the care provided is service. But vaccines and injectables, though inputted as an inventory item, should be sold as a service item. As such, unlike in a retail warehouse, medications that are not high-demand must still be stocked. This is why inventory turnover should be calculated according to their classification. 

Strategies for Effective Inventory Management

Now that our concepts are thoroughly cleared, let’s get to the meat of the inventory management matter. Inventory makes up the bulk of the tangible assets of a veterinary clinic. They are also integral to maintaining high performance and service quality in a clinic. So, effectively coordinating inventory between multiple platforms, as taxing and time consuming as it may seem, must be done. Among the most complicated elements of Inventory Management are inventory monitoring, replenishment, cost reduction, categorization. Here are some tips and techniques to eliminate the complexity from these functions and save time to focus on animal care.

Start at the Drawing Board

The movements of inventory form part of the workflows in the clinic. Like with workflow mapping, recognizing the vulnerabilities is essential before taking the initiative to strengthen them. Doing this can really highlight the flaws and failures of the current system. This will help you identify the pressure points, areas where your team is overstretched.

Begin by formatting every activity in the inventory lifecycle into a process from the point of origin to the end result. At every step, ask feedback on simpler methods and shortcuts from the team members performing the tasks. This is important when coordinating many moving parts of the inventory mechanism. Then establish or update standard operating procedures (SOPs) to prevent the past mistakes from being repeated.

Careful and Consistent Categorization

The practical basis behind your inventory management system may already be lost to the ages. Perhaps you used the ABC method at some point but this analysis was never refreshed. Perhaps you simply recognized the item by location, i.e., supply closet, cabinet, or storage unit. Other criterion may include brand, demand, criticality, medical purpose, or monetary value. When inventory is recorded in a logical fashion like this, it is easier to compare your category sales to well-established benchmarks in the veterinary industry.

But which of these is the most important indicator of treatment and quantity of supplies? 

Studies have shown that a multi-criteria decision support model could result in a more efficient hospital inventory management system [1]. Using sensitivity analysis, the items were classified into W, B, and M sets. This signified that the items be monitored on weekly, bi-weekly, and monthly basis respectively.

Perpetual Inventory

Are you mentally wincing at the thought of having to take count of stocks so very often? Then a perpetual inventory system might be the solution for you. Perpetual Inventory Management System (PIMS) is a real-time stock monitoring and updating system. Using your electronic records and point-of-sales systems, it maintains an accurate and highly-detailed account of changes in inventory. Recording methods can range from manual to RFID (which is recommended) and the software tracks the order, delivery, transfers, usage, and any kind of transaction. This includes the pipeline inventory so that it is never overlooked by staff. If the order is delayed or unable to be fulfilled, the PIMS will record that. It will even provide the location of each category of stock to ease accessibility and prevent theft.

Unlike periodic method, where regular physically counts are required, perpetual inventory provides accuracy and leaves no place for inconsistencies. This eradicates the issue of stock-outs and customer disappointments with one stone.

Smart Ordering

Remember that, when ordering, there is no size that will fit every item. If you have utilized a multi-criteria classification model, you can distinguish items based on their demand. For medications and supplies that are used in large quantities and at high rates, bulk buying is suggested. But this would not be feasible for high urgency, low usage supplies.

Inventory replenishment is no easy task. Re-ordering the right amount at the right time requires lots of historical data to accurately forecast. The software must take into consideration the lead time or else the order may be filled up late. Rely on your inventory management software by feeding it a minimum quantity point for each item. Once it reaches that threshold, it should automatically ping you or add that item to your reorder list.

Consolidating suppliers can streamline the price comparison process. This will also cut down the time spent by staff paying invoices, loading, transporting, and restocking goods. Make use of our Suggested Order App to maximize your gains and your savings by comparing discounts from multiple suppliers, pharmacies, and manufacturers in one place. The app is easily integrated with our inventory management system so that you can get suggestions that are relevant to your precise needs. 

Tipping the Balance in your Favor

The major issue with managing costs is that there is no precise solution. You cannot simply reduce the size of your order to reduce holding costs. Conversely, that would increase the labor costs. Why? It takes time and effort to compile, place, receive, and restock the product throughout the hospital floor. And it’s the same vice versa. If you do not strike a balance, you not only forego precious revenue, you also fail to provide care that you have promised your patient.

When ordering, consider your sales based on frequency. Order certain items weekly, monthly, or after a fortnight, based on their demand. Even if you require only 40 units of white goods, if they come in a box of 50, order the full box instead.

Use your storage area size and inventory turnover rate to determine the frequency and quantity of your order. The ideal inventory turnover rate is 10 to 12 times per year. But of course, veterinary clinics work differently than your typical retailer. The average veterinary practice typically has a healthy turnover rate of 6 to 8 times a year. Keeping in mind your storage level can really help optimize your inventory management system and improve overall efficiency.

Drop-shipping

Let’s face it: having enough medications, supplies, injections, and vaccine available to customers at all times is nigh-impossible. But when products are unavailable to clients, those Big Box retailers start to look pretty attractive. And then there go your sales rates. Yet what if you could have every single animal care item under the sun available at the push of a button? And better yet, what if it took up no extra space on your shelf? And neither did you have to build an extra warehouse to hold it all?

If balancing the costs is too much hassle, consider drop-shipping. Show all the merchandise as “available” at your ecommerce outlet without having to hold it all in the clinic. Once the client places the order, the goods are shipped directly from supplier to customer. It’s so convenient for the pet’s parent, not to mention the cost-savings to your business. Obviously, this cannot apply to your entire inventory. Service goods and other items vital to the clinic’s operation would have to be available on hand. But it can immensely reduce the burden of sales stock. 

In Conclusion

Achieving effective inventory control requires striking a delicate balance between maintaining sufficient inventory levels and not overburdening your financial resources and storage capacity. Given the diverse range of challenges involved in inventory management, including those related to geopolitical events and technology advancements, there is no one-size-fits-all approach that guarantees success across all enterprises. In addition, it may be necessary to manage different types of inventories differently, such as perishable versus non-perishable goods. To determine the most effective approach for your business, it’s essential to keep accurate records while experimenting with different methods, and to use specialized software to monitor key metrics, generate reports, and develop dashboards that provide valuable insights.

[1] de Assis, A.G., dos Santos, A.F.A., dos Santos, L.A. et al. Classification of medicines and materials in hospital inventory management: a multi-criteria analysis. BMC Med Inform Decis Mak 22, 325 (2022).

Human resource allocation in a veterinary hospital is no piece of cake. So, when extra, out-of-hours clients arrive with demands and expectations, it is easy for the already scarce triage staff to feel overwhelmed. Diverting veterinarians from their primary tasks or downtime to perform extra tasks can result in a breeding ground for inadequate patient care and veterinary workers’ burnout. Worse still, many of the patients occupying space in the waiting lines are non-critical and could afford to wait without the risk of extreme clinical outcomes. Tele-triage can avert many of these problems.

Veterinary nurse teams can help owners to attend to their pet themselves. But this requires clear instructions and solid communication capabilities from the veterinary hospital. Thus, a well-functioning tele-triage system is crucial in determining the priority of patients, separating those who require immediate attention from those who can wait safely.

WHAT IS TRIAGE?

Triage is the evaluation of patients based on their physical parameters. Patients are subsequently allocated to the appropriate care area according to the acuity and severity of their conditions. This is a critical step as it can identify life-threatening signs early and determine what resources the animal needs.

There are typically three stages in the triage process:

1. Tele-triage or pre-triage
2. Triage on Arrival
3. Post Triage

In this article, we are going to be discussing in detail the assessment measures, information collection and information provision concerning the first stage – Tele-triage – and how effective implementation can lower the caseload of veterinarians.

TRIAGE ASSESSMENT

There are different triage scales and scoring systems, from Animal Trauma Triage to the Manchester Triage System (MTS).

The Animal Trauma Triage (ATT)

A trauma specific illness severity score that objectively measures the seriousness of a patient’s injury through quantification. The numeric values (ranging from 0 to 3) indicate the level of severity, the highest value signifying the lowest likelihood of survival.

The Manchester Triage System (MTS)

A globally utilized clinical resource by healthcare professionals to manage patient flow during times of high demand and limited capacity. The MTS is reductive in that it works backwards from the premise that the patient is in a life-threatening condition. This way, no serious potential conclusions are missed. The MTS does require experienced personnel who have completed approved training from a registered MTS instructor.

The Veterinary Triage List

Developed by Ruys et al (2012) using the MTS as a basis. The triage system was categorized based on different bodily systems such as circulatory, gastrointestinal, respiratory, urogenital, neurological, obstetrical, and generalized, with varying levels of urgency dictating the required wait time.

The Simple Triage and Rapid Treatment (START) technique

Used by first responders during mass casualty incidents. START was designed for triage when faced with a high-density of incoming patients. The paramedics/nurses can segregate patients based on three primary observations: Respiration, Perfusion, and Mental Status (RPM). Included are the patient’s pulse, respiratory rate, capillary refill time, presence of bleeding, and the patient’s ability to follow commands. Victims are classified into 4 categories accordingly: Green (minimal); Yellow (delayed); Red (immediate); Black (dead).

TELE-TRIAGE

Let us turn to the procedures and precautions involved in Tele-triage:

Process

This primary form of triage is done over phone or chat, supplemented by images and video, where necessary. In such dilemmas it is understandable for the pet owner to be flustered so it is paramount that the nurse in question be level-headed and trained in tele-triage methodologies. The nurse should maintain a calm, polite, and sympathetic demeanor as they log and record the call. This must be done to protect the nurse and the clinic as the instructions or counsel given on call could have legal ramifications. First, they must ascertain the owner details and pet’s symptoms, and then provide directions for how to reach the trauma center and handle the pet appropriately, according to their condition. This includes warning the owner of potential aggression, which may require the animal to be muzzled. Based on this, an estimated time of arrival should be generated and submitted.

Tele-triage Questions to help determine whether the pet needs urgent treatment

• Recent incidents of trauma? (Patients who have suffered recent trauma must be seen without delay)
• Is the breathing too labored or shallow – what color is the mucous membrane? (bluish color in the skin, lips, and nail beds must be addressed immediately)
• Any noticeable swelling or discharge?
• Any recent changes in weight or body condition score?
• Development of symptoms – slow progression or sudden decline? (Sudden decline signifies a more pressing issue and demands prompt attention)
• Have prescribed medications been taken? The owner should be advised to bring the medication.
• Has there been any known or suspected exposure to toxins? (In case of toxin ingestion, the patient must receive immediate attention)

WHY IMPLEMENT TELE-TRIAGE?

The benefit of the adopting appropriate tele-triaging is the structure and stability it creates in the emergency department.

It also means you can offer specific, professional advice and aid to patients, which builds your client’s confidence in your ability to serve.

With lower over-crowding, fewer vet techs, nurses, and surgeons would be required to remain on call. Studies have suggested that on-call shifts have a negative impact on veterinarian job satisfaction, well-being and personal relationships [1], especially among female associates. For this reason, veterinary hospitals could benefit from exploring alternative options to traditional on-call shifts.

TELE-TRIAGE SOFTWARE

For small veterinary clinics, this may mean making a choice to invest resources into building infrastructure around tele-triage. But in order to truly reap the benefits of tele-triage as more than just ancillary support, the right software must be adopted. Since animals are unable to communicate their experiences verbally, veterinarians often rely on visual, auditory, olfactory, and tactile cues. These can include the visible breathing pattern, color of mucous membranes, alertness and response to stimuli, capillary refill, and heart rate, among others.

There are three major body systems that must be assessed, namely the neurological, respiratory, and circulatory systems. On the basis of these evaluations, the triage staff can determine whether immediate diagnostic and therapeutic intervention is needed. Thorough triage assessment can ensure the appropriate level of care is provided for the animal. Usually, tele-triage is used as a supplement to in-person triage. But during times of overcrowding or high density.

Neurological assessments

These involve determining mentation i.e., whether the animal is stuporous / obtunded / hyper / comatose. Patients having seizures should be admitted immediately for monitoring and diagnoses. Therefore, voice and video calls should certainly be considered. A tele-triage service would be crippled without the ability to send and receive messages, photos, and documents such as EMRs and lab reports.

Respiratory assessments

These include checking the airways for obstructions and trauma, checking the respiration rate and effort. Oxygen therapy should be commenced in the case of respiratory compromise  or anesthesia and intubation in the case of obstructions. 

Cardiovascular assessments

These include evaluation of pulse rate, peripheral pulse quality, mucous membrane (MM) color, capillary refill time (CRT) and auscultation. Some wearable sensors can measure heart rate, the regularity of pulses, blood pressure, galvanic skin responses, and even perform electrocardiograms (ECGs). Hence, having an app that is compatible with animal monitoring devices would be highly valuable. Having access to such data can really help a trained nurse determine whether the pet is in a critical state. When you are available for your client in a time of distress with accurate and reliable information and assurances, it builds further trust in your service.

A pilot study comparing the performance of real-time remote telescreening and in-person screening showed that properly implemented tele-screening could achieve the same level of efficiency as in-person screening [2].

Implement tele-triage to amplify the efficiency of your clinic with our V-Clinic App, to make yourself and your ER team available to your clients anytime, anywhere. Fast-track your clinic’s performance with an app that gives you the ability to reach your customers regardless of distance while lowering the workload on your veterinary teams. Email us now at sales@celeritasdigital.com or info@celeritasdigital.com to learn more.

REFEREINCES

[1] Kogan L, Schoenfeld-Tacher R, Carney P, Hellyer P, Rishniw M. On-Call Duties: The Perceived Impact on Veterinarians’ Job Satisfaction, Well-Being and Personal Relationships. Front Vet Sci. 2021;8:740852. Published 2021 Oct 27.

[2] Rademacher NJ, Cole G, Psoter KJ, et al. Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine. JMIR Med Inform. 2019;7(2):e11233. Published 2019