Prescott Animal Hospital in Prescott, Ariz. opened its doors in 1947. The practice served the community well over the years, growing in size and reputation, and the building was expanded and remodeled in 1977. Six years ago, the American Animal Hospital Association named Prescott Hospital of the Year.

That was when Kenneth Skinner, DVM, one of the three practice owners, decided that the 5,000-square-foot facility with six exam rooms needed to be updated to match the hospital’s standards of care.

“It became my mission to have a building that reflected our policies and high standards,” Dr. Skinner says. “I wanted a practice that looked like a university or an institution, not a house or a strip mall practice. We are very professional, dress professionally, act professionally and needed a building to match.”

Thus began his four-year journey to building Prescott Animal Hospital as it now stands, a 14,885-square-foot, 13-exam-room hospital that screams professional in every way. This attention to detail earned the hospital top honors in the 2020 dvm360 Hospital Design Competition—a Hospital of the Year award for practices larger than 8,000 square feet.

Having not been renovated since 1977, Prescott Animal Hospital was feeling a bit outdated. It was beyond time for a change, and the doctors had outgrown the space at least 10 years earlier.

“We live by this mantra: We are a full-service hospital offering clients top-notch customer service and exceptional veterinary care for their fur babies,” says Dr. Skinner, who spearheaded the entire project. “As the 2014 AAHA Hospital of the Year recipient, I wanted a facility that lived up to that honor and promise.” The first design goal? “We wanted the space to be fear-free, cat friendly and improve the client experience,” he says.

The second design goal was to bring more natural light inside and allow an outside view from most places in the hospital. “I describe our old building as being in a Las Vegas casino,” says Dr. Skinner. “You never knew if it was day or night.” This led Dr. Skinner to choose skylights, large exterior windows throughout, and even a large portion of the interior walls to be made partly of completely of glass to allow team members to see throughout the hospital spaces without having to enter and interrupt staff and patients.

All of the animal spaces also have exterior and interior windows, allowing for natural light and the ability for staff to monitor patients. Dr. Skinner says the windows and the open plan increase productivity and decrease noise as well as staff and patient stress. “I really like to be able to scan the entire treatment, lab, ICU, and surgery areas from the doctor workstations in the fishbowl,” he says.

The third concept Dr. Skinner had in mind was to make the building look prestigious and hospital-like, somewhat scholarly and modern. “I know it may be a big step for a small cowboy town, but I wanted the building to show our pride in the community and reflect our commitment to be the most advanced full-service hospital in Northern Arizona,” he says. Some hospitals want their space to look cozy and homelike to show their warmth and care for people and pets. Dr. Skinner says he thinks the professionalism of his staff shows warmth more than any throw pillow or comfy couch could ever do.

 Drs. Kenneth Skinner, Bryan Nolte and Cameron Dow

The final concept integrated into the plan was to accommodate the zoo work that Dr. Skinner and his team do. He visits one of three zoos each week, and about once a month has a large animal brought into the hospital for care. This led to them installing a tiger entrance to bring large zoo animal crates into the building and creating a secure space for sedation. This area features wider hallways and double doors to more easily move large crates throughout the treatment and surgery areas.

While the hospital may be big and prestigious, Dr. Skinner’s favorite parts of the building are what he calls the forgotten spaces.

“My favorites are the useful spaces like our giant pack and prep area, the laundry room, our central receiving room,” he says. “It’s the spaces that maximize our storage and efficiency that I like the best.”

He says the central receiving area, which doubles as the tiger entrance, allows for delivery of pallets of dog food straight into the building, instead of leaving them outside and having to haul the items into the building by hand. Also, the conference room and janitors’ closets make him happy.

“The operating room and exam rooms are nice, but every practice has them,” says Dr. Skinner. “The forgotten spaces are what make our hospital great, improving efficiency and comfort.”

Dr. Skinner credits working with a veterinary-specific architect for making the design of the hospital so great, including designing these forgotten spaces to be so beneficial. In 2007, Prescott Animal Hospital built an equine hospital on a separate piece of land, without using a veterinary architect. While the practice worked out fine, he says he learned then that he needed someone well-versed in veterinary medicine to guide him through the flow of a hospital.

“Not only that, but a veterinary architect is able to ease the construction process as an advisor, knowing things to look for that we might miss,” he says. “They know what things need to be there that you might have forgotten, they understand the equipment you use, the washing machines you need, and so on. Working with a professional who you know and trust and can work with on an everyday basis is super critical.”

 to see the other 2019 winner (under 8,000 square feet), Tustin Legacy Animal Hospital in Tustin, Calif.

Sarah A. Moser is a freelance writer in Lenexa, Kan.

Articles

A longstanding community practice needs a facility that reflects its standards of care—and fulfilling that mission earned one hospital the highest honors in the 2020 dvm360 Hospital Design Competition. 

Mission: Build an institution

To help raise standards and increase the confidence and competence of veterinary professionals with regard to pain management in animals, the Global Pain Council (GPC) of the World Small Animal Veterinary Association (WSAVA) has launched the “Teach the Teachers” program, the main goal of which is to create a “global network of key opinion leaders in pain management” who are motivated to share their knowledge with other professionals.

“Our ‘Teach the Teachers’ program is an exciting new initiative which we hope will lay the foundations of a global network of veterinarians and veterinary technicians with specific expertise in pain management and the passion and knowledge to educate their colleagues,” says GPC Chair Duncan Lascelles, BSc, BVSc, PhD, FRCVS, CertVA, DSAS(ST), DECVS, DACVS.

Most notably, this new program includes two scholarship competitions, one for veterinarians and another for veterinary technicians who have a demonstrated interest in pain management. 

The winner of the veterinarian scholarship is Nathanael Herry Lutevele, DVM, a graduate of the Sokoine University of Agriculture in Tanzania.

Dr. Lutevele is a member of the Tanzania Small Animal Veterinary Organization (TASAVO) and strives with other members to help improve the health and welfare of small companion animals in Tanzania.

The veterinary technician scholarship will remain open to applicants until June 30.

The program is divided into two phases for both techncians and veterinarians:

The selected candidate will travel to a host location and receive eight to 12 weeks of training in small animal pain management from GPC members. Training topics include the pathophysiology of pain in dogs and cats, assessing and treating acute and chronic pain, and how to approach clinical pain research.

The candidate will return home and run courses on pain management with local veterinarians or veterinary technicians and their WSAVA member associations. They will be awarded a certificate of completion when both phases are finished.

According to WSAVA, creating targeted education through this program is just another step in working to reduce the variation in pain assessment and management techniques around the world.

“All companion animals are sentient [and] feel pain,” Dr. Lascelles says. “This is what makes pain management such an important issue for veterinary professionals.”

Interested veterinary technicians can apply on the 

. Priority will be given to candidates from WSAVA tier 1 and tier 2 countries and to those involved in WSAVA member associations.

“We are looking forward to reviewing applications for our first GPC pain management scholars,” Dr. Lascelles says.

The new WSAVA initiative has already awarded one veterinarian with scholarship funds, pain management training and the title of the first key opinion leader of veterinary pain management, but the technician scholarship is still up for grabs.

Pain management scholarship still open for technicians

Addison’s disease, or hypoadrenocorticism, is a rare, life-threatening illness in dogs that is notoriously difficult to recognize. But veterinarians at the University of California, Davis School of Veterinary Medicine have annouced the development of an algorithm

 to detect Addison’s disease accurately and more effectively.

Veterinarians teamed up with an electrical and computer engineer to develop the algorithm, which is powered by artificial intelligence (AI), and has reported that the new screening tool has an accuracy rate greater than 99%.

“We set out to create an alert system that uses information from routine screening tests,” Krystle Reagan, DVM, PhD, DACVIM (SAIM), a board-certified small animal internist with the UC Davis veterinary hospital and lead researcher on this tool, said in an article on the 

UC Davis School of Veterinary Medicine website

. “The alert should be able to inform veterinarians when Addison’s disease is likely, and prompt further investigation.”

Often the first tests ordered when a sick dog visits a veterinarian are routine blood tests. The veterinary team used this routine blood work to train their AI program to detect complex patterns from more than 1,000 dogs previously treated at UC Davis. Once the tool analyzes the routine blood tests, it will alert the veterinarian when Addison’s disease is suspected.

The veterinarian can then take further action and give the canine patient an adrenocorticotropic hormone stimulation test—the gold standard to confirm Addison’s disease.

“We see dogs with Addison’s disease come through the clinic, and they’ve been misdiagnosed for two to three years,” Dr. Reagan continued. “Once Addison’s disease is properly detected, though, it is generally easy to treat with an excellent prognosis for the patient.”

Addison’s disease also affects many humans, which the veterinary team notes could be the next step in developing this tool. Dr. Reagan is currently collaborating with physicians and human health researchers on a translational component of the tool to help people with this disease.

The AI program may also surpass just Addison’s disease. UC Davis notes this program has potential to optimize detection of other veterinary diseases, including leptospirosis—a disease in which early diagnosis is crucial and current tests do not work well early in the infection.

According to the article, the Addison’s disease screening tool will be commercially available by the end of 2020.

“Veterinarians need a safety net to prevent dogs with Addison’s from falling through the cracks,” Dr. Reagan said. “This AI program is now that safety net. It has the potential to revolutionize the detection of Addison’s and save many dogs’ lives.”

For a look at the original research, click 

According to the university's veterinary team, this screening tool is superior to any other that utilizes routine blood tests available to veterinarians.

UC Davis veterinarians create life-saving Addison’s disease diagnostic tool

As COVID-19 cases continue to spike across the United States, veterinary practices are hunkering down on precautionary measures to help prevent the spread of disease among staff and clients.

Christopher, Shapley, DVM, CVA, veterinary acupuncturist and herbal medicine specialist at Brick Town Veterinary Hospital in Brick Township, New Jersey, says his practice is requiring staff to wear personal protection equipment (PPE).

“Our staff members are wearing masks and gloves," he tells dvm360.com Chief Veterinary Officer Adam Christman, DVM, MBA, adding that the practice has postponed wellness visits and elective surgeries and is strictly caring for sick patients. “We are still doing laser therapy [and] anal gland expressions … we aren’t doing nail trims.” 

Dr. Shapley has also adjusted his veterinary house-call protocols. He now bumps elbows with clients instead of greeting them with a handshake, and he doesn't touch any surfaces in the home. 

“There’s no more than one or two people in the home … we’re not hugging, we’re not shaking hands … we’re keeping [our] distance … the only thing I’m touching is the pet,” he says, noting that he will continue offering mobile acupuncture therapy to sick patients not out of obligation but because of his love for these animals.

To learn more about the precautions this veterinary practice is taking, watch the video  below.

Videos

A New Jersey small animal veterinarian shares how the pandemic has impacted his practice and explains his new approach for veterinary house calls.

COVID-19: The changing face of veterinary practice

News and regulations related to COVID-19 are changing on a daily, if not hourly, basis. To date, veterinary practices have been labeled as essential businesses by states that have mandated stay-at-home orders and/or the closure of non-essential businesses. Even with the ability to operate, it is hardly business as usual for veterinary hospitals. In the midst of taking measures to safeguard themselves and their families, veterinary hospital owners and managers are tasked with protecting staff, clients, patients and the overall business during these uncertain times.

“Once we get through this initial crisis period of flattening the curve that we’re trying to do, we are still going to be at a level of some sort of crisis for the next 12 months or so,” said Timothy Davis, a partner at national workplace law firm Constangy, Brooks, Smith & Prophete. He and his colleague, William Principe, led a COVID-19–focused employee law webinar hosted by the Veterinary Hospital Managers Association on March 24.

“You can, and probably should, expect some level of impact of spiking up and down [of cases] over the next 12 months,” he said. “And how that impacts your business will be something that you are going to have to monitor as it goes along.”

At this stage, veterinary practices must enact new means of conducting business, particularly if the hospital resides in a state with indefinite shelter-in-place orders. To continue providing exceptional patient care while protecting staff, Davis outlined some of the measures hospitals have instituted in recent weeks:

Restrict business to urgent or emergency cases only.

Limit the number of staff in the practice at one time.

Ask clients to drop off pets for examination rather than entering the facility.

Create special times, and perhaps even entry points, for high-risk clients.

Enhance cleaning and sterilization protocols.

When possible, instruct staff to work from home.

Provide letters for staff confirming they work for an essential business in case they are stopped en route to the hospital.

Even with all of the recommended precautions in place, practices should plan for when an employee becomes infected or comes into contact with someone infected with COVID-19. “Someday you are going to get the call,” Davis warned.

In addition to new laws specific to COVID-19, practice owners should be familiar with and adhere to all existing federal and state employment laws. This includes the Family Medical Leave Act (FMLA), Americans With Disabilities Act (ADA) and Fair Labor Standards Act.

On March 18, the Families First Coronavirus Response Act was signed into law and will become effective April 2. All businesses with fewer than 500 employees are covered and must comply with its mandates. Businesses will be 100% reimbursed by the federal government for all accrued costs via not paying payroll taxes. “If the amount you pay exceeds that, you will receive a direct check from the government,” Davis explained. There are two elements to the law that have slightly different requirements:

Provides 12 weeks of job-protected leave for employees who have been on payroll for at least 30 days. There is a 10-day unpaid waiting period followed by 10 weeks paid. The pay rate during this leave is no less than two-thirds of the usual pay for normally scheduled hours. This applies to both full- and part-time employees with a per-employee cap of $200 per day and $10,000 total. The only qualifying event for this type of leave is for an employee to be unable to work or telework because they must care for a child under age 18 if the child’s school or place of care is closed.

All employees on payroll are eligible for this leave and there is no 30-day employment requirement. Under this law, employees receive 80 hours of paid sick time at their regular rate of pay if they need time off for their own illness. If they need to care for others, they will receive two-thirds of their regular pay rate. The pay cap for this aspect of the law is $511 per day for personal illness, up to $5110 in total, and $200 per day up to $2000 total to care for others. The law sunsets at the end of 2020 and cannot be carried over into the following year.

The qualifying events for emergency paid sick leave are much broader. Employees can file for this leave if they are:

subject to a federal, state or local quarantine order related to COVID-19

advised by a healthcare provider to self-quarantine due to COVID-19

experiencing COVID-19 symptoms and seek a medical diagnosis

caring for an individual who is subject to quarantine or has been advised by a health care provider to self-quarantine due to COVD-19 concerns

caring for their child whose school or place of care is closed

At the time of the webinar, the Coronavirus Aid, Relief, and Economic Security (CARES) ACT had not been passed by Congress. However, Davis urged attendees to monitor the progress of the bill closely. “If it is passed, there is a substantial likelihood that you will have a significant portion of your payroll covered by the federal government during these times.”

The proposed law would provide employers with a cash stimulus and prevent layoffs. “They are doing this through the Small Business Administration process where if you keep employees on board there is a mathematical formula you would calculate based on your costs,” Davis said. “That formula would take into account your payroll costs, health insurance costs and your mortgage or rent costs.”

Businesses can apply for loans of up to $10 million to cover costs during this crisis. That loan would be 100% forgivable. “It would essentially be a direct grant of money from the federal government to you,” he said.

The law is being designed with the understanding that all businesses, albeit some more than others, are going to experience financial hardships as a result of the pandemic. Davis encouraged attendees to watch for legislative approval and to contact their business accountants and lawyers for guidance on how to best take advantage of the law once it is enacted.

As cases of COVID-19 became widespread, many employers turned to the Occupational Safety and Health Administration (OSHA) for guidance on how to proceed. “The reality is, this remains primarily a public health concern and OSHA does not have the internal expertise to play a very significant role,” explained Principe.

No current OSHA standard addresses airborne diseases and viruses. However, on March 9 the agency issued a guide for preparing workplaces for COVID-19. The document does not create any new legal obligations but instead provides employers with an understanding of their business’s perceived risk level and steps for determining appropriate control measures.

According to Principe, veterinary hospitals would fall into the category of being medium to low risk in terms of coming into direct contact with people who may be infected. As such, practices should follow guidelines that advise sick employees to stay home, provide resources for proper hygiene (tissues, hand soap, disinfectant wipes, etc.) and use appropriate personal protective equipment to prevent exposure.


A recent webinar for veterinary practice owners and managers shed some light on how to reduce workplace exposure to the novel coronavirus, and the legal rights and responsibilities when it comes to employees and their business.

COVID-19: employment law updates

Your clients may be confused about the name of these deadly worms, and you might get a chuckle out of imagining little worms with heaters warming the insides of a dog, but our clients just may be onto something with this mispronunciation. We now know that adding a bit of heat may be the key to diagnosing heartworm infections. Here’s why.

Traditional heartworm tests rely on the ability to detect soluble heartworm antigen in the patient’s blood. However, some of our positive patients develop antigen-antibody complexes that block the test’s detection and cause false-negative results. This is especially problematic for patients with low worm burdens that already would have had low levels of circulating heartworm antigen. So, what can we do about it?

If we add some heat to our heartworm test samples, we can break down the antigen-antibody complexes and be able to detect those sneaky ‘heatworms.’

Veterinarians should consider adding some heat—for both dogs and cats—when clinical signs of heartworm disease are present but a heartworm test result is negative. This may occur in dogs with a history of using the “slow kill” method for heartworm treatment, when chronic inflammatory problems that stimulate the immune system significantly (e.g. pyoderma) are present, or in a pet from a highly heartworm endemic area that does not have a consistent prevention history and tests negative.

, heat treatment can be accomplished easily in your hospital in five easy steps:

 Dilute the serum sample with an equal volume of 0.9% NaCl. Put the diluted serum in a glass collection tube.

 Fill a 500-ml glass beaker with about 250 ml of tap water.

 Microwave the beaker to the point of boiling (about two minutes in a 1,000-watt oven).

 Remove the heated water from microwave and place the tube(s) with diluted sample into the heated water for 10 minutes. (Be sure to remove the rubber stopper before heating; some warping of the tube is expected.)

This mispronunciation may elicit giggles, but our clients may actually be onto something. Here’s why veterinarians might want to turn up the heat on heartworm tests.