Wednesday, June 27, 2012

1056. KPI and follow-up: Open Pyometra chihuahua

On Jun 15, 2012, the breeder's Chihuahua that had been adopted by a couple was spayed after 24 hours of IV drip and antibiotics.
12 days later, the owner complained about some bloody discharge from the dog's vagina.
"Is she eating normally?" I asked. "Yes," he replied. "Some cases of pyometra do have small amounts of bloody discharge some days after operation," I prescribed him antibiotics.

Today, I review the June 14 blood test result. Total WCC 14.4 (6-17) was normal. N59%, L21%, M15%, E2%, B3%.   Platelets wee lower at 175 (200-500). Platelet clumping noted. However, the dog is normal and the high monocytes (M) and low platelets did not adversely affect this dog.


USING STATISTICS TO LOOK AT MY BUSINESS PRACTICE - TIME SPENT/DOG SPAYED BY THE VET. IN THIS CASE, THE VET IS MYSELF.

HOW LONG IT TAKES TO SPAY AN OPEN PYOMETRA CHIHUAHUA?
Date of surgery: Jun 15, 2012
Vet: Dr Sing Kong Yuen
Procedures: Spay and dental scaling
Chihuahua, F, 9 years old, 2.2 kg, 37.2C.
No. of packets used: 2. Type: Polysorb absorbable 2/0 and 3/0
Dom + Ket at 25%    0.02 + 0.03 ml IV

1.  A:  IV inj Dom + Ket    10.07 am
2.  B:  Isoflurane gas first given  10.09am
3.  C:  Isoflurane gas Stopped: 10.51am (spay and then dental work)
4.  D: First skin incision: 10.18 am
5.  E: Skin stitched: 10.44 am

E-D = 26 minutesE-A = 37 minutesA small breed dog or cat spay should be completed (E-D) in less than 20 minutes and (E-A) should be less than 30 minutes. For pyometra as in the above dog, the time taken is longer as the womb is filled with pus and extra care and longer skin incision are needed during surgery.






I am still doing a trust and audit check on my vets to make sure that the time spent/spay is not too long due to lack of planning and inefficiency or idle chatting. Employees love to chat and that is part of human nature. However, no chats should be done during surgery as there must be focus on the patient's life.

Proper accounting must be done to ensure that the business can survive in this harsh economic environment.



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