Tuesday, July 10, 2012

1072. Update. KPI for a small breed dog - false pregnancy & pyometra

An efficient and not protracted surgery is important for the safety of the animal and for the productivity of the surgeon. Surgical audits need to be done by the licensee so as to maintain a high standard of care and build up the reputation of the veterinary surgery. I publish some bench-marks of how long I take to spay a small breed with false pregnancy and one with pyometra




1. KPI for spaying a dog with false pregnancy











1.  A:  IV inj Dom + Ket: 3.17pm

2.  B:  Isoflurane gas first given: 3.27pm

3.  C:  Isoflurane gas stopped: 3.47pm (spay and then dental work)

4.  D: First skin incision: 3.31pm

5.  E: Skin stitched: 3.50pm

E-D = 19 minutes

E-A = 33 minutes





Spay of a small breed should be less than 20 minutes. One of my cases is  shown in the image. It takes 19 minutes to operate in this case. Just be careful about the false pregnancy milk falling into the abdomen.



Overall, the process takes 33 minutes. The lady owner in her late 40s and her mother had gone to the temple to pray for a good outcome.



During surgery, there was some bleeding as the ovaries were abnormal. Probably polycystic. This dog has false pregnancy at around 3-monthly and even produced milk at the 26th day after spay.



No need to return for stitch removal in 99% of my spay cases as the stitches do dissolve and the surgical wound do heal well as in this case. No extra subcuticular stitches are done by me in all spays and so there is less suture irritation and stitch abscesses.



Stitching involves the linea alba and skin only. Keep spay simple and short. No fanciful "hidden SC stitches" to impress the owner but if you want to do it, use an appropriate smaller sized needle and 3/0 suture.





The dog is more "aggressive" after spay. She still produces milk even 26 days after spay. Why? This behaviour is hard to explain as the dog may be protecting herself against dressing changes by the lady owner. She has a history of false pregnancies every 3-4 months and her estrus cycle was not normal.

2. Spaying a dog with pyometra



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 minutes

E-A = 37 minutes



A 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 26 minutes. It takes 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 esp. with the impending world recession due to the euro crisis.


5399 - 5402. Old Chihuahua, adopted from a dog breeder, has open pyometra. The dog recovered with no problem. Recently she had a cough, was treated and had recovered.

CONCLUSION

A database of the process of spays done by associate vets at Toa Payoh Vets will enable me to know the efficiency and productivity of the veterinary surgeons. For example, I have encountered vets using 2 packets and 3 packets of sutures to spay a small and large breed dog respectively. This is not a best practice and the vet has to find out why he or she needs to use more packets when the usual practice is one or two packets.

UPDATES ARE AT:
http://www.bekindtopets.com/20120707key_performance_indicators_dog_spay_toapayohvets.htm

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