Lessons Learned from Curbside Care

About a year and two months ago, the world changed for veterinary practice.  The traditional model of a pet owner bringing the pet into the clinic, waiting in the waiting room, then being escorted by a staff member into the exam room changed.  Now we had to meet the client at the car, take the pet away from the client while maintaining the six-foot social distancing requirement from the client.  This step violates the basic rule of Fear Free (Sm) and  Low-Stress Handling (TM) principles of keeping the pet with the owner.  In response to many inquiries about how can we decrease stress when we have to keep the client out, I created my webinar low-stress curbside care    Over 300 attendees have created ways to keep the stress low as they are avoiding contagion.  Staying in touch with the attendees, and participating in various veterinary forums, here is what we learned from Curbside care:

The good:

1. Those empty waiting rooms reduced stress.  Many dogs were a lot less upset entering the clinic, in the exam and treatment areas because they did not see or hear other dogs in the waiting area.  The clinics with cathedral ceilings likely noticed this the most.  Both cats are dogs are benefitted from not waiting in the waiting area.   Ideas that clinics are trying out are allowing the client in with the pet but waiting in the car, and checking out remotely using an online payment meth2.Outdoor exam areas for stressed dogs.  Grassy areas behind the clinic, or creating a quiet corner next to the car avoids the stress trigger of the clinic.  I think many of us did not realize the amount of stress building up from arrival, walk across the parking lot, and entering our clinics.
2.  Creating the outdoor exam space is a great way to decrease pet stress.  This concept has been promoted in the Fear Free(sm) practice building guidelines.  I think we will be seeing more outdoor spaces adapted for a low-stress exam area.  Yea, winter can be tough.  But my discomfort of kneeling in the snow, with a cold wind blowing is worth the reduction of aggression in this animal and have a safe, low-stress care experience. .  Make yourself less comfortable, to help the animal be more comfortable.  It is a small price to pay for improved safety, welfare, and care experience.
3. Sending online history – check-ups, estimates, and releases increases the efficiency of curbside care.  Decreasing the wait time for check-in is appreciated by clients.  Send these forms directly, or the link to your website page to make it easy for clients to use them.    Technology is your friend.  technology your friend.  Be forward and send it to the client in an easy way to fill out and return to you. 4.
4. Video chat services –  the clinics that changed from in-person to video chat exams for specific services were able to leverage staff, provide more service to clients, decrease wait times, and create a profit center.   You can provide telehealth / teletriage/ teleadvice services in addition to telemed.  The AVMA with AAHA  has published Telehealth/ Telemed guidelines 5.
5. Text to landline – Zip Whip, and other platforms allow your clients to text to your landline number from their smartphones.  You can text back from your computer.  Fewer ringing phones, less urgency and stress for your staff, and you can wait until you have all the info to give in a return text.   Text communication is documented and can be copied into the medical record, keeping communication clear.6.
6. Less Client stress affecting pets – with the client out of the room, some pets are better behaved.  Aggression is reduced as resource guarding the owner is eliminated. Any anxiety from the owner is no longer telegraphed to the pet.  As we move forward,   note which pets were less anxious with the owner absent, and request that the owner stays out of the exam room.  If the owner wants to be present, suggest the owner stand outside the door and listen to the pet.  Or you can video call the client from your smartphone to thier’s, keeping them on mute.  Knowing what is happening to the pet builds trust.  Be creative with ways to keep the owner out yet connected.

The bad:

1. Long waiting times!  – I heard that wait times in curbside have exceeded two hours in general practice, and 4 hours was in emergency medicine.   The result – Crabby Covid Client syndrome.  Studies have shown that 1 minute feels like 4 minutes when one is waiting.  So, clients are impatient.  Double booking, trying to fit in the acute care patient while seeing scheduled patients, patients who are reluctant to come out of the car, are not easy to handle on a leash, the client who adds 5 more things to the exam, and lack of automation has been a culprit creating the long wait times.  As a lesson, when we have to provide curbside care – automate, inform your clients what to expect, set up video or remote consults using a remote worker as much as you can.    It will always be more efficient to set up 4 exam rooms with clients at various points of the exam process so communicate that curbside will take longer.
2. Separating pets from owners.   For some pets, keeping the owner near made it easier to walk into the clinic, and be calm for care.               Some pets were really anxious and even aggressive without the owner.  So, removal of the pet for these cases is not good.  Note on the medical record which pets need the owner nearby and plan ahead to keep the owner near.
3. .Cats escaping from carriers.  I demonstrate in my Low-Stress Curbside Care how to use a towel to cover the gate to prevent escape,                      hold the cat inside a pillowcase, and check the carrier for secure latching before removing it from the car.   A cat will easily startle and dart out of a cattier from noise, movement, or touch stimuli.  Think ahead and keep the cat safe and securely covered.
4.   Darting dogs: Dog backing out of collars that are too loose was frustrating and dangerous.   Most of these dogs were upset about leaving the owner or entering the clinic with a collar that was too loose.  As I show in the webinar, lure a dog into the slip lead as he comes out of the car routinely – on all dogs.  This will prevent escape problems.

Curbside future:

Curbside care opened up a range of experiences for many practices,   Increased efficiencies, and less client interaction were appreciated by some practitioners.   Others missed the client connection,  or found automation to increase efficiency was rejected by the clients.  It is certain that every practice has found something helpful from curbside care.  Take what works for your practice from curbside care and grow.   I look forward to hearing how practices are finding ways to integrate some of the benefits of curbside care as we come out of the pandemic shutdown.

Stay healthy and low-stress!

Sally J Foote DVM, CABC-IAABC, LSHC-S