Trends®

Inside AAHA, December 2023

AAHA president-elect Scott Driever, DVM, urges practitioners to check the numbers, and not just reply on your gut feeling for all things financial. The Community discusses how to set up a fire evacuation plan.

Published Aug 4, 2021

By Scott Driever, DVM

December 2023/span>

See the Full Issue

December 2023

View from the Board

Numbers Don’t Lie

I can’t speak for everyone, but I can say that when I entered veterinary school, I did not do so with the intention of hoping to someday worry about inventory management and watching key performance indicators (KPIs). I entered veterinary medicine because it was exciting, and I loved the challenge of helping those who cannot speak for themselves. I loved the problem-solving component mixed with science. At no point did I fantasize about watching KPIs, much less worrying about how those KPIs would affect my staff, myself, and occasionally my patients and clients. Even when I became a partner in a practice, I didn’t fully understand the importance of watching them. It wasn’t until I became a sole owner that I realized just how important KPIs are to the health of my practice. Fast forward to now, and I am watching my KPIs regularly. I am making strategic practice decisions based on trends in my KPIs and have a much healthier practice because of it.

I learned pretty quickly in practice that while going with a gut feeling is important, it is not a good bellwether from which to make decisions. Generally, numbers don’t lie. They can be skewed, even ignored, but they don’t lie. When I started watching KPIs such as payroll, cost of goods/inventory, taxes, electricity/water, and so on, it became apparent that when costs of things increased, that directly affected profitability and my ability to reinvest in the practice. I found that the easiest way for me to manage that was by watching my inventory and cost of goods like a hawk. Holding myself accountable to a budget set based on my KPIs had the most direct effect on my ability to pay my staff. When the hospital is more profitable, there is more money as a percentage of gross for payroll. This makes for happier staff, and I can feel better knowing that I am supporting them at a higher level financially than I was able to previously.

The things I found that helped control my inventory are not new ideas. Practice consultants have been talking about them for years. I did not create these ideas, I just started listening to them and implemented the ones that seemed to make the most sense. The biggest help was not carrying multiple versions of items that did the same thing. This includes things like heartworm prevention. In my area this is easily the largest percentage of inventory, and limiting the options that I carry in house did a great job of helping the bottom line. The same goes for ear medication and anti-inflammatories. Yes, we have an online store for the one-offs, but that is still pretty minimal. With in-house pharmacies shrinking due to online options, it is important to not have a lot of money sitting on the shelf collecting dust when it can be put to use in other ways, such as updated equipment, new areas of revenue, or staff payroll.

My recommendation is to not rely on any gut feeling. Every hospital should have someone who geeks out on the numbers to help guide the ship and make strategic decisions that are in the best interest of the business. Numbers don’t lie, but they also don’t tell you anything if you don’t look at them.

Scott Driever, DVM, is president-elect of the AAHA board. Driever is a Houston native who received his DVM degree from Texas A&M University in 2000. Upon graduation, he moved back to Houston and began his veterinary career at Animal Hospital Highway 6 in Sugar Land, Texas, where he became a partner in 2005. In 2015, he purchased the rest of the practice and became the sole owner. His wife, Susan, is the office manager at the practice.

This month in AAHA’s Publicity Toolbox . . .

Here are the downloadable social media images available for AAHA-accredited members at aaha.org/publicity this month:

If you’re cold, they’re cold.
Season’s Greetings
National Cat Lovers Month
Happy New Year’s Eve: December 31

What Does Your Fire Evacuation Plan Look Like?

We have been revamping our Safety and Health SOP, and evacuation plans are top of mind. We have a fire evacuation plan and a group meeting place; however, we would love to hear from others when it comes to their protocol. Thanks in advance!

A: AVMA also has a Safety Standards regarding a written disaster and emergency management plan. Check them out here: avma.org/resources-tools/animal-health-and-welfare/disaster-preparedness.

A: Call your local fire department and ask them to help set up a plan. They were great!

Share your tips by logging into community.aaha.org

For help, email [email protected].

New Device Gives Voice to Animals’ Pain

by Emily Singler, VMD

How often do you find yourself trying to convince a client that their pet is in pain, even though they aren’t crying? How about those times when you are wondering if your patient’s behavioral changes may be pain-related? The practice of veterinary medicine is undoubtedly more challenging because our patients cannot verbalize what they are feeling.

We are, of course, experts at reading animal body language and gleaning as much information as we can from it. But there are still times when it is hard to know how much pain our patients are experiencing. A new device called PainTrace is changing all that by “giving a voice to pain.”

To learn more, I caught up virtually with three representatives of BioTraceIT, the manufacturer of PainTrace. Deb Dullen, president and CEO; Ralph Harvey, DVM, MS, DACVAA, chair of the veterinary advisory board; and Katie Hickey, global clinical program director, joined me on a call from the National Institutes of Health (NIH) Pain in Animals Workshop in Bethesda, Maryland, to share more.

What Is PainTrace?

As Harvey, a veterinary anesthesiologist, eloquently described it, “the language of pain is electrical activity.” PainTrace is a small device about the size of a deck of cards that is attached by a cable to two small metal sensors created to measure skin-based electrical activity that is indicative of pain within the body.

This noninvasive device boasts the ability to measure both acute and chronic pain, to document trends in pain levels over time, and to help localize pain in the body.

“It takes on the individualized experience of pain,” Dullen said, which includes not only the physical sensation but also the psychological and social aspects of pain.

How Does It Work?

PainTrace is designed to be used in the veterinary clinic during a physical examination, while the patient is moving, during a surgical or dental procedure, or during recovery from a procedure. The sensors are placed and acquire a systemic signal comprising the whole body, regardless of the suspected pain localization.

Once the sensors are applied to the skin with an adhesive, the device communicates wirelessly with an iPad equipped with PainTrace software, allowing for real-time electrical readings that determine a patient’s “pain score,” which is a cumulative measurement of pain throughout the patient’s body.

On the iPad, users will see a graph with a line tracing of the pain score of the patient and how it changes (if applicable) as the patient moves or when certain parts of the body are touched or manipulated. This helps veterinary professionals to localize the pain and determine its severity.

According to Harvey, PainTrace can detect pain that was otherwise not detectable on physical examination, even by experienced practitioners. Pet owners can also witness the results in real time and have a more tangible indicator of their pet’s pain.

How Have the Results Been Validated?

Much of the initial research and development was conducted in humans, who thankfully can verbalize their pain to corroborate the electrical readings. In patients, functional magnetic resonance imaging has been used to measure changes in the brain that are known to be consistent with pain responses. These findings were correlated with pain score readings from PainTrace.

Harvey and Hickey performed a live demonstration for me on the call. Harvey, who has been diagnosed with arthritis in one of his wrists, applied the sensors to his skin. Hickey showed me the pain score tracing on an iPad while she flexed one of Harvey’s wrists and then the other. There was a clear spike in the pain score reading when Harvey’s painful wrist was flexed, but no spike when his other wrist was flexed.

Case Summary: A Paralyzed Dog Gets a Second Chance

Harvey also shared a case summary to illustrate the value of PainTrace. A dog with a spinal injury had become paralyzed. The dog was treated with physical therapy for weeks and did not appear to be improving. The dog owners were strongly considering euthanasia because of poor quality of life.

The treating veterinarian had a PainTrace device and decided to use it to look for any evidence of spinal cord activity. With the device connected, the veterinarian performed a toe pinch and plantar pinch and measured an electrical response. This was enough to convince the owners to hold off on euthanasia and wait a little longer. The dog is now walking, albeit not perfectly.

Future Impacts on Patient Care

Dullen suggests that the implications of more widespread use of PainTrace are significant. “Veterinarians report that when pet owners see pain live, they are more motivated to make a decision with the vet to treat their pet’s pain,” she said, meaning more animals will get the relief they need.

This technology also presents a new diagnostic option for animals who cannot safely be handled without chemical restraint, since PainTrace can still obtain accurate readings in sedated or anesthetized patients.

Future Impacts on Team Wellbeing

The device may also make a positive impact on the mental wellbeing of veterinary personnel. Dullen said that based on published research, one of the biggest contributors to veterinary staff wellbeing is client satisfaction at the time of the visit. When pet owners partner with their veterinary team to provide the care that their pet needs, veterinary personnel can experience greater job satisfaction and improved wellbeing.

Clinical Trials Are Ongoing

The BioTraceIT team has big plans for PainTrace. Clinical trials are ongoing to gain FDA approval for human clinical use. The team also envisions a future where the device is already on hand in pet owners’ homes, for use with both humans and animals. In this scenario, the veterinary team could instruct the pet owner to obtain their pet’s pain score at home to either triage or monitor their pet’s condition.

PainTrace was created to “speak for animals who have no voice,” Harvey said. Hopefully, this technology can also help strengthen our bonds with our patients and our clients.

Emily Singler, VMD, is a 2001 graduate of Penn State University and a 2005 graduate of University of Pennsylvania School of Veterinary Medicine. Her career in veterinary medicine has included experience in shelter medicine, in private practice, and as a relief veterinarian. She currently works as a veterinary writer, consultant, and mentor and enjoys writing for both pet owners and veterinary professionals. Her writing interests include public health, preventive medicine, the human-animal bond, and life as a working mom. She is the author of Pregnancy and Postpartum Considerations for the Veterinary Team, which was published by CRC Press in November 2023 and is available to order now at www.emilysinglervmd.com.

Photo credits: Esin Deniz/iStock via Getty Images Plus

New Study Explores Vaccine Hesitancy in Dog Owners

by Emily Singler, VMD

Many of us have had experiences with pet owners who refuse vaccines for their pets. These owners will offer a variety of reasons for their resistance, or sometimes no reason at all. Up until now, we have only had anecdotal evidence of this trend. Now, for the first time, researchers have started to quantify vaccine hesitancy in dog owners.

Matt Motta, PhD, assistant professor of health law, policy, and management at Boston University School of Public Health; Gabriella Motta, VMD, associate veterinarian at Glenolden Animal Hospital; and Dominik Stecula, PhD, assistant professor of political science at Colorado State University, recently conducted a study on canine vaccine hesitancy (CVH) and some of its causes and effects.

The Mottas, brother and sister, spoke with me and shared their motivation for conducting this research. They report that all three coauthors have been “aware for years” that some dog owners don’t want to vaccinate their dogs.

From a Campfire to Cross-Disciplinary Research

Matt Motta, a researcher who has studied vaccine hesitancy in humans, and Gabriella Motta, a small animal veterinarian working in the trenches, recall sitting around a family campfire, trading “horror” stories from work. The subject of vaccine hesitancy came up.

Seeing that there were a lot of anecdotal similarities between their experiences with humans and animals, they kept talking about it. They continued that conversation “for a while,” Matt Motta said, comparing human vaccine hesitancy, particularly to the COVID-19 vaccine, to pet owners who refused to vaccinate their dogs.

But unlike in human medicine, the authors noted that no one had made an effort to quantify vaccine hesitancy in animal owners or determine the effects of this behavior on public health and health policy. So, they set out to do just that.

Factors of Vaccine Hesitancy

According to Matt Motta, their findings suggest that the same factors (political party, level of education, promotion of vaccine misinformation, and others) that make people less likely to have a positive opinion of vaccines for themselves negatively affect their opinions on vaccines for their dogs.

This has been termed the “vaccine spillover effect,” whereby views toward one vaccine affect views toward other unrelated vaccines. Matt Motta wrote in another article that negative attitudes toward the COVID-19 vaccine may be spilling over into attitudes toward mandatory vaccination of children for other diseases, for example.

The Rabies Example

The researchers documented that, among the dog owners surveyed, 37% found canine vaccines to be unsafe; 22% found them to be ineffective; and 30% found them to be unnecessary. Fifty-three percent of dog owners agreed with at least one of these positions.

In terms of the canine rabies vaccine specifically, 84% of dog-owning respondents indicated that they were sure that their dog was up to date with their rabies vaccine. Forty-eight percent of respondents opposed mandatory rabies vaccination for pets, believing that the decision to vaccinate should be left to the pet owner.

The sequelae of vaccine hesitancy in pet owners can be detrimental to both human and animal health, particularly in the case of rabies vaccination. Whereas transmission of rabies from dogs to humans can be largely prevented by vaccinating at least 70% of dogs in high-risk areas, the study authors report, areas where this 70% canine vaccination threshold is not met typically can see thousands of human deaths from rabies each year.

Opposition to rabies vaccine laws may contribute to relaxation and/or eradication of such laws in some municipalities, increasing the public health risk in those areas.

Vaccine Hesitancy and Veterinary Wellbeing

CVH also likely negatively affects the mental wellbeing, stress, and burnout levels of veterinary professionals, the researchers add. When pet owners disregard our expert advice to vaccinate their pets, the veterinary professional–client relationship can be damaged.

Conflict can also arise when unvaccinated animals are denied services such as boarding, surgeries, or nail trims to protect other animals, especially when veterinary staff and owners don’t understand or agree with the decision. Veterinary professionals who do handle unvaccinated animals can experience increased stress as they worry about exposure to themselves, their coworkers, and their other patients.

The Mottas agree that their study is just the beginning. Future work will measure feline vaccine hesitancy, collect more qualitative information about why pet owners are hesitant to vaccinate their pets, and try to document correlations between infectious disease trends and vaccine hesitancy in pet owners.

They also plan to study any proposed changes to rabies vaccine laws in the past 40 years to determine how often changes have been made, why the changes were proposed, and what the effects of those changes have been.

Is Vaccine Hesitancy a Messaging Problem?

When asked if vaccine hesitancy in pet owners shows a messaging problem in veterinary clinical practice, the Mottas each relayed their own experiences. Matt Motta responded that, in his research with human vaccine hesitancy, “one of the best predictors of how people feel about medicine is how people feel about science and experts.” These feelings can be affected by a number of factors, including political party affiliation and religion.