Emergency Relief Doctor - Operating Manual - SAGE Veterinary Centers
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Emergency
Relief Doctor
Operating Manual
1
Revised: March 2020
Welcome to SAGE
Thank you for joining us as an ER Relief
Doctor!
We created this guide to help make your transition easier.
By now, you have received an ezyVet walkthrough or ezyVet
informational documents. Please let your ER nurse shift coordinator,
medical director, or hospital manager know if you have any questions.
We’re looking forward to building this new relationship and are grateful
to have your skills and experience here at SAGE.
At the end of your time with us, you will receive an evaluation.
Please take the time to complete it. Your feedback is invaluable!
2
General Information
3
Medical Records
Clients should be updated at the end of your shift on the progress of their pet;
more frequently if the case dictates. Let them know when to expect the next
phone call, even if not during your shift.
A summary needs to be created for every patient seen that has a primary
care veterinarian listed.
A medical record needs to be sent on every patient seen that has a primary
care veterinarian listed. This includes pets that are deceased on arrival
(DOA) or euthanized. In addition, if a patient arrives DOA, dies in hospital or
is euthanized, you must call the primary care veterinarian to inform them and
document the call in ezyVet.
You should also:
• Check the communication tab, answer all client calls, and return phone
messages
• Document all client communication
• Have CSCs place a comment appointment in the record if a patient of a
SAGE specialist is seen through ER or comes in DOA, dies in hospital,
or is euthanized.
• Link records to primary care veterinarians. Print or email homecare for
clients.
4
Estimates and Invoices
Be sure to:
• Review all estimates created by nurses prior to showing clients.
• Review creation of estimate documents and familiarize yourself with
“bundled” estimates called Sales Templates in ezyVet.
• Ask questions if you don’t understand line items and charges.
Monitor the invoice of your patients and have discussions with the clients if
the estimate needs to be revised.
Have a discussion with the client if the invoice is approaching the high end of
the estimate.
• If the estimate is increased over $1,000 or more than 50% of the
original estimate, the client should be directed to leave an additional
deposit and should be transferred to a CSC to complete the
transaction.
5
Collaboration With Specialty Medicine
Prior to transfer of an emergency patient to specialty, be sure the client wants
specialty care for their pet.
An initial specialist consultation and continued hospitalization for the day
including anticipated treatments and tests should be built into the emergency
estimate. Add in Consultation, Hospitalization Day, and Ultrasound –
Abdomen (if applicable).
Check the schedule in ezyVet to see which specialty doctors are on call for
the evening and/or weekend.
Outside Radiologists may be called in for emergency ultrasounds when
SAGE specialists are unavailable.
• For Concord and Dublin, use Bay Area Veterinary Imaging (BAVI).
• For Campbell, use Veterinary Radiology and Ultrasound Services
(VRUS).
Redwood City does not currently have any outside radiology service.
Service Doctor Contact Number
BAVI Mark Matteucci 510-908-3388
BAVI Dave Detweiler 530-574-0505
VRUS Mark Lee 831-227-4665
6
Hospital Operations
If you are busy, please have staff members update clients and keep the
clients informed of wait times and patient or test status (if applicable).
You are expected to make every effort to attend the release of a patient and
speak to the client.
Be sure to discuss with your nurse team the best time to schedule the release
to minimize wait times.
We understand emergency situations can occur and delay a release.
Preplanning can assist with this and your nurse team can help direct you.
7
SAGE Services
8
Specialties available at each location
SAGE Veterinary Centers has several specialty departments offering a
variety of services and consultation options with board-certified specialists.
Campbell (408) 343-7243
Concord (925) 627-7243
Dublin (925) 574-7243
Redwood City (650) 417-7243
Veterinary Vision San Carlos (650) 551-1115
Veterinary Vision San Francisco 1 (800) 427-5367
Our specialty departments include:
Specialty Location
Cardiology Campbell, Dublin, RWC
Dermatology Dublin
Emergency All locations
Imaging (CT) All locations
Imaging (MRI) Campbell, RWC
Integrative Medicine Concord, RWC
Medicine All locations
Neurology Campbell, Dublin, RWC
Oncology All locations
Ophthalmology Veterinary Vision in San Carlos, San
Francisco
Physical Rehabilitation Campbell and RWC
Surgery All locations
9
Cardiology: Dublin, RWC
• Echocardiography
• Electrocardiogram (ECG)
• Holter monitor (24 hour)
• Event monitors
o 14-day patch recording
o Implantable loop recorder
• Pacemakers, temporary and permanent: Waxman (Dublin)
o Can be done on emergency basis if critical
• Valvuloplasty: Waxman (Dublin)
• Minimally invasive PDA occlusion
• OFA congenital cardiac screening
• Opening of subaortic stenosis with cutting balloon: Waxman (Dublin)
Dermatology: Dr. Holz, Dublin
• Skin cytology
• Trichograms
• Skin biopsies/aspirates
• Bacterial and fungal cultures of ears and skin
• Intradermal allergy testing
• Customized Allergen Specific Immunotherapy
o Including Sublingial Immunotherapy (SLIT)
• Cryotherapy
• Targeted antimicrobial therapy including topical therapy
• Chronic inflammatory and infectious disease management
o Including immune-mediated and allergic skin disease, and methicillin
resistant Staph.
Emergency: 24/7 in all locations
• Criticalist consults: Beymer (Concord), Krentz and Wong
(Campbell), Oparil (RWC) and Lieblick (Dublin)
10Imaging
• CT: plain, contrast
o Advanced (PSS, thoracic duct, guided biopsies)
• Fluroscopy (Dublin, RWC)
• MRI (Animal Scan in Redwood City and Campbell – both on site)
Integrative Medicine: Dr. McCabe (Concord), Dr. Martin (RWC)
• Chinese herbal therapy
• Acupuncture
• Cold laser
• Food therapy
Medicine: Saturdays in Dublin, Redwood City, and Campbell
• Endoscopy/Colonoscopy
o Foreign body removal
o Biopsies
o Gastric/esophagostomy tube placement
o Esophageal stricture dilation
Including special tubes that allow for continued dilation at home by
client
• Rhinoscopy
o Foreign body removal
o Mass identification/biopsy
o Nasopharyngeal stenting: Roberts (RWC)
• Bronchoscopy
o Diagnostics
o Tracheal stenting: Roberts (RWC), Strasser, Dugas (Dublin)
• Cystoscopy/Vaginoscopy
o Stone removal
o Collagen injections for incontinence: Roberts (RWC)
o Biopsy
o Ectopic ureter identification
o Urethral stenting: Strasser (Dublin), Rivara, Kiselow (Campbell), Roberts
(RWC)
11Medicine (cont’d)
• Voiding urohydropropulsion for stone removal: Rivara, Garcia (Campbell),
Roberts (RWC)
• Continuous glucose monitoring
• Ultrasound
o FNA
o Ultrasound guided biopsies (liver, kidney, lymph node, prostate, masses)
• Bone marrow aspirates/biopsies
• Parenteral nutrition
• Fecal transplants: Bruskiewicz (Concord)
• ALICAM internal intestinal camera capsule: Roberts (RWC), Nicholson
(Campbell), Bruskiewicz (Concord)
Neurology: Campbell, Dublin, RWC (see ezyVet for schedule)
• Diagnostics and management of all neuromedical diseases
• Surgical management of brain and spinal cord conditions
o Disc surgery
o Brain/spinal cord tumor removal
o Surgery to address brain and spinal malformations
o Spinal stabilization
• Interpretation of advanced neuroimaging
o MRI and CT scan
• Electrodiagnostics
o EMG (electromyography)
o Nerve Conduction Velocities
o BAER (brainstem auditory evoked response)
• CSF collection and interpretation
Oncology (Saturdays Dublin, Campbell, Redwood City)
• Biopsies/aspirates
• Bone marrow aspirate/biopsies
• Chemotherapy
• Stereotactic radiation (Campbell with PetCure Oncology)
• Cryotherapy (Campbell)
• Electrochemotherapy (Dublin, Concord)
12Oncology (cont’d)
• Palliative care
• Immunotherapy
• Biopsies/aspirates
• Bone marrow aspirate/biopsy
• Chemotherapy
• Stereotactic radiation (Campbell with PetCure Oncology)
• Cryotherapy (Campbell)
• Electrochemotherapy (Dublin, Concord)
• Palliative care
• Immunotherapy
Ophthalmology (Veterinary Vision in San Carlos and San
Francisco)
• Cataract management and surgery
o Cataract extraction and artificial lens implantation using
phacoemulsification technology
• Eye registration screening exams
• KCS management
• Glaucoma management and surgery
o Gonioscopy to aid in differentiation of primary and secondary glaucoma
o Laser cyclophotocoagulation
• Diode laser treatment for iris cysts and pigmented tumors
• Slit lamp examination
• Indirect ophthalmoscopy
• Applanation tonometry
• Electroretinography for detection of retinal disease
• Ocular ultrasonography for detection of ocular or orbital tumors and retinal
detachments
• Additional less commonly used modalities:
o Fundus photography
o Aesthesiometer to measure corneal sensitivity
o Rose Bengal vital corneal stain
o Chromatic pupillometry
13Physical Rehabilitation: Fishman (RWC), Daly (Campbell)
• Consultations by therapist
• Splinting and prosthetics
• Platelet rich plasma therapy
Surgery (Saturdays in Campbell and Redwood City):
• Arthroscopy
• Laparoscopy
o Biopsies
o Exploratory
o OHE/Ovariectomy
o Prophylactic gastropexy
o Cholycystectomy with scope: Glerum (RWC)
• Thoracoscopy
o Pericardectomy
o Thoracic duct ligation
o Lung or lymph node biopsy
o Lung tumor removal with the scope: Glerum (RWC), BBanz (Campbell)
• Total hip replacement: Walls (Concord)
• Urethral occlusion device placement for urinary incontinence
• CUE Elbow replacement: Walls (Concord)
• Ureteral stenting
o Questions about whether a case is a good candidate (Strasser in Dublin or
Roberts in RWC)
• Stem Cell Therapy
• Platelet Rich Plasma Therapy
• Vacuum-Assisted Closure for Wound Management
• Laser Surgery
14Exotics, Pocket Pets, and Birds in ER
SAGE sometimes provides emergency supportive care for exotics. If you are
not comfortable seeing exotics, inform the CSC’s. If you are hesitant, check
with your staff. We have many nurses that are very comfortable and skilled
with exotics.
If an exotic pet is admitted, we expect the client to transfer to their veterinarian
or to an exotics veterinarian the next business day.
Euthanasias: Try to accommodate if you can. Generally, the owners are not
present. If the pet is small like a hamster, they can often be a “ride along”
cremation for free if they are communal so we can save the cost to the clients.
Please see following page for advice and referral information.
15Question and Referral Information
UC Davis
UC Davis has an exotics residency. Occasionally you will be able to speak to a
resident.
UC Davis Companion Exotic Animal Service
Location: Davis Hours: 24/7
UCD Companion Exotic Animal Service: (530) 752-1393
Rabbits: Chabot Veterinary Clinic: Dr. Harvey and Dr. Neely
Location: Hayward Hours: Tues-Sat 8am-6pm
Chabot Veterinary Clinic: (510) 538-2330
Oasis Veterinary Hospital: Dr. Asseo
Location: Martinez Hours: Mon-Fri 8am-6pm
Oasis Veterinary Hospital: (925) 954-8087
Berkeley Dog and Cat: Dr. Siperstein and Dr. Harkewicz
Location: Berkeley Hours: 24/7
Berkeley Dog and Cat: (510) 848-5041
Ohana Animal Hospital: Dr. Steffes
Location: Livermore Hours: Mon-Fri 8am-6pm, Sat 9am-2pm
Ohana Animal Hospital: (925) 394-4990
Bay Area Bird Hospital: Dr. Marcucci and Dr. Dustin
Location: San Francisco Hours: M-F 8am-6pm, Sat 9am-3pm
Bay Area Bird Hospital: (415) 566-4359
Santa Clara Pet Hospital: Dr. Littlehale, Dr. Lawrence, and Dr. Piert
Location: Santa Clara Hours: M-F 7:30am-6:30pm, Sat 8am-2pm
Santa Clara Pet Hospital: (408) 296-5857
16Birds: Medical Center for Birds in Oakley
Location: Oakley Hours: Mon-Sat 9am-5pm
Medical Center for Birds: (925) 625-1878
Berkley Dog and Cat: Dr. Siperstein
Location: Berkeley Hours: 24/7
Berkley Dog and Cat: (510) 848-5041
Bay Area Bird Hospital: Dr. Marcucci and Dr. Dustin
Location: San Francisco Hours: M-F 8am-6pm, Sat 9am-3pm
Bay Area Bird Hospital: (415) 566-4359
Santa Clara Pet Hospital: Dr. Littlehale, Dr. Lawrence, and Dr. Piert
Location: Santa Clara Hours: M-F 7:30am-6:30pm, Sat 8am-2pm
Santa Clara Pet Hospital: (408) 296-5857
17Reptiles: Oasis Veterinary Hospital: Dr. Asseo
Location: Martinez Hours: Mon-Fri 8am-6pm
Oasis Veterinary Hospital: (925) 954-8087
Berkley Dog and Cat: Dr. Siperstein and Dr. Harkewicz
Location: Berkeley Hours: 24/7
Berkley Dog and Cat: (510) 848-5041
Ohana Animal Hospital: Dr. Steffes
Location: Livermore Hours: M -F 8am-6pm, Sat 9am-2pm
Ohana Animal Hospital: (925) 394-4990
Bay Area Bird Hospital: Dr. Marcucci and Dr. Dustin
Location: San Francisco Hours: M-F 8am-6pm, Sat 9am-3pm
Bay Area Bird Hospital: (415) 566-4359
Santa Clara Pet Hospital: Dr. Littlehale, Dr. Lawrence, and Dr. Piert
Location: Santa Clara Hours: M-F 7:30am-6:30pm, Sat 8am-2pm
Santa Clara Pet Hospital: (408) 296-5857
18Logins and Passwords
19Software Systems
WiFi Login:
Username: SVC-Medical
Password: p3tsc0nn3ct
Campbell Concord
Windows Windows
Login: nurseco Login: nurseco
Password: t34mw0rk Password: t34mw0rk
Document Printer: CA-CCU Document Printer: CO-ER3
Label Printer: CA-LABEL4 Label Printer: CO-LABEL1
TigerConnect TigerConnect
Login: campbell@sagecenters.com Concord does not have ER doctors
Password: #Tiger123 sign in to Tiger Connect
ezyVet ezyVet
Login: rdoctorCA@sagecenters.com Login: rdoctorCO@sagecenters.com
Password: Sagerelief1 Password: Sage1234
Smartflow Smartflow
Login: rdoctorCA@sagecenters.com Login: rdoctorCO@sagecenters.com
Password: sagerelief Password: Sagerelief
20Software Systems
Dublin Redwood City
Windows Windows
Login: nursedu Login: nurseco
Password: t34mw0rk Password: t34mw0rk
Document Printer: DURECORDS Document Printer: RC-LAB
Label Printer: DULABEL2 Label Printer: RC-LABEL6
TigerConnect TigerConnect
Login: dublincasualer@sagecenters.com Login: redwoodcity@sagecenters.com
Password: Medical#1 Password:
ezyVet ezyVet
Login: rdoctorDU@sagecenters.com Login: rdoctorRC@sagecenters.com
Password: Sagerelief1 Password: Sagerelief1
Or
Smartflow Login: rdoctorRC2@sagecenters.com
Login: rdoctorDU@sagecenters.com Password: Sage1234
Password: Sagerelief
Smartflow
Login: rdoctorRC@sagecenters.com
Password: Sagerelief1
21Lab work
Idexx is our preferred lab for most bloodwork.
Go to: www.vetconnect.com or www.vetconnectplus.com
(vetconnectplus will allow you to view both in-house and lab out
results.)
VDx is our preferred lab for most cytologies and histopathologies.
Go to: mail.sagecenters.com
Campbell Concord
VDx VDx
Sign in: calab@sagecenters.com Sign in: colab@sagecenters.com
Password: sagelab Password: sagelab
Idexx Idexx
Sign in: sagecampbell Sign in: sageconcord
Password: sage Password: sage
Dublin Redwood City
VDx VDx
Sign in: dulab@sagecenters.com Sign in: smlab@sagecenters.com
Password: sagelab Password: sagelab
Idexx Idexx
Sign in: sagedublin Sign in: sagesanmateo
Password: sage Password: sage
22Radiology Services
Vet Rocket
Username: User
Password: User123!
Campbell Concord
Pet Rays Pet Rays
Username: Campbell Username: sageconcord
Password: Xray7243 Password: Xray7243
Eagle Eye Eagle Eye
Username: sagecampbell Username: sageconcord
Password: sagecampbell Password: sageconcord
Remedy View/VRUS Remedy View/BAVI:
Username: vsacampbell Username: vsaconcord
Password: remedy Password: remedy
Dublin Redwood City
Pet Rays Pet Rays
Username: sagedublin Username: sanmateo
Password: Xray7243 Password: Xray7243
Eagle Eye Eagle Eye
Username: sagedublin Username: sagesm
Password: sagedublin Password: sagesm
Remedy View/BAVI: Remedy View:
Username: vsadublin Username: vsasanmateo
Password: remedy Password: remedy
23HELP 24
If you need help, there are a variety of resources available to you depending
on what you need help with.
The nurses generally know a lot of troubleshooting information as
well as who to contact for further assistance.
Here are some general resources:
For who is on-call:
Drs: Check the ezyVet scheduler. It will tell you who is on-call at each facility.
To view Master Schedule for Specialty:
From any SAGE computer, go to the public H drive:
Select public (\\sage-files) (H:)
H:\Calendars & Schedules\Medicine Cardio Oncology Doctor Schedules
Open the Excel spreadsheet.
There will be 2 links. Select the link appropriate for the year (ie: 2019)
Make sure link opens in Google Chrome or Mozilla
To view Staff Directory for personal phone numbers:
From any SAGE computer, go to the public H drive.
H:\Staff Directory\Sage Employee Phonebook
Select the most current version, then use the tabs along the bottom to
navigate to the facility you want.
The names and phone numbers are in alphabetical order.
25Standard
Operating
Procedures
26ER Doctor Shifts
Plan to arrive at least 30 minutes prior to the start of the shift. This allows
time to settle in and to round with the specialists and previous ER doctor.
Be ready to start receiving cases at your shift start time.
This will be the general guideline as there will be exceptions during very busy
shifts (stay later), or somewhat slow times (leave early) – the overlapping ER
doctors should communicate regarding a variance. For example, the departing
doctor may need to stay longer when the caseload is high and to start a case
for the incoming doctor. The incoming doctor should assume continued work
up and care of that case as soon as possible so that the departing doctor can
leave.
Before you leave:
1. In ezyVet, check the diagnostics tab, review and “green check” all the
diagnostics you ordered. Link them so the pDVM can view the results in
the portal.
2. Check you patients.
3. Check the Smartflow sheet for your inpatients and make sure the orders
are complete and correct.
4. Round your patient to the doctor taking over his or her care.
5. Update the client.
6. Check the communication tab in ezyVet and make sure all calls have
been returned.
7. Create a summary and link it through the portal.
8. Sign sympathy cards as appropriate
9. Call all pDVMs of patients who came in DOA, dies in hospital, or were
euthanized.
Nurses can be tasked with checking estimates, making new estimates, calling
pDVMs regarding deceased patients, etc., but it is the doctor’s responsibility
to make sure these things are completed.
27ER Doctor ALL SHIFTS
1. Attend/obtain rounds from previous shift and Specialty as appropriate.
2. New Patients:
a. Exam
b. Estimate
c. Review Smartflow treatment sheet and initial (nurses will make)
d. Update owners with any test results
e. Arrange for specialty consult or service as needed
f. Call pDVM if patient is admitted to update
g. Start Homecare as appropriate if transfer to specialty not anticipated
h. Fill RX’s for in-house use and for dispensing
i. Call client with update before leaving for the day
j. Advise owners to call between 6-7am for an overnight doctor update
k. Complete medical records and email to pDVM
l. Review charges in ezyVet to ensure accuracy
m. If it is a Specialty patient, place a callback comment in ezyVet for the
specialist so they know their patient was seen through ER.
3. Fill RX requests in ezyVet as appropriate.
4. Check Diagnostic Results tab in ezyVet for outside labs (ie: VDx and Idexx)
a. Interpret results
b. Email results to pDVM
c. Call owner with results and write client communication
d. Create summary and link summary to pDVM via portal
e. “Green check” in ezyVet on diagnostics list to mark complete.
5. Check Communications tab in ezyVet and return any messages for the doctor
6. PTS, DOA, or Deceased Patients
a. Create summary and link record through the portal to pDVM
b. Call pDVM to update- okay to leave a message
c. Sign sympathy card
d. If it is a specialty patient, ask a CSC to put a callback comment in
ezyVet for the specialist so they know their patient was euthanized.
7. Round patients to next shift/Specialty as appropriate.
8. Take final look at your patients and make sure everything is ok before leaving.
28ER Doctor DAY SHIFT
Inpatients:
1. Examine inpatients
2. Review Smartflow treatment sheet, make changes as necessary
using the Check Doctor Note, initial in the Doctor Approval
Signoff box if correct.
3. Ensure estimates are up to date and prepare new estimates if
needed.
4. Call clients to give updates on patient status and any diagnostic
results both in the morning and at the end of the day.
• Let the client know to expect a call from the overnight
doctor if there is a problem.
• Ask the client to call between 6am and 7am the following
morning for an update from the overnight doctor.
5. Arrange for specialty consult or service as needed
6. Call pDVM with update as appropriate
7. Create a summary and link to pDVM in the portal.
8. Review the invoice in ezyVet for accuracy and approve invoice.
9. Call clients with competed lab results.
29ER Doctor SWING
1. Take care of inpatients during the gap period between when the day
doctor and specialists leave and when the overnight doctor comes in.
2. Receive rounds from the departing specialists on their inpatients.
3. Help the day doctor if you are caught up and they are not (ie: Call
owners with lab results, RX requests, etc).
4. Round the overnight doctor on all inpatients.
30ER Doctor NIGHT SHIFT
Inpatients:
1. Exam
2. Review Smartflow treatment sheet and make changes as necessary in
the notes section, then highlight the “Check Dr Orders” box.
3. Ensure estimates are up to date and prepare new estimates if needed.
4. Call clients to give updates on patient status and any diagnostic results
during your shift, or if their status is deteriorating.
• Let the client know to expect a call from the you if there is a
problem.
• Take client calls in the morning and update on how their pets did
overnight.
5. Arrange for specialty consult or service as needed
6. Create a summary and link in Portal on any patients that admitted
overnight. Be sure to call the clients of your admitted patients before
leaving.
7. Review charges in ezyVet
8. Arrange for release time with owner if the patient will be ready to go
home in the morning.
9. Start discharge instructions and make medication labels/prescriptions
for admitted patients.
31ER Transfers to Specialty
ER sees patients regardless of presenting complaint, we provide
stabilizing care, then either continue to care for them or transfer them
to a specialist.
Some clients will also elect to transfer their pet back to their pDVM.
Be sure to contact their pDVM to confirm whether they are able to
take the case or not.
Criteria for Transferring to Specialty:
1. Patient would benefit from specialty care
2. Owner wants to transfer to specialty
3. Long-term follow-up is needed.
ER is not the appropriate department for long-term ongoing care for chronic
conditions. ER will see patients regardless of presenting complaint, provide
stabilizing care, then either continue to care for them or transfer them to a
specialist as appropriate.
32Examples of what kinds of cases go where:
Cardiology
1. Heart disease
Dermatology
1. Generally doesn’t have inpatients, but may do in-house consults
Emergency
1. Cardiology case if cardiologist off duty
2. Surgery cases if surgeon off duty
3. Neuro cases that don’t go see neurologist
4. Toxicities
5. Blocked cats
6. Gastroenteritis
7. Parvo
Medicine
1. DKA
2. Addison’s Disease
3. Visceral organ failure or inflammation
4. Immune mediated disease
5. FUO
6. Respiratory disease
Neurology
1. Epilepsy
2. Ruptured disc
Oncology
1. Cancer
2. Will also manage surgical oncology patients pre and post op (ie:
post op splenectomy due to probable hemangiosarcoma)
Surgery
1. Fractures
2. Foreign bodies
3. Wound care
4. Laryngeal paralysis
33Gray Zone
Sometimes more diagnostics are required to determine the department best
suited to care for the patient.
Example: Vomiting dog admitted overnight for abdominal ultrasound
immediately after rounds. If it’s a GI foreign body, it would go to
Surgery. If it is just gastroenteritis it would stay with ER.
When to transfer
Usually the next day following admission.
Example: pDVM refers a DKA, ER admits it if Medicine is unable to
receive it directly. The following day, ER will round the case to
Medicine.
Outside Labs Pending
If you know which doctor will be receiving the transfer, you can submit the
diagnostics under their name, provided you are confident they will be the
ones interpreting and conveying the results. If you’re unsure, submit under
you.
Examples: Histopathology, cytology, urine culture, etc.
Tips for Success
1. Make sure the owner knows their pet will be transferring to Specialty
2. Include the referring pDVM in the decision to transfer to Specialty (ie: “I
will take care of Fluffy tonight and in the morning the internist can take
over her care. Does that sound like a good plan?”
3. Provide an adequate estimate for the specialist to get started. A good
rule is to estimate for 24-36 hours of hospitalization and treatment, the
consultation, and then any tests you anticipate (ie: ultrasound,
echocardiogram, etc.).
4. Include a generous Miscellaneous of at least $500 on the estimate.
5. Use pre-populated surgery estimates for an approximate amount.
• They are in ezyVet in the estimates screen. You can search
through them by clicking “Sales Template”, then clicking on the
spy glass
6. If specialty is open during your shift, you can ask them to make you a
detailed estimate (ie: fracture repair, endoscopy, splenectomy, etc.).
34Caring for Specialty Patients
ER takes care of specialty patients when specialty departments are not in the
hospital. Typically, Monday through Friday after evening rounds, Saturday
evening through Sunday, and holidays.
When taking over patient care, emergency assumes all the responsibilities of
that patient:
• Medical care
• Client communication
• pDVM communication
• Finances
Generally, the specialists are available by phone if you have questions.
ER swing shift doctor:
1. Get rounds from specialist
2. Is responsible for patient care until overnight doctor arrives
3. Round overnight doctor
ER overnight shift doctor:
1. Get rounds from swing doctor
2. Examine all inpatients
3. Interpret overnight lab work
4. Make any treatment plan changes (medications, diagnostics, etc)
5. Write SOAP in ezyVet
6. Call owner if patient deteriorates or with any major changes
• Charges for exam, hospitalization, and any added treatments or
diagnostics go under overnight doctor, all other items stay under
specialist.
• Specialty doctor will present patient in morning rounds, with ER doctor
providing any applicable updates.
Saturday evenings and Holidays:
• Patients are completely turned over to ER service until Monday morning
or the next non-holiday business day
• ER department gets all charges for the patient starting Saturday night
or the eve of a holiday until the specialists return.
35After Hours
“After hours” includes weekends, holidays, or times when specialty services
are not open/not in the building. Saturday nights, Sundays, and weeknights
after specialty closes are consistently considered “after hours”.
Holidays
(July 4th, Thanksgiving, Christmas, New Year’s Eve)
There is a SAGE doctor on call for Dublin and Concord, and another SAGE
doctor on call for Campbell and Redwood City.
Exceptions
Memorial Day and Labor Day
SAGE pricing
• Emergency specialty after hours fee
• Ultrasound abdomen fee
If a holiday falls on a weekend, a SAGE doctor will be on call for the
holiday of that weekend.
36To view Master Schedule for Medicine, Oncology, Cardiology,
Dermatology, and Integrative Medicine:
• From any SAGE computer, click on the small manila folder icon along
the bottom of the screen in the task bar.
• Select public (\\sage-files) (H:)
• H:\Calendars & Schedules\Medicine Cardio Oncology Doctor Schedules
• Open the Excel spreadsheet.
There will be 2 links. Select the link appropriate for the year (ie: 2019)
Make sure link opens in Google Chrome or Mozilla
To view Staff Directory:
• From any SAGE computer, go to the public H drive.
• H:\Staff Directory\Sage Employee Phonebook
• Select the most current version, then use the tabs along the bottom to
navigate to the facility you want.
• The names and phone numbers are in alphabetical order.
37Outside Radiograph Review and Emergency
Ultrasounds
Options for outside radiograph review:
1. Pet Rays
• Available 24/7, can get a stat read in 30 minutes.
• They have many radiologists reviewing images so interpretation
can differentiate between the people interpreting the
radiographs.
• They will read rabbit radiographs.
• Send radiographs using Vetrocket then log in to petrays.com to
fill out a request form.
Pet Rays Logins:
Location Username Password
Campbell Campbell Xray7243
Concord sageconcord Xray7243
Dublin sagedublin Xray7243
Redwood City sanmateo Xray7243
38Options for outside radiograph review (cont’d):
2. Eagle Eye
• Service 365 days per year.
• Cases submitted by 4:30pm PST will be interpreted the same day
(usually by 5:30pm).
• Turnaround time on case submissions is routinely less than 2 hours.
• Server checked twice per day on weekends and holidays.
• Stat cases are always given first priority.
• Stat cases submitted after 4:30pm will usually be read first thing the
following morning.
• Additional fee for stat read. Add the stat fee to the invoice in ezyVet if
requesting stat.
• Submit through eFilm/Remedyview by using their login.
Eagle Eye Logins:
Location Username Password
Campbell sagecampbell sagecampbell
Concord sageconcord sageconcord
Dublin sagedublin sagedublin
Redwood City sagesm sagesm
39Options for outside radiograph review (cont’d):
3. Bay Area Veterinary Specialists
• Service 365 days per year from 5-6am to 8-9pm
• Dr. Matteucci and Dr. Detweiler along with 4 or 5 other radiologists
read.
• Additional fee for stat read. Add the stat fee to the invoice in ezyVet if
requesting stat.
• Submit through eFilm/Remedyview by using their login.
Remedy View/BAVI/VRUS Logins:
Location Username Password
Campbell vsacampbell remedy
Concord vsaconcord remedy
Dublin vsadublin remedy
Redwood City vsasanmateo remedy
40To have radiographs read:
In ezyVet
1. In clinical record, click on Diagnostic Request
2. Under Diagnostic Supplier, select Outside Radiologist or Outside
Radiologist Stat.
3. In the Diagnostic Request Specifics/History box, type the name of the
radiology group (ie: Sent radiographs to Eagle Eye for review).
4. Click on the blue Add button.
• This will put the charge in the invoice
5. For ease of viewing results all in one place, copy and paste the
radiology report into the Diagnostic Request Specifics/History box when
the report is back and check the green box.
• You may also save the report to your desktop as a PDF and
upload to the results section.
6. When results are back, open the request field in ezyVet, select the
“Mark as Processed” tab, and enter the results.
Eagle Eye and Remedy View requests
Request through eFilm
1. Open the study through eFilm
2. Click on the pencil at the top of the page above the xrays
3. Be sure you are logged in to the radiology group that you want to use.
4. Fill out the request form
• Choose “stat” as necessary, and enter the charge on the invoice.
5. Computer will prompt you to close the site
• Click “yes”
To view results:
• In eFilm, click eyeball icon at the top of the page
• In Remedy View, you will see a list of studies including yours. If the
study is locked, it means the radiologist is reading it.
o Results are not utomatically uploaded into ezyVet. They must be
manually entered (copied and pasted).
41To have radiographs read (cont’d):
Pet Rays requests – 2 step process
Step 1:
1. Open Vet Rocket
2. Check the box on the left column next to the eyeball icon on the line of
the study with your patient’s name.
3. Click “Send” (dark blue box at the top of the page)
4. Click the box on the left column next to where it says “PetRays” on the
AE Title column.
5. Click “dicom send” (dark blue box at the top of the page)
Step 2:
1. Go to petrays.com and log in
2. Fill out the request form and submit
3. You can add another set of films within 24 hours at no additional cost
• If you prefer a certain doctor to read your radiographs, you
cannot use the stat feature.
• You can use the 30 minute stat feature with no additional
cost to the client.
Recommendation
Bookmark remedyview.com and petrays.com. When you log in to your
computer, open them and keep them in the background for convenience.
For invoicing:
• In ezyVet, the line items for the estimate/invoice are “Radiograph-
consult (OS)” or “Radiograph- consult + Stat (OS)” if you need a stat
read.
42Sage Emergency Medical Boarding
Medical Boarding is provided as a courtesy for existing patients who are
stable. This service should be approved by the doctor of record. Occasionally
an inpatient that no longer needs hospitalization will be converted to a medical
boarder.
Example:
A TPLO that has recovered and is ready to be discharged, but the owners
want to leave him in the hospital through the weekend. Space is limited, so
please check before committing.
What level of care is provided?
• One exam per 24-hour period
• One TPR per 24-hour period
• Medication administration
• Feeding and walks
What to include on an estimate:
• Inpatient exam per 24 hours
• Medical boarding per shift
• Medication administration
• Miscellaneous for contingencies (ie: seizures, hypoglycemia if diabetic,
etc.)
43Sage Emergency Medical Boarding (cont’d)
How to do it:
• Doctor of record approved medical boarding request from owner
• Doctor or nurse prepares estimate
• If the pet is being dropped off when the doctor of record is not on duty,
they will notify ER team and put on ER schedule.
• Owner fills out medical boarding sheet which has pertinent information
such as:
o Diet
o Medications and schedule
o Emergency contact information
o Special considerations (ie: food allergy)
• Owner should bring food/meds
• ER doctor will generally take care of the patient if the doctor of record is
off duty/during a weekend or holiday.
Considerations
• One exam per 24-hour period, so the overnight doctor does not need to
do an exam.
• Call the owner with an update once per day (or have a nurse call)
• Call the owner if the patient has a change in status.
44You can also read
