Surgical patient flow

To help understand how the roles in a practice fit together, it is helpful to understand the jobs that need to be completed on most days and weeks in a veterinary clinic.

Most of these will vary depending on the clinic though they are generally performed in a very similar manner in most GP practices.

Surgical patient flow

Generally, an animal coming into hospital for a routine surgery will go through the following process:

• A discussion with the owner while booking patient in (often days or weeks prior) about fasting the pet overnight (for dogs and cats).
• The fasted patient arrives at the hospital the morning of their surgery.
• A nurse or receptionist will admit the animal, giving a basic examination and asking the owner questions to check if they understand the procedure. Paperwork is signed and often a discharge appointment is booked for later in the day.
• The patient is weighed and then settled in a cage or kennel with their paperwork clearly identified.
• When it is nearing that patient’s turn for surgery, they will be given a pre-medication (this is a light sedative and pain relief to reduce their anxiety, make induction of anaesthetic smoother, and reduce pain sensation affecting the anaesthetic).
• After 30 minutes, the patient is ready for their procedure. An intravenous catheter is placed in preparation for the IV injection of an anaesthetic agent. Once asleep, the patient is intubated (a breathing tube placed down their trachea) and attached to gaseous anaesthetic which flows into their lungs as they breathe.
• The anaesthetised patient is shaved (clipped) and prepared for surgery by disinfecting the area where the surgery will take place and attached to various monitoring devices, while the surgeon is preparing themselves for surgery by doing a surgical scrub of their hands, putting on surgical gowns, gloves, masks and hats depending on clinic policy and the procedure being performed.
• The patient is moved to a sterile surgery room.
• Surgery is performed.
• The gaseous anaesthetic machine is turned off once surgery is complete, allowing the animal to breathe in only oxygen and slowly expel the anaesthetic in their lungs.
• The patient is moved to their recovery cage (usually not the same as their hospital cage, as they need to be closely monitored now), and fully supervised while waking.
• Once awake enough to try to swallow, the tube is removed from their trachea and the patient carer can usually provide slightly less intense monitoring for the remainder of their recovery. Longer-acting pain relief is often given at this stage.
• The owner is phoned with an update on surgery and a discharge time is confirmed.
• Medications to take home are dispensed and notes about the surgery and anaesthetic are written up in line with practice policy.
• Once the animal is able to walk and recovered well, they are ready to go home.
• A discharge appointment with the owner (without the animal in the room) to go through care instructions and medications.
• The account settled at reception.
• The animal returned to the owner and leaves.

This long list of actions needs to happen for each patient – in small clinics, this might be only 2 or 3 surgeries per day but in large clinics can be 10 to 15.

If multiple veterinarians are doing surgery in a large hospital, even more than this is possible.