Just as the design of veterinary facilities has changed over time, so has caging and caging needs. I recently read an article in a human healthcare magazine that talked about the increased importance of progressive care units. These units equate to what we call telemetry units, intermediated care units, or step-down wards. For the most part these are relatively new concepts to veterinary facility design. And while they might not be found in a small one- or two-doctor practice, almost all of our larger specialty projects have intermediate care wards. Let’s look back at how we got to this point.
In the very earliest veterinary hospital (and school), L’Ecole Veterinaire (established in Paris in 1760), there were no surgical or medical areas; there was just an oversized stable. There was no distinction between wards or stalls or medical working areas. Wherever the animal was standing was where procedures took place. And when James Herriot wrote about veterinary practice in mid-twentieth century Yorkshire, England, the typical veterinary facility was still pretty spartan. A kitchen table in a thatched roof house served as the surgery theatre. But in the United States, things progressed a little faster.
The first true small animal hospital was designed and built in Raritan, N.J., in 1929, by Mark Morris, DVM.
By the mid 1960’s and 1970’s, veterinary facilities were being built in any number of suburban locations and for the most part they looked very similar to our current facilities—with one big exception. They were heavily weighted toward animal holding instead of animal treatment. In the plan from 1948, you can see how small the working area is versus the holding areas.
This was a direct reflection of the type of medicine being practiced. Animals were treated and held over a number of days instead of being sent home the same day. I don’t think veterinarians had a specific expectation as to how the animals would recuperate. Unfortunate setbacks and remissions were probably common at the time. Understanding how animals recover was intuitive and not a benchmarked, analytical process. In contrast to these ward-intensive facilities, in the late 1980’s and early 1990’s we designed a couple of veterinary hospitals that had no wards whatsoever. These facilities didn’t have low animal holding capacity counts, they just opted to place their caging right in the treatment area. I remember one facility where the four walls of the treatment area were lined with cages. You can imagine what kind of noise and mayhem there was in that room, but it was efficient. There was no distinction between what level of care an animal required and which staff member was going to care for that animal.
These lines in the sand run counter to the James Herriot solution and create more specialized and segmented facility solutions, and in turn more staffing requirements. On the positive side, with an intermediate care ward, you can have a knowledgeable nurse or veterinary technician with the right equipment and technology immediately available for patients that need a tad more care than the general populace, but not as much as a full-blown ICU patient. Most importantly, the step-down ward provides the potential to downsize your ICU.
This leads us into a concept that was new to me before I read this human healthcare article—a care map. A care map “outlines the progress that someone recovering from, for example, a heart attack should make on each subsequent day,” says Kenneth J. Rempher, R.N., of Sinai Hospital of Baltimore. A care map is a flow chart for a facility. Much like a flow chart for a manufacturing plant lays out how materials and assembly occur within a process, a care map is a flow chart for your hospital. A care map is also a way to benchmark how a patient is progressing. It establishes levels of care and ultimately, an accompanying fee schedule for care provided.
A care map can also be an actual map of your facility showing where an animal should be housed based on the way it is recuperating. It’s a way to create a diagram for your caregivers, showing them where they should be and what level of care they should be providing animals at each stage of recovery. The intermediate care ward is a step, or benchmark, in a patient’s recuperation. For a small facility, this line in the sand may be unnecessary, but for a larger specialty hospital, stair steps, diagrams, and maps can enable you to stay on target. You should be able to map out how any major medical procedure is provided and how animals are housed and cared for, and then build your facility around this mapping.