By Scott M. Ruth, DVM
Thereís no way to get around it: There are only so many hours in a day. When your goal is to perform as many spay/neuter procedures as possible in the shortest amount of time, every minute matters.
Of course, not all of the time in a working day is allocated for surgery. Patients must be checked in; records must be created and maintained throughout the day; patients must be discharged to their owners following surgery; the facility must be cleaned and maintained; and, depending on local laws, staff may be required to take midday breaks.
Increasing the number of surgeries the clinic can perform each day requires both minimizing the time spent on non-surgical duties and maximizing the rate at which the surgeon performs each procedure.
During the past decade, I have identified 13 methods of increasing the speed at which a Spay/Neuter Clinic can perform its many functions while still operating at maximum safety. While some are surgical techniques and others are management principles, all of these steps will help you save precious time and allow for more surgeries. The end result is something we all are working toward: A reduction in animal suffering caused by unwanted births.
1. Rapid patient check-in.
Any routine or procedure involving paperwork, movement of clients through the facility, and patient handling that can be shortened should be, as long as patient care is not compromised. It is most desirable to get all animals checked in before surgery starts, without allowing interruptions during surgery time.
2. Staff available to prepare animals for surgery.
All procedures that do not need to be performed by a veterinarian should be done by lay or licensed staff (depending on state and local laws). That way, the surgeon is concentrating on performing surgeries and minimizing delays between animals.
3. Tilt surgery table.
A gentle incline on the surgery table that raises the hind legs above the head helps the intestine to stay out of the way of the surgeon while searching for the uterus. This step makes locating and retrieving the uterus faster and easier, thus saving a significant amount of time on many surgeries.
4. Adequate anesthesia.
Anesthesia relaxes the patientís body wall muscles so the incision is more easily shifted over the abdominal organs. This allows the surgeon to view and manipulate the organs more easily. Surgery becomes easier, faster and safer for the patient.
5. Position of incision.
Properly placing the incision makes surgery faster and easier by allowing the organs to be manipulated more easily. For dog spays, this varies depending on the age of the patient.
6. Small incision.
A small incision is faster to close than a larger one and is less uncomfortable for the patient. Leaving more body wall intact also allows for less abdominal organ migration into the incision, minimizing interference with manipulation of the uterus and ovaries.
7. Cut out subcutaneous tissue (fatty tissue between skin and muscle layer).
This simple maneuver allows better visualization of the linea alba (central band of tough tissue between the body wall muscles) so the surgeon can make a better positioned, less bloody incision.
8. Spay Hook.
This instrument allows the surgeon to reach into the abdomen and find the uterus without making a large incision.
9. Rupture the suspensory ligament.
This common maneuver is avoided by some surgeons because they believe there will be excessive bleeding, but this is generally not the case. The maneuver has a significant advantage because it allows the surgeon to get the ovary out of the abdomen much more easily.
10. Rochester-Carmalt Forceps.
This clamp securely holds the ovarian blood vessels so they can be cut before being tied off. This clears the surgeonís view of the vessels and makes the work easier and much faster.
11. Body wall suture pattern.
The surgeon can incorporate subcutaneous tissue with body wall (working from each end of the incision toward the middle) and finish with a cruciate stitch in the middle. This allows visualization until the surgeon is ready to close the last part of the body wall incision.
12. Skin suture pattern.
Use a subcuticular (buried) suture pattern, with each "pass of the suture" wide, so that fewer passes are needed.
13. Records have minimal variation.
Medical records typically must show details regarding anesthesia and surgery. Because surgeries of each type are done nearly identically, records can be designed so that information that is common to all surgeries is preprinted. Variable maneuvers are described in a blank space or a list of possibilities that can be circled or checked off on boxes. The goal is to minimize writing in each patientís record, saving staff time for patient care.
The time that is saved by each of these maneuvers is small, but overall savings in time can be quite substantial.