Vets Now team with ultrasound
Research Team Findings Improve Canine Dystocia Outcomes
1 year ago 
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A team of researchers from Vets Now have published a case study following a quality improvement project which the team hopes will help the veterinary and nursing professions improve maternal and neonatal care for canine dystocia cases.
The quality improvement project took place from 2012 to 2021, across Vets Now’s group of 60 clinics across the UK. The project has already yielded internal improvements in clinical outcomes in canine dystocia cases at Vets Now clinics, and it’s hoped by publishing the findings, improved outcomes can be experienced across the whole profession.
The team have published reliably measurable results on important aspects of clinical management, such as: between 2018 and 2021, ultrasonography rates increased from 45% to 65% of cases, rates of foetal heart rate measurement increased from 27% to 49% of cases, and use of multimodal analgesia during Caesarean section increased from 55% to 79% of cases.
The research team was also awarded a Knowledge Award for Quality Improvement by the RCVS in 2022, celebrating the individuals that have driven improvement within their organisation.
In response to a recognised need for updated guidelines and training for canine dystocia cases, the audit began with the formation of a working group, who audited key clinical outcomes connected with dystocia cases seen in Vets Now emergency clinics and hospitals. The group used this data to create resources that were disseminated to clinicians across all Vets Now teams.
The study’s authors are Lucy Leicester, Aoife Reid, Sophie Gilbert, and Racheal Marshall of Vets Now and Dan G. O’Neill of the Royal Veterinary College.
Lucy Leicester, Vets Now internal auditor, said: “We recognise that managing dystocia cases can be challenging and we identified room for improvement in the care of these cases, ultimately improving our maternal and neonatal care.
“As emergency vets, we see a high number of dystocia cases at our clinics and hospitals throughout the UK and as such, our clinical teams were looking for updated guidelines and training and a working group was created to support this.
“We’ve now published our findings, and we hope this paper will be significant in helping outcomes for maternal and neonatal care across the wider veterinary and nursing professions. “
Lucy explained the study itself: “We began by auditing and capturing benchmarks for dystocia cases across Vets Now clinics back in 2012. To support clinicians with decision-making and improve patient welfare, we used this data to inform guidelines and resources relevant to care we are providing.
“Both the data and the resources were disseminated across our clinical team through specialised training. The level of engagement in the audit highlighted team-wide commitment to improving patient outcomes.”
Mandisa Greene, medical director at Vets Now added: “At Vets Now we’re passionate about animal welfare and providing high-quality care through clinical excellence. That’s why we use clinical audits to help us recognise excellent clinical care and identify areas for further improvements.”
Mandisa added: “As well as the report’s authors, I’d like to say a huge thank you and well done to the whole team involved including Dan Lewis, Laura Playforth, Dave Leicester, Richard Campbell plus a team of dedicated 16 volunteer vets and nurses at Vets Now who gave up their time to audit cases.”
About the Dystocia project
The first phase of the project started with a dataset which consisted of over 700 cases of canine dystocia from September 2012 to February 2014 from the Helix database, Vets Now’s bespoke practice management system. Data on nine key clinical outcomes were collated from the electronic case records. Best practices for Vets Now staff were developed and disseminated following the analysis of the initial data, and the knowledge gained from the audit was disseminated in papers and infographics on risk factors and treatment methods for dystocia. Phase 1 also led to the creation of the first canine dystocia checklist, and a focus on the management of canine dystocia cases during clinical onboarding for new employees
Phase 2 of the audit expanded the reach of the project into the business, with all clinical staff invited to participate in data collection and 21 clinical auditors recruited. The audit’s scope was broadened to include 12 additional key clinical outcomes relating to further details of surgical and pharmacological management of Caesarean sections. The results and findings of Phase 1 and 2 were widely shared within Vets Now, with internal webinars, discussions and educational modules. The additional learnings also resulted in the creation and dissemination of updated checklists and guidelines for use in dystocia cases in clinic.
The third phase of the audit was an impact assessment using data collected from dystocia cases between June and August 2021. The assessment showed that between 2012 and 2021, there were significant increases in the number of cases with recorded bodyweight, recorded usage of diagnostic imaging, recorded usage of ultrasonography and recorded usage of oxytocin and calcium gluconate. Additionally, the educational and clinical materials created coming out of the audit were used hundreds of times by clinic staff across the Vets Now business.
Summary of results: Between 2014 and 2021, statistically significant increases were demonstrated in recording of bodyweight, use of diagnostic imaging, use of ultrasonography, recording of fetal heart rates, use of calcium gluconate, and use during caesarean section of intravenous fluid therapy, multimodal analgesia, full agonist opioids, paracetamol and local anaesthesia. Statistically significant decreases were demonstrated in median first quantity and median first dose of oxytocin, and in the use of NSAIDs during caesarean section.
To read the full report, click here and for more information on Vets Now, visit www.vets-now.com
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