The Growing Role of Teletriage

A Better Way to Care for Patients, Improve Efficiency, and Ease the Burden on ERs

by Lavanya Sunkara

Teletriage—the process of determining the severity of a patient’s condition via telephone, chat, or video—helps both the veterinarian and the client. The veterinarian can streamline the clinic’s workflow, build a stronger bond with the client, and have a better life-work balance. The pet owner can avoid long wait times and expenses at the emergency room (ER); they can calmly decide when to bring the animal to see the veterinarian rather than rushing to urgent care the moment something is amiss. It’s a win-win for everyone involved.

Teletriage also reaches millions of pets who don’t have a primary care veterinarian. To diagnose illnesses and prescribe medication via telehealth, the veterinarian must have an established VCPR (veterinarian-client-patient relationship) through an in-person exam in a majority of states. Veterinarians can use teletriage to help animals not covered by primary care by providing general medical advice and guiding owners in determining when they should go to the veterinarian.

During the COVID-19 pandemic, virtual health has dramatically changed the way veterinarians are providing care for their patients. Although some practices have resumed in-person visits, telehealth and teletriage can still play a vital role.

Read on to find out how teletriage can help veterinarians better assess the animal’s situation, streamline workflow, build loyalty with clients, and improve their life-work balance, all the while helping pets in need and providing pet owners with peace of mind.

Improved Workflow

In a typical practice, a concerned pet owner calls the receptionist and relays a problem their animal is having. If the client doesn’t want to set up an appointment, the receptionist takes down the information and promises to call back after consulting with the doctor. Somewhere between the initial call and the veterinarian getting in touch with the owner, a communication gap can result in crucial information being lost. Because the veterinarian hasn’t actually seen the patient, it leaves the client frustrated and the doctor unable to provide the proper assessment.

Shlomo Freiman, DVM, cofounder and chief veterinary officer of telemedicine app Petriage, decided to create an automated way for his clients at the Animal Hospital of Factoria in Seattle, Washington, to avoid any miscommunications and, more importantly, “to assess urgency.”

“When the phone rings, if we don’t know what the issue is, we cannot prioritize. Maybe somebody has scratchy skin versus an animal gasping,” said Freiman. “In a working clinic, it’s much more efficient to manage cases at least initially, via synchronous and asynchronous chat.”

Freiman elaborated that his assistant can use the app to ask the worried client all the right questions and request a picture or a video when needed. After having read the chat in its entirety and seen the clips and images of the issue, he can then jump in and address the concern. While initial triage is occurring, Freiman can focus on emergencies and not have to worry about a pile of sticky notes detailing less time-sensitive cases. Petriage supports live video along with synchronous and asynchronous chat. Synchronous chats occur in real time, while asynchronous messaging gives participants the freedom to start, pause, and resume a conversation as their time permits. It also provides a nurse line to help the client get in touch with the clinic either after hours or if the veterinarian is too busy. Veterinarians anywhere in the country can sign up for the Petriage platform and use it with their own clients for a monthly fee.

Practices have a wide variety of telehealth services to choose from and can even implement their own. Membership-based Small Door Veterinary in New York City offers their own proprietary telemedicine system, which is available to members in the NYC metro area. Regardless of which service is utilized, the goal is the same: better workflow.

Josh Guttman, cofounder and chief executive officer of Small Door, said that telehealth “is incredibly useful for triaging. It allows us to quickly identify cases that are safe to be monitored at home and those that require urgent care. It saves time for our veterinarians and nurses and helps us to more effectively allocate emergency appointments to the pets most in need of care.”

More importantly, he said, clients are extremely satisfied.

“Countless members have shared with us how useful our teletriage features have been to help them avoid unnecessary hospital visits and help put their minds at ease,” Guttman said.

Smarter Scheduling

When veterinarians can assess the urgency of cases, it makes room for smarter scheduling. By conducting teletriage and determining when a patient needs to come in, whether it’s a week or a month from the telehealth call, a clinic can better manage the veterinarian’s schedule.

“Over 3,000 calls that I took virtually, I probably sent maybe 50 to an emergency,” said Jeff Werber, DVM, chief veterinary officer at Airvet, a platform that offers on-demand video calls for pet owners. “If a picture is worth more than 1,000 words, a video is worth 100,000 words. It’s amazing how many things I can pick up just by looking at the patient to know whether or not something is serious.”

Airvet, which started in 2018, allows veterinarians to directly speak with their clients via video calls. Werber says the platform has also made communication during COVID-19 easier. “The technician running back and forth between the car in the parking lot and the doctor to answer questions is turning a normal 20- to 30-minute appointment into an hour and a half. No wonder they are only seeing 50 people a day,” he added. Telehealth will cut that time down significantly, affording both the clinic and the client more flexibility, efficiency, and peace of mind.

Anthony Hall, DVM, MPH, and a relief veterinarian in Dallas, Texas, introduced Airvet to a clinic where he was working. They found it helped make things a “lot easier and freed up their appointment bookings.” He explained that by using telehealth for things like mandatory rechecks on surgical patients, the practice can use in-person appointment slots to book clients that will spend money for their pet needs. “It becomes more lucrative, and you’re also able to help more animals at the same time, especially those in more need,” Hall said.

Additionally, it prevents owners from taking their sick animals elsewhere if the practice’s schedule is booked with unpaid rechecks.

Better Engagement

According to Freiman, some of the most common complaints coming in virtually from pet owners tend to be concerns about their pet’s vomiting or diarrhea. With a telehealth visit, the urgency of these conditions is easily assessed; the veterinarian can advise what to do to make the animal feel better at home and help them decide over the next 24 hours if the pet needs more urgent care.

Often, the animal is doing better the next day and the client avoids a costly and time-consuming visit to the emergency room. This honesty and transparency builds loyalty and leads to happier customers, according to Freiman. “We now have a relationship that is very different,” he said. “The next time your dog has an issue and I advise you to do blood work or something else, you are much more likely to listen to me because this doctor is not always telling me to come in.”

Easing the Burden on ERs Teletriage can also significantly reduce the number of patients heading to the ER, giving them breathing room to serve pets in need.

Wait time for emergency care can be hours. “If it is something that can sit in a parking lot for four to eight hours, it may not actually be an emergency,” said Cherice Roth, DVM, chief veterinary officer at Fuzzy Pet Health, a membership-based platform that offers chat sessions with veterinary technicians to address pet problems regardless of whether they are under the care of a primary veterinarian.

“ERs are closing right and left because either they don’t have a doctor or they don’t have a support staff, and some of them are having to turn away cases,” Roth stated about the condition of veterinary medicine today. The Fuzzy platform engages with 175,000 pets via video and chat annually, out of which only 5% end up going to the emergency room, according to Roth.

“The technicians are looking for things that are life-threatening. Those are really the things that should be going to the emergency room,” Roth said.

Roth knows firsthand about the importance of prioritizing cases. “I remember being an ER doctor and having to try and treat emergency ear infections or anal gland abscesses,” she said. “Those are so hard because you do want to help that pet. But then, in the next kennel, you have a pet that’s in heart failure or a pet that had to go through emergency surgery.” Roth further emphasized the importance of teletriage for single practitioners in rural communities. “For these clinics, time is a commodity and often these doctors don’t get time off. Because they are usually seeing their own emergency cases, teletriage can help determine whether or not they need to come in.” She added, “If you’re going to get out of bed to go to the clinic, you want to know if it’s actually an emergency. So that is definitely one of the ways that Fuzzy can help. We’re able to say, ‘we’ll hold on to the on-call doctor’s number, and if we determine it’s an emergency, we’ll give the number so you can call the doctor.’”

As far as partnerships with practices, Roth said that Fuzzy aims to “not sell them software or a platform, but to really be there to help their operational support.”

Fuzzy provides unlimited telehealth and teletriage access to technicians for an annual fee. Pet owners can sign up for Fuzzy independently and clinics can encourage clients to sign up for a discounted fee. Roth hopes that the increased use of telehealth can give clinical doctors the flexibility to “maybe stay at home when their child is sick, or hang out with a relative, or not miss every family function because they’re on call.”

Enhancing Your Business

At the end of the day, by streamlining the clinic’s workflow and making clients happier, teletriage can also enhance business. It not only allows doctors to care for patients who are in real need but also facilitates seeing more cases courtesy of smarter scheduling. While telehealth may never fully replace in-person exams, it is an incredible resource for pet owners and veterinary professionals.

Lavanya Sunkara is a freelance writer living in New York.

Photo credits: hocus-focus/iStock via Getty Images; Photo courtesy of Shlomo Freiman, DVM. Photo courtesy of Anthony Hall, DVM, MPH. SbytovaMN/iStock via Getty Images; PA Analysis Diagram courtesy of Shlomo Freiman. Photo courtesy of Jeff Werber. Photo courtesy of Anthony Hall.; Photo courtesy of Cherice Roth