AAHA Certification: The AMC Takes the Test to Meet Veterinary Practice Standards of Excellence

July 30, 2014

AAHAlogoDedicatedThe Animal Medical Center undergoes a triennial accreditation evaluation by the American Animal Hospital Association (AAHA). The AAHA is an industry leader that sets the standards for small animal hospitals in North America, standards which are often emulated internationally. For example, in Japan, the Japanese Animal Hospital Association (JAHA) serves a similar role to AAHA in the United States. Recently, AAHA has added new accreditation categories for referral hospitals and university hospitals.

The Benchmarks
Over 900 different standards are assessed during the accreditation evaluation. The standards focus on the quality of care in the areas of: anesthesia, contagious diseases, dentistry, pain management, patient care, surgery and emergency care. The standards are grouped into 20 large categories covering quality of care in diverse areas such as contagious disease, dentistry, diagnostic imaging, emergency and critical care, and pain management. Mandatory standards detail 46 critical/crucial hospital functions required of every AAHA accredited hospital. These “deal breaker” standards include the requirement that dentistry is performed under general anesthesia with tracheal intubation, and all patient care is provided under the supervision of a licensed veterinarian. The standards require hospitals to provide diagnostic services (x-ray and laboratory) facilitating quick and accurate diagnosis of your pet’s illness. Accredited hospitals must dispense medications so treatment can begin immediately.

The focus of the benchmarks is not just on patient care, but on how the veterinary team interacts to achieve high quality patient care. Standards pet owners might not expect as part of the evaluation process include an assessment of confidentiality, security and integrity of medical records, fire safety, diagnostic image archiving, continuing education, and referral standards. While not exactly medical standards, these functions are clearly critical to an accredited hospital’s ability to provide top-notch patient care.

Exam Prep
The AMC is continuously prepping to meet the AAHA accreditation standards. Our accreditation team reviews the benchmarks and educates the staff regarding their responsibilities in implementing each standard. When a new standard is issued, the appropriate hospital team writes our policy to ensure the new standards are met. That policy is then distributed to the implementation teams. Each new standard improves the quality and safety of The AMC’s patient care.

A Pop Quiz
On-site examiners perform a full-day thorough and comprehensive review of the hospital. Preparing for an AAHA evaluation is like preparing for a pop quiz; they can ask questions about any of the 900+ standards and they don’t have to give you a heads-up as to which ones are on the quiz. The examiners speak with a variety of staff and review hospital policies to ensure standards are met. If any deficiencies are identified, they suggest methods of improvement.

Perfect Scores
The accreditation process is rigorous and encompasses all aspects of pet healthcare. Only 15% of all veterinary hospitals meet these stringent quality standards. The AMC is proud to say it has been an AAHA accredited hospital since 1976 and passed its most recent evaluation with flying colors. We achieved a perfect score in six of the 20 categories of standards. All of the standards ultimately affect the care pets receive at The AMC, but most important to pet owners are the A pluses The AMC received for management of contagious diseases and emergency and critical care medicine. Overall, we received a solid A, or 94%, which does not mean we got six questions wrong. We scored 30,250 out of a possible 32,310 points! No wonder it took weeks to prepare for this evaluation.

Standards Met
For over 100 years, The AMC has been a leader in veterinary teaching, research and exceptional clinical care. The AAHA is another leader in veterinary medicine whose opinions and stance are relied upon for setting high hospital standards. Achieving AAHA certification is just one way we continue to provide the highest quality of medicine and surgery to nearly 40,000 patients every year.


Lung Disease with a Twist

October 23, 2013
Muneca

Muneca

“I’m sorry, but you need to take your dog to see a cancer specialist.” These are words no pet owner wants to hear, but despite their anguish about their beloved dog’s illness, Muneca’s (a name which means “pretty baby doll” in Spanish) family followed the recommendation of their primary care and emergency room veterinarians and brought the little poodle to be examined by the Oncology Service at The Animal Medical Center. This photo shows what a happy dog she was before her illness.

Muneca’s story starts with a trip to her primary care veterinarian who, using an x-ray, discovered that fluid was accumulating around her lungs. Shortly after seeing her primary care veterinarian, Muneca’s appetite decreased and she had trouble breathing, so she was brought to the to the ER by her owners.

Emergency room visit
The ER doctors found Muneca had a blue tongue. She was not getting any oxygen into her bloodstream because the fluid surrounding her lungs prevented them from expanding. Carefully, the ER doctors administered a light sedative to allow nearly one liter of bloody fluid to be removed from around the lungs of this 25 pound tan poodle. Immediately she was her old self, but the ER doctors again recommended Muneca be examined by an oncologist.

A new diagnosis
Although cancer is a very common cause of fluid accumulation around the lungs, there are other causes. When I saw Muneca, another x-ray was taken to determine if the fluid had returned since it had been removed by the ER doctors. The fluid had returned, but when Dr. Anthony Fischetti, one of The AMC’s board certified radiologists, reviewed the new films with me, he saw something that intrigued him – bubbles of air trapped within the right middle lung lobe. Immediately he became optimistic that Muneca could be saved! The diagnosis was revised to lung lobe torsion.

A lung lobe torsion is a rare disorder seen in dogs, cats and humans. The lung lobe twists around the bronchus, or air tube, and the blood vessels supplying the lung. This traps air and blood in the lung lobe, explaining the bubbles seen on the x-ray and the accumulation of fluid around the lungs. Fluid leaks out of the lung because the blood cannot exit though the twisted vessels.

Muneca recovering after surgery

Muneca recovering after surgery

Major surgery
The treatment for a lung lobe torsion is surgery to remove the twisted lung lobe, but this is a major procedure. In Muneca’s case, The AMC provided more than just the diagnostic and surgical expertise. One of our Community Funds, the Patient Assistance Fund, covered the majority of the cost for Muneca’s surgery. Muneca’s surgeon, Dr. Janet Kovak, entered Muneca’s chest on the right side between the third and fourth ribs and removed the right middle lung lobe, which was swollen and adhered to the diaphragm. Muneca recovered rapidly and was discharged from the hospital to her happy and grateful family two days later. In the second photograph, you see her completely recovered and resting at home in her favorite spot.

A winning team
Muneca is just one patient example of why I love working at The AMC – it’s all about the team. Without The AMC team of specialists, that includes board certified radiologists and surgeons, Muneca would not be healthy once again and home with her family and what’s not to like about that!


Avoiding the Knife: Preventing Pet Surgeries

April 11, 2013

At The Animal Medical Center, our board certified surgeons and neurologists perform approximately 1,500 surgeries each year. A recently released pet insurance study completed in 2012 listed the top ten surgery claims for both dogs and cats:

Top-10-Canine-Conditions-large

Survey attributed to VPI Pet Insurance 2012

Since none of us want our pets to be subjected to the difficulties most surgeries pose, I will devote this blog to suggestions on how to avoid some of the most common canine and feline surgeries.

Tooth extractions

Topping the surgery list for cats and coming in at number three for dogs were tooth extractions. Keeping your pets’ teeth healthy means daily brushing and annual dental cleanings. The American Veterinary Dental College website provides good information about home dental care in dogs and cats. Remember, doggy breath often means periodontal disease, so if your pet has smelly breath, see your veterinarian for treatment before extractions become necessary.

Skin abscess, inflammation and pressure ulcers

This list of skin conditions ranks number two as a reason for surgery in both dogs and cats. Pressure ulcers generally occur in older dogs with limited mobility. Padding, padding and more padding will help prevent pressure ulcers on their elbows and thighs. Investigate orthopedic beds for your dog and try to keep him from laying on hard surfaces like the bathroom tile floor which can aggravate pressure sores. Promote mobility in your dog through regular exercise and management of arthritis with diet and medications.

Feline bite wounds

When I was a veterinarian in a more suburban area, we treated cat bite wounds on a daily basis. Preventing cat bite injuries is as simple as keeping your cat indoors. Cat bites not only cause wounds which can become abscesses, but cat bites transmit the feline immunodeficiency virus and possibly blood parasites as well. Priceless is how I define the value of keeping your cat indoors and healthy.

Aural hematoma

The tenth most common surgery in dogs was to repair an aural (ear) hematoma. Cats can develop aural hematomas too, just not as commonly as dogs. This condition is essentially a blood blister inside the ear flap. Blood accumulates in the ear flap when your dog incessantly shakes his head or scratches her ears. Usually, the shaking and scratching is in response to an allergy or an ear infection. If you see this behavior, check inside the ear for redness or discharge. See your veterinarian immediately to treat the cause of the shaking and scratching to prevent the development of an aural hematoma.

While some surgeries are unavoidable, these are prime examples of how a visit to your veterinarian for routine preventive care can help your pet avoid surgery.


Neutering: Not Just Doggie Birth Control

January 23, 2013

200487404-001Dexter, a new dachshund patient of mine, was in last week for another round of puppy shots. He will soon be six months old and it was time for me to discuss the next step in his preventive health care plan: neutering.

Neutering meets the guidelines

The American Veterinary Medical Association has developed guidelines for responsible pet ownership. One of the guidelines obligates pet owners to control their pet’s reproduction through spaying and neutering; subsequently helping to control pet overpopulation in their community. Neutering is the common term for castration of a male dog or cat and spaying refers to removal of the ovaries and uterus, or in some cases just the uterus, of a female pet.

Lifesaving responsibility

Pet overpopulation is a serious issue in the United States today. According to the Humane Society of the United States, over 4 million unwanted pets are destroyed annually. For every puppy or kitten prevented by neutering an adult pet, there is one less homeless and unwanted puppy or kitten euthanized in an animal shelter.

The traditional surgery

Surgical removal of the testicles is the current standard of care in both dogs and cats. This surgery renders a male dog or cat unable to reproduce and also removes the major source of the male hormone, testosterone. Removing the source of testosterone eliminates mating behavior in males and also plays a role in eliminating other unwanted dog behaviors. In both the dog and cat, neutering involves a small skin incision through which the testicles are removed. Cats typically go home the same day, but dogs may stay overnight to recover from anesthesia and for incisional monitoring.

My recommendation

Dexter’s owners were concerned about the surgery. They asked if he could just have a vasectomy instead of the traditional neutering surgery. Because my job is to make the best medical recommendations for the specific health concerns of each of my patients, I recommended the traditional surgery for Dexter. It provides him with the greatest number of health benefits. The surgery prevents unwanted litters of puppies and also prevents prostatic disease, testosterone-induced tumors and behaviors linked to testosterone production.


Hurricane Sandy: The Animal Medical Center Story

October 31, 2012

The view down E. 62nd Street on Monday night

By Sunday night, the Governor and Mayor had shut down all mass transit in NYC, our schools were already closed for Monday, and by Monday morning even the New York Stock Exchange suspended trading for the day. New York City was silent; everyone was indoors and the wind and rain of Hurricane Sandy had not yet arrived. Despite all the closures, The Animal Medical Center was open for business as usual.

As far back as anyone can remember, The AMC has never closed. We mean it when we say we are open 24/7. When a disaster is anticipated, the staff work together to determine how best to cover shifts and maintain adequate nursing and medical expertise for our patients. During blackouts, natural disasters, and human disasters, our staff comes to work prepared. Many employees came to work on Sunday with food, clothes, and bedding, planning to stay for the duration of the storm. The AMC stores inflatable beds for those employees sleeping at the hospital. The beds got blown up Monday afternoon since the electricity fluttered on and off during the day. Lucky for us, our favorite deli and neighborhood diner were still open.

It was a good thing we were open for business, as really sick animals needed care. Here is a sampling of the Sunday night admission list: a stray cat and a stray dog were brought to The AMC since the shelters were closed for the night; Harley, a cat, came in with complications of diabetes; Lexi, a bulldog, was admitted for serious vomiting; Gus the cat developed heart failure; Monkey, a Pekingese, required an emergency MRI and back surgery; a golden retriever named Aristotle became unconscious and he too required an emergency MRI ; Rysiu was admitted for feline bladder stones resulting in a urinary blockage. On Monday, he had an urgent surgery to remove the stones.

Visits to our emergency room were steady on Monday morning, but most scheduled patients cancelled their visits. The ER continued accepting patients overnight, even though there was at one point a foot of water in the first floor lobby. Our power went out from about 10 p.m. until 1 a.m., during which time our generator kicked in to run essential electrical equipment. Once the high tide began to recede, the lobby was squeegeed dry and, except for internet service that was slow to be restored, we were back to normal. The banners on the north side of the building are in tatters and our awning has a rip, but these are cosmetic only and we feel very fortunate to only be slightly damp around the edges.

New York pets were fortunate, too. For the second hurricane in a row, pets were allowed in evacuation shelters and in his Monday press conference, Mayor Bloomberg announced 73 pets had already been accepted into shelters.

Find more information about Hurricane Sandy and pets here.

For help in planning for the next disaster, click here.


Fracture Repair in Dogs and Cats

July 21, 2011

A couple of weeks ago I was interviewed by a reporter about pet owner administered first aid for dogs and cats when an injury may have resulted in a fractured bone. The article has good information for pet owners to read now in preparation for a potential emergency in the future. This blog post will pick up where that article left off and explain the fracture repair techniques used by veterinary surgeons The Animal Medical Center.

For the veterinarian, the critical piece of successful fracture management is to immobilize the fracture. This can be accomplished using one of several different methods. For some fractures, more than one method might be appropriate and for others there may be only one solution to fix the broken bone. All x-rays were taken by the AMC’s Diagnostic Imaging Service.

For centuries, fractures have been treated by immobilization using casts or splints. These days the old style plaster of Paris cast has been replaced in human medicine by plastic or fiberglass. In animals we tend to use splints of fiberglass or plastic for repair of simple fractures where the bones do not need realignment. The arrows in the photo to the right point to two toe fractures in a young dog which healed when the paw was placed in a splint.

Optimal healing of a fracture requires the joints above and below the fracture be immobilized. When the fracture occurs in a location where these joints cannot be adequately immobilized by an external bandage or cast, the fracture must be repaired internally via a surgical procedure. The x-ray to the left shows the use of two small pins in the front of the hind leg bone known as the tibia.

If a bone is fractured in multiple places or spirals along the length of a bone, a simple pin will not provide enough support to immobilize the fracture and allow healing. Shown below are before and after x-rays of a fractured arm (radius and ulna) in a dog. Notice the splint on the before films. The AMC’s Emergency Service placed the splint to immobilize the fracture until surgery could be performed. The AMC surgeons chose to repair the leg with a plate and screws since both bones of the leg were broken.

As research discovers more about fracture healing, methods of repair are changing. When possible, minimally invasive procedures are chosen as large invasive surgeries disturb the covering of the bone (periosteum), the blood clot at the fracture site and the muscles which provide the blood supply to the fracture. The AMC surgeons are using a new technique called MIPO (minimally invasive plate osteosynthesis) or percutaneous plating. This method of fracture stabilization, involves application of a bone plate through small skin incisions on either end of the fracture site. The fracture is aligned and the plate and screws are placed using guidance from a special intraoperative x-ray machine. Not all fractures are amenable to MIPO.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit http://www.amcny.org. To make an appointment, please call 212.838.7053.

Images: AMC Diagnostic Imaging Department


The Pen Cap May Be Mightier than the Sword…

July 15, 2011

But it can’t beat a bronchoscope!

Barcley

One thing I love about pets is their unpredictability. You just can never guess what they will do next. Here’s the story of Barcley, the French bulldog and the nearly fatal pen cap.

The beginning seemed innocent enough: a dog playing with a bright blue highlighter pen. Suddenly, he couldn’t breathe and his owners rushed him to The Animal Medical Center. Quick administration of oxygen and a sedative by the ER staff seemed to alleviate the breathing problem enough to allow a chest x-ray to be taken.

No one would have predicted the x-ray would show Barcley’s windpipe contained what looked like the cap of the bright blue highlighter!

Barcley’s chest x-ray. Arrows point to outline of pen cap in his windpipe.

The ER staff had to think quickly and cleverly. Barcley needed anesthesia and a bronchoscope to remove the highlighter pen cap, but the standard anesthetic plan of placing a breathing tube into the windpipe was out of the question; it was already full of the highlighter cap. To further complicate matters, Barcley is a brachycephalic (short nosed) dog, a type of dog known to have a greater risk of anesthetic complications.

Dr. Stacy Burdick of The AMC’s Internal Medicine Service was called in at 1:30 am to perform the procedure which took 20 minutes, but seemed like a lifetime. She placed a small rubber tube in the windpipe to deliver oxygen and administered an injectable anesthetic agent into Barcley’s vein. Dr. Burdick cautiously advanced the bronchoscope down Barcley’s windpipe. She was worried the windpipe could have been damaged as the cap went down, or worse, the windpipe could tear when she pulled it back up.

Pen cap in windpipe

On the right, you can see what Dr. Burdick saw when the cap came into view. The cap blocked the entire lumen of the windpipe. Knowing she had to work quickly to restore the delivery of oxygen to the lungs, she passed a special grabber device through the bronchoscope, grabbed the cap and gently pulled it gently out through the mouth as she pulled out the bronchoscope.

Barcley’s life was saved from the pen cap by the mighty bronchoscope and the skilled Dr. Burdick.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit http://www.amcny.org. To make an appointment, please call 212.838.7053.


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