Horse Health: Vaccinations
April 3, 2016
Straight from the Horses’ Mouth
June 1, 2016
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The Role of the Referral Hospital

At some point or another, all field veterinarians have had a case where they felt that they were running out of options.  One of the most common cases that this may occur with is the colicky horse whose pain can no longer be controlled despite aggressive drug use.  This is where a referral center with the ability to treat the more serious cases comes into play.  However the thought of having to meet and deal with a veterinarian you have never meet before during a potentially life threatening situation for your horse may overwhelm some owners.  Maybe it would help to understand how the relationship between the referring DVM (your local vet) and the referral hospital works, and what is needed from both sides to make the relationship continue to work in the best interest of the patient.

What is a referral hospital?

First, what is a referral hospital?  A referral hospital is a veterinary center that provides care that either cannot be done in the field, or is done in a better way in a hospital.  A good example of this is surgery for a cryptorchid horse.  Although technically this procedure can be done in the field, because of the potential to need to enter the abdominal cavity, it is best to perform this surgery in a hospital with full surgical capabilities so that any complications encountered can be readily addressed during the procedure.  Additionally, although not always, a referral hospital is often manned by specialists in their respective fields of veterinary medicine.  That may include a board certified surgeon or a board certified internal medicine specialist.  Now the question of what is board certification should be asked.  In the case of the American College of Veterinary Surgery, the College that oversees the certification of Veterinary Surgeons, or Diplomates of the American College of Veterinary Surgery, a veterinary surgeon has undergone additional training after veterinary school in order to become a specialist. This training consists of a minimum of a 1-year internship followed by a 3-year residency program that meets guidelines established by the American College of Veterinary Surgeons (ACVS).  This means that the Veterinary Surgeon has undergone extensive and intense training in advanced surgery to allow them to better perform more complicated procedures for your horse.  Currently there are 22 specialty colleges recognized by the American Veterinary Medical Association, with these 22 Colleges 40 distinct veterinary specialties.  Whether or not your local referral hospital employs a specialist or not, the idea of referral remains the same, and that is to provide care beyond what may be done safely and effectively in the field.

The referral hospital and the referring veterinarian relationship

It is also important to understand as an owner how the relationship between a referral hospital and the referring DVM works.  With the onset of the referral process a new member to the horse’s healthcare team is added for the given situation, whether that is an elective situation or an emergency one.  All parties involved have certain expectations that need to be met, and thus it is important to understand them.  From the standpoint of the referral hospital it is important for a horse owner to recognize what they are being sent to the referral hospital for.  Meaning by this that the new veterinarian involved will need to first perform a complete examination on the horse to assess its status before treatments can be done.  If, as a horse owner, you were under the understanding that you were only being referred to have your colicky horse treated with IV fluids, then when the referral hospital vet recommends bloodwork, you may become a little confused.  Even more important than this however, is to understand that your horse is being referred for a specific situation or reason.  Many referral hospitals try not to “step on the toes” of their referring veterinarians by performing unnecessary procedures such as a routine dental float on the horse that was referred for a lameness issue.  One of the final important aspects of this relationship for the horse owner to recognize is that following discharge of the horse from the referral hospital, then the responsibility of the care of your horse returns to your regular veterinarian.  That said, the referral hospital remains an active participant in complete recovery of the horse as long as you and veterinarian need their input and recommendations.

Be prepared and talk to your veterinarian

Just as in the field of human medicine, sometimes it takes a large team to provide the best care possible for your horse.  This is where the referral hospital can help you, your regular veterinarian, and most importantly your horse.  If you have never had the need to have your horse referred to a different hospital, then you can always talk with your regular veterinarian about what all is entailed in having your horse referred if it ever needs this done.  A little knowledge in advance may help to ease some of the concerns if the need ever arises!

Mike Cissell, DVM, MS, Diplomate ACVS-LA
Large Animal Surgeon
Prescott Animal Hospital Equine Center