The Challenge: A Big Building, a Bigger Team, & No Room for Guesswork
Oakland Veterinary Referral Services (OVRS) in Bloomfield Hills, Michigan, operates a 24/7 emergency department. And it’s not small. It spans more than 38,000 square feet and includes various specialty departments.
“Our ER department is the biggest part of OVRS,” said Kyla King, ER nursing manager. “We have about 90 technicians and assistants, and about 15 veterinarians on staff that rotate throughout the week. Usually at any point, we have maybe 20 or 25 of those team members here at a time that we’re trying to juggle.”
Kyla named the breakdowns they were experiencing, like relying solely on verbal communication in a 24/7 environment with constant shift changes, assuming instead of confirming, and information that isn’t passed over correctly at shift or team changes. In any clinic, undocumented information can quickly become a liability.
“Documentation is always super important, especially in a practice like ours where we have 24/7 hours,” said Kyla. “We have shift changes with patients that are bridging those shift gaps, so it’s really important to have things actually noted down versus just verbal communication.”
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The Solution: Standardized Workflows Built on Instinct EMR
Office and client service manager Jessica Rose runs a roughly 30-person client service representative (CSR) team. With half the team remote and half in the building, everyone needs to know what’s happening with every patient. Rather than bolting on a separate messaging tool, OVRS built communication directly into the workflow it was already using in Instinct EMR.
“[We wanted] central documentation that all teams can reference,” Jessica said. “Not just a sticky note on someone’s computer that only one person has access to. We think it’s really important that everybody has access to all the communications.”
OVRS also made full use of Instinct EMR’s tools, which are flexible enough for every clinic to use them in its own way:
Patient & Client Alerts
At OVRS, a patient alert is how the front desk notifies the treatment team that a veterinarian is cleared to begin. If a veterinarian is waiting on a deposit before running diagnostics, the CSR who collects it flags it instantly.
The same channel carries safety-critical information that the treatment team needs before they ever approach a patient. If a client mentions at the front desk that their dog is fearful or aggressive, that alert is added immediately so it reaches the treatment area ahead of the patient. Any member of the treatment team can add their own alerts once the patient moves through.
Triage Tags
OVRS utilizes Instinct EMR’s triage tags as a color-coded status language specific to its emergency service:
🟢 Triage complete: The technician has gathered history and confirmed stability
🟠 Waiting on diagnostics
🔵 Ready for euthanasia once the client is checked out and the room is ready
🩷 A client is visiting a hospitalized pet and shouldn’t be interrupted
🔴 Ready for discharge
Both Kyla and Jessica described the colors becoming reflexive once a new hire has used them for a while. They’re part of the training, posted for reference, and then simply second nature.
“Those patients that have the orange triage tags—if those clients come up to the desk waiting for an update, we are able to tell them, ‘I know that your pet is waiting to have diagnostics performed,’” Jessica said. “Or maybe we’re just waiting for another set of hands for X-rays or to draw blood. We can give them that update without even having to interrupt the emergency team.”
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Task Lists
Task lists became one of OVRS’s most widely used communication tools. Every specialty department uses them, with several being automated. When a cardiologist determines that a patient also needs to see an oncologist, they add a task to a list monitored by a dedicated receptionist.
“We get email fatigue here,” Jessica said. “Kyla can attest to this. We get hundreds of emails a day. So anything that we can do to reduce another email is great. Our task list for department schedulers is very helpful with that.”
OVRS routes stat records requests to a list monitored by one person throughout the day, so urgent requests from referring veterinarians get handled first. Even the maintenance and custodial teams live in Instinct EMR. And to address decision fatigue, there are standardized workflows that prevent the team from re-deciding how to do routine tasks all day.
The Scheduler & ‘On the Way’ Board
OVRS uses the Instinct EMR scheduler alongside its whiteboard to keep a time-stamped record of every arrival, which is useful for live coordination and as historical data that the hospital can review later. The standout is the “On the Way” board. When a triage technician takes a call from an owner or a referring veterinarian, the incoming patient is moved up before they arrive.
To make that work cleanly, the team built “phantom” patients: a possible on-the-way and a confirmed on-the-way. The team writes the reason for the visit, the estimate provided to the client, and the anticipated arrival time right into the notes.
“If we have a dog that we’re really worried is super critical, we can put a stat in there so they know to call it as something immediately,” Kyla said. “It just kind of takes some of the guesswork out of it, and it keeps us a little bit more organized throughout the day knowing what’s about to roll in the door.”
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How Instinct EMR Rebuilt OVRS’s Discharge Workflow
Discharge is where OVRS puts the most deliberate design work, because patient discharge touches the veterinarian, the care team, the reception desk, and the client. OVRS wrote an SOP for it so any new employee has the process in black and white, then wired the steps together with Instinct EMR’s tools and built in deliberate checks and balances.
“Something so simple as a discharge is really pretty involved,” Kyla said. “Every step of the discharge process is really standardized and has been developed for communication.”
| THE PROBLEM
A patient is cleared to go home, but the front desk doesn’t know whether the invoice is final, so checkout either stalls or happens before charges are captured. |
HOW INSTINCT SOLVED IT
A non-billable “completed” product on the invoice is the veterinarian’s green light. CSRs won’t check a client out until it’s there. |
| THE PROBLEM
In an unpredictable ER, a discharged patient gets forgotten while the team is pulled onto the next case. |
HOW INSTINCT SOLVED IT
Once checked out, the patient moves to the outpatient board and the status turns red, so multiple teams share responsibility for getting them out the door on time. |
| THE PROBLEM
A veterinarian goes off-shift before their patient leaves, and downstream charges are still populating. |
HOW INSTINCT SOLVED IT
The completed tag travels with the patient; automated charges can still post afterward, and the front desk knows it’s safe to proceed. |
The Client-Facing Payoff of Instinct EMR
Because patient status lives on a shared board, the CSR team can get ahead of client anxiety instead of reacting to it. OVRS trains its greet team to watch how long clients have been waiting and to offer updates before they’re asked.
“Our CSR team is really good about giving proactive updates without having our clients ask for them,” Jessica said. “Even if it’s not much information, just having the communication from us kind of settles their nerves—letting them know, ‘Maybe I don’t have any information, but I know that your pet is resting comfortably. I just went and checked on him.’”
The shared board also tells the CSR exactly who owns a case, so updates come from the right person rather than having to hunt them down. Kyla noted that knowing who has the information and who should receive it is half the battle. A CSR can read the outpatient board, see which veterinarian is on the case, and direct the question precisely.
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What’s Next for OVRS
OVRS treats its workflows as living systems, and the newest layer is automation. The hospital runs a dedicated ER lab team and its old process for routing lab work was workable but clunky. Staff had to open the task list, search for the lab work request, and add the patient by hand, which left room for tests to land on the wrong list or under the wrong name.
Now an automation does it for them. The moment a test is completed on the treatment sheet, whether it’s a chemistry and CBC, a urinalysis, or another order, it automatically shifts to the lab work task list with the patient name and the test already attached.
“[The automations] have been really nice,” Kyla said. “I’m excited to see what more automations are gonna be coming out.”
If your front desk and treatment teams are still bridging the gap with verbal updates and sticky notes, a short demo will show you what a shared, real-time picture looks like. Book a free, no-pressure demo today.
