Save Time and Even Improve Outcomes with Diagnostic Baselines

Establishing a Patient-Specific Baseline

If you've worked in veterinary medicine for any length of time, you'll have come across the concept of "within normal limits." Whether we are running a preventive care screen or dealing with an infection, the values that we get back are only useful if we have something to compare them to. Normal limits, also known as reference intervals, represent the range of expected values for an apparently healthy member of a given population, and most lab reports will call out items that fall outside of those boundaries. Your doctor team can then use that information, along with other knowledge of their patient, to identify which if any issues are the most important.

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Population-wide ranges may not reflect your individual patient and that can be a real problem when dealing with an acute condition. Often, when we're dealing with a patient that's in distress, we rely on blood work and chemistry values to determine possible causes of symptoms. Without historical values, it's nearly impossible to know if an out-of-range value relates to the presenting complaint or is normal for this patient. Your team may then waste time on something that isn't going to help the patient while a real problem goes unaddressed. A good baseline helps to filter out the artifacts, improving your team's efficiencies and reducing frustration for clients, who want to keep their pets healthy.

Spotting Trends

The more commonly discussed benefit of regular preventive care screenings is early detection. I've found a misconception among some of my clients that a single point-in-time snapshot of a patient is all that it takes to spot a problem. Sometimes that's true, and we definitely see patients, especially older ones, who have diseases that have progressed to the point where they're easily detectable. However, at that point, it's often too late, and treatments become more complex, expensive, and less effective.

We can get much better results when we can spot a trend toward increasing values, even within the reference interval, before it becomes a serious issue. Consider, for example, alanine transaminase. We know that high levels can indicate possible liver damage, but when is the right time to start investigating? If you only have a single data point showing a value that's high but not outside the reference interval, it may be overlooked. However, having several data points allows the doctor to look at the trend. If moving higher, it may indicate a condition that is worsening, thereby giving the team a head start on addressing the problem sooner.

Getting Client Support

Preventive care is a critical and growing area in veterinary medicine. We are moving away from wellness care that meets the minimum standard required by local law and, instead, toward providing clients with as much quality time with their pets as possible. Many clients may still need help to understand the real value of regular workups; that is where a little education can go a long way. My team has found a few things that really help to get the message across:

• Pictures help to illustrate how multiple data points can be used to spot a trend, even before a single test may have flagged the issue. We use 2 charts, one with a single data point marked close to the top of the reference interval, and a second chart showing 3 previous points that start in the middle of the range, and grow towards the final point.
• Clients know that their pets age more quickly than they do, but reminding them of just how quickly helps them to empathize.
• Don't discount the immediate benefit that we may find conditions on the first pass, but let them know there is still value to "all normal" results.

Sometimes, we need to remind our clients that bodies don't work like machines. Although their pets' bodily processes generally work the same way, there are myriad small differences that need to be taken into account. Establishing a clear baseline and collecting more data points to compare to baseline can improve outcomes, helping doctors to better care for pets' long and happy lives.