A study found two-thirds of dogs were stressed in a veterinary waiting room.

A 2015 study found that two-thirds of the dogs exhibited at least one stress sign for more than 20% of the observed time in a veterinary waiting room [1].   Video analysis by a behaviorist classified 28.9% of the dogs as experiencing moderate stress and 28.9% showed high-stress levels. The Bayer veterinary usage study found that 40% of cats had not been to the vet in the last year and one of the main reasons given by clients was their cats were difficult to get in the crate and showed signs of stress at the veterinary clinic [2].  These studies indicate that many pets have developed negative associations with veterinary clinics and they start showing signs of stress long before they enter the exam room.  Stressed animals increase the risk of injury to staff, cause pet parents to put off bringing their pets in leading to later diagnoses and lost revenue.

The good news is there are many options for reducing stress while waiting for veterinary visits that are low cost, although some of the best options may only be achievable when renovating or building a new clinic.

Options for Owners

  • Dogs who waited outside were correlated with lower heart rates and serum cortisol concentrations than dogs who waiting in waiting rooms [3]. If the weather allows, arrange to stay outside when scheduling an appointment.  Upon arrival, call the clinic to check in from the car and then take your dog on a sniff walk near the clinic.  The clinic can either call the pet parent’s cellphone when an exam room is ready or come to the entrance door and escort the pet parent to the exam room.
  • If waiting outside is not an option, teach your dog to be calm in the waiting room. Look up a relaxation protocol and start working on this protocol at home. Learn more about relaxation protocols here.
  • Build your dog’s stay cue and work on the Look At That game. All of these training items should be started in your dogs at home.  Gradually build up to working on it at other locations and eventually utilize it during Happy Visits at the vet clinic. Here is a video of a pet parent using the Look At That game in a veterinary waiting room to help her reactive dog be more relaxed.
  • Bring high value treats and do Happy Visits in between the normally scheduled visits. Take your dog to the clinic and throw a treat party where you plan to wait for scheduled visits, most clinics will gladly accommodate this at no charge.  If your dog shows several stress signs, take a step back and start with throwing the treat party in your car, then closer and closer to your designated waiting area.
  • Use Positive Reinforcement training to teach dogs to walk onto the scale and stay. Many dogs find the scale to scary, by pairing the scale with positive reinforcement training you will be reducing your dog’s fear and making this step easier for you and your dog. Weigh your dog when you first enter the waiting room [4]
  • Bring a friend or family member. When waiting in the waiting room have your dog or cat sit between the two of you or have your animal sit near the edge of the waiting space with both people providing a buffering effect between the animal and the rest of the clientele. If waiting outside, when you enter the waiting area to go to the exam room have one of you on each side of the animal. This provides an effect called splitting and can reduce anxiety. The extra pair of hands is also useful for helping for body blocking any overly friendly dogs if needed as well. This is especially useful for reactive or scared animals.  One study found that dogs who came with couples were more stressed, but this could be because pet parents with fractious pets were more likely to bring their partner [4].
  • If your dog is highly stressed at the veterinary clinic, ask the veterinarian about medications that can alleviate your dog’s anxiety. There are many great options, but please do not use Acepromazine for this purpose [5]. Acepromazine has some important uses, but relieving fear is not one of them. It is a tranquilizer which may make your dog appear calm but it has done nothing to address fear and anxiety and may make it worse over the life of the pet.  Read more about acepromazine here.
  • An in-depth article by Veterinary Services that provides more information can be found here [5].

Low Cost Options for Veterinary Clinics

  • Stagger appointment times so that there are fewer animals in the waiting room at one time. Some clinics stagger appointment start times by 5 or 10 minutes. One study showed that dogs were less stressed when the waiting room is not chaotic, and dogs are given time to relax than dogs that were moved quickly. [6]
  • When possible allow the animal to wait in the exam room instead of the waiting room, give stressed or fractious animals the priority for this option.
  • Create a flexi lead exchange program. Improperly used flexis allow a dog to go from one end of the waiting room to the other in seconds, potentially stressing other animals out and possibly instigating a fight or tangled leashes.  Have clients trade out their flexis for 4 or 6-foot leashes for the duration of their stay at your clinic. Flagler Animal Hospital’s flexi lead exchange program picture went viral on Grooming Foolery.  Here was their facebook announcement that went viral.
  • Veterinary Speciality Center created a PSA video regarding flexi leads which could be shared with clients to encourage use of fixed length leashes.
  • Start doing payments and check-out inside exam rooms so that patients can walk straight from exam room to the exit.
  • Split Waiting Room by the primary species that frequent the clinic for fewer close encounters between species. [7,8]  Please find a way that works for your clinic to prevent situations like the photo.
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Photo courtesy of Kevin Gatlin Photography. This was an intentional setup to showcase what not to do using an empty cat carrier with dog treats inside.  Ideally, owners would leave flexi leads at home and prevent their dogs from approaching other animals in the waiting room.
  • Create Cat only appointment times, so cats will not see dogs and smell dogs less. [7,8]
  • Encourage clients to wait outside with their dogs, make your landscaping walkable and enticing for a sniff walk [3]. Install a park bench away from the clinic entrance.  Post a sign encouraging clients to wait outside and providing the phone number for check-in.
Outdoor Waiting
Photo Courtesy of Renne  Lincoln
  • Play classical, soft rock or reggae music at a low volume [9,10].
  • Train the receptionist to intervene when a dog comes into the clinic overstimulated by the other animals in the waiting room. Intervention options will depend on the clinic’s set up and environment and how crowded the waiting room is. The best option is to move the dog out of sight of the other animals such as going back outside or to an exam room or utilizing a visual barrier or a client bathroom. Have the Receptionist walk in-between the overstimulated dog and the other animals during this move.  Talk to the client about options for next time, such as waiting outside or using a back entrance, or scheduling the dog at a less busy time of day and encourage the owner to have high value treats for an appointment that does not contradict the use of food. Here is a video by Dr. Sally Foote showing how a receptionist can intervene.

Moderate Cost Options for Veterinary Clinics

  • Provide Visual Barriers. Visual barriers are a standard tool in reactive dog classes to reduce stress levels and prevent reactive episodes. There are many ways to provide visual barriers. My favorite for hospitals has complete cubicles with doors which blocks other animals from paying the inhabitants of a cubicle a visit and encourages clients to space out.

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Photo courtesy of Kevin Gatlin Photography and Frontier Veterinary Hospital featuring Astrid and myself role-playing as the obnoxious dog and naughty Flexi Lead dog owner.

Other options include panels coming out of the bench to provide visual blocking for animals sitting near the bench from each other. Cube shelving to divide the waiting room into at least 2 sections.

  • Raised resting locations for cat carriers. These can be benches or shelves. This helps further separate cats and dogs and allows the cats to be in a more natural safe space.  Cubical shelves have the added benefit of providing visual barriers between cats. Have towels or sheets available for owners to cover their carriers covering the front of the cage.  Here is a video by Dr. Sally Foote showcasing the Okaw Veterinary Clinic waiting room where she describes some of the design features she has found useful, they found that by raising the location of the cat carriers, dogs pulled less toward cat carriers and the cats were less stressed.
  • Pheromone diffusers for dogs and cats. Recent studies have shown that pheromones may reduce stress for some animals in the clinic setting, other studies have had inconclusive results. [2,11,12]
  • Floor Scales that are flush with the floor. Herander’s study found dogs found being on scales to be more stressful than the waiting room itself [4]. Great clients will train their dogs to voluntarily hop onto normal scales, but many clients will not do this without active encouragement from veterinary staff, flush floor scales are a nice solution because untrained and fearful dogs are more willing to walk onto these scales. One example of this product can be found here.

Making the Best of Low Cost Options

I take my dog to Murrayhill Veterinary Hospital, they have primarily utilized the low cost options listed above. They stagger appointment start times, allow owners to wait outside, escort fractious pets to and from exam rooms, allow check out and payment in the exam room. They have a spread out waiting area with bench seating along the wall and a couple locations with limited visual barriers, I strongly prefer this arrangement to the U shaped seating arrangement of some waiting rooms. Click here to see their virtual tour. Here is their Fear Free Plan.  Their cooperation and adherence to Fear Free ideas have helped me be able to keep Astrid relaxed and has prevented her from having any reactive episodes in their clinic.

Gold Standard

Frontier Veterinary Hospital has the best designed waiting area I have seen in person. They have 2 fully enclosed cubicles to provide visual barriers and block unwanted animal interactions and additional standard bench seating away from the front entrance for when their clinic is busy. They provide outdoor green space with 2 benches with protection from the rain over 1 of the benches. They keep the waiting room as empty as possible through scheduling and moving clients to exam rooms when available. I am very pleased with their care for my cat’s mental and physical wellbeing and Astrid loved visiting their clinic for this photoshoot.40618471_2136289386583736_5838499055222652928_n

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The Ideal Waiting Room

The ideal waiting room would be no waiting room at all.  In 2016, 1st Pet Veterinary Centers in Mesa, Arizona won the Hospital of the Year with DVM 360 for achieving this.  They made a smaller receptionist area and utilized the space savings to increase the number of exam rooms, Patients are escorted to the exam rooms immediately upon arrival. Here is their feature article on DVM 360.

Conclusion

I understand that change takes time and money. I hope that clinics will consider starting with the low-cost options and when it comes time to renovate or replace waiting room furnishings that clinics will consider the impact their selections have on clients.

Some of these options are not feasible for ER clinics. Because animals in ER clinics may experience increased waiting times in more crowded waiting rooms in a strange place they have never been before with a stressed and emotional pet parent, identifying reasonable ways to reduce stress in this environment should still be addressed because stress can hinder healing [13]. One feature I would really appreciate in ER clinics is visual barriers to help provide both the pet and the emotional pet parent some privacy.

Reducing the stress of dogs and cats at veterinary clinics has many factors, the waiting for appointments is one factor that has many low-cost options.   Reducing the stress of cats and dogs in the veterinary setting has the potential to increase revenue through the increased patronage of clients when they see their animals are more comfortable in the clinic.  To learn more about comprehensive programs for reducing stress in veterinary clinics, I recommend looking into Fear Free, Low Stress Handling, Cat Friendly Practice, Cooperative Veterinary Care by Alicea Howell and Monique Feyrecilde,  and Karen Overall’s Manual of Clinical Behavioral Medicine for Dogs and Cats.  Free resources include this webinar by Marty Becker on Fear Free, Dr. Sally J Foote’s YouTube channel, and the late Sophia Yin’s YouTube channel.

Special Thanks to reactive dog trainer Annie Phenix, author of The Midnight Dog Walker and admin for The Official Midnight Dog Walker facebook group. Her experience during a long wait at an ER with her elderly weak Border Collie Echo provided the prompt for this article and she has been so kind to review this article amidst Echo’s fight with cancer.

References

  1. C Mariti, E Raspanti, M Zilocchi, B Carlone, A Gazzono 2015 The assessment of dog welfare in the waiting room of a veterinary clinic. Animal Welfare 24: 299-305 iSSN 0962-7286 doi: 10.7120/09627286.24.3.299
  2. John O. Volk, Karen E. Felsted, James G. Thomas, and Colin W. Siren. Executive summary of the Bayer veterinary care usage study.  Journal of the American Veterinary Medical Association 2011 238:101275-1282
  3. Perego, R., Proverbio, D. and Spada, E. (2014), Increases in heart rate and serum cortisol concentrations in healthy dogs are positively correlated with an indoor waiting‐room environment. Vet Clin Pathol, 43: 67-71. doi:10.1111/vcp.12118
  4. Hernander L. Factors Influencing Dogs’ Stress Level in the Waiting Room at a Veterinary Clinic. Student Report. Swedish University of Agricultural Sciences, Department of Animal Environment and Health, Ethology and Animal Welfare Programme. [(accessed on 21 December 2016)];2008 Available online: http://ex-epsilon.slu.se/3006/1/huvudversion_klar_lollo.pdf.[Ref list]
  5. Lloyd J. Minimizing Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can Be Done about It. Veterinary Sciences. 2017, 4(2), 22; doi:10.3390/vetsci4020022
  6. Dawson, Lauren & Dewey, Cate & Stone, Elizabeth & Guerin, M.T. & Niel, Lee. (2016). A survey of animal welfare experts and practicing veterinarians to identify and explore key factors thought to influence canine and feline welfare in relation to veterinary care. Animal Welfare. 25. 125-134. 10.7120/09627286.25.1.125.
  7. Volk JO, Felsted KE, Thomas JG, Siren CW J Am Vet Med Assoc. 2011 May 15; 238(10):1275-82.
  8. Lloyd, J. K. F. (2008). Concepts in animal welfare: environmental enrichment. The New Zealand Veterinary Nurse, 48(14), 22-27.
  9. Engler W, Bain M. Effect of different types of classical music played at a veterinary hospital on dog behavior and owner satisfaction. J Am Vet Med Assoc 2017, 251, 195-200
  10. A. Bowman, Scottish SPCA, F.J. Dowell, N.P. Evans. The effect of different genres of music on the stress levels of kenneled dogs. Physiology & Behavior. 2017; 171 : 207-215
  11. Kim Y-M, Lee J-K, el-aty AMA, Hwang S-H, Lee J-H, Lee S-M. Efficacy of dog-appeasing pheromone (DAP) for ameliorating separation-related behavioral signs in hospitalized dogs. The Canadian Veterinary Journal. 2010;51(4):380-384.
  12. Landsberg GM, Beck A, Lopez A, Deniaud M, Araujo JA, Milgram NW. Dog-appeasing pheromone collars reduce sound-induced fear and anxiety in beagle dogs: a placebo-controlled study. The Veterinary Record. 2015;177(10):260. doi:10.1136/vr.103172.
  13. Jessica P. Hekman, Alicia Z. Karas, Claire R. Sharp. Psychogenic Stress in Hospitalized Dogs: Cross Species Comparisons, Implications for Health Car, and the Challenges of Evaluation. Animals 2014, 4(2), 331-347; doi:10.3390/ani4020331

 

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wheredogsandsciencemeet

I am Rebekah Hudson. I am a Fear Free CVT and am the Admin of Canine Research Studies facebook group. I have a BS in Biology and am currently working on a masters in Biostatistics (basically doing math for scientists). I love training animals, but training people not so much, so I adopt reactive dogs and help them transform into good canine citizens. My work experience has lead to skills in finding, reading, and understanding scientific papers.

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