A veterinary practice: vet and nurse records merged into one timeline
A mixed veterinary practice in Shropshire was keeping two parallel sets of patient notes, one by the vets and one by the nurses. Reconciling them at discharge was a daily argument.
The reading
A mixed small-animal and equine practice in rural Shropshire. Four vets, six veterinary nurses, two receptionists, a practice manager. The practice ran a standard veterinary PMS, but the vets used it in one way and the nurses used it in another, with the result that each patient effectively had two sets of notes.
The vets recorded diagnoses, prescriptions, and clinical decisions. The nurses recorded observations, nursing care, feeding, and the small practical details of a hospitalised animal. Each regarded their own records as the primary record; neither regularly read the other's.
At discharge, the practice manager tried to produce a coherent summary for the owner. On most days, she managed. On the busy days, important details did not reach the owner.
Two records, one animal
The division was partly cultural (vets and nurses used the system differently because they had been trained differently) and partly structural (the PMS had separate note types for "clinical" and "nursing" that did not share a timeline).
The senior vet was aware that she sometimes prescribed against observations she had not read. The senior nurse was aware that she sometimes recorded a change in condition that the vet did not see for a day. Both wanted the problem solved; neither had the time to solve it.
- 2 record types per patient, no shared timeline
- Approximately 40 hospitalised patients a week
- Discharge summary reconciliation by one person
- Occasional prescription-against-observation incidents
- No single view of a patient's day in the practice
What we built
We did not replace the PMS. We built a reading view that pulled vet notes, nurse notes, prescriptions, observations, and treatment entries into a single chronological timeline per patient. The vets and nurses continued to enter notes as they always had; the timeline showed everything, interleaved, to anyone who opened the patient record.
The technical choice we are satisfied with: the timeline was read-only. Writes continued to go to the PMS through its existing interface. We did not try to be clever about where a note "belonged"; the timeline simply showed everything in time order, with a small icon indicating role. The senior vet described the result as "finally being able to see what happened overnight".
Stack: a .NET service reading the PMS SQL database on a 60-second poll, Postgres for the timeline cache, a web view the staff opened on wall-mounted screens in each prep room.
The numbers at ninety days
| What | Before | After |
|---|---|---|
| Prescription-against-missed-observation incidents | 3/month | 0/month |
| Discharge summary preparation time | 25 min | 6 min |
| Vet reading of nursing notes | Occasional | Routine |
| Owner complaints about discharge information | 11/quarter | 2/quarter |
| Staff asking "what happened overnight?" | Daily | Rare |
The record is the animal
The practice's older framing was that there were two professional perspectives on each patient. The newer framing, after the timeline, was that there was one animal with two professions attending to it. The timeline made this obvious; the system had been encouraging the opposite.
The one-week training test here was simple. A new nurse joined in month four, read the timeline on day one, and asked a question about an observation from a vet that she would not previously have seen until the end of the week. The system is doing what it should: making continuity of care the default.