Healing at Home
Newly launched Equi-Assist program allows patients to recuperate in the comfort of their own barns while also allowing New Bolton Center researchers to gather important data
Eby has been through a lot. Complications following surgery to remove his diseased upper incisors left 26-year-old retired Thoroughbred racehorse thin, in poor health and depressed.
But, since returning to his home turf at the end of December, Eby has been thriving in his familiar surroundings.
Because of his previously poor health, however, the horse needed continued careful monitoring of his weight, body condition and general demeanor to ensure a total recovery. And, while the barn manager where Eby is located is a competent, seasoned equestrian, providing day-to-day care for the many horses in the barn demands all of her time. The extra care and close monitoring that are crucial to Eby’s continued improving health are often too much for her busy schedule.
Eby’s case presents an ideal scenario for Equi-Assist.
Home field advantage
Equi-Assist is the innovative equine home nursing care program developed through the Laminitis Institute at the School of Veterinary Medicine’s New Bolton Center and the vision of Margaret Hamilton Duprey. The basic premise is to provide a high quality, clinical and post-hospitalization nursing service to all equine patients at their home or lay-up facility, within a reasonable driving radius of the campus. Launched in December 2010, the program is the first of its kind anywhere.
The equine home nursing care program is grounded in the same principles that have caused an explosion in home nursing care for humans: • Patients are more comfortable and more secure at home than in the hospital, and therefore more likely to recover faster; • Home nursing care provides a savings over exploding hospital costs; • The technical skills of a home nursing professional are available at every stage of recovery.
Laminitis, or founder, is a painful and life-threatening condition in which the tissue bonding the coffin bone of the foot and the hoof wall becomes inflamed.
When Ms. Duprey, a well respected, lifelong equestrian in Chester County, Pennsylvania, learned first-hand about the time and skill required to care for a laminitic horse properly, she realized the need for a medical service that offers high quality, highly skilled, compassionate and experienced professional care. This service would bridge the gap between hospital and home care for horse owners, something she was not able to provide safely and competently on her own.
Ms. Duprey approached Dr. James Orsini, associate professor and director of the Laminitis Institute at Penn Vet, to brainstorm the creation of a home care nursing program for horses and, once the idea took shape, she was instrumental in guiding the design of the program. Ms. Duprey made a generous gift to Penn Vet to see the program completed.
“I’m thrilled to see a dream, a vision and a program setting quality-of-care standards for equine health, become a reality,” said Ms. Duprey.
A wealth of care
When Eby first returned to his home barn following surgery, it was Equi-Assist nurse Jennifer Wrigley who noticed the gelding was not bouncing back to his normal self as quickly as he should. Under Dr. Orsini’s direction, Wrigley quickly began treatment, starting fluids and giving the clinician a precise and detailed account of the horse’s clinical signs and response to therapy.
Now that he is completely recovered, she continues to check on Eby once a week. Wrigley monitors his general body condition, ensuring that he is maintaining the proper weight for his age and level of exercise and that his daily nutritional needs are met. With more than 15 years of clinical nursing experience, she runs her hand down his legs to check for heat or swelling, and feels his feet for heat or an increased pulse. She looks at his mucous membranes and observes his eyes, checks for nasal discharge, listens to his heart, lungs and bowel sounds and draws blood for periodic lab tests when indicated.
Wrigley also makes use of the latest pocket technology, taking digital pictures of Eby to share with the horse’s primary care veterinarian, the doctors at New Bolton Center and the owners. Videography is occasionally part of the clinical picture, used to document a horse’s behavior for analysis by clinicians at New Bolton Center.
One of the goals of the Equi-Assist program is, according to Dr. Orsini, to “redefine what is possible in stall-side nursing.” In 2006, the average hospital stay for an ill horse was seven days. In 2010, it dropped to four days, a situation that makes the need for more skilled care for equine patients returning home even more compelling.
By taking on the role of the communication bridge between owner, primary care veterinarian, New Bolton Center clinician and farrier, the Equi-Assist nurse is able to optimize continuity of care. In addition to monitoring general health, the Equi-Assist nurse has the expertise and experience to clean and rebandage tricky wounds, provide post-operative care, tend to neonates, deliver difficult-to-administer medications, monitor pregnant mares and much more.
In the case of horses suffering from laminitis, home care might include pain management, assessing nutritional needs and bandage changes. Trained in equine massage, the Equi-Assist nurse can also provide for stall-bound patients the benefits of total body massage. Perhaps most importantly, the trained equine nurse is able to identify emerging problems quickly so that small problems do not become big problems.
Benefits for the future
The costs and health benefits of early hospital discharge are clear. The average daily stay for a horse at the George D. Widener Hospital for Large Animals is variable, and can run into many hundreds of dollars. The cost for professional care through Equi-Assist is often a fraction of the in-house cost, based on a mileage charge and the length of time the home visit requires. Dr. Orsini believes that the non-tangible results will be even more valuable. While health care professionals in the human world investigate the benefits of early discharge and continued care at home, parallel studies have not taken place in the animal world.
“Our research efforts will focus on critically assessing our hypothesis that horses do recover faster and with less stress at home than they would in a hospital setting,” said Dr. Orsini.
The program will also contribute to the development of evidenced-based treatment protocols. Care at home, coupled with investigations at New Bolton Center’s labs could have even greater short-term results.
“Ultimately we would like to identify clinical or biochemical markers enabling us to take preemptive action to prevent a laminitic event or other post-hospital complication,” Dr. Orsini said.
A model for care
As New Bolton Center veterinarians release their patients to the care of Equi-Assist professionals, and local veterinarians refer clients to the service, the shape and scope of the program will become more clearly defined. Additional nurses are in training, and it is envisioned that, as the program enjoys growing success, the Equi-Assist team might define a new veterinary technology specialty in home care nursing.
“Our goal is for this program to become a model for the standard of care in the home environment,” said Dr. Orsini.
James Orsini, DVM, DACVS is an associate professor at New Bolton Center with a special clinical and research interest in laminitis. As director of the Laminitis Institute at Penn Vet, Dr. Orsini is responsible for setting strategic direction.
“We have a mission to make certain that the next generation of researchers and clinicians see laminitis as an important area for investigation and even solving the puzzle,” he said.
Established in 2008, the Laminitis Institute is currently involved in three major projects (see Laminitis article). In its brief history, the Institute brought international awareness to the need for advanced research, promoting international cooperation and collaboration.
Patricia Welch, BS is associate director of Equi-Assist and oversees day-to-day operations of the program. An integral player in the development and leadership of the Laminitis Institute's core missions of research, education and clinical service, Welch has more than 20 years of combined experience in the private and academic management sector, including a background in accounting and business.
Jennifer Wrigley, CVT is the program’s first Equi-Assist nurse. A certified animal health technician, Wrigley has 15 years of clinical experience in critical care, medicine and surgery. She has received advanced training in nutrition as well as equine massage. Wrigley has a special interest and experience in caring for horses with laminitis, equine nutrition, neonates and post-hospitalized equine patients. Wrigley coauthored a book chapter entitled "Homecare for the Chronic Laminitis Case" in Veterinary Clinics of North America: Equine Practice.
They Are What They Eat
Equi-Assist also provides clients with an Equine Home Care Nursing Program Nutritional Consultation service, based on the nurse’s training in the requirements and current recommendations in equine nutrition. A board-certified nutrition specialist reviews all nutrition consultations, and recommendations are made for maintenance of health, recovery and peak performance. An initial visit allows for review of the horse’s current feeding program by acquiring body condition measurements, assessing pasture conditions, reviewing of current food types and amounts and analyzing feed and forage nutrient formulations. A second visit follows two weeks later and, equipped with a written report of all analyses, interpretations and relevant nutritional information, recommendations are made for an improved feeding program, which takes into consideration the management style and the needs of the caregiver. The program is reevaluated as needed.