feral‐like behavior or deemed unsafe to handle on entry should be identified so that they can be housed appropriately in enclosures that are especially secure and designed to minimize animal handling and stress, such as those that contain guillotine doors for dogs, or cat dens for cats. See Figure 2.1a and 2.1b.
2.3.2 Step 2: Problem Identification
The second step in medical problem solving is problem identification. Problems are identified based on the information gleaned from the animal's minimum database. These include historical, physical and behavioral problems as well as quality‐of‐life/welfare, public health, and/or safety concerns. Problems should be stated at their current level of understanding, and historical problems should be verified whenever possible.
2.3.3 Steps 3: Plan Formulation
If problems are identified, a plan can be formulated to address them within the mission, philosophy, and resources of the shelter, and with respect to state and local laws that stipulate legal holding periods that allow owners the opportunity to find and claim their pets. Plan formulation ideally involves outlining the clinical reasoning process to rule in/out potential causes or differential diagnoses for each problem identified. The plan should take into consideration three elements, including any necessary (i) diagnostic testing, (ii) initial therapy, and (iii) relevant staff and/or adopter education.
2.3.4 Step 4: Assessment and Follow‐Up
The final step in medical problem solving is assessment and follow‐up. This involves making calculated clinical appraisals based on available patient data and outcome options and documenting case progression over time. Timely action is essential in the shelter where animals may be triaged to adoption, foster care, rescue groups, isolation, or euthanasia. Plans and outcomes must be continuously moved forward through the shelter system with efficient ongoing assessments as needed. Regular reassessment is imperative, especially for animals that undergo long‐term stays in shelters, to update known problems and to identify any new problems that may develop. In this way, all problems can be addressed in a timely fashion to ensure the wellbeing and safety of the individual animal as well as that of the population and the shelter staff.
Figure 2.1 (a and b). A commercially available “cat den” serves as a secure hiding place for a fearful cat. The den's circular portal door can be closed from a safe and nonthreatening distance while the cage is spot cleaned as needed. The cat can also be securely transported in the den and the guillotine door provides a means of safe transfer to or from another box style enclosure, such as a trap or squeeze cage, if needed.
A very useful initial assessment that facilitates triage of individuals and efficient population management involves designating animals as either “fast” or “slow track” based on the findings in their initial minimum database. Fast‐track animals are those that enter the shelter in good physical and behavioral health and thus may be rapidly processed for immediate placement in adoption, foster care, or with rescue groups, serving to minimize the LOS of these animals. This, in turn, can be expected to free up more time and resources for slow‐track animals that may require special medical and/or behavioral care. Identifying and triaging fast‐ and slow‐track animals at intake facilitates efficient care, which helps reduce LOS, and ultimately promotes both individual animal and population health (Newbury and Hurley 2013). Please see the Introduction in Chapter 1 for more detailed information about fast‐ and slow‐track management.
Many shelters elect to house animals with existing medical or behavioral problems that may be designated as slow‐track animals. When special needs animals are housed in the shelter, it is imperative that an efficient and humane plan for diagnosis, treatment/management, monitoring, and housing is implemented. Special needs animals should not be kept in the shelter unless appropriate medical and behavioral care can be provided for them, including adequate pain control. When determining if animals with special needs can be humanely cared for in the shelter, the following goals and considerations should be addressed:
Will the care provided to the animal result in a cure or adequate management of the disease or problem behavior?
Will the animal be adoptable?
What steps can be taken to minimize the holding time required for treatment?
What measures must be implemented to prevent transmission of disease to other animals or people?
Can the shelter afford the cost of and time for care?
How will holding the animal impact resources available for other animals?
Can adequate care realistically be delivered in the shelter or in foster care?
What factors will be used to assess if the treatment plan is working or should be modified?
If the animal is adopted, what can be done to decrease/eliminate the return of the animal for their special needs?
If the pet is not adopted, what welfare assessments will be used to measure their quality of life in the shelter?
Do humane long‐term care options exist in the shelter?
A regular system of physical and behavioral health surveillance should be in place for the follow‐up of all animals. At a minimum, walk‐through rounds should be conducted twice daily by medically trained staff or volunteers to observe each individual animal as well as the environment for signs of problems. Early recognition and timely action are critical for effective control of infectious diseases and mitigation of emotional distress. According to the ASV Guidelines for Standards of Care in Animal Shelters (ASV 2010), “Just as a severe or rapid decline in an animal's physical health constitutes an emergency situation and requires an urgent response, so do such changes in the behavioral or mental health of an animal.” Post‐adoption follow‐up should also be provided (especially for special needs animals); it may help increase adopter satisfaction and reduce shelter returns.
2.3.5 Medical Record Keeping and Data Collection
Medical records are essential in order to assure quality and timely medical care is provided. Record‐keeping procedures must comply with state and local practice acts and federal drug laws (i.e. Drug Enforcement Act [DEA]) and should follow guidelines provided by state and national veterinary medical associations. Animal shelters commonly use commercially available software such as PetPoint (http://www.petpoint.com), Chameleon (https://chameleonbeach.com) or others to maintain, facilitate, and manage individual animal medical records as well as population data.
A medical record should be prepared for each animal that includes the intake date; an individual animal ID number; signalment; physical description; historical, physical, and behavioral findings and observations; results of microchip scanning; body weight and body condition score; names and dosages of all drugs administered or prescribed and routes of administration including vaccines, parasite control products, other treatments, and anesthetic agents; results of any diagnostic tests performed; surgical procedure(s) performed; any presumptive or confirmed diagnoses, abnormalities or problems that are identified; and any other pertinent information regarding the animal's condition. Standardized examination and operative/surgical reports may be used to document both normal and abnormal findings but should allow for additions