VSS HOSPITALISATION INVOICING SCHEDULE

To define the invoicing pattern for hospitalisation activities at VSS.

• Animals admitted to hospital should have a hospitalisation item invoiced.  If the animal is put into a hospital cage, then an invoice item should be generated.  
• In general, hospitalisation categories will relate to intensity of treatment requirement
• Hospitalisation will be broken into increments of half days (6 hours).  
• Invoicing will occur at a defined time threshold in the 6 hour period.
• At least one hospitalisation item should be invoiced each day if the patient is admitted to hospital.  If there are multiple levels of hospitalisation within a half day (6 hour) period, the higher of the two levels should be invoiced.
• Estimates to clients will contain an approximation item but the final invoice should reflect actual hospitalisation activities.

Length of stay:

• Guideline - 6 hours or less

Reason for Hospitalisation:

• Admit for diagnostics, not requiring sedation or anesthesia

• Patients being dropped off for recheck appointment

Treatment Protocol:

• 1 x TPR
• 1 x 4-hourly check

Examples of these patients would be:

• Blood tests (e.g., ACTH stim, bile acids)  

• Conscious Ultrasound  

• Conscious radiographs 

• Chemotherapy admission

Length of stay:

• Guideline - 6 to 12 hours

Reason for Hospitalisation:

• Admit for post op orthopedic radiographs, requiring sedation or anesthesia (not for patients that have had additional procedures while under GA. EG: Lump removal.

• Admit for diagnostics requiring sedation but not fluid therapy

Treatment Protocol:

• 1 x TPR
• 2 x 4-hourly check

Examples of these patients would be:

• Previous orthopedic surgery patient requiring follow up radiographs - single region only, low care requirement, patient is stable enough to be in dog ward once recovered 

• This fee is also to be used on day of discharge for patients who have stayed overnight following the day of surgery, these patients would be well enough to come off fluid therapy in the morning and scheduled for discharge at anytime during the day

• Patients that have been in hospital for multiple days for treatment. EG Post sx spines with no urinary catheter but bladder management is required  

• Sedation for ultrasound 

• Chemotherapy patients staying for over 6 hours  

• Cardiology patients (Day Stay + Cardio nurses to charge) 

Additional Charges:  

• Blood Pressure - one reading included, if serial (two or more) readings to monitor a patient, then the ‘Doppler blood pressure 0.1’ (PF 6012886) should be invoiced once per day

Length of stay: 

• Guideline - up to 12 hours

Reason for hospitalisation: 

• A patient requiring observation in the main hospital (not suitable for dog ward) 

Treatment Protocol: 

• 3 x TPR 

• 4-hourly checks  

• Patient may have IV catheter in place BUT not on fluids 

• Patient may have feeding tube or urinary catheter

Examples of these patients would be: 

• Admits for minor procedures, not on fluid therapy 

• Patient with urinary catheter or feeding tube, patient NOT requiring fluid therapy BUT requiring observation 

• Twilight GA recoveries for FNA or other procedures NOT on fluid therapy (closely monitored for complications post procedure)  

Additional Charges:  

• Blood Pressure - one reading included, if serial (two or more) readings to monitor a patient, then the ‘Doppler blood pressure 0.1’ (PF 6012886) should be invoiced once per day

Length of stay: 

• Guideline - up to 12 hours  

Reason for hospitalisation: 

• A patient requiring observation in the main hospital (not suitable for dog ward) on fluid therapy  

• This is for any patient requiring IV fluids during their hospital stay (including patient’s under anaesthesia)  

• May include barrier nursing for immunocompromised patients or unvaccinated patients (requires examination gloves only, no additional charges required) 

Treatment Protocol: 

• 3 x TPR 

• 4-hourly checks  

• Patient may have IV catheter in place & be on fluids  

• Patient may have feeding tube or urinary catheter  

• Patient may have up to 2 CRI pumps 

• Patient may require physiotherapy  

Examples of these patients would be: 

• Day one post operative surgical patient 

• A stable medical patient who requires medical fluids (pancreatitis, kidney disease etc) 

Additional Charges:  

• Blood Pressure - one reading included, if serial (two or more) readings to monitor a patient, then the ‘Doppler blood pressure 0.1’ (PF 6012886) should be invoiced once per day 

This item is added to the relevant level of hospitalisation should a patient need genuine barrier nursing. 

Length of stay: 

• Guideline - up to 12 hours  

Reason for hospitalisation: 

• Patients receiving full PPE barrier nursing.   

Treatment Protocol: 

• As per the applicable hospitalisation protocol 1A to 2B 

Examples of these patients would be: 

• Infectious diseases (parvovirus, leptospirosis etc)  

• Neutropenic patients  

• Cytotoxic patients who have recently received chemotherapy  

• Multi-drug resistant patients  

Length of stay: 

• Guideline - up to 12 hours 

Reason for hospitalisation: 

This category should be selected for stable patients, that still require advanced care but are able to maintain their own systemic stability with less time-consuming treatments. These patients need to be observed in ICU rather than hospital but do not require 1:1 nursing care.  

Treatment Protocol: 

• 3 x TPR 

• 2 - 4 hourly checks  

• Patient may have IV catheter in place & be on fluids  

• Patient may have feeding tube or urinary catheter  

• Patient may have up to 2 CRI pumps 

Examples of these patients would be: 

• Cardiac patients requiring hourly respiratory monitoring 

• Post op brachycephalic patients (stable, day 2 post op) 

• Post CSF/Myelography 

• Controlled seizure patient 

• Major surgery completed 2 or more days ago and now very stable 

• Post op stable surgery (eg splenectomy) requiring ECG monitoring 

• Oxygen dependent patients 

Additional Charges to a Critical Care Level 4 fee:  

• Charge oxygen set up initially & then oxygen charges Q6H  

• Charge is under procedures - Oxygen Nasal Setup 0.5 (Initial setup) 

• Charge is under procedures - Oxygen per 6 hours

Length of stay: 

• Guideline - up to 12 hours 

Reason for hospitalisation: 

This category should be selected for patients that require very advanced nursing care, often with 2 or more lines in place (urinary catheter, chest drain, IV line, feeding tube, O2 lines). These patients are often unstable and require lengthy treatments.  

Treatment Protocol: 

• 3 - 6 x TPR 

• 2 - 4 hourly checks  

• Patient may have IV catheter in place & be on fluids  

• Patient may have feeding tube or urinary catheter  

• Patient may have more than 2 CRI pumps 

• Patient may have a chest drain  

• Patient may require nebulising and/or physiotherapy 

Examples of these patients would be: 

• DKA/Unstable diabetics requiring regular blood glucose reading and vet interaction for insulin dose doses 

• Severe pancreatitis patients  

• Septic patients 

• Major post operative care (day 1) - eg thoracotomy, critical exlap 

• Unstable seizuring/neurological patient 

• IMHA patients 

• Post op Brachycephalic respiratory monitoring - concern of airway obstruction  

Additional Charges to a Critical Care Level 5 fee:  

• Charge oxygen set up initially & then oxygen charges Q6H  

• Charge is under procedures - Oxygen Nasal Setup 0.5 (Initial setup) 

• Charge is under procedures - Oxygen per 6 hours

Length of stay: 

• Guidelines - 3 hour allotments  

Reason for hospitalisation: 

• Any patient requiring 1 to 1 vet or nurse monitoring and support 

• This fee is charged in 3 hour allotment  

• A further level of hospitalisation should be charged when 1:1 nursing ceases  

Treatment Protocol: 

• 1:1 nursing   

Examples of these patients would be: 

• The patient would be struggling to maintain its own life.  

• A crash bench priority patient, awaiting a treatment plan. 

• An unstable patient in ICU following a procedure or intervention where high intensity nursing and veterinary care (typically 1:1) is required. 

• A CPR patient. 

Effective date - 13 February 2023