Maximizing Space

In the past, when veterinary medical knowledge was limited, husbandry issues including diet were the predominant focus for patient care. As new diseases were described, nutritional issues did not become any less vital to successful patient care, but their importance was slowly diluted by the sea of new diagnostics and therapeutics that became available to veterinary medicine. Fortunately, our knowledge of nutrition has not remained static as the rest of veterinary medicine has advanced, and thus, the wisdom of integrating diet into a patient’s therapeutic management has been proven in a growing number of disease states. Given the importance of nutrition in veterinary medicine, the goal of this chapter is to illustrate how nutrition can be successfully integrated into any clinical practice.

Sean J. DELANEY
BS, MS, DVM, Dipl DACVN

Dr. Delaney holds a Bachelor's degree in Zoology from the University of California, Santa Barbara, a Master's degree in Nutrition and a Doctorate degree in Veterinary Medicine from the University of California, Davis. He attained Diplomate status with the American College of Veterinary Nutrition following completion of a clinical nutrition residency at UC Davis. He is currently a lecturer in small animal clinical nutrition at the Veterinary Medical Teaching Hospital at UC Davis. He is also the founder of Davis Veterinary Medical Consulting, Prof. Corp., which specializes in nutritional consulting for the pet food industry.

Andrea J. FASCETTI
DVM, PhD, Dipl ACVIM, Dipl ACVN

Andrea Fascetti graduated from the University of Pennsylvania School of Veterinary Medicine. Following graduation she completed an internship and medicine residency at The Animal Medical Center in New York City. She holds a doctoral degree in nutrition from the University of California, Davis. She is a diplomate of the American College of Veterinary Internal Medicine and the American College of Veterinary Nutrition. Andrea is currently an Associate Professor of Nutrition at the University of California, Davis. She is also the service chief for the Nutrition Support Service in the Veterinary Medical Teaching Hospital of the University of California, Davis. Her current research interests are trace mineral metabolism in dogs and cats, improvement of pet foods and taurine bioavailability and metabolism in the dog.

Veterinary medicine is transitioning into a two tier system of providing medical care. The first tier in this system is the primary care provider (PCP). The second tier in the system is the referral practice (RP). In addition, it is assumed that a RP inherently sees more complex and refractory cases as a percentage of its caseload.

Size is not necessarily related to the type of activity; some of the recommendations in this chapter for a RP may be more appropriate for a PCP with a large number of veterinarians. However, this assumption may not hold across all practices, and therefore the reader is encouraged to review and consider all of the following recommendations.

Regardless of practice type or size, there is an inherent need to dedicate space to nutrition. The ability to store and provide more dietary options is somewhat dependent on the quantity of space that a practice allocates for that purpose. Since a significant percentage of a practice's earnings are frequently from food sales, this allocation of space is most likely economically justified. As there are always limitations on the amount of space available, the following section discusses strategies to maximize available space and recommends the minimum inventory necessary to treat the majority of cases.

Veterinary caduceus of the Netherlands. (© A. Fliek).

Veterinary caduceus in France. (© A. Fliek).

From top to bottom:

- Veterinary caduceus of United States
- Veterinary caduceus of South Africa
- Veterinary caduceus of Germany.

Every veterinary practice is different whether that be due to geographic, socioeconomic or practice style differences. Therefore, any guideline that is created cannot anticipate every specific need that a particular practice may have. However, certain significant differences between practices are likely to be universal based on practice size and type.

1. Maximizing Space

If space is limited, the amount of stock on hand will inherently need to be limited. A small inventory demands either one of two management strategies - frequent delivery or limited sales.

Clearly, limiting sales either intentionally or unintentionally is less than desirable. Limited sales can frequently mean that the importance of nutritional management in patient care is under-recognized. This can have a deleterious effect on both patient and practice health.

Orders cannot be placed once a week or month, but rather may need to be made daily in order to prevent prohibitively long delays in providing patients or clients with needed diet. Inevitably, there is a cost associated with having a small inventory. The cost of a small inventory may not be realized if the only cost recognized is the expense associated with the additional square footage and not lost sales or increased labor costs.

A large inventory allows a practice the luxury of having infrequent deliveries and/or high diet demand. This system allows the workload to reduce due to frequent ordering. The downside to this is the added space that such an inventory requires.

A practice that deals with many obese patients may wish to carry a higher percentage of diets designed for weight loss than a practice that focuses on oncology. (© Renner).

Managing Incoming Stock

Several companies have developed control systems that allow product sales to be tracked in addition to assisting with inventory management. This type of sales data allows the practice manager to better assess the practice's needs and to stock a practice-specific diet inventory. Whatever management tool is used, it is necessary to decide:
- The quality offer available to clients;
- The minimum volume to be stocked for each reference.

Selecting Available Products

In an effort to address space limitations a priority should be placed on stocking diets that are used frequently. Diet selection should be based on disease prevalence and the proven importance of nutrition in disease prevention and treatment (Table 1).

The list of therapeutic diets should meet the canine dietary needs of most practices.

Other diets are available for growth and maintenance, degenerative joint disease support, hepatic and cardiac disease support that are not listed in the table, but may be useful depending upon the practice preferences and demographics.

Although a single commercial diet for each category above may be adequate for the majority of patients, there are times when palatability, learned aversions or other qualities will necessitate the use of a diet that is not in stock. To facilitate identifying diets that may serve as adequate surrogates, practices should keep up-to-date product guides for all available manufacturers. These product guides can also serve as references for nutrient data for patients with extensive diet histories.

Almost all patients can be managed through the use of commercial diets; however, a small subset of patients may require specially formulated, home-cooked diets. In these cases special training in veterinary nutrition is recommended to ensure all situations can be handled correctly.

Keeping Inventory at a Minimum

The minimum inventory is equal to the quantity that will theoretically be sold between the order date and the delivery date. If orders are made daily and the delivery time is 24 hours, the minimum inventory must constitute 1/6 of weekly sales. This inventory can of course be supplemented by a safety margin to offset a delay in delivery or increased consumption for a limited period.

An order must be triggered when the stock reaches a minimum threshold. The quantity to be ordered depends on the quantity of products that can be put on the shelves. For various references, it is also important to take into account the potential growth of the sales.

Consistent product usage has the benefit of allowing product performance for a particular disease state to be determined and adjustments in recommendations to be made when indicated. Usage that is too inconsistent may limit the practitioner’s ability to recognize a product’s effectiveness. (© M. Lechardoy. Avec l’aimable autorisation de T. Hazan.).

Storage

Retail Space

Stock must be arranged neatly, separate from the storage zone (Figure 1) and as clearly as possible for the client. Arrange according to species (with a visual for fast identification), then by brand and lastly by product family to help clients find what they want. Labels to the front will make them easier to read.

Figure 1. Example of the floor plan for a veterinary clinic.

Large packs mean you have to have a lot of space between shelves. Since the number of diets that a practice wishes to stock will often exceed the amount of available space, stocking smaller sized bags can allow for increased storage. Using small bags for dietary trials allows the hospital to need less space for food storage and a larger bag can be subsequently special-ordered when the diet's palatability and performance has been proven. Moreover, due to the decreased mass of smaller bags, higher (and easier) shelving can be employed, increasing storage capacity.

Initiating a policy that encourages clients to bring their pet's typical diet from home when the dog is to be hospitalized can also limit the amount and variety of maintenance foods that need to be stocked and prevent the risk of aversion.

Frequent replenishment will facilitate a rapid response to the request of owners, but will increase the workload for staff. (© Davis Nutrition Center).

The Storage Zone Itself

There are four must-dos to use the storage zone optimally:
- Space optimization: reduce the distance between shelves by laying large packs flat;
- Product accessibility: label the shelves to make products easier to find. Large bags should be nearest to the ground.
- Respect storage conditions: products must be kept dry and must not be subjected to extreme temperatures or humidity
- Respect expiration dates: new stock should be placed behind older stock on the shelves.

Managing Outgoing Stock

Outgoing stock should normally trigger three actions:
- Billing and payment or charging
- Stock is updated automatically by the computer system
- A new order to replenish the stock at required levels.