Outdoor Exam Rooms
Veterinary design trend offers options for appointments with social distance.
As essential businesses, veterinary practices raced to adjust how clients access their services in the early weeks and months of the COVID-19 pandemic. In many communities, that meant not allowing clients inside the facility at all. It has been an adjustment for everyone, but all those parking-lot handoffs may have provided the perfect preamble for the next stage.
Outdoor exam rooms have the potential to address two issues at once:
- Providing veterinary team members and clients the chance to connect while maintaining social / physical distance
- Giving fearful pets more space and less stress during exams
The act of walking into the veterinary hospital feels like running a gauntlet of smells and other triggers that can ramp up fear for some patients. After braving the entry area, it’s no picnic in the typical practice lobby either, depending on the sound levels and number of people and pets there waiting. Then, patients go into relatively small indoor exam rooms that can increase feelings of being trapped. And, that’s all before anyone from the practice team starts the official appointment.
Marty Becker, DVM, founder and CEO of Fear Free, which certifies individuals and whole practices that use strategies to lessen patient fear levels during veterinary encounters, explains, “One of the things we’ve learned from Fear Free is that each pet has different triggers. What triggers fear, anxiety, and stress? What basically triggers a panic attack or PTSD? It’s different for each pet.”
Another challenge that makes veterinary experiences harder, he says, is that most pets don’t get enough time outside – with us forever telling them to hurry up on potty breaks or on walks. Being outside, unrushed, and calm is good for us. It’s especially good for pets.
Taken in combination, potential triggers and lack of outside downtime, it makes sense that outdoor exam spaces may make some pets feel less worried in a veterinary setting. Becker says it’s likely the fact that outdoor exam spaces reframe the scenario for pets in several ways:
- Pets don’t feel as confined.
- They get to enjoy outside smells.
- They benefit from robust air exchange.
While first steps toward outdoor veterinary exams can start as easily as examining pets in their own cars or in a designated area of the parking lot, the trend toward veterinary designs that include outdoor exam and treatment spaces is growing.
Outdoor veterinary exams can start as easily as examining pets in a designated area of the parking lot.
Outdoor exam rooms are part of
something called biophilic design, explains Heather E. Lewis, AIA, NCARB, a
principal with Animal Arts, an architecture firm based in Boulder, Colorado,
that specializes in humane animal care facilities (veterinary hospitals, animal
shelters, and some pet boarding facilities).
“Architects like to use fancy words,” she jokes, “but it’s a way of justifying through science and some actual discipline that it’s important to have people and nature connected in physical spaces.”
She goes on to explain, “What we’ve learned is that people respond really well physiologically to connection with the out of doors, and animals do as well, so when we have people and animals in a space, having some physical connection to the out of doors can be calming … When we talk about animals, physiologically similar to human beings, I think it’s even more important to do the right thing for an animal because they don’t know why they are going to the hospital, and the hospital is sometimes inherently stressful or scary or has the potential for stress and scariness.”
Calling outdoor exam spaces an “incredibly nice tool for a hospital to have,” Lewis says these spaces can be particularly useful for dogs who are hard to handle or very fearful. In addition, they provide another comfort care option for a euthanasia appointment outdoors—especially if you can add some pet-safe plants, flowers and a trickling fountain.
Lewis offers these design considerations as a starting point:
Size: At least 10 x 12 feet, even 10 x 16 feet, which should allow for practitioners and clients to keep at least 6 feet between them.
Overhead weather protection: At least partially covered so that it can be used in more types of weather by providing sun and precipitation protection (roof overhang, sun sails or shades, etc.).
- South facing works well in most climates because you can shield summer sun with an overhang but still get winter sun in colder months.
- East facing also may work well in most climates.
- West facing in most North American climates is going to be too harsh and hot in the afternoon.
- North facing will probably be too cold and shady much of the year, except maybe in southern Florida with moderate winter temps and need for total shade in the summer heat.
Other needs: Hose bib, concrete pad with radiant heat to melt snow, if needed.
Comforts: Overhead radiant heaters, like what restaurants with patios use. “If you orient the building properly in relation to this exam area and then put in a few comforts, then you can use it more times of the year,” Lewis says.
Fencing: 6-foot fence, with no gate to the outside or a double-gate system. Wood works, but metal fences or vinyl plank fences are easier to clean and disinfect.
Furniture: Garden benches for seating, sun-resistant fabric cushions, large ottoman with washable covers for examining small dogs or padded areas on the ground for examining bigger dogs.
“I want to say that the nicest outdoor examination spaces are actually spaces that are connected to an indoor exam space,” Lewis says.
Convenience caution: Bishop Ranch Veterinary Center in San Ramon, California, started using an outdoor exam space about four years ago. It’s located off an exit door that the practice doesn’t use as an exit. Hospital director Margaret Simuro says, “It’s a good idea, but it’s in the wrong location for us. It’s hard for doctors to get to. They have to go around the building, so it’s not ideal.”
What about cats?
Outdoor exam spaces for feline patients need to be fully enclosed, including a secure top. Think screened-in catio.
“I am convinced that some hospital is going to do an indoor/outdoor catio for their cat exams, which I think is going to be delightful, and to my knowledge, it hasn’t been done yet,” says Heather E. Lewis, AIA, NCARB, a principal with Animal Arts.
Q&A with Allison Malandra, DVM
Pet Health Center of Tiffin, Tiffin, Iowa
How is your outdoor space set up?
We had an existing outdoor kennel that connected to our “isolation” area, so the concrete slab/drainage was already present. We would take dogs with or without owners outside to our fenced backyard not uncommonly to reduce stress. This was a large space with no seating and no protection from the elements. We wanted to utilize an existing space to better meet this need. We removed the wire fencing and had an all-weather privacy fence installed. The dimensions of the space are 10' x 14'.
There is an outdoor rug and patio furniture with a large umbrella we can use, if needed, depending upon the time of day/sun position and temperature.
We were also sure to purchase outdoor furniture that went to the ground, so there was no way for the animals to try and climb underneath the chairs and couch.
What kinds of patients are best suited for outdoor exam? Do you have criteria for when/how it’s used?
Because it is not completely secure (no cover and small gaps under the fence), it is only used for medium and large breed dogs. We have dogs that are “known” reactors when they enter the building and/or the normal exam rooms. Generally, these are just anxious dogs that are evasive in the exam room. Those dogs are scheduled for the outdoor exam room and don't even enter the building.
The vast majority of the time its use has been more impromptu—i.e. there is a nervous dog acting very evasive/anxious, and we say, “Let’s try going outside and see how the dog responds.” A lot of the time they are immediately, visibly more at ease out of the building and usually distracted by the different smells/sounds of the outdoors.
We have had many referrals from local trainers as well as clients who have heard about the space from friends and called to schedule their own pets.
It's also a good place for pets with mobility issues since clients can park close and the concrete/rug provides much more traction than the laminate floors in the clinic.
How do you keep it secure? Not only for patient safety but your supplies/equipment and such?
The fence has a gate that is locked, and we open this only when the room is in use. The only equipment that is constantly out there is the furniture. We even bring the cushions inside when not in use.
Our supplies are all kept in the ante-room, and we have most all we need in a portable caddy that can be taken outside. We do occasionally need to run and grab something else, but this has not been a huge issue.
When the outdoor exam room is in use, all the staff in the clinic is aware so safety has not been a concern. We have a portable doorbell we give the clients to ring if they need something which will alert in the treatment area.
Do you have any tips/concerns to share?
The types of dogs that benefit from the outdoor exam room are dogs that need a longer appointment time scheduled as they need a slower more considerate approach, which can be frustrating for staff and clients alike. For some dogs, the fact that they are outside will do nothing to change their anxiety, and sedation will be needed anyway.
Be prepared for weather to affect your scheduled appointments/space usage.
Be prepared for the learning curve which will initially be present for set-up and supply stocking. In the beginning, schedule with known clients that will be understanding if things take longer and a few trips are needed inside to grab things.
Every client that has used the outdoor exam room has been so grateful that it was an option. They appreciate that we care to go above and beyond to make the visit less stressful for them and their dog(s).