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Dr. Davidson on the Terry Center

Dr. Michael Davidson, CVM associate dean and director of veterinary medical services, discusses the advanced diagnostic and treatment technologies available through the Randall B. Terry, Jr. Companion Animal Veterinary Medical Center; what the Terry Center will mean to companion animals, clients, and referring veterinarians; how the medical facility enhances CVM teaching and research; and why the Terry Center is a State of North Carolina resource that will improve human as well as animal health.

How important is the opening of the Terry Center to the CVM?                                                                        

It’s incredibly important that we continue to provide the best in patient care, clinical research, and veterinary education. The Terry Center will most assuredly provide a strong foundation for these efforts for decades to come. It was a totally different era in veterinary medicine when the Small Animal Veterinary Teaching Hospital was built in 1983. Essentially, the hospital was designed and operated as a large general practice. There has been nothing less than an explosion in specialization during the past 27 years. We now have a state-of-the-art veterinary medical center that is designed as a multidisciplinary specialty practice. Another aspect that has changed is our house officer population. As recently as 2003 we had 30 officers [residents and interns]. We now have 82. House officers come to us for specialty training and the Terry Center is ideal for that since it is a group of specialty practices. Another change is that animal owners are willing to pay for and expect high quality advanced medical care. Our new facility reflects all of this. It is an incredibly important step in the evolution of the CVM, and a step in the evolution of veterinary medicine.

What are the features and technologies in the Terry Center that are most exciting?

One of the technologies I’m particularly excited about—and one that I think will develop tremendously during the next 10 to 15 years—is the biplane fluorocopy unit. The fluorocopy unit will help revolutionize surgical techniques; it allows a minimally invasive procedure to accomplish what had been done with major surgeries involving a large incision, prolonged time on the operating table, and prolonged healing time. The fluoroscopy unit allows the Cardiology Service to perform interventional procedures, of course, but patients in other services—neurology, soft tissue surgery, orthopedic surgery—are going to benefit as well. The biplane fluorocopy unit offers the ability to see the body’s internal structures in fine detail and manipulate those structures in a way that’s not possible with traditional surgery tools. I’m also excited about our new Emergency and Critical Care Service with the greatly expanded Intensive Care Unit. We have three dedicated emergency exam rooms as well as a separate pavilion entrance for emergency cases. Our faculty expressed an interest in developing the ER as a trauma center so that animals with life-threatening injuries can be triaged, treated much more quickly, and saved. Of course, there is so much more—the 64-slice CT scan, which provides dynamic images in seconds rather than minutes with the previous 16-slice CT, the new linear accelerator, and our four ultrasound stations for advanced noninvasive imaging. We moved from five surgery suites to 10, and we have doubled the number of exam rooms to 30. There’s a spacious pharmacy, plus all of the patient-focused design features. Another element is nonmedical, but it’s a point of pride. The Terry Center is a LEED-certified building. LEED is an acronym for Leadership in Energy and Environmental Design. The certification process is exacting and involves natural heating and cooling, the type of construction materials used and how much is recycled and of local origin, and various other sustainability efforts. The Terry Center is one of the first ‘green’ specialty veterinary medical centers in the United States. All of this is very exciting.

You mentioned the Terry Center is designed as a multidisciplinary specialty practice. What does that involve?  

The Terry Center, in fact, is an integrated collection of specialty healthcare service clinics. Each service area was designed after consulting with the clinical faculty and staff in that discipline. So the features of the Ophthalmology Service were influenced by the clinicians and staff in ophthalmology. The Cardiology Service has all the features and technologies that were deemed necessary or useful by the cardiology staff, and so forth.  I would say every service has a ‘value-add’ that the clinicians requested. For example, the Ophthalmology and Neurology Services each have a special copper-shielded, electro-diagnostic room that helps prevent the interference of the signals required for leading-edge diagnostics. In the past, the services shared a single room that was not shielded. We designed the Terry Center not only around advanced patient care and clinical procedures, but also teaching and professional enrichment. Each of the services has a spacious rounds room—a dedicated teaching area that is an important design feature. The building design offers space for the house officers, for DVM students, and for the faculty to teach.

Teaching, then, remains a cornerstone of the Terry Center even if the word ‘teaching’ is not part of the name as in the original Veterinary Teaching Hospital?

Preparing the next generation of veterinarians, veterinary specialists, and veterinary researchers is why the State of North Carolina established the College of Veterinary Medicine. The Terry Center is one component of this educational enterprise that promises to enhance the training of our DVM students and house officers and help us expand clinical research opportunities. All of the operating rooms have the capability of having a camera mounted in the surgical lights and we have created an audio/visual system that can transmit surgery images to the rounds rooms, our theaters and classrooms, or on closed circuit television within the Terry Center and CVM. We will have the capability of having a senior clinician be at home, log on, and observe a resident do surgery.  Our DVM students, even if they are going to be general practitioners, need to understand and be knowledgeable about specialty medicine to offer appropriate referral care to their patients. Our specialty practices are where students gain problem solving and critical thinking. While it’s a less hands-on technical experience, it’s where our DVM students get to think about their cases, formulate a diagnostic plan, and a treatment option list. These are necessary skills for a successful practitioner. Importantly, the transition to the Terry Center also means we are able to renovate the Small Animal Teaching Hospital into the Veterinary Health and Wellness Center, which will provide primary care experiences for DVM students and create needed space for various support functions such as clinical trials, blood bank services, behavior medicine, dentistry, nutrition, and continuing education for veterinarians, veterinary technicians, and animal owners.  Teaching remains the foundation of what we do.

You referenced clinical research trials. Do you expect the Terry Center will enhance CVM research?

The Terry Center and the College of Veterinary Medicine are located on the NC State University Centennial Biomedical Campus. Research, of course, is part of our mission. The close connection between clinical research and basic or bench research has always been a CVM hallmark. This effective ‘One Medicine’ relationship has been enhanced further with the creation of the Clinical Studies Core through the NC State Center for Comparative Medicine and Translational Research. There is a great partnership between the clinicians, clinical research, and the scientists in the Center for Comparative Medicine and Translational Research or the CCMTR. Many of our Terry Center clinicians are also CCMTR researchers. We expect the advanced technologies in the Terry Center will not only enhance care of the individual patient, but will offer further opportunities for clinical research into the various disease mechanisms. This, in turn, is of great interest to the comparative biomedical researchers in the CCMTR who are able to study the causes—and possible cures—of naturally occurring diseases in companion animals. A dog or cat that lives with us and develops a naturally occurring disease is a far superior study model than a lab mouse with an induced disease. What is learned in a Terry Center oncology clinic about canine lymphoma, for example, can have direct benefit to human medicine. This is why we have ongoing collaborations with the Lineberger Comprehensive Cancer Center at UNC Health Care System and Duke Medical Center, to name but two of many CVM research partners.

Patient comfort as well as health and well-being are elements in the Terry Center building design?

Yes, definitely, and staff members are also part of the equation. The intent was to build a veterinary medical center that focused on patient care but also staff efficiency. The abundance of natural light we have throughout the Terry Center, thanks to large windows and skylights, is an important physical element in animal recovery, as well as providing a pleasant work environment for our staff. The exercise yard behind the Intensive Care Unit is a beautiful space—not just an empty corner. Getting the animals outside in the fresh air and moving is really important in the healing process. There are other elements that marry design and function. For example, we now have a reverse isolation unit to serve the Canine Bone Marrow Transplant Program. The reverse isolation unit is a special air filtration system that protects the bone marrow transplant patients while they are immunocompromised during recovery. We also have high flow air filtration in four different isolation units so we could treat four patients with different infectious diseases. The Intensive Care Unit also has what we call ‘night comfort’ lighting so the 24/7 staff can work but the patients can sleep without bright lights.

How will the Terry Center change the experience clients have when they bring their cat or dog in to be seen by one of the services?

Client consideration was underscored by the design team in its planning sessions. There are separate pavilions and reception areas so patients are admitted more quickly and clients can enjoy a less crowded and more comfortable space. There’s a pleasant coffee shop that is part of the Terry Center. Wireless connections are available everywhere in the facility. So a waiting client can have coffee and something to eat while checking e-mails, working, or whatever. There are nice outdoor spaces, including the Normin Garden—a contemplative space where a client can reflect, be with their animal or with family members. The reason clients come here, of course, is for advanced specialty care for their pets. One consideration that is not readily apparent but is important is that the scheduler the client calls to make an appointment is the same person who greets the client as the receptionist in the service pavilion. This is beneficial for client and client relations. Another change is that a special pneumatic tube system transfers specimens to labs to speed patient diagnosis and to deliver the prescribed medication to the client in the pavilion reception area as the patient is being discharged. No more walking to the pharmacy and waiting for a prescription.

Another critical public for the Terry Center is the referring veterinarian. What changes will veterinarian partners see?

We have a 95 percent client satisfaction score once the pet is seen by our services. This is great positive reinforcement for our referring veterinarians. The key phrase is “once the pet is seen.” The capacity and features built into the Terry Center will allow us to handle more cases and handle them more efficiently, which will be appreciated by our referring veterinarians. As but one example, outpatient care will be streamlined with these ‘day’ patients having separate areas designed around their particular treatment requirements and staff needs for case efficiency. Another consideration high on the referring veterinarian’s list is timely and effective communication. We have incorporated new features into the telecommunications system so that when a veterinarian calls to check on a patient’s status, that call goes to the appropriate service and clinician. No more leaving a voice mail message and waiting for a call back. We are moving toward e-mail consults and have established web pages where an interested veterinarian can request an electronic consult. The goal is having referring veterinarians and Terry Center clinicians work as one team providing seamless patient care. We worked hard to develop this teamwork and we’ll build upon it in the Terry Center.  

The Terry Center complex is a $72 million undertaking during a time of budget cutbacks and fiscal constraints. Is there a concern about spending in this environment?

You are right to use the term complex because the project includes building preparation, infrastructure, a parking deck, rerouting William Moore Drive, and other related activities. Funding for the Terry Center is accomplished through an innovative public/private partnership that began in a very different fiscal climate. Some dozen years ago Mr. Terry donated about $3 million to initiate the planning process. This allowed us to have design and building and construction documents in hand when we approached the university and the State of North Carolina with a feasibility plan of creating one of the best veterinary medical centers in the nation. Following Mr. Terry’s death in 2004, the R.B. Terry Foundation presented NC State with $20 million to build the Terry Center. The NC General Assembly provided $38 million in 2006 appropriations. We are now raising the remainder of the funds from private sources and are grateful that the R.B. Terry Foundation will match these donations. It’s important to remember that we remain in a fundraising stage, and we encourage individuals to participate in Mr. Terry’s vision of building a national model of excellence. As envisioned by Mr. Terry, the Terry Center is a state resource that advances human as well as animal health. It’s a valuable component to NC State University’s Health and Well-Being initiative, and will be a significant contributor to the critically important biomedical research collaboration within Research Triangle Park, the state, and the nation.