How many after-hours calls does a TPLO actually generate?
Almost no practice knows. The calls land at 10pm on somebody's cell phone and they never reach a report. This is a free four-week count that gives you your own number.
One email back and I send the sheet plus the two-page method. Nothing to install, and you do not have to get on a call.
| Time | A/H | Day | Reason | Min |
|---|---|---|---|---|
| 21:40 | Y | 2 | INC | 11 |
| 23:05 | Y | 1 | BEH | 18 |
| 02:15 | Y | 3 | PAIN | 9 |
| 06:50 | Y | 2 | MOB | 14 |
| __:__ | _ | _ | ______ | __ |
One line per contact, on paper, at the desk where calls get answered.
The gap
Everybody guesses. Nobody counts.
Ask a practice how many after-hours contacts an orthopedic discharge generates and you get a guess. Ask the person who actually carries the phone and you get a different guess, usually a bigger one.
The calls happen at night, in someone's kitchen, on a personal cell. They do not get logged, so they do not get counted, so they never reach anywhere a practice makes decisions. Two surgeons doing the same number of TPLOs can be carrying very different call loads, and neither one can prove it.
Four weeks of counting settles it. This is not a survey, and it is not benchmark data borrowed from another practice. It is your patients, your phone, and your number.
The method
Four weeks, one sheet, five rules.
The whole thing runs on paper next to the phone. Nothing changes about how your practice treats a patient while the count is running.
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Log every owner contact about an ortho post-op patient
Phone, text, email, portal. Date, time, days post-op, who took it, roughly how long, how it ended. If you are unsure whether something counts, log it and let the analysis sort it out.
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Mark after hours yes or no on every line
After hours means anything outside your posted hours, or anything that reaches an on-call phone, a personal cell, an answering service, or an ER.
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Log every ortho discharge too
That is the denominator, and it matters as much as the count itself. Twelve calls across thirty discharges is a completely different practice than twelve calls across six.
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Keep admin calls separate as a control
Billing, scheduling, records, refills. They get logged and held out of the headline number. If admin traffic ever moves the same way clinical traffic moves, the month was slow and the result is worthless. Better to catch that than to believe it.
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Say nothing to owners
No study, no trial, no new paperwork. Owners who know they are being measured call differently. Nothing about the count is visible to anyone outside the practice.
At the end I hand back a one-page readout: after-hours contacts per ortho discharge, when in the recovery week they cluster, what they were about by reason code, and roughly how much on-call time they ate. The number belongs to you whatever you decide to do next.
Realistic effort: about ten seconds a line, from whoever already answered the phone.
Ground rules
What this is not.
Worth saying plainly, because most things that arrive in a practice inbox are one of these.
- SoftwareThere is none. Nothing to install, no login, no integration with your practice management system. It is a sheet of paper and an email at the end.
- Pet ownersThey never hear from me, during the count or after it. Owners are never told they are being counted, never surveyed, and never emailed.
- Medical recordsNone of them leave your practice. Use whatever patient identifier you already use on your own sheets. All I need are counts, times, and reasons.
- Clinical guidanceI am not a veterinarian and I write none of it. The count measures phone traffic, not medicine.
- MoneyThe count is free and there is nothing for sale while it runs. If the number turns out to be worth acting on, that is a separate conversation you are free to skip.
Two paths
It depends on who takes the call at 10pm.
You own the line
The cost shows up as on-call hours, and as the slow burn on whoever carries the phone. The count tells you how many of those calls came from ortho post-ops, which nights they land on, and how many were about the house rather than the medicine.
Nights route out
The cost shows up somewhere you cannot see it. An owner who could not get a dog up the stairs at midnight becomes an ER visit, a bill you did not set, and a recovery week you did not control. The count catches the ones that landed elsewhere.
Who runs it
One person, no company, no product.
My name is Nick. I am not a veterinarian, I have nothing to sell you today, and there is no company behind this. I am one person trying to answer a question that does not seem to have a published answer: how much after-hours phone load an orthopedic discharge actually creates, and how much of it is about the house instead of the surgery.
The honest version of my interest is this. If the number is large and mostly about logistics at home, I want to build something that fixes it, and I would want the practices who counted first to be the ones I build it with. If the number is small, or it turns out to be all pain and medication questions, then I am wrong about the mechanism, and I would rather learn that from four weeks of your data than from two years of my own life.
Either way you keep your number and you owe me nothing.
Nick Kaufman · nick@afterhourscount.com
Questions
The things practices ask first.
What does it cost?
Nothing. There is no invoice at the end of the count and no card on file. The cost to you is the staff time it takes to write one line per contact for four weeks.
How much work is this really for my staff?
About ten seconds per contact, from whoever already answered the phone. The sheet has fixed columns and short reason codes so nobody is writing sentences at 2am.
The one piece that needs discipline is the discharge log, because that is the denominator. One line per ortho discharge, on the day it happens.
Do we have to tell owners anything?
No, and please do not. Owners who know they are being counted call differently, which would make the number useless. Nothing about the count is visible outside the practice.
What if we miss some calls?
Write down that you missed some. A note that says "Thursday night was chaos, probably missed two or three" is worth more than a clean sheet that is quietly wrong. Missed lines get handled honestly in the readout instead of hidden.
Are you selling something?
Not now, and not while the count is running. There is no product, no prototype, and no waiting list.
Long term, yes, I want to build something for practices like yours and sell it. That only happens if the counts show a real problem, and if it happens the practices that counted first will hear about it before anyone else. You are free to say no then, having lost nothing.
Who sees the data?
Only me, and only the counts. No medical records, no owner names, no client contact details. Your practice is not named in anything I write or say about the results unless you tell me otherwise in writing.
Why orthopedic patients, and why TPLO first?
TPLO recovery drops a strict eight to twelve week restriction plan into a house that was never built for it: stairs, slick floors, a dog that will not settle in a crate, an owner who cannot lift eighty pounds. That is where I expect the after-hours calls to concentrate. Starting narrow is what makes the number readable.
What happens if the number turns out to be small?
Then you learned something true about your practice for free, and I learned that my idea is wrong. I will tell you it did not move, in writing, and I will tell the other practices running the count the same thing.
Want to know your own number?
Reply with your practice name and who takes the call at 10pm. I send back the count sheet and the two-page method the same day. If it is not for you, say so and that is the end of it.