Mass Medical Prophylaxis
Dispencing/Vaccination Clinic
Whenever possible, planners should develop a single generic Dispencing/Vaccination Clinic (DVC) design (including floor plan and patient flow plan) for use throughout their community. Having a single master DVC plan will simplify training and improve interoperability of staff, increase the ability to forecast patient flow and therefore resupply needs, and maintain flexibility to uniformly alter all DVCs in response to unfolding events.
DVC design may range from very simple to extremely complex, depending on the nature of the event, requirements of the response, and time frame for action.
DVC operations may be divided into core and support (or "non-core") functions. Core functions include all processes that directly facilitate the dispensing of drugs and vaccines and almost always involve one-on-one interaction between staff and patients. Exceptions include distribution of forms and patient briefings, in which one staff member may interact with a large number of people at once. Core stations are sites within the DVC where core functions take place. Support functions include all the processes that take place in the DVC that are critical in supporting the core stations. These tasks range from medication or vaccine resupply to security to command and control. Core and support staff are equally important to the overall success of the DVC plan.
One of the first tasks for mass prophylaxis planners is to determine which core stations will be included in the basic DVC plan for their community and what the physical arrangement of those stations will be in each DVC. The choice of core stations for a given DVC design depends on a number of factors, including the target patient flow rate (larger, more complex station arrangements will inevitably lead to slower patient throughput), the availability of personnel to adequately staff those stations, and the physical space for DVC activities. The patient flow diagrams shown below illustrate DVC designs of increasing complexity. Note that while increasing complexity generally requires increased staff and time, it does allow for valuable (and perhaps necessary) additional processes, such as data collection.
DVC floor plans should take into account the possibility that queues will form at each station as part of the natural variation in arrivals, staffing, and processing times. The amount of space allocated for these queues cannot be accurately predicted prior to running of the DVC. One general rule of thumb is that for 2 stations with identical arrival rates but different processing times (and therefore different numbers of staff assigned for baseline operation), the removal of a staff member at the quicker station will lead to more rapid development of a queue than removal of a staff member at the slower station.
One of the most difficult features of DVC planning is determining how many staff would be needed to work at a given station within a DVC. The accompanying Bioterrorism and Epidemic Outbreak Response Model (BERM) allows calculations of the number of staff needed to carry out a prophylaxis campaign using 2 different pre-specified DVC designs, one for antibiotic dispensing and another for vaccination. The calculations underlying these estimates are described in detail in the model's Technical Appendix, but deserve comment here as well. The main concept underlying these calculations is the notion that every DVC should be capable of what is called "steady-state operation." This means that every clinic should be capable of operating at full capacity without developing progressively larger bottlenecks, which would show up as queues.
In other words, the operational goal of any DVC should be that, at minimum, it does not continuously back up to the point of complete shutdown. A DVC operating at this "steady-state" has achieved a balance between the number of staff, the number of patients, and the time needed for those staff to process those patients such that there is no increase in bottlenecks or queues. While this may never actually occur during real-life operations (due to a variety of factors such as unpredictable surge arrivals, etc.), all DVCs should, at a minimum, be designed to achieve steady-state operation.
Fortunately, it is possible to calculate the number of staff needed to run a system that is operating in a steady-state manner. These calculations can provide planners with 2 important sets of data: either estimates of the minimum number of staff needed to process patients at a given rate of arrival and for a given processing time, or estimates of the maximum processing time permitted for a given number of staff to process patients at a given rate of arrival.
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