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*Acknowledgements: Thanks to site managers at Kaiser Permanente Northern California, Intermountain Healthcare, University of California San Francisco, California Department of Public Health, Beth Israel Deaconness Medical Center, Tufts Healthcare, Harvard Medical School, Ariadne Labs, CVSHealth, Los Angeles Department of Public Health, Alameda Health System, HealthRight360, and Collective Health for providing input parameters based on their experience to date.
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Instructions:This tool is intended to assist site managers at outpatient clinics or offsite locations with preparation, workforce planning and budgeting for COVID vaccination in compliance with NASEM, ACIP, state, and county guidelines and regulations, principally focused on Moderna, Pfizer, or AstraZeneca vaccine distribution. The workflow below is utilized for the budget spreadsheet and estimated time requirements. Input parameters can be customized and adjusted in the yellow highlighted columns at the right, and will automatically update the Results sheet (next sheet). The current version assumes costs of the purchasing the vaccines themselves are subsumed and federally funded under current CARES Act provisions, hence the calculator focuses on prep and administration costs including workforce, PPE and auxiliary supplies. Calculations are meant to be estimates only, with usual disclaimers. Prior to use, we recommend this readiness quick-start guide. See also the SINGLE DOSE VERSION for Johnson and Johnson (Janssen) administration protocols.
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Contact:Sanjay Basu MD PhD, sanjay_basu@hms.harvard.eduPLEASE GO TO FILE => MAKE A COPY TO EDIT
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Adjustable parameters:
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StageStepDescriptionInput parametersUnitsMean estimate from interviews*Lower bound estimateHigher bound estimateNotes/sources
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Off-site prep1Site registration - CDC, state, and/or county registration and verification Admin/provider registration timeHours, once per site315
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2Cohort ID - Generate roster of eligibles for each of 13 NASEM/ACIP subphasesIT/informatics workforce time
Hours, once per subphase (of 13 subphases)
215
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3De-duplication, contact info correctionsHours, once per subphase10.52
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4Contact - Telephonic and/or electronic outreach of rostered patientsOutreach and scheduling staffingPer diem cost per worker per hour, MA$27$17$36mean, 25th percentile and 75th percentile from: https://www.ziprecruiter.com/Salaries/Per-Diem-Medical-Assistant-Salary
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5Outreach and pre-screening timeMinutes per outreach, including callbacks7310
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6Scheduling and documentation time
Minutes per outreach, calendaring and notes
5310
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7Outreaches per subphase14328052058ADJUST FOR NUMBER OF PATIENTS IN EACH SUBPHASE; placeholder estimates based on subphase population estimate by Surgo/Ariadne Vaccine Allocation Planner and by number of outpatient primary care clinic sites using AHRF data
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8Scheduling - Telephone and/or electronic scheduling of responsive patientsVaccine clinic availability
Days per week (opening/closing times below)
537ADJUST FOR NUMBER OF DAYS SITE IS OPEN EACH WEEK
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9Scheduling changes, cancellations
Probability of changes/cancellations for dose 1
0.10.020.2
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10Minutes to reschedule/cancel for dose 15310
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11Staffing - Hiring or shift rescheduling for on-site staffing Admin time buy-outAdmin/supervisor hours per subphase403060
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12Staffing planning time for adminsHours, once per site5310
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13HR per-diem processes, hiringHours, per hire325
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Overhead rate for per diem hiresAdmin/benefits cost as proportion of salary0.30.20.5
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15Staff training Hours, once per site528
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16Dry runHours, once per site21.53
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17Equipment prep - PPE, paperwork, equipment, and supplies PPE ordering and costs, stocking, loggingHours for ordering time, once per week10.51.5
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18PPE costs per staff member per day$25$7$61J. Hosp. Med. 2020 May;15(5):295-298. DOI: 10.12788/jhm.3429 and https://www.mcknights.com/news/analysis-ppe-costs-increase-over-1000-during-covid-19-crisis/
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19Stocking and logging time, per week10.52
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20Paperwork printing and collation timeHours per day0.50.251
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21Pharmacist support for delivery and storageHours per subphase214
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22Refrigeration transport/setupHours, once per site324Assumes separate budget/line item for freezer/refrigerator purchase, or reuse of existing refrigeration devices
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Supply ordering and costs (complete CDC list)
Cost per 100 vaccinations prepped$53$27$106Based on https://www.mckesson.com/Medical-Supplies/SupplyManager/
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24QI - Revision of workflow and staffing for optimization during and after each subphaseInitial PDSA cycle: cohort id and schedulingHours per subphase425
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25Follow-up PDSAs: workflow, staffing ratiosHours per subphase425
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On-site activities26Safety - PPE donning, room cleaningPPE donning, cleaning timeMinutes per vaccination112
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27No shows - Proportion of scheduled patients not coming to appointmentVaccine hesitancy, duplications or errorsProbability of no-show0.050.020.1
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28Registration/intake - identity and insurance verification, pre-admin safety checklistRegistration area IT/equipment setupHours, once per site214
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29Registration workerPer diem cost per worker per hour, MA$27$17$36
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30Time of first patient appointmentTime of morning8:15 AM8:00 AM9:00 AMADJUST FOR TIME OF DAY SITE IS OPEN (calculations will assume 1hr lunch break)
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31Registration time per patientMinutes per patient426
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32Waiting area - capacity, spacing, maintenanceWaiting room setup timeMinutes, twice per day527
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33Clean-up/maintenanceMinutes, twice per day10515
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Back room - Vial prep (thawing, mixing, time checks), needle prep, pre-admin checklists
Back room staffingPer diem cost per worker per hour, MA$27$17$36
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35Vial prep and monitoring, checklistsMinutes per batch of 24 vaccines302045Batches of 24 prepped for 2 hour admin window
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36Needle prep and documentationMinutes per batch of 24 vaccines121024
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Vaccination room - id re-verification, assessment, counseling, injection, needle disposal
Assessment and counselingMinutes per vaccination325
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38Injection staffingPer diem cost per worker per hour, nurse$29$25$33mean, 25th percentile and 75th percentile from: https://www.ziprecruiter.com/Salaries/Per-Diem-Nurse-Salary
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Number of simultaneous injecting staff on site
214ADJUST FOR NUMBER OF STAFF PERFORMING INJECTIONS SIMULTANEOUSLY AT SITE
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40Injection and safe disposalMinutes per vaccination112
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Post-admin41Clean-up - PPE doffing, admin room clean-upPPE doffing, cleaning timeMinutes per vaccination112
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42Documentation - vaccination card, EHR/registry reporting, VAERS reportingVaccination card, electronic reportingMinutes per vaccination115
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43Observation - capacity, spacing, reactions/anaphylaxis monitoring, epi administrationObs timeMinutes per vaccination151530Assumes on-site registration MA can simultaneously perform observation
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44Anaphylaxis rateProbability of anaphylaxis after admin0.00000360.00000250.0000047doi:10.1001/jama.2021.1967
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45Epi/anaphylaxis suppliesCost of supplies required on-hand$650$600$700cost of epi-pen
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46VAERS reporting timeHours per adverse event10.52
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47Follow-up - 2nd dose schedulingTime of last patient appointmentTime of evening5:00 PM4:15 PM7:00 PMADJUST FOR TIME OF DAY SITE HAS LAST APPT (calculations will assume 1hr lunch break)
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Scheduling changes, cancellations, questions
Probability of changes/cancellations for dose 2
0.10.020.2
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49Minutes to reschedule/cancel for dose 25310
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50Closing up - End-day activities, securing site, overnight prepClean-up/maintenanceHours, once per day, including biohazards1.512
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51Per diem cost of worker per hour, custodial$12$10$14mean, 25th percentile and 75th percentile from: https://www.ziprecruiter.com/Salaries/Custodian-Salary--in-California
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52Nightly vaccine overnight storage, securityHours, once per day0.50.250.75
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53Billing admin - Payment for servicesClaims coding, submission, reconciliationMinutes per vaccination123
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