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6 | *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. | ||||||||||||||
7 | 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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9 | Contact: | Sanjay Basu MD PhD, sanjay_basu@hms.harvard.edu | PLEASE GO TO FILE => MAKE A COPY TO EDIT | ||||||||||||
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11 | Adjustable parameters: | ||||||||||||||
12 | Stage | Step | Description | Input parameters | Units | Mean estimate from interviews* | Lower bound estimate | Higher bound estimate | Notes/sources | ||||||
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14 | Off-site prep | 1 | Site registration - CDC, state, and/or county registration and verification | Admin/provider registration time | Hours, once per site | 3 | 1 | 5 | |||||||
15 | 2 | Cohort ID - Generate roster of eligibles for each of 13 NASEM/ACIP subphases | IT/informatics workforce time | Hours, once per subphase (of 13 subphases) | 2 | 1 | 5 | ||||||||
16 | 3 | De-duplication, contact info corrections | Hours, once per subphase | 1 | 0.5 | 2 | |||||||||
17 | 4 | Contact - Telephonic and/or electronic outreach of rostered patients | Outreach and scheduling staffing | Per diem cost per worker per hour, MA | $27 | $17 | $36 | mean, 25th percentile and 75th percentile from: https://www.ziprecruiter.com/Salaries/Per-Diem-Medical-Assistant-Salary | |||||||
18 | 5 | Outreach and pre-screening time | Minutes per outreach, including callbacks | 7 | 3 | 10 | |||||||||
19 | 6 | Scheduling and documentation time | Minutes per outreach, calendaring and notes | 5 | 3 | 10 | |||||||||
20 | 7 | Outreaches per subphase | 1432 | 805 | 2058 | ADJUST 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 | |||||||||
21 | 8 | Scheduling - Telephone and/or electronic scheduling of responsive patients | Vaccine clinic availability | Days per week (opening/closing times below) | 5 | 3 | 7 | ADJUST FOR NUMBER OF DAYS SITE IS OPEN EACH WEEK | |||||||
22 | 9 | Scheduling changes, cancellations | Probability of changes/cancellations for dose 1 | 0.1 | 0.02 | 0.2 | |||||||||
23 | 10 | Minutes to reschedule/cancel for dose 1 | 5 | 3 | 10 | ||||||||||
24 | 11 | Staffing - Hiring or shift rescheduling for on-site staffing | Admin time buy-out | Admin/supervisor hours per subphase | 40 | 30 | 60 | ||||||||
25 | 12 | Staffing planning time for admins | Hours, once per site | 5 | 3 | 10 | |||||||||
26 | 13 | HR per-diem processes, hiring | Hours, per hire | 3 | 2 | 5 | |||||||||
27 | Overhead rate for per diem hires | Admin/benefits cost as proportion of salary | 0.3 | 0.2 | 0.5 | ||||||||||
28 | 15 | Staff training | Hours, once per site | 5 | 2 | 8 | |||||||||
29 | 16 | Dry run | Hours, once per site | 2 | 1.5 | 3 | |||||||||
30 | 17 | Equipment prep - PPE, paperwork, equipment, and supplies | PPE ordering and costs, stocking, logging | Hours for ordering time, once per week | 1 | 0.5 | 1.5 | ||||||||
31 | 18 | PPE costs per staff member per day | $25 | $7 | $61 | J. 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/ | |||||||||
32 | 19 | Stocking and logging time, per week | 1 | 0.5 | 2 | ||||||||||
33 | 20 | Paperwork printing and collation time | Hours per day | 0.5 | 0.25 | 1 | |||||||||
34 | 21 | Pharmacist support for delivery and storage | Hours per subphase | 2 | 1 | 4 | |||||||||
35 | 22 | Refrigeration transport/setup | Hours, once per site | 3 | 2 | 4 | Assumes separate budget/line item for freezer/refrigerator purchase, or reuse of existing refrigeration devices | ||||||||
36 | 23 | Supply ordering and costs (complete CDC list) | Cost per 100 vaccinations prepped | $53 | $27 | $106 | Based on https://www.mckesson.com/Medical-Supplies/SupplyManager/ | ||||||||
37 | 24 | QI - Revision of workflow and staffing for optimization during and after each subphase | Initial PDSA cycle: cohort id and scheduling | Hours per subphase | 4 | 2 | 5 | ||||||||
38 | 25 | Follow-up PDSAs: workflow, staffing ratios | Hours per subphase | 4 | 2 | 5 | |||||||||
39 | On-site activities | 26 | Safety - PPE donning, room cleaning | PPE donning, cleaning time | Minutes per vaccination | 1 | 1 | 2 | |||||||
40 | 27 | No shows - Proportion of scheduled patients not coming to appointment | Vaccine hesitancy, duplications or errors | Probability of no-show | 0.05 | 0.02 | 0.1 | ||||||||
41 | 28 | Registration/intake - identity and insurance verification, pre-admin safety checklist | Registration area IT/equipment setup | Hours, once per site | 2 | 1 | 4 | ||||||||
42 | 29 | Registration worker | Per diem cost per worker per hour, MA | $27 | $17 | $36 | |||||||||
43 | 30 | Time of first patient appointment | Time of morning | 8:15 AM | 8:00 AM | 9:00 AM | ADJUST FOR TIME OF DAY SITE IS OPEN (calculations will assume 1hr lunch break) | ||||||||
44 | 31 | Registration time per patient | Minutes per patient | 4 | 2 | 6 | |||||||||
45 | 32 | Waiting area - capacity, spacing, maintenance | Waiting room setup time | Minutes, twice per day | 5 | 2 | 7 | ||||||||
46 | 33 | Clean-up/maintenance | Minutes, twice per day | 10 | 5 | 15 | |||||||||
47 | 34 | Back room - Vial prep (thawing, mixing, time checks), needle prep, pre-admin checklists | Back room staffing | Per diem cost per worker per hour, MA | $27 | $17 | $36 | ||||||||
48 | 35 | Vial prep and monitoring, checklists | Minutes per batch of 24 vaccines | 30 | 20 | 45 | Batches of 24 prepped for 2 hour admin window | ||||||||
49 | 36 | Needle prep and documentation | Minutes per batch of 24 vaccines | 12 | 10 | 24 | |||||||||
50 | 37 | Vaccination room - id re-verification, assessment, counseling, injection, needle disposal | Assessment and counseling | Minutes per vaccination | 3 | 2 | 5 | ||||||||
51 | 38 | Injection staffing | Per diem cost per worker per hour, nurse | $29 | $25 | $33 | mean, 25th percentile and 75th percentile from: https://www.ziprecruiter.com/Salaries/Per-Diem-Nurse-Salary | ||||||||
52 | 39 | Number of simultaneous injecting staff on site | 2 | 1 | 4 | ADJUST FOR NUMBER OF STAFF PERFORMING INJECTIONS SIMULTANEOUSLY AT SITE | |||||||||
53 | 40 | Injection and safe disposal | Minutes per vaccination | 1 | 1 | 2 | |||||||||
54 | Post-admin | 41 | Clean-up - PPE doffing, admin room clean-up | PPE doffing, cleaning time | Minutes per vaccination | 1 | 1 | 2 | |||||||
55 | 42 | Documentation - vaccination card, EHR/registry reporting, VAERS reporting | Vaccination card, electronic reporting | Minutes per vaccination | 1 | 1 | 5 | ||||||||
56 | 43 | Observation - capacity, spacing, reactions/anaphylaxis monitoring, epi administration | Obs time | Minutes per vaccination | 15 | 15 | 30 | Assumes on-site registration MA can simultaneously perform observation | |||||||
57 | 44 | Anaphylaxis rate | Probability of anaphylaxis after admin | 0.0000036 | 0.0000025 | 0.0000047 | doi:10.1001/jama.2021.1967 | ||||||||
58 | 45 | Epi/anaphylaxis supplies | Cost of supplies required on-hand | $650 | $600 | $700 | cost of epi-pen | ||||||||
59 | 46 | VAERS reporting time | Hours per adverse event | 1 | 0.5 | 2 | |||||||||
60 | 47 | Follow-up - 2nd dose scheduling | Time of last patient appointment | Time of evening | 5:00 PM | 4:15 PM | 7:00 PM | ADJUST FOR TIME OF DAY SITE HAS LAST APPT (calculations will assume 1hr lunch break) | |||||||
61 | 48 | Scheduling changes, cancellations, questions | Probability of changes/cancellations for dose 2 | 0.1 | 0.02 | 0.2 | |||||||||
62 | 49 | Minutes to reschedule/cancel for dose 2 | 5 | 3 | 10 | ||||||||||
63 | 50 | Closing up - End-day activities, securing site, overnight prep | Clean-up/maintenance | Hours, once per day, including biohazards | 1.5 | 1 | 2 | ||||||||
64 | 51 | Per diem cost of worker per hour, custodial | $12 | $10 | $14 | mean, 25th percentile and 75th percentile from: https://www.ziprecruiter.com/Salaries/Custodian-Salary--in-California | |||||||||
65 | 52 | Nightly vaccine overnight storage, security | Hours, once per day | 0.5 | 0.25 | 0.75 | |||||||||
66 | 53 | Billing admin - Payment for services | Claims coding, submission, reconciliation | Minutes per vaccination | 1 | 2 | 3 | ||||||||
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