Planning an Outpatient Pharmacy: Small, Medium, or Large?

Most outpatient pharmacies that are located within a hospital or in an ambulatory care center (on or off-campus) fall into one of four categories ― minimal, small, medium, or large. Assuming that outpatient demand has been established based on the availability and convenience of similar services and potential competition from commercial pharmacies, the primary determinant of an outpatient pharmacy’s size is the average number of daily prescriptions (scripts) that will be filled during the busiest eight-hour shift. This generally determines the numbers and sizes of rooms or areas and overall space.

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How Sacramento’s Busiest ED Doubled Capacity Without Expansion

Emergency SignThe emergency department (ED) at the Kaiser Permanente South Sacramento Medical Center, one of California’s busiest EDs, has cut patient turnaround times by hours and to far below the national average, through operations improvement, according to Healthcare Informatics. This Level II trauma center saw its workload almost double from 2008 to over 120,000 annual patient visits by 2015. The existing ED space was constrained with only 49 ED bays of which three are dedicated for trauma and four are dedicated to psychiatry. This calculates to 2,500 annual patients per ED bay compared to a recommended 1,500 to 1,800 for a well performing ED. The increasing patient volume and space constraints resulted in long ED wait times with patients waiting five to six hours to see a doctor and every night there were 30 to 40 patients in the waiting room.

After an intensive operations improvement effort using “lean” production principles, South Sacramento Medical Center’s average wait time in the ED was reduced to 19 minutes, less than half the national average of 58 minutes. The average length of stay (LOS) in the ED was reduced to 43 minutes for low-acuity patients compared to a national average of 118 minutes. The LOS for discharged patients was decreased from 4.5 hours to about 2 hours and the LOS for admitted patients dropped from 8 to 6 hours. According to Karen Murrell, M.D., the chair of emergency medicine at Kaiser Permanente Northern California, “Decreasing the length of stay creates capacity, so if we have a patient in a bed for two hours rather than four hours, we can see twice as many patients.”

Source: “How Eliminating Waste and Opening Data Helped Kaiser South Sacramento Create a “No Wait” ER” by Heather Landi, October 23, 2015 [Retrieved online at]

This article is an update of a previous post.

Key Ways Hospital Design May Affect C-Section Rates

According to a new report published by Ariadne Labs and MASS Design Group, the physical design of a hospital’s birthing unit may affect its Cesarean section rate. Based on previous research, the team knew C-section rates can vary from 7 percent to 70 percent simply depending on the facility. As many as half of these C-sections are unnecessary and add surgical complications and increase costs. To begin to determine how much the physical layout of a hospital may impact C-section rates, the team chose 12 diverse childbirth locations — three birth centers and nine hospitals. They conducted site visits and phone interviews to develop facility profiles and compare the childbirth locations as quantitatively as possible.

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Physician Offices and Outpatient Clinics: Key Space Allocation Factors

There is significant variation in the amount of space planned to accommodate a specific number of annual outpatient visits to a physician office or outpatient clinic. In some cases the department gross square feet (DGSF) may be more than double for the same workload — even when the types of patients seen and physician specialties are similar.

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USP 797 Impacts Pharmacy Space and Design

BiocabinetThis post has been replaced with a new post Pharmacies are Renovating Space to Comply With USP 800 that addresses the compounding of hazardous drugs as well as the updated USP 797.

USP 797 is a regulation that governs any pharmacy that compounds sterile preparations including centralized and satellite hospital-based pharmacies, outpatient pharmacies, and off-site pharmacies. USP 797 is designed to cut down on infections transmitted to patients through pharmaceutical products and to better protect staff working in pharmacies in the course of their exposure to pharmaceuticals. Issued by U.S. Pharmacopeia (USP), USP 797 has been endorsed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) who expects that organization will be in full compliance by January 2008.

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