Abstract
BackgroundThe COVID-19 pandemic has significantly stressed healthcare systems. The addition of monoclonal antibody (mAb) infusions, which prevent severe disease and reduce hospitalizations, to the repertoire of COVID-19 countermeasures offers the opportunity to reduce system stress but requires strategic planning and use of novel approaches. Our objective was to develop a web-based decision-support tool to help existing and future mAb infusion facilities make better and more informed staffing and capacity decisions.Materials and MethodsUsing real-world observations from three medical centers operating with federal field team support, we developed a discrete-event simulation model and performed simulation experiments to assess performance of mAb infusion sites under different conditions.Results162,000 scenarios were evaluated by simulations. Our analyses revealed that it was more effective to add check-in staff than to add additional nurses for middle-to-large size sites with ≥2 infusion nurses; that scheduled appointments performed better than walk-ins when patient load was not high; and that reducing infusion time was particularly impactful when load on resources was only slightly above manageable levels.DiscussionPhysical capacity, check-in staff, and infusion time were as important as nurses for mAb sites. Health systems can effectively operate an infusion center under different conditions to provide mAb therapeutics even with relatively low investments in physical resources and staff.ConclusionSimulations of mAb infusion sites were used to create a capacity planning tool to optimize resource utility and allocation in constrained pandemic conditions, and more efficiently treat COVID-19 patients at existing and future mAb infusion sites.
Highlights
AND SIGNIFICANCESpreading rapidly, Coronavirus disease 2019 (COVID-19) became a global pandemic in early 2020 [1]
To demonstrate the utility of the web-based calculator and shed light onto important planning and research questions for monoclonal antibody (mAb) infusion sites, we focused on four main areas: (i) the impact of scheduling on performance metrics, (ii) the effect of infusion duration on patient length of stay (LoS), (iii) the role of medication preparation duration for walk-in encounters, and (iv) when and where to add additional staff to improve overall performance
In addition to IV infusions, mAb treatments have been approved as subcutaneous injections, which were not the focus of our study. During his speech addressing the nation on September 9, 2021, President Biden emphasized the importance of mAb treatments for saving lives and reducing the strain on the U.S healthcare system by preventing severe disease and reducing hospitalizations and reiterated his administration’s commitment to making mAb treatments available [18]
Summary
BACKGROUND AND SIGNIFICANCESpreading rapidly, Coronavirus disease 2019 (COVID-19) became a global pandemic in early 2020 [1]. In November 2020, the Food and Drug Administration issued emergency use authorizations for monoclonal antibody (mAb) monotherapy bamlanivimab and combination therapy casirivimab/imdevimab to treat COVID-19 among individuals at high risk for progressing to severe disease [5]. These mAb treatments were shown to be effective for preventing progression of disease and COVID-19-associated hospitalizations [6, 7]. The addition of monoclonal antibody (mAb) infusions, which prevent severe disease and reduce hospitalizations, to the repertoire of COVID-19 countermeasures offers the opportunity to reduce system stress but requires strategic planning and use of novel approaches. Our objective was to develop a web-based decision-support tool to help existing and future mAb infusion facilities make better and more informed staffing and capacity decisions
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