Forecast capacity levels review the information in Exhibit 13-1. The exhibit assumes three chairs and one 40-hour RN, for realistic capacity level of seven patients infused per day.

Required:

Prepare another infusion center capacity level forecast as follows; assume the same three infusion chairs, but add another nurse for either a four or six hours per day. How would this change the daily capacity level for number of patients infused per day.

Once you understand the timing of the process and, in particular, when a nurse needs to work directly with the patient and when she can be working with another patient, you will be ready to create a schedule for the available number of chairs. So, start with Chair 1. If a nurse arrives to work at, say, 9:00 and gets a patient started in Chair 1 right away, when will she be available to start another patient in Chair 2? Then, what about Chair 3? etc. Be careful, though. At some point in time she will need to go back to take care of the patient in Chair 1, Chair 2, Chair 3, etc. She is going to be very busy moving back and forth between chairs all day. So, as you work through the schedule for the day for each chair, you need to make sure that you don't schedule the nurse to be 'hands on' in two chairs at once!

If you chart out what she will be doing at each chair every hour/half hour/etc. you will see what can be accomplished.

So, if you take a look at what her day might look like it could be something like....
9-9:30am chair 1 / patient 1 steps 1-4
9:30 - 11am chair 1/ patient 1 steps 5-7
At 11am patient 1 can leave and chair 1 is free.

At 9:30 when the nurse is done with patient 1 steps 1-4 she can move onto chair two to start patient 2.
9:30 - 10 patient 2 chair 2 steps 1-4.
10-11:30 patient 2 chair 2 steps 5-7
At 11:30 patient 2 can leave and chair 2 is free.

At 10:00 when the nurse is done with patient 2 steps 104 she can move onto chair three to start patient 3.
10 - 10:30 patient 3 chair 3 steps 1-4.
10:30-12 patient 3 chair 3 steps 5-7
At 12 patient 3 can leave and chair 3 is free.

Now, you have a decision to make (and some trial scheduling to do!). If you start patient 4 at 11 am in chair 1 the nurse can go to lunch at 1pm. Or, you can not start another patient until after lunch and have her go to lunch at 12 when patient 3 is done. Regardless, she will be working 40 hours a week (I guess in this hospital they have unpaid lunches). Anyway, the process then continues again with each of the three chairs. You would need to keep going with the scheduling, but if you think about it, chair 1 could theoretically have three patients in a day -- even with a 30 minute change over. While the other chairs are available to handle the same volume, when you plan out the details of the scheduling you will see that the need for the nurses attention during steps 1-4 really limits when patients can start in the other chairs.

  

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Exhibit 13-1 Capacity Level Checkpoints for an Outpatient Infusion Center Outpatient Infusion Center Capacity Level Checkpoints #infusion chairs. #staff. 3 chairs 1 RN #weekly operating hours... # of hours per patient infusion............ average 2 hours (for purposes of this example) Work Flow Description For each infusion the nurse must perform the following steps (generalized for this purpose; actual protocol is more specific): Work Flow Comments 40 hours 1. Obtain and review the patient's chart 2. Obtain and prepare the appropriate drug for infusion 3. Interview the patient 4. Prepare the patient and commence the infusion 5. Monitor and record progress throughout the ongoing infusion 6. Observe the patient upon completion of the infusion 7. Complete charting It is impossible for one nurse to start patients' infusions in all three chairs simultane- ously. Thus the theoretical treatment sequence might be as follows: Assume one half-hour for patient number one's Steps I through 4. . Once patient number one is at Step 5, the nurse can begin the protocol for patient number two. • Assume another one half-hour for patient number two's Steps I through 4. • Once patient number two is at Step 5, theoretically the nurse can begin the protocol for patient number three. This sequence should work, assuming all factors work smoothly; that is, the appropriate drugs in the proper amounts are at hand, the patients show up on time, and no one patient demands an unusual amount of the nurse's attention. (For example, a new patient will require more attention.) Exhibit 13-1 Capacity Level Checkpoints for an Outpatient Infusion Center Outpatient Infusion Center Capacity Level Checkpoints #infusion chairs. #staff. 3 chairs 1 RN #weekly operating hours... # of hours per patient infusion............ average 2 hours (for purposes of this example) Work Flow Description For each infusion the nurse must perform the following steps (generalized for this purpose; actual protocol is more specific): Work Flow Comments 40 hours 1. Obtain and review the patient's chart 2. Obtain and prepare the appropriate drug for infusion 3. Interview the patient 4. Prepare the patient and commence the infusion 5. Monitor and record progress throughout the ongoing infusion 6. Observe the patient upon completion of the infusion 7. Complete charting It is impossible for one nurse to start patients' infusions in all three chairs simultane- ously. Thus the theoretical treatment sequence might be as follows: Assume one half-hour for patient number one's Steps I through 4. . Once patient number one is at Step 5, the nurse can begin the protocol for patient number two. • Assume another one half-hour for patient number two's Steps I through 4. • Once patient number two is at Step 5, theoretically the nurse can begin the protocol for patient number three. This sequence should work, assuming all factors work smoothly; that is, the appropriate drugs in the proper amounts are at hand, the patients show up on time, and no one patient demands an unusual amount of the nurse's attention. (For example, a new patient will require more attention.)

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