title: Comparison of a hybrid medication distribution system to simulated decentralized distribution models.
abstract: OBJECTIVE
  The results of a study to estimate the human resource and cost implications of changing the medication distribution model at a large medical center are presented.
  
  
  METHODS
  A two-part study was conducted to evaluate alternatives to the hospital's existing hybrid distribution model (64% of doses dispensed via cart fill and 36% via automated dispensing cabinets [ADCs]). An assessment of nurse, pharmacist, and pharmacy technician workloads within the hybrid system was performed through direct observation, with time standards calculated for each dispensing task; similar time studies were conducted at a comparator hospital with a decentralized medication distribution system involving greater use of ADCs. The time study data were then used in simulation modeling of alternative distribution scenarios: one involving no use of cart fill, one involving no use of ADCs, and one heavily dependent on ADC dispensing (89% via ADC and 11% via cart fill).
  
  
  RESULTS
  Simulation of the base-case and alternative scenarios indicated that as the modeled percentage of doses dispensed from ADCs rose, the calculated pharmacy technician labor requirements decreased, with a proportionately greater increase in the nursing staff workload. Given that nurses are a higher-cost resource than pharmacy technicians, the projected human resource opportunity cost of transitioning from the hybrid system to a decentralized system similar to the comparator facility's was estimated at $229,691 per annum.
  
  
  CONCLUSIONS
  Based on the simulation results, it was decided that a transition from the existing hybrid medication distribution system to a more ADC-dependent model would result in an unfavorable shift in staff skill mix and corresponding human resource costs at the medical center.
authors.affiliation: Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. johngray@cshs.org
authors.forename: John P
authors.initials: JP
authors.lastname: Gray
authors.forename: Brad
authors.initials: B
authors.lastname: Ludwig
authors.forename: Jack
authors.initials: J
authors.lastname: Temple
authors.forename: Michael
authors.initials: M
authors.lastname: Melby
authors.forename: Steve
authors.initials: S
authors.lastname: Rough
mesh_terms: D003198:Computer Simulation; D017721:Hospital Costs; D006801:Humans; D008510:Medication Systems, Hospital / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D009726:Nurses / Q000191:economics / Q000458:organization & administration; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration*; D010596:Pharmacy Technicians / Q000191:economics / Q000458:organization & administration; D013996:Time and Motion Studies; D016526:Workload