The effect of additional shots on the vaccine administration process: results of a time-motion study in 2 settings

Am J Manag Care. 2000 Sep;6(9):1038-44.


Context: The introduction of combination vaccines to the pediatric regimen offers the possibility of reducing the number of injections required to reach full vaccination status. Fewer injections benefit the patient/child and the parent/caregiver, and the healthcare provider may benefit from savings in personnel time associated with vaccine administration. To date, however, these savings have not been quantified.

Objective: To study the vaccine administration process in a managed care environment.

Study design: We studied 2 settings in which vaccinations were administered: (1) a devoted injection room and (2) the examination room as part of the well-child examination. For each setting, we documented the vaccine administration process, identified vaccine-related activities, and quantified the time savings in each activity by reductions in the number of shots.

Patients and methods: For vaccine recipients younger than 2 years, time-motion data on vaccine-related activities in 2 managed care settings were collected by a professional industrial engineering consultant. Activity time data by the number of shots administered were analyzed using linear regression adjusting for patient age.

Results: We observed 276 vaccination visits (137 in an examination room, and 139 in an injection room). Total nurse time associated with vaccine administration decreased by 2.4 and 1.7 minutes per shot eliminated in the examination room setting (P = .006) and in the injection room setting (P < .001), respectively. Significant time savings were realized for activities associated with vaccine preparation, vaccine injection, and administrative duties. In addition, infant crying time decreased by 1.0 and 0.4 minutes per shot eliminated in the examination room and injection room settings, respectively (P < or = .001 for both).

Conclusions: Significant reductions in vaccine administration time could be achieved by eliminating injections during a well-child regimen.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Health Services / organization & administration
  • Child Health Services / statistics & numerical data*
  • Crying
  • Drug Administration Schedule
  • Humans
  • Infant
  • Managed Care Programs / organization & administration
  • Managed Care Programs / statistics & numerical data*
  • Nursing Services / organization & administration
  • Nursing Services / statistics & numerical data
  • Office Visits / statistics & numerical data*
  • Process Assessment, Health Care*
  • Time and Motion Studies*
  • Vaccination / statistics & numerical data*
  • Vaccines, Combined


  • Vaccines, Combined