Think for a moment about the enormous number of things that move through a veterinary hospital every day. Items such as food, drugs, money, medical records, medical supplies, retails supplies, trash and sharps, and deceased animals are common to most veterinary hospitals. In addition to these, you may handle materials that are specific to your particular practice, such as chemotherapy drugs, blood, or semen. If you offer boarding, you will need to deal with items such as cat carriers and other things that owners leave with you.

The first step in organising all of these categories is to visualise a flow chart for how the items move from place to place. For example, let's follow a roll of gauze through your hospital:

·         Receiving - the gauze arrives with a shipment of other items in a box.

·         Staging - it is stacked in your pharmacy or in a medical supply closet.

·         Use Area - it is moved to your treatment room to a cabinet where it is handy.

·         Intermediate Disposal - the used gauze is disposed of in medical trash.

·         Final Disposal - it is taken out in the trash to the dumpster.

As illustrated, even a simple item follows a complex path and demands storage through each stage. The trick to solving the storage problem is to design effective solutions for an item as it moves in, occupies, and moves out of your hospital. This sounds like a lot of effort, but by thinking of storage in terms of material handling, you can create more efficient solutions. This is critically important, because storage space does not earn you money, and wasted space compromises your revenue-generating capacity. The following area some rules of thumb for designing storage solutions.

Keep it Simple

If storage is inconvenient, it will become cluttered and unorganised and will take up more space in the end. Here are a few examples of complicated solutions that many people are tempted to try:

Storage in attics. This type of space is difficult to access. Therefore, once something goes into an attic, it rarely comes down. However, if you are serious about using your attic for storage, you will need to structurally reinforce the floor of the attic, which can be expensive. You will need to consider other building code requirements, such as fire protection.

Storage in basements. Basement space may seem like a good idea, but it frequently adds significant cost to a project and is not often worth the investment. This is particularly true in veterinary hospitals, because it is more difficult to put floor drains into a suspended floor system. Basements can also have access and egress issues.

Storage in inconvenient locations. You may be tempted to store something in every nook and cranny of your hospital. However, some locations, such as inside waiting or exam room benches or above dog urns, are inefficient. You and your staff should not have to bend over to get something, stand on a tall ladder in a run with a Rottweiler, or move Aunt Martha and Fifi off the bench to access the storage. What you should try to achieve instead is storage that is convenient to the place where the item is being used.

Create Specific Solutions to Specific Problems.

Once you have eliminated the places that you know will not get used properly, focus on specific, efficient solutions.

Maximise upper cabinet space. You would be surprised how many times we have walked into a stuffed and overflowing treatment area, only to look into the lower cabinets and find nothing in them. Because people do not want to crawl on their hands and knees to get items that they use every day, spaces below counters do not get used as efficiently as spaces above counters. Therefore, strive to maximise your upper cabinet storage space and install drawers in your lower cabinet space. They are easier to use and more effective. Also, consider using space below your lower counters to store bulky items that are used less frequently, or leave the space open and use it to park equipment, trash cans, and carts out of the way.

Design for the size and mass of the item you are storing. For example, install heavy-duty shelving supplied by food manufacturers that is designed for food storage. Here are some other good ideas:

• Retail Display - a slat wall is an effective way to display smaller retail items.
• Files - choose file systems that are designed specifically for medical files. Some systems can be set on sliding rails to maximise space usage.
• Pharmaceuticals - store pharmaceuticals in your dispensing pharmacy in shallow, open shelves or glass cabinets with specifically designed pharmaceutical shelving, so that all products are easy to see and access.
• Computers and Hardware - your goal should be to keep your counter tops uncluttered. Consider using pull-out, ergonomic keyboard trays with a wireless mouse for each. Also, flat panel monitors occupy less space. CPUs can be stored under counters on trays off the floor.
• Equipment - to free up floor space, hang equipment, monitors and anaesthesia units in surgery, dental, special procedures, and treatment areas from a track on the ceiling on swing arm supports.
• Utility Areas - Invest in deeper than standard, durable work surfaces in laundry and food prep for a more effective surface.
• Odd-Shaped Items - for things such as "Elizabethan" collars, trays, and other wide, yet flat items, consider using narrow base cabinets with full-height doors that will allow you to insert these items vertically.
• High-Density Storage - for your bulk storage areas, it is important to come up with solutions that minimise wasted space. At the same time, it is important to be able to easily find and get to everything. For your numerous smaller items, consider high-density bin storage systems developed for storing pharmaceuticals in human medicine and for storing items in hardware stores. These can be brilliantly effective for categorising items and creating easy-to-access bulk storage.
• Bulky Items - for larger items, invest in heavy-duty shelving, which can be adjusted for the size of the item that is being stored. Resist stacking these items on the floor.
• Storage at Animal Caging - while storage over runs is usually inefficient, many manufacturers of cages and cat condos are creating modular units with storage built in. This can be a very effective place for bowls, litter, towels, toys, and personal items. The space above ICU cages can be designed with shelves for monitors and with oxygen and electricity outlets for the various pieces of equipment you need.

Develop Effective Methods for Inventory Control and Security

Another important reason to understand the flow of goods and materials through your hospital is to have a good handle on inventory control and security. If you have no idea where something is, chances are you won't notice when it goes missing. Inventory control is very important, not just for controlled substances, but also for general ordering and re-ordering and for tracking where supplies go and how they are used.

A good inventory control strategy will also help you save space by reducing the "five ketchup bottles in the refrigerator" syndrome. Here are some ideas to consider:

• Centralise receiving, staging, and bulk storage. Consider developing a centralised receiving and staging area that is directly associated with the bulk storage room. A good example of this is the model used in large and mixed animal hospitals. A central supply and pharmacy is also used for ambulatory truck stocking, so all items move out of one location before going anywhere else. If you follow this model, be sure that you have a method for tracking items as they leave this centralised area. Large hospitals, or hospitals with ambulatory veterinarians, may need to have a system for daily re-order from central supply so items are tracked effectively. In some cases, it may be necessary to dedicate a staff member to organising this task.
• Reduce duplication. It might be more effective to have one refrigerator parked outside the exam rooms than an under-counter refrigerator in each exam room. This is an individual decision, but reducing the number of places that an item may be located can simplify your inventory control.
• Consider technological solutions. Medication dispensing systems have been available for the human medical market for some time. These systems are similar to vending machines and allow authorised staff to access medications and supplies while recording the transactions for tracking purposes. Bar code readers can also be effective for tracking items. Finally, remember that the greatest benefit of the digital age for veterinary hospitals is not the elimination of paper (which we know is a fictional promise), but the ability to run your business and track goods and services at any location in your hospital on a common network.

Final Considerations

Scale back. The veterinary profession changes at light speed. Before you move into your new hospital, sort through your stored items and prevent carrying unneeded things with you to the new building. Do you really need that broken x-ray view box or that defunct computer? If you haven't seen it in a year, chances are you can live without it. Remind yourself that your building makes more money as a hospital than as a storage unit.

Consider off-site storage for rarely used items. There are some things that you really do need to keep for some time, but you rarely, if ever, use. Old files and records belong in this category. At today's construction costs, it may be more effective to keep these items in an off-site storage location rather than build a dead file room into your facility.

Identify unique circumstance. Be sure to identify any storage needs that may be unique to your practice. For example, if you treat cats with radioactive iodine, you may need a gowning area and a storage space for "hot" wastes. By reviewing how you handle materials in each area, you can help your design professional identify these unique circumstances.

Summary

Design effective storage solutions for your practice is an exercise in understanding material handling. It easy to get caught up in the details of designing your treatment room cabinetry, but without a good idea of how things flow in and out of your treatment room, you may find yourself with spaces that are not as useful as you hoped.

Once you have a good understanding of your own storage flow chart, the real challenge is to keep the storage solutions simple and efficient. If you do this, you may spend more money on shelves, cabinets, and storage systems, but you will save yourself square footage. Most importantly, you will save time and energy for yourself and your staff.

Source:  Mark R Hafen Hospital Design Conference 2009