1. November RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 12.5%

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1 PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, December 2013 Terry Dentoni, RN, MSN, CNL, Interim Chief Nursing Officer 1. November RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 12.5% AREA RN VACANCY RATE NO. VACANT FTE TRAINING PROGRAMS Med/Surg (Includes 4B/Stepdown unit) Critical Care (Includes 4E/5E/5R) Perinatal (Includes 6C Birth Center & 6H Infant Care Center) 7.7% % % 7.0 Recent Jail Health Service RN reassignments have filled three positions. Remaining positions will be filled with staff reassignment candidates. apply for positions. Applicant selection pending interviews. Perioperative (Includes OR/ PACU/ Surgicenter) 17.4% 9.3 Emergency 25.7% 18.2 apply for positions. apply for positions. Psychiatry (Includes PES & acute inpatient units only) 18.9% 16.7 Recruitment process currently on hold. Behavioral Health Center 25% 4.0 Recruitment process currently on hold. Clinics (Includes Specialty clinics/ hosp. based Primary Care) 9.5% 5.7 apply for positions TOTALS 13.9% 91.2 Patient Care Service Report Terry Dentoni (lh) Page 1 of 6

2 2. Staffing Ratio Data for the Month of November 2013 Critical Care PACU Step- Down Medical Surgical Telemetry Pediatrics Perinatal Psychiatry ED 1:2 1:2 1:3 1:5 1:4 1:4 Varies 1:6 Varies Area unable to meet minimum Area unable to cover breaks Surgeries postponed related to Admissions held related to Beds closed / ED zone closed related to ED diversion related to Patient Care Service Report Terry Dentoni (lh) Page 2 of 6

3 3. Professional Nursing for the Month of November 2013 Retention/Professional Development: November s Nursing Grand Rounds and Journal Club, sponsored by the Research Council were successful in disseminating knowledge regarding motivational interviewing and the care of people with dementia. Nursing Excellence: Justin Dauterman RN, Clinical Educator for Critical Care has been selected as the Interim Staff RN Co-chair for the Coordinating Council. Justin previously served as the co-chair for the Professional Development Council and currently serves as the Co-chair for the Critical Care Service Council. Justin will co-chair the Coordinating Council with CNO, Terry Dentoni. Justin is taking on a key role in advancing shared governance to meet the milestones for the Magnet journey. Patient Care Service Report Terry Dentoni (lh) Page 3 of 6

4 4. Emergency Department (ED) Data for the Month of November 2013 The Emergency Department (ED) had a Diversion rate of 34% (246 hours) for November Trauma Override rate was 3.51% (25 hours). ED Encounters totaled 5122 patients, 798 of those were hospital admissions. SFGH Emergency Department Activities 7,000 6,000 5,000 Encounters 4,000 3,000 2,000 1,000 0 Admits Non-Admit Visits Patient Care Service Report Terry Dentoni (lh) Page 4 of 6

5 5. Psychiatric Emergency Service (PES) Data for the Month of November Hours on Condition Red Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec PES had 602 patient encounters during October 2013 and 611 in November. PES admitted a total of 137 patients to SFGH inpatient psychiatric units in November 2013, a decrease from 157 inpatient admissions in October. In November a total of 474 patients were discharged from PES: 48 to ADUs, 19 to other psychiatric hospitals, and 407 to community/home. There was an increase in Condition Red hours from October to November. PES was on Condition Red for hours during 10 episodes in November. The average length of Condition Red was 6.97 hours. In October, PES was on Condition Red for 35.4 hours, during 10 episodes, averaging 3.53 hours. The average length of stay in PES was 16.7 hours in the month of November, an increase from hours in October. Patient Care Service Report Terry Dentoni (lh) Page 5 of 6

6 6. Request for Inter-Facility Transfer to PES from other Hospitals A priority of PES is to improve the timeliness and appropriateness of inter-facility transfers from referring hospitals. The following three types of PES referrals have been observed: Accepted and Arrived, Accepted and Cancelled, and Inappropriate Referral. Accepted and Arrived Referrals refer to patients that have been approved by PES for admission and are admitted to the unit. Accepted and Cancelled Referrals refer to patients that have been approved for admission by PES, but their transfer is cancelled by the referring facility. This could be because the referring hospital has decided to place the patient on their own psychiatric unit, or because the patient has cleared psychiatrically and the 5150 hold has been dropped. Inappropriate Referrals refer to patients identified through the PES screening process to be inappropriate for further PES evaluation and placement. Common reasons for declining transfer of a patient from a referring hospital are medical status (not medically cleared at the time of screening) and insurance status (e.g., private insurance or out of county Medi-Cal). PES referral data above suggest that timeliness and appropriateness of inter-facility transfers are being achieved. Of referrals between October and November, the percentage of which the patient was accepted and was admitted to PES increased from 52% to 69%. The percentage of which the referral was accepted but cancelled decreased from 21% to 13%. This month, 18% of the referrals were considered to be inappropriate. These included medically unstable patients, and those with private or out of county insurance. The number of requests increased from 67 in October to 90 in November. Patient Care Service Report Terry Dentoni (lh) Page 6 of 6