Roma P. Guy, M.S.W. President John L. Umekubo, M.D. Vice President Edward A. Chow, M.D. Ron Hill Lee Ann Monfredini HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO Willie L. Brown, Jr., Mayor Department of Public Health Mitchell H. Katz, M.D. Director of Health Sandy Ouye Mori Executive Secretary Harrison Parker, Sr., D.D.S. Tel. (415) 554-2666 FAX (415) 554-2665 David J. Sánchez, Jr., Ph.D. MINUTES Web Site: http//www.dph.sf.ca.us JOINT CONFERENCE COMMITTEE MEETING FOR SAN FRANCISCO GENERAL HOSPITAL Tuesday, September 12, 2000 3:30 p.m. 1001 Potrero Avenue, Room #2A6 San Francisco, CA 94110 1) CALL TO ORDER The regular meeting of San Francisco General Hospital was called to order by Chairperson, Lee Ann Monfredini, at 3:35 p.m. Present: Absent: DPH Staff: Lee Ann Monfredini Edward A. Chow, M.D. Gene O Connell, John Luce, M.D., Ken Jensen, Beth Maloney, Kimberly O Kane, Monique Zmuda, Joseph Pendon, Hiro Tokubo, Melinda Garcia, Alan Gelb, M.D. Ms. O Connell introduced new Medical Staff office employee Kimberly O Kane, who came from St. Mary s Hospital. 2) APPROVAL OF MINUTES OF JULY 11, 2000 Action Taken: The Committee adopted the minutes of July 11, 2000. 101 Grove Street San Francisco, CA 94102-4505
3) HOSPITAL HEALTHCARE UPDATE (Gene O Connell, Executive Administrator, San Francisco General Hospital Medical Center) UPDATE ON STATUS OF PSYCHIATRY IN MEETING PERFORMANCE CRITERIA For the past two months, Barbara Garcia and Gene O Connell have been co-chairing a committee comprised of representatives from Community Mental Health Services (CMHS), Laguna Honda Hospital (LHH), Mental Health Rehabilitation Facility (MHRF), San Francisco General Hospital and Finance, to monitor the following: Performance Measure #1 The rate of hospital admissions from Psychiatric Emergency Services (PES) at SFGH will stay at the current level (40% for Medi-Cal and indigent patients) or will decrease over the next year. This is measured by comparing the ratio (of hospital admissions to diversions to alternative services and program) on a monthly basis. (STATUS: From July 1 st to August 22 nd, the goal is met). PES Dispositions* July 1 to August 22, 2000 (844 Episodes) PES to 4P 8% PES to SFGH 29% Non-Hosp* 60% PES to FFS 3% Performance Measure #2 The average length of stay of 15 days will be maintained throughout the year. This measure will exclude patients who remain hospitalized over 90 days when awaiting placement to locked skilled nursing facilities or Napa State Hospital. This measure also excludes patients in the hospital prior to July 1, 2000. (STATUS: From July 1 st to August 31 st, the goal is met). Page 2
FUNDING SOURCE LOS # OF DECERT. PATIENTS AVERAGE LOS # DENIED DAYS # ADMIN DAYS TOTAL # OF DECERTIFIED DAYS (Admin + Denied) Medi-Cal 105 10 10.5 6 7 13 Medi-Medi 49 4 12.25 2 19 21 Short-Doyle 48 3 16 0 17 17 TOTAL 202 17 11.88 (< 15 days) 8 43 51 days (25% of total 202 days) Performance Measure #3 Referral of patients to inpatient psychiatry beds will reflect the payor mix as assumed in the revenue budget and will maintain the use of SFGH as the safety net for all indigent patients. (STATUS: Goal has been met.) Performance Measure #4 PES and Inpatient Psychiatric Services will continue its policy of not admitting out-of-county Medi- Cal and Medicare patients to SFGH, as many of these patients are not reimbursed by the county of residence. (STATUS: from July 1 st to August 31 st, goal is NOT met). An Eligibility Worker will be assigned in October to focus on PES Funding Source of all SFGH Psychiatry Admissions FY 1999-2000 (2242 episodes) Funding Source for all SFGH Psychiatry Admissions July and August, 2000 (407 episodes) SFGH Medi-Cal NOT SF SFGH Medi-Cal SF 27% SFGH Medi-Cal SF 25% SFGH Others 6 SFGH Medi-Care not SF SFGH Medi-Care SF 12% SFGH Private Insurance 0% SFGH Others 58% SFGH Medi-Care not SF SFGH Medi-Care SF 13% SFGH Medi-Care Not SF SFGH Private Insurance 0% In addition to monitoring the Performance Measures, the Committee is also problem solving patient flow and placement issues. A sub-committee was formed to look specifically at patient flow and placement between the San Francisco General Hospital (Medical-Surgical, Psychiatry, and SNF), the Mental Health Rehabilitation Facility, and Laguna Honda Hospital. The subcommittee has met as a whole once already, and in addition both Campuses (LHH & SFGHMC) have held their separate meetings to identify internal processes that could be improved to facilitate patient flow and placement. Page 3
MAMMOGRAPHY CQI TASK FORCE UPDATE There are approximately 8,000 CHN patients (females over 40 who are regular primary care patients) who may represent the target population for annual mammography screenings. These patients reside primarily in the Mission, Excelsior, and Bayview Hunters Point areas of the City. Currently the CHN does about 4,000 annual mammograms (almost a 20% increase from FY 1997-98), reaching about half of the patients identified above. About 25% reside in the Mission, 14% in the Excelsior and 16% in Bayview and Visitation Valley; however, patients come from all over the City. Currently, Radiology has two rooms where they perform approximately 16 screenings a day. Three days a week are used for diagnostic treatment and four days a week for screenings. Budget constraints, space constraints and staff shortages affect Radiology s ability to provide the number and kind of services that would be optimal. To help address this, the Task Force is pursuing options and recommendations on how CHN could best provide breast health services. Members of the Task Force have been meeting since mid July and include representatives from Radiology, Surgery, Oncology, Specialty Care, General Medicine, Family Practice, Community Primary Care, and Population Health and Prevention. Current next steps for the Committee include: Continue brainstorming alternatives for providing services. Discuss pros and cons of each proposal. Recommendations are targeted for completion by November. Kevin Grumbach, Chief of Family and Community Medicine, will provide data on target number of patients using varying parameters. Gayling Gee will cost out staff and equipment for providing services at CHN. Diane Carr will investigate other models of care. I will continue to update the JCC-SFGH as the mammography committee progresses. ANNOUNCEMENT OF SUSAN CURRIN AS NEW CHIEF NURSING OFFICER Ms. O Connell announced the selection of a new Chief Nursing Officer for San Francisco General Hospital. After several rounds of interviews with numerous candidates, Susan Currin has been selected as the new Chief Nursing Officer position. During the past two years, Sue has been at Oakland Kaiser Permanente Hospital and Health Plan serving as the Quality and Service Leader for the East Bay Service Area. Sue has served in various nursing capacities during her 20-year career at San Francisco General Hospital. Sue will begin on October 6, 2000. Ms. O Connell thanked Joseph Pendon for all of his hard work in serving as the Interim Chief Nursing Officer. When Sue begins as the Chief Nursing Officer in October, Joseph will return to his role as the Director of Medical Surgical Nursing. Page 4
DEPARTURE OF ERIC MILLER, DIRECTOR OF FACILITY SERVICES Mr. O Connell announced that Eric Miller, Director of Facilities and Plant Services for the Department of Public Health will be leaving on September 15, 2000. Eric has served the Department of Public Health for 15 years in various capacities. He has accepted a position with Oakland Kaiser Permanente Hospital and Health Plan. San Francisco General Hospital will be hosting a farewell reception for him on Wednesday, September 13 th from 4:00-5:30 p.m. in the Main Cafeteria. MENTAL HEALTH REHABILITATION FACILITY RECIPIENT OF APNA S BEST PRACTICES AWARD The Mental Health Rehabilitation Facility Program has been selected to receive the American Psychiatric Nurses Association BEST PRACTICES AWARD for Best Treatment of Schizophrenia in an Inpatient Program. Drs. Mozettia Henley, RN, DScN and Peggy Wilson, RN, DScN, submitted the proposal "Beyond Old Boundaries: A Nursing Model for the New Millennium," which was selected for the award. Dr. Henley serves as the Program Director of the Mental Health Rehabilitation Facility and Dr. Peggy Wilson is the Clinical Nurse Specialist for the Mental Health Rehabilitation Facility. The award will be presented at the opening of the 14th Annual APNA Conference in Washington, D.C., on October 25, 2000. 4) PATIENT CARE REPORT (Joseph Pendon, RN, MSN, Acting Chief Nursing Office) Bed Utilization Committee In response to the continued high volume experienced by the Medical Center since mid-june, a Bed Utilization Committee consisting of Physicians and Registered Nurses, convened to focus on developing strategies to maximize patient flow and utilization of acute care beds. This Committee meets on a bimonthly basis. Examples of strategies identified by the Committee include: a) detailed review of patients admitted to the various levels of care, and particularly those patients admitted to4b Step Down, b) early identification and facilitation of patients to be discharged to the community or to skilled nursing systems, c) closer communication between discharge planners, utilization review, and the direct care providers, and d) piloting an Admission/Discharge Nurse to facilitate patient movement during peak movement hours of 1500-2100. In addition to this Committee, the continued practice of meeting at 0730 with nursing representatives from the Emergency Department, Perioperative, Critical Care, Step Down, and Medical Surgical with Nursing Operations/AODs, to mutually develop detailed operational plans prioritizing and coordinating admission, transfers, and discharges occur. This proves to be an efficient mode of communicating the various needs of individual patients and respective units. Voluntary Staff Reassignment On July 24 th, 2000 a letter was sent to the Inpatient Nursing Staff of SFGHMC advising them of the need to reduce staffing that was connected to the 20 medical surgical bed decrease proposed in the DPH s FY 00/01 budget. Attached to the letter were specific areas with targeted reduction as well as units with available positions. The letter encouraged staff to seek voluntary reassignment to areas of Page 5
interest, including those within their service line. The Nursing Staff received this letter from Administration in a very open and receptive manner. Within the time frame identified; staff voluntarily solicited opportunities in areas such as Health At Home, Jail Health Services, as well as specialties within the Inpatient areas, thereby, eliminating the need for mandatory involuntary assignments. Diversion Statistics for July and August 2000 July 2000 Statistics For July 2000, San Francisco General Hospital experienced1three episodes of critical care diversion for a total of 212 hours and 20 minutes. This represents a total percentage of 28% for July 2000. This represents a 13% increase from June. As of August 1, 2000, critical care diversion is permanently suspended in San Francisco. The Emergency Department recorded 47 episodes of total diversion for 231 hours and 20 minutes. This represents 3 for July. This is an increase of 9.5% from June. The ED was impacted to capacity during the episodes of total diversion. The Emergency Department recorded four episodes of trauma override for a total of 18 hours and 10 minutes or 2.4% for June 2000. This shows a 0.6% decrease in trauma override in July. August 2000 Statistics In August, critical care diversion was indefinitely suspended in San Francisco. This is reflected in the total diversion and trauma override increases for the month. The Emergency Department recorded 48 episodes of trauma override for a total of 67 hours and 10 minutes or 9% for August 2000. This is an increase of 1 from July. The ED was impacted to capacity during the episodes of total diversion. The Emergency Department recorded 10 episodes of trauma override for a total of 67 hours and 10 minutes or 9% in August 2000. This shows a 6.6% increase in trauma override in August. 5) FINANCE REPORT STATEMENT OF REVENUES AND EXPENDITURES (Ken Jensen, Chief Financial Officer, CHN) Mr. Jensen submitted the July Revenue and Expense Summary, (Attachment A). Mr. Jensen reported that the annual audit for SFGH and Medicare audit are in progress. Medi-Cal is starting the 1999 audit. Monfredini suggested that the other Health s receive the latest information on decertified beds, the census, and diversion rates. 6) GENERAL PUBLIC COMMENTS ON ANY MATTER WITHIN THE SUBJECT MATTER JURISDICTION OF THE JOINT CONFERENCE COMMITTEE FOR SAN FRANCISCO GENERAL HOSPITAL None. Page 6
7) PUBLIC COMMENTS ON ALL MATTERS PERTAINING TO THE CLOSED SESSION None. The Committee went into closed session at 4:10 p.m. and came out of closed session at 4:35 p.m. Individuals in the Closed Session were the same as in the open session. 8) CLOSED SESSION PURSUANT TO EVIDENCE CODE SECTIONS 1157(a) AND (b); 1157.7, HEALTH AND SAFETY CODE SECTION 1461; AND CALIFORNIA CONSTITUTION, ARTICLE I, SECTION 1 Action Taken: The Committee approved the closed session minutes of July 11, 2000. 9) RECONVENE IN OPEN SESSION Consideration of Medical Audit, Quality of Care, Quality Assurance and Credentialing Matter Action Taken: The Committee voted not to disclose any discussions held in closed session. The revisions to the SFGH Medical Staff Bylaws will be calendared for the October 3, 2000 Health Commission meeting. Copies of the revisions will be given to the s. The meeting was adjourned at 4:40 p.m. Sandy Ouye Mori Executive Secretary to the Health Commission Attachment (1) Page 7