Report Contents: PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, June By: Terry Dentoni, MSN, RN, CNL - ZSFG Chief Nursing Officer 1. Professional Nursing......1-2 2. Emergency Department Data.....3 3. Psychiatric Emergency Services Data... 4-5 4. Request for Inter-Facility Transfer to PES from other Hospitals.....6 1. Professional Nursing for the Month of May Nursing Professional Development The last week of May, the ED held a week-long Kaizen improvement event focused on the Emergency Department's Consultative Services. The event directly impacts our hospital s Strategic Flow metric to reduce ED patient s length of stay. During the week the Orthopedic, Neurology and Emergency Services worked together to expedite the consultation process and reduce the time a patient waits for a consultation. Mary McLaughlin, SICU staff nurse, presented an organ donation patient case study June 1 st at the Organ Donation Symposium. The ZSFG Donor Committee and the Donor Network West sponsored this educational course. Critical Care nursing has two staff nurses who just graduated from their Nurse Practitioner programs: Emily Uphoff and Brooke Carpenter. Alek Kersten just passed his CCRN certification exam. Rachel Perry Limon RN, MS, CNS, CEN is presenting the Pediatric Trauma course at this year s San Francisco Emergency Nursing Association annual education conference held at ZSFG on June 12,. Rich Nepomuceno, RN, MS, CNS, CEN taught the Stroke/Neurologic course along with Christine Martin, RN, CNS stroke program coordinator and Dr. Claude Hemphil at the SF Paramedic reach for stroke training this month. John Fazio, RN, CNS taught a segment at the Emergency Neurologic Life Support (ENLS) training course that prepares the multidisciplinary team to manage neurologic patient emergencies with standardized protocols, checklists and suggested communication to use during patient management. Nursing Recruitment and Retention Nurse hiring managers teamed up with Tina Hinnant and Human Resources staff to host a targeted four hour on-site ZSFG Career Fair Saturday, June 17 th. Recruiting had been reaching out to experienced RN
candidates as well as other as MEA, Imaging Techs and Surgical Techs. The managers had a chance to assess the applicants experience and skills in a more relaxed way. Medical-Surgical - nursing division started a new 8 week training program for 22 nurses on June 1st. Psychiatry nothing to add Emergency Nursing - has 8 new nurses in the last phase of their 6 month department training program. There are another 8 nurses that are in the middle of their didactic portion of their training. They will be orienting to working in Pods A, B and C through July. Maternal Child Health - Three staff have completed their orientation to Labor and Delivery while another 2 have completed orientation to the post-partum nursing care delivery area. Additionally, two new 2320 and three P103 staff were hired and are in orientation. Peri-Operative - The operating room just completed interviews for 4 positions for their training program that will begin in July. Critical Care training program begins - June 12 th for 2 nurses in the SICU and 2 new nurses for the MICU. Social Services - We welcomed Glen McClintock, MSW, LCSW to ZSFG June 12 th as the new Director of Social Services overseeing Social Services throughout ZSFG including the Emergency Department, Acute Psychiatry, Inpatient areas, Outpatient clinics and programs.
2. Emergency Department (ED) Data for the Month of May 8,000 Emergency Department Total Census with Activities 7,000 6,000 5,000 4,000 3,000 2,000 1,000 - Admits Seen in ED and D/C'd LWBS/LWBT Triaged/Referred Out JCC Diversion Report 80% 70% 60% 50% 40% 30% 20% 10% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 46% 50% 38% 41% 50% 42% 46% 52% 44% 47% 51% 55% 59% 60% 62% 46% 43% 61% 62% 62.60% 61% 59% 57% 60% 67% 68% 59% 48% 48% May Diversion Rate: 48% ED Diversion = 298 hours (40%) + Trauma Override = 58 hours (8%) Total Ed Encounters: 6373 ED Admissions: 1001 ED Admission Rate: 15.71%
3. Psychiatric Emergency Service (PES) Data for the Month of May ZSFG Psychiatric Emergency Service Activities Admitted to 7B ADU Transferred to private hospital Discharged to Community 800 700 600 500 400 300 200 100 0 ZSFG PES Condition Red 60% 50% 40% 30% 20% 10% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 10% 16% 16% 22% 26% 21% 27% 34% 46% 32% 47% 26% 34% 36% 41% 49% 30% 47% 51% 17% 33% 24% 28% 22% 27% 17% 18% 20% 18% 2015
Hours Psychiatric Emergency Service (PES) Data for the Month of May continued 30 ZSFG PES Average Length of Stay 25 20 15 10 5 2015 0 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 2015 19 18 20 20 20 17 17 18 19 18 21 19 20 19 21 22 20 22 27 17 23 20 22 19 21 18 19 19 18 25.0% ZSFG PES Admission Rates 20.0% 15.0% 10.0% 5.0% 2015 0.0% Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 2015 20.1% 17.0% 19.3% 18.4% 15.0% 13.6% 13.5% 12.2% 10.7% 11.0% 9.9% 11.4% 11.6% 12.3% 11.9% 8.6% 10.9% 9.5% 7.8% 11.6% 10.5% 9.7% 7.4% 7.3% 6.30% 8.70% 10% 8.90% 11.3%
4. 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 transferred and admitted to PES. The transfer of these patients has been authorized by PES based on EMTALA regulations as well as the communication of clinical condition between the sending and the receiving physicians. Screened Appropriate but Cancelled Prior to Acceptance refers to patients that have been screened by a triage nurse and have preliminary approval, but the paperwork has not been reviewed by a physician. Their transfer was then cancelled by the referring facility. This cancellation 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 transfer and admission to PES for evaluation and disposition. Common reasons for PES to decline transfer of a patient from a referring hospital are medical status (not medically stable for transfer) and insurance status (e.g., private insurance or out of county Medi-Cal). Disposition of PES Referrals from Other Hospitals 120% 100% 80% 60% 40% 20% 0% 20% 11% 17% 63% 73% 73% 64% 17% 16% 10% 6% June N=75 July N=62 August N=78 30% Sept N=80 16% 22% 19% 24% 27% 56% 28% Oct N=68 71% 7% Nov N=55 58% 56% 56% 10% 23% 19% 17% 9% Dec N=43 Jan N=62 Feb N=66 28% 27% 81% 45% 56% March N=68 27% Apr N=75 17% May N=63 Accepted & Arrived Screened Appropriate and Cancelled by presenting hospital Inappropriate Referral The percentage of patients who were accepted and arrived to PES from other hospitals decreased this month. The percentage of patients who were screened as appropriate by PES and later cancelled by the presenting hospital had a small increase, from 45% to 56%.