HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO

Sonia E. Melara, M.S.W. President Edward A. Chow, M.D. Vice-President Cecilia Chung Commissioner David.J. Sanchez, Jr., Ph.D. Commissioner Belle Taylor-McGhee Commissioner 1) CALL TO ORDER HEALTH COMMISSION CITY AND COUNTY OF SAN FRANCISCO Edwin M. Lee, Mayor Department of Public Health MINUTES JOINT CONFERENCE COMMITTEE FOR SAN FRANCISCO GENERAL HOSPITAL Tuesday, April 09, 2013 3:00 p.m. 1001 Potrero Avenue, Conference Room 2A6 San Francisco, CA 94110 Barbara A. Garcia, M.P.A Director of Health Mark Morewitz, M.S.W. Executive Secretary TEL (415) 554-2666 FAX (415) 554-2665 Web Site: http://www.sfdph.org Present: Staff: Commissioner Edward A. Chow, M.D., Chair Commissioner Cecilia Chung Commissioner David J. Sanchez, Jr., Ph.D. Sue Currin, Sue Carlisle MD, Sue Schwartz, Iman Nazeeri-Simmons, Troy Williams, Baljeet Sangha, Terry Dentoni, Roland Pickens, Shannon Thyne MD, Kathleen Murphy, Anson Moon, Dan Schwager, Jenny Chacon (QM), Colleen Riley MD, Yifang Qian MD, Sharon Wicher, Jeanette Cavano, Jeff Critchfield MD, Mark Wilson MD 2) APPROVAL OF THE MINUTES OF THE MARCH 12, 2013 SAN FRANCISCO GENERAL HOSPITAL JOINT CONFERENCE COMMITTEE MEETING Action Taken: The minutes of the March 12, 2013 SFGH JCC were unanimously approved. 3) SERVICE EXCELLENCE UPDATE Baljeet Sangha, Chief Patient Experience Officer, gave the presentation. Commissioner Comments/Follow-Up: Commissioner Chow asked for clarification of which providers participated. Dr. May and Dr. Thyne stated that medical staff and affiliated medical staff participated. Commissioner Chung asked whether the impact of the project will be sustainable taking into consideration the turnover of residents. Mr. Sangha stated that sustainability of the service excellence is being implemented on all units. During Human Resource interviews for new staff, candidates are told of the importance of service excellence. Mr. Sangha also stated that there are train-the-trainer programs in place to keep the knowledge and reinforce good practice at SFGH. Dr. Carlisle stated that many residents at SFGH also practice at the Page 1

Veteran s Administration (VA) and UCSF, both of which have service excellence projects. These residents often bring issues and projects to SFGH from their experience at the VA and UCSF. Commissioner Chow asked how service excellence will be brought to other sections in the DPH. Ms. Currin stated that the Integrated Steering Committee has discussed the issue. LHH and COPC are currently participating; the next phase will bring in Population Health and Prevention clinics such as TB and City Clinic. She stated that Mr. Sangha is working with SFGH and COPC. LHH will soon have its own designated staff person working on service excellence. Mr. Pickens stated that as DSRIP ends in October of 2015, the funding for the service excellence programs may shift. 4) QUALITY MANAGEMENT REPORT Sue Schwartz, Director of Performance Improvement, gave the report. Commissioner Comments/Follow-Up: Commissioner Chung asked for clarification on the issues with antibiotic selection. Ms. Currin stated that there were two cases where antibiotics were not available. Dr. Thyne stated that because the number of total cases in this area is so small, these two cases resulted in statistical significance noted in the report. Commissioner Chow asked for clarification on the reduction in the overall rating. Ms. Currin stated, access to services is the issue and she gave the example of SFGH patients having to call to make an appointment instead of doing so online. Commissioner Chow asked for clarification on the score reflecting the rate of staff explaining medication side effects. Ms. Dentoni stated that there is a task force working on plans to improve these scores. Commissioner Sanchez recommended having checklists for staff to use as a guide. Commissioner Chung asked how SFGH measures whether the medical provider has heard a patient s concerns. Ms. Dentoni stated that SFGH audits the nurses in regard to the process of explaining issues related to medication. Ms. Nazeeri-Simmons stated that if the Usually and Always scores are combined, SFGH achieves scores in the upper 80 s on these measures. Mr. Williams stated that SFGH is attempting to send out the surveys soon after discharge to assist in improving scores. 5) HOSPITAL ADMINISTRATOR S REPORT Susan A. Currin, Chief Executive Officer, gave the report. Program Updates: Lean Update San Francisco General Hospital established a Lean Visibility Wall, located on the second floor of the Main Hospital, outside of 2A5 Administration Suite. Utilizing the Visibility Wall, the lean specialist (value stream support) conducts Tier 1 Report Outs to the CEO and Executive Team weekly on progress made towards Improvement Plan s targets, status of standard work, 5S sustainment, challenges, barriers, and successes. In March, the Executive Team selected the 4D Med-Surg Unit as the 4th Value Stream, which will launch in July 2013. Page 2

Nurses Week May 6, 2013 is National Nurses Day, and also the first day of National Nurses Week. Several events are planned at SFGH, including the Nurses Week Reception on May 9, 2013, where we will recognize and celebrate the contributions of the DPH Nursing Staff. There will be Nursing Grand Rounds on May 8 and Nursing Leadership will thank the night shift staff with It s It Ice Cream bars on May 9. Rebuild, Neighbors and City Partner on Potrero Ave. Streetscape Plans Potrero Ave. is due for a facelift from 21 st to 25 th Streets that could include repaving, widening sidewalks and planting medians along the corridor. The Rebuild team is partnering with neighbors, DPW, the Planning Department and SFMTA to finalize these plans and coordinate schedules to coincide with the completion of the new hospital. At the March 26 th Rebuild community meeting, the Department of Public Works shared two initial options for street improvements. Option A would replace current painted medians along the center of Potrero Ave. with raised, planted medians; add sidewalk bulb outs at bus stops to improve pedestrian safety; and add a twofoot buffer zone between car traffic and existing bike lanes. DPW also plans to repave streets around the hospital, including 22 nd St., 23 rd St., Vermont St. and San Bruno Ave. Option B would widen the east sidewalk to 15 feet (currently nine feet), eliminating 30-40 parking spots, and would also include the planted median, bulb-outs and a one-foot buffer for the existing bike lane. Neighbors voiced their opinion both in favor and against aspects of the proposals and then broke up into small groups for in-depth conversations with engineers and planners. Plans will be revised based on feedback and presented at a second public meeting in May 2013. Design and planning will continue through 2013, with construction starting in summer of 2014 and wrapping up in the summer of 2015. More information is available on the Potrero Streetscape Improvements page at sfdpw.org. Patient Flow Reports for March 2013 A series of charts depicting changes in the average daily census is attached. 6) PATIENT CARE SERVICES REPORT Terry Dentoni, Interim Chief Nursing Officer, gave the report. 2320 RN Vacancy Rates for the Month of March 2013 The overall 2320 RN vacancy rate for areas reported is 4.3%. Staffing Ratio Data for the Month of March 2013; all shifts were covered. Professional Nursing for the Month of March 2013 Retention/Professional Development: San Francisco State University is recruiting SFGH RN staff interested in completing a BSN degree to begin classes in the fall of 2013. Classes will be held on the SFGH campus. The first SFGH cohort of 13 is scheduled to graduate in May 2013. Two Dorothy Washington Scholarships will be awarded at the May Nurses Week celebration to SFGH staff who are enrolled in BSN or MSN programs. Emergency Department (ED) Data for the Month of February 2013 The Emergency Department (ED) had a Diversion rate of 39% (288 hours) for the month of March 2013. The Trauma Override rate was 5% (34 hours) a 45% decrease compared with February. ED Encounters totaled 5048 patients, 827 of those were hospital admissions. Psychiatric Emergency Service (PES) Data for the Month of March 2013 Page 3

PES had 569 patient encounters during February 2013 and 623 in March. PES admitted a total of 142 patients to SFGH inpatient psychiatric units in March 2013, a decrease from 147 patient admissions in February. In March a total of 481 patients were discharged from PES: 33 to ADUs, 24 to other psychiatric hospitals, and 424 to community/home. There was an increase in Condition Red hours from February to March. PES was on Condition Red for 84.6 hours during 15 episodes in March. The average length of Condition Red was 6.33 hours. In February, PES was on condition Red for 70.8 hours, during 12 episodes, averaging 5.89 hours. The average length of stay in PES was 16.98 hours in the month of March, a decrease from 17.26 hours in February 7) MEDICAL STAFF REPORT Shannon Thyne, M.D., Chief of Staff, gave the report. LEADERSHIP/ACHIEVEMENTS/MEDIA Annual Medical Staff Dinner The 2013 Annual Medical Staff Dinner will be held on Thursday, May 23, 2013. Bennie Jeng, MD, Chief of Ophthalmology Dr. Bennie Jeng will be leaving SFGH in August to accept the position as Chairman, Ophthalmology Department of the University of Maryland. Members congratulated Dr. Jeng, and thanked him for his outstanding leadership of the SFGH Ophthalmology Service. A Search Committee will be underway in the coming months. ADMINISTRATION/REGULATORY/COMPLIANCE Major Hospital Initiative Presentations In efforts to disseminate information and engage all faculty/staff on Health Reform, MEC leadership (Dr. Alice Chen, Dr. Todd May, Dr. Jeff Critchfield and Dr. Will Huen) will be coming to Clinical Services faculty meetings to present and discuss major hospital initiatives, including Service Excellence, Pay for Performance, and other components of the Affordable Care Act. Service Chiefs are asked to allot 30 minutes of one of their faculty meetings for this presentation before June 30, 2013. Members recognized the critical need to ensure that all faculty and staff are educated on the Affordable Care Act, and its impact on the delivery of care at SFGH. Members also applauded Dr. Neil Powe, Dr. Jeff Critchfield, Dr. Alice Chen, and Dr. William Huen for the excellent and powerful presentation entitled UCSF/SFGH in the Era of Health Reform at the March 19, 2013 Medicine Grand Rounds. Members proposed a repeat of the Medicine Grand Rounds presentation for the entire SFGH campus. Standardized Procedures: Anesthesia NP SP CLINICAL SERVICE REPORTS/RULES AND REGULATIONS Emergency Service Report Christopher Barton, MD, Service Chief The report outlined the following: Mission Statement Scope of Services Faculty and Staff Volume Statistics Visits and Admissions by Year, Ambulance traffic reports, ED Diversion, Ambulance Bunching, Trauma (types of patient injuries seen), Trauma Activations, ED-CDU Census, Performance Metrics, Efficiency Metrics Finance Profee Collections by Month/Yr, Sources of Income, Expenses, Revenue and Expense Projections Teaching/Residency Numerous teaching awards received by the ED faculty Research/Publications Over $5M in research funding as of last year, an 846% increase from 2010. Page 4

PIPS PI Measures/Indicators 2013, OPPE, Complications Reporting, Patient Satisfaction Data Hospital Committees Participation/Communication to Medical Staff and Hospital Leadership Dr. Barton highlighted the Service mission to teach students and house staff how to provide compassionate care to the underserved patients from many cultures with undifferentiated illnesses regardless of social standing. Dr. Barton gave an update about the Service s 2011 accomplishments, including EDIS (Emergency Department Information System) which went live April 2011, revenue enhancement with the use of EDIS and outsourcing billing, professionalism in the work place, and activities to improve and optimize patient flow. Dr. Barton also highlighted under Scope of Service, the new ED- Clinical Decision Unit, an e-bed observation unit that started in November 2012. The unit is for patients with disorders requiring extended LOS but not admission. Goals for 2013 include plans to develop a streamlined and organized approach to trauma management, improve patient flow, and strict adherence to the hospital s Professional Standards of Conduct policy. Emergency Medicine Service Rules and Regulations The key areas of content change are: Job Descriptions for leadership positions (Medical Director, Director of PI, Director of CDU) Emergency Services Consultation Criteria for Orthopedics Clinical Decision Unit and the attachment describing the Rules and Regulations for CDU. Meeting requirements. Emergency Medicine Service OPPE The ED OPPE form was revised to include specific thresholds on parameters. Language clarification requested for Conscious Sedation Comps to indicate Moderate Sedation Complications. Emergency Medicine Service Specific Practice Guidelines Dr. Barton presented three clinical practice guidelines: STEMI Activation System TBI Intubation Guidelines Trauma Airway Management Guidelines Commissioner Comments/Follow-Up: Commissioner Chow asked if SFGH uses independent Nurse Practitioners (NP) in anesthesia procedures. Dr. Thyne stated that physicians conduct the initial patient assessment and then the NP conducts a follow-up as part of the preoperation procedures. A physician also sees the patient directly before surgery. Action Taken: The following were unanimously approved: Standardized procedures: Anesthesia NP SP Emergency Medicine Service Rules and Regulations Emergency Medicine Services Specific Practice Guidelines 8) QUALITY COUNCIL REPORT Iman Nazeeri-Simmons, Chief Quality Officer, gave the report. Action Taken: The Report was unanimously approved. 9) BEHAVIORAL HEALTH CENTER REPORT Yifang Qian MD, Medical Director, Jeannette Cavano, pharmacist, SFBHC, and Sharon McCole-Wicher, Nursing Director, gave the report. Page 5

Commissioner Comments/Follow-Up: Commissioner Chung asked for more information on the discharge plans for patients who were deemed aggressive. Dr. Qian stated that the Behavioral Health Center (BHC) has ongoing assessments for all patients to note changes in a patient s condition. Ms. McCole-Wicher stated that the BHC works with DPH Placement to find appropriate facilities when developing a discharge plan. If a patient is at risk for harming someone or him/herself, the patient will not be discharged at that time. The majority of patients are discharged to LHH or board & care facilities. Commissioner Chow asked how client satisfaction is validated for the BHC population. Dr. Qian stated that staff review the surveys in groups but do not assist in helping patients fill out the forms. She added that most of the patients who do not respond do not participate in groups. 8) PUBLIC COMMENT There was no public comment. 9) CLOSED SESSION: APPROVAL OF CLOSED SESSION MINUTES OF MARCH 12, 2013 CONSIDERATION OF CREDENTIALING MATTERS CONSIDERATION OF PEER REVIEW, QUALITY OF CARE, PERFORMANCE IMPROVEMENT RECONVENE IN OPEN SESSION 1. Possible report on action taken in closed session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).) 2. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) (Action item Action Taken: The Committee approved the Credentials Report and the Performance Improvement and Patient Safety Reports and voted not to disclose other discussions held in closed session. 10) ADJOURNMENT The meeting was adjourned at 5:01pm. Page 6