Reprt Cntents: PATIENT CARE SERVICES REPORT Submitted t the Jint Cnference Cmmittee, By: Terry Dentni, MSN, RN, CNL, SFGH Chief Nursing Officer 1. Prfessinal Nursing.. 1 2. Emergency Department Data....2 3. Psychiatric Emergency Services Data.. 3 4. Request fr Inter-Facility Transfer t PES frm ther Hspitals....4 1. Prfessinal Nursing fr the Mnth f Transitin Initiatives: Our transitin teams are cntinuing departmental staff educatin and training sessins fcusing n new equipment and unit wrk flw scenaris. In the Operating rm, n fur different days, nursing staff are wrking with the OR multidisciplinary teams testing their new wrk envirnment in different patient flw scenaris. On 12, the Emergency Department is cnducting a multicasualty simulatin drill in Building 25 testing wrk flw in their new envirnment. On Saturday, 21 patient mve in day arrives. The first patient will be mved frm building 5 int Building 25 at 7am and all nursing units are expected t be fully mved in by that afternn. Nursing Prfessinal Develpment: Events The annual DPH Nurses Week event was held n 5 in the ZSFG cafeteria as an acknwledgement f the dedicatin and wrk f DPH Nurses. The evening receptin was attended by mre than 300 DPH staff where multiple nursing awards were presented: the O Cnnell award, the SFGH Friend f Nursing award, the Primary Care Nursing award, the DAISY award and the Drthy Washingtn Schlarships. A secnd receptin was hsted by SFGH Nursing leaders fr the night shift staff frm 5 t 7 am in the SFGH Wellness Center the fllwing mrning. Awards - The fllwing awards were presented during the Nurses Week receptin: Jeffrey Schmidt was awarded the O Cnnell Award which is presented t a DPH RN wh demnstrates leadership in clinical, administrative r educatin and advances the care f DPH patients r advances the prfessin f Nursing. Jeffrey has given tirelessly f himself ver the past year functining as AOD and Rebuild Transitin Crdinatr. Terry Saltz was presented with the SFGH Friend f Nursing Award acknwledging all f his supprt thrugh the rebuild prcess frm day ne and all his wrk t ensure that everything is wrking fr us n mve in day. P a g e 1
The Primary Care Nursing Award was presented t Dana Nelsn, 3M Nurse Manager recgnizing her rle in advancing the care f patients in the 3M Surgical Specialties clinic and thrughut ZSFG. The DAISY Award, recgnizing staff nurses fr their utstanding cntributins which make a significant impact n patients and families was presented t Eduard Gutierrez RN 3M Surgical Clinic. The Drthy Washingtn Schlarship prvides mnetary supprt fr the prfessinal develpment f nurses at ZSFG. The fund supprts the develpment f culturally diverse nurse leaders prepared t care fr the peple f San Francisc. This was the visin f Drthy Washingtn and a cmmitment she exemplified ver her 35 year nursing career at SFGH. The fllwing staff are this year s Drthy Washingtn Schlarship recipients, wh have either chsen t btain a nursing degree r have gne back t schl t btain advanced degrees in nursing: ia Creena Velasc, RN - 5E/5R Critical Care. ia has wrked at SFGH since 2009. She is an expert clinician wh has als wrked as a relief charge nurse, as well as being a member f the MERT team. ia will begin the Acute Nurse Practitiner Prgram at UCSF in ember. Kevin Langley, RN 4E Surgical Trauma ICU. Kevin started his career at ZSFG in 1998 n 5A AIDS/Onclgy Unit and since 2003 he has wrked in 4E ICU. He currently wrks as a relief charge nurse n the night shift, MERT nurse and enjys precepting new staff and students. Kevin is pursuing his master s degree in Nursing frm UCSF. Rsita Estaci Patient Care Assistant 4D Surgical Trauma Unit. Rsa has wrked at SFGH since 2011 and is attending the University f San Francisc fr her Bachelr s Degree in Nursing. Juliet Huntingtn, RN 6C Birth Center. Juliet has wrked with ZSFG since 2011. She is a dedicated nurse that has demnstrated her cmmitment t the mst vulnerable patients and is a charge nurse n the night shift. Juliet is currently attending UCSF in there Certified Nurse Midwife /Wmen s Health Nurse Practitiner Prgram. P a g e 2
Jan-13 April June Aug Nv 14-Jan Apr june aug Nv 15-Jan April June Aug Nv 16-Jan April Encunters 2. Emergency Department (ED) Data fr the Mnth f SFGH Emergency Department Activities Admits Nn-Admit Visits LWBS/LWBT Triaged/Referred Out 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 JCC Diversin Reprt 70% 60% 50% 40% 30% 20% 10% 0% Jan Apr Jun Jul Aug Sep Nv 2014 49% 39% 36% 36% 35% 35% 45% 48% 46% 46% 43% 45% 46% 50% 38% 41% 50% 42% 46% 52% 44% 47% 51% 55% 59% 60% 62% 46% April Diversin Rate: 46% ED diversin hurs 239 (33%) + Trauma verride - hurs 92(13%) P a g e 3
Axis Title Axis Title Axis Title ED Encunters: ED Encunters 6500 6000 5500 5000 4500-15 Apr-15-15 Jun-15 Jul-15 Aug-15 Sep-15-15 Nv-15 Nv-15 Jan-16-16 -16 Apr-16 ED Encunters 5753 5328 5617 5589 5667 5882 5776 5882 5776 5605 5775 6141 5806 5834 ED Admissins: ED Admissins 1000 950 900 850 800-15 Apr-15-15 Jun-15 Jul-15 Aug-15 Sep-15-15 Nv-15 Nv-15 Jan-16-16 -16 Apr-16 ED Admissins 923 867 893 901 915 987 898 987 898 936 907 930 914 915 ED Admissin Rate: ED Admissin Rates 25% 20% 15% 10% 5% 0% -15 Apr-15 - Jun-15 Jul-15 Aug-15 Sep-15-15 Nv-15 Nv-15 Jan-16-16 -16 Apr-16 15 ED Admissin Rate 21% 16.20% 15.80% 16% 16% 17% 16% 17% 16% 17% 16% 15% 16% 16% P a g e 4
-14 Jun-14 Jul-14 Aug-14 Sep-14-14 Nv-14-14 Jan-15-15 -15 Apr-15-15 Jun-15 Jul-15 Aug-15 Sep-15-15 Nv-15-15 Jan-16-16 -16 Apr-16 Hurs n Cnditin Red 3. Psychiatric Emergency Service (PES) Data fr the Mnth f 400 350 300 250 200 150 100 50 0 Cnditin Red in PES 1 2 3 4 5 6 7 8 9 10 11 12 2014 800 700 600 500 400 300 200 100 0 SFGH Psychiatric Emergency Service Activities PES Intakes Resulting in SFGH Admits PES Nn-Admits Intakes PES had a dramatic increase in encunters in, peaking in August at 747 patient encunters. April had 677 patient encunters, which is high fr PES ttal mnthly encunters in the pst-medical Screening Exam prtcl change era. In April a ttal f 619 patients were discharged frm PES: 33 t ADUs, 8 t ther psychiatric hspitals, and 578 t cmmunity/hme. PES admitted a ttal f 58 patients t the SFGH inpatient psychiatric unit in April, a large decrease frm 72 patients in ch, cntinuing the trend ver the past 6 mnths f histrically lw inpatient bed availability. This limited inpatient bed availability related t difficulty placing lwer level f care patients cntinues t negatively impact PES Cnditin Red, PES average length f stay, and PES inter-facility transfer acceptance rates. The average length f stay (ALOS) in PES increased t 21.68 hurs in the mnth f April (up frm 21.46 hurs in ch). There was an increase in Cnditin Red hurs frm ch t April. PES was n Cnditin Red fr 350.82 hurs (48.7%) during 31 episdes in April. The average length f Cnditin Red was 12.28 hurs. In ch, PES was n Cnditin Red fr 303.6 hurs (40.8%) during 24 episdes, averaging 12.65 hurs. P a g e 5
4. Request fr Inter-Facility Transfer t PES frm ther Hspitals A pririty f PES is t imprve the timeliness and apprpriateness f inter-facility transfers frm referring hspitals. The fllwing three types f PES referrals have been bserved: Accepted and Arrived, Accepted and Cancelled, and Inapprpriate Referral. Accepted and Arrived Referrals refer t patients that have been apprved by PES fr admissin and are transferred and admitted t PES. The transfer f these patients has been authrized by PES based n EMTALA regulatins as well as the cmmunicatin f clinical cnditin between the sending and the receiving physicians. Screened Apprpriate but Cancelled Prir t Acceptance refers t patients that have been screened by a triage nurse and have preliminary apprval, but the paperwrk has nt been reviewed by a physician. Their transfer was then cancelled by the referring facility. This cancellatin culd be because the referring hspital has decided t place the patient n their wn psychiatric unit r because the patient has cleared psychiatrically and the 5150 hld has been drpped. Inapprpriate Referrals refer t patients identified thrugh the PES screening prcess t be inapprpriate fr transfer and admissin t PES fr evaluatin and dispsitin. Cmmn reasns fr PES t decline transfer f a patient frm a referring hspital are medical status (nt medically stable fr transfer) and insurance status (e.g., private insurance r ut f cunty Medi-Cal). 120% 100% 80% 60% 40% 20% 0% 15% 11% 25% 13% 8% 5% 14% 22% 27% 49% 53% 65% 67% 59% 63% N=93 48% 40% 34% 25% 28% 26% June N=88 Dispsitin f PES Referrals frm Other Hspitals N=84 August N=88 N=75 N=79 Nv N=76 25% 35% 29% 26% 21% 22% 53% N=68 24% 41% 54% 54% 41% Jan N=74 30% 20% 25% N=83 N=74 Accepted & Arrived Screened Apprpriate and Cancelled Inapprpriate Referral Apr N=71 ANALYSIS N significant change ver the past 12 mnths in the number f requests fr transfer frm ther hspitals t PES. April shwed n change in patients which were Screened Apprpriate but Cancelled (frmerly Accepted but Cancelled), cntinuing at 54%. This mnth shwed an increase in prprtin f requests which were Accepted and Arrived, 25%. There was a decrease in Inapprpriate Referrals in April t 21%. These are requests fr transfer f patients that are fund t be medically unstable fr transfer, r wh are nt residents f San Francisc. The factrs causing this change are nt clear. P a g e 6