PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, February 2013 Terry Dentoni, RN, MSN, CNL, Interim Chief Nursing Officer 1. 2320 RN Vacancy Rates for the Month of January 2013 The overall 2320 RN vacancy rate for areas reported below is 1.6%. AREA RN VACANCY RATE NO. VACANT FTE TRAINING PROGRAMS Med/Surg (Includes 4B/Stepdown unit) 1.1% 2.1 FTE Ongoing recruitment. Critical Care (Includes 4E/5E/5R) 1.4% 1.5 FTE Ongoing recruitment. Perinatal (Includes 6C Birth Center & 6H Infant Care Center) 4.1% 3.0 FTE Ongoing recruitment. Perioperative (Includes OR/ PACU/ Surgicenter) 3.5% 1.9 FTE Ongoing recruitment. Emergency 3.3% 2.3 FTE Ongoing recruitment. Psychiatry (Includes PES & acute inpatient units only) 0% 0 FTE Behavioral Health Center 0% 0 FTE Clinics (Includes Specialty clinics/ hosp-based Primary Care) 0% 0 FTE TOTALS 1.6% 10.8 FTE Patient Care Service Report_T. Dentoni_01_13 hvm/ha Page 1 of 7
2. Staffing Ratio Data for the Month of January 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_T. Dentoni_01_13 hvm/ha Page 2 of 7
3. Professional Nursing Practice Data for the Month of January 2013 Recruitment and Training: Retention/Professional Development: Sponsored by the Professional Development Council, Nursing Grand Rounds is scheduled for February 6. Annie Bustin RN, Disaster Coordinator for the SFGH ED, will present on the role of Nursing in disasters. Annie has experience working with the federal government on both national (Katrina) and international (Haiti earthquake) disasters. A DAISY award will be presented at the start of Grand Rounds. January is the start of the Spring semester /Winter quarter for Schools of Nursing. SFGH is a clinical placement site for multiple schools of Nursing: USF, CCSF, SFSU, Samuel Merritt, UCSF, and Dominican University. SFGH hosts LVN students and graduate students from Nurse Practitioner and Clinical Nurse Specialist programs. Each semester, approximately 300 undergraduate nursing students and 50 graduate students complete clinical placements with teaching and guidance from SFGH nursing staff. Nursing Excellence: NDNQI RN Survey results from October 2012 are being prepared for dissemination to all Nursing staff and Nursing Directors. Recruitment: Hiring has been completed for a training program in the ED, scheduled to begin in February, and a training program in Critical Care, scheduled to begin in March. Currently, the OR is interviewing candidates for a training program scheduled for March/April. Psychiatry will be interviewing candidates for seven positions, both for a training program and for experienced RNs. Patient Care Service Report_T. Dentoni_01_13 hvm/ha Page 3 of 7
4. Emergency Department (ED) Data for the Month of January 2013 Encounters 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 SFGH Emergency Department Activities Admits Non-Admit Visits LWBS/LWBT Triaged/Referred Out The Emergency Department (ED) had a Diversion rate of 34% (254 hours) for the month of January 2013. The Trauma Override rate was 20% (154 hours). The ED encounters totaled 5104 patients, 854 of those were hospital admissions. The hospital invoked Condition Yellow Status for 502 hours of the month. Patient Care Service Report_T. Dentoni_01_13 hvm/ha Page 4 of 7
5. Psychiatric Emergency Service (PES) Data for the Month of January 2013 SFGH Psychiatric Emergency Service Activities 700 600 500 400 300 200 100 0 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 PES Intakes Resulting in SFGH Admits PES Non-Admits Intakes PES Condition Red Data: 2011 to 2013 400 350 300 Hours on Condition Red 250 200 150 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2011 2012 2013 Patient Care Service Report_T. Dentoni_01_13 hvm/ha Page 5 of 7
In December, PES had 590 patient encounters. In January, PES had 604 patient encounters. PES admitted a total of 170 patients to SFGH inpatient psychiatric units in January, an increase from 166 patient admissions in December. In January, a total of 434 patients were discharged from PES: 35 to ADUs, 19 to other psychiatric hospitals, and 380 to community/home. There was an increase in Condition Red hours from December to January. In December, PES was on condition Red for 23.8 hours, during 5 episodes, averaging 4.76 hours. In January, PES was on Condition Red for 76.6 hours during 9 episodes. The average length of Condition Red was 8.51 hours. The increase in Condition Red can be attributed partly to timing of patient arrivals, with large groups arriving in PES in a short period of time. In addition, patient complexity has increased in January. The average length of stay in PES was 17.97 hours in the month of January, an increase from 15.43 hours in December. Patient Care Service Report_T. Dentoni_01_13 hvm/ha Page 6 of 7
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. 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 May 2012 and January 2013, the percentage of patient that were accepted and arrived to PES increased from 29% to 64%, the percentage of accepted and cancelled referrals decreased from 41% to 15%. Inappropriate referrals increased from 16% to 21% between the months of December and January. Clients categorized as an inappropriate referral included medically unstable patients and those with private or out of county insurance. An increase in referrals occurred between December and January, from 62 to 92. However, a greater proportion of these patients were cancelled or inappropriate referrals. While the percentage of patients accepted and arrived during that time period decreased, the actual number of patients increased to 59 patients in January, up from 46 in December. Patient Care Service Report_T. Dentoni_01_13 hvm/ha Page 7 of 7