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UCSF Medical Center Mission Bay Operations Planning. Clinical Affairs Committee Max Meng, MD, Chair Wednesday , June 27, 2012 4:30 – 6:00 p.m. Room CL 222. Scott Soifer <Title> Brian Herriot Director MB Operations Planning UCSF Medical Center. Building continues…. Planning our journey.
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UCSF Medical CenterMission BayOperations Planning Clinical Affairs Committee Max Meng, MD, Chair Wednesday, June 27, 2012 4:30 – 6:00 p.m. Room CL 222 Scott Soifer <Title> Brian Herriot Director MB Operations Planning UCSF Medical Center
Planning our journey This is an incredible opportunity to improve patient care at UCSF! We need your ideas and want to answer questions that are important to you You already know our overall scope, approach and MB Operations team structure Therefore, our format will be mostly Q&A Lastly, we’d like to share physician-centric operational items of interest and ask for your feedback
Q & A Offices for physicians who are primarily working at the new campus?Most units have an office for the Medical Director and whomever is Attending at the time. The rest is hoteling space. Will there be an adult ER at Mission Bay, to accommodate adults associated with children at MBH? Current plan is for two Adult rooms in the ED. Admission or transfer of adult patients’ criteria from MB? Who specifically will be admitted as an adult to the new MB hospital? The following slides indicated services moving to MB from Mt. Zion.
High Level Overview of Services Moving to MB As of 3/24/2012
High Level Overview of Services Moving to MB As of 3/24/2012
Q & A • Living donors for transplant? Will there be an adult ICU or equivalent? There will be an Adult ICU. • From an adult rheumatology standpoint, sometimes pregnant women develop critical illness related to autoimmune disease that requires hospitalization and daily monitoring by the rheumatology consult team. However, the rheumatology fellows already have heavy burdens on their time, making daily travel to MB challenging. I am eager to hear the thoughts of the Clinical Operations Planning Committee about coverage issues. I suppose one possibility would be for the MB Hospital to be covered by SFGH staff. However, I suspect many providers at SFGH are unfamiliar with APEX. Questionnaires regarding consults and coverage being prepared to go to Department Chairs. Is telemedicine an option for Rheumatology?
Q & A There is a frequent shuttle service directly between MB and Parnassus, but for our fellows that sometimes need to go to multiple UCSF sites in a day (SFGH, VA, Laurel Heights, Parnassus), driving is a necessity. Will a parking permit for Parnassus cover parking at the new MB hospital? (Currently, the Parnassus Parking permit DOES cover parking at the MB Community Center, but does NOT cover parking at Mt. Zion.) For faculty, the A permits work at the cancer center buildings. Presumably they will still work at Mission Bay? To be discussed with the Campus Parking. Some of the cancer center clinical group will move, and some (at least for now) will remain at Mt Zion. Coordination of services will be critical, and understanding how to manage shared patients since patients will have to travel back and forth in order to see the various cancer practice physicians, and to access specific services.Yes.
Q & A I've stopped referring to my field as pediatric cardiology, in favor of congenital cardiology, to reflect the large and increasing number of adult patients we see in clinic, as in-patients surrounding surgery done by "pediatric" cardiovascular surgeons, and surrounding interventional procedures in our cardiac catheterization lab. Here at Parnassus we have variable support by an adult congenital service, and more frequently, by the adult general cardiology service. At MB we will have little of this accessible in a useful manner. So this falls into the consult issue brought up by others, but also in-patient admission and ICU management. Because the needs of these diverse populations will be proportionate to the diversity of their underlying illnesses a general consideration of where adults will be cared for is probably insufficient. Specifics are going to be extremely important. The correct answer should probably not be that will be routinely transporting critically ill patients back and fourth between MB and Parnassus.Adult Cardiology will have a clinic across the street. They will need to provide coverage for both the Cancer patients and the CHD patients. How this will be done will be decided by that Department.
Q & A I'd also be interested in hearing about the integration of IT at the MB campus. The future of clinical care is probably going to involve increasing reliance on mobile platforms. How is MB preparing for this? MB IT Executive Steering Committee.I know we're barely into APEX but we have to have a proactive approach. The current APEX mobile platforms are cute and useful for browsing patient information, but insufficient for clinical care. Have Seth Bokser come to another meeting to explain. Also, an increasing reliance on mobile platforms will require a fairly broad bandwidth. Will MB have robust enough wireless services to accommodate this IT progression (including imaging, which is high-bit stuff)? Yes. Seems that the whole consult issue is going to be dependent on divisions & departments developing a plan and staffing. Who is going to ensure that all the relevant groups have thought about the issues in detail? Physician strategy group.
Q & A From the Emergency Department perspective: Staffing of the Mission Bay ED is going to be problematic. First of all, the desire of Children's Hospital leadership has increasingly been to have practitioners that have been trained in and focus primarily on pediatric care treat children. This will require that the ED be staffed with Pediatric EM trained physicians. However, adults will also be presenting to this ED thus there will be a need for physicians trained in adult/general EM as well. There are very few practitioners with these credentials available in the Bay Area thus the specter of double covering a low volume ED 24/7 exists. How will this be paid for? Is the Medical Center prepared to heavily subsidize this operation? We need to think of Direct Admit model for Cancer patients with the assumption being that all EM physicians can stabilize a patient for either admission to MB ICU or Parnassus.
Operational topics of interest to physicians • Intranet webpage dedicated to topics of interest to physicians.Considerations for content and design: • MD office space in the hospital and OPB • Location of MD workstations • Dictation and consultation rooms • Nursing stations (for chart location) • Conference rooms and policies • Medical staff lounge locations • Call room location and allocation • Med room and clean/dirty utility locations • PPE locations • Crash cart locations • Access & badging, card reader locations • Communication (patient tracking board locations, Vocera design, …) • Rounding workflows • What else interests you?
Appendix Mission BayOperations Planning
Mission Bay Hospital Planning Team Mark Laret CEO Ken Jones COO Cindy Lima Executive Director Mission Bay Project Kim Scurr Executive Director Operations Planning • MB PHYSICIAN STRATEGY • Stacy Alexander • Scott Soifer, MD • Peter Carroll, MD • Elena Gates, MD • Program Refinement • Volume projections • Physician Coverage/Consult • Faculty Recruitment • Department Service Level Agreements • Medical Model—Ambulatory/ED • CLINICAL OPERATIONS PLANNING • Brian Herriot • Jennifer Hood • Operational Readiness • Patient Experience • Process flows • New Operations and programs • Process Implementation • Process redesign • Workflow • Staffing Requirements • Transition • Orientation/Education • Policies/procedures • Licensing/Regulatory • Move Training • Donor Tours/Opening • MB FINANCE COMMITTEE • James Bennan • Operating Budget 2015 • Expense Budget • Staffing Model Review • Labor Standards Review • New Program Review • Transition Budget • MB IT EXEC STEERING COMMITTEE • Jean Burns • Core Infrastructure • Telecommunications • Application Configuration • Nurse Call • Telemetry • Time and Attendance • Telemedicine • Audio/Visual Clinical • Patient Experience • OR Equipment Integration • Real time location • Unified communication and mobility • Intercampus Integration
Clinical Operations Planning: Guiding Principles Plan workflow processes which place patients and families at the center of care Patient and staff safety are key considerations in all workflow practices Be responsible financial stewards by minimizing change to space and equipment program Challenge existing workflow processes to maximize efficiency and the quality of care Maximize use of new and existing technology and the new environment as it was designed when planning future workflow Embrace practices and workflow processes that promote “Quiet Hospital” and “Clean Facility” goals Plan workflow to provide effective communication within departments and throughout the hospital Incorporate infection control and prevention measures Pilot new processes and technology at the Parnassus and Mt. Zion campuses to the extent possible and evaluate outcomes prior to Mission Bay campus deployment
