SAN FRANCISCO GENERAL HOSPITAL

1. SAN FRANCISCO GENERAL HOSPITAL WELCOME Sue Carlisle, PhD, MD Associate Dean for UCSF at SFGH

2. San Francisco General Hospital & Trauma Center

3. SFGH Mission Statement:“ To provide quality healthcare and trauma services with compassion and respect.” “We Save Lives”

4. SFGH is one of 19 public hospitals in CA • Today, just 6% of hospitals • Provide nearly half of the hospital care to the state’s uninsured • Operate almost 60% of CA’s trauma centers • Operate almost 45% of the burn centers • Serve 2.5 million patients per year • During the economic crisis, the need for services is growing

5. SFGH Serves San Franciscans • Only Level 1 Trauma Center in San Francisco • Only Psychiatric Emergency Service • Largest Acute & Rehabilitation Hospital for Psychiatric Patients • General community hospital and ambulatory care services for San Francisco’s under- and uninsured • Referral Center for DPH and its affiliated partners • Provides 20% of all inpatient care in San Francisco

6. SFGH DIVERSITY OF PATIENTSFY 2008-2009 N=98,698 Age Sex Race

7. Payor SourcesFY 2008-2009

8. Top 10 Discharge Diagnoses FY 2008-2009 • SCHIZOPHERNIA • NEWBORN DELIVERY • PNEUMONIA • CONGESTIVE HEART FAILURE • CHEST PAIN • ALCOHOL WITHDRAWAL • LEG CELLULITIS • SHORTNESS OF BREATH • HIV DISEASE • OBSTRUCTIVE CHRONIC BRONCHITIS

9. SFGH ValuesFY 2008 - 2009 • Patient and staff safety • Quality healthcare • Disease prevention • Staff retention and recruitment • Culturally responsive care • Efficient resource management • Academic excellence in training and research

10. SFGH Goals FY 2008-2009 • Promote patient safety • Enhance clinical care • Promote staff retention & recruitment • Maintain hospital infrastructure • Comply with all regulatory standards & attain specialty certifications • Maintain services during hospital rebuild

11. SFGH FACTS:FY 2008-09 • $670 Million Total Budget • 100,000 Unduplicated Patients • 600,000 Outpatient Visits • Licensed Beds: • 403 General Acute Care • 106 Acute Psychiatric • 59 Skilled Nursing Mental Health • 30 Skilled Nursing Med/Surg

12. SFGH FACTS:FY 2008-09 • 16,031 Admissions • 10 Operating Rooms • 6,695 procedures • 48% are emergency • 1,118,100 surgical minutes

13. Baby Friendly Hospital • SFGH named by World Health Organization as Baby Friendly in May 2007 • Only Baby Friendly hospital in San Francisco • 1 of 63 hospitals in U.S. • 1,340 babies were born at SFGH • 1,1470 women received prenatal care, 25% high-risk

14. Trauma and EmergencyFY 2008-09 • Over 53,000 Emergency Room visits – 15% are admitted • Over 7,200 Psychiatric Emergency encounters - 26% are admitted • Receives 30% of all ambulance traffic in San Francisco • 3,500 adults and children are treated for injuries requiring the trauma activation.

15. Stroke Center • SFGH Stroke Program was started in 1996 • JCAHO certified as a Stroke Center in 2007 • Recertified as a Stroke Center May 2009 • SFGH as site of CASPR (California Acute Stroke Prototype Registry) • Stroke Pager: 443-NERV (6378)

16. Multicultural stroke population reflective of SF

17. Emergency Department

20. SFGH-UCSF AFFILIATION SFGH has partnered with UCSF for over 130 years through our teaching, research and clinical affiliation 1959: First Formal Affiliation • $174,000 for clinical services • 10 full time faculty 1994: Renegotiation of Affiliation Agreement • $46 million • 237 active medical staff (All UCSF Faculty) • 1200 UC employees

21. SFGH-UCSFAFFILIATION 2008-2009: • 480 UCSF faculty on active medical staff • Approximately 2500 UCSF faculty and staff • Total amount of contract - $95,231,732 • Physician Services • Clinical Laboratories • Respiratory Therapy • Biomedical Engineering

22. Clinical Training School of Medicine • 32% intern/resident training in 18 academic departments • 35% medical student clinical training • On average, 238 residents, 75 medical students and 42 clinical fellows per day • Includes training requirements not available at other UCSF sites • Several training programs based at SFGH

23. Clinical Training School of Dentistry • Oral surgery: 6600 clinical encounters/year • Residency: 4 residents/day • Dental students: 16 students/day

24. Clinical Training School of Pharmacy • Poison Control Center • Average 5 students/day at SFGH • Average 3 residents/day at SFGH

25. Clinical Training School of Nursing • Average of 26 nurse practitioner students/year • 15 masters students do SFGH rotation each spring • 5-40 graduate nursing students/day

26. Research at SFGHCurrent Situation • Dedicated research and academic space • 248,495 ASF • Grants awarded to PIs at SFGH as of 7/09: • $450 M total with $170 M for 2009 • Number of PIs –186 • Average 80 research fellows and 5 graduate students per day

27. Research and Training at SFGH • Our mission is to provide excellent clinical care for residents of San Francisco while teaching UCSF students/residents. • An academic environment is essential to attracting (retaining/recruiting) an excellent faculty to provide this care and teaching. • Research is an essential component of an academic environment. • Thus, research is essential to the mission of UCSF at SFGH and of the hospital itself.

28. ChallengesReplacement of Research Space • Majority of the research is now located in 1916 “red brick buildings” • UC Office of the President regulations require that we vacate these buildings by 2015 for seismic reasons • Academic Planning Committee recently evaluated future needs and recommended replacement of outdated labs and expansion of research space • Currently negotiating with City for land to build state of the art research facility at SFGH

29. ChallengesRebuild of Hospital • SB 1953 requires all CA hospitals meet new seismic standards • General obligation bond ($887.4 M) passed in November (84% approval) • Initial construction is underway • Will impact parking availability • Will generate moves, dust, noise • Completion expected by 1/2014

30. California Assembly Bill 211 (AB-211)January 2009 • AB 211 provides fines and civil penalties against any individual who negligently discloses or knowingly and willfully obtains, discloses, or uses medical information in violation of state / federal laws. • Enforced by Office of Health Information Integrity (CalOHii) • Penalties various fines per violation, one of which has a maximum of US$250,000 • misdemeanor if the patient suffers economic loss or personal injury • potential for civil action by the patient with statutory damages ($1,000) in addition to actual damages • notify the licensing board for further investigation or discipline of individual providers • May apply to institutions or to individuals or to both

31. California Senate Bill 541 (SB 541)January 2009 • SB 541 imposes penalties upon institutions failure to prevent or report for unauthorized access use, or disclosure of medical information. • Enforced by Calif. Department of Public Health (CDPH). • Penalties: • up to US$25,000 per patient • up to $17,500 per subsequent access, use, or disclosure • $100 per day that the violation is not reported within the 5-day reporting period • Applies to institutions, not to individuals.

32. SFGH Orientation Material • Prior to doing their initial rotation at SFGH, all new residents or fellows must review the SFGH Orientation material. • The material is posted on both the GME and the SFGH Dean’s Office web pages, entitled “SFGH Hospital Orientation.” http://www.medschool.ucsf.edu/sfghdean/links • For purposes of documentation, residents are to send an email to their program and site coordinators stating that they have completed a review of the hospital’s orientation material. We hope to automate this latter procedure in the near future.

33. The Heart of the City