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Executive Committee Operational Plan for Chandler Hospital - January 25, 2010 -

Executive Committee Operational Plan for Chandler Hospital - January 25, 2010 -. Draft – Still Under Revision. Operational Goals. Eliminate virtual beds (ADC of ≈ 33) Emergency Room ≈ 17 PACU ≈ 5 CDU ≈ 6 8TU ≈ 5 All private rooms Target occupancy levels: Non-ICU: 80-85%

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Executive Committee Operational Plan for Chandler Hospital - January 25, 2010 -

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  1. Executive Committee Operational Plan for Chandler Hospital - January 25, 2010 - Draft – Still Under Revision

  2. Operational Goals • Eliminate virtual beds (ADC of ≈ 33) • Emergency Room ≈ 17 • PACU ≈ 5 • CDU ≈ 6 • 8TU ≈ 5 • All private rooms • Target occupancy levels: • Non-ICU: 80-85% • ICU: 90-95% • Optimize patient, MD, RN and other provider experience • Maximize acceptance of all transfer requests • Maintain or enhance efficient use of variable supplies and disposables • Improve patient cohorting and provider workflow • Consolidate observation cases • Maintain labor costs at current or decreased levels • Metrics will be established to track occupancy rates by unit, patient cohorting, physician satisfaction, etc. • The opening of 4North in August as a Progressive Care Unit has corrected some of the ICU egression problems by providing an additional 12 Progressive Care beds; however, the shortage of Routine beds continues Draft – Still Under Revision

  3. Chandler Stacking – Current State

  4. Patient Redistribution to PCF • “Neuroscience” Floor • All cases Age > 17 • Trach cases with admit service of Neurology and Neurosurgery • Neurology, Neurosurgical, and Spine DRGs • Excluding epilepsy, cases with Family Medicine admit service or elective spine cases currently at Good Samaritan • NS Admit Service Remaining • NEU Admit Service Remaining • ICU stay for the following: • Epilepsy / Seizure • Pulmonary Intensivist • “Trauma/Surgical” Floor • All cases age > 17 • Trach cases with admit service of Blue Surgery or principal diagnosis of trauma • All cases with Blue Surgery admit service • Excluding Neurology, Neurosurgical, and Spine DRGs placed on Neuroscience floor • Remaining cases from the ED with trauma diagnosis • Excluding cases with a Medicine admit service • ICU stay for the following: • Kidney/Liver Transplants • All Other Surgery Admit Services Draft – Still Under Revision

  5. Pulmonary Transfers Draft – Still Under Revision • Based on historical averages, it has been projected that an additional 42 pulmonary admissions per month could be accepted with additional bed capacity • In October 2009, 48 pulmonary transfers were missed • Assuming ICU portion of stay would occur in the PCF Neuroscience ICU, then the PCF Neuroscience ICU occupancy would increase from 55.74% to 91.75% • The combined PCF ICU occupancy will increase from 69.69% to 87.69% • Missed Pulmonary Transfers will be an additional ADC ≈ 15 (including ICU ADC ≈ 9) • A plan must be developed to ensure enough Pulmonary Intensivist/Hospitalist coverage is available to accept this additional volume

  6. Patient Redistribution in Chandler • Shift Cardiology Service • ICU - 1st Floor ICU • Intermediate - 6th Floor • Progressive - 6th Floor • Routine - 6th Floor • Shift CT Admit Service • ICU - 1st Floor ICU • Intermediate - 6th Floor • Progressive - 6th Floor • Routine - 6th Floor • Shift All Medicine & Misc. Services (Exc CAR & BMT) • ICU - PCF Neuro ICU / 2nd Floor ICU /1st Floor ICU • Intermediate - 6th Floor / 7th Floor • Isolation - 5th Floor • Progressive - 4 North • Routine - 5th Floor / Markey • Shift BMT Admit Service • ICU - 1st Floor ICU • BMT ICU - Markey BMT ICU • Intermediate - 6th Floor • Progressive - 6th Floor • Routine - Markey • Shift Vascular Surgery Admit Service • ICU - PCF Trauma Floor – ICU • Intermediate - 8th Floor • Progressive - 8th Floor • Routine - 8th Floor • Shift Liver & Kidney TX • ICU - PCF Trauma Floor – ICU • Intermediate - 8th Floor • Routine - 8th Floor

  7. Patient Redistribution in Chandler • Shift Burn DRGs • ICU - 2nd Floor Burn Unit • Routine - 8th Floor • Shift Plastic Surgery (Excl Burn DRGs) • ICU - 2nd Floor Burn Unit • Intermediate - 8th Floor • Progressive - 4 North • Routine - 8th Floor • Shift Seizure pop., DRGs 100 & 101 • ICU - PCF Neuroscience ICU • Intermediate - 7th Floor • Progressive - 4 North • Routine/EMU - 7th Floor • Shift Surgery Services excl CT, Trauma, Plastics and Vascular • ICU - PCF Trauma Floor - ICU • Intermediate - 8th Floor • Isolation - 5th Floor • Progressive - 8th Floor ( 4 North as backup) • Routine - Markey/ 7th & 8th (50% each) • Shift LDR / Mother Baby Patient Pop. • Routine - Mother – Baby Unit • Shift Wait Days for Discharge • Intermediate - 4 North • Isolation - 3 North • Progressive - 4 North • Routine - 3 North

  8. ICU Assessment Draft – Still Under Revision • Twenty ICU Beds on second floor will need to remain open • Allows for closure of virtual ICU beds, CDU, and 8TU • Allows for acceptance of Pulmonary intensivist referrals currently turned away • Lowers occupancy level to more manageable level with room for some growth as build-out of third PCF floor is planned • Allows for more appropriate and timely location of ICU patients from the ED

  9. Markey Re-Distribution • Bed complement remains the same • All private rooms • Only significant patient movement related to non-oncology patients shifting out of Markey to appropriate location

  10. Chandler North Re-Distribution • Bed complement remains the same • All private beds • Only significant patient movement related to non-oncology patients shifting out of Markey to appropriate location • 3 North will house a “waiting for transfer” unit and observation cases • Observation cases include those in CDU, ED and currently assigned to 3 North • The combined ADC for “waiting for transfer” and observation cases exceed capacity of unit

  11. Chandler Main Re-Distribution • Level 1: CDU closed • Level 2: SICU and NSICU combined to form MICU (17 beds to 15 beds).Burn unit remains at 5 beds with focus on burn and plastic surgery patients • Level 4: No change • Level 5: Becomes a Medicine floor (excluding Cardiology) • Semi-privates required • Level 6: Becomes Cardiac floor and Medicine (Tele) • Converted to all private • Level 7: Becomes a combination of Surgery (Routine), Medicine (Tele) and Epilepsy • Converted to all private • Level 8: Becomes a Surgery Floor for those surgical cases not placed in PCF. • 8TU is closed • Converted to all private

  12. Critical Care Tower Re-Distribution • Overall bed reduction in tower related to movement of patients out of virtual units • G Level: Patients requiring ED virtual beds moved to appropriate units • Level 1: ICU converted to 16 bed Cardiovascular ICU and 15 bed MICU focused on patients requiring pulmonary intensivist services • Level 2: Patients requiring PACU virtual beds moved to appropriate units • Level 3: Unchanged • 16 Post-Partum (private) • 8 LDR (private) • Level 4: Unchanged • 30 private / 12 semi-private beds

  13. PCF Re-Distribution • 128 additional beds added: • 48 ICU • 16 Step-down • 64 Routine (telemetry capable) • 7TH Floor houses trauma and general surgery • 6TH Floor houses neuroscience as well as missed ICU referrals requiring pulmonary intensivist services

  14. Chandler Stacking – Proposed State

  15. Net Bed Impact - Chandler * Routine beds in PCF will all be telemetry capable Note: Between the opening of the new ED (July 2010) and the PCF Floors (May 2011); virtual beds will need to remain in operation and old ED will still serve as staging area for ED borders

  16. Discussion Points • If 5 North added back into full service, the 5TH Floor could move to all private rooms and cohorting improved • Unable to guarantee fully private rooms with cohorting in all areas • KCH capacity planning • CFAR project pending • 3 North and 4 North have significant occupancy issues • Pulmonary Intensivist and Hospitalist capacity must be expanded to handle incremental volume • Additional inpatient movement to Good Samaritan • Use of old ED space • Flexible space used as staging area • Pediatric obs. • eICU, cockpit telemetry monitoring and camera monitoring • Naming conventions of buildings and floors • Analysis based on FY10 budget versus actual activity

  17. Appendix AResults of Redistribution – Trauma / Surgical PCF Percentages in this column are inclusive of all non-ICU beds Draft – Still Under Revision

  18. Appendix AResults of Redistribution – Neuroscience PCF Percentages in this column are inclusive of all non-ICU beds Draft – Still Under Revision

  19. Appendix BChandler Occupancy Includes Observation and Missed Pulmonary Cases Draft – Still Under Revision

  20. Appendix C Good Samaritan Draft – Still Under Revision • Good Samaritan currently has capacity to operate 147 beds (excluding SNF, LTAC and 2ND Floor of 1983 Building) • 2 Main in 1983 building (green) has 12 ICU and 10 Telemetry beds; Currently operated for overflow purposes. Long-term use most likely for expansion of OR/PACU operations. • The 3RD and 7TH Floors of the 1971 Building (blue) will each have capacity for approximately 30 private acute beds if tenants move out. (Cardinal Hill scheduled to vacate space in December 2010)

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