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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 HerriotDirectorMB Operations PlanningUCSF Medical Center
Building continues…
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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
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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.
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Children's Inpatient
Outpt. Surgery/
Procedures NotesPediatric Gen Peds/Hosp. Primary Care @ MZ with other adult/pedi Primary CarePediatric Adolecent MZ MZ and MBPediatric Medical Specialties Al l - Cardiology, endocrine, GI/Liver, Genetics , Immunology, Pulmonology, renal , Rheum, Hem/Onc/BMT
Pediatric Neurology Pediatric Surgical Specialties All - OHNS &(audiol & cochlear), OPH, Ortho ,NS, Uro, Plastics, Craniofac, Gen Surg.Pediatric Dermatology MZ MZ and MB - majority at MZPediatric DentalPCRCPediatric Rehab PH or MB inpt.No dedicated outpt. pedi rehab in the MB OPB. Final operational plan pendingPediatric Acute Care CenterPediatric Treatment CenterPediatric Outpatient DialysisPediatric ED
Women's Inpatient
Outpt. Surgery/
Procedures NotesObstetrics All of OB/Plaza level to MB
MZ Portions of OB/MZ to MBGeneral GYN MZ Portions of General GYN to MBSpecialty GYN UroGYN/FibroidsPrenatal DiagnosticsReproductive Endocrinology Serramonte OB/GYN
Moves to MB
Pending
Doesn't move to MB
Service not applicable in this setting
MZSerramonte
Outpt. Clinic
Outpt. Clinic
MZ
High Level Overview of Services Moving to MB
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As of 3/24/2012
High Level Overview of Services Moving to MB
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Cancer Inpatient
Outpt. Surgery/
Procedures NotesGIColorectal (benign & malig)GYN OncGUOrtho OncologyHead & NeckEndocrinologyBreastMelanomaDysplasiaThoracic PH PHMalignant Hem/BMT PH PHBrain Tumor (Neurosurgery) PH PH
Infusion MZ/PH Outpt. Infusion at MB for GI, GU, Colorectal, GYN Onc, Ortho, Endo crinology pts only Moves to MBPendingDoesn't move to MBService not applicable in this setting
PHPH
MZMZMZMZMZ
Outpt. Clinic
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?
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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.
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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.
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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.
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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.
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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?
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Mission BayOperations Planning
Appendix
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An Unprecedented Opportunity
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Mission Bay Clinical Program: Phase 1
Mission BayNew specialty hospitals for
children’s, women’s, and cancer services
ParnassusRenewed campus focused on
high-end adult surgical and medical services and emergency medicine
Mount ZionRemaining the major outpatient hub with a
diagnostic and therapeutic focus, and women’s health
services
An Integrated Campus
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Mission Bay Hospital Planning TeamMark Laret
CEO
Ken JonesCOO
Kim ScurrExecutive Director
Operations Planning
Cindy Lima Executive Director
Mission Bay Project
MB IT EXEC STEERING COMMITTEEJean 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
MB FINANCE COMMITTEE
James Bennan
Operating Budget 2015
Expense Budget Staffing Model Review Labor Standards
Review New Program Review Transition Budget
CLINICAL OPERATIONS PLANNINGBrian 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 PHYSICIAN STRATEGY
Stacy AlexanderScott 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
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Mission Bay Hospital Clinical Operations Planning Team
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Operations Planning: Integrated Scope of Work
MB clinical operations schedule
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ITFi
nanc
ePh
ysic
ian
Stra
tegy
Ope
ratio
ns
Plan
ning
2012
Status Q1J F M
Q2A M J
Q4O N D
Q3J A S
2013Q1
J F MQ2
A M JQ4
O N DQ3
J A S
2014Q1
J F MQ2
A M JQ4
O N DQ3
J A S
2015Q1
J F M
5/1 Common Nursing Practices WF Design Complete3/1 Future State 6/30 Transition Planning Ends
Day in the Life
12/15 Licensing Visit
2/1 Patient Move
10/1 11/1 1/1
Licensing go/no-go 12/1
1/15
1/15
1/31
11/1 Orientation & Training
9/1 Non-clinical Dept. Moves
12/1 Clinical Dept. Moves
Today
3/14 Deliver Equipment / Start BMS Install
8/20 Hospital Temporary Commissioning Network Go Live
5/1Workstation / RTLS, Voice Ready to Validate
12/1 Emergency Dept / PeriOp WF Design Complete5/1 Future State 8/1 PH/MZ Pilots
5/1Common Clinic Practices WF Design Complete7/1 Future State
5/1 Patient Flow (+admit/discharge), Lab & path, Imaging, Pharmacy WF Design Complete10/1 Future State 1/1 PH/MZ Pilots
9/30 Code Response, P Tube WF Design3/1 Future State 6/1 PH/MZ Pilots
1/1 Dept. Support Services WF Design8/1 Future State
6/1 Dept. Clinical Units/Practices WF Design8/1 Future State
9/30 Dept. Support Services WF Design1/1 Future State
12/14 Purchase Requisition
8/23 Data Center Go Live1/25 Purchase Requisition 6/3 Deliver Eqpt
1/10 EC Go Live 4/18 OPB Go Live
3/31 Requirements Approved 3/5 Purchase Requisition
5/29 Deliver Eqpt
6/17 EC Go Live 9/23 OPB Go Live 4/9 Hospital Permanent Network Go Live
Nurse Call Requirements Approved 11/9
7/16 Requirements Approved
10/30 Purchase Requisition
8/7 Deliver EC Equipment4/1 Deliver Hospital & OPB Time & Attendance Equipment
6/28 Requirements Approved 2/4 Purchase Requisition 6/9 Deliver Telemetry Equipment5/16 Requirements Approved 10/14 Purchase Requisition 6/2 Deliver RTLS Equipment
7/6 Req’ts Approved 11/5 EC Purchase Requisition 4/14 Deliver OPB& Hospital Workstation & Peripherals Equipment12/3 Hosp & OPB Purchase Requisition3/19 Deliver EC Equipment
6/11 Requirements Approved 9/29 Deliver Hospital Voice Equipment8/25 Deliver OPB Eqpt3/28 Purchase Requisition 7/22 Deliver EC Eqpt
9/1 Present FY15 Labor Cost budget and Transition budget to SLC
3/31 Build Case MB Labor Cost Estimates
5/2012 Begin to define and vet MB transition budget
6/30 Develop MB ED Medical Model
9/30 Quantify MD coverage re: ward config.9/30 Develop Adult ICU coverage model`
9/30 Resolve OB coverage needs at PH99/30 Facilitate access for community MD
12/31 Quantify scope/volume/mode of consult services
6/30 Define cross-campus programmatic interfaces
12/31 Determine evening/night coverage arrangement
Q4O N D
2011
Past Due or At Risk
· Outpatient surgery for Endocrine, Breast, Melanoma, Dysplasia pending.
· Consult and coverage framework now beginning to be documented
· Need decision on 23-hr stays at Mount Zion. Determine if Mount Zion is to be 100% outpatient.
· Additional Support Services work (e.g. loading dock plan, detailed materials & supplies paths of travel guidelines) will continue throughout 2012.
· Proposed MB fixed staffing model is not affordable; committee formed to challenge requests.
· Ask leadership to help manage IT expectations for MB facility given budget dollars allocated.
· IT staff availability given Apex deployment is a risk.
12/31 Finalize scope of services moving to MB1/31 Complete “Cancer to 1A” planning
10/28 Present summary to SLC12/7 Propose initial labor budgets; share “rules of the road”
1/31 Depts. prepare budgets
Hold Finance office hours 4/30
6/30 Facility Access / Materials WF Design Complete2/1 PH/MZ Pilots
12/5 Future State
6/1 Kick off project2/1 Build Ops planning team
8/31 Ready Room pilot
Completed: · Completed Phase 2 current state training· Completed Phase 2 current state workflows· CNP completed workstation assessment for
levels 3, 4, 5, 6· Drafted Ops communication plan, including
project site and intranet site approach· Closed out Phase 1 operations planning· Closed discussion on summ. vol projections
Completed: Hosted MB Periop & ED overview sessionsLaunched Phase 2 future state planningPrepared MB ancillary services coverage docChose preferred consult & coverage models for Telemedicine pilotDavid Radcliff consulted on ready roomCNP with Support Services: demo’ed nurse call & workflow monitor functions
Completed:· CNP: Finalize all workstation requirements-
location and model· Initial transition budget preparedNext up: · Periop & ED: future state WFs and gaps· Plan ready room pilot· Detailed planning for Telemedicine pilot· Challenge MB fixed staffing via committee
Next up: · On board Min Zhu, Ops planning project mgr· Launch ready room pilot· Prepare for Phase 2 stand & deliver· Orient Phase 3 interdisciplinary and
department specific team leads· Present MB transition budget plan to SLC· Develop user requirements for other MB IT
systems
Apr 2012 May 2012 Jun 2012 Jul 2012
Operations Planning Phase Transition Planning Phase
7/1 Current
7/1 Current
12/1 Current
2/1 Current
9/1 Current
Next up: · Improve ready room pilot and plan for
expansion· Host Phase 2 stand & deliver· Kick off Phase 3 interdisciplinary and
department specific workflow planning under revised methodology
Aug 2012
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
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