SAN FRANCISCO GENERAL HOSPITAL

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SAN FRANCISCO GENERAL HOSPITAL

• WELCOME
• Sue Carlisle, PhD, MD
• Associate Dean for UCSF at SFGH

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San Francisco General Hospital Trauma Center

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SFGH Mission Statement To provide quality
healthcare and trauma services with compassion
and respect.

• We Save Lives

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• SFGH is one of 19 public hospitals in CA
• Today, just 6 of hospitals
• Provide nearly half of the hospital care to the
  states uninsured
• Operate almost 60 of CAs 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

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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 Franciscos under- and uninsured
• Referral Center for DPH and its affiliated
  partners
• Provides 20 of all inpatient care in San
  Francisco

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SFGH DIVERSITY OF PATIENTSFY 2007-2008 N98,680
Age
Sex
Race
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Payor SourcesFY 2007-2008

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Top 10 Discharge Diagnoses FY 2007-2008

• NEWBORN DELIVERY
• PSYCHOSIS
• PNEUMONIA
• SCHIZOPHRENIA-AFFECTIVE
• CONGESTIVE HEART FAILURE
• HIV DISEASE
• PARANOID SCHIZOPHRENIA
• DEPRESSIVE DISORDER
• ALCOHOL WITHDRAWAL
• OBSTRUCTIVE CHRONIC BRONCHITIS

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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

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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

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SFGH FACTSFY 2007-08

• 659 Million Total Budget
• 98,244 Unduplicated Patients
• 506,150 Outpatient Visits
• Licensed Beds
• 403 General Acute Care
• 106 Acute Psychiatric
• 59 Skilled Nursing Mental Health
• 30 Skilled Nursing Med/Surg

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SFGH FACTSFY 2007-08

• 16,031 Admissions
• 10 Operating Rooms
• 6,872 procedures
• 49 are emergency
• 1,118,100 surgical minutes

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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.
• 1,263 babies were born at SFGH
• 1,908 women received prenatal care, 25 high-risk

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Trauma and EmergencyFY 2007-08

• Over 51,000 Emergency Room visits 18 are
  admitted
• Over 7,200 Psychiatric Emergency encounters - 25
  are admitted

• Receives 29 of all ambulance traffic in San
  Francisco
• 3,317 adults and children are treated for
  injuries requiring the trauma activation.

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Stroke Center

• Certified as a Stroke Center in 2007
• Recertified as a Stroke Center May 2009

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Emergency Department
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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

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SFGH-UCSF AFFILIATION

• 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

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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

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Clinical Training School of Dentistry

• Oral surgery 6600 clinical encounters/year
• Residency 4 residents/day
• Dental students 16 students/day

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Clinical Training School of Pharmacy

• Poison Control Center
• Average 5 students/day at SFGH
• Average 3 residents/day at SFGH

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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

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Research at SFGHCurrent Situation

• Dedicated research and academic space
• 248,495 ASF
• Grants awarded to PIs at SFGH as of 3/09
• 448 M total with 161 M for 2008
• Number of PIs 169
• Average 80 research fellows and 5 graduate
  students per day

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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.

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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

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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

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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 US250,000
• 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

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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 US25,000 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.

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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 Deans Office web pages, entitled SFGH
  Hospital Orientation. http//www.medschool.ucsf.e
  du/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 hospitals orientation material.
  We hope to automate this latter procedure in the
  near future.

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The Heart of the City