HomeMy WebLinkAboutMINUTES - 05041999 - D3 . m
FHS #22 -�?
TC3v BOARD OF SUPERVISORS #io-1" i" CONTRA
COSTA
FROM: Family and Human Services Committee :4 i, COUNTY
DATE: April 27, 1999
SUBJECT: Tracking and Monitoring Hospital Emergency and Critical Care Capacity
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUNDAND JUSTIFICATION
RECOMMENDATIONfS}:
1. RECOGNIZE that since the County began monitoring the number of available intensive care
beds, other monitored beds and general medicallsurgical beds in January 1998, the hospitals
in both Contra Costa and Alameda Counties have established a system of"hospital census
alerts."
2. RECOGNIZE also that since January 1998, the County has implemented a policy Which
requires approval of the County Health Officer prior to a hospital implementing diversion.
3. RECOGNIZE that the midnight patient census required by the state does not necessarily
reflect pear daily patent loads, but is a more accurate figure than the current afternoon count
since it is less subject to variations in admission and discharge procedures.
4. AUTHORIZE and DIRECT the County Health Officer to monitor hospital emergency and
critical care capacity, utilizing the information from the midnight census, the census alert
system and diversion status, thus eliminating the need for the daily afternoon reports on
available intensive care beds, other monitored beds and general medical/surgical beds.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR_RECOMMENDATION OF BOARD COMMITTEE
APPROVE —OTHER
vl
SIGNATURE(S): ICK DESAULNIER GAYUILHGEIVIA
ACTION OF 13i?ARE)ON 1 APPROVED AS RECOMMENDED OTHER X
See Addendum for Board action
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A
X uNANIMOUS(ABSENT ) TRUE AND CORRECT COPY OF AN
AYES: NOES: ACTION TAKEN AND ENTERED
ABSENT: ABSTAIN: ON MINUTES OF THE BOARS}OF
SUPERVISORS ON THE DATE SHOWN.
Contact:Sara Hoffman,338-1090
ATTESTED.... �c`�� 4, 1999
PHIL BATCHELOR,CLERK OF
THE BOARD OF SUPERVISORS
AND COUNTY ADMINISTRATOR
cc:
CAO
William Walker,Health Services
Art Lrop,EMS
Lynn Bassett,Hospital Council(vela EMS) BY �� ,DEPUTY
FHS#22
5. DIRECT the County Health Officer to move forward on establishing a Web Site for hospitals to
use in reporting total available beds and patient census for critical care, monitored and general
medical/surgical beds, as is currently done in Alameda County.
6. ENCOURAGE the hospitals in Contra Costa and Alameda Counties to join with the Contra Costa
and Alameda County EMS Agencies to establish ReddiNet to facilitate tracking hospital status
and sharing information during emergencies.
7. AUTHORIZE the County's financial participation in the ReddiNet project estimated at
approximately $30,000 plus annual maintenance for the County's share .
IBACKGROUNDIREASONS FOR RECOMMENDATIONS:
On April 12, 1999, the Family and Human Services Committee reviewed the attached report on the
update on hospital emergency and critical care services from Art Lathrop, Emergency Medical Services
Director.
Sill 'Walker; Health Services Director and County Health Officer, reported that the department has
continued daily monitoring of hospital emergency and critical care bed capacity since the January 1996
crisis. While availability has varied, at most times there seems to be an ample cushion of capacity. As
explained by Dr. Walker, this is due in part to other changes in policy including: 1) requirements that the
Health Officer must give approval prior to a hospital implementing diversion and 2) implementation of
the census alert system.
Given the greater range of information and controls provided by the diversion policy and census alert
system, Dr. Walker recommended that the County shift from midday reporting of available staff beds to
a midnight census report. The midnight census report is the most accurate since it is a stable period
for the hospitals and less subject to the variations in admission and discharge procedures that affect the
afternoon count. The midnight census would also be consistent with the practices in Alameda County
and support our desire to move toward a web-based reporting system, also consistent with Alameda
County.
In addition, Dr. Walker recommended County support for ReddiNet (Rapid Emergency Digital Data
Information Network), a proprietary network for linking hospitals and county EMS agencies/dispatch
centers in order to facilitate tracking of hospital status and sharing of critical information during disasters
and multi-casualty incidents. Both Contra Costa County and Alameda County EMS agencies are
recommending the system as a joint project. County cost is estimated at approximately $30,000 plus
annual maintenance.
Supervisor Dark DeSaulnier stated his belief that the County needs to establish a consistent format for
reporting. Supervisor Gayle Uilkema agreed. She further stated that the County's job is not to try to
regulate those over which we have no regulatory authority; however, she questioned what can we do
to best protect the public. Dr. Walker responded that the County has no ability to prevent a hospital
from closing or to regulate the practices of health maintenance organizations. However, the County
does have the ability to develop and provide information. Currently, the County is participating in a
hospital capacity study to assess the impact of hospital downsizing as well as project need over the next
five years. He acknowledged that the health care industry is currently in turmoil, creating many public
policy issues. Hospital downsizing, increasing numbers of uninsured individuals and changes in the
health maintenance organization industry will continue to create difficulties for the County and increase
demands on the County to provide healthcare services. He felt than there would be a major crunch„
over the next five years.
After further discussion, Supervisors DeSaulnier and Uilkema agreed to recommend that the Board move
to the midnight census system; to support the ReddiNet Project and to establish a 'Web Site for hospital
reporting emergency and critical care capacity.
2
ADDENDUM TO ITEM D.3
MAY 4, 1999
On this cyte,the Board of Supervisors considered the report from the Family and Human Services
Committee on tracking and monitoring hospital emergency and critical care Capacity.
Dr. Walker,Director,Health Services Department,presented a brief history of the tracking and
monitoring process.
The following persons presented testimony:
i�'ancy Casa a,2690 Sonoma Way,Pinole, California Nurses Association;
Pam Herron,606 Fisher Street,Rio vista;
Jim Ryder,2000 Franklin Street,Oakland,
Arlene Boyd,4676 County Hills Drive,Antioch,
Nettie Del Rio, 133 Clay Street,Vallejo;
Deborah Bayer, 5706 Sacramento,Richmond;
Kevin Reilly,2000 Franklin Street,Oakland;
Lynn Baskett,2850 Telegraph Avenue,6f Floor,Berkeley,Hospital Council;
Joe Keffer,no address given.
Following discussion of the matter,the Board took the following action.:
APPROVED the recommendations of the Family and Human Services Committee on Tracking
and Monitoring Hospital emergency and Critical Care Capacity amended to allow the Health Services
Lacer to ask the Hospital Council if they would continue to provide the County with the mid-afternoon
information and perhaps retake it more workable for the parties and a more real.number.
ECEIVED
MAY - d 1
PATIENT CENSUS - OAKLAND KAISER
Shift: by Shift Basis CLERK BOARD OF SUPERVIsORS
19 Guys In 1996 CONTRA COSTA CO.
Dates Midnight Day Evening Midnight
4/1 Monday 173 197 172 173
4/2 Tuesday 178 190 173 179
4/3 Wednesday 175 197 201 179
414 Thursday 187 199 183 183
415 Friday 176 188 187 178
4/6 Saturday 183 180 155 148
4/7 Sunday 161 173 161 154
4/8 Monday 154 178 171 146
4/9 Tuesday 144 184 182 171
4/10 Wednesday 174 200 171 170
4/11 Thursday 166 184 187 184
4112 Friday 184 166 177 153
4/13 Saturday 169 176 165 148
4/14 Sunday 154 162 159 157
4/15 Monday 159 177 198 178
4/16 Tuesday 189 201 188 164
4117 Wednesday 158 196 160 159
4/18 Thursday 159 196 177 172
4/19 Friday 180 192 183 173
Total 3223 3536 3350 3160
Average 170 186 176 166
Submitted by Nancy Casazza
May 4s 1999
W:LLiAM! & WALxEP, M. D. CONTRA COSTA
HE,i SERVICES DIRECTOR
EMERGENCY
ART LA11,0P
EMS TOR
MEDICAL SERY[CES
J&OpSEP' i $APGER, M.D.
i EWCAI DIRECTOR CONTRA CO TA 50 Glacier Drive
[ Martinez, California
HEAs i 1 L g�i S E R 1zT 1 C S 94553-1631
Pit(92 s)645-4698
Fax(925)645-4379
April 7, 1999
To: Family and H an Setrices Carr mi�t� - _ _ --
From: Art Lathrop J
Svbi: Update on Hospital Emergency and Critical Care Services
In the Health Services last report to the Family and Human Services Committee dated
October 21, 1998, we reported on the on-going daily monitoring of hospital emergency and
critical care monitoring and on other activities undertaken by the hospitals and EMS to plan for
the 1998-99 winter flu season. This report provides an update on hospital monitoring and related
plarming activities through the 1998-99 winter season.
Hospital Monitoring
EMS monitoring of hospital emergency and critical care capacity began.in January 1998
in reaction to reported,shortages of hospital critical care beds and emergency department
overloading. 'These problems were brought about in part due to the severe flu season, which had
struck the state. While the impact on hospital resources was a problem statewide during the
1997-98 winter fu season. particular concerns were raised in Contra.Costa County due to the
recent hospital closures and.downsizing. Hospital closures included Los Medanos Hospital in
Pittsburg,the Veterans Administration Hospital in':Martinez, and Kaiser Foundation Hospital in
Martinez. Additionally, the Kaiser Foundation Hospital in Richmond lead been downgraded with
the closure of intensive care and elimination of inpatient services. (Kaiser has since upgraded its
Richmond facility to include inpatient services and intensive care and has committed to
upgrading from Standby to Basic Emergency Service status when surgical services are
established by the first of next year.)
As a part of the EMS hospital monitoring process,.hospitals are requested to submit a
daily report to the EMS Agency showing the number of available staffed beds in each of three
categories–intensive care beds, other monitored beds, and general medical/surgical beds.
Reports are faxed to the EMS Agency by 2:00 PM each day. EMS staff make follow-up
telephone calls to those hospitals which have not submitted famed reports. On weekends and
• Contra Costa Community Substance Abuse Services • Contra Costa Emergency Medical Services • Contra Costa invironmental Health • Cortra Costa Health Plan
• Contra Costa Hazardous Materials Programs •Contra Costa Mentai Health • Contra Costa Public Health • Contra Costa Regional Medical Center , Contra Costa Health Centers
holidays, an EMS staff member is assigned to come in to conduct the daily polling.
The table below shows the overall bed availability for ICU beds, monitored beds
(including both ICU and other monitored beds), and general medical/surgical beds during the
four-month winter season from December 1998 through March 1999. Also shown for
comparison purposes is bed availability for February 1998 and July 1998. The figures show that
average daily bed availability for the 98-99 winter season ran around 20 ICU beds, 42 total
monitored beds (including ICU), and 58 general medical/surgical beds. These figures are a little
tighter on ICL; and medical/surgical beds than corresponding figures for February 1998,
following the Board's declaration of a local emergency due to bed shortage problems.
Available Staffed Reda Compared for Selected Time Periods
Available Staffed Bads Dae 98—Mar 99 Feb 98 July 98
Intensive care beds
Average 20 24 29
Lowest day 4 11 17
Highest day 41 35 41
All monitored beds (incl. ICU)
Average 42 40 53
Lowest day 16 22 28
Highest day 80 80 87
0
General medical/surgical beds
Average 58 69 76
Lowest day 24 35 44
Highest day ; 147 139 119
Source: Contra Costa EMS daily hospital polling.
Noteworthy is the range of bed availability. Staffed available ICL:beds ranged from 4 to
41 during the 1998-99 winter season. Availability of all monitored beds ranged from 16 to 80,
and general medical/surgical bed availability ranted from 24 to 147 beds. lay-to-day variation
can be seen in detail in the attached charts showing the actual daily bed availability figures for
December 1998 through March 1999. Baily differences-nay be due to actual differences in
patient load or may an artifact of the reporting process. .:"or example,reporting on different days
may occur before or after a discharge cycle. Also perceptions of a hospital's ability to staff beds
may vary by the person reporting. To some extent,hospitals can shift staff internally to meet
varying demands.
An alternative approach to measuring hospital bed availability, an approach currently
being implemented in Alameda County, is to track the difference between the number of
physically available beds and the actual patient census. Alameda County EMS has established a
Web site for hospitals to report total available beds and patient census for critical care,
monitored, and general medical/surgical beds. Patient census is reported as of midnight as
rewired for State reporting. The midnight census, while not necessarily reflecting the peak daily
patient load, provides a stable figure less subject to vacation from admission and discharge
procedures. Midnight census data is recorded and retained by hospitals and therefore retrievable
after the fact. Patient census data alone would provide information only on physically available
beds, riot on staff resources. However, if used in conjunction with Census Alert reporting
discussed below, patient census data would provide a better overall picture of hospital resource
availability than is currently available.
Hospital Census Alerts
Together with the local EMS Agencies and the hospital Council, the hospitals in the
Contra Costa and Alameda counties have established a system.of "hospital census alerts."Alerts
are initiated at the hospital level when resources become sufficiently taxed to warrant special
action. Each hospital establishes its own internal criteria for initiating a Census Alert I (first
level) or a Census Alert II (second level) base"upon such factors as emergency department
volume; available staff,beds, and equipment; gnd current and anticipated surgery schedules.
Alert I's and Alert II's trigger certain internal actions such as canceling non-urgent procedures,
extension of clinic hours, modifying staffing patterns, canceling time off, and so forth. Alerts are
also reported to the local EMS agency—Alert I's by fax and Alert II's immediately by 24-hour
notification procedures.
While ile detailed procedures for reporting and tracking hospital census alerts were not in
place at the beginning of the winter season,hospitals are now routinely reporting alert status.
During the month of March, four hospitals reported being on either Census Alert I or II over the
course of a total of seven days.
Emergency Department Diversion of Ambulance Patients
Hospital diversion of ambulance patients continues to require prior authorization of the
ora-call Health Officer. This procedure works well. During the first three months of 1999,there
were seven authorized diversion periods involving three different hospital totaling five hours.
One of these was for an internal emergency. Six were for emergency department overload.
ReddiNet
R.eddiNet(Rapid Emergency Digital Data Information Network) is a proprietary network
for linking hospitals and county EMS agencies/dispatch centers for tracking hospital status or,a
day-to-day basis and sharing critical information during disasters and multicasualty incidents.
The system was developed by the nonprofit Healthcare Association of Southern California and is
3
in place in Los Angeles and certain other southern California counties. Both Contra Costa and
Alameda.County BMS agencies are recommending implementation of the system as a two-
county system. Cost is estimated at approximately $30,000 per hospital or county site plus
annual maintenance. Demonstrations were held in both Alameda and Contra Costa Counties in
early March, and hospitals are now considering committing to the system.
cc: William B. Walker, M.D.
attachments
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