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HomeMy WebLinkAboutMINUTES - 07182000 - C156 FHS #22 tr ' '� ' CONTRA TO: BOARD OF SUPERVISORS r.: 1 COSTA, COUNTY FROM: Family & Human Services Committee ;r DATE: July 10, 2080 SUBJECT: Update on Hospital Emergency and Critical Care Service Monitoring SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION(St: 1. ACCEPT the attached report from the Health Services Director on the status of hospital monitoring. 2. DIRECT the Health Services Department, Emergency Medical Services Division, to continue monitoring hospital census, alert status and ambulance diversion, using ReddiNet or other available means until such time as ReddiNet is operational. BACKGROUND/REASON(S1 FOR RECOMMENDATION(S): On June 26, 2000, the Family and Human Services Committee heard a report from Art Lathrop, Emergency Medical Services Director, on the status of its hospital monitoring program (see attached report). Supervisor John Gioia asked if any hospitals had provided afternoon census data in addition to the midnight census data. Mr. Lathrop responded that only the Contra Costa County Medical Center had complied with the request. The other hospitals maintained that the afternoon census reporting was not only intrusive to their operation, but provided data that was not meaningful. Their position was that hospitals staff only to the extent they need to; therefore, there will always be few available beds, based on the definition used by the report. CONTINUED ON ATTACHMENT: YES SIGNATURE: --RECOMMENDATION OF COUNTY ADMINISTRATOR—RECOMMENDATION OF BOARD COMMITTEE APPROVE Oe„OTHER SIG"yATfJRE(S)e_JOE CANCIAMILLA JOHN M. CIOIA ACTM OF BOARD ON_ u Y 18 . APPROVED AS RECOMMENDED L OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A UNANIMOUS{ABSENT �t 1 �� TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND ENTERED ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact:Sara Hoffman,335-1090 ATTESTED July- 18 , 2000 PHIL BATCHELOR,CLERK OF cc: CAO T QVCJARD OF SUPERVISORS Bib Walker,Health Services ANERCIBUNTY ADJAINISTRATOR Art Lathrop,EMS B DEPUTY AC ND A F M Ti nt'd Art Lathrop also pointed out that the afternoon censuscount also varied because of definitional interpretation. Some hospitals counted only the nurses that were associated with each bed; others included those where nurses could be easily pulled in from other parts of the hospital or on an on- call basis. Dr. William Walker, Health Services Director, noted that he also felt that the midnight census was a better index of capacity since it was more stable and allowed for identification of trends. Beverly Wallace from Richmond asked what good is the census alert if it is reactive. Art Lathrop responded that once a hospital announces a census alert, the hospital implements a number of steps that increase its ability to take patients. For example, call in more staff, institute longer shifts, discharge patients, cancel elective surgeries and implement the disaster plan. Mr. Lathrop stated a benefit of the census alert has also been increasing the ability of hospitals to share information on what they are individually doing to create an orderly process for increasing capacity. Dr. Walker added that the success of the census alert is best seen in the statistics on emergency department diversions, which have gone down significantly over the past few years. Supervisor Joe Canciamilla asked what authority does the County have beyond voluntary compliance. Dr. Walker responded that voluntary compliance was the extent of our authority. Ms. Wallace asked if other counties were using ReddiNet for reporting. Art Lathrop responded that its use for this purpose was basically in Contra Costa and Alameda counties. This prompted a question from Supervisor Canciamilla as to why it was developed in Southern California. Mr. Lathrop responded that ReddiNet was originally created primarily for ambulance diversion, which is not an issue in Contra Costa County. Mr. Lathrop also stated that ReddiNet will allow us to go beyond just monitoring. For example, in multi-casualty incidents, hospitals will be able to be alerted very rapidly, allowing for allocation of patients by hospital, a task which is now done by phone. In addition, there is a disaster screen to allow monitoring of hospital status with regard to availability of power and water during disasters. Supervisors Canciamilla and Gioia thanked the department for their report and asked that it be forwarded to the Board of Supervisors for their review and approval. 2 �a WILLIAM B. WALKER, M. D. t,"ONTPA COS A WALrk SERVICES DIRECTOR _ L rr ART LAT H RO t 1�V�E Ii1 E l CY EMS DIRECTOR MEDICAL SERVICES JOSEDARGER M.D. C O N T RA COSTA MEr71caL DIRECTOR 50 Glacier Drive Martinez, 553 31 HEALTH SERVICES 94553-1531 Ph(925)646-4690 Fax(925)646-4379 June 20, 2000 To: Family and Human Services Committee From: William B. Walker, M.D. subj: Update on Hospital Emergency and Critical Care Services Recommendation: DIRECT Health Services through its Emergency Medical Services division to continue monitoring hospital census, alert status, and ambulance diversion using ReddiNet or other available means until such time as ReddiNet is operational. Background. On April 27, 1999,the Board of Supervisors approved the recommendations of the Family and Human Services Committee(1) authorizing and directing the County Health Officer to monitor hospital emergency and critical care capacity utilizing,information from the midnight census, census alert system and diversion status; (2)directing the County Health Officer to move forward on establishing a web site for the hospitals to use in status reporting; (3)encouraging hospitals in Contra Costa and Alameda Counties to join with the counties in establishing a ReddiNet system for monitoring and tracking hospital status; and(4)authorizing the County's participation in the ReddiNet project. The Board also asked that the Hospital Council be requested to continue providing afternoon reports on the number of available beds. Hospital Monitoring Process Prior to April 1999, hospitals had been reporting on their numbers of staffed, available beds by category (acute, intensive, other monitored)and on the general status of their emergency departments (busy, moderate, slow) in response to telephone calls made by EMS staff on a daily basis in the afternoon. This practice had been initiated by EMS during the crisis in hospital critical care capacity experienced during the 1997-98 flu season and was continued on a daily basis at the direction of the Board. In April 1999, the Hospital Council notified the County that • Cortra Costa CoriNrlumry SuGStar+.Ce Ab,p Se saraes ' Con."a Ccsta Emer^yer -Medid Services • CJrr'a Costa Envircrnenzai r'eath • Corlrra Costa^e iR?!an • Ccr-lla Costa Hazarccus Materia:s PmaraTs •Cortra W,s.a Mvtaj Waal".f • Ccrtra Costa aC;: �-'eairh • C-V-.'a Ca3ta ',Ae„cal __rt' _vsra ua1 rn rgn�rs s hospitals were no longer willing to provide daily data on staffed available beds and emergency department status. Hospitals were willing to continue providing data on hospital census alert status and emergency department diversion and would begin providing midnight census data showing the numbers of acute care patients, intensive care patients, and other monitored patients. Hospital Council staff indicated that the Council's position was firm on the issue of not providing routine daily information on staffed available beds. A"Hospital Census and Alert System Notification Form"(Exhibit A)was developed by EMS for use by hospitals in reporting midnight census and in reporting changes in hospital census alert status.* This form is completed by hospitals on a daily basis and faxed to the EMS Agency. Contra Costa has been working with Alameda County in the development of a secure web site to facilitate reporting. A web site has been developed for use by hospitals in both counties and is operational,however, Contra Costa hospitals are continuing to fax their reports until Alameda County resolves security issues related to the web site. The long-range plan is that hospital census and status information will be reported via the ReddiNet system. ReddiNet ReddiNet is a radio-based computer communications network developed by the Healthcare Association of Southern California, sister organization to the Hospital Council of Northern and Central California. The system is used to link hospitals and county control points (EMS agencies and dispatch centers) in order to share information on hospital operating status, availability of critical care resources, and information related to multicasualty incidents and disasters. Separate screens are available for day-to-day operations, multicasualty events, and disaster operations. The system is in use in several southern California counties including Los Angeles, Orange, and Riverside. The Alameda-Contra Costa system will be the first two-county system, and, at this time both counties and all hospitals except Children's have agreed to use the system and have signed contracts with the Healthcare Association for ReddiNet installation. A users' group has been meeting to design customized screens for the Alameda-Contra Costa system. Installation is scheduled to begin in October 2000 pending FCC licensing. Full implementation of the system is planned for spring of 2001. Hospital Census Alert Monitoring The results of hospital census alert monitoring from October 1, 1999 through the present are shown in Exhibit B. During the period from October 1999 through May 2000,there were a total of 117 Level 1 or 2 alerts involving six hospitals. Only Doctors San Pablo, Doctors Pinole, and Kaiser Walnut Creek reported no census alerts. CCRMC reported the largest number of alerts (53), followed by John Muir(26), Sutter Delta(14), San Ramon(12), Mt. Diablo (1), and * The Census Alert system was developed by the hospitals and EMS agencies in Alameda and Contra Costa Counties with the assistance of the Hospital Council as a means of identifying that hospitals are implementing pre- identified measures to deal with high demand. A hospital on Census Alert I has implemented its first series of measures to deal with high demand. A hospital on Census Alert 2 has implemented more extraordinary measure to deal with high demand. 2 Kaiser Richmond(1). There were 41 Level 2 alerts and 76 Level 1 alerts. Out of 244 days during the October 1999 through May 2000 time period, 94 days had one or more hospitals on either Level 1 or 2 census alert, 39 days had one or more hospitals on Level 2 alert, 14 days had two or more hospitals on Level 1 or 2 alert, 2 days had two hospitals on Level 2 alert, and 5 days had three hospitals on Level 1 or 2 alert. There were no days when more that three hospitals were on a census alert and no days with more than two hospitals on Level 2 alert. Exhibit C shows the number of Level 1 and 2 alerts by month. December and January were the heaviest months for census alerts, with 29 and 30 alerts, respectively. Emergency Department Diversion Monitoring Hospitals are permitted by EMS policy to temporarily divert ambulances when their emergency departments are on overload and when authorized by the Health Officer or his designee. Hospitals must have an internal diversion policy on file with the EMS Agency and must report diversion episodes to EMS. Episodes of diversion by year from 1995 through the present are shown in Exhibit D. Diversion, always relatively low in Contra Costa, has declined from 121 episodes averaging 2.2 hours each in 1995 to 20 episodes averaging 1.8 hours each in 1999. Major users of diversion have shifted from CCRMC, Doctors San Pablo, and Mt. Diablo during 1995-1997 to Sutter Delta since 1997. Interestingly,there were no instances of emergency department diversion by a hospital on Level 1 or 2 census alert. Midnight Census Monitoring Midnight census monitoring compares the number of physically available (operational) beds in three categories—intensive care, acute care, and other monitored beds—with the midnight census of patients in those categories. By subtracting the patient census count from the number of operational beds, the number of beds available for new patients is obtained. This number of available beds does not take staffing into account. For example, a hospital with 12 operational intensive care beds and a patient census of 8 would have 4 available intensive care beds. However, additional patients could be accommodated only if sufficient intensive care nursing staff'were available to provide the mandated ratio of one nurse per two patients. During the period October 1999 through May 2000,the midnight census results showed an average of 38 intensive care beds and 328 acute care beds. The 328 available acute care beds included 52 beds with patient monitoring capability. These numbers provide a baseline against which to measure availability of beds during periods of high demand. cc: Hospital Council Art Lathrop, EMS Director 3 •+ _ Exhibit A G� CO NTA COS T A F. yAT i,H SERVICES Emergency Medical Services Agency i uii L r eta= and AAA Sat9177 ftIffsaftn Form Type of Notification: ouo"ant only Hospital reporting; C) Midnight Census Date/time reporting: Q Alert level 1 ON U {Tart level 1 OFI: Clatseltirne lista compiled: C) .Alert level Z ON O Alert level 2 OFF fer,tert .wet 2 OONO SW MMY ft CWW NsaM Contact person/telephone: QMW we 5riertfl"a ftponft Of 1905) 6464441 ., wf Llwnr�351 ./ ammum atw- 0 Normal Operating Status ;,,�, „rte„ ►r err Q Census Alert level 1 Ct Census Alert level 2 U ED Diversion ir►o.D.May be et nem+et,W#*i , at z sats=} Liaanaad_Be!dsr Ayg&&re As& �"c"�fl1�Lt Qua intensive Cara Intensive Care intone!"Can Med/"bads_,,,,,._. ...^_ Med/3ury berlsr,.—.._„o,,,,_,_ Med/Sur+g beds Monitored bids Monitored bade Monitored beds IsacdudM+p iiDACU1""`- lexcWny Etinlexckwing TEwcul'— Admits wsitirt� Definitions: Licensed sada: The number of licensed scute care beds stated on the hospital's license excluding nursery besainots end iMensed beds placed in suspension. Avollable gads: The comolement of beds (excluding nursery bassinets) physically existing and actually available for overnight use, regardless of staffing levels. Excludes beds placed in suspense or in nuraing units converted to nonpatient cars uses, beds closed for construction, by hospital policy, and overflow beds. Current Coma: The actual number of pstionts, including patients who are *odmits waiting'. This number may be higher than the total Ucansed or Available Beds numbers. Monitored gods: These tyre a subset of the medical/surgical licensed bed category, and do not include emergency department or intensive care beds. These beds have cardiac monitoring capabilities and may be identified as transitional. stip-down, or intermediate care beds by different hospitals. Admits Waiting: Those patienix. including these in overflow beds, who have not been placed in an appropriate licensed bed.' !Hiram Mx v*fo m to flea WS Agmey or t9261 649.470. Av 7 moons W(925) 6,96•4680 da*n&MW boars. Exhibit B Hospital Alert Status � Census Census H Alert 2 Alert 1 w Data w DootorslSP Dootors/PKaiser/Rioh� CCRMC N Mt Diablo W S Delta ' Muir YNKalser/WC ?Y San Ramon w� w w w ; w. _ w 10/1/1995 10/2/1999+ ........................................................................................................... ..................... ...........,..,..,... .................. .. 10/3/1999c. 10/4/1999: 10/5/1999 10/8!1999. , . _._ .. ..... w w..... _. }..........................p..................,..,.,...}................,,.,,,....y...........................p.......................... .................... }.,.......................4..........,........,.......y..........................3....................... 10/7/1999: 10/8!1999; 10/9/1999; 10/10/1999 W ...................................... ............................................................................................... ........................ ........................... ..................... 10!11/1993: ; E ................-..;.,,+..,.,.,»..»,...,.,,....,..y».....__.---_....,_........y,.,..».,,..........._..._..«p..,.,,....,,..,....,..,,.....,,,.}....».,..,,.,.,,,.,.,,.,,,,»{ .......»„».....,...j 10/12/1999 w 10/13/1999: ;rA.,.F......... 10/14/1995 y..........................¢......,...................p..........................p..........,.........,,.,.,p..........................p.................,,.......p........................,.p..........................p..............,............p..........................{ 10/15/19991 .,,10!18!1995�.,..................... .......»�.,..,.... ,................ ..,,w.....,,„•„„ ..............., ....,......_w,,..., ....... .... .�.,.,.,,.,......... .-..w»..,,...., 10/17/1995 --------- 10/18/1999i ...................................................................................... .................. ... ....... 10/19/19991 10/20!1999, 10!21/1999 Xf 10/22!1995 >..........................¢..........................;.......................... ...................,......Q..........................4....,..................... .............,.,..,...,... ..,....,......,........... ...,,.....................a.......... i 10/2_3/1999,_ ............ 10/24/1999: ww.,-...,....,... �..w.�........,... _.»..,_...,.... w...,.Y..... ,.........,_,,..,... ...__,�......,.,. ...,..,,,..,_,..,..,... ...,.�,..,_,....... .,_............... 10/25/1995 ` —w..—... s ................................ 10/28/1999, ...................................................... :...........................:...........................:......................... ................... ..................... 10/27/1995 E i .................w»».._- .......... 10/28/1999, k _10/29/1999 10/30!1899; ..,._,............. ...,,.N ...�................. ....,..........a,... .............,... ....�......_.,,..,,. ..v...,...._...a r�...a........... ......,......�. % ............................ .,..................,..,..p...........,....,........¢.,,,..,,..................¢..........................ry..........................¢.......................... ..........................;............,........... ................. 10/31/19991 11/1/1899; ,.,�..».�»..._..w.._... .».._......»,.,..... ,..,w,.,»�..,... �........_,.»....».., ...,.�....,...�..... ,..w�..a..�..�.. ........w...... ...,,..,.,,....,.... ------------ 11/2/1899; 11/3/1999 ........................................................................................................... .........,........ ..................... ....... ............ ........,............ 11!411999 1 i 1/5/1998: 11/8/1999? 11!7/1993' : ? ,......,.., p- p. p..........................' ....,.......<..,,,........¢..........................;..........................$,,,,,,.................. 11/8_/1999, � p ......... .........� 11!9!1999;». .............»..., ...........,.....,. ._........,..._. _........,....,.. »...,,.,,........ ...........a.. .............. ._.,..,,,,,..�...... 11/10/1999 11/11/1993 ...........................:.......................................................:•,......................,..:.....................,. ..................... ........................... 1 11!12!1993 i 1 ¢ �.... ,...., ' 11/13/1999:' 11/14/1993 1 11/15/1995 11/16/1999i 11/17/19991, t �... >....,...,...,.,.K..........,.o-....,..........,_........N....�.b...............,,.....-.....,i.....,........,.,�........d.,..,..H...�........_..,.,�H.....,.,....N..y..,....o-„w....,.......................>_...u............,,.,.N..,i.,....,.._..K....M.,...,..b.u.....,....H....,.....,.. ------------ 1111911994 ..... ................................................:..•........................:.,.,........,........... ....................., .............. 11/20/1998 ..... ..._... ;.._. ......w........... ........................�.»»„...».,, Source : Contra Costa Emergency Medical Services Agency, 8/19/2000. Page 1 Hospital A ler; Status Census Census /�'i ai®rt z alert 1 MDsta hX Doctors/SP YDoctors/P Kaiser/Rich �CCRiVIC Mt Diablo V S Delta Mufrais A er/ W 4KWC San Rarnon 11/22/1999:' � �......�.,V...........................: y,....,. ..... ..... ....................,. 1....,..., .,,. .,,,.,. ,.t,,.. ... .,,,.,..,., ,a... i. ,....»,..,. ... w. .,,... .,,, ,..a......,..,....,._..........., 11123/1999 ............................................................................................................... ....................... ..................... ...................... ..................... 11124/1999.' r,....... .................,,......., , ,...,.... ..,..,.,, _..,, ,._.. E ,.,_.� ._ ;....,,...,,...w,., ,w.-..�,,.. ,,_ � .,.., ...._. ¢... .,__. �_. .................... .�. . ...._....,,. - 11/25/199 11/26/1999 .............. ;... 11/27/1993; f }..........................}.......................... .......................f..........................t........................... .....,.....,.............. ..........................4........................... ...................... ...................... 11/28/1999: 11129/1993'. .,,,.,.........,,.,. ..,,.,.,......- ...,.._...... � � � i ------------------ 11/30/1999:' ` E 12/1/1999 12/2/1999; 1213/199Smoot 3 12/4/19994. i 12/5/1995 i . i i ...., .... .. .,...,......,..,..N ....,,,..,_........ . ................ ....................... .y.,.......................$....................,.....;..........................;........,,................d..........................p.......................... ..........................,'}.......................... 12/9/1999: ------------- i 12/8/1999 12/9/1999; ,.....12/10/1999.................................................. .: ..................... .......................4.........................................,................................................................... g 12/11/1993 12/12/199 ......................... 3 12/13/1993 >..........................<........,.......,.........�..........................a............,.......,..... ;.................... ...... ..........................p..........................� 12/1411999 12/15/19991, , �_.,.....,,......, .......w.,,,.,w..• .,.,.....,......,.. .....�.,,....�....,, .....,.,,........,.,.. ,...w._.,......12/18/1999i. i t E i a 12/17/199.9: ...................•........................,.......................................... ... .....................:...........................:..........................: ..................... ..................... ...................... 12/18/1999,i 12/19/1999i ------------ 12/20/;999 �� i 12/21/1995 }........................_0.........................g..........................p..........................;..........................;.......................... ..i 12/22/19991 12/23/1999. .........,.w�,.., .............. _...�..._..... ...,.,....,,..,....„..... .,....,„,-,,,.,,,.a, ...,,�......... ...,...,»...,w._ ,...,..,.,...,,.,., i 12124/1993 12J26/1999 ....................................................... :...................................................... ........................... ..................... ..................... ..................... ;... 12/28/1993 12/2711994. 12128/19_99; '• 12/29/1994, .....,..,,.,..,,.., .................... ..,,...,..a...M,.H .........._.,.., .,_....,.... .....,..,,.... }..................................................... b............,............. .......................... ........................ .........„....,..........>.......................... 12/30/1989' 12/31/1993 .�._,w,,-,....w._.. ...,w............... ,,.,.�......,,,.. ,._.,w.......,w .....,.....,.�._.., -.,.....,.w..� --------- 1/11/20001 1/2/2000;. .......... ..................... .. 1/3/2000' 11412000: ------------- �...,,,..,,_.w___...........,�.,,..w............,.,....,.i...-,,...................... ,,...�.,...,....,,,..,.., 1/612_000 ,.. .......t/a/260t;<........,,,.....HN..,.. ...........�.......,. w,.,.,,.......M,... ......W....,.,,.........,.. _.....„ ..,..,..._.....M. .....,,, }..........................4..........,,.......,......5....................,..... ........, ...............,.......... ......_...,._1/7/2000'..........................,....,...,.,..,-.....,.,..,,,... ..,_...........`,..,......., ¢..........,.....,.. .'III 1 III ....,,..,....-..«,_........ ,,.w.,.w..,,....,....,,...,.,:.,. .,,..........,_.+ 1/8/2000? ._. .......�..y; ,..,.M.,..,w.,,, ,.{ 1/912006. ----- 1/10/200d ..........i...........................' ....................i........ 1111/2000 1/12/200a s Source : Contra Costa Emergency Medical Services Agency, e/19/2000. Page 2 Hospital Alert Status Census Census Alert 2 Alert rt I ,.._..•Date Doctors/SP 4M Dootors/P Kaiser[Rloh CCM 1j Mt Diablo 4 N S Delta Muir yKaiserfWC Sen Ramon --.. V 1113/200CY �' w w M 1/14/2000 ................................................................................... .. 1/15/2000c* 1/1 6/200(}'._ 1/1712000: 1118/200dx ... ..,..,..--- .. ... }..........................¢.......................... ....,....,................ ..........................p.......................... .......................... ..................,....... ............. ....... 1/191200CF iiia/2cida ----.� ------------- 1/21/20009.' 1/22/200a ...........................:......................................................................•...........,........................ ................... ;... 1/23/20003 ----- 1/24/200a., _1/2_5/2_000 1l26/2dd0i. ,,..,.<.�........._,.....;., v....,...............,.;.. ,.w.,,.,..,....,. ,` .w,...,.,...,.�..., .;,, ....,..�........,.,;.. N.............,_ .,..,...._.,....,,.,.,,..,..;.........._,,.......,....,.,..; y......... ..... .......¢....................,,..<.y..........................iJ...,......................p..........................q.......................,...d........,......:. -..,3.,.................,.... 1/27/2ooa 1/29/2000 1/30/20001 .................................................................................................... ...................., ... ...........................:..........".".............: ..................... ........... 1/31/2006' E 3 2/11200d. 2/2/2d0d 213/2d0(k; ...,.......,w,,;.,........._,.�.,,,... - - --- ....,.....................:...........M..- --- - - ..,..._....... ..,,,,.....,,�......,..,.,,,,.,._,.,_...},......_.,�..,...........,. ;.............. .......¢..................,......"; ......... ..... ............,........ ¢..............,...........;.......................... � ¢................. 4............... 3 2/4/200() 2/5/2000; 2/6/2000; 2/7/2000: ..................................................................:.......................... :.............................................."........:..............,"....,......:.,..................... ....: 2/8/2000; 2/9/2000: 2/10!200_0 2/11/2006. y..........................¢.,.......................,b..........................¢.......................... ......................,...y............. .............o..........................y. 211_2/2400 .................................................... 2/13/2000, ,..,,.,,_..._..,.., ,..�............. ..,,..,w...,_,. ....,...„,,...,._ ,.....,,.........,.,, ,,,.,.,....,_,.., .....,.w,,.,.,,.,w�..,.. ......,w... 2/14/2000 i E 2115/200a ...................................................................................:...................... ..................... .... 2/16/2000 2/17/24003 ..........................w. ¢.w.......,..,__,.,........;}•,...,.,,.,.....,.._...,, 2/18/2000 2/19/2000. }..........................¢...,......................q.....................,....d.........................,y.,.................... ....4..........................q..............,.. 2120/204Ck ......... .......•••...••........... .......................... ....,..,............... 2/22/2000;. 2/23/2000 ..................................................................................;. .................. ...... :.. ...... 2/24/20000 ? ; 2/25/200d. w u.�... 2/26/2000; 2/27/2006 ...............<,..,,.....¢..........................y.......,.........,........a..........,...............b..........................y..........................d,.........................y ...................... 2/28/2000? 2/29/20003 3 3/1/2000: 3/ ..............2/2000 ......................................... :...........................:......................... ...:... :... . ................ 3/3/2000; 3/4/200(} Source : Contra Costa Emergency Medical Services Agency, 6/19/2ood. Page 3 Hospital /alert Status � Census Census Alert 2 Alert 1 M4 M Date ,V Doctors/SP Doctors/P YKalserlRiehMN M CCRMC N Mt Diablo_ S Delta Muir uKalsei/ C Y San Ramon w.315/2000 _ �. n w ...,.,,,,..,.,...a...,..M. ., _... , ,.a... .., ..•._......._. .... . ..... a W.. .,.., ,, a..M. , m . ... L .... .,, ....,.. ..... .... ...,..�..,.t.S_.. .,..,., .. 3/6/2000. .................................................:...........................:........................ ...................................................:...........................:........................ ......................3/7/20017.'3/8/2001} ,,._.w.,..._,__�.,..�,......,.,.......,,,,.,.,...� ,.w,.._...._.._,.....,.}.,,...._...,...._.,....�..w M _3/8/2000 �µ �.3/10/200Ck.�..._,._........,.... .......,.......... ..y..,............y:.... ..................�. _......_,�._ ��......,.,...� ..._,...,.......r..,. .......�...�_..,.... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .............. .•, 3/1 1/2ooa ..,.3112/200tk; .................... ,.,.,w.,�, ,........�.,,...,.. w..,.w._........ _.,,...,...,......., .....,..w......_,.. „,.,,,,,..,w. w...,...,....,,,.... 3/13/200( 3/14/2000:^ ...................... ...:... 3/15/2000, 9 i 3/16/2000. 3/17!2000; ,,,.,,...,.200 3/18/2000( 3 .......................... ..........................4.............,..,....... ..4.......................... .......................... .......,.....,....,.......4......,...................¢.......................... ,........................s....................... 3/18/2000 : t 3/20/2000; w ------ 3/21 i i 3 '• . :. . ....,.o-... v .... x...� .. i,. .. ,. ..� .. . ,s....., o. a Hs . . � 3/22/2000: ..................................................................................:........................... .................... ..................... ..................... 3/23/2000 3/24/2000i 3/25/200a ................�,.,.............,.,,-.„......�,,..,...,,....,.�,,.......a,.,.,.......,.,...,..,....,.y.. ,,.,,..,..,•.,,.�, ,.tr,....,,,,.�..».,...,..,a,w.....,.....,.,....,,,..7�,,,,,...,.,......,,,,,,.,i..,.._,,,......,.,.,,,,_..q 3/25/2000; .,,,...... .. 3/26/2000; 5........... ..........................;........,.................;......................,... .........,.......,........¢.,....,.„,.,..,........ .. ..,....e........................ ............. ...................... 3/27l200d Fµ3!28/200Ck ....- ----- -- 3/28/200(. >. , o.,.. _..,.......... ... ....N..... . �...... 3/30/2000. ............................................. .................................:........................... .........................:...........................:........................... 3131/2006, 4/l/2006. 4/2/2000 4/3/2000 ?......................:,..>............•....•........ .......................p.......................... 4/41200(Yp..........................¢.........,...........,.... ..,,......................q........................ s .,..4/5/2000:....,....,.,,„w,��,,. ,,...,......... ................ ..,... w..._...,..... ..,.,.x..,.a..,..,.. ..,.,......,...., ,�...,,,.,......_ : ' 4/6/2000; ' 4/7/20da °. .. V r� ,•.. N. ..................... ....... µ{ 4/8/2000. 4!8/20001 4/10/2001k '• 4/11/20017 y..........................a..........................y..........................y.................... 4/12/2000: 4/13/2006 ------------ 4/14/2000. 4/15/2000; ..................................................................................I,..................... ...., ..........,..,....... .............., .., ...:... ...a:,... ........ 4/16/2000; 4_/17/2000 .................—.,..- ----------------------- 4/18/200a �x 4/19/2000 ....... ...............>..........................g.......................... .......................... ........................., ..........................o........................,. .......................d 4/20/200(} 4/21/200d. , i i 4/22/2001.. o-..._...v...............N,.a..............................$......w......_.,..._..,H.a.-.._......,.,.......»---..o-......v...,........,.,.._;....,,.....,,,...,........n..o.........,.v............,.b...,....,............................ ................_,..•a.............M.........,.....e 4/23/200a .......................................................:...........................:...........................: ...................... 4/24!200(2 i ........ .....,,..,..,._.._.,,--------------- ..... ;....,._._._.......... .. � ......., � W..� 4/25/2000. Source : Contra Costa Emergency Medical Services Agency, 6/19/2000, Page 4 Hospital Alert Status census Alert rt2 Census 2 Alert 1 4^ Date F Doctors/SP� Dootors/P Katser/Rich N �CCRMC I� MtDiablo Y S DeltaMuir IiaisarfWC� X San Ramon 4/2f)/20010:,' ~w4 4/2 712 0 0 01 ...................................................................................:........................ ...... . i 4/28/20012. i 1 ••• 4!29/2000; _ r 4/30/20003 M .Y 5!1/2000' 3.......................... .....................................................-0•..........................• `.......,.,......,,..,... ..q.........................0.......................... ...........................?......,.................. .5/2/200_0 .. ..A.. ,. .. �. 5/3/2000: 5/4/2000': >.... µ. .. u. ... . .,., s.�. r a---.....------............a .._..... . a..,... w . ...., ... i 515/2000: # i :......... ...........................................:...............................°.................... ................ 5/_8_/_2_0_00 H ;......,,..6/7/20001 a.........................�.......,....,,,.......,_..3..,...,°,....,,,....,...,,..y........,...,.w.,.,,.,,..x...,,.,......,...._._..___}.....w,,.,._..a..,,.....a..,,..w.°..,,,..,.,..,....,.,,...,..,_....,,....._.,....',-..,,.....,..,..,,..._,,...i ------------------- 5/8/2000: 5/9/2000; i y..........................a..........................e..................,.......y...,..........,........... ..........................¢..........................a..........................o• 5/10/20001 511 1/20OU. 5/12/200 5/1312000: ,........_...............'s.....,..�.,..............o..�...,..............y....o,...•,.�,..,...,...,..,...., ...........................:........................... .................................................. ..................... :... 1 1... ............. 5114/2000; ...+ ...;.,. .. 5/18/2_0003 5117i2000' YxYY..,.............,;.............._�...... ..;....................... .,........,...,,.._.,... ............,... ..1 .�.,,.,..........;...............,��_- � �....�ym.....,,.....,,.. ,......... ..... .......y........................,.o-....,...................,.$..,....................... ......,..........,....b.......................... ........................,.$....................... 5/18/2001 5/19/2006, ° 5.......................... w 5/20/2000,' --------------- y,.., y.............. a . .... . a .......-------.• a. .. o .. .. i 5/21/2001k .y.d.................._,.._e�........,......,.,..,.......n..,...,,....................3-•,..,.._......,.......N..< ...............:........................... : ..................... 5/22/2040 .... ...................... 5/23/20001 r,.,.w..,,,.F.,.....,.,,-•.a,..,.............._.......y......................._.,.d,,,..,.........,..,.,..,.....�.....�......................• 5/24/2000 ,� 5/25/2000 w y5l28/2{?b ...*'....... o.................. �...... ................ o.... a ..... a ...........{ Ci 5/27/2000: .�.,..., .....,......�...,...w......,...� ,......,,._,.�..,.. ..,.,�,.,,...,, .�.,..W.,w,.,,. ...,.....,., ,........ > �5/28/200Cx ... - .. _ i { 5/29/200Cj .....,...".............................................1.............:...,.,,......1.,..,,........,.,........,:1....,................... 5/3or2ool ;... ...1..........................1........................ ........................;.........................., 5/31/2000' 6/1/2000j i 8!2120001 ...........I..............tr............... .....y... ...............b............,., a ........................a.......................... ............. a,....,.............. ........................ 8/3/2000 ' i.......................... ..6/4l2000__......................�y.�... .._,...w.......... ............. ........w...._. „.w...,.....,... ,.�......,..,...... ,.....w..w,�,.,.... 1. 6/5/200d. 81812 0 0 01 i . ... ..8/7/200Ck. .............................................."....1.......................... ..... d/E/20003 Source : Contra Costa Emergency Medical Services Agency, 6/19/2000, Page 5 Exhibit C e- CN Cf Q1 N tt3 J d 9 tG C3 9 CL G7 W �d V♦ 9 t� (3) CP d F O Z CA d LOC� Ul) C'V 04 Y- (sAea) s:pslVjo jegwnN Exhibit D Emergency Department Diversion 1995 1996 1997 1998 1989 2000 thio 6/18 Contra Costa Regional #of events 62 50 25 4 a Total time 155.2 hrs 115.5 hrs 41.3 hrs 17.1 hrs 2.5 hrs 0.0 hrs Avg tune/event 2.5 hrs 2.3 hrs 1.6 hrs 4.3 hrs 1.25 hrs 0.0 hrs Doctors" Pinole # of events 0 0 3 0 1 0 Total time 0 hrs 0 hrs 5.4 hrs 0 hrs 2.5 hrs 0.0 hrs Avg time/event 0 his 0 hrs 1.8 hrs 0 hrs 2.5 hrs 0.0 his Doctors San Pablo # of events 35 16 34 6 1 0 l time 49.8 hrs 24.7 hrs 77.8 hrs 6.2 hrs 2.5 hrs 0.0 hrs Total Avg l tivent 1.4 hrs 1.5 his 2.3 hrs 1.0 hrs 2.5 his t}0 hrs John Muir 0 0 1 0 0 2 #of events Total time 0 hrs 0 hrs 1.4 hrs 0 hrs 0.0 his 2.2 hrs 0 hrs 0 hrs 1.4 hrs a his 0.0 hrs 1.1 his Avg time/event Kaiser Martinez #of events 0 1 Total time 0 his 13 his N/A N/A N/A N/A Avg time/event 0 hrs 13 hrs Kaiser Richmond # of events 2 0 0 0 Total time 26.0 hrs 0 hrs N/A N/A 0.0 hrs 0.0 hrs Avg time/event 13.0 hrs 0 hrs 0.0 his 0.0 hrs Kaiser Walnut Crack # of events 0 0 3 0 0 0 Total time 0 hrs 0 hrs 12.8 hrs 0 hrs 0.0 hrs 0.0 hrs Avg time/event 0 hrs 0 hrs 4.3 hrs 0 hrs 0.0 hrs 0.0 hrs Mt Diablo #of events 20 19 9 1 0 0 Total time 34.6 his 46.2 hrs 14.0 hrs 1.7 hrs 0.0 hrs 0.0 hrs Avg tune/event 1.7 hrs 2.4 hrs 1.5 hes 1.7 hrs 0.0 hrs 0.0 his San Ramon Regional #of events 0 1 0 0 0 2 Total time 0 hrs 1.1 hrs 0 hrs 0 hrs 0.0 hrs 8.4 his Avg time/event 0 hrs 1.1 hrs 0 hrs 0 hrs 0.0 hrs 4.2 hrs Sutter Delta #of events 2 6 13 10 16 14 Total time 2.0 hrs 5.5 hrs 28.5 hrs 10.2 hrs 27.8 hrs 16.0 hrs Avg time/event 1.0 hrs 0.9 hrs 2.2 hrs 1.0 hrs hrs 1.1 hrs Source: Contra Costa Emergency Medicai Services, June 19, 2000.