Transcript 12 04 24 CAC Presentation on MFP Emerg

WUMC Master Facility Planning
Clinical Administrator Committee
April 24, 2012
Master Facility Plan Goals
1) Increase inpatient capacity to meet bed demand & volume growth goals
Expand med/surg acute care bed capacity
Expand critical care capacity to 15% - 20% of total bed base and increase flexibility for future
use of bed base
● Increase campus-wide private inpatient rooms from current 40% to 80%
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2) Develop programs and address facility issues
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Address current space constraints and grow BMT/Medical Oncology program
Expand SLCH Pediatrics program
Integrate and grow Mothers & Infants Program
Grow Med/Surg bed base by decompressing East & West Pavilions
Replace Queeny Tower
Replace BJH inpatient imaging platform and consolidate procedural areas to increase
operational efficiency
Provide faculty offices & academic space proximate to clinical programs to fullest extent
possible
3) Define an Affordable / Phased implementation Plan
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Project Scope – North & South Campus
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Planning Process
1) HOK was engaged in early 2011 to conduct a high-level study of future space needs
through CY2020 based on the BJH and SLCH Multi-Year Models
2) Project broken into 2 phases:
North Campus (Phase 1): Cancer & select surgical programs, SLCH expansion & M&I program
South Campus (Phase 2): Med/Surg, Behavioral Health & Inpatient Ancillaries
3) Workgroups were commissioned to validate future growth projections and conduct
“concept” level program planning for the Phase 1 components:
Logistics Workgroups:
Clinical Program Workgroups
Critical Care
Medical Oncology/BMT (Inpatient/Outpatient)
Surgery & Surgery Support Functions
Ancillary Services – Lab, Pharmacy, Radiology, Etc
Mothers & Infant
Pediatrics
Office & Administrative Spaces Workgroups:
Academic Office Space/Research
Administration/Finance
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Food Service
Logistics/Support/Materials
Built Environment Workgroups
Infrastructure
Parking
Wayfinding/Circulation
Sustainability
Summary of Phase 1 Deliverables
• An “open chair” will be created by demolishing the JH Kingshighway, Steinberg,
Yalem and College of Nursing buildings
• New north campus facilities will be constructed on this site, including:
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Expansion of SLCH
New Mothers and Infants facility
Expanded adult cancer and surgical inpatient services
Expansion of ambulatory care services and academic office space
New Parkview parking garage (900-1,000 cars)
• SLCH Expansion
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Increase inpatient bed base by 40 to 223 beds
Increase private inpatient rooms from current 51% to 94%
Expansion of diagnostic and treatment areas
Strategically positioned shell spaces for future growth beyond 2020
• Mothers & Infants Program
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OB services relocate from South Campus and integrate with SLCH (sized for up to 5,600 births)
New well baby nursery and special care nursery physically & operationally integrated with NICU
Dedicated entry and parking for M&I patients and visitors
Expanded OB/Gyn physician practice space and ambulatory diagnostic/treatment facilities
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Summary of Phase 1 Deliverables
• North Campus Adult Services
• Med/Surg acute care inpatient bed base increased from 175 to 318 (+143 beds) for:
• Expansion of Medical Oncology/BMT service
• Relocation and growth for select surgical services (benign gyn, gyn oncology, minimally
invasive surgery, urology and colorectal)
• Added OR (16 rooms) and Critical Care Capacity (28 beds)
• Shell space for future growth beyond 2020
• Faculty Academic Office Space (~98,000 dgsf)
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Medical Oncology/BMT
OB/Gyn
Other north campus surgical services
Pediatric clinical research space expansion
Details and specific
locations being finalized.
• Expansion of Ambulatory Care Space adjacent to CAM
• 57-70,000 dgsf for projected growth in WUSM ambulatory encounters thru 2020
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Phase 2 (South Campus) Deliverables
• Vacated OB/Gyn space in E/W Pavilion renovated to accommodate Queeny Tower
inpatient beds
• Queeny Tower demolished and replaced by new inpatient facility integrated with
the E/W Pavilion and Southwest Tower
• Increase in critical care beds
• Increase in number of private inpatient rooms
• New imaging platform
• New consolidated procedural area
• Reconfigured surgical support
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2020 Campus Renewal
Improved clarity, function and aesthetic qualities of the campus
by:
• Constructing 1.5m new sf and renovating 266k sf of existing space
• Demolishing 705,000 sf by removing JH Kingshighway, Steinberg, Yalem, JH College of
Nursing and Queeny Tower
• Creating 799 new, private inpatient rooms, while closing 600 obsolete beds, for a net
increase of 188 beds
• Total of 1,728 beds (848 north and 880 south)
• Increasing BJH campus-wide private room availability from 40% today to >80%
• Improving all aspects of patient/family/visitor arrival, departure & circulation
• Creating clear pedestrian paths connecting North-South and East-West
• Adding 2,400 parking spaces
• Consolidating and relocating all service traffic
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Request for Inspiration
As part of campus planning process, 3 teams of internationally recognized
architects and urban planners were invited in November to share their creative
thinking and visionary concepts:
• Pelli / Cannon / Civitas
• Skidmore, Owings & Merrill
• Stantec / Foster Sasaki
Common Themes:
• Opportunity for signature architecture along Kingshighway Boulevard
• Avoid significant building mass over KH entrance to Parkview Avenue
• Blur the campus edges, connecting to Forest Park, CWE, etc
• Importance of creating clear North-South and East-West campus connections
• Opportunity to enhance MetroLink Station as a point of arrival
• Green space opportunities (ex: greenway along Metro tracks, collection of small parks
throughout campus, green balconies and terraces)
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Current Status and Next Steps
February 2012 – Detailed briefings to BJC board and to WU Buildings and Grounds
and WUSM Medical School Finance Committee, including:
• Project scope, programmatic components and timeline
• Estimated capital budget
• $18.6 million approved for demolition and schematic design of Phase 1
Spring 2012
– Select executive architect, chief engineer and CM manager
Summer 2012 – Complete BJH/SLCH MYM and validate capital affordability
August 2012 – Re-engage clinical workgroups in design process for Phase 1
Fall 2012
– Present refined design concepts and validated capital request to
BJC Board to obtain funding for Phase 1 construction
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Mass Casualty Response Plan
Emergency Preparedness
Encompasses a variety of types of events:
1) Building-Specific Events on campus (ex: sustained power
outage, flood, or fire affecting one or more buildings)
2) Campus-wide Events (ex: shooter on campus, hostage
situation, mob formation, etc)
3) Community-Wide Mass Casualty Event requiring a major
emergency medical response (ex: tornado, earthquake,
terrorism, etc resulting in multiple casualties)
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Emergency Preparedness Requires Planning
1) Mass Casualty Medical Response Plan
2) Business Continuity Plans:
• Medical Research
• Medical Education
• Human Resources
• Information and Communication Systems
• Financial Management
3) Internal and Public Communication Plan
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Emergency Preparedness
Critical Success Factors
1) Emergency Preparedness Requires Close Coordination and
Partnership at Multiple Levels:
• WUSM and its Teaching Hospitals
• Community Emergency Response Providers and Other Area
Hospitals
• WUSM and Danforth Campuses
• WUSM Central Administrative Units and Departments
2) Communication & Ongoing Education of Key Stakeholders
3) Regular Drills
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WUSM-BJH Mass Casualty Response Plan
Approved by FPP CPC on April 14, 2009
Purpose
Disasters are unexpected, unforeseen occurrences, which may
cause an unusually large number of injured patients to arrive at
Washington University Medical Center for acute care over a
short period of time.
The WUSM-BJH Mass Casualty Plan has been developed to
respond to disasters, both internal (ex: fire in WUMC building)
and external (tornado, explosion, earthquake, terrorism, etc).
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Mass Casualty Response Plan
Levels of Implementation
The WUSM-BJH Mass Casualty Response Plan has 3 levels
of implementation based on the number of casualties and Red
Cross triage criteria for defining severity of injury:
• Red (critically ill)
• Yellow (moderate-to-severe injury)
• Green (mild-to-moderate injury)
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Mass Casualty Response Plan
Criteria for Defining Level of Disaster
Level 1
The ED is capable of handing the expected number and severity of casualties with minimal
assistance (ex: <5 triage “red” casualties)
Level 2
The ED needs some assistance to handle the unexpected casualties (ex: 5-9 triage “red”
casualties)
Level 3
Full implementation of Mass Casualty Response Plan is required to handle the expected casualties
(ex >10 triage “red” casualties or any combination of triage “red” and triage “yellow” casualties that
merit Level 3 designation)
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Mass Casualty Response Plan
Notification
If a Level 2 or Level 3 disaster is declared on the basis of the
above criteria, the following steps are taken:
1) BJH ED notifies BJH Nursing Administration (during day hours) or Nursing Supervisor
(during weekends) to activate the BJH Command and Communication Center
2) BJH Command/Communication Center notifies the WUSM Associate Vice Chancellor for
Clinical Affairs of Level 2 or Level 3 disasters:
 If the AVC for Clinical Affairs is not available, the Dean should be the first contact
 If neither the AVC for Clinical Affairs nor Dean are available, the chair of Anesthesiology will serve
as the first contact
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Mass Casualty Response Plan
Notification
WUSM Associate Vice Chancellor for Clinical Affairs:
1) Authorizes BJH Command Center to use the WU Everbridge Emergency Notification
System to redirect/recall required WUSM physician faculty to respond to disaster as
deemed necessary
2) Notifies the Dean, Associate Vice Chancellor for Administration & Finance and WUSM
Department Chairs that a Level 2 or Level 3 disaster has been declared and the need to
redirect/recall WUSM faculty to respond
3) Contacts the WUSM Incident Commander (John Ursch, Walt Davis or Steve Reynolds) to
activate the WUSM Command/Communication Center as needed
4) Assists the BJH Command Center, as requested, in calling up WUSM physician and other
provider resources to meet situational needs
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Mass Casualty Response Plan
Notification
Level 2 Disaster
• The BJH Command Center will use the Everbridge Emergency Notification System to contact WUSM
faculty physicians and providers by subspecialty need according to each clinical department’s physician call-up
algorithm
• Responding providers will be asked to call the BJH Command Center for further instructions including where to
report for duty
Level 3 Disaster
• The Everbridge Emergency Notification System will utilize pre-recorded messages to call up the required
physician resources
• Responding physicians can indicate their availability by pressing different phone keys (ex: “Press 1 if physician
can be present within 30 minutes, Press 2 if physician can be present within 60 minutes, Press 3 if physician is
out of town and not available, etc”)
• The Everbridge pre-recorded messages will advise responding providers to report to <cite location – ex: EP
auditorium> for further instructions
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Mass Casualty Response Plan
BJH House Staff
• The BJH Command Center will decide if it is necessary to redirect House Staff assignments
and/or call in additional House Staff
• All Chief Residents will be notified of the disaster by the BJH Command Center
• All House Staff will remain on the WUMC campus until departure is approved by their Chief
Resident
• House Staff assigned and working at the time of the disaster in the ED or ICU’s will remain in
those areas. House Staff assigned to other patient care areas will remain in those assigned
areas unless otherwise directed.
• The BJH Command Center will determine nursing unit assignments for patients requiring
admission
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Mass Casualty Response Plan
WUSM Clinical Faculty, Fellows & Support Staff
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WUSM clinical faculty, fellows and clinical support staff should remain at their jobs until
advised otherwise by the BJH or WUSM Command/Communication Centers
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Off-duty WUSM faculty and clinical support staff may be called in as needed
WUSM Students and Non-Clinical Employees
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To receive information about what to do in the event of a Level 2 or Level 3 disaster, WUSM
non-clinical employees and students (medical school students, graduate students, etc) may
call the BJC/WUSM Emergency Hotline at 362-5056 (and press zero)
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Mass Casualty Response Plan
Departmental Responsibilities
1) All Department faculty and staff should be familiar with the WUSM-BJH Mass Casualty
Response Plan:
• The plan is accessible on the FPP intranet site (http://FPP.wustl.edu) and on the WUSM
Emergency Information web (http://emergency.wustl.edu)
• A hard copy of the plan is maintained in the Department Chair’s office
2) Each department should develop “Emergency Response Manuals” similar to the
Department of Medicine’s Red Book / Contents should include:
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Accurate personnel roster with contact information and primary work site
Responsibilities, plans for faculty and staff
Communication plan for faculty and staff families
Checklists – “What to do if…”
Emergency kits
Food, accommodations, supplies for faculty and staff
Emergency power priorities
Designated Emergency Coordinators for each departmental physical location
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Mass Casualty Response Plan
Departmental Responsibilities
3)
The Department will maintain current contact information for all clinical faculty & staff in
HRMS including:
• Work, home and cellular phone numbers
• Pager phone numbers
• Email address
This information will be updated and verified at least annually in HRMS – contact
information for mass casualty responders will be automatically fed into the WU
Everbridge Emergency Notification System
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In the event of a Level 2 or Level 3 disaster, the Department Chair should direct their
clinical faculty, fellows, house staff and clinical support staff to remain at their jobs until
advised otherwise
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As appropriate, each Department can develop and submit a Provider Call-Up
Algorithm
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Mass Casualty Response Plan
Department of Otolaryngology
Physician Call-Up Algorithm
Tier 1:
Attending faculty and residents on-call that day
Tier 2:
Adult Subspecialty Otolaryngologists
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Head & Neck Surgeons
Facial Plastic & Reconstructive Surgeons
Oral & Maxillofacial Surgery
Tier 3: General Otolaryngologists/Otologists
• General Otolaryngologists
• Otologists
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Emergency Preparedness
Outstanding Issues/Challenges
1) Central administration Business Continuity Plans in need of regular updating
2) Development and regular updating of departmental Emergency Preparedness
Manuals
3) Regular updating and verification of faculty and staff contact information in HRMS
4) Need for regular drills and creation of a joint WUSM-BJH oversight body that
regularly meets to assess our state of readiness
5) Need to develop a coordinated WUSM-SLCH/BJH Mass Casualty Response Plan
6) Need for redundant telecommunication systems on and off-campus
7) Need to have plans for adequate inventories and timely access to:
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Medications
Lab and blood banking services
Patient transport
Food
Cash
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Emergency Preparedness
Next Steps
1) March 7 Executive Faculty presentation and discussion (done)
2) Conduct a “readiness assessment” to identify gaps in emergency
preparedness at all levels:
• Central Administration
• Departments
• WUSM-Teaching Hospital Coordination
3) Assign accountabilities for closing identified gaps
4) Implement processes for ensuring sustainability of our state of readiness
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Discussion
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END
APPENDIX