001Okay, we ready? Okay, it's five o'clock straight up. Gonna call the meeting to order. I have to acknowledge closed session, right? Oh, after public comment. Okay, do we have any comments from? The audience, do we have anybody online? Whitney? Okay, for any topics that are not on the agenda. All right, board chair comments. I'd just like to say that we are coming off a month of May that was a huge month for us to acknowledge healthcare, our nurses, the hospital, EMS. We started the month with the Women's Healthcare Symposium, which I thought was a really wonderful success. And I see Leslie in the room, and I think it was even more meaningful to me because I think this is the third, fourth year in a row that we've had that co-sponsorship with UCSF. And I
002thought it was a wonderful event for those of you who were able to attend. We followed that with a celebration of Nurses Week. and really acknowledge many of the nurses in the hospital. We honored them for their quality of care, their collaboration, and their presence. That was followed by hospital week. Some of us partaked in the barbecue, and that was good to be able to be with the staff of the hospital. And then I think the following week at the Tuesday Farmers Market we had a co-presence of the hospital with the EMS team. There was an ambulance out front and a fire truck out front and the kids got to climb. So it was a really nice month, acknowledging that we should do that all year round, right? So that's my opening comment. I'm going
003to move on to acknowledging two closed sessions that have occurred since the last board meeting. We had one on May 1st, and that was to discuss potential new services for the district. And we just came out of a closed session to discuss potential litigation. Move on to consent calendar. We have a number of items in the consent calendar board me minutes from the last meeting We had a joint board and Finance Committee meeting just this last week Quality committee minutes Finance Committee minutes affiliation oversight minutes that were from February policies and procedures and medical credentialing so any questions comments on the consent calendar items. Motion to approve? Motion to approve. Second. All in favor? Aye. Any opposed? Go now to, we have the privilege, I think this is Louise's first opportunity to present in this
004forum. She is going to give us the annual hospital quality report. So thank you, Louise, for being with us. Thank you for having me. Could somebody help her with the mic that's over her head? There you go. You've got to be right in front of you for everybody to hear. Thank you, Louise. Can you hear me now? Yes. All righty. Thank you for having me, and I look forward to sharing with you some of the things that I know that happened in 2024 because of the flood. Okay. So I just wanted to say thank you that I'm here to present. I'll give you some information I know from 2024 since I wasn't here. And so based on what I've gathered, I wanted to share some of the things that I know that happened in 2024
005and some of the exciting things that we're going to be doing in 2025. So just wanted to introduce you to the team and, like I said, go over the 2024 and some of the things that happened, such as age-friendly health system, the data from patient safety risk and management report, grievances and complaints, the correction action plans for policy procedures and observation for high-risk patients, and the Q review reports for 2024 and press scanning reports for 2024, and then the quality scorecard. This is the team. There's Cindy that's standing next to me. Cindy is a senior quality data analyst and regulatory reporting specialist. She's been with Sonoma Valley since 2003. She's in IT, very, very strong with data analytics, the backbone for us as far as an analyst, application analyst. And so she really, really supports
006the hospital. not just my team and my department, but the whole hospital for data collection and reporting. Of course, me, I... I came, started in, not going to age myself, but anyway, I started off as an ICU nurse in adult care. I did ICU for 15 years and then went to law school and started that trajectory and worked in law firms, basically as a nurse paralegal. for about five years and then found my way into risk management, quality management, worked at system levels, different types of facilities, and so found my way to Sonoma Valley. And then Stephanie Montesino, infection preventionist. She's also an employee health nurse. She's been with the company since 2020, and she's working towards her bachelor's degree in health science and will focus on acute care hospital leadership, and she's expected to...
007graduated in October. She's on the Dean's List. She's very integral with both her duties as an infection preventionist and also with employee health. Last but not least, we have Mario Marino. He's the manager of case management. He's been with Sonoma Valley since 2022, and he brings over 27 years of experience in healthcare and worked in six years in case management. He oversees a team of four, two case managers, one coordinator, and one social worker. That position is currently vacant. So just wanted to share with you some of the things that we do. By all means, this is not complete. It's a lot that the four of us try to manage and maintain. I'm not going to go through the list. You guys have had time to. digest it but yeah so and like I say
008we also support other departments as well as as well as regulatory requirements and also federal requirements is down and trying to make sure that we stay in compliance any questions on any of our roles and responsibilities oh 2022 2024 review So we kicked off, I think, in 2023, our age-friendly health systems. And for you guys to know what that is, it's just basically making sure that we are... working with the elderly population, 65 and up, and understanding what matters most to them and what medications they're receiving and their mentation and their mobility. And so we track that, and it's also a requirement of CMS. And so what matters most comes from basically auditing medical records. It's a manual process. Medication, mentation, and mobility is pooled electronically. from the epic. And so just to share with
009you some of the outcomes since we've implemented this process in 2023 and 2024, you saw that patients were going home and then skilled nursing facilities and SNF. And so now in 20, since 2025, since the program has existed, we've had more people going home than in SNF. That's what I was trying to say. And so in 2025, we're still ahead because we want people to go home instead of going into the SNF. And so we support those patients with their medications and their mobility. They're more likely to go home than they will with a SNF. Some of the action plans now that we have is we want to work more with the medical, surgical and IC units doing the CAM. The CAM is basically what the document that is used to determine some of these,
010determine where they fall. Um, as far as these medications mentality, I mean, um, mutation is concerned, mobility, um, more restraint education and make sure that if we are dealing with, if we are managing their dementia, they won't. need to be restrained. Also increase the nurse practitioner hours in the hospital. Right now she's kind of divided between the clinic and the hospital and so we're looking at opportunities to bring her back to the bedside to help promote this program. The other things that we're looking at is getting certification accreditation for geriatric emergency department certification. So when the patients do come to the emergency room, we have implemented the whole process, age-friendly process as well. And also we're working with the providers in the OR, the surgeons, to also get a verification level and all that's in
011progress at this point. Any questions on the internet? Okay. So for 2024, I just wanted to pull the top 10 reported MIDAS events. MIDAS is our event reporting system. And so as you can see, 45% of what was being reported and pulled out is medication. And then we have some behavior issues, and that can include both physician and nursing staff and also other staff members in the hospital. Falls on the 9% for 2024. have some iv related incidents documentation issues where we look at documentation and determine whether a person has documented appropriately and then follow up with that five percent diagnostic testing critical responses and looking at labs if a critical lab is called or where are we in our time frames and patient safety good catch we have some good catches good catches of
012when it doesn't reach the patient, we identify the issue prior to and it's shared. And so we can use that as a process improvement if needed. And then 3% injury. So on the next slide, it breaks down. I have a question on that side. Okay. So of the pie, how many risk management events were there? I'm sorry, what did you say? In terms of the risk management events, the number in total? Do you have that? I don't have the number. I just did the top 5%, I mean the top 10. It was relatively low. One of the things that I am going to work on is re-educating the staff on using the risk management system to report because based on what I'm seeing, the numbers are relatively low. And for a variety of reasons, a
013lot of people say it takes too long to put those things in. And so it's... It's re-education. It takes about three to four minutes average to complete a required field. And so it's just more communication, conversation with the staff to help them to understand how important this is. And so I've started that process in new employee orientation. And my plans are to do a refresher and have staff to start understanding how important this is to report, even if it doesn't reach the patient. Louise, the following question was, so every staff member has access to MIDUS, and is it anonymous? It can be. It can be. It can be. And we do have people who are for it anonymously. And so for segue in from the previous slide, just wanted to share with you, based on
014those 10... top 10 to break down the event harm levels. And so if you do the math, it's about less than 50% that actually don't get, how am I putting this? Okay, 42% has no harm. And so the minor and... Minor and moderate temporary harm is about 25%. So if you look at it, it's really, we're not really, based on what's being reported, some of these issues are not really harming the patient. They are just being reported as possible issues and things that we need to look at and other processes that need to be addressed through pharmacy or nursing. grievances and complaints. The ER has the most complaints, but that's what we talked about earlier. That's usually the par for the course because people don't want to go to the ER. They don't want to
015sit and wait for a physician. And so those are basically some of the complaints that you see. So I wanted to break it down to three ED complaints with no standing, three ED complaints related to billing due to qualitative care, and then there was 12 ED complaints related to qualitative care. And some of these are not, you go in and you look at them and they are not, they don't meet the standard of a quality of care issue even though they were listed as a quality of care. This is the corrective action plan for policies and procedures. We should be targeted at 90%. We've been at about 70%, less than 80%. We need to have six months of continuous compliance. And so the action plan is for me to start assigning these policies and procedures
016to some of those leaders. who need to get those policies pushed out so we've started that process and so more policies and procedures you'll start seeing more coming to the board to get approved within the next six months oh okay And this is the high-risk self-harm patients, another corrective action plan that came from the CIHQ survey back in 2023. And they'll be back in 2026, by the way. And so we are working, trying to... make sure that we are continuously observing those high-risk patients one-to-one, making sure the physician are writing the orders for the one-to-one. And so it's an ongoing process for patients who come into our ED. This is our press gaining. I thought this would be interesting to look at. And so based on 2024, they don't really like our rooms. Not sure
017why. and they're really not happy with the meals and so but this was 2024 so I'm I'll be excited to see what happens in 2025 they nursing and physician 82% 80% favorable with nursing says 67% favorable physicians. Personal issues, when I looked at it, 75%, it was kind of all over the place. It wasn't really anything that you could track and trend. Some of it was like the care was excellent or I don't have anything to say. I don't know why they even have this as a bucket. They may have changed. I know they made some changes to press gainy questions for 2025, and so maybe we won't see this as an option for personal issues. Is this the online survey that you get once you leave the inpatient, or is it the text message
018survey? No, that's not the text message. This is the one that you get. Typically, they send it through mail. Through the mail. Yeah. A lot of people don't have email. Next. This is the one that you were asking about. So I thought it would be interesting to see the breakdown of the gender and also the age. Overall, for 2024, we were at 4.84, and that's all of inpatient, imaging, outpatient, emergency room. Outpatient surgery was 4.89 overall and imaging 4.9. Inpatient 4.8 and emergency department is 4.71. As you see, most of the females, most people who respond to the Q reviews are females. And also, most people who respond are 70 years of age, which is really our population. And so that's the age breakdown for that. And then, what is that, 80? Most of the
019people who do respond are on Medicare. I thought that was interesting to see. For 2024 and the first quarter of 2025, the quality scorecard. And so I wanted to be able to show you for 2024 what the targets were for 2025 so you can see where we are in comparison for 2024 and 2025. Most of the measures we are on target for and pretty much the same as 2024 there are some differences we're working on maintaining our hand hygiene we did have a blip in march but i can't tell you for even for may we're back up to 92 90 96 on the hand hygiene we look at about 50 people employees a month to see so we can make sure we get a good average and a good trend For mortality, so for 2025
020first quarter septic shock mortality we were at 28.6%. And some of these, the population, I mean the denominator is low. So if you have about two or three that hits, then you're going to have, it looks like we're not doing well, but we actually are. And so I take a look at all those cases to see whether there are some opportunities and share it with the providers. And then that one, 43% was for January, and I think it was maybe two patients out of five or six or something like that. So it was pretty high. Next. PSI 90, that's where we look to see whether or not there are certain harms that happened that falls into this category. And so we look at those and see whether they're coded to see, and it could be
021a fall, it could be a surgery injury. One of these was just a patient who pulled out his Foley. And so that got coded as a PSI 90 because he, yeah. And for no falls, we're doing great on falls. Per 1,000 days, our 2.808 for this first quarter is pretty good. We're below the baseline for that. And then med errors, we're doing great on the med errors. Lab transfusion effectiveness at 100% and no transfusion reactions reported. Blood culture contamination rate, we talked about this a little bit in the Quality Board meeting last week, various. reasons of why that you have a contamination rate. It could be a lot of them happen in the ED, you're moving fast, trying to get those blood cultures in done and so and not proper cleaning of the skin and
022so one of the things that Jessica talked about was having re-education and talking to the staff to make sure they're slowing down and that they're actually cleaning the skin properly. Doing great on our stroke measures. Not much I can say about that. I have a quick question on stroke. Is this green, is it largely attributed to our relationship with UCSF? No, this is basically all time frames and making sure that we follow in the process We're looking at some of that there's some Differences and metrics for get with the guidelines and so we've talked about trying to report some of those things out But we're actually you know, we don't really really easy is doing really great with those stroke measures and making sure that we're Seeing those patients in time and getting them out
023and diagnosing Average length of stay, we are working towards our average length of stay. I'm going to start drilling down to physician levels to see whether or not there's physician involvement, that patients, we can get them out earlier, and just looking at the data to see where the opportunities lie with that. And I know sometimes it's hard for us to get patients out because of the social issues, which tends to lead itself into this a little bit. And so we are working on trying to improve our lethacy. And so more to come on that. We're doing really good on our co-op measures and the median time for ED arrival time was in January, it was 1.54, but as you see, 154 minutes and so you can see now we've dropped that time drastically. So early
024management bundles, severe sepsis and septic shock, and three-hour bundles, those are some of the things that we are working on. We are starting to meet and have a sepsis committee to address some sepsis issues. For the most part, based on what I reviewed, we're pretty good in sepsis. There are some times when we miss a bundle or the patient is diagnosed late, and so we miss our window. So they may come in the ED and they don't show signs of any of the criteria for sepsis, and then it shows up later on, and then we're already behind the eight ball because everything is time imposed. Thanks. Okay, so what's next up for 2025? These are some of the things that we're working on. So what's required with CMS is health care equity. And so we
025do have some leaders that are participating in a racial health equity action academy to mitigate any found disparities in our patient population and community. And so this is, like I said, a requirement for CMS. And so we look at our social determinants of health and monitor those. so we can make sure we're in compliance with that. Talked about reducing average mental state. One of the things that I think is very, very beneficial is that we have a team of staff that daily attend multidisciplinary rounds. And we have discussions about the patient and see what is needed so that we can address those as soon as possible. CMS teams transforming episode accountability models systemically. This is just starting. It's a bundle payments based on care episodes, based on hospital admissions or surgery. And so what they're
026trying to do is make sure that we are getting... best bang for our buck and so of course it's going to be based on a certain percentage and so this is really really new and so we are going to be meeting about this probably the next month or two and try to make sure that we are in compliance we have to determine what how do we how do we participate and and move forward with that one improve CMS star rating we have to do that and we are going to do that by making sure we're meeting our core measures looking at how they are grading us and also again make sure that we are in compliance and looking at those core measures again okay Other, talked about our age-friendly health systems, and we are still
027trying to bolster that up, and so we'll continue with that. Survey readiness, we're doing monthly departmental rounds. We started in May where we're going to each department like we are joint commission and looking under the covers and making sure that what we are doing. see if there are areas that we could get a deficiency and reporting it to leaders and going back to those areas to see whether those things that we've identified have been repaired. And so we've got some really good feedback. And so it's, I'm excited about it. Like you said, we are in the window for GAC and also the CIHQ survey is next year. Re-admission reduction project for CHF and COPD, we got that off the ground Monday. And basically what we're looking at are those particular diagnosed patients, bringing in a
028team of nutritionists, make sure nutritionists are speaking with that patient, that they start getting educated right out the door, giving them an action plan. right out the door when they first arrive. Also bringing in pharmacy to make sure that the pharmacy having conversation about their medication and so they can understand the medication and how important it is and to make sure they have medication on discharge. skilled nursing facility nursing collaboration we started that in March it was March March April April and so we've been meeting with we've met with Sonoma post-acute Valley of the Moon and also we've met with Broadway Villa with some of their administrators and trying to create a collaboration with them so that we can have an ongoing conversation and feel comfortable in communicating with them about some of the concerns
029and issues that we may have and vice versa. Promoting interoperability program measures in EHR is a required CMS measure. They are basically pulling data from EPIC and measuring us. And so we are looking at that data that they are pulling to make sure that we are in compliance with what the standards are and the guidelines. I talked a little bit about the sepsis program, the pre-op rehabilitation project that goes into the, okay, that is also, it's going to help with the age-friendly health system. It is us making sure that the patient is, when they come in for surgery, that we understand what their needs are prior to being discharged, basically. The Med to Bed program, we started, kicked that off, and actually we had a patient this week that benefited from the Med to Bed
030program. And this is basically, we partnered with Adobe Pharmacy. So if we identify a patient who has transportation issues or any kind of financial issues or just need that extra support. for medications, they will bring the medication to the bedside. And we did have a patient a couple days ago in which they brought the patient medication to the bedside, and we were able to get that person discharged same day, which was one of the processes of that to make sure that it can reduce lithus stay as well so we're not holding on to that patient. So it worked out well. We also relaunched the Infection Prevention Committee and combined it with the Anti-Microbial Stewardship Committee, talked about the partnership with Adobe, and then we have a charity medication program. Also with Adobe, just in case
031a patient, we need to get that patient discharged, but they don't have medication. And all of this is to reduce... return and readmission to make sure they have the proper medication. And so it's seven days to get them jump started so that they will be able to get their medication on time, take their medication on time. Any questions? Louise, I just want to thank you and your team for all the catch-up you've had to do for one thing since we were without a quality director for so long, and then compliment you on these initiatives that you've instigated and got going and getting going on. So I appreciate all of your work. Thank you so much. All right, see you next year. Louise, as you run out the door, she's got a flight to check. I
032just want to ditto what Dan said. You've gotten your arms around this program really quickly, and I appreciate it. Thank you. Travel safe. Our next presenter is Dr. Walther. She's going to be doing our Chief of Staff Boer Report. Welcome. Hi. And thanks for being here. Whitney, are we having audio problems? So just really speak into the mic if you could. Raise it up. Is that, it's working though? Oh, with Zoom, okay. All right. Okay. Thank you for being. Okay. Yeah. Anyway, good evening. Good to see you all. Great. Okay, so I think it's been for a while since last time I report. It was summertime. So my report term is the August 2024 to March this year. So let's begin. So the subject is as usual just the current medical staff followed by medical
033staff quality and then also medical staff summary. So let's start with the medical, current medical staff. By numbers we have total medical staff 138 people and an active medical staff of 29. And then we welcome the new medical staff of 10 medical staff since September 2024. As you can see in the slide, the designations is a nine and they are all voluntary and no problem here. I had a question. What is the definition of active? How do you define active? Activists are actively working in the Sonoma Valley Hospital like me or emergency physicians, cardiologists and radiologists and actively working in there. So the other 100 then are? Just either some like the ornery medical staff who are just the medical staff but they are not coming here or the telemedicine or those kind of people
034including as well. So I'm going to go through the quality part that Louise mentioned about the Q review. And then I just focus on the medical staff because I'm the chief of staff. And then there are six questions including for Q review as you probably already knew. This is a courtesy of the doctor and then also waiting time in the ED. and then if the health staff explained to you and then overall experience and would you recommend us to the friends and loved ones and then time to spend, for the doctor time to spend for the patient. And then they send out those kind of Q-review to the emergency department patient after discharge as well as inpatient services. And then here's the emergency department care feedback. The one top with the little circle, those are
035overall score. That is including six questions there, not the medical stuff specific. But as Luis already showed you, and they're performing pretty well overall. The Q4 to Q1, usually the ER inpatient service, the very busy service for the flu and so on. But the score overall pretty well, around 4.6, 4.8. Down there with the how would you rate the courtesy of your doctor, this is more doctor specific questions. And then we send out those review to approximately average of the 600 each month. And then response rate about 20% on average. And then you can see that those rates for the physician courtesy. It's like December, although they're so busy, like a bit, they marked the 4.9. That is, I think, just outstanding. And then also you can see the bottom of the graph that most
036of the patients are rating for five stars. They're a little bit outliers in the three stars and the four stars. That's bringing down to the average, but the most are rating as the five stars for the doctors. That is great. And this is inpatient feedback as well. The inpatient, including the hospitalist team, which probably including about 85% of the inpatient service we see, and otherwise local primary care physician, Dr. Budichi and Dr. Campbell still admit the patient, their own patient to the inpatient service. And then also general surgery and orthopedics inpatient, bariatric surgery also within in this bucket. This is November to March. Again, we marked a pretty high score, consistently about a 4.8 and the margin 4.6, but still pretty good. And then at the bottom, same as the ER, how would you rate
037the courtesy of your doctor? And then, as you can see, the November and the January, we earned five stars. Yay! Even like, you know, the numbers 10 to 12, the 14, about, you know, five stars is great. By the way, thank you. And the nature of the inpatient is smaller number than ER. So usually the sense survey around 75-ish monthly respond rate is 15%. And then we are doing pretty good job on that. And then those are just the text review. Yes. Walter, if I look at the numbers, generally speaking, they look great. You know, if there was no explanation. But if I look at the trend, we reached a peak of 4.88 in December and we're down to 4.6 in March. Furthermore, our responses are going up. So I'm wondering, not that there's a
038large problem, but is there a minor problem that you could put your finger on as to why you think our ratings are going down? Yeah, again, like, you know, this inpatient feedback, for instance, I see that the whole Q-review data is for the years and monthly, very detailed, and each even provider, individual. And then the trend itself is not just that this particular month something going wrong, just that you can see, let's say, for the March and the physician part, that became 4.8, and you see the one little three star. That's bringing down, and I can nail it who they did the one stop to who. So we have some sort of system we can nailing down who's individual, and then we can see the case in something that we really need to concern to
039address in the peer review, which wasn't the case. Yeah. So, this kind of fluctuate, but the number is small, so sort of like seems like a very drop, but actually the overall trends are steady. And then I can see next slide for the more like a CAHPS review for Pris Garni. We can see more of the long-term data. So this is more official. The Q-review was designed because, you know, the Prisgarni, this data usually come around six months or three months later coming to the mail. But this Q-review is kind of adjusting the equation with Prisgarni so we can kind of see and feel what the patient's temperatures are before the survey would be sent. We could not do anything about it, but at least the Q-review can tell us, you know, what they're feeling
040immediately. These are more nationwide, just the open data for the prescribing. And this is ambulatory surgery overall. This is like a Q3 2022 to 2025, since I became chief of staff, we kinda got the pretty good data here. And then so blue line, it's indicating for the facility overall rating of the caps. And then burgundy in color is the the physician and outpatient service surgery, the physician's rating. So that you can see that the Q3 to Q1 2025, it's just that I would say the cali- I did not put in this one in the graph but the California average in Q3 2024 is 81. and then ours is 86.7 even. Same as Q4, that we rated even exceeding 90. That is phenomenal. California states, this press colony, nationwide data is average 81. So we are
041above 10 point. And then also Q1 2025, it's like we did 87, and whereas the California states, 84. And then that's kind of, this is a kind of trend that we are above the California states and the other states, which we have been doing a great job. And then so I'm very proud of the surgery team, especially the Q4 above 90 is the pretty amazing data. And then this is next slide. Next one is inpatient HCAP, the same thing, Prescarney, we send. The same thing, facility rating is the blue line, and then burgundy color is the doctor-specific domain. And then the Q3, 85.5, and then Q4, 83, and then Q1 is 86. It is again, California average has been around 78 to 80, never exceeding 80. We consistently above 80. And so this is also
042very good. And we usually going above California state's average. And then so for instance, the sci-fi eye, the Q3 2024, California average is 79. We are 85. Q4, California 80. We are 85. Q1, California 78, we are 86. So we are pretty in a great spot here. Oh, by the way, and then this is a monthly HCAP. This is a quarterly, but also we received a monthly HCAP. And then in March this year, physician domain, we achieved 100 points for the physician courtesy number of the 13. I never seen 100 since I started working in Somerville Hospital. So I think that's the great teamwork, I would say. So those are quality and then I'm going to go to the medical staff meeting update. So a little bit of a germy slide. So census has been
043increased in both ER and inpatient approximately 10 to 15% since last year. And the trends continue. So from the emergency department, they're holding steady with incredible numbers despite of ongoing challenge with transfer times and holding inpatient admissions. And then average wait time is less than 10 minutes. I don't know where we're going to go in the ER and we just wait less than 10 minutes. I think that's impossible. I'm so great in the ER team. That's a great job. And then also their leave without being seen remains at 1%. That is a great number. And then also inpatient service, it's been a busy winter and spring for us as well. And the start of ICU construction during this season added an extra layer of the challenge, but still we navigated successfully, maintained a low readmission
044rate, and then also an excellent patient satisfaction score that I shared in the previous slide. And the primary care part, you know, from the outpatient service in the community to the ER and inpatient settings, the flow is so smooth. And then I'm contacting the primary care doctors in each office individually. They don't have any big complaint on the issue. They are very happy about our current workflow. Some specialties we have including for the internal medicine part, we have a telerneurology from UCSF, infectious disease cardiology service from Marine General Hospital, and also telepsych from different company. And then I meet regularly with the infectious disease cardiology service and then periodically I contact with the tereorology director to make sure we are working okay in any issue. So far we don't have any issue that they're all
045working as a team and then we are pretty happy to have those strong subspecialty team in our service. And then move to the surgery committees. So all the committees, Dr. Walter joined the orthopedic service, which has been running smoothly. And the general surgery team has secured some coverage following Dr. Sabrina Kitt's departure. Dr. Alexandra is working so hard on this. And then we continue to operate smoothly. And then our anesthesia, Dr. Andrew Solomon, the director of the anesthesia, our anesthesia team come from Marine General Hospital. We got a great comment from Andrew that, you know, the anesthesiology service from Marine really love to come here to work because the team are great. And then also especially the nursing director of the operation is phenomenal. So even though they have a commute and the... traffic in
04637, sometimes crazy, but they still would love to walk in here. So that's great to hear that from the director, Dr. Solomon. And radiology service run by Dr. Adam Nevitt, he's also saying that the service runs smooth and then going well, no issue here. So moving to the MEC, we got quite changed a little bit, but MEC General Session, Ben kindly joined for the finance report quarterly, and now he's the interim CEO. Thank you very much. And then also the... Dr. Cusick served as the interim CMO and Dr. Louise Wyatt joined the director of quality. So those kind of bringing fresh perspective and I cannot wait to see the new CMO, Dr. Golo. And about MEC executive session, we became notably more efficient and collaborative, driven by open trust-based discussions. This improvement is largely attributed
047to the success launch of the medical staff leaders dinner, which has forced us stronger relations and mutual respect. So, and then performance improvement pharmacy therapeutics. The performance improvement part, Luis already talked in details. Pharmacy part, he, Dr. Chris Kazza, just does a lot of protocols and revising, revamping, and he does great job. The last one, as Luis mentioned about the MEDS 2BETS program, we just launched the... And then I'm going to say a little bit more details, basically, this service in which patient identifies as meeting criteria. For now, this is a pilot program, so we are focusing on the patient who has congestive heart failure, also COPD, and then also kind of complicated social background. Those people are now targeting to offer the service. And then upon their discharge, we will... prescribed, we mean the
048doctor prescribed the discharge to the Adobe. And then Adobe side is going to deliver those medication to the pharmacist in the inpatient service. And the pharmacist is going to deliver those medication at the bedside and then giving the education those medication they are receiving at the bedside. And then that purpose is that, you know, some people discharge sometimes and then people elderly, they don't have any. transportation, they could not refill the medications or could not get it, pharmacies closed, whatever it is, and that would put them in danger of readmissions. And then also not good for the patient's health. And then also it's not great for the patient's satisfaction. And then a few days ago, we did use this service and I discharged the patient and then we got the medication from Adobe. their list
049is probably 20 medications and super complicated social background patients and then we did all good through from the physician to prescribe to Adobe to deliver to the pharmacy to bring to the bedside and then case manager making sure everything goes well and then we did success. So hopefully this pilot program work well so that we can give more service to the broader populations in Sonoma community. So here's the concerns and the update. So challenge continue with significant difficult. these remaining in transferring patient to UCSF. We discussed about this before. We have made no real progress with the transfer to UCSF. Unfortunately, they continue to take an unreasonable amount of time, which patient often boarding an ER for a day or two. Inpatient service, no exception. which is obviously terrible for the patients and inpatient service
050also physician nurses everyone elevating our anxiety hopefully the new CEO new CMO really have to some talk with the UCSF because the meaning of UCSF affiliation with medical staff services, not just only C-Suite. I really wanted to discuss with this issue that when new administration team comes in. Go ahead. Like this happens. Is there a counterpart at UCSF that you can have a dialogue with as to why? Yeah, why mainly no beds. Okay. It's they are not selectively delaying our process. I do not think so, of course, because we are affiliated. But I think that we will many times be told, you have 20 beds ahead of you. And then, but I don't know real details. You know, I don't compare to the other USS affiliates in the Washington Hospital or, you know, Marine General.
051But we certainly have delay here. So that. for a non-medical. That seems to be reasonable if they don't have a bed to accept our patient. We can't really accuse them of any... Yeah, however... Or bad faith. However, this is affiliation that we really wanted the affiliation real meaning. It's that we could take it to prioritize. There are so many hospitals in the Bay Area. Yeah. And then they affiliated probably seven or eight from South Bay to North Bay to East Bay. Right. John Muir and the Washington Hospital, Marine General Hospital and others also there. But is that something they do differently between affiliated USACEF and non-affiliated? Have you asked that question? No, and then I think that's going to be more like a CEO or C-suite. People need to talk with administration. I think this
052is beyond my expertise, I think. Yeah. Follow-up question. So there is a documented workflow to do the transfer. Workflow? There is a document? Yeah, absolutely. Absolutely. We have the workflow. Mainly we do contact with the UCSF transfer center to start. And then I think ER is more having difficulty in patient's life. It's difficult, but it's number-wise ER experiencing more than inpatient does. Yeah. For the nature of the case, the number. I remember it's been a while now. There was an effort. by UCSF to put in a bed management system across all their affiliates because they don't have, I call it, you know, control tower for all bed availability. And so you end up calling every facility. But there was supposed to be an effort for bed management across. It just seems that you can't do
053anything if there are no beds. I mean, that is a supply and demand problem. Yeah, but also they might have secured the bets for something real. For others. Like a patient really bleeding from the brain, they will accept the patient much faster. But the patient is not bleeding, but they're really critical. Deptic shock with full pressers with urgent hemodialysis or whatever. Right. Sitting there, right? It's so like for us and everyone, emergent, urgent. But like probably and then also not one department You know controlling the beds. I think UCS is so huge So like there are a lot of team and then level layer with the levels of the people Managing the beds. So it depends how they you know triage the patients that I don't know so yeah And I think the question maybe
054isn't the physical access to a bed but to have a resident cover the patient transfer. So, you know, the doctors, many of the doctors use resident coverage, so you have covered service. So if the covered service, the residents have been working a long time and they can't, they're not able to take another patient, it gets delayed even though there's an empty room. So it's a balance between, you know, how they're managing their coverage of the beds, physician coverage, residents and fellows. versus how they have a vacant room. And I guess we have a new issue, especially as residents. They're allowed to work a certain number of hours, and if that hour ends, so is there a commitment to care? Well, I mean, I think that's UCSF's problem. Yeah. You know, they've got to figure out
055how to do that because their medical staff, you know, the faculty doesn't necessarily want to be taking patients late afternoon or late night. That's what a resident, that's resident training. Right. Exactly. Yeah, I'm sure the multi-factorial in June and July. That's our favorite time, the new resident interns coming. Anyway, but on the other hand, I have a bright side of the report here next. So we started meeting the Marine General Hospital and the Selma Valley Hospital meetings. Marine General, including CMO and CNO and the hospital's directors, and then Selma Valley Hospital, including Dr. Cusick and myself. And then also we recently invited Dr. Renaud, the cardiology working both on the liaison, both the cardiology service. And then it has been great, actually, that since we are discussing our relationship and then our challenges, and the
056CMO and the CNO and the Marine General Hospital really understanding our challenges and then... they really opened their door open so that they can accept the patient as much as possible. And then also they recently created for the patient with the GI bleed, how we can just go through the pathway to get to the Marine General Hospital bed, which is very thorough and helpful. Myself, I was on the service and then a couple weeks ago I need to transfer the patient to the Marine General Hospital. Three cases which they immediately accept and then also the patient's transferred to the Marine General. It's not just only to do with these meetings. Probably they need to have the bed available, they need to have transportation available, so everything's went well. But I think that before like... Cardiology
057case relatively easier, but the non-cardiac, it's got a lot of pushback we had. I don't see any pushback anymore. And then also, recently, the wellness team in the Marine Health hosting the happy hour for the Sonoma Med staff people. I could not make it, but some people, Med staff in Sonoma. joined and they really enjoyed that. I really like to see that the support from the marine health as well. And next one that's ongoing delays in providing inpatient microbiology results on the weekends. So what does it mean is the We don't have the enough microbiologist in our lab in the Summabadi Hospital. So what happened is on the weekends when we send the culture, blood culture, urine culture, usually that every single day we're going to get update of what kind of bug we have,
058a preliminary report. Urine culture usually three days, blood culture usually five days, and then other culture usually three to five days. However, we don't have enough stuff there for weekend comes that there's no update in EPIC. So what happened is that the patient come in with the urinary tract infection with the sepsis on the Friday, fairly getting better on Sunday, or Thursday afternoon come in the sepsis and fairly getting better on Saturday. And then we wanted to identify the bacteria so that we can change the oral to discharge the patient. The patient want to go home as well. We don't have any result available depending until Monday. And then so this is not great for the length of stay for the inpatient services. Patient get upset about that, of course, or patient, you know, just
059needed to stay longer in the weekend. And then also it's not safe if sometimes we need to discharge the patient blindly because patient anxious to go. In that case, we're going to sort of like get the best guess to give the medication for the oral antibiotics. Sometimes that guess was not right and then patient come back in ER. We have a few cases for that. So regardless, that microbiologist coverage consistently needed in weekend. I know that Dan working very hard on this and really appreciate Harry Ford's and we continue to work on this, but I wanted you guys aware of that this is one of the concern we have. The other concern is another huge one, but this is an ongoing issue, enhancing PCP primary care physician access to the inpatient data, bridging gaps between
060EPIC and their electric health record system. Now it's got much better. Our local Sonoma PCP all has access to the EPIC. By logging in, they have the password, so they can. Some provider is using different EHR, which is a totally different infrastructure. with a data set from the EPIC. So it's so hard to transfer to the other EPIC data to straight to the other different EHR system, which is kind of understandably challenging. But our IT team are consistently working with the PCP who has this issue to mitigate their stress. And lastly, I have the 2025 to 2027 Medical Supply Leadership nominations. I think I sent email each of you today. If you haven't or question, just let me know. We started on the vice chief election yesterday, and we will close the vote June 20th.
061And we will follow up on the results, and hopefully we can start the new phases. leaders in July. So having said that, next slide is my last slide. So when I started Chief of Staff two years ago, I set three goals I want to accomplish here. And the first one, a foster trust and a unity among medical staff leadership to forge the strong cohesive team. Before I became chief of staff, I felt like we have meeting with MEC. We meet all the directors and head of the team and discuss about a lot of challenging issues. And after MEC done, we cannot go each department, even we don't talk. We don't have any collateral communication, kind of typical doctor stuff. And I really dislike this because when you, if you don't know each other, then when
062we communicate in a meeting, it could create a misunderstanding, fear to speaking up, and lack of transparency. So bottom line, we really need to trust each other. Otherwise, we cannot make any efficient meeting. For this purpose, I started with the quarterly dinner meeting outside. That's been so successful. Now I believe that MEC meeting was so great, especially the executive session. Everyone took whatever they wanted to talk, transparent, even challenging time, like we're exchanging our opinion without fear because we knew each other. And so that is great. Last one actually was a few days ago. They really love it, asking me that they want to continue with these new traditions, which I think that now I became the post-immediate chief of staff. So I think probably I can do that if Dr. Amara wants to do
063that. And so hopefully we can continue this tradition. Second one is to build a strong relationship with the new ER group. It's no longer new. The NAPA group has been just as great a performance. And then Dr. Cusick and I just promptly meeting each other. If any issue from ER, any issue for the inpatient service, we every time call, see each other, talk about it, and communicate immediately. And for that, you know, I don't hear much of the complaint from my inpatient service side as director of the inpatient service. Also, Dr. Cusick didn't hear much of the issue from the ER service about the inpatient services. And if you have any, we will discuss. And now he's interim CMO, the chair of the staff. So we discuss pretty frequently about all operational issues as well.
064So it's been great. Last one. strengthen connection with the local PCPs for smoother patient care transitions. I really do believe that the patient in the community to PCP, to emergency department, to inpatient service, to discharge, to back to community, to PCP, that's so important. And then I think we are doing well. We visited each PCP office with Q-Second and I, and then later I periodically communicated with the local PCPs and to see if any... questions or any issues. My impressions, they have great impression to the new ER group and then our communication between the patient information between ER to PCP has been the issue before but now got much better. They can get information from the emergency department by logging in the EPICS system. In addition to that, I started on to involving the local
065skills nursing facility, which Luis mentioned about, starting the monthly meeting with the Summer Post-Acute Valley of the Moon Broadway Villa. Because we have a lot of patients from the emergency department and they're causing the readmission. Also, just revisit ER for... not really needed to come. This is absolutely not great for the patients and also our hospital and the Secure Science Facility. And so now we are talking about what the operation, our operation, the meeting including the doctor, physician in the Secure Science Facility and the DON, and then also executive team and the other stakeholders. and our team also like myself and then also case manager head and then also Luis as well as head of the inpatient service nurse, head of the emergency department nurse nursing. So like we have so many things we discover
066how much they can do, how much we can do. It's been very productive. And then if any cases we have concern, we will present the case to making sure. Sort of like a case review between SNF and then... our services so that we would not gonna make a mistake again to make an improvement. So it's been very exciting and even after I finish this my term and I will continue to participate this monthly meeting to continue to improve our service. And that's what I got today and then thank you so much. This is my last report as a chief of staff and thank you so much. I'm so honored to serve this community. That's all. Any questions? Questions? No, no questions, but tremendous thank you for all your work the last couple of years. You've
067done a great job, really, with the relationship building between the hospital and the medical staff. I applaud you for that. Thank you so much. Thank you. Thank you. Okay, next we have Ben and Ben. So we have the 2026 budget update and then financials. Yes. So thank you, Wendy. We had the opportunity to go over next fiscal year's budget last week in quite a bit of detail. So I will, in lieu of kind of walking through that again, I guess I would take the opportunity to see if you all had any further questions post our meeting before hopefully taking action. Ben, just one comment on your disclaimer at the beginning. It says potential impacts of administrative policy. It sounds almost like it's the administration of the hospital, but it's the bigger administration. Yeah, definitely not.
068So that is certainly at the federal level. We don't need him to go through this, right? Assuming we have the joint meeting. No, we had the joint meeting the Finance Committee reviewed it following the joint meeting, you know, there's some additional information here Very well done schedules, you know kind of bridge schedules on Changes in revenue and expense, but it all is the same just more than what we had seen previously and So in absence of no questions, is there a motion to approve? I would move we adopt the budget. Dennis, all in favor? Aye. Any opposed? All right. Thank you. Thank you. It was a great package. Thank you. Thank you. And I do, you know, certainly want to... highlight all of our leaders behind me. You know, this is a joint effort with
069the budget. You know, we kind of pull everything together, roll it up, and, you know, make adjustments, and it really is a team effort, you know, combining finance and talking through it. It really is actually a... Tends to kind of come about when I feel like sometimes we're most busy But I really do enjoy the process because it is an opportunity for us to really learn And you know allows us to kind of solve problems together and this group behind me just does such a great job And I felt that way ever since I came here, so I just I want to highlight and call out the great work from you all as well as to Lois, our accounting manager, who had to really step in. This is her second budget year, and she really
070took the lead on it. So just want to make sure that we acknowledge her efforts as well. So thank you. All right, so on financials, I did have a couple just verbal updates in terms of a CEO report. I will next month put those actually into writing. As Dr. Walther did. Highlight, pleased to report that we do have a CMO. Dr. Patrick Okolo did accept, formally accept the CMO role about three weeks ago. So that is getting kicked in motion. The one caveat, he does have a 150-day out clause in his current agreement. So he will be, and he's currently working on seeing what he can do to shorten that down. At the worst case scenario, he'll be here early October. So we are working with Dr. Cusick on just what that looks like from
071a transition standpoint. Also ways we could potentially pull in Dr. Arcolo earlier, just if there's some other higher priority things he can kind of help. But he is a gastroenterologist. And so once he comes on in October, the plan is going to be that he'll be full-time CMO for the first six months. still working out, getting licensure, but that will, I think, allow him to transition, I think, pretty nicely into that role, build relationships while we also work on building out his clinic. So then after that six-month time frame, the plan would be he'll go down to half-time CMO and then half-time in building out his clinic practice. So certainly a big milestone for us to check off, and we're extremely excited to work on bringing him on. Is he open to engaging earlier remotely?
072Yes, he is. So we just kind of need to work out what that looks like. But he is. Yeah. Yeah. So I had a question. So where is he now? He is in Rochester, New York. Okay. And the six-month CMO only is due to? Part of that was at the time we didn't know where his licensure status was at. I think with talking with just, you know, the interim CMO, there is a there's a lot of work needed where felt like this would be a good bridge for him to, you know, focus on transition while, again, we kind of build out build out his clinic. I think, you know, we were a little concerned about trying to do that, you know, while he's still out in New York. So this just gives us a little
073more runway to. To work through all that transition, but he's already started the application process. He has started the application process Yeah, yeah, given the void of GI it would be great to get in practicing. Yeah, agreed. Yeah, okay And then just a couple updates on projects So ODC, there's an item here right after this to discuss a proposal that provides a little more context just on where we're at as we're still discussing options in terms of what to do with the current part of the MRI phase. I can report that the phase two of the CT project is complete. So what that means is our CT does have emergency power. And that is significant because there have been actually a couple times we've had to divert stroke patients. when we've lost power and everything
074else has been on emergency power. So that was big, certainly to get the CT on emergency power. And the central wing demo is currently ongoing, and that is on track to be here completed hopefully sometime this summer. And then hopefully that lines up well with just some of the other plans in place. On the PT project is progressing nicely. The HVAC has been delivered and installed. So another big milestone that we can check off. Construction is on schedule to be completed this month. So now we're kind of flipping the deck and working on getting occupancy and working on getting temporary occupancy and working with respective individuals on that. The ICU project is finishing up. We should be complete in July. And the lab project has begun. We've ordered pieces of equipment, and that should be
075complete sometime in the fall. We're working on building out kind of a full Gantz to see what that looks like in terms of just a full estimated date when we can expect that to be fully up and running. Just on the operational side, really, really quick. Obviously, you touched on budget. That was a big part of this month. Financially, April was a really good month for us, and especially volumes, too. You know, that drove a lot of the revenue growth. We saw some good increases in imaging volumes. CT volumes, we did nearly 500 exams last month, which I think is an all-time high. our inpatient activity relative to you know our recent run rate also we saw a busy house there as well it was the second busiest month of this fiscal year on the
076inpatient side and it was the second busiest month of this fiscal year for pt volumes as well we averaged over 32 visits a day in the emergency room so that was uh you know and our target i think went with the new group coming on was 30. so certainly that was a very strong and on the surgical side it was a big month in surgeries. We did 170 surgeries in a month that these last two months in particular have now brought our surgeries equal to budget. So we've seen some nice upticks there so hopefully we see that growth continue and that's been driven a lot by Dr. Alex Andretis and GI as well as Dr. Walter and some of our other ortho physicians. So for the month, we had a positive opera in EBDA of
077nearly $400,000, which was a plus $100,000 versus budget and was mentioned in the PowerPoint of the budget. But, you know, again, just a very positive trajectory this year. We are on track to significantly outpace both budget and prior year. And we are on track to significantly outpace fiscal year 13 as well, which was what. which is one of our big goals in putting together this current year budget when we were going through it about a year ago. So some really good stuff there. And just two other quick updates. We actually finished our IGT negotiations for the rate range program for what our allotment would be for next fiscal year. Happy to report that we actually have been approved to IGT in about $10 million, which that would be double. when you compare that to current
078year. So that would bring our net benefit from anywhere from little under seven million from anywhere to 10 to 11 million. So that is significant. Obviously, we have to work through the working capital piece of that on the paying. And that obviously becomes a top priority for us in these next 30, 60 days. So that's great news. And I think on the flip side of that, you touch on it in our budget, we do have a couple critical capital needs that we're working on trying to find the best strategy to fund. So we will more than likely be coming to you all shortly in terms of what our recommendations will be to solve some of those items. So that was the gist of my report, but happy to answer any questions you guys may have.
079What's the status on the new air conditioners? Yes, so some of that equipment has been ordered. So that's great. So we can reduce the lead time there. We are now working on just pulling together the remaining costs of the budget just to see what that looks like. Because I think you all approved not to exceed of $250,000. So we're going through that process to see just what all those additional costs are. But we have... We have ordered that equipment, which has been huge because that's allowed us to get ahead of this prior to the really hot days of the summer. Any other questions for Ben? Congratulations on IGT. All right, next we have feasibility study by Ed. So in the packet we have a proposal that was reviewed by the Finance Committee and approved to
080look at the outpatient MRI building. which was one of the components of the ODC project, which over the course of however many years it's been going, has been met with a combination of delays, escalations, and changes in how some projects were going to be delivered, resulting in some financial challenges to finalize the full execution of... that original plan, which would be to move the MRI into a permanent location. We've asked this group, 19-6, to provide us with a couple thoughts around leaving the MRI in its current location and providing a more appropriate way to get there. which would involve they're gonna look at a couple different concepts but would not involve umbrellas so that would be an improvement in the patient experience we met with them Ben and I and Wendy met with them on
081Monday and Dawn and she helped us all make sure we didn't get sucked into the MRI with appropriate screening and They're Challenged as you can see in this to come up with some fairly quick observations of plans to relook at this including meeting with the city of Sonoma Regarding concerns that they may have so we will have more to report You know probably in July August timeframe but we're hopeful that there is a acceptable alternative solution that doesn't require us to expend another seven million dollars and we think there is so we will wait their Follow-up. We are working with a consultant Ryan Eves Eves who is a third-party consultant who is going to be helping coordinate the work with 1906 as well as costing third-party costing of the work that 1906 provides. Questions? Any
082questions for Ed? I just would like to thank Ed for his leadership on this and Dan and Don for engaging at 7.30 in the morning on a Monday. But appreciate it. All right. We have two, well, we have one committee update from. Right. So we have, the finance committee has a charter of nine members. We currently have seven seated, or we did have seven seated. We were informed within this week that Carl Gerlach is resigning from the committee. due to personal time commitments that he has with some other things that he's doing nowadays. So we now have six members and our goal has been to try to broaden some of the representation on the committee to attempt to get both a balance of we have an excellent group of people on the committee to get
083a balance of some skills and perhaps some perspective. So we have two people who have We've been looking at I don't know if we want to do them individually and vote on them individually because this board has to approve Or if you want to take them together, let's do them individually and that just to be safe so the first person is Andrew Exner and He has a great background. He has extensive not-for-profit organization experience he has a resident with a family here in town. He's served on finance committees, he has an operational background in other areas, and having met with him and Dennis met with him, I think is an excellent candidate. He will help us, you know, perhaps broaden some perspective on certain issues, but also provide a critical voice in some of the
084challenges that we're going to face in the coming year with financing. So I would recommend that he be approved as joining the Finance Committee. All in favor? Aye. Any opposed? The second member, Paul Chakmak, I'm going to ask Dennis to provide a summary. He and Dennis have worked together in the past, and I met with Paul and found him to be, again, a very interesting and... an important addition, but Dennis, you want to go through? I've known Paul for three decades, maybe four. He and I were both bankers in our 20s. He left banking and went to become CFO and then COO of a public gaming company. Paul has tremendous operational experience, tremendous finance experience, auditing experience. He and his wife live in Sonoma. They retired here half a dozen plus years ago. Paul will
085add a tremendous amount of skill, discipline, focus to an already pretty strong finance group. So I couldn't say anything more positive about him. I will say I think he and Andrew collectively add tremendous depth to our team. Like my conversation with Andrew and subsequently with my conversation with Paul, Paul currently serves on the board of Vintage House in the city. He started off as a member of the board, then he became treasurer of Vintage House, then he became president of Vintage House. Now he's just a board member again. So involved in the community as well. So I think he and Andrew will add tremendous capacity. One thing that Ed did mention, but because of Carl and being short, we had trouble convening a quorum a couple months ago. So I think with these two extra
086individuals, that shouldn't happen again. I would make a motion to have Paul join the Finance Committee. I'll second that. All in favor? Aye. Opposed? And I think what was important in talking to both of these is their strong interest in community service. I mean they really want to be engaged and want to you know help us with the skill set that they bring. which to some extent is redundant to skill sets that already exist, but new perspectives are going to be very helpful. And while we definitely miss Carl's, all the things that he's done over the years with the hospital were really sad. Sad in one hand to see him go. On the other hand, it's for a good reason and things that he's able to do that he really enjoys. It does open up
087a seat for us to continue to try to find a member who maybe isn't, you know, a financially oriented person, but operationally in the community with some of the service agencies or things that we, you know, want to interact with. So we'll have that seat available, and we will continue to reach out to try to find people who might be able to help us. And, you know, we're not. We're not pressed at this point to fill a seat. So we're not in violation of, what did you say, nine members? There's nine members. We had seven. We were okay with seven. Oh, okay. It was just the problem was getting a quorum because the seven members we have still have, we'll call it a lot of free time to travel internationally. So it was hard sometimes
088to get four of them to come to a meeting. Well, maybe if I disguise my voice, I can speak up. Well, yeah. If you could, yeah. All right. Any other comments from board members? If not, do you want to do it, Denise? Meeting adjourned. Thank you.