COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

October 29, 2007

BOARD MEETING DATE:

December 18, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Sang-ick Chang, MD, Chief Executive Officer, San Mateo Medical Center

SUBJECT:

Amendments to the Agreements with AMN Healthcare, Inc., Arcadia Health Services, Inc., Cross Country Travcorps, Inc., Emerald Health Services, First Call Nursing Services, Health Talent, Medstaff, Pelican Resources Registry, Relief Nursing Services, and UNI

RECOMMENDATION:

Adopt a Resolution authorizing an Amendment to the Agreements with AMN Healthcare, Inc., Arcadia Health Services, Inc., Cross Country TravCorps, Inc., Emerald Health Services, First Call Nursing Services, Health Talent, Medstaff, Pelican Resources Registry, Relief Nursing Services, and UNI to provide nurse coverage where needed at San Mateo Medical Center increasing the maximum collective amount payable by $2,675,000 to $6,505,000

VISION ALIGNMENT:

Commitment: Ensure Basic Health and Safety for All

Goal 5: Residents have access to healthcare and preventive care.

The Agreements contribute to this commitment and goal by continuing to provide nurse coverage where needed at San Mateo Medical Center.

Performance Measure(s):

Measure

FY 2005-06
Actual

FY2006-07

Actual

FY 2007-08
Projected

Nursing vacancy rate

14%

14.2%

12%

Hours per month that Emergency Department was in Diversion Status

52

60

90

BACKGROUND:

San Mateo Medical Center uses nursing registries to augment permanent nursing staff. Registries are used to fill nursing vacancies, meet unexpected increases in census and patient acuity, and to cover employees’ illnesses and extended leaves of absences.

DISCUSSION:

An unexpected increase in the need for supplemental nurse staffing has resulted in the depletion of the funds on the current contracts. The increase in funding will allow for the continued use of these much needed registries.

The Medical Center is experiencing a greater than 14% vacancy rate in the nursing department. The majority of vacancies are in the critical care areas of Emergency Department (ED), the Intensive Care Unit (ICU), and the Operating Room (OR). Vacancies also exist in all other nursing units. The Medical Center uses an average of 16 “Traveler Registered Nurses (RNs)” (contract RNs who work an 8-13 week contract) to cover shortages in the ED, ICU, some OR and Medical/Surgical units. The ED has experienced a 30% increase in the number of patients seen and the ICU is staffed to support a census of 6.

All in-patient nursing units also use a day-to-day registry (an RN, LVN or CNA who works one shift at a time) for the following reasons: 1) To cover medical leaves, education, sick days and resignations; 2) To staff 1:1 and 1:2 patients in the medical surgical area; 3) To provide support to Burlingame Long Term Care; 4) To avoid emergency department diversion by providing staff for units to accept patients from the Emergency Department in a timely manner so as to improve patient flow and decrease patient wait times; 5) To provide quality care to existing patients; and 6) To adjust to quick increases in census.

The implementation of the Nursing Ratio Legislation in January of 2004 has caused the Medical Center to increase access to this type of short-term registry staff to meet the required ratios and avoid citations and fines from the Department of Health Services who are monitoring this issue closely.

Aggressive efforts are being made to recruit nurses to fill the vacancies in SMMC’s specialized areas with the goal of reducing the use of registry staff. It is hoped that with the recent increase in nurses’ pay, SMMC will become a more attractive employer.

County Counsel has reviewed and approved these amendments.

FISCAL IMPACT:

The terms of the ten Agreements are from July 1, 2006 through June 30, 2008. The maximum amount the County shall be obligated to pay collectively for all ten agreements is increased by $2,675,000 to $6,505,000. The increase is necessary due to the vacancies in nursing positions as well as the increase in patient load. The actual charge rates remain the same. Funds to cover this cost have been included in SMMC’s and Health Services (AIDS Program) Adopted Budgets for FY2007-08. Funds will be included in SMMC’s and Health Services’ FY2008-09 budget requests.