WUMC Master Facility Planning Clinical Administrator Committee April 24, 2012

WUMC Master Facility Planning

Clinical Administrator CommitteeApril 24, 2012

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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%

2) Develop programs and address facility issues● 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 programSouth 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:

Clinical Program WorkgroupsCritical CareMedical Oncology/BMT (Inpatient/Outpatient)Surgery & Surgery Support FunctionsAncillary Services – Lab, Pharmacy, Radiology, EtcMothers & InfantPediatrics

Office & Administrative Spaces Workgroups:Academic Office Space/ResearchAdministration/Finance

Logistics Workgroups:Food ServiceLogistics/Support/Materials

Built Environment WorkgroupsInfrastructureParkingWayfinding/CirculationSustainability

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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:• 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• 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• 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) • Medical Oncology/BMT• OB/Gyn• Other north campus surgical services • Pediatric clinical research space expansion

• Expansion of Ambulatory Care Space adjacent to CAM• 57-70,000 dgsf for projected growth in WUSM ambulatory encounters thru 2020

Details and specific locations being finalized.

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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

Mass Casualty Response Plan

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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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Critical Success Factors1) 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

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).

Approved by FPP CPC on April 14, 2009

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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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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 2The 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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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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NotificationWUSM 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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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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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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WUSM Clinical Faculty, Fellows & Support Staff• WUSM clinical faculty, fellows and clinical support staff should remain at their jobs until advised

otherwise by the BJH or WUSM Command/Communication Centers

• Off-duty WUSM faculty and clinical support staff may be called in as needed

WUSM Students and Non-Clinical Employees• 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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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:• 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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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

4) 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

5) As appropriate, each Department can develop and submit a Provider Call-Up Algorithm

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Department of Otolaryngology

Physician Call-Up Algorithm

Tier 1: Attending faculty and residents on-call that day

Tier 2: Adult Subspecialty Otolaryngologists• Head & Neck Surgeons• Facial Plastic & Reconstructive Surgeons• Oral & Maxillofacial Surgery

Tier 3: General Otolaryngologists/Otologists• General Otolaryngologists• Otologists

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Outstanding Issues/Challenges1) 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:• Medications• Lab and blood banking services• Patient transport• Food• Cash

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Next Steps1) 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

END

APPENDIX

Documents

WUMC Master Facility Planning Clinical Administrator Committee April 24, 2012