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Section 2 Institutional Overview Nephrology Vascular SurgeryThe services provided at SFGH&TC are grouped into the followingmajor categories: Fig. 2-310,173 skilled nursing days were provided inthe year of 2006-2007Diagnostic ServicesInpatient ServicesAmbulatory Services (Primary & Specialty Care)Emergency ServicesTrauma ServicesWithin each of these categories is a broad range of services, whichdefine the complex level of care provided at the Hospital.INPATIENT SERVICESCurrently SFGH&TC is licensed for 403 general acute beds, 106acute psychiatric beds, and 30 Skilled Nursing beds. It is the largestprovider of acute psychiatric care in San FranciscoIn Fiscal Year 2006-2007, there were 16,209 acute admissions, ofwhich 16% were acute psychiatric. There were 109,959 patient daysof which 27% were acute psychiatric. The ten most frequentlyoccurring acute inpatient diagnoses were: Newborn ongestive Heart Failure Depressive DisorderHIV DiseaseParanoid SchizophreniaAlcohol WithdrawalLeg CellulitesSFGH&TC maintains a 30 bed short-term Medical/Surgical SkilledNursing unit. This unit provides short-term non-acute care forpatients awaiting or recovering from a procedure, patients requiringaftercare that is unable to be administered at home, and patientsawaiting placement. Average length of stay is 26 days.San Francisco Behavioral Health Center In addition, SFGH&TC ishome to the San Francisco Behavioral Health Center (SFBHC). SFBHCserves the sub-acute psychiatric population of the City and County ofSan Francisco, providing diagnostic evaluation and treatmentservices, with a rehabilitation focus that promotes improvedindependence and enables residents to achieve their highest level offunctioning, for residents with severe and persistent mental illness.The SFBHC is designed to help residents move along the continuumof care and to transition to the most appropriate community setting.SFBHC has three level of care: Mental Health Rehabilitation: licensed by the CaliforniaDepartment of Mental Health (DMH), the Mental HealthSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-4

Section 2 Institutional OverviewRehabilitation Program has 47 beds and focuses onpsychosocial rehabilitation of clients with severe and persistentmental illness. Skilled Nursing Facility: licensed by the Department of HealthServices (DHS), the Skilled Nursing Facility has 59 beds andprovides for continued care of psychiatric patients withmedically complex needs.Fig. 2-4San Francisco General Hospital Clinic Entrance94,266 outpatient admissions were registeredin the year of 2006-2007 Adult Residential Care Facility: licensed under the CaliforniaDepartment of Social Services’ (DSS) Community CareLicensing Division, the Adult Residential Care Facility has 41beds and helps clients transition back into their community.AMBULATORY SERVICESIn Fiscal Year 2006-2007, over 94,000 people were treated in thehospital’s clinics. 506,150 visits were documented, of which 25%were primary care, 28% were specialty care and 4% were urgentcare. Ambulatory clinic services are organized and provided under 6major centers:Adult Medical CenterThe Adult Medical Center providescomprehensive primary care services through its General MedicineClinic and specialty services to persons over 18 years of age.Specialties services include: Hepatomegaly tensionAdult Surgery Center The Adult Surgery Center provides a full-rangeof ambulatory surgical specialties, where comprehensiveconsultation, surgical procedures and recovery are provided in thehospital setting. Surgical Specialty Services includes: TraumaGeneral FootBreast osurgeryOptometryUrologyOral SurgeryChildren’s Health Center The Children’s Health Center providesSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-5

Section 2 Institutional Overviewculturally competent and sensitive medical services to children andyoung people up to the age of 21. It serves children requiringevaluation of health status, diagnosis and treatment of acute illness.In addition to primary and specialty care services, off-hours pediatricurgent care services are available for patients of the CommunityHealth Network and its affiliated partners.Specialty services include: Asthma Dermatology Cardiac Urology HematologyRenalNeurologyNutritionWomen’s Health CenterThe Women’s Health Center providesgeneral obstetrical and primary women’s health care for women ofadolescent to geriatric age.Specialty services include: Infertility treatment Prenatal education and exercise programs Teen obstetrics programsExtensive family planning services, including therapeutic abortions,and counseling services are provided within the Family PlanningClinic.Family Health CenterThe Family Health Center providescomprehensive primary care to all family members of all ages,including culturally competent care for the diverse population of thecommunity served by SFGH&TC. Using a Family Practice model, staffincorporates patient education, counseling, diagnostic, screeningand therapeutic services in the patients’ care and emphasis is onprevention, health maintenance and early diagnosis and treatment ofillness.Services include: Prenatal care Perinatal case management Well child care Pharmacist consultation Mental health services Nutritional assessment and education Substance abuse counseling Family therapy HIV family clinic Social services Minor surgery Health education Diabetes education and case managementSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-6

Section 2 Institutional OverviewPositive Health Program The Positive Health Program is a multidisciplinary service that provides specialized care to HIV-infectedpatients. The program delivers compassionate care with a focus oncontinuity and quality provided by an enabled, committed, expertstaff. Research is focused to improve care, and maintain adequateresources for meeting the care demands of its service population.Fig. 2-529% of all ambulance traffic in San Franciscois received by the SFGH&TC Emergency andTrauma CenterServices include: Primary Care Dermatology Pulmonary Endocrinology Neurology Mental health servicesLymphomaWomen’s HealthOncologyHealth educationEMERGENCY SERVICESThe SFGH&TC Emergency Department (ED) is a 24-hour, 7-day aweek service licensed by the State of California for comprehensiveemergency services. The ED provides resuscitation care for theTrauma Center (Level 1) and is the primary receiving facility for masscasualties’ events. In Fiscal Year 2006-2007, over 53,000Emergency Room visits occurred, of which 22% resulted in anadmission.Psychiatry Emergency Services (PES) provides 24-hour, 7-day aweek emergency assessment, stabilization and disposition for acutepsychiatric patients. Last year, over 7,700 people were treated, ofwhich 25% were admitted.Trauma Program The SFGH&TC Trauma Center was one of the firstprograms organized in the United States to combat death anddisability due to injury. It has also been designated as the Level ITrauma Center for both adults and children by the EmergencyMedical Service Agency [EMSA] of both San Francisco and SanMateo Counties.A designated Trauma Center (Level 1) is defined as a specializedhospital facility that has an adequate depth of personnel, resources,services, equipment and supplies to provide care for the injuredpatient throughout all phases of the patient’s care from resuscitationthrough discharge. This continuum of care includes the EmergencyDepartment, Radiology/Imaging Services, Laboratory and BloodBank, Operating Room, Intensive Care Nursing, Medical-SurgicalNursing, Physical Therapy, Social Services and psychological supportfor the patient and family. This level of comprehensive care isimmediately available 24 hours/day every day of the year.San Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-7

Section 2 Institutional OverviewAs San Francisco’s only Trauma Center SFGH&TC providesresuscitation, diagnosis, treatment and rehabilitation for complexinjuries affecting all areas of the human body. Approximately 3,300adults and children are treated each year for injuries requiringactivation of a multi-disciplinary team of surgeons, nurses,technicians and therapists.Fig. 2-6Every year 2,500,000 doses of medication aredispensedPoison Control Center SFGH&TC is the home for the Poison ControlCenter in northern California, where information about poisoningsand treatment is provided around the clock to healthcare providersand the general public over a telephone network.Urgent Care The Adult Urgent Care Service provides evaluation andtreatment to patients with non-emergent conditions, who, in the past,were diagnosed and treated in the Emergency Department. The clinicis open 7 days per week including holidays for 80 hours of servicecoverage. Adult Urgent Care documented over 21,800 medicalencounters in the year 2006-2007.DIAGNOSTIC SERVICES & ANCILLARY SERVICESFig. 2-7Around 200 clinical nursing placements forstudents from California State ties and colleges are offered eachyear. Clinical LaboratoriesFood and NutritionInfection ControlNursingPastoral CareRehabilitationRespiratory TherapyPharmaceuticalMedical/Psychiatric SocialRadiologyInterpreterMaterial ManagementMessengersMedical Staff OfficeParkingPatient/Visitor CenterUtilization Management AdmittingBiomedical EngineeringBusinessEducation and TrainingEnvironmentalFacilities ManagementHuman ResourcesHealth and SafetyHospital AdministrationHealth Information SystemInformation SystemQuality ManagementRisk EMICS AND RESEARCHThe UCSF Dean’s Office is confirming the number of principalinvestigators conducting research on the hospital campus. Throughits long-standing affiliation with the University of California, SanFrancisco (UCSF), SFGH&TC serves as a major teaching hospital forMedicine, Nursing, Pharmacy and Dentistry. All of the physicians atSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-8

Section 2 Institutional OverviewSFGH&TC are UCSF faculty. Approximately 1,400 UCSF physicians,specialty nurses, health care professionals and other professionalswork side-by-side with 3,000 City employees at SFGH&TC. The Cityand County Of San Francisco pays UCSF for the patient care servicesthrough an affiliation agreement. Each year, over 350 third or fourthyear medical students, 800 residents and 60 clinical fellows aretrained at SFGH&TC. Thirty-two percent of all the UCSF internstraining, in 17 academic departments, and 35% of all UCSF medicalstudents’ clinical training are conducted at SFGH&TC.Fig. 2-8Over 160 UCSF principal investigators conductresearch through programs based at SFGHMCIn addition SFGH&TC provides approximately 200 clinical nursingplacements at the Associate, Baccalaureate and Masters level forstudents from UCSF, the California State University System,community colleges, and Bay Area private universities and collegeseach year.The hospital is also home to more than 20 research centers andmajor laboratories. Over 160 principal investigators conductresearch through programs based at the hospital campus.Research work and studies in the following areas are currently beingcarried out at the SFGH&TC :Trauma related research: Rapid response improvement Emergency Department Management Violence Prevention Surgical techniques and Wound Care Brain Spinal Cord Injury Management Bone regeneration.Bioterrorism and Mass Casualty: Development of Treatment for Botulism Toxin Decontamination methods for exposures Drug and Antibody Delivery Systems Predictive models of needed resources.AIDS related research: Treatment to the homeless Adherence to treatment Outcomes in the urban poor Treatment and prevention of Drug Resistant HIV Immunology of AIDS Drug Trials Management of Illness to preserve productivity Reducing sexual risk behavior Post exposure prophylaxis (needle stick, prenatal, sexual, etc.)Cancer related research: Treatment of MesotheliomaSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-9

Section 2 Institutional Overview Medical Marijuana useBreast cancer treatment and preventionsOvarian Cancer Drug Delivery SystemPrevention of Basal Cell CarcinomasCardiovascular related research: Heart attack prevention and treatment Stroke prevention and treatment Vascular malformations and aneurysms prevention and treatmentPulmonary related research: Asthma-treatment, prevention, and genetics Interstitial lung disease-management and causes Chronic Lung Disease-pathology and preventions TB-prevention, control, and treatment Pneumonia-genetic risk factors, treatment.Health Disparities: Racial and Ethnic Disparities in adults, children and newborns Genetic Differences Health Care Delivery Systems, Literacy and Cultural Effects Comparisons of the SFGH&TC system to other systems.San Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-10

Section 2 Institutional OverviewPOPULATION CHARACTERISTICSThe following tables and maps show the population characteristicsfor the year 2005 in comparison with the last IMP in 1987 or withfigures available for recent years.PATIENTSGender / Race / Age The total number of all SFGH&TC patients Inthe fiscal year of 2006-2007 was 98,244 with the followingpercentage regarding gender, race and age compared to 1992.GenderFemaleMaleFY 2004 - 2005FY 2006 – 200743%49%57%51%RaceCaucasianAfrican AmericanHispanicNative AmericanAsian/Pacific IslanderOther /UnknownFY 2004 - 200527%24%29%0%15%5%FY 2006 – 200724%19%29%1%20%7%Age0-1718-4445-64Over 64FY 2004 - 200520%55%18%6%FY 2006 – 200714%46%32%8%Patient’s origins by zip code SFGH&TC plays a vital role inproviding quality health care services to San Francisco’s vulnerablepopulations, which include the uninsured, homeless, children, frailelderly, low-income, racial and ethnic minorities, and persons fromlow-income neighborhoods.The following maps indicate, by zip code, the origin of all inpatients in2006-2007 (Fig.2-9) and all patients in 2006-2007 (Fig.2-10)treated at the SFGH&TC.San Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-11

Section 2 Institutional Overview0–2%2–4%5–7%8 -10 %11 – 12 %DistrictMissionHunters PointOuter MissionNorth of MarketSouth of MarketVisitacion ValleyCivic CenterParksidePotrero HillWestern AdditionWestern AdditionOtherZip Code12% 941109% 941249% 941127% 941027% 941035% 941344% 941093% 941162% 941072% 941152% 941171%0–2%2–4%5–7%8 -10 %11 – 12 7941039411294107941149411094116941319412794132Fig. 2-9Percent of SFGH&TC Inpatients by zip code ofresidence in the year of 2006-200713% are homeless9412394129941249413494112San Francisco General Hospital & Trauma Center94123941299413394108 ictMissionHunters PointOuter MissionNorth of MarketSouth of MarketVisitacion ValleyCivic CenterParksidePotrero HillWestern AdditionWestern AdditionSunset12%8%9%7%6%6%4%3%2%2%3%2%Zip 41159411794122Fig. 2-10Percent of all SFGH&TC Patients by zip code ofresidence in the year of 2006-20077% are 1249411294134San Francisco General Hospital & Trauma CenterSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-12

Section 2 Institutional OverviewSources of Patient Revenue The following table shows the currentactivities by payer type for fiscal year FY 2006-2007.Payer atient days28%4%34%23%8%Outpatient Encounters35%2%26%18%19%Utilization Statistics The following summary describes the hospitalactivity during the recent fiscal year of 2006-2007.Inpatient Services The number of acute patient days for the fiscal year of2006-2007 was 109,959, of which 27% were related to theacute psychiatry 16,209 acute admissions, of which 16% were to acutepsychiatry There was a total of 43,222 skilled nursing days, 84% wereat the SFBHCIn Surgery: 6,612 surgical procedures were performed in 10 operatingrooms, of which 50% were emergent. 41,089,390 surgical minutes were performedIn Obstetric/Gynecology: 1,232 babies were born at SFGH&TC Over 2,300 women received prenatal care, of which 30%were high-risk casesOutpatient Services 94,266 individuals were seen Total of 506,150 clinic visits; of which 25% were primarycare, 28% were specialty care, 4% were Urgent care visitsand 20% were diagnosticEmergency Services Over 53,000 Emergency Department visits, with 22%resulting in an admission Over 7,700 Psychiatry Emergency encounters, with 25%being admitted 29% of all ambulance traffic in San Francisco was receivedby SFGH&TC.Trauma Center 3,279 adults and children are treated for injuries requiringactivation of the trauma teamSan Francisco General Hospital & Trauma Center Institutional Master Plan Update – September 2006 (Rev. 3/08)2-13

Section 2 Institutional OverviewNumber of Discharges by Service The following table shows acomparison between 1992 and 2007 for the number of dischargesby serviceNumber of dischargesby otalFY 19924,903 – 23.00%8,072 – 37.87%1,380 –6.47%1,589 –7.45%2,058 –9.70%21,315 – 100.00%FY 20074,797 – 28%7,132 – 42%401 – 2%2,688 – 17%1,247 – 7%16,265 – 100%Licensed Beds The following table shows a comparison between1992 and 2007 for the number of licensed beds. It shows anincrease of acute psychiatric beds and 130 new skilled nursing bedsdue to the opening of the SFGH&TC Behavioral Health Center.Licensed BedsGeneral acute bedsAcute psychiatric bedsSkilled nursing bedsTotalFY 199249587-582FY 2007403106136645Average Length of Stay The following table shows a comparisonbetween 1992 and 2007 for the number of discharges by serviceAverage Length of StayMedical / SurgicalAcute CarePsychiatric Acute Car

San Francisco General Hospital & Trauma Center Institutional Master Plan Update - September 2006 (Rev. 3/08) 1-1 Section 1 Introduction The San Francisco General Hospital & Trauma Center (SFGH&TC) submits this Institutional Master Plan (IMP) to update the September 2006 IMP Update with a revision dated March 2008 currently on file