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ZSFG CEO details screening, testing limits and CADDIE ambulance triage as ED volumes fall
Summary
ZSFG CEO Dr. Ehrlich reported a sharp drop in emergency department visits but higher admission rates, detailed expanded screening and visitor limits, said rapid testing remains limited, and credited the city's CADDIE ambulance‑destination project with reducing diversion while adherence to the protocol improves.
Dr. Ehrlich, chief executive of Zuckerberg San Francisco General, told the Health Commission that the hospital has overhauled staff screening and visitor policies as part of its COVID‑19 response and is working to rebuild ambulatory capacity. "I've never experienced anything like this in my career," she said, describing daily screening, temperature checks in clinical buildings, and a policy generally allowing one visitor per patient with an exceptions team to handle special cases.
Ehrlich presented data showing a substantial decline in emergency‑department volume with a higher admission rate among those who arrive: roughly 16% historically versus about 24% during the April drop, which she said indicates sicker arriving patients. She said the hospital tests everyone admitted and screens patients scheduled for procedures, and that testing focuses on higher‑risk groups and congregate settings. On rapid tests she cautioned that the most available rapid assays are "the least sensitive," and said she does not foresee routine rapid testing of visitors in the near term.
The CEO credited a pandemic‑coincident project called CADDIE — an ambulance destination and level‑loading system that routes paramedics by clinician consultation — with helping to reduce ambulance boluses and diversion. She said CADDIE has improved outcomes when paramedics call the on‑duty physician, but that adherence to the call protocol has ranged and remains a work in progress.
Ehrlich also described changes to psychiatric emergency services (PES): the unit’s census has been capped to maintain distancing, staff now use N95 respirators when close to patients, and a PES psychiatrist is available daily in the ED to evaluate and, when appropriate, discharge patients without moving them to PES. She said these steps have reduced transfers and improved patient flow while protecting staff.
The report closed with an update on ICU and medical‑surgical census trends: a spike in ICU admissions in April followed by lower med‑surg census driven by fewer ED arrivals. Ehrlich said ZSFG had cared for roughly 30% of the city’s hospitalized COVID patients at the surge peak and that current inpatient COVID cases were materially lower at the time of the report.
The commission asked follow‑up questions about equity metrics and visitor screening; Ehrlich pointed to department dashboards that track race, ethnicity and language completeness and agreed to expand reporting on equity initiatives in a future session.
