You are the newly hired Director of Risk Management for Westview Clinical Center, New York City’s largest clinical research medical center (“Westview”); a medical facility that is in crisis. Westview’s 3,000-bed main hospital facility is located in central Manhattan. The remainder of the clinical center, consisting of an Oncology Center, Radiology Center, medical school, pediatrician center, psychiatric facility, and research facilities are also located in central Manhattan (within a few blocks of the main facility), New Jersey and Connecticut. On average, Westview sees over 3,500 patients each week, mainly through its emergency room department. Patients who are seen through the ER typically spend1.5 hours on average from presentation to discharge. If patients are admitted, they typically spend 2 days in the hospital. Westview takes pride in its prompt, safe, and efficient delivery of medical services.Recently, the State of New York conducted a random audit of the facility, including reviewing its readmission rates and incidents of nosocomial infections (i.e., secondary infections, hospital-acquired infection). Secondary infections are infections that happen as a result of receiving treatment in a hospital or medical center but are secondary from the patient’s original admitting diagnosis. The State audit revealed that, of all the readmissions to the hospital, a staggering 85% are the result of secondary admissions. What’s worst, many of the secondary infections are for acute or communicable infections (e.g., tuberculosis, bacterial meningitis, pneumonia, strep throat, etc…). In fact, 78% of the cases are bacterial in nature, with the remainder, viral in nature. As a result of its review, the State has determined that the ER is the main entry point for these infections and that Westview must close its ER. If the ER closes, Westview will immediately go bankrupt.After much discussion between Westview’s legal department and the State regulators, the State has agreed to allow Westview to remain open if it:

1. Determines the main cause of the spread of infections from one location to the next
2. Resolve any additional training needed to prevent (mainly, reduce) future incidents of infection
3. Draft an acceptable Risk Management Plan to minimize and/or prevent incidents of secondary infections.

Westview has agreed to the State’s terms. The Chief Medical Officer’s first act was to terminate the former Director of Risk Management and hire you. The CMO gives you the task.