Piedmont Medical Center has received the corporate go-ahead to begin a $19.8 million expansion of its emergency department.
The Tenet Healthcare Corp. Board of Directors approve the project last week to meet the rising numbers of people coming to the emergency department. Peak volumes are about 200 people a day, sometimes resulting in longer wait times for service.
Plans call for building a 21,000-square-foot addition where the helipad is currently located. The helipad will be relocated to the roof of the emergency department. The new space will allow Piedmont to add 11 exam rooms for a total of 37.
Piedmont officials had hoped to start construction as early as April. No timetable has been announced, however, as architects Gresham, Smith & Partners of Charlotte are meeting with staff members to finalize plans and to integrate the latest “best practices” of emergency room design and operations.
The emergency department will remain open during the construction and renovation of existing space.
People who work in the emergency department said the changes are long overdue. They say the biggest change patients should see is less wait time.
Piedmont’s emergency department volumes have increased for the past two years, from 60,000 patients in 2010 to 67,000 in 2012. The rise mirrors national statistics, which show emergency room visits rose 10 percent from 2008 to 2009, the latest year national statistics are available. The increase was the steepest single-year surge on record.
Piedmont staff members didn’t have information on why the hospital’s volume has increased, but noted the flu season was responsible for recent spikes.
Nationally, health care experts said the surge can be tied to the economy. In better economic times, people are more willing to spend money on primary care and preventive medicine, experts said.
The surge in emergency department volume, however, is not expected to drop. Experts predict health care reforms that go into effect in 2014 will increase emergency department use.
Despite an increase in patients, Piedmont has maintained its “door-to-bed” times for the emergency department. In 2012 the time from a patient’s arrival to bed was 37 minutes. Last month, the “door-to-bed” time dropped to 32 minutes.
Emergency department personnel stress the expansion will not change the quality of care.
“We already have all the bells and whistles,” said Jay Mellon, nurse manager.
The emergency department has about 100 people on its nursing staff and 15 healthcare providers or physicians.
The department’s goal is to have a nurse cover four beds, Mellon said. “You can’t spread that out thinner,” Mellon said.
Patient care will continue to be based on an “acuity” system where patients with the most severe conditions are seen the quickest.
Some changes may be made in how walk-in patients are assessed, Mellon said.
Currently, patients report to the “triage” desk where information is taken and their complaints heard. The desk can order any needed X-rays or blood work so those procedures are ready when a patient reaches an exam room. In some cases, physicians can see patients in the waiting room, said Connie McIntyre, a clinical supervisor.
One of the current best practices being evaluated is having a second assessment area past the triage desk, Mellon said.
Several physical changes should also help patients as well as staff, said Mellon and McIntyre.
Plans call for a more open layout so staff members can “put multiple eyes on patients,” Mellon said.
Plans also call for 25 of the exam rooms to be for acute/trauma cases. Twelve will be for fast/express care rooms. Flexibility is being incorporated into the design so these rooms can be changed to meet patients’ needs, McIntyre said.
The “major” exam rooms will have monitors that report patient information directly to the nurse station. Minor exam rooms will have portable monitors.
More space should also allow those coming in by ambulance to get to a room, McIntyre said. Currently, people on stretchers line the department hallways when no beds are available, she said. A patient’s acuity, however, determines their priority.
Patients with a low acuity who come in via EMS can still be sent to the waiting room, McIntyre said.