Dartmouth-Hitchcock Medical Center project to bring more patient beds in May
Opening of new $150 million patient pavilion will meet growing demand for services
As hospitals throughout the region continue to struggle to meet demand for healthcare services, Dartmouth Hitchcock Medical Center in Lebanon is preparing to open additional beds in a new $150 million patient pavilion in May.
The expansion at the 32-year-old, 396-bed academic medical center in Lebanon will be gradual, beginning with a net gain of 28 beds on May 3.
“Currently we are at capacity at DHMC,” Dr. David Min, director of clinical cardiology at Dartmouth Health, said in an interview late last month. Demand for heart care, testing, treatment and procedures is growing in the region and nationally. At DHMC, providers are seeing an increase in the severity of patients’ illnesses, he said.
As the acute tertiary care referral center for the Upper Valley and Vermont and New Hampshire, DHMC gets calls from across both states from patients who are looking to come to Lebanon for their heart care “that we just don’t have the space for,” Min said.
That demand extends across other specialties as well. DHMC is often at 110% capacity, and more than 300 patients are turned away each month, according to a recent news release. The result is that many patients are forced to stay at their home institution or go elsewhere, potentially even further from home, Min said.
The new tower’s opening comes as DH continues to struggle to achieve a positive operating margin. The system’s most recent financial filings indicate that it saw an operating loss of $78 million, or 5%, in the first six months of its fiscal year, ending Dec. 31, 2022. In the Feb. 27 filing with bondholders, DH CFO Dan Jantzen said the loss is related to the national shortage in health care workers as well as the shortage of post-acute care beds in the region — also related to workforce shortages — which delays discharge from hospitals, meaning that hospitals are often caring for people who no longer need acute-level care.
In November, DH initiated a financial improvement plan with the aim of achieving break-even budget on a monthly basis in the fiscal year that begins on July 1, 2023. That work focuses on bringing up revenues, reducing expenses and increasing capacity at DHMC.
The system, which includes DHMC as well as several clinics, four smaller hospitals and a visiting nurse association, “will be in a stronger position to meet excess patient demand when it opens its newly constructed Patient Pavilion at DHMC in May 2023,” Jantzen wrote in the filing.
Flexibility to renovate
Beginning May 2, three wings of the new tower will hold 12 intensive care beds and 36 medical beds for the hospital’s heart and vascular service, which is an increase of 12 from those currently available for that department, Min said. The additional ICU beds are aimed at freeing up critical care space elsewhere, he said.
A fourth wing, slated to open the next day, will hold a new 16-bed medical specialty care unit, Scott Slogic, director of clinical special services for nursing who is director for the patient pavilion activation, said in phone interview last week. The step-down care provided there will be a higher level of care than that provided in a medical/surgical unit with lower nurse-to-patient ratios but below that of an ICU.
But the 64 new beds will be offset by 36 beds that will be left vacant by the move of the heart and vascular service.
The vacant heart and vascular beds are slated for renovation, which will begin a round of renovations throughout the older “legacy towers” that is slated to last several years, Slogic said. The goal of the renovations is to co-locate similar services near each other to improve efficiency in the delivery of that care. The renovations also aim to provide upgraded technology, replace flooring, upgrade bathrooms and remove wooden fixtures.
“The pavilion gives us the flexibility to close the unit, renovate and reopen,” Slogic said.
The new patient tower also has two floors with room for 64 additional beds, but no date has yet been set for that build-out, Slogic said.
In addition to adding beds, the new pavilion features private rooms and several technological upgrades. Slogic described the new rooms as “future-proof” in that they can serve as medical/surgical rooms, step-down or even critical care, depending on what is needed at the time.
The technologic upgrades include whiteboards that tie in with the electronic medical record so that providers will have access to “patient dashboards” in each room. Patients and their families also will have access to MyChart Bedside, an app similar to MyDH that will offer them information about their inpatient stay. Slogic said he expects the app will eventually allow patients to order food from a menu and be available throughout DHMC.
The new rooms will have more space for families to stay with patients, as well as private bathrooms, Min said. The new monitors are wireless, which frees up space for patients, family members and caregivers to move around.
“The space in and of itself is much more warm and inviting for healing,” he said.
In addition to the new patient rooms, the new pavilion is slated to include an expanded discharge lounge on the first floor, which is to have space for up to 15 patients as they wait for friends or family members to pick them up, according to DH’s website. The lounge will have iPads, wi-fi and space for charging devices. It also will have a room with a refrigerator, freezer and microwave.
While the lounge is meant to be comfortable for the patients, it also serves a purpose for patient flow.
“It allows newly vacated patient rooms to be turned over quickly for patients who are waiting and require an inpatient bed,” Michelle Buck, vice president for inpatient nursing, said in a news release about the lounge.
In the weeks before opening the new tower to patients, those involved will be busy. A ribbon cutting and open house for employees are planned for April, Slogic said. New and current employees also will begin conducting simulations in the new space in mid-April. On April 25, members of the public will begin accessing the “legacy towers” through the new tower.
The move of the heart and vascular unit on May 2 is being planned in advance, Slogic said. Providers will know the night before which patients are being discharged and which will need to make the move. The move involves transporting patients to the new space, as well as their medical records and medication.
There will be “safety officers all along the way,” Slogic said. “Planning for the movement of these patients is its own separate project.”
The next day the new medical specialty care unit is slated to open and about a month later, autonomous robots are slated to begin delivering medication from the hospital’s inpatient pharmacy to patients in the new tower.
They are small and “kind of look like R2-D2,” Slogic said.
Inside the pharmacy, a pharmacist will load the medications into locking compartments and then send them on their way. The robots will alert clinicians to their arrival by making a noise and then only certain staff will be able to access the medications using a badge card to administer them to patients. Eventually the robots will be used across the hospital and will also be able to deliver food, Slogic said.
After 20 weeks of renovation, on Aug. 7, some of the beds vacated by the heart and vascular service will reopen as surgical beds, Slogic said.
Ten medicine beds will then close for renovation. They are slated to reopen as neurology specialty care beds in November, which will put them closer to other neurology care.
Another neurology project will convert care spaces into private rooms, which are slated to open in April 2024.
In February 2024, 12 surgical beds are slated to close and to reopen after renovations as psychiatric beds in November 2024, for an addition of three new psych beds to the nine the hospital currently has, Slogic said. At that point, the pavilion will have yielded a total of 54 new beds.
Another project to reopen the vacated psych beds as medicine beds does not yet have a completion date.
In all, he said it’s “five major renovation projects related to the pavilion. We’re very excited.”
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