ECH begins $13M expansion of ED

By on May 9, 2012

By: MICHELLE REIFF Review Staff, Staff Writer

Ephrata Community Hospital (ECH) says it has responded to the needs of the community by breaking ground on a $13 million expansion project.

The expansion will double the size and treatment capacity of its Emergency Department (ED). Currently, there are 16 treatment areas; there will be 26 treatment areas when complete. The project adds 13,000 square feet to the hospital, creating a 26,000 square foot ED.

According to John M. Porter Jr., hospital president and CEO, the challenges in patient throughput due to the increasing number coming into the ED, precipitated the decision to expand. The project actually has been in the works for several years.

"We had intended to start this process in 2008 and ’09. The economic downturn hit hospitals as well as every other business," he said. After waiting a period of time, the hospital got the go-ahead from the board last fall to proceed with the projects.

The current ED was built in 1986 to serve 16,000 patients annually. The hospital anticipates that 32,000 patients per year will seek emergency care at Ephrata in 2012.

"Unfortunately this means that we serve patients in the hallways every day," said Porter. "Sixty percent of our admissions come through our department. That is not the way we would like people to start off being served. We just do not have enough room to process patients correctly."

Porter assures the decision to expand had no correlation to Lancaster General Hospital’s (LGH) construction of an Ephrata area urgent care facility. He said LGH was open with him about that decision.

"We’re so undersized with what we have that it would have not deterred us one iota in terms of going forward with the project," he said.

In fact, ECH is developing its own urgent care strategy, but it is not finalized yet. It already has one urgent care center in New Holland which basically operates after hours, evenings and weekends; it is looking at how to add another entry to that market.

The hospital previously addressed the problem of throughput in the emergency department in 2004 when it took an adjacent space in the hospital formerly housed by the respiratory therapy department and created E-Care. This urgent-care-type division has a triage function where patients meet with nursing staff to identify their concerns; if they do not need the emergency department immediately then they are served in E-Care. The fact that E-Care is adjacent and not contained in the ED has created a challenge with staff efficiency. In light of that, the new addition will bring the E-Care function back into the department. It will allow for streamlined triage, diagnosis and treatment of emergency patients, especially for those with more acute needs.

Although Ephrata’s ED receives less patients than Lancaster General and Reading, which both handle over 100,000 visits per year, patients often come from outside the normal service market of 15 miles in all directions. One reason for this is constriction in terms of volume at other facilities.

"I think generally, too, our campus is accessible; our campus, location and facilities are fairly easy for people to navigate at a time when they’re under stress," said Joanne Eshelman, director of community relations for ECH."

In addition, Porter attributes the volume increase to the reputable institution the hospital has become.

"Ephrata has developed a good reputation as an institution for quality and service and I think that’s really how institutions have to differentiate themselves today," he said. "It’s not the facility itself or the technology; it’s the service and the people that make the difference."

This reinforces the challenge to live up to what people expect their experience as a patient to be. Therefore, the new addition will also feature expanded services, care and safety.

The expansion will include a behavioral health crisis center for better evaluation of patients with behavioral health concerns. Currently there is only one room for this type of care.

Another feature will be a dedicated area within the new ED to be used for incoming stroke patients.

"We are a certified stroke center by joint commission today," said Porter. "We’ve been surveyed twice — we’ll just now have the facilities to go with that as well."

Because the emergency department will be larger, there will be an increased level of privacy for patients and their family members.

Security features within the new emergency department allow for a quicker lock-down of facilities for the safety of all patients. The new unit will include an enhanced security monitoring system for patients entering the system and those in triage.

The first phase of the project has already begun. On May 1, demolition work was started on site prior to construction of a new garage to house Advance Life Support units. The garage is set to be complete in August.

"We have built the garage with strengthened steel so that eventually we’ll be able to put a helipad on the top of the roof of that building," said David Peck, assistant vice president of support services. "If in need of a helicopter evacuation we can bring them right out and right to the helipad." The hospital has received FAA approval and is waiting on final borough approval for the use.

In August, work will begin on the ED addition, set to finish in March 2013. After this, renovations to the existing space will begin, along with a new entrance and conference rooms. The completion of the entire project is set for December 2013.

Work on this project will be done in phases, designed to maintain the full services of the department. During the project, there will be changes in traffic flow for ambulances and walk-in patients. Patient care will continue at the same level throughout the entire process; staff will work with customers to clearly communicate the changes as they occur.

Before the ED construction could even begin, however, another project needed to be completed: the HVAC system was 35 to 40 years old and needed to be upgraded. This work began in fall 2011.

The first step was installation of a new chiller that increases the cooling capacity and allows for increased facility growth in the future. The system is energy efficient and reduces the hospital’s expenses for energy use.

"We took our cooling capacity from 750 tons to 1,000 tons of chilled capacity (measurement refers to tons of ice) and we changed out one of our chilling capacitors to make it bigger," said Peck.

Work on the boiler will begin this summer. The hospital will be replacing the two 30-year-old boilers with two brand new 530-horsepower boilers.

The HVAC project costs total $2.2 million, with $1 million coming from RAC-P funding through the Commonwealth of Pennsylvania.

Another related project commencing at the end of this month will be the addition of two C-section rooms to the hospital in the third- floor maternity unit. With these new rooms, patients will no longer need to be transported, as they are now, down one floor in an elevator to the main operating room. The added third-floor space will overlook the new ED.

The larger ED will create a positive economic impact by allowing for potentially 20 to 30 new positions within the hospital. Also, during the two-year construction project, the expansion will create work for more than 300 construction workers and subcontractors.

"We are adding 10 beds, so I would estimate some of those positions will be required to treat the patients in the emergency department," said Eshelman. These positions could include nursing, support staff and potentially mid-level physicians.

"It certainly has infused capital dollars into the local community — most of the companies that we have used are local," said Peck, referring to Benchmark Construction Company Inc., the general contractor, and Frey Lutz and Guardian Electric, sub-contractors, all from areas closely surrounding Ephrata.

Construction will cost approximately $8.5 million; $4.5 million will be needed for equipment. The bulk of this will include lifts for bariatric patients in some rooms, new stretchers and the replacement of all the monitoring equipment which, according to Peck, goes hand-in-hand with the hospital’s conversion to electronic medical records.

"The data will flow right into medical records, which will increase patient care and decrease error," he said.

The project will be financed through Fulton Bank and the hospital is conducting a capital campaign to help with the costs of this important expansion. The campaign chair is Charles M. Evans, MD, a retired orthopedic surgeon who was a long-time member of the ECH medical staff and a current member of the hospital’s board of directors.

Campaign committee members have been actively involved in securing gifts over the past year. The initial, private phase of the hospital’s campaign has raised over $3.1 million already from board and executive members and close business associates.

The public phase of the campaign will begin on June 2 at the annual Day in the Park event, where actual floor plans and architectural renderings of the building will be available to view.

"And people that drive by are definitely going to notice that there is work starting on the campus," said Eshleman.

Over the next year, the community will be encouraged to help build the new ED — which could touch any community member on any given day — through their contributions to this campaign. The total goal of the capital campaign is $5 million.

Porter is pleased with the money raised so far and said it is right on target with goals.

"This touches a lot of people that live in this particular area. I think it’s easy for them to understand that this is something the community needs to address," he said. "As a non-profit institution we are owned by the community and we want to be an asset for them." More ECH, page A16

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