Hospital to revamp ER

By COLIN M. STEWART

Tribune-Herald staff writer

North Hawaii Community Hospital is set to begin this summer a $9 million expansion of its emergency department.

The project, said hospital CEO Ken Wood, is part of a larger effort to help the small, rural facility meet the growing demand for medical care services in North Hawaii.

“Our hospital just had its 15th birthday last May,” he said on Friday morning. “It was built at a very different time, even in the technology and the way emergency departments were configured.”

From its beginning serving about 6,000 patients a year, the emergency department has ballooned to serving about 12,000 a year, Wood said. By comparison, Hilo Medical Center, the second busiest emergency department in the state, serves just shy of 40,000 patients a year.

“When we have a busy day, people are delighted with our care, but some of our beds are in the hallway,” Wood said. “Even though most rooms have curtains, it’s gotten to where there’s no real privacy. The world has changed.

“We saw we needed to step back and see how we were providing emergency care and see how we could better serve our patients.”

Hospital administrators, staff, physicians, patrons and even patients provided input on how to improve the experience in the emergency department, Wood said. First and foremost, the hospital looked at decreasing wait times.

“I hate having people wait in the emergency department before getting to see somebody,” said Medical Director Dr. Gary Goldberg, “but sometimes we’ve been forced to do that.”

Traditionally, emergency rooms have given low priority to treating patients with minor injuries and illnesses, he said. But as people in the community turn to emergency rooms more and more for primary care services, hospitals must be able to adjust.

“People coming in for non-urgent care account for 70 percent of our visits,” Wood said. “We decided to try and deal with these minor issues within a onehour target. That way we can send them on their way and deal with more emergent situations.”

Meanwhile, handling patients with emergency situations followed by discharge, which accounts for 12 percent of the visits to NHCH’s emergency department, would be handled within a two-hour or less window, and emergency care followed by admission to the hospital (accounting for 14 percent of visits) would be handled within no less than three hours.

Lastly, emergent care situations that would require transfer to an off-island hospital like The Queen’s Medical Center, which makes up 3 percent of visits to the emergency department, would be handled with a goal of taking no longer than four hours.

“This represents a substantial decrease in wait times,” Wood said.

The hospital plans on making such decreases a reality by improving efficiency, technology, work flow and facilities. Perhaps the biggest change will be the way in which test results are obtained and provided to the patients.

“Fifty to 70 percent of lab work can be done with portable machines right at the bed side and take no more than 5 to 7 minutes,” Wood said. “That’s a big difference over a phlebotomist taking 45 minutes to an hour to turn around blood lab work. It also provides the physicians with greater continuity of thought. Now they can see the lab results almost immediately and make a decision before moving on to the next case.”

Making a move to using electronic medical records will also cut down on patients having to fill out endless forms each time they show up in the hospital, while keeping all pertinent information at an emergency room doctor’s fingertips.

Lastly, he said, the emergency department will be more than doubling in size, going from 2,700 square feet to 6,000 square feet, providing a capacity of up to 16,000 visits a year. The expansion will take the department from four beds to 12, creating 12 private treatment rooms, including one designated for full trauma, nine for regular treatment, and two triage or minor treatment rooms.

The extra room will mean increased privacy for patients, making the experience less stressful for them, Goldberg said.

“I’m a big believer in getting people into the department quickly and having high quality of service, while also maintaining people’s dignity,” he said. “When you stick somebody in the hallway, that message gets lost.”

Goldberg added that hospital staff have worked hard to make due with the room they now have, and the expansion will go a long way to making their jobs easier.

“I have tremendous respect for the nursing staff and hospital crew in terms of what we try to do for our patients,” he said. “We haven’t had space to provide the service we’d like to provide.”

Construction on the new addition will begin this summer and continue for a year. The pricetag for the work is estimated to be $9 million, of which about half has already been raised through donations from the community. Because the hospital is private and not part of the state network of hospitals, it will have to raise all funds itself through donations, Wood said.

For more on the emergency department expansion and ways to help fund the project, visit www.nhch.com and click on “Giving” on the top menu bar.