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Rendering of Ocean Springs Hospital's new emergency department.

Mississippi hospitals aim to relieve the pressure on their emergency rooms by investing in efforts to make them bigger, smarter and more efficient.

ER expansions going on now at Delta Regional Medical Center (DRMC) in Greenville and Ocean Springs Hospital on the Mississippi Gulf Coast, as well as other recent projects around the state, point to hospitals’ efforts to better manage the unit that’s become the “safety net” for their communities.

At DRMC, groundbreaking was held in late March for a $10.6 million building program that includes a new 5,920-square-foot ER expansion along with 3,445 square feet of renovations to the existing space.

The new emergency department is the largest aspect of the hospital’s current four-part expansion. The project also includes the conversion of the former burn center into a heart and vascular center, an expansion of the Maternal Child Center and the addition of a new 64-slice CT scanner.

As the region’s only Level 2 trauma center, DRMC’s emergency department logged more than 45,000 patient visits in 2006. Its expansion over what was previously an area of parking and covered outdoor steps will involve a new, larger waiting area with restrooms. The existing waiting area is to be converted into patient exam rooms, and an existing east dock area is also to be enclosed to create more patient exam rooms.

The remaining space is to be renovated for a more-efficient design, with improvements to consultation rooms, admission and reception areas and nurses’ stations.

As part of the project, the Chest Pain Clinic observation area is being expanded to four beds along with improvements to the cardiac monitoring telemetry equipment. This will connect it to the Chest Pain Center, Intensive Care Unit and the Heart and Vascular Center, so that from any of these locations the record of a patient’s telemetry activity will be available for 72 hours back — no matter in which of these areas the patient has been treated.

“The availability of a 72-hour continuous monitor record for the provider will improve the continuity of care for our patients,” said chief nursing officer Florence Jones.

As the Delta expansion gets underway, Ocean Springs Hospital (OSH) is currently in the midst of a 3,400-square-foot addition to add nine beds for a total of 27 in its emergency department.

The project comes about as pressure in the ER has intensified in the wake of Hurricane Katrina due largely to the fact that many residents do not have primary-care doctors, said David Higdon, director of emergency services.

“We have a lot of folks who’ve moved here that didn’t live here before the storm, including workers trying to rebuild,” he said. “And we have a lot of folks under the care of doctors who decided to leave after the hurricane. We’ve had to absorb all those primary care visits.”
The OSH emergency department has seen 9 percent growth during the last fiscal year with the increased demand for services, and significant growth in the several years prior as well. But some 65 percent of its cases are classified as Level 4 or 5 non-emergencies, Higdon noted.

The current expansion involves increasing the size of the registration and lobby area and enlarging the nurses’ station. The new areas are slated for completion in early September, and will be followed by additional work inside to construct new treatment space in the former lobby. The entire project should be completed by the end of this year.

In the finished design, patients will enter through a new entrance and will be channeled through a new fast-track area for minor illnesses and issues. It will include a four-bed area and dedicated work stations for physicians and nursing staff.

In addition, the new main nurses’ station will be centralized, instead of having all the patient rooms on one side of the hall and doctors and nurses on the other.

“As a result of this, we were able to sit down and redesign the work flow,” Higdon said.

That’s allowed for simple solutions such as providing a more-direct route between the ER and the CT scan and ultrasound areas — which are right next door, but previously had to be entered through another department.

As in any hospital expansion, the biggest challenge at OSH has been building around the ongoing daily work of the department.
“The way our facility is laid out, the entrance that leads into the lobby is at the same end of the building where the expansion is occurring,” Higdon said.

That’s required creating a new, separate entrance for walk-in emergency-room patients a couple hundred yards away from the old ER entrance, and setting up and staffing another triage station at that point. Ambulance patients continue to arrive at a separate entrance and undergo bedside triage.

Since layout and design of an emergency department can have a direct impact on the swiftness and effectiveness of patient care, planning an ER rebuild must begin with careful analysis of the way things work — and how they could work better.

“What you really need to do is map out all the processes and subprocesses that go on from the time a patient walks in,” Higdon said. “You have to pull together all the people who have a stake in it to see what ideas they have, what could be done better from their standpoint and what barriers they’ve faced in the old design. It doesn’t need to be just one guy saying, ‘This is what I like.’”
Even with the larger space and more-efficient layout, pressure on the ER isn’t likely to let up any time soon — particularly as the Mississippi Gulf Coast continues rebuilding.

“As far as we’re concerned, it’s going to be some time before we’ve got enough private primary-care physicians in the community to make much of an impact on the non-emergent use of the ER,” Higdon said. “Given five years’ time, this whole area is going to look totally different, but the next few years are going to be a struggle to get all the physicians we need. I think we’re going to continue to be the community’s safety net.”


June 2007

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