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Rick Newman of DEW Construction sweeps up a section of the second floor at the new doctors office complex in Lebanon on March 12, 2012.

Valley News - Jennifer Hauck
Tuesday, March 13, 2012

Hospital has $16.6m expansion plans

LEBANON – A $16.6 million renovation is being planned for Dartmouth-Hitchcock Medical Center to give some breathing room to the critical care and medical surgical units, where available patient beds have been increasingly in short supply.

The project, which New Hampshire hospital regulators will review Thursday, would add 14 adult critical care beds and 16 beds in the medical/surgical unit.

Expanding those two areas is crucial in order to accommodate patient demand, now and in the coming years, said Gail Dahlstrom, vice president of facilities management at DHMC.

The project comes as New Hampshire’s largest health care provider continues to close what was once a projected $100 million budget gap this year, and is now down to $48 million. But adding these 30 beds is considered essential for DHMC to meet its mission, Dahlstrom said.

DHMC is the only hospital in the Upper Valley with the resources to provide critical care, which is for patients with life-threatening conditions who need constant monitoring. Critical care requires staffing levels, training and equipment that smaller hospitals typically don’t have, Dahlstrom said. Thus, the 32 beds currently in DHMC’s critical care unit are in high demand. It is not unusual for DHMC to turn some patients away and send them elsewhere for treatment because there is no room at the hospital, she said.

The critical care and medical/surgical units aren’t always 100 percent full, but they usually aren’t far from it. In 2010, the overall occupancy rate of both areas was at 93 percent. In two years, it is projected to rise to 99 percent and by 2016, the average demand will exceed what is available, according to DHMC’s application for a certificate of need. New hospital construction projects over $2.9 million in New Hampshire require a certificate of need, a process in which hospitals must demonstrate why a new or expanded service is necessary.

Besides forcing critically ill patients to seek care elsewhere, the cramped conditions in the critical care unit has caused “gridlock” that affects other parts of the hospital. Patients end up staying in the emergency department longer than necessary, for example, because there’s no room in the critical care ward, according to the application. The two-phase renovation project is aimed at addressing this gridlock, not only providing more beds for critical care patients, but also expanding the medical/surgical unit for those people in critical care to be transferred when ready.

DHMC is licensed for 396 beds and this renovation will not change that figure, Dahlstrom said. The hospital operates 385 beds total, both licensed and non-licensed beds. (Some types of beds, such as bassinets, do not need to be licensed by the state.)

The renovation is at the heart of a larger shuffling of DHMC staff and resources that will be happening later this year. This fall, about 200 physicians, nurses and staff will move into a new 102,00-square-foot complex being built on Heater Road. Also, DHMC’s mail services are being moved off the Lebanon campus and into a former U.S. Postal Service building in Centerra Park. Those two moves are intended to free up space at the main campus for adding beds.

The $38 million Heater Road building is proceeding “on budget and on schedule,” Dahlstrom said. Meanwhile, the hospital is gearing up to do $150,000 in renovations at the post office building, according to a recent building permit filed with the city of Lebanon.

The renovation proposal also comes as DHMC closes a projected $100 million budget gap this year. As of this week, the shortfall was down to $48 million, said DHMC spokesman Rick Adams. The hospital has cut staff levels through layoffs and early retirement buyouts, closed services such as a pediatric clinic in Canaan, and saved money by being more efficient, Adams said.

System-wide, Dartmouth-Hitchcock has shed 400 positions, Adams said. Most of those cuts came through the early retirement offers and attrition, though 60 people lost their jobs to layoffs, he said.

The Dartmouth-Hitchcock system includes Mary Hitchcock Memorial Hospital in Lebanon, Dartmouth Medical School, the Veterans Affairs Medical Center in White River Junction, the Dartmouth-Hitchcock Clinic and community group practices in Keene, Concord, Nashua and Manchester. The organization employs 8,452 people, more than 6,000 whom work in Lebanon.

Financing for the $16 million expansion could come from either of two different sources, Dahlstrom said. The hospital could make an equity investment in the project using whatever profits it has this year, or it could borrow the money.

Previously, DHMC has looked at more ambitious construction efforts to address rising demand for critical care services, Dahlstrom said, including building a third tower. Such a project, however, could have cost up to $100 million and been prohibitively expensive, she said.

Plus, there’s no guarantee that demand for critical care will keep rising. The advancing years of baby boomers have created a short-term need for more beds. But when that generation has passed, the demand will likely slacken. Plus, the trend within health care is to boost investment in primary and preventative care. And if those investments pay off with fewer people needing to be hospitalized, then a major expansion of critical care beds might not be needed in the long term.

This more modest project is what hospital officials feel is appropriate, she said.

“We consider this the project fundamentally important to provide the right built environment for our patients,” she said. “We believe it is a wise, prudent and essential project at this time.”