The Duke University Medical Center Emergency Department will receive $29.8 million to expand and renovate its emergency room facilities in the hopes of improving patient flow issues and preparing for future growth.
"We aren't meeting the needs of the community from a patient-sensitivity perspective," said Kevin Sowers, chief operating officer of Duke University Health System, adding that the current emergency room was built for a volume of 38,000 visits per year and is now seeing more than 60,000.
Kathleen Clem, chief of emergency medicine and an associate professor in the School of Medicine, noted that the average patient acuity, a term doctors use to describe how ill a patient is, has sharpened since the emergency department was originally constructed.
"As a result we are increasingly crowded, and at the present time we are seeing patients in the hall on a daily basis because we don't have the space to see them in regular rooms," she said.
The renovated space is designed to accommodate 90,000 visits per year. Sowers said studies indicate that growth will continue--by 2017, the department expects 70,000 visits per year.
The project, which has been in the design phase for over two years, involves overhauling the pediatric emergency room and creating a more patient-friendly and sensitive environment for adults. The plan also includes two new trauma rooms and space for radiology services.
"The truth is that if you fix the ER overcrowding, you fix lots of the patient flow problems for the whole hospital," Clem said. "We have done what we can to improve efficiency inside the department. Now it's time to enlist the hospital--and the hospital is stepping up to the plate."
Slated to begin in January 2005, the construction will renovate 23,000 square feet of space and add an extra 22,000 square feet over the course of 30 months.
"One reason the project is going to take so long is that we need to maintain full operations during construction," Clem said. "We have an excellent staff in our emergency department who have already gone through two minor additions. During that time we were able to maintain full operations even though walls were coming down and construction was right there."
The previous projects included a clinical evaluation unit, constructed three years ago, and a psychiatric evaluation center that opened in November 2003. Both were designed to increase the emergency department's efficiency and decrease overcrowding, officials said.
"Duke is not unique in the national problem of emergency room overcrowding. What is unique is Duke's way of dealing with the problem in the fact that Duke is being responsive to the needs of the patients," Clem said. "Not only are we working to build a better ER, but also looking at patient flow admissions to help patients move more quickly through the department in general."
The start of construction depends partially on a state-issued Certificate of Need, for which officials will apply in June. A CON is intended to check expansion of facilities and services and prevent excessive or duplicative development in hospitals.
Finch, however, said the expansion is necessary. She noted that even though the facility lacks space, the staff's ingenuity in addressing the problem has led to interesting solutions. For instance, normal consult rooms have been retrofitted with examination tools to try and help relieve the congestion of patients.
"We got ace people here," Finch said. "[We have] professionals who love what they do. We have processes that are tried and true, researched and the ones that you want to have in the emergency room. You put us in a new facility to enhance patient flow and we will be the top emergency department in the nation."
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