DHMC opens new patient tower


Valley News Staff Writer

Published: 05-08-2023 11:51 AM

LEBANON — On a recent afternoon in late April, “Felix” lay in a new hospital room in the recently completed patient pavilion at Dartmouth Hitchcock Medical Center.

Short of breath, but in stable condition, Felix was in a bed in the heart and vascular section awaiting treatment from a care team that was still getting familiar with the new $150 million tower in Lebanon.

With Felix was Mark Cookson, who was sitting in the hospital room’s private bathroom with a laptop.

Cookson is a senior simulation technician at DHMC, and Felix is no normal patient, but rather a robotic mannequin.

He normally lives with the other robots in the hospital’s simulation center. He’s able to mimic the breathing and eye movements of patients and can even emit fluids. On this morning, Felix was there to help nurses and other providers adjust to the lighting, layout and communication system of the new space.

“Small changes can make a big difference to the work experience,” Peter Thurber, manager of DHMC’s Patient Safety Training Center, said.

As a result of feedback from previous training sessions, the hospital had already changed the sound of some of the unit’s alarms. Other training sessions in April included calling emergency teams from other parts of the hospital to determine response times.

This past Tuesday, DHMC moved the first patients to the new tower. It was the culmination of years of work to expand the medical center with the aim of helping to reduce a bed crunch across the region, which sometimes forces patients to travel outside of northern New England for the care they need.

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The opening also comes at a time when the Lebanon-based health system is facing industry-wide financial challenges and workforce shortages.

“For a long time this organization has really tried to manage the care of people in the region with a very, very small inpatient facility,” Dr. Joanne Conroy, Dartmouth Health’s CEO, said during an April 14 ribbon-cutting in the lobby of the new five-story, 240,000-square-foot building.

The two older patient towers, which opened in 1991, contain 396 beds “not including bassinets,” Conroy said. That’s “not a lot of beds to care for an expanding community.”

Last Tuesday, the medical center opened three wings of the new building for the 48-bed heart and vascular service in the new tower, and Wednesday, it opened a new 16-bed medical specialty care unit, which offers a higher level of care than medical/surgical beds, but a lower level of care than an intensive care unit. The 64 new beds were offset by the 36 heart and vascular beds left vacant in an older tower, for a net gain of 28 new beds last week.

The vacated rooms will be renovated and reopened, allowing for other renovations elsewhere in the “legacy towers” that within a few years are expected to yield a total gain of 64 beds, which is about a 16% increase in capacity.

The new tower also has two additional floors that could be built out to add another 64 beds. The timeline for that construction has yet to be determined.

As a result of the new building, DHMC will be able to serve more people in need of care, Susan Reeves, executive vice president of DHMC and DH’s chief nursing executive, said during the ribbon-cutting event.

She pointed to the hospital’s location on the border of two of “the fastest aging states,” Vermont and New Hampshire, and noted that health problems tend to increase with age.

In an interview, Reeves said DHMC is full almost every day. She described the facility’s transfer center as an air traffic control tower and said that being so full is “stressful for everybody”.

The gradual “loosening up” of the facility’s bed tightness allowed by increasing the number of beds is “a good start” to addressing the problem, she said.

In addition to adding more beds, the new building also offers a “comfortable waiting room” for patients to wait for rides after they’ve been discharged, which helps free up their beds for other patients sooner, she said.

Reeves described the design of the new building as “human-centered” and said that each of the patient rooms can provide ICU-level of care and are equipped for telehealth.

“This way the level of care comes to the patient,” she said.

Dan Bennett, CEO at Gifford Health Care based in Randolph, said he is looking forward to any relief that the new beds at DHMC might provide from the bed crunch that can make it difficult to find beds nearby for patients who need a higher level of care than Gifford can provide, but workforce challenges remain.

“We all have dozens of (...) programs underway to train, educate and retain people in the health care field,” he said. But “there’s not enough people out there to just come in and fill all the positions that we have open.”

While opening new beds will help move some patients to the higher level of care available at DHMC, the challenge of how to staff beds at all levels of care remains, Dr. Joe Perras, CEO of Mt. Ascutney Hospital and Health Center in Windsor, said in a phone interview.

Amid fallout from the pandemic, the retirement and other departures of health care workers from the workforce has meant that beds at many facilities that hospitals typically discharge to, such as nursing homes or group homes, aren’t available.

“All the access in the world (is) only good until every bed is full,” he said.

Mt. Ascutney and other members of the DH system are doing what they can to build pipelines to train new workers, Perras said. But, “it takes a while.” In the meantime, facilities are left competing with each other for workers.

As of Thursday, DHMC and DH clinics had nearly 800 positions listed on the jobs page of its website.

DH officials have cited the workforce shortage and the difficulty discharging patients to other facilities as driving forces behind recent financial losses. The system’s most recent financial filings from February indicate that it saw an operating loss of $78 million, or 5%, in the first six months of its fiscal year, ending Dec. 31, 2022.

Late last year, the health system, which includes DHMC, Mt. Ascutney, Alice Peck Day Memorial Hospital in Lebanon, New London Hospital, Cheshire Medical Center in Keene, a visiting nurse agency and several clinics, launched a performance improvement plan with the goal of achieving a break-even budget in the fiscal year that begins July 1, 2023. The plan includes goals such as bringing up revenues, reducing expenses and increasing capacity at DHMC.

In the February filing, Dan Jantzen, DH’s CFO, said the new pavilion would put the system in a “stronger position to meet excess patient demand”.

DH officials said several times that the project was completed “on time and on budget”. The money for the project was secured through the issuance of bonds in January 2020, before the COVID-19 pandemic hit the Upper Valley.

Conroy, in an interview, said the project managers anticipated supply chain issues early on in the project and ordered materials ahead of time. Supplies, such as steel, which they ordered as much as a year in advance, where stored in Lot 9, a parking area located in Hanover near Jesse’s Steakhouse. In addition, she said they worked to complete the exterior quickly to allow workers to work in warmer interior spaces. The construction teams worked through the COVID-19 pandemic, often with as many as 15% of workers out due to illness, but Conroy said they “figured it out”.

At the ribbon cutting, Reeves spoke about the new Barrington Nursing Education Center, housed on the first floor of the new pavilion, which brings together DHMC’s nursing education efforts in one place. The space will be a hub for the 1,000 nurses, medical assistants and traveling nurses the facility welcomes annually, Reeves said.

The new building also includes features aimed at reducing strain and increasing safety for employees such as co-working spaces, respite rooms and natural light.

In addition to the lobby and discharge lounge, the building’s first floor has a new interfaith chapel, as well as private showers and changing rooms for patients’ family members who may spend the night on the pullout couches in the patient rooms. The inpatient floors, levels 3 and 4, also have lounges where visitors and family members can sit and gather.

The rooms are equipped with electronic room signs that will be connected to patients’ electronic medical records to inform those caring for them of information such as allergies the patient may have, Scott Slogic, director of clinical special services for nursing who is director for the patient pavilion activation, said during the ribbon cutting event. In the older parts of DHMC, that information is less readily available. A monitor next to the bed will be regularly updated through the medical record, providing caregivers with information such as vital signs and the patient’s pain management plan.

Through an iPad connected to the bed, the patient will have access to an application called MyChart Bedside, so they can view their own medical record. Each room also is equipped with a video monitor to allow for consultations with a specialist, or for meetings with the patient, care team and out-of-town family members.

These features are intended to benefit patients and their families, as well as the facility’s employees.

“While the Pavilion is impressive for its structural capabilities, I think its greatest strength will be what it will do to empower and support our people,” Brant Oliver, Dartmouth Health’s system vice president for care experience, said in a news release about the project. “And our people remain our greatest asset.”

Lia Fiore, a traveling nurse who helped bring Felix back to life after his heart stopped beating during the training in the new pavilion in late April, said she was impressed by the design of the new rooms. The colors and big windows gave her “a relaxed vibe”, she said following the session.

According to a description by HDR, the project’s architect, the new building includes accents of reclaimed wood from New England barns. Large windows and views of the outside are intended to help reinforce circadian rhythms and promote healing.

The aesthetic of the new building also struck Roberta Hines, who chairs DHMC’s board.

“I personally am just enthralled with the artwork,” she said in her remarks at the ribbon cutting. It “feels so welcoming and warm and homelike. (I) can’t wait to hear what our patients think.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.