Looking for the epicenter of America’s health care crisis? Look no further than hospital emergency rooms.
In April 2013, The Atlantic reported that annual emergency room visits soared from 88.5 million to 127.2 million nationally from 1991 to 2010, although 11 percent of the nation’s emergency departments closed during that two-decade span. And between 1990 and 2005, 339 of the nation’s certified trauma centers closed, leaving communities with fewer and more-distant options in the most desperate circumstances.
Northeast Philly-based Aria Health is reversing that national trend locally with the debut of a new, $37.1 million emergency department and Level II trauma center this week at its Torresdale campus. Monday’s ceremonial ribbon-cutting occurred barely one year after Aria opened a new, $15 million emergency facility at its Frankford campus.
At Torresdale, capacity will increase from about 45,000 emergency visits a year to about 70,000, according to Tom Kurtz, the hospital’s new senior director of clinical operations for emergency medicine.
“Nationally, the number of emergency department visits is increasing, but the number of emergency departments is declining,” Kurtz said. “We want to be the leader in this region in providing that service.”
“If you want to be a destination for emergency care, you have to look the part and this looks the part,” said Dr. Gerald Wydro, Aria’s chairman for emergency medicine.
According to The Atlantic article, which cited data by the American Hospital Association as well as joint research by an emergency physician and economist, operational costs are driving many hospitals away from emergency care while lack of personal health insurance drives many patients to use emergency rooms for their primary care. A downward spiral ensues as hospitals end up eating more of the costs of treating underinsured or uninsured patients.
This is not to say that most of Aria’s emergency visits could be handled more efficiently by family doctors or urgent care centers. In fact, 60 percent of all emergency department visits at the system’s three campuses (Torresdale, Frankford and Bucks County) are considered at the middle or high end of a five-tier severity scale, Kurtz said during a recent tour of the new Torresdale facility.
Many severely injured patients, such as car accident and gunshot victims, are routed to Torresdale because the next closest trauma centers are in Center City, Abington, Montgomery County, and Newtown, Bucks County. Frankford takes about 55,000 emergency visits a year and Bucks about 25,000. Neither is a certified trauma center.
Age is another factor contributing to demand. As a whole, the population is getting older and in greater need of emergency care, Kurtz said. But demand wasn’t the lone factor in Aria’s decision to expand emergency services. The new Torresdale facility is also more efficient and technologically advanced than its predecessor. The staff seeks to reduce or eliminate waiting times and improve “patient flow.”
“If a patient comes in and has to wait to be seen, you haven’t accomplished anything,” Kurtz said.
The new construction covers about 80,000 square feet of space over two floors. Aria obtained $3 million in public grant money from Pennsylvania’s Redevelopment Assistance Capital Program with help from state Sens. Mike Stack and Robert M. Tomlinson. Aria used its own financial reserves and financing from M&T Bank to cover most of the construction costs.
The campus added about 50 new permanent positions to its 2,000-member workforce, in addition to between 80 and 100 temporary jobs related to construction.
The main floor is configured with separate entrances for ambulances and for those who arrive in private vehicles. A nurse will staff the registration desk at the walk-in entrance to provide immediate assessment of a patient’s condition and call for emergency treatment as needed.
Treatment areas are arranged into three pods, each with about a dozen private rooms. Pod 1 will remain open around the clock and is designed to handle the most severe emergencies. Pod 2 will usually open from around 9 a.m. to 2 a.m., depending on demand, and is designed to accommodate middle- to high-severity patients. Pod 3 will open during peak hours, usually from 11 a.m. through the afternoon and into evening.
All pod rooms are equipped with cardiac monitors, wall-mounted computers for real-time charting, flat-screen televisions and washing stations.
An additional five rooms have been designated as “fasttrack” rooms for patients with non-severe ailments such as minor sprains and cuts. These rooms will have a faster turnaround. There are two additional isolation rooms for patients with contagious conditions, such as influenza or tuberculosis. They have private bathrooms and are next door to a decontamination room with private showers.
Uniquely, the new emergency department has a dedicated CT scan room so patients don’t have to be taken to another part of the hospital for advanced diagnostics. X-ray services are also inside the emergency department.
The trauma room is one of the greatest improvements over the former Torresdale emergency facility. At about 1,000 square feet, it has three permanent resuscitation bays and room for several more “litters” in case of large-scale disasters.
“With trauma activation, you have a multi-disciplinary team — doctors, assistants, nurses, X-ray technicians, anesthesiologists,” Kurtz said. “You could have eight to ten people by a bedside. To have enough room for these folks is key.”
The trauma room is a straight line from the ambulance entrance, allowing medics and staff to take gurneys directly from the door into the treatment area. An elevator leading to the upper-floor operating room is just across the hall.
The new construction also includes patient waiting areas, administrative offices, a conference room, a coffee shop and a courtyard. Further, the hospital reconfigured its campus to expand parking and facilitate vehicle flow.
“It’s a game-changer, especially coming from an environment that’s been cramped and undersized,” Wydro said.
“It’s a morale booster for sure, a palpable boost,” Kurtz said.
Visit www.ariahealth.org for more information about Aria Health. ••