BRATTLEBORO—When the current emergency department at Brattleboro Memorial Hospital (BMH) opened its doors in 1982, it handled about 6,000 visits per year.
Today, the BMH emergency room handles about 13,000 visits a year. According to President and CEO Steve Gordon, 72 percent of the patients admitted to the hospital start their medical journey there.
The space that was adequate for the patient volume of 1982 is now cramped and crowded, and fails to meet today’s codes and standards, he said.
“The emergency department is the front door for the hospital. It is the vital lifeline between the hospital and the community,” Gordon said. “It is time to create a better environment for our patients.”
Consequently, BMH has begun the process of modernizing and expanding its emergency department, a project expected to cost about $7.7 million.
In a news conference March 28, Gordon outlined the various stages of the project, which will renovate 8,500 square feet and add 2,500 square feet to the existing footprint.
Last month, the state Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) issued BMH a Certificate of Need for the project.
“We got very resounding support from the state for this project,” Gordon said.
Now that BMH has BISHCA’s approval in hand, the hospital is quickly moving ahead.
After refining the final design, hiring a general contractor/construction manager, navigating the Act 250 approval process, and conducting a campaign feasibility study, Gordon said he hopes to see construction begin this fall and be completed by the end of 2013.
Leading the project will be BMH Director of Plant Services Rob Prohaska and the architectural firm of Lavallee Brensinger Architects of Manchester, N.H. The general contractor/construction manager should be on board shortly, Gordon said.
The project is a complicated one. The first step is to relocate the hospital’s MRI equipment from its temporary trailer to a permanent location in the Richards Building.
After that phase is complete, the project calls for extending the hospital’s current front entrance outward to create a walk-in entrance for the emergency department, one that is separate from the ambulance entrance.
The new emergency department will expand into the space where the gift shop and coffee shop are now located. A new café-style coffee shop will open on the opposite side of the present lobby.
Gordon said the goal is to reduce waiting time, improve patient privacy, and give the emergency department more space to do its work.
“There is a need not just for more space, but for the right kind of space,” Gordon said. “The problem we have now is with the general flow. The space is chopped up, and the staff has tried to make do.”
The new emergency department will have three ambulance bays, six private rooms, a separate entrance for walk-in cases, and a private admissions area.
But until the work is complete, Gordon said, staff and patients alike will have to put up with the disruption of trying to rebuild and expand the department while it is still is in operation.
“The original ER was in a good spot to begin with,” he said. “We plan to work closely with the staff and physicians to minimize the impact.”
Following the plan
The emergency department expansion has been at the top of the hospital’s priority list since the BMH Board of Directors approved its master plan in 2009.
The emergency department overhaul is the last major piece of that plan, which included the construction of the Richards Building in 2009 and modernization of the hospital’s labs and diagnostic areas in 2010.
“This is mostly catching up,” said Gordon. “The ED is 30 years old. When you look around us and see what other hospitals have done, they have a lot bigger capital projects than Brattleboro has done.”
“In a way, that’s a positive. We’re in a good position financially, we’re in the black, and the board has been very conservative with our capital expenses,” he said. “At the same time, I’m cognizant of our limitations.”
One of those limitations is the continued shortage of primary care physicians in Windham County. Gordon said the hospital is purchasing properties in Putney and Brattleboro so the hospital can establish new primary care practices.
“If you lose your primary care base, you won’t have a hospital,” he said.
Gordon is committed to maintaining the hospital’s relationship with Dartmouth-Hitchcock Medical Center in Lebanon, N.H. He said BMH is one of the top five hospitals in New England for referrals to Dartmouth-Hitchcock.
But for now, he said, BMH will maintain its independence.
“We don’t know where health care reform is going,” he added. “You can never say never, but the board is taking a very pragmatic approach when it comes to what the future will look like.”
“We are a very integral part of this community, and I don’t think anyone wants to think about Brattleboro without a hospital,” Gordon said. “As for the issue of independence, we have to see where the marketplace ends up.”
Paying for it all
Even though the hospital is in good financial shape, BMH will be undertaking a major fundraising campaign to help cover the costs of the emergency department upgrade.
Ellen Smith, BMH’s Director of Development, said no formal fundraising goal has been set. “The hospital would love to raise as much money as we can, so we don’t have to go into our reserves or borrow,”she said.
She added that the hospital hasn’t reached out to any of its big donors yet, but that BMH officials have already had individuals step forward to express interest in donating.
“We’re very, very lucky that we have a generous community, and we have a lot of supporters of this hospital who have indicated to us a strong interest in supporting this project,” said Smith.
“It is a very compelling case for philanthropy,” said Gordon.