Lifespan plans to spend more than $60 million expanding or renovating cramped, aging surgical units at each of its three acute-care hospitals in Rhode Island.
New inpatient surgical suites at Miriam and Rhode Island hospitals would cost about $25 million each and roughly double the amount of operating-room space in each hospital. The outmoded surgical units at both hospitals constrict the flow of patients and equipment, compromise patient privacy and fall far short of industry standards, according to certificate-of-need applications submitted to the Health Department by Lifespan on June 10.
Also proposed is a $10.2 million renovation of the inpatient medical and surgical units at Newport Hospital, which would relocate the hospital’s inpatient surgical suite from the fourth floor to a larger space on the second floor.
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The Health Department by state law must determine whether large capital investment in new health-care projects is necessary and affordable. It should make separate rulings on the Lifespan proposals by mid-October.
At Miriam Hospital, officials have proposed construction of a two-story, 49,000-square-foot expansion, to be built adjacent to the existing inpatient surgical unit on the hospital’s northeast side, along Seventh Street. Two small research buildings will be demolished to make way for the expansion.
The surgical suite would occupy the second floor of the expansion and include 10 operating rooms, connecting directly to the hospital’s recently renovated intensive-care and cardiac-care units. The first floor of the expansion would be left vacant and eventually house new services – possibly a radiology unit, said Dr. Kathleen Hittner, president of Miriam Hospital.
The expansion would replace the hospital’s 40-year-old inpatient surgical facilities, which are the oldest in the state. Although there would be no net gain in the number of operating rooms, the project would boost inpatient surgical space from 15,200 to nearly 34,000 square feet.
"The (current) surgical suite is located in facilities half the size of what industry benchmarks recommend," the certificate of need reads. "The physical environment is gloomy and the building infrastructure is obsolete."
For example, guidelines from the American Institute of Architects of Health regarding surgical-suite design require general operating rooms to be at least 500 square feet, but Miriam’s rooms measure just 350 to 370 square feet.
In particular, the hospital needs more space in its cardiac operating rooms to accommodate technological advances in surgical procedures. Cardiac surgeries account for nearly half of all surgeries at the hospital, and Miriam provides roughly 40 percent of cardiac surgical care in the state.
The benchmark size for cardiac operating rooms is 600 square feet, but Miriam’s largest cardiac room is only 400 square feet.
"Some of the rooms are so small, any cases requiring a lot of equipment we can’t do in those rooms," Hittner said.
The lack of space requires the shuffling of equipment in and out of operating rooms, which hampers efficiency and sometimes postpones surgical procedures.
For instance, Hittner said only a few rooms are large enough to accommodate bulky equipment needed for more-complex procedures. When surgeries pop up requiring one of the larger rooms, elective procedures often get rescheduled or moved to another hospital.
And the old infrastructure, limited corridor space and aging ventilation system make it more difficult for the hospital to manage the risks of surgical infections, the certificate of need says. "We have a fantastic staff that has accomplished a great deal with what we have," Hittner said. "But (the project) will make what we have better for our patients, doctors and employees."
The existing surgical area would be renovated to expand diagnostic/treatment services. The entire project would take three years, with a projected opening in 2005.
The new surgical suite at Rhode Island Hospital would be built atop the future, $41 million emergency department, which was approved by the Health Department late last year. The emergency department is to be built across Dudley Street, extending between the hospital’s cooperative care center and the existing emergency department.
The expansion would add roughly 38,000 square feet to the hospital’s current 50,700 square feet of operating-room space. Also, about 36,000 square feet on the third floor, above the new surgical suite, would house a central sterile area for surgical equipment and instruments.
Unlike The Miriam Hospital, which has not experienced an increased number of surgical procedures in recent years, Rhode Island Hospital is scrambling to accommodate growing surgical demand.
Inpatient surgeries have grown 6 percent over the last five years, and the complexity of cases has increased as well, which consumes a greater amount of operating-room time. As a result, annual procedures per operating room have swelled from 784 in 1996 to 869 in 2001. To keep pace with demand, some surgeries are scheduled as late as 11 p.m., according to Dr. Joseph Amaral, president of Rhode Island Hospital.
What’s more, the hospital expects the growth to accelerate as the population ages, and the flow of patients increases from the planned new emergency department and the $20 million cancer center, also approved by the Health Department last year.
"We’re very cramped for OR time, and patients end up getting delayed and moved around," Amaral said. A satisfaction survey of surgical patients conducted last year by the Health Department rated Rhode Island Hospital below the national average. Amaral said he thinks much of the problem stems from the outdated infrastructure.
To alleviate pressure, the expansion project proposes a net gain of two operating rooms, bringing the total of inpatient operating rooms to 18.
Amaral said the larger, more-advanced surgical facilities, along with its proximity to the new emergency department and easier access to the sterile area, would enhance efficiency and allow for increased volume. The emergency department and new surgical suite, to be done concurrently, would take at least three years to finish, he estimated.
At Newport Hospital, 16,400 square feet of space on the second floor – recently vacated by the relocation of services to the hospital’s new east wing – will be renovated to make way for the inpatient surgical unit, now housed on the fourth floor. Once that happens, the fourth floor would be renovated for the medical inpatient unit.
The renovations are needed because both the inpatient surgical and medical units have mostly two-bed, semi-private rooms, resulting in a lack of patient privacy, congested nurses’ stations and scant storage space, according to Newport Hospital’s certificate of need. The project would make 43 of the 57 beds on those units private.
