The first patients will come in after 7 a.m. That’s the switchover time – arrive at 6:45 tomorrow, and you’ll be treated in the old Rhode Island Hospital emergency room; arrive at 7:01, and you’ll go into the vast, sparkling-new emergency department in the Bridge Building.
Two full staffs will be on duty for the day, along with the people who’ve been working for weeks to prepare the new E.D., set up the wireless network, install the equipment.
ISO 9001:2026: A Practical Opportunity to Build for What’s Next
For Rhode Island manufacturers, ISO 9001 has been much more than a certificate on the…
Learn More
Hospital President and CEO Dr. Joseph F. Amaral was just starting his career when the old E.R. opened, in 1983. It looked huge at first, he recalls, and yet soon it was full. Within two years, it was operating beyond its capacity. The patient care cubicles had to be divided in half.
The space built for 50,000 patients saw 76,170 last year, and 80,072 in 2002 – before the construction project on Dudley Street created such a mess that some patients started going elsewhere. Even on a quiet day, patients are lined up on stretchers, separated from their families, waiting to be taken into treatment areas. On busy nights, the stretchers are everywhere: alcohol-poisoned college students lying next to grandmothers with chest pain as car-crash and gunshot victims are rolled in.
It’s congested, undignified and stressful for everyone, said Dr. Andrew Sucov, director of the emergency department. “The patients’ anxiety feeds off each other.”
No more. At 51,000 square feet, with long corridors, private treatment rooms for most patients, and segregated units for people with different needs – from the cardiacs, to the psychiatric cases, to the sprained ankles – the new facility will bring sanity, modernity and an overall higher quality of care to New England’s busiest E.R., Amaral said.
“We want to have an emergency room that meets the needs of the people who come here,” he said. “The emergency room is the front door to the hospital. It should be the most appealing place. It should be the most receptive place, the most efficient place.”
Rhode Island Hospital has long wanted to expand and improve its emergency facilities. In 1999, the state Department of Health approved a $20.2-million expansion plan, but hospital officials decided to wait and build a larger space instead.
Meanwhile, the patient volume continued to grow. In 1995, the year after the new Hasbro Children’s Hospital E.R. opened, the Davol emergency room saw 69,249 people. Given the national and local growth trends, by 2010, the hospital expects to treat 103,714 E.R. patients.
Rhode Islanders are particularly heavy E.R. users, national comparisons show, with 429,773 visits, statewide, in 2000, or about 41 per 100 residents. The Northeast average was 37.6 visits.
As the state’s only Level I trauma center, the Rhode Island Hospital E.R. takes a particularly big share of those patients – anyone in a major car crash, gunshot cases, stabbing victims, and others with severe, life-threatening injuries. Its central location, right off Route 95, also makes it particularly easy to get to, further adding to the patient volume. And it’s also the closest place to go for South Providence residents, many of whom are poor and uninsured.
Many in Rhode Island health care circles, especially among insurers and those concerned about high Medicaid expenditures, say reducing E.R. visits, especially those for non-urgent conditions, should be a priority, because treating patients in the E.R. is far more expensive than having them go to a primary-care doctor or a walk-in clinic.
In that context, Rhode Island Hospital’s new facility has raised some eyebrows, and Amaral has faced questions about whether it will in fact encourage more E.R. overuse.
“There are a lot of reasons people end up in our E.R., and some of them aren’t right, but I can’t do anything about it,” Amaral said. “People get incredible care in that environment, and we have an obligation to create a situation where the people who work there have enough space to do what they’re doing, and for the patients to be treated in a civilized manner.”
Or as Sucov put it: “It’s not that we decided to build this huge emergency department so we could get a lot of new patients. We had to correct the problems we had to correct.” And, both men noted, the hospital doesn’t want to make the same mistake twice.
“We expect this new (E.R.) to last at least 20 years,” Amaral said. With its flexible design, he added, “it’s built in such a manner that it could be here forever.”
About two-thirds of the patients admitted to Rhode Island Hospital come through the E.R. – though only one-quarter of E.R. patients are admitted. On average, those who are discharged spend four and a half hours in the E.R., Sucov said; those who are admitted, seven.
In the current E.R., the patient care spaces are so small (about 50 square feet, separated by curtains) that the nurses can barely fit in there; companions have nowhere to sit or even stand.
In the new facility, each patient will have a small room, about 120 square feet, with real walls, quiet and privacy. Family members can stay with them. And patients who come in with chest pain, and would’ve been admitted, just overnight or for a day, to be tested and observed, going up and down the elevators for different procedures, now have a self-contained unit where they can rest, take a stress test, and get any other tests they need, never going through the burdensome admission process, Sucov said.
The new emergency department also provides for two kinds of patients who, most agree, could be better served elsewhere, but that the hospital expects to continue to get in large numbers: the non-urgent visits, who will be treated in a large “fast-track” area, and psychiatric and intoxicated patients, for whom there will be a 10-room unit (including one isolation room).
And to reduce the need for patients to be wheeled around the hospital to get X-rays, CT scans, and various other diagnostic tests, the facility includes a large diagnostic imaging area with four radiographic rooms, ultrasound, two CT scan machines and other gear.
Barbara Riley, senior nursing director for the hospital, said the improved facilities and much-larger workspaces will make a “tremendous” difference for staff and patients alike.
“The nurses are so incredibly excited and enthusiastic about this,” Riley said. They see it as a chance to do their jobs better, she said.
