Hospital agrees to build on community projects
Women & Infants Hospital has been cleared by Dr. David R. Gifford, the state health director, to build a $64-million, five-story addition to its main building, including a new neonatal intensive-care unit, but only after agreeing to build new community partnerships.
Specifically, the hospital agreed to develop a pilot program to ensure continued care for fragile infants who come out of its NICU, in collaboration with the state Department of Human Services, RIte Care payers and physicians in health centers, hospitals and private practice.
In addition, the hospital agreed to expand its work with health and social service providers in the community to better care for women in high-risk pregnancies, help lead statewide research on low birth weight infants, and improve patient services at its Women’s Primary Care Center, extending its hours and providing at least an after-hours phone line.
The conditions, to which Women & Infants President and CEO Constance A. Howes did not object, were attached to the project approval on Nov. 1 by the state Health Services Council, which advises the health director on “certificate of need” applications.
The council, which went on to approve the project unanimously, was responding to concerns from Health Insurance Commissioner Christopher F. Koller.
The council’s Project Review Committee, which had been examining the hospital’s plan since July, had unanimously recommended approval, without any added conditions, two weeks earlier. But Koller, who worried that the new NICU would accelerate an already fast rise in utilization of intensive-care services, worked with the hospital and with community-based providers to find ways to try to prevent unnecessary hospitalizations.
“I think he was concerned about what are we doing to prevent prematurity, to provide care in the appropriate place,” Howes said in an interview.
The NICU treats babies who are very fragile, often severely premature, and even after they’re released, they often have chronic lung disease or other medical problems that can lead to frequent emergency room visits, Howes said.
By working to provide a “medical home” for each baby, with a caregiver who knows how to handle such problems and detect early signs of a crisis, the new Women & Infants programs may help reduce hospitalizations by keeping the babies healthier, Howes said.
Regarding other planned efforts, geared to reducing the rate of premature births, Howes was somewhat less optimistic. On one hand, she said, Women & Infants already has researchers working on identifying possible genetic risk factors.
“But there are many cases of premature birth where there are no identified risk factors,” Howes said. Rhode Island has done “a pretty good job” of reducing premature births, she said, and while she’s committed to doing better, she called it “a big challenge.”
As for the Women’s Primary Care Center, Howes said the hospital is looking at whether expanding the hours would be a cost-effective way of dealing with women who have “routine or urgent care matters” who are now getting emergency care.
The hospital could use a reduction in the emergency patient volume, Howes said, because “we often have very overcrowded conditions, and that leads to lengthy patient waits.” With pregnant women, however, “the line between urgent and emergency is very fine,” she said, and sometimes, emergency care is necessary.
The 144,500-square-foot addition, which along with the new NICU will include 30 new obstetric beds and more space for family services, is the biggest building project for Women & Infants since it opened its facility at Gay and Dudley streets 19 years ago. It will increase the building’s size by 54 percent.
To pay for the project, the hospital plans to borrow $30 million in tax-exempt bonds, raise $16 million from donors, and get the remaining $18 million from equity funds.
The single-biggest reason for the expansion, as Howes has described it, is the severe overcrowding of the current NICU, which was built for 41 infants but now serves, on average, about 65 babies each day. The new NICU would accommodate 80 infants, and would incorporate a new model of care, with individual rooms, instead of a big common area – an approach that research has shown leads to better health outcomes.
Women & Infants delivers about 73 percent of all babies born in the state – more than 9,600 last year, more than any other New England hospital – and it serves as a regional hub for women and babies who need advanced and intensive medical services.
Now that Gifford’s approval is in place, the addition has entered the design phase, Howes said. Hospital staff and patients and their family members are being invited to participate, “so we can get the best design possible.” Construction is slated to begin in about a year.
