Kaweah Delta begins expansion of overcrowded ER


Hospital will spend $32 million to double the size of its Emergency Department over the next two years

By Reggie Ellis @Reggie_SGN

VISALIA – The average person spends more than three hours in the Emergency Department at Kaweah Delta Medical Center. That’s a long time to wait to find out the severity of an illness or injury, or if a loved one will make it through the night. And while that time is about average for hospitals nationwide, Kaweah Delta wants the experience to be better by adding more space, comfort and staff.

On Monday, Dec. 4, Kaweah Delta closed down the primary entrance to its Emergency Department (ED) to begin construction to expand the ED. The two-year, $32.8 million project will nearly double the size of the ED from 41 to 74 beds and will more than double the size of the waiting area to accommodate over 100 people compared to about 65 currently.

Kaweah Delta CEO Gary Herbst said the hospital’s ED was built in 1992 to accommodate 36,000 patient visits per year. When the Acequia Wing was built in 2009, the ED was expanded to accommodate 72,000 patients per year. But less than five years later the demand for care at the ED had already outpaced space. The ED saw more than 80,000 patients in 2013 and more than 93,000 in 2015. In 2017, Kaweah Delta’s ED sees more than 250 patients per day. Herbst said he expects those numbers to grow.

“If this hospital were in Los Angeles, it would be the third busiest ED in town,” Herbst said.

The reason for increased demand at the ED is three-fold. Kaweah Delta is the only Level III Trauma hospital between Fresno and Bakersfield and serves about 600,000 people between Tulare and Kings counties. EDs are required by law to treat every patient, regardless of the acuity of their condition and their ability to pay. And, many people misuse the ED for conditions such as minor strains, sprains, lacerations, fractures and cold and flu symptoms for the elderly and those with related health concerns (such as asthma) should go to urgent care, which could be treated more efficiently and less costly at urgent care. EDs should be only be used for open fractures, severe trauma (such as a traffic accident or falling off a roof), gunshot wounds, chest pains, emphysema or patients who are not responsive.

In order to treat patients with non-life threatening injuries or conditions without turning them away, Kaweah Delta will also be carving out a new Fast Track section behind the main lobby to act as an on-site urgent care. Dan Allain, assistant chief nursing officer for critical care administration, said the Fast Track will have eight exam rooms to see patients with non-life threatening conditions.

“Most hospitals now have a similar place for those patients,” Allain said.

The current ED will not be affected, except for the occasional construction noises, and all of the hospital’s services will remain open during construction, but there will be changes for those arriving at the hospital on their own. Patients requiring emergency care will enter the ED through a side door near the hospital’s main lobby entrance or through the temporary tent sent up to handle overcrowding during flu season. The ED tent went up last month and will remain part of the ED through January.

With parking set to be eliminated on site Kaweah Delta has worked with its partners to convert Acequia parking structure levels 2, 4 and 5 to all day parking while leaving Level 1 as a three-hour parking. Photo by Reggie Ellis.

With parking set to be eliminated on site Kaweah Delta has worked with its partners to convert Acequia parking structure levels 2, 4 and 5 to all day parking while leaving Level 1 as a three-hour parking. Photo by Reggie Ellis.

In order to accommodate the 75 parking stalls that will be lost to the expansion, Kaweah Delta has worked with the City and private partners to provide more three-hour and all-day parking in the parking structures across from the hospital. Across from the Acequia wing of the hospital, all of Level 1 of the Acequia parking structure is three-hour parking and levels 2, 4, and 5 are now all-day parking. Across Locust Street from the main hospital, the Willow Plaza parking structure’s Level 1 is all three-hour parking, while levels 2 and 5 are now all-day parking. Fifty-one parking stalls will remain in the parking lot below the helipad.

“The valet will also be expanding its hours and is a completely free service,” Herbst said.

Phase one of the project began Monday and included closing the ED’s main entrance and the hallway to the right of the main lobby. The new ED lobby and 24 of the new 33 exam rooms will be built in Phase 1 between February 2018 and Spring 2019. Phase 2 will include constructing a lab draw station and Fast Track for non-emergent patients and is expected to be completed by winter 2019. Phase 3 of the project will complete the expansion by adding nine new exam rooms north of the current ED.

“My belief is that the chairs will go away after the expansion,” Allain said.

The estimated $32 million project will be funded through $100 million in revenue bonds that the non-profit hospital district sold in December 2015. Partial proceeds from the bonds are also paying for the expansion of the Exeter Health Clinic and a second urgent care at Riggin Avenue and Demaree Street.

Kaweah Delta’s urgent care is expected to open in late spring 2018. Once the ED expansion and northwest urgent care are complete, Allain said he thinks Kaweah Delta will be able to accommodate the current and some future demand for emergent and urgent care services.

“Our best estimates say this should be able to handle the volume for the foreseeable future,” Allain said.

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