Sunday, March 3, 2024

NHRMC’s $55M expansion aimed at alleviating ED, Novant claims staffing issues ‘resolved’

Novant Health proposes adding two new floors and 25 acute care beds to the Women and Children’s Tower in New Hanover Regional Medical Center. (Port City Daily photo/Johanna F. Still).

WILMINGTON — Novant Health submitted an application to the state in March to receive a certificate of need in order to expand. 

It proposes adding two new floors and 25 acute care beds to the Women and Children’s Tower in New Hanover Regional Medical Center. The application, obtained by Port City Daily, says the addition is in response to the region’s population growth and will help reduce bottlenecks in its emergency department.

READ MORE: Novant reverses mindset on travel nurses, CMS action plan details recruiting efforts

The move will require North Carolina Department of Health and Human Services’ approval of a certificate of need application. The state has 150 days to review the application, with a public hearing scheduled next month.

The expansion will make the NHRMC’s Women and Children’s Tower five stories tall. The fourth floor will be used as a mechanical and interstitial place while the 25 acute care beds will be located on the top floor. There will also be 10 observational beds, only used by patients for a few hours at a time as they’re being monitored by staff. 

In its application, Novant states the vertical extension is the most cost-effective and quickest option compared to demolishing existing buildings on the 17th street campus.

The total cost of the project is $55 million: $43 million in construction cost, $4 million paid in architect, engineer and consultant fees, $3.4 million to purchase equipment and furniture and a $5-million contingency. Novant will fund the expansion from its reserves; according to its application, the project “will not result in negative net income at any time.”

Construction is slated to begin in October 2024 and finish in July 202 the additional services are planned to open October 2026.

More space, more staff

NHRMC’s ask is based on the 2023 State Medical Facilities plan, which projected the hospital would need to develop 25 additional beds by 2025 to meet community needs. The increase of the acute bed count would bring NHRMC to 696.

It also means it would have to add more staff to outfit the 25-bed expansion.

Last year, understaffing of nurses caused holdups in the emergency room and unsafe nursing-to-patient ratios. The conditions culminated in the death of a 77-year-old woman who coded in the ER waiting room after going more than four hours without a check-in. 

A June investigation led to the hospital being put in “immediate jeopardy” by the Centers for Medicare and Medicaid, threatening the facility’s Medicare contract. CMS restored the hospital’s compliance in August.

A month before the immediate jeopardy determination, NHRMC began reducing travel nurse contracts, contributing to worsening conditions cited by CMS. As part of its action plan, Novant began hiring back traveling nurses, with the goal to fill 315 spots. 

“The staffing issues have been resolved,” the certificate of need application states. “ As of February 1, 2023, [NHRMC] has all the nursing staff it requires and has experienced no recent bed closures due to staffing issues.”

Hospital administration has stated it plans to reduce its reliance on travel workers in the long-term. The hospital also hired more than a hundred permanent nursing staff in the months following the violation. 

It also implemented several programs to recruit and retain positions. Effective February 2023, Novant increased its minimum wage to $17 per hour in North Carolina, benefitting more than 4,400 team members system‐wide.

The hospital’s goal is to continue reducing problems in its emergency department. 

The certificate of need application states NHRMC “needs the proposed acute care beds to ensure emergency department patients requiring inpatient care will be admitted to beds promptly. This will reduce crowding in the emergency department and improve quality of care and patient satisfaction.” 

Novant’s data shows emergency department patients almost always exceeded the number of treatment rooms available at NHRMC from July 2022 through January 4, 2023.

A Novant spokesperson did not respond to requests for how many employees the facility will need once the addition is completed. 

Forecasting future need 

According to Novant’s growth projections outlined in its application, it claims the beds at NHRMC will be highly utilized, reaching 93% occupancy in 2025. Novant stated its certificate of need approval relies on its crucial role in the community coupled with growth expectations through the end of the decade. 

In 2022 it served 30,614 acute care patients and is expected to grow that number by 5,000 by 2027.

NHRMC was purchased by Novant Health in February 2021 and serves seven counties. It’s also only one of two acute care facilities in the region.

The health care entity, which operates more than a dozen hospitals and emergency rooms across North Carolina, is also in the process of building the Scott’s Hill facility to replace the orthopedic hospital on Wrightsville Avenue, along with two other projects in other parts of the state. 

NHRMC is also the only hospital in the primary and secondary service areas that performs open-heart surgery, is designated for Level II trauma services, offers air ambulance services and provides telehealth services to other hospitals.  

Only one other provider in the same region has NICU beds — Onslow Memorial Hospital, located more than 60 miles away. Onslow Memorial and Columbus Regional Healthcare System (the latter more than 48 miles away) are the only providers in the area with licensed pediatric beds. NHRMC is home to half the operating rooms in the service area and has more than 54% of its acute care beds.  

According to the U.S. Census, population growth in New Hanover County grew by roughly 1% from 2020 to 2021, with Pender and Brunswick’s rates at 1.6% or more.

Not only is the region growing, but patients could also have higher acuities once they arrive at the hospital. A Gallup poll shows 38% of Americans reported they or a family put off treatment in 2022, up 12 percentage points from the same poll in 2021. Gallup reports lower-income, younger adults, and women were most likely to report delaying care.

According to Novant, 26% of NHRMC’s patients will identify as a race or ethnicity other than Caucasian, non‐Hispanic, Latino white by 2029. Women will make up 56.5% of patients, 65 and older will make up 46.8%, with Medicare beneficiaries making up 50.9% and Medicaid comprising up to 14.2%.

As a result, Novant anticipates longer lengths of stay and increased patient days — which has trended upward since 2017. In 2021, it listed the average patient days at 6.05, compared to 4.58 in 2017. 

NCDHHS is holding a public hearing on Novant’s certificate of need request April 12 at 11 a.m. in Cape Fear Community College’s Health Sciences Building, room L-107, located at 415 N. Second St. in Wilmington. The department is also accepting written feedback by email and mail.

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