Steve Spencer, owner of the Birmingham Medical News, recently sat down with Keith Granger, CEO of Grandview Medical Center to talk about the new facility.
Has patient volume increased in the new location?
In our first two weeks, we're seeing an equivalent number of patients, but that is trending upward, increasing pretty dramatically over the last ten days. We're getting more patients through ambulance arrivals to our emergency room and they seem to have a higher level of acuity than what we saw at the other facility.
Are many of the new patients coming from areas you had not serviced before?
We are finding a much more significant influence into the south, east and west portions. But we would've predicted that with the connectivity with I-459, 280 and I-20 as well as up and down I-65. The location is convenient. It's no more than a 10 minute drive in many cases.
What percentage of patients are people who never used Trinity?
We've just started to capture that data. I don't think it's statistically significant at this point, but intuitively, we see a lot of people who have never used our facility before. We're getting patients from up and down the 280 corridor and we're amazed at how much of that has been an east and west draw.
What percentage of your patients is coming from doctor referral versus the patient picking the hospital?
In general, about 40 to 50 percent of admissions will route themselves through the ER or direct referral from a doctor. Others are more elective in their decision making.
But we've always had a large service area that represented over 100 zip codes. We think that will continue to be the case here, but we'll see a heavier penetration in certain zip codes.
Many people have asked us for recommendations for physicians who are on our medical staff so that they can get aligned with one of our physicians.
The other thing we've noticed is the strength of relationships up and down the 280 corridor with physician offices, imaging centers, and urgent care centers. There are a lot of providers who are already in the marketplace and we want to be a collaborative partner with them.
What's the difference in capacity between Grandview and Trinity?
Trinity was typically staffed for 275 to 300 patients. Here we'll have a capacity of 372 patients. Even though we had more licensed beds at the old facility (500 beds versus 372 beds), the volume was not as high as the licensed bed capacity.
So the 372 beds we have here for inpatient capacity will allow us to have growth but so far, the outpatient volume growth has been faster than the inpatient growth. That's because so many surgical procedures are now performed on an outpatient basis.
How quickly are you moving people through the ER?
We've had a history of having the shortest wait time from patient arrival to seeing a physician. We pride ourselves on trying to get a physician to see every ER patient within 30 minutes of arrival. We actually average less than 30 minutes. According to the data, we had the shortest wait times in the city over the last year.
Once the patient's presentation has been identified and we determine the level of acuity, the average patient spends two to three hours in our ER based on the level of care required.
We built this emergency room to handle up to three times the volume we had at Trinity. We built some overflow areas adjacent to the ER should there be some major natural event in our community like a hurricane or flood. We have the capacity to do a surge activity, incorporating the use of some pre-operative and post-operative rooms adjacent in our cardiac cath lab and bronchoscopy areas.
We have located our cath lab right at the ER so we can get a heart attack patient quickly to the cath lab to open up arteries to avoid damage. This will be much quicker than typical set-ups where you're going down long corridors, catching elevators to go somewhere else in building.
That's an advantage of building a new facility. You can design some of these work flow efficiencies into the building.
Did you redesign much inside the building?
Floors five through nine were fairly complete. But we did have an open footprint on floors one through four, as well as 10 and 11 above.
We took a lot of the features that had been put into the building and utilized them. The OR floor, for example, was always intended to be the 4th floor. And we left it there. We took some of the initial design and incorporated that into it.
We adjusted where it was required. The biggest thing we did was make sure we had the right departments in the right places so that those that needed to be side by side were properly situated.
And we had to plan for the parking deck. It was not originally designed quite the way we did it. We took the physician office building and the hospital and we formed an L, and we dropped the parking deck between them so you can park once and go to either one. This reduces people's walking distance.
What's different for patients at Grandview compared to Trinity?
I would say the flow of services and the ease of access. We've designed it to be patient friendly. Whether you're going to get something to eat or to your loved one's room, it's one floor. There is vertical integration so you don't have long halls and have to walk through multiple buildings to get to a particular point.
It's a beautiful building with almost a hotel look. Patient rooms have windows looking out at a comforting view. And it's a quiet building. It's designed so that noise doesn't travel from room to room a whole lot.
Also, we've incorporated some technology that will be very beneficial both clinically and for the patient's experience. They can get education about their illness on the flat screen TV in their room. Certain information from their medical records is displayed on a digital board - your nurse's name; your next of kin; phone numbers; your pain threshold; your goals for recovery; things that allow the patient to be connected to their care through digital technology.
We're also using some monitoring equipment. We've elevated the level of physiological monitoring in our ICU and certain med surge floors where changes in patient's conditions can be detected quicker. And we've given our nurses technology that will allow them to be immediately alerted through a smart phone.
The patient can initiate an alert. And some of the alerts are automatic. For example, a patient's heart could be elevated, setting off an alert. Or a drop in the patient's oxygen concentration could initiate an alert. This helps us catch problems quickly.
One thing that does not differ between Trinity and Grandview is our staff's focus on patient satisfaction.
There is a friendliness and compassion that we bring from Trinity.
Is the POB full?
It's about 85 percent full in the offices that are finished, which is a little ahead of where we expected to be. Some physicians have already moved in while others will be moving in each month. We wanted to have some excess capacity for growth.
Of the 85 percent - how many are from Montclair and how many are new?
Probably about two-thirds are existing physicians. And about one-third are new physicians who have come to our medical staff. We have had tremendous interest from doctors around the community. We have a whole pipeline of applicants who are now being processed.
What has been the effect on traffic?
AL Dot did a great job with improvements. And we've tried to be conscious of traffic in how we staff. Most of our employees shift changes are 6:00 or 7:00 am and pm. All our surgery patients are here by 6:00 am. We also participated with the state in adding a lane both east and west. So we think in many ways we haven't been a major factor in traffic.
The EMS people say it will cut their drive time by half getting to us compared to going downtown. That allows them to get back in service quicker which is good for emergency patients. So we think we've helped the EMS system.
What is your vision for the hospital?
Our vision is that we will be drawing patients from multiple states. In fact, just this week, one of our physicians had five cases and three of them were from Tennessee. We'll have some very sophisticated, specialized care that other community hospitals may or may not offer.
Our goal is to grow the footprint of Birmingham. It's already a great medical community. We want to add to that and draw more patients in from other states, other referral sources and bring the best physicians here.
The Cahaba Grand is a great asset to share the campus with because we'll be able to have conferences there. A group of surgeons might fly in to learn about a special level of technology that we've added. We could pipe video from our ORs to the conference center so they can see. And they can come to the hospital and observe.
We have a great number of possibilities that will unfold over the next five years.
How does this facility compare to some of the best facilities in southeast?
I think that, with what we are putting together right now and some of the technology we've deployed, we will have as good a facility as anybody in the southeast. In fact, there are only 40 to 50 sites in the USA that have some of the physiological monitoring we're putting in place. We're the first in the southeast with this.