RWJUH's Emergency Room growing in size, scope

NEW BRUNSWICK – Robert Wood Johnson University Hospital is going through a growth spurt — doubling the size and quadrupling the scope of its Emergency Department (ED). Yet, through these major changes, the ED remains open for business, almost oblivious to the goings-on outside.

In the not-so-distant future, the current RWJUH ED will become focused even more on patient needs and access, said John Gantner, CEO and president of RWJUH in New Brunswick. He called the project a "bold undertaking."

"This is no ordinary community hospital ER," he said. "A lot of thought has been put into this. It is all about access and unique populations such as behavioral health, infectious disease, trauma patients, pediatric patients and it is what you would expect from an academic health center that is catering at a different level to the communities we serve. The important message is the uniqueness of the project and that is really designed about access and will be an extraordinary ER."

All services will continue to be offered in a non-disruptive fashion, Gantner said.

"The ER is a source for most of the patients who come into the hospital — they come in through the ER," he said. "So when you entertain a project like this, it disrupts the normal access of flow of patients coming into the facility. There's some dirt being moved around, but Robert Wood is still in business 100 percent." 

As of June 14, the Emergency Department expansion's Phase II began. This phase is expected to last six weeks. All vehicles and visitors seeking treatment must access RWJUH’s Emergency Department via the intersection of Easton Avenue and Little Albany Street during this time. During this time, this area will be used entirely for Emergency Department and patient-related services. Any non-emergency related drop-offs/pick-ups, deliveries or activities will not be permitted as this project continues. The hospital advises that alternate arrangements should be made. Vehicles entering Rutgers Cancer Institute of New Jersey should access Little Albany Street via Easton Avenue.

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Solving growing pains

The ED expansion project is a direct response to an increasing need for emergency medicine and trauma care services in the greater Central New Jersey area, said Michael Valendo, assistant vice president, nursing and patient services at RWJUH. To cater to this need, RWJUH and RWJ Barnabas Health launched the ambitious project, which expands RWJUH’s current ED 50 percent — from 40,000 to 60,000 square feet — and its patient load capability from 42 to 100 individuals.

"We had outgrown that space," said Lori Colineri, senior vice president and chief nursing officer at RWJUH.  

RWJUH sees about 96,000 pediatric and adult visits each year, said Leigh Anne Schmidt, nursing director for the RWJUH Emergency Department.

"We did some modeling and see it going north of six figures in the next decade," Valendo said. "To the 110 to 115,000 visit range based on demographics in the community and population growth."  

"We have grown every year," Schmidt said. "It was very important to have the capacity and make sure we are not opening in full the first day." 

Composed of seven different projects, the ED expansion in its entirety is expected to cost $60 million. That includes more than construction and incorporates movement of various departments, including the Respiratory Care Department and some patient units, internally, Faith Orsini, administrative director, construction services at RWJUH. Further, the Rutgers University Clinical Research Department formerly housed in the hospital is moving to the nearby East Tower building. That opened up a great deal of space for the project.

The Emergency Department remains open during the construction period which is expected to be completed in 2019.

"The majority of the clinical parts of the Emergency Department will be done in two years," Orsini said.  "There will be some tail-end pieces, like offices and back-house space that will go into 2020, but the majority will be done within the first phases — about one-and-a-half to two years."

Outside work

The project started in March with exterior construction — with the dropping down of 28-inches of Little Albany Street in front of the ED entrance and the establishment of new ambulance and front walk-in entrances.

This work also will allow a new ambulance bay better structured to the needs of Emergency Medical Services (EMS), emergency and ambulance professionals. The current ambulance bay goes under the building and that area will be recaptured for interior space, Orsini said. 

"The new real estate we get is crucial," she said. "This allows us to do construction without impacting the operations inside. All of our phasing for the project is on the order of not affecting the daily operations."

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A new ambulance bay will accommodate eight ambulances at one time. During the planning phase, several local EMS providers had the opportunity to give input on the design.

"This will help our EMS providers too," Valendo said. "It is much more efficient area for them than what we currently have. There will be an increase in capacity and we have some dedicated space for them — not only for their equipment but for their staff as well. That is something we currently don't have." 

On the inside

Interior construction is expected to begin shortly after a shuffle of departments and offices are complete, Orsini said.

Once complete, the Emergency Department will feature more than 100 private treatment areas for patients with sliding glass doors, as opposed to the current curtained areas. There will be three additional new state-of-the-art trauma bays that can run two traumas at a time if need be.

"That would be six trauma patients at a time," Orsini said. "And they are being designed pretty close to operating room standard."

The expanded space also offers patients radiology imaging in the department, adjacent to the trauma area. That detail can potentially reduce wait times for test results, Orsini said.

"The minutes that we can save can potentially save lives," Valendo said.

Space for special needs

The Pediatrics ED, already a part of the current facility, will be relocated to near the front door.

"It's current location is not necessarily ideal," Orsini said. "Your sickest adults come in by way of ambulance, but your sickest pediatric patients come in their parents' car. So we will be able to peel those patients off almost immediately as they reach the front door."

The Pediatrics ED also will be revamped with special consideration given to sensory and visual needs of autistic and special needs patients with different flooring, lighting, furniture and paint. There will be a special room, called a "Snoezelen" room that is a controlled multi-sensory environment. 

"A good population of our pediatric patients are special needs and the sensory and the environment is so crucial to keep them in a calm setting and in designing a new pediatrics ED we would miss the opportunity if we didn't incorporate this into it at this point," Colineri said. "Environment is key."

The unit will remain able to see 17 patients at a time but now with private rooms, a play area and a waiting room housed within the Pediatrics ED.

The new ED model will have a dedicated infectious disease room that will be able to segregate those patients immediately. It is able to be accessed from outside, Orsini said. RWJUH is designated as the hospital in the state that handles global diseases, such as Ebola, and has specific trained staff to handle such cases. 

Another new section is a 12-room dedicated behavioral health/mental health suite, which all agreed is a "critical" addition. There are also several internal family support areas that will be situated throughout the ED.

The new ED's flow model includes a fast-track option for patients who arrive at the department with less emergent diagnoses, Colineri said.

"It will allow patients to get in and out quicker," she said. 

Needs of families, patients

Colineri said it is important for RWJUH to take into consideration what patients and families need.

"When we listen to the voice of the customer, we listen to things like privacy and flow — getting in and out quickly, getting to see their doctor or the person who is going to treat them the quickest," Colineri said. "So those are the things in the design — the flow and the redesign of the emergency room to meet the needs of our patients and families. Get them the quickest service of the highest quality and the safest care and package that." 

Though valet parking is being encouraged at this time due to the outside construction, the parking deck will remain the same. Consumers can either valet park at the hospital entrance on Somerset Street or self-park through the Easton Avenue entrance. Valet parking is open 24 hours during this phase. New Brunswick police also are on site to aid with the safety and direct consumers in the construction area.  

The project has several professionals working on the project including John Huddy of Huddy Healthcare Solutions of Fort Mill, South Carolina for space planning and strategic planning, architect Francis Cauffman of Philadelphia, DCC Design Group of Wilmington, Delaware for interior design, Langan Engineering of Parsippany for civil engineering, Highland Associates of Summit, Pennsylvania for MEP (mechanical, electrical and plumbing) engineering and O'Donnell & Naccarato with offices in Philadelphia, Bethlehem, Pennsylvania and Mountainside for structural engineering.   

For more information about the the hospital system, visit www.rwjuh.edu/rwjuh/home.aspx. 

Staff Writer Cheryl Makin: 732-565-7256; cmakin@mycentraljersey.com