LRGH

Private rooms like this one, furnished with state-of-the-art equipment, have replaced curtained spaces and facilities following a $7.5 million renovation to the emergency department at Lakes Region General Hospital in Laconia. The renovation – which was funded entirely with private donations – also focused on making physical improvements to improve the work flow and make patient care more efficient. (Courtesy photo)

LACONIA — Even as they try to solve financial problems through a merger, Lakes Region General Hospital leaders are maintaining and enhancing as much local care as they can, President and CEO Kevin Donovan said Thursday.

Front and center in that effort is the completion last week of the first and largest phase of a $7.5 million emergency department renovation funded by private donations.

Donovan said doctors designed a department where private rooms and state-of-the-art equipment replaced curtained spaces and facilities that were starting to show their age.

“They went through each and every room and planned where things should be hung on walls and everything,” Donovan said. “There was a tremendous amount of thought from the staff’s perspective to get it right. Unlike a traditional build or redesign, where the architects do it, the clinicians were involved first on how the flow should go.”

Donovan, Dr. Joshua Morrison, medical director for the emergency department, and Cass Walker, chief human resources officer, sat down for an interview Thursday to discuss hospital improvements and future plans.

Speed of the essence

“We are proudly part of a team that leads the state in many of the quality and efficiency benchmarks for emergency departments,” Morrison said. “We sit at about the 85th percentile nationally for our benchmarks, but we are striving to be better. We’d love to see that 95th percentile for our benchmarks.”

Seconds count in emergency medicine, so the ability to be efficient and see patients promptly is a key to good outcomes.

The average wait from entering the emergency department to seeing a doctor is 12 minutes, with the most serious cases seen first.  

Physical improvements allow for better traffic flow and permit health care providers to work more closely as a team.

“How we used to do it was separate work space,” Morrison said. “As a physician I’m sitting in one spot and the rest of my care team is behind a wall on the other side. But as we’ve learned going forward in emergency medicine, we really work best all in the same space.”

The department includes a negative pressure room for use in the case of highly communicable disease, a resuscitation bay, a bariatric room, monitored high-level beds and rooms with recliners for lower acuity patients.

Stabilize the patient

The goal is to medically stabilize the most seriously ill patients so they can undergo longer care treatment.

“It’s honestly rare that we can’t stabilize a patient and get them to the trauma center,” Morrison said.

Two serious cases that came in close to one another Thursday involved a tractor accident and an industrial accident involving a large fall.

An 8-week-old girl visited the emergency room on several different occasions recently. She was suffering from a serious heart condition.

“Almost every time she hit a different team, different physicians were on and different nurses,” Morrison said. “Every time, they did a fantastic job in stabilizing this baby and getting her up to Dartmouth (Hitchcock Medical Center) and ultimately they were able to finally get control of the condition she had.”

At a recent dinner, a man came up to Fred Jones, the hospital’s chief medical officer, to thank him. Jones had stabilized him in an emergent situation and got him to a urology specialist.

“We don’t always hear the downstream effect,” Morrison said.

“So to have somebody a few years later say, ‘You really came in at a pivotal time and got me the care that I needed’ — and we were all able to do it here within our network and it started right out of the emergency department, is always nice to hear.”

Orthopedics specialty

Another part of the hospital’s focus on local care can be seen in orthopedics, where the region’s aging population creates a demand. There is a national trend toward hospitals focusing on specialties in which they excel, Donovan said.

“We can't be all things to all people,” he said. “It’s just not possible, from finding specialized providers, to affording the equipment, to having enough of a volume to provide good quality.”

If or when LRGH merges with a large health care system, an expertise and emphasis on orthopedics could become part of what distinguishes the hospital.

“So very clearly that’s what we are looking to do as part of a system, and orthopedics would be an area that we would continue to put some heavy focus on,” Donovan said. “In fact, actually, we just hired another hand surgeon and we recently made some offers to a couple more orthopedic surgeons.”

Merger talks are ongoing as LRGH seeks to remedy financial problems stemming from its heavy debt load and the payment problems afflicting community hospitals nationwide.

“We are deep, deep into discussion of a potential partnership,” Donovan said.

He said LRGH, the biggest employer in the region, has a positive cash flow, but continues to lose money overall.

“Unless we find a larger partner, you know our future would be a little bit more in question and that’s why we feel good about the partnership discussions that are going on,” he said. “And as we quantify some of the savings that could come from that partnership, the dollars are huge. We are talking about millions upon millions of dollars that, through partnership, could be removed from the system.”

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