DHMC To Add 29 Beds

Lebanon — There’s not much extra space for treating the most severely ill patients at Dartmouth-Hitchcock Medical Center, and hospital officials say the demand for critical care beds keeps growing.

Now, DHMC is preparing to address those concerns with a $17.5 million expansion that will give it more room for treating the sickest of the sick.

The Lebanon hospital has begun renovations to add 14 adult critical care beds and another 15 beds in the medical/surgical unit over the next year. The additional capacity will allow DHMC to respond to a rise in severe cases in recent years, many of them referred from smaller hospitals that can’t care for them, DHMC officials said.

As it stands now, the Lebanon hospital often is at full capacity and can’t take on more patients in urgent need of attention, said Ed Merrens, chief medical officer at Dartmouth-Hitchcock. The additional beds should change that.

“You need the ability to say, yes we have a bed,” Merrens said. “And we do not have that ability right now.”

DHMC is the only tertiary care hospital in the Upper Valley with the resources to treat patients with life-threatening conditions who need constant monitoring. This kind of care requires high staffing levels, training, space and equipment that smaller hospitals don’t have.

The volume of critical patients arriving at the hospital has grown in recent years, Merrens said, and there are many times when DHMC has no beds left for them. In 2010, the overall occupancy rate of the critical care and medical/surgical units was at 93 percent, according to DHMC’s application to the state of New Hampshire for a certificate of need, which was granted in April. In two years, the occupancy rate is projected to rise to 99 percent and by 2016, the average demand will exceed what is available.

Over the past 300 days, DHMC’s beds have been filled to capacity nearly half of the time, Merrens said.

DHMC’s crowding issue a problem for small hospitals, too.

Whenever New London Hospital finds itself treating a person suffering from a heart attack, stroke or some kind of trauma, those cases typically get transferred to DHMC. But there are times when New London has to scramble for other options.

“We will frequently make a call and be informed that Dartmouth doesn’t have any bed capacity,” said Bruce King, chief executive officer at New London Hospital.

No one gets denied care, but they might end up transferred to other large hospitals farther afield, such as Fletcher Allen Health Care in Burlington or Elliot Hospital in Manchester.

Alice Peck Day Memorial Hospital has had a similar experience to New London. The Lebanon hospital is only a few miles away from DHMC, but has frequently needed to find alternative accommodations for patients because DHMC had no room, said Sue Mooney, APD’s president. It’s an issue Mooney is eager to address.

“When we call them and say help us, and they say ‘we don’t have a bed,’ that’s not good for anybody,” she said.

The solution is more complicated than simply adding beds at DHMC, said King and Mooney. It’s also important that smaller hospitals lighten the pressure on DHMC by taking less intensive patients who don’t need to be in a tertiary care hospital. Many of these patients could be cared for in a hospital closer to home.

Maria Ryan, chief executive officer at Cottage Hospital in Woodsville, said that is the relationship she’s sought to have with DHMC.

“We depend on DHMC to take care the sickest of the sick, therefore we fully support DHMC’s desire to add intensive care beds,” Ryan said in an email. “Cottage Hospital... continues to work with DHMC to bring patients back to our community expeditiously, allowing for quicker accessibility for critically ill patients.”

There’s more behind this project than just responding to volume. People are living longer and developing more severe conditions later in life. Patients also are growing in physical size, requiring equipment that can support a person who weighs more than 500 pounds. Those kinds of machines also take up space in a way that wasn’t anticipated when DHMC was built, and so the actual size of the rooms needs to be larger.

“This is a very different world than it was in 1991,” Merrens said.

The project is at the heart of a larger shuffling of DHMC staff and resources this year. But, as with any change at such a large medical center, the shuffling has been complex.

“There’s an enormous amount of cascading moves to make anything happen on this campus,” said Gail Dahlstrom, vice president of facilities management.

Last month, DHMC moved around 170 people from various departments into a new facility on Heater Road. That effort cleared the way for shifting people around on the main campus. An outpatient rehabilitation unit on the third floor near Bank of America is moving into another part of the building so that renovations can begin for the 14 critical care beds. The medical/surgical beds are going on the second floor, where the sleep clinic had been. The sleep clinic is now on Heater Road.

By this time next year, the project should be done. That doesn’t mean DHMC is finished growing. Demands for its services are evolving with broader trends, Merrens said. The Twin States have an aging population with residents who are living longer and requiring advanced care over extended periods of time. In New Hampshire, residents over the age of 65 account for 14 percent of the population, and 15 percent in Vermont, according to the U.S. Census. The percentages are even higher in the Upper Valley, putting this area well above the national average of 13.3 percent.

DHMC has responded accordingly, but in some ways has become a victim of its success.

“This is a destination for people who want to retire. ... Having a tertiary care center nearby is a big draw for retirees,” Merrens said. “We’re seeing people who have diseases that might have been terminal before, who are now getting lifelong support.”

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.


This article has been amended to correct an earlier error. Dartmouth-Hitchcock Medical Center is adding 29 beds as part of an expansion of critical care and medical/surgical beds. A headline in the Sunday Valley News gave an incorrect number.