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Dartmouth-Hitchcock officials work to direct ER patients to Alice Peck Day

Valley News Staff Writer
Published: 12/7/2019 10:33:20 PM
Modified: 12/7/2019 10:33:18 PM

LEBANON — Officials at Dartmouth-Hitchcock Medical Center and Alice Peck Day Memorial Hospital are trying to steer more emergency room patients to the smaller hospital near downtown Lebanon, part of the continuing integration of the two hospitals.

That follows the merger of DHMC and APD’s obstetrical services after last year’s closing of APD’s birthing center.

This past May, APD, a 25-bed critical access hospital, adopted the same electronic medical record as D-H, the parent system, which in addition to the 396-bed DHMC and APD, also includes three other hospitals in Vermont and New Hampshire.

And, in September, the two hospitals began sharing staff to cover APD’s emergency department and hospitalist services, after a staffing contract between APD and the Texas-based EmCare ended. At the same time, APD also adopted D-H’s “TeleEmergency” service, which uses video technology to connect providers at APD with emergency medicine physicians and nurses to provide back-up, patient care, documentation, second opinions and transfer coordination.

“Combining our hospitalist and ED services on campuses located only four miles away from one another is part of our strategic plan to meet the needs of our community,” APD spokeswoman Kelli Pippin said in an email. “This effort is to help alleviate the pressure at the DHMC ED while also increasing the complexity of care we can provide at APD.”

DHMC’s emergency department sees an average of 32,000 visits annually, a number that dwarfs the average of 6,000 visits that APD’s emergency department sees.

While this is at least partly because DHMC has the staff and equipment necessary to perform more complicated procedures, Michael Lynch, APD’s new chief medical officer, said that visitors to APD’s emergency department can expect to be seen quickly, usually within 14 minutes.

Lynch spoke during a discussion of the emergency services available at APD at the Kilton Public Library in West Lebanon on Tuesday. The discussion was part of a broader effort to encourage more patients to come to APD’s emergency department.

“This to me seems like one of the rare win/wins,” said Dr. Scott Rodi, D-H’s interim section chief and regional director of emergency medicine.

If more patients turn up at APD, that could reduce the number at D-H, said Rodi, who also spoke at the library event hosted by the Friends of APD.

“Hopefully everyone is happier,” he said.

APD’s invitation was welcomed by members of the approximately 30-person audience.

“I would always come to APD,” said Jill Carter, of Hanover. “When the word gets out, you’re going to be swamped.”

Shifting more patients to APD might even out the workflow for providers.

Dr. Matthew Babineau, the interim medical director of APD’s emergency department who works at both hospitals, said that at APD these days he has more time to talk with patients and think through decisions versus “working up the hill (where providers) have to just kind of be running.”

The hospitals have been working with area ambulance services to encourage them to bring people to APD rather than DHMC when medically appropriate.

In certain cases, such as a heart attack or a broken hip when a surgeon may not be available at APD, Lebanon Fire Chief Chris Christopoulos said the city’s emergency medical technicians know to bring patients to DHMC.

In other cases, depending on a patient’s wishes, the drivers might call providers at APD to determine where the patient would be best cared for, he said.

Though there are still some circumstances where patients need access to specialists or equipment available only at DHMC, there are others when EMTs determine it makes sense to take people to APD, such as when someone has fallen, but doesn’t have a fracture; or when they are having chest pain, but don’t have cardiac anomalies, Christopoulos said.

Christopoulos, who said he has been in talks with hospital officials to bring more patients to APD for over a year, said the city would be glad to transport fewer patients to DHMC because the crowds there can mean that an ambulance has to wait there for 45 minutes until a patient on one of the city’s stretchers can be seen.

“That’s a little bit problematic,” he said.

While a city ambulance is waiting at DHMC, it can’t respond to other calls, he said. In addition to Lebanon, the city’s ambulance service also covers Grantham; Enfield, during the week; and the northern part of Plainfield. The city transports about 1,800 people annually, he said.

Christopoulos said he’s “encouraged” by the conversations with the hospitals in recent months. He said he views the change as “just a progression in that relationship between the two hospitals,” which is “better for patients.”

More change is on the horizon. For example, APD is working to expand general surgery coverage, perhaps in partnership with other D-H system members Mt. Ascutney Hospital and Health Center in Windsor and New London Hospital, Lynch said.

And D-H announced in October that it is partnering with the California-based nonprofit West Health to make visits to the emergency department more helpful for people over age 65 by gaining accreditation as a geriatric emergency department from the American College of Emergency Physicians.

In the first year of the program, D-H plans to get the geriatric emergency department up and running at DHMC. Then, it aims to use telemedicine to expand the program, serving as a hub for rural hospitals to connect with specialists such as geriatric social workers.

It’s not yet clear what effect this might have on seniors who come to the emergency department in Lebanon’s smaller hospital.

“... We are waiting to see what it will mean for APD,” Pippin, the hospital spokeswoman, said in an email.

Valley News Staff Writer Nora Doyle-Burr can be reached at or 603-727-3213.

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