by Paula M. Riley

A view of the patient entrance to Chestnut Hill Hospital’s new emergency department. (Photo by Paula Riley)

Dr. John Cacciamani, CEO of Chestnut Hill Hospital, considers the hospital to be one of the community’s best kept secrets.

“We are trying to educate everyone about the gem hiding in Chestnut Hill,” he said.

He cites recent accolades, including its designation as one of the nation’s Top Performers on Key Quality Measures by the Joint Commission and the hospital’s affiliations with Jefferson’s Stroke Center and Penn Presbyterian’s Heart Rescue Program.

With a brand new state-of-the-art emergency room, intensive care unit and operating room opening on Monday, Oct. 22, Cacciamani has lots to brag about. The three-story, nearly 60,000-square-foot wing includes a 22-bed ER, a 14-bed ICU and four operating rooms.
Improving the patient experience was paramount in the design of the new wing, according to chief operating officer Michael Hite.

Outside, the new ER has a completely separate entrance and area for EMS vehicles and ambulances from the one used by ambulatory patients. Inside, the layout is like a racetrack with core functionality – nursing stations and work areas – in the center and private rooms along the perimeter. The hallways are wide and bright.

“It’s all about the flow and through-put,” Hite said. “We want to maximize efficiency.”

Patients are separated upon arrival as EMS, ambulatory and fast track patients, and there are treatment areas and staff dedicated to each. Fast track is designed for patients with minor injuries, cuts, bruises and sprains who can be seen and treated relatively quickly.

Hite cites the triage assessment area and process, on-site digital imaging room, quick processing of lab work and overall work flow as contributors to the improved experience. The goal, he explained, is “immediate rooming” – getting the patient in to be treated as soon as possible.

“Within 20 minutes you will be assessed by a doctor in the ER – that’s door to doctor,” Cacciamani said.

The new ICU rooms are private rooms, each 280 square-feet and almost three times the size as the old ICU. Each hosts its own bathroom, flat screen TV and large lounge chair for family members who are always welcome. All the medical equipment is new, including those used for inducing hyperthermia for cardiac arrest protocols. Perhaps what is most striking, however, is just how bright the rooms are.

“Natural light helps create normal sleep and wake cycles, and patients heal better with natural light,” Hite explained, pointing to the room’s large window.

Designed so that patients heal better and staff work better, the new unit has bright nursing stations with plenty of open space. Desks are situated in the hallways, strategically placed between two rooms so staff can complete clinical documentation with an eye into the windows of the patient rooms.

Much of the surgery performed at Chestnut Hill Hospital is minimally invasive, performed by a da Vinci robot and other advanced technology.

“The incisions are much smaller, but this requires that the machines be much larger,” said Dr. John Scanlon, the hospital’s chief medical officer. “These 650 square-foot operating rooms make it easier for large equipment to be moved in and around the rooms.”

Like the ICU, the OR is set up to create the ideal patient and staff experience. Five pre-procedural areas are large, bright and private, and patient registration, pre-op and recovery are all in the same space. Families have a large waiting area as well.

The hospital broke ground on the new ER/ICU/OR two years ago, but much of the preparation for this new addition was happening long before shovels hit the dirt.

“We engaged in a five-year study of our Emergency Department with the belief that every delay in the ER would result in a patient not being cared for in the best way possible,” said Teresa Kelly, M.S.N., chief nursing officer. “Our goal is to make the patient’s time in the waiting room as short as possible. To do this, we needed to change our culture and that’s just what we did.”

After a comprehensive review, the hospital implemented improved processes to eliminate the delays that kept patients waiting – both in the waiting room and in an ER bed (bay). Based on best practices, the ER evaluation committee created order sets of their top 15 diagnoses so ancillary tests could be completed for patients with specific symptoms in advance of being seen by an ER physician.

Triage nurses were empowered to order contrasts and lab tests in advance, and a new patient tracking system was implemented. Staff embraced what Kelly calls a “culture of customer service” where the focus is on care, courtesy, education and respect.

“We underwent a huge mindset change,” Kelly said.

She explains that the entire in-house admissions process was revised. For example, rather than an ER doctor processing the admission, an attending doctor now decides whether or not an ER patient will be admitted. By changing the admissions process, the wait time for an in-house admission was cut down to just 30 minutes.

“We are moving into a new environment in the best position possible,” Kelly said. “We ensured that all processes were in place long before the move.”

The doctors are in place as well. Cacciamani said that last year Chestnut Hill Hospital partnered with a board certified physician group, TriCity Emergency Room Physicians. The ER is fully staffed and looks forward to expanding the staff as its ER volume increases.

Improvements are being made to the original hospital as well. The lobby has gotten a facelift and more renovations are planned. The bridge from the parking garage has been redone, walls have been painted, carpets replaced and the lobby ceiling just got 96 new glass panes.

“We want to convey the cleanliness, calm and order of our hospital from the patient’s very first impression,” Hite explained.
Design decisions reflected the desire to convey this image but there is much more to these choices.

We wanted to be sensitive to the community, so we worked hard to connect the look and feel of the old building and the new,” Hite said, illustrating the hospital’s efforts to match the exterior material to the Wissahickon schist on the original building and in the area.

The new pavement and traffic flow in the existing hospital and new wing will ease the drop off/pick up experience, and near neighbors won’t hear the beeping of ambulances backing up because their entrance includes a full turn-around loop.

“We hope all the wonderful changes happening at Chestnut Hill Hospital will galvanize the community,” Scanlon said. “We are committed to our community and to our patients so they get the best of us.”

In celebration of this new wing, Chestnut Hill Hospital is hosting a Community Day and Health Fair, free and open to the public from 10 a.m.to 2 p.m. Saturday, Oct. 20. There will be free hot dogs, pizza, funnel cake as well as entertainment including magic shows, jugglers, face painting and inflatable rides. The health fair offers free health screenings for the whole family.

On Saturday evening the Chestnut Hill Black & White Gala and Silent Auction will be held on the grounds of the new wing, and the hospital is the presenting sponsor. “Masquerade” is the theme of the annual gala organized by the Chestnut Hill Community Association and the Chestnut Hill Community Fund. Tickets are still available, and guests are invited for a festive evening of cocktails, dancing, raffle and silent auction.

Scanlon is happy that the hospital can provide the venue for this celebration and work to support the efforts of the community association.
“Fundamentally, this is what we are all about,” he said, “working together to improve the quality of life in Chestnut Hill.”

For tickets to the gala, visit www.chestnuthill.org