Published 12:00 am Wednesday, December 2, 2009

By Kathy Chaffin
Salisbury Post
For Dr. Celia Entwistle, the competition between Rowan Regional Medical Center and Carolinas Medical Center-NorthEast is a family affair.
Entwistle works for the physicians group contracted by Presbyterian Hospital Huntersville, a Novant facility like Rowan Regional, to staff its 14-bay emergency department. Her husband, Austin Entwistle, is on the board of directors for the CMC-NorthEast Foundation.
“I think NorthEast is a great institution and they have fabulous physicians,” she says. “I have nothing but good things to say about their doctors.”
But Entwistle disagrees with the concept of the 24-hour a day, seven days a week freestanding emergency department proposed by NorthEast of Concord in a Sept. 18, 2007, application to the state. Carol Hutchison of the Certificate of Need Section, N.C. Division of Health Service Regulation, says a decision is expected later this month.
A decision on Rowan Regional Medical Center’s application for a community hospital in southern Rowan should follow in March as it was submitted on Oct. 15, almost a month after NorthEast’s. State officials say each application will be judged on its own merit and that both could feasibly be approved.
Entwistle says she’s not worried about the Emergency Medical Service taking patients who need more care to a freestanding emergency department. They’re well trained, she says, and know who needs to go to a hospital with a surgical department or trauma capabilities.
“The problem is when patients don’t know,” she says. Someone, for example, could take a person with a gunshot wound to the CMC-NorthEast freestanding emergency department “and not realize it’s not connected with a hospital.”
Or, Entwistle says, using a former patient as an example, a man injured when his son’s karate instructor demonstrates a kick on him could drive himself to the emergency room not realizing he has a ruptured spleen.
“We couldn’t get him stabilized to get him downtown,” she says. The surgery to repair the injury “took all the blood in the hospital. It was a long, long procedure.”
If this man had gone to a freestanding emergency department, Entwistle says, there might not have been “the margin of safety” needed to save his life.
Carolyn Knaup, vice president of ambulatory services for WakeMed Health & Hospitals in Raleigh, which has the only two freestanding emergency departments in the state, presents a different view.
“You have to be prepared for everything,” she says. The WakeMed North Healthplex, for example, has a critical care vehicle on site for patients who need to be transferred to the WakeMed Raleigh Campus for surgery or more specialized care.
Though there is not a helipad at the facility, Oral Wise, director of ambulatory services for the North Healthplex, says helicopters have landed in the parking lot.
The WakeMed Apex Healthplex, which opened Feb. 4, does include a helipad.
Dr. Andrew Matthews, medical director of the Emergency Care Center at CMC-NorthEast, was among a group from the medical center which toured the North Healthplex before submitting its certificate of need application.
“One of my wishes would be to incorporate what they’ve done there,” he says. Matthews adds, however, that plans for the freestanding emergency department are a work in progress.
“Right now, we’re anticipating using our critical care transport,” he says. “That will change as the patients’ needs change. It may evolve to putting a helipad out there.”
Matthews says he envisions the transport from the freestanding emergency department proposed for Lane Street in Kannapolis to CMC-Northeast “as just a longer hallway than we have here.”
Dr. David Templeton, medical director of the emergency department at Rowan Regional Medical Center, which officially merged with Novant last month, says even in the best of circumstances, a patient requiring hospital admission would still have to endure another trip.
A critical care transport, for example, “is a bumpy ride,” he says, “and it’s inconvenient to the patient, not to mention the patient’s family, which would then have to via their own vehicle find their way to the facility.”
The transport also causes extra stress for the patient and the family, he says.
Speaking of patients’ families, Templeton says the traditional emergency room in a hospital setting offers better availability of services. “A few examples of those would be a cafeteria or vending, clergy, patient advocates, case managers and interpreters.”
Templeton says another advantage to the traditional emergency department is that the response time from on-call specialists is likely to be faster.
“If patients require operative service or any specialized equipment not found at the standalone ED,” he says, “then that patient would have to be transferred to a main hospital campus to even receive that consultation even if that patient ultimately is discharged.”
If the goal of a hospital is to provide medical care to the community, Templeton contends, “the only reason to build a standalone ED instead of another hospital would be to save money … ultimately offering less services to the community by doing that.”
Matthews says freestanding emergency departments are required to meet the same criteria and standards as any other emergency department. “The goal is that if you came into the CMC-NorthEast emergency department or you came into the CMC Kannapolis standalone, it would be the same exact care,” he says.
Templeton says another advantage to the traditional emergency department is the access to more extensive ancillary services such as pharmacy, radiology and laboratory.
“Pharmacy services is a big issue because each hospital has a pharmacy that is comprehensive and covers all the major categories of medication,” he says. “A standalone ED would usually have a pharmacy limited to the most common medications, and this is purely a logistics issue.”
Across the country, more and more freestanding emergency departments are being built. Matthews says he and other NorthEast physicians and officials plan to visit a freestanding department in Florida in the near future.
The concept is a way to provide emergency care at reduced cost. “The initiative for the past 20 years was to try to divert patients away from emergency departments,” he says. Today, “patients are coming in record numbers.”
Now the initiative is to try to offer emergency department treatment more efficiently and at less cost, Matthews says, which is what today’s healthcare consumers want and expect.
The state Division of Health Service Regulation has already granted approval for a freestanding emergency department in the southern end of Cabarrus County. The $20.2 million, 23,689-square-foot facility will be constructed in Harrisburg.
The certificate of need application calls for the Kannapolis facility to cost $17.2 million. The 23,973-square-foot facility would include 10 treatment bays, two observation beds, imaging (CT, ultrasound and X-ray) and laboratory and pharmacy operations to support emergency services.
As proposed, Rowan Regional Medical Center South would be located on Moose Road near the Interstate 85 intersection. The $107 million, full-service acute care hospital would include 50 beds, 42 of those medical surgical and eight observation.
In addition to a 24-hour emergency department with 12 treatment rooms, Rowan Regional South would include a four-bed intensive-care unit; four labor, delivery, recovery and post-partum maternity suites; three surgical operating rooms with an endoscopy suite; a wide range of imaging services; and full-service pharmacy and laboratory.
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Contact Kathy Chaffin at 704-797-4249 or kchaffin@salisburypost.com.

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