ROCKPORT — It’s been a long and challenging road for staff of Pen Bay Medical Center in the past year, notably care team members of the Emergency Department, as the hospital embarked on a multi-year redesign of its ED.

The department, which has not seen any updates since it was last remodeled in the early 1990s, is currently under a three-phase redesign with the whole project scheduled to wrap up in 2024, pushed back from its original opening time frame of late 2023.

Although updates are a welcome sight for care team members around the building, challenges persist, as they work around construction and supply chain drawbacks.

Phase One nears completion

The old Emergency Department was in dire need of a redesign as medical care made leaps and bounds forward, but a lack of funding and the number of people needed to come together and put a plan in place held the project back.

In summer 2021, PBMC announced it would spend $9 million — funded by local donations and MaineHealth — on the update, expanding the footprint from 9,000 square feet to 15,200 square feet and increasing the number of exam rooms from 13 to 25. Plans also call for adding an additional triage room for a total of two; three dedicated behavioral health rooms; and three more rooms that will also be outfitted for behavioral health, if needed, when all the updates are complete.

Phase One is scheduled to open in late September or early October as the department moves into the new space and the old space shuts down for construction and redesign. Separating construction into three phases allows the hospital to continue to care for patients on a daily basis.

The model of the new ED comes after plucking bits and pieces of redesigns made at other MaineHealth hospitals, such as Waldo County General Hospital in Belfast and Maine Medical Center in Portland.

“One of the biggest takeaways, we saw, were sightlines and overall accessibility from a general patient care perspective,” Coastal Health Alliance Senior Director of Operations Steve Garhartt said about touring other hospitals.

Nancy Jackson, director of emergency services for CHA, said the increased space will be beneficial.

“We truly need the space to properly care for our patients, including room space,” Jackson said. “The ultimate end goal is to really have an efficient Emergency Department with the right amount of rooms to care for patients and to be able to place patients in certain areas for improved safety, and a more spacious department will be wonderful for us.”

Dr. Nir Harish, an emergency department physician who has been apart of the planning for the past five or six years, added the redesign maximizes good care and communication.

“Making sure it’s easy for nurses and providers to see their patient rooms and the patients to be able to see their providers (is important),” Harish said. “It’s a much more open design. We think that’s really important for safety, as well as for the patient experience.”

Waiting area looking toward patient entrance. Photo by Zack Miller

Sightlines are also a strong focal point in the new design.

“You’ll be able to see all the way across the department with staff members seated throughout, and easily accessibility for patients and family members to approach them if they have an issue,” Harish said. “In addition, the big windows along the rooms give us the ability — as long as the patient is comfortable — for us to able to see into the room while we are doing things outside of the room. That bodes very well for patient care.”

All changes and sightlines were mapped out ahead of time, as construction and hospital staff diagramed where each tool would be located in each room to maximize the layout and make sure care team members were best equipped to do their jobs as efficiently as possible.

Dry runs will be conducted before the official open of the department with practice patients for care-team members to get used to the new space, while IT tests equipment.

“I’m excited to see the look on individuals’ faces, since they’ve been packed into this small space, and now they’ve got this brand new space available to them,” Garhartt said.

Harish said, “Historically, departments were built with a lot of walls that limited communication. This new design is intended to be much more glass and open, and I’m looking forward to not having to go look for someone, and communicate more easily.”

Construction and supply chain challenges

Unfortunately, a hospital never sleeps, and when construction is added into the mix, challenges arise for care team members and patients alike such as space limitations and construction noise.

Jackson said, “We’ve worked very well with our construction teams and they with us. There have been times where we’ve had to halt for a minute, maybe because we have a patient who is really bothered by noise on the other side of the wall. There’s been a lot of planning around that.”

Harish noted, “In some rooms we have false walls up, so there’s really been no sound protection there, which has been a challenge. The building team has been responsive when we’ve had issues with that, but some of it is inevitable.”

Jackson added, “The communication has really been an important and valuable piece to the whole project. Not just communication between our construction team and operations team and all the folks involved in this project, but also how we translate that back to our own staff members who are trying to move patients through our department.”

Despite great communication, construction closed two of the 13 rooms of the ED, adding to struggles with space limitations, while a temporary emergency entrance was built on the opposite side of the department.

“Going down rooms has been one challenge,” Harish said. “It’s certainly been difficult on patients when we first switched the entrances to the emergency room, so we had to have a lot of extra staff waiting at the old entrance and redirecting people.”

Supply chain issues have been a larger problem, as they are mostly out of the hands of the staff, and have to be approached in a hurry-up-and-wait mode.

“Things that used to take two or three weeks, or you could overnight it, now take months,” Garhartt said. “There are things we ordered months ago that we just received. Things like that can make or break a project, and it’s something you have no control over.”

Looking from nurses’ station area at triage rooms (backside entrance) to waiting room. Photo by Zack Miller

Garhartt said the supply chain problems are “very frustrating” and compound into other problems.

“The project gets stalled for a period of time and the contractors you had lined up are going to do other projects because you had them lined up for specific times and now they can’t be there,” he said. “A project that was supposed to take a year, now takes 16 or 18 months and it continues to grow.”

Garhatt admits he “can live with” the supply chain problems compared to the changes the ED staff is experiencing.

“Triage is (currently) in a hallway,” he said. “In winter, there was no heat in the hallway and we had an employee sitting there for patients. All these people got uprooted and moved.”

The hallway heat problem was resolved by installing a duct to pump heat in; moving registration to its temporary location involved moving panic buttons, technology that calls out to hospital switchboards and all the phones in the hospital.

“There’s definitely been some challenging conversations on both sides,” Garhartt said. “For example, there was a time where we had to consolidate a room down and if we had known framing wasn’t going to be in for another month, we probably wouldn’t have demoed that room and left it for the staff a little bit.”

Phases Two, Three on horizon

With Phase One set to cross the finish line, there will not be much downtime until Phase Two construction begins.

The second phase will be a redesign of current space where the ED now sits, as opposed to constructing an addition like Phase One, and will include building out the behavioral health space and new trauma rooms. This phase takes out a larger piece of the department and will be more intrusive to the hospital.

The dedicated behavioral health space is an important one which the hospital has not had in its history. It retrofitted rooms to be able to care for people when needed, but never its own space.

“As we all know, there is an epidemic for behavioral health patients and the need for them to have treatment and be treated in a way that works for them,”Garhartt said. “There are different layers of care that we need to provide, and it’s something we’ve always done for a lot of other disease states.”

On adding behavioral health-dedicated rooms,  Jackson said, “That is going to be incredibly important to the safety of staff and patients. The rooms, rather than be retrofitted as we have done over the years to accommodate regulations for safety, we are going to have rooms that are already designed at the safest level for patients who require that type of care and safety. That is going to be huge for us. It’s going to make a big difference, and we can’t wait for that.”

Garhartt added, “We are accessible to people in wheelchairs or someone that broke their leg, but not necessarily accessible to someone that needs to be in a dark room, isolation, therapy or one-one-one conversation. Our previous department didn’t have that and it was something we’d seen pop up across departments around America and inside our system.”

Phase 2B “should be relatively quick,” according to Garhartt, and includes updating a break room, bathroom and one exam room.

Garhartt admits he’s “most nervous for” Phase Three of the project — the ambulance entrance update.

“This one will be interesting because we need to adjust the ambulance entrance for pickup and drop-off,” Garhart said. “In addition, we are going to have some care-team members on one side and some on the other, with a hallway in the back, and any patient that needs to (be transported through) will need to go through triage, go to the back and go across (to the other side).”

With many moving parts around the hospital, communication has, and continues to be, key.

“If we did not maintain that level of communication and level of training for them, I think the anxiety and concern would be significant,” Jackson said. “We want to make sure they are as comfortable stepping into a brand-new space on day one, that they know where their most important pieces of equipment are as soon as they step into that space. I think that’s the biggest concern any clinical care team can have.”

Shiny new space around the corner

Despite the challenges and headaches, the wait will be worth it in the end for the care-team members.

“I think they are very excited when they get a chance to be reminded of what’s coming,” Jackson said. “They are excited about their new waiting rooms, triage rooms, finally moving back to some normalcy, because we haven’t had it.”

This old department is old,” Harish said. “We’ve been plagued by dripping faucets and issues like that which are detrimental to the patient experience, and I think having a new and thoughtfully designed department will make the whole experience better from beginning to end.”

Despite the excitement, Jackson continues to keep an eye forward as she recognizes the new space means losing existing rooms to new construction until the final ED is complete.

“We have to make sure we remove any barrier for them that exists, so they can focus their mind on taking care of their patients in the best manner possible,” she said.

Garhartt said, “Every phase is going to come with its own challenges and I don’t know what they are going to be yet, but it will be fun to go through them and figure them out. Each thing is going to be its own challenge. I don’t foresee anything that’s going to stop the project. I’m just ready.”