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Texas Hospital Construction Takes Divergent Paths

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(credit: newparkland.parklandhospital.com)

(credit: newparkland.parklandhospital.com)

DALLAS (AP) – The view from two helipads atop the new 17-story Parkland Memorial Hospital provides a dizzying panorama of Dallas’ burgeoning medical district and a downtown that looks like an architect’s model off in the distance.

Officials at the new Parkland have earned their bragging rights for undertaking “the largest hospital construction project in America.” When it opens in May 2015, it will be considerably larger than the old 730-bed Parkland hospital, boasting 862 beds, 2.5 million square feet and a price tag of $1.3 billion. Also on Harry Hines Boulevard, a second new teaching hospital is opening late next year, the $800 million William P. Clements Jr. University Hospital. At 460 beds, it will be dwarfed by Parkland, but it will be much larger than the 300-bed St. Paul University Hospital that it is replacing.

With health care in flux, executives planning the Dallas hospitals say they’ve had to guess how many beds they’ll need for a growing, aging population and the future doctors they’ll train over the next three to five decades. In both cases, they guessed bigger. So have officials in Galveston, where the University of Texas Medical Branch is expanding its capacity with a new teaching hospital to complement the current John Sealy Hospital.

But in Austin, Seton Healthcare Family officials are keeping it small.

Their new teaching hospital will be significantly smaller than the others under construction in Texas and close to the size of the hospital it’s replacing. They see a future in which their hospitals are used less as more care gets delivered in clinics and physician offices. The new doctors it trains will work inside and outside the hospital as Seton works with the public Central Health hospital district to coordinate services to patients. A goal is to keep patients healthier and steer them to less-costly outpatient services.

The new $295 million hospital is projected to have 220 beds versus 224 beds at the current teaching hospital, University Medical Center Brackenridge. In addition to being the main training ground for a new UT-Austin medical school opening in 2016, it will continue UMC Brackenridge’s tradition of being the community’s main safety net hospital.

UMC Brackenridge, the oldest public hospital in Texas, will close when the new hospital opens, under Seton ownership.

But it won’t be the only place doctors are trained. Two other Seton hospitals — its flagship medical center on West 38th Street and Dell Children’s Medical Center — will be key sites, adding 600 existing beds to the mix, said Greg Hartman, Seton’s chief of external affairs. Not every bed will be used, but Dell Children’s already is a major teaching hospital for pediatricians, Hartman said.

“Part of it is rethinking how we distribute care in our community,” he told the Austin American-Statesman. “There’s not just one safety net site” or just one place for training doctors and doing research.

Austin’s new hospital will be among the smaller teaching hospitals nationally, said Dr. Joanne Conroy, chief health care officer for the Association of American Medical Colleges. The average size of a major teaching hospital is 600 beds, she said.

But hospital use is going down nationally, said UT System Executive Vice Chancellor for Health Affairs Kenneth Shine, who believes the new Parkland is much too big. And Seton officials said they expect to significantly curb hospital admissions as the federal health care law penalizes those that readmit certain patients within 30 days.
Changes in insurance also are a factor. More employers are shifting a larger share of health care costs to their employees, and that is causing patients to be less likely to seek hospital services, Seton spokeswoman Adrienne Lallo said.

In a decade, “we are thinking we will drive down inpatient admissions by 40 percent,” said Charles Barnett, Seton’s executive board chairman.

Hospital officials in Dallas said they don’t know whether Austin’s planned hospital is too small or just the right size.

“With health care reform, nobody’s got a handle on what’s going to happen,” said Lou Saksen, senior vice president for the new Parkland construction.

Size depends on mission, he said. As the primary safety net hospital in Dallas, demand from the needy is growing dramatically at Parkland, Saksen said.

Parkland also is the highest-level trauma center and takes burn patients from the region; Austin’s burn patients will continue going to San Antonio. With its long tradition of providing trauma care, Parkland also takes patients from out of state and is on standby for a visiting president. Built in 1954, it tended to President John F. Kennedy’s wounds in 1963.

“The rhetoric around health care reform is `everyone is going to be an outpatient,”‘ Saksen said. “But we’re getting older, and more people will be on Medicare. We don’t see demand going down for that.”

Dallas is the nation’s ninth largest city and had 1.2 million residents in 2012. Though Austin climbed to No. 11, with 842,592 residents — many fewer than Dallas — it was fifth in population growth in 2012.

UT Southwestern medical students and residents train at two university-owned hospitals, St. Paul and Zale Lipshy University Hospital, as well as at Parkland Memorial and Children’s Medical Center of Dallas. After the Clements hospital opens, St. Paul eventually will be torn down.

Dr. John Warner, CEO of UT Southwestern hospitals, said that while he believes a bigger university hospital is needed, he understands the new health care model Seton wants to achieve. “I think if I were in Austin, I would be doing what they’re doing,” he said.

Flexibility, including the ability to add or subtract beds, is being built into the DNA of the two Dallas hospitals, Warner and Saksen said. UMC Brackenridge is similar; it can add beds if needed, said Peter Rieck, Seton’s vice president of facilities and support services.

UMC Brackenridge has 533,514 square feet, while the new hospital will have 480,000, Lallo said.

“It’s all about how you use the space,” Shine said. “The role of this hospital is to be part of a diversified, integrated health care delivery system for a population of patients who will get increasing amounts of care on an ambulatory (outpatient) basis. That’s why the size of this hospital makes sense.”

UMC Brackenridge, built in phases over two decades and completed in 1984, is outdated, officials said. The replacement hospital will be owned by Seton, which is in the early stages of figuring out how it will look and function.

Hartman said the new hospital, to be located north across 15th Street from UMC Brackenridge’s parking garage, will have slightly larger rooms for patients, but it won’t have space eaten up by administration and other purposes that don’t require “the expensive real estate” of a hospital.

Officials already know the hospital will have a new medical-psychiatric unit but will drive some services to other Seton locations. For example, the new hospital is expected to have fewer patients with heart, lung and cancer conditions but more with digestive, brain and bone and joint ailments. Cancer and maternity patients will go to Seton Medical Center Austin, under preliminary plans.

But many other details aren’t known yet. Seton officials announced June 18 that Dallas-based architectural firm HKS will design the hospital and that a more careful look at the cost had bumped up the construction costs by $45 million, to $295 million.

They said the hospital will focus on “patient-centered care,” a buzz phrase in Dallas, where officials said they cast a wide net early on to consult with everyone from doctors to patients.

“Get patients involved in the design,” Warner advised. “We made lots of U-turns along the way. We would have what we thought was a really great idea, and the patients would say, `That’s not what we want.”‘

Seton is on a tight time frame and is going to seek feedback mainly from doctors and other medical personnel, President and CEO Jes·s Garza said. Officials received patient and family feedback from three other hospitals Seton opened in recent years and will draw on that as well as patient satisfaction surveys, Rieck said.

Patient rooms at the new Dallas hospitals have room for family members, in addition to flat-screen TVs equipped with cameras to make Skyping with loved ones possible, as well as for off-campus medical consultations.

Nurses will chart on computers in a patient’s room and just outside the door. Window blinds on rooms will enable staff to look in on patients without waking them. The rooms will feature natural light and views, a concept that promotes faster healing.

Austin’s new hospital also will take advantage of views and light, like Dell Children’s, which opened in 2007, Hartman said. Rooms could be oriented to look out toward the Capitol or Waller Creek, he said.

Also, like Dell Children’s, the new hospital will feature walls of artwork.

A big expense that hospitals and other health care providers are grappling with is a conversion to electronic records. The two new Dallas hospitals will be essentially paperless. “You won’t find a chart rack in the building,” Warner said of the Clements University Hospital.

Austin’s hospital won’t be paperless initially, Seton officials said, but UT’s Shine said he expects that to be the goal.

Tranquility is another goal, Hartman said. Noise is the No. 1 complaint hospitals receive from patients on satisfaction surveys, and low scores on those surveys can result in lower hospital payments.

Both hospitals in Dallas were designed to separate patients from noisy trash, linen and food carts. Parkland has the greatest amount of separation with one corridor for patients and families and a separate one for staff. “You won’t have dirty trash carts or dirty linen running around,” Saksen said.

Seton officials are looking into the separation concept “without breaking the piggy bank,” Rieck said. They believe their new hospital will rival any in the nation.

“The whole will be truly greater than sum of the parts,” Barnett said.

(© Copyright 2013 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)

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