In April, construction will begin on a $32.8 million expansion that will ultimately increase the number of beds in the department from 33 to 67. Ten of the beds are being added as a result of renovations to the existing Acequia Wing of the hospital, while a 13,495 square-foot building being constructed in the east parking lot will provide 24 treatment rooms and related facilities. The current emergency department is only about 12,000 square feet.

A recent surge in patient volume has highlighted the need for expansion.

Designed to accommodate around 50,000 patients annually, the emergency department (ED) treated upwards of 90,000 last year. In January, Kaweah Delta’s ER had such a great influx of patients that the hospital set up a temporary reception tent outside to receive, evaluate and register ED patients during peak periods of demand.

“We currently have 33 treatment rooms and on Jan. 9 we had 49 patients in the emergency room who needed beds and an additional 35 to 40 patients waiting,” Kaweah Delta Health Care District Emergency Department Chair Dr. Jerry Jacobson said. “That was just one day. Another day we had 33 patients admitted for those 33 rooms, and it’s normal to have 15, 20 or 22 beds full at a time, so space is a huge problem.”

While some of the increase in patient volume can be attributed to a growing and aging population, Jacobson said the department has seen a substantial increase under the Affordable Care Act (ACA), which allowed more people to obtain insurance, but not necessarily access to care.

“The intent of ACA was to increase access to primary care and maybe in some areas it did, but in the Central Valley that’s not the case,” Jacobson said. “More people have insurance but still no access to primary care so they end up using the ER for primary care issues…The availability of doctors even for those with good insurance is limited.”

To meet the need, Kaweah Delta has increased its family medicine residency program from six to seven physicians, and the hospital also has three (soon-to-be four) affiliated urgent care clinics. Combined, the three existing clinics are also currently treating around 90,000 patients annually. More physician assistants and nurse practitioners have also been brought onboard to treat patients.

While all these efforts have helped, Jacobson said there is still a long way to go and the ED expansion will have a more significant impact on addressing the demand.

Dan Allain, the director of critical care, trauma and emergency services at Kaweah Delta Health Care District, said the expanded space will allow for a better triage area and provide a fast track to patients being seen for common illnesses such as the flu. This fast track space will operate like an urgent care clinic and will free up space needed to treat more patients with more serious, life-and-limb-threatening concerns.

“Those patients who come in with life-threatening issues are still the first priority and are seen first no matter what. And right now that means some patients who are really sick and do need a room will sometimes have to wait or be moved into the hallway, which is less than ideal,” Allain said. “As acuity goes up, patients of lower priority are placed in the lobby and have to wait until higher priority cases move on or are treated, and that complicates triage.

Physicians and nurses are constantly evaluating everyone coming through. Even if you come in on a gurney from an ambulance, you can still wind up in the waiting room if your vitals are good. That is why we really need more space.

“In the new space, patients with of lower priority will be sent to a fast track area so they can move through quicker and that frees up beds for those of higher priority,” he added.

With the increase in real estate, Allain said the department will also need to increase its staffing, although how many staff members are necessary at a given time will depend on the number of patients and how many beds are full on a given day. He estimates the department will need at least 20 more registered nurses on a daily basis.

“I don’t have a crystal ball to see how much additional staffing we’ll need; It really depends,” Allain said. “We want to be fiscally responsible and also take care of patients. We will need to add between 16 and 20 RNs, and we have 21 right now so we’re essentially going to double our RN staff…The rest [physicians, assistants and nurse practitioners] will be driven by patient volume.”

Renovations on the infill portion of the project should be completed by May of 2018, Allain said, while the major construction project is estimated to be complete by March of 2019.