As we look toward the opening of our new Pavilion for Advanced Care (PAC) and the transition of our trauma center from the Hospital of the University of Pennsylvania (HUP) to Penn Presbyterian Medical Center (PPMC), throughout the month of January, the News Blog is highlighting some of the latest news and stories from across the areas of Penn Medicine that will find new homes in the PAC.
Construction on the PAC is in the final stages on the Presby campus, and over the next five weeks, we’ll see a slew of PPMC departments — including Emergency Medicine, Surgery , Radiology and Critical Care —open their doors to patients. This seven-story, 178,000 square foot facility encompasses both new space and renovated areas in existing buildings at Presby, all designed to provide the optimal patient care experience.
As expected, there are many changes ahead with such an addition, but perhaps the most complex is the transitioning of PPMC to become Penn Medicine’s Level-I Regional Resource Trauma Center, set to open on February 4. It’s a tall order, to say the least.
“This is the first time in the state – and possibly anywhere in the country – that an established trauma program has been moved to a different hospital site within a health system,” said Alyson Cole, MPM, assistant executive director of PPMC.
Trauma care is complex. Indeed, depending on the type of injury, a trauma patient could require treatment by a neurosurgeon, an orthopaedist, an ophthalmologist, an obstetrician….and many other subspecialties. And that doesn’t count all the nursing, allied health, social work, pastoral care, respiratory, and other disciplines that are all essential parts of the trauma team.
Now, consider what it would take to move this multidisciplinary group to a new location. That was the challenge facing the Penn Trauma Program when Penn Medicine decided to move its Level 1 Trauma Center to PPMC. Cole and John Gallagher, MSN, Trauma Program manager, worked with members of the Trauma program, clinical practice leaders and hospital directors across both campuses for three years, pulling together the many pieces would lead to a successful transition.
The decision to move trauma was based on a number of factors, but two important goals were to increase Penn’s Medicine’s capacity to care for patients and spread the capacity across the entire health system. The move would immediately benefit HUP, providing breathing room to allow the land-locked hospital to expand its inpatient services.
It would also support growth -- and major upgrades -- on the PPMC campus.
First up was Radiology, when its MRI unit started seeing patients this winter. Next are the critical care floors and the Emergency Department in the coming weeks.
Renovations will upgrade the capacity and efficiency of the new ED, which will connect the existing ED in the Myrin building to the new first floor of the PAC. In addition to added emergency bay and operating room capacity, a new state-of-the art trauma resuscitation area in the ED will be dedicated to the evaluation and stabilization of critically injured patients.
Two entire floors of the PAC have also been dedicated to critical care patient beds, and the new surgical site will bridge the second floor with previous space to make a new “short procedure unit” with over 30 beds.
The PAC will also facilitate improvements in centralized patient flow, and a new concourse will provide a location for family, patients, and staff to gather and provide an exceptional thoroughfare for way finding.
A new 65’ x 65’ square helipad on the roof of the PAC is also part of the new construction. The helipad is equipped with an automatic snowmelt system that can melt snow at the rate of 2” per hour and an automatic fire suppression system.
Perhaps more complex than planning the physical infrastructure has been ensuring the proper transition of staff. Trauma will shift 2,000 additional admissions to the PPMC campus.
What staffing resources would be needed to care for these extra patients? The Transition Team turned to the trauma registry, which tracks patients from the time they come in until discharge. As Gallagher explained, “This data helped us, for example, map out how many x-rays a trauma patient will require and how many staff to do it, how many trips to the OR, how many lab tests, blood units …” and the list goes on and on.
“Every division had to decide what they needed for the move –- and for 24/7 coverage -- in terms of additional attendings, additional nurse practitioners, additional residents,” he added.
Also, they had to consider the move’s impact on Penn Medicine’s missions of research and teaching. “We’re taking the most complex injured patients out of HUP -- these are cases residents want to see,” he said. “We have to make sure we provide residents and fellows with the educational experience they need.”
Based on the trauma registry information, keeping the trauma program operating at the same level will require an estimated 320 additional staff members at PPMC. At special town hall meetings at HUP and PPMC, “we explained to staff what we were building and how we needed these teams to join us,” Cole said. “We needed to move current staff with trauma expertise and experience to keep this program at the same level of excellence.”
“The program has to remain as intact as possible to maintain our accreditation as a Level 1 Trauma Center,” Gallagher said. “Because of Penn’s long history of good outcomes and good survey outcomes, the Trauma Foundation is transferring accreditation, we’re not starting from scratch.” If the Foundation had not allowed Penn to retain its accreditation, “we would have had to duplicate both trauma centers for a period of time … or close both for a time.”
The group depended on feedback from the extended trauma team when designing the various areas of the new Pavilion for Advanced Care – from trauma bays and ORs to periop areas and ICUs.
“We took the knowledge that we had from front-line staff to create improvements,” Cole said. “This is a totally different design than anything that exists in Penn Medicine.”