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DHMC updates its master plan in the face of space needs

"It's no secret to anyone that we're out of space," says Susan Reeves, vice president for neuroscience, orthopedics, rehabilitation, and emergency services at DHMC. She and Frederick Nothnagel, vice president for facilities management, are working together to help DHMC address the need for new clinical, administrative, educational, and research space.

Since the 1991 move to the Lebanon campus, DHMC has experienced "major growth in outpatient volume, interventional procedures, imaging modalities, and care management," according to Reeves. She says the Emergency Department, the dialysis facility, and the infusion suite all require expansion as well and that inadequate parking is a problem, too.

The latest iteration of Dartmouth-Hitchcock Medical Center's site master plan shows the placement of various projected new buildings and of more parking (the latter most likely in multilevel structures of some sort), as well as a likely location for long-range development (indicated with the white arrow in the lower left); the loop road currently runs inside this area.

Courtesy Shepley Bulfinch Richardson and Abbott

Updated: The DHMC master plan is updated every five years. The new plan that Reeves and Nothnagel are working on represents a major departure from the previous plan. When the last one was done, in 1994, "there were no pressing space issues," says Reeves. It "represented a futuristic 'what do we think health care is going to look like'" view.

Some elements of the 1994 plan have been completed (including construction of a hangar for the Dartmouth-Hitchcock Air Response Team (DHART) helicopter and of an office building on nearby Mount Support Road), while other needs (like a health club and an inexpensive place for patients and family members to stay) have been met by private businesses.

But with outpatient volumes increasing two percent a year, DHMC is running out of space to handle the growing demand. And even though inpatient volumes have dropped—the number of hospital beds has decreased from 392 in 1991 to 335 today—that decline has done little to alleviate the space crunch. The overall increase is attributable to the growing number of older Americans, to population increases in the Upper Valley, and to new technology that allows procedures which once required hospital stays to be performed on a same-day basis.

In the Emergency Department alone, 20,000 visitors are expected this year, compared to 17,000 in 1993. Key reasons for that increase, says Reeves, include the addition of the DHART helicopter service; more seasonal visitors to the region; an especially bad flu epidemic this year; the aging population; and the fact that small hospitals without the resources to keep sicker patients increasingly send them to DHMC.

Focus groups: As part of the current planning process, several different focus groups met last fall. Ten provider cluster groups reviewed demographic, market, and technology trends; growth projections; preferred practice models; and space needs. Three patient focus groups—one made up of DHMC patients, another of patients of the Dartmouth- Hitchcock Community Health Center (an off-site primary care practice), and one of people who receive their care elsewhere— discussed their expectations for health care. And three academic cluster groups looked at trends in academic medicine; characteristics of the research and educational environment; and existing space deficiencies.

Timeline: Although there's no firm timeline for construction, and any plans will be subject to approval through the state Certificate of Need process, Nothnagel says the immediate priorities are to increase the space for ambulatory care near Building 6 (possibly by constructing Building 6A) and to extend Building 2 (the diagnostic and treatment building, which includes the Emergency Department and the OR and radiology areas). The plan for increasing parking capacity currently calls for building multilevel parking structures of some sort.

Future plans include more space for DMS—Buildings 7 and 9—as well as possible construction in a now-undeveloped area of the campus.

The site master plan represents a "road map for future construction," says Nothnagel. But, he adds, health care may become more centralized or more homebased. "The need [for still more space at DHMC] may never develop. We just don't know."

Laura Stephenson Carter

If you would like to offer any feedback about this article, we would welcome getting your comments at DartMed@Dartmouth.edu.

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