Access to emergency health care is often a matter of life and death.
However, and not surprisingly, many rural communities nationwide do not offer hospitals that are readily accessible, creating potentially grave consequences for those with immediate life-threatening emergencies like heart attacks and strokes.
Spring Hill, Tenn., a mainly sprawling suburban community located 30 miles south of Nashville on the border of Williamson and Maury counties, clearly faced this reality for years.
Officials representing Spring Hill this approached HCA-subsidiary TriStar Health with concerns about accessing emergency care. They did so knowing that although the community is seemingly well situated between Maury Regional Healthcare System and Williamson Medical Center, traffic problems on the frequently congested Interstate 65 thoroughfare create potentially fatal inaccessibility.
The Tennessee Health Services and Development Agency ultimately denied TriStar's certificate of need application to build a Spring Hill hospital. However, the construction of a freestanding emergency room was approved, as the state considered it a department of TriStar's Centennial Medical Center flagship hospital located in Midtown Nashville.
TriStar Spring Hill ER opened in 2012 and is representative of both modern emergency room design and the health care industry's strategy of offering increased access points.
"Our ultimate goal is to be — either through technology or brick and mortar — within 10 minutes of anyone in the mid-state area," says Tim Scarvey, HCA TriStar Health senior vice president of strategy and development.
The strategy include affiliations and clinical agreements with 10 CareSpot walk-in urgent care facilities and Minute Clinics at CVS pharmacies. TriStar also operates a freestanding ER in Portland, Tenn., and will break ground on a third in Dickson this year.
"We think these are valuable access points, and the state has agreed," Scarvey says.
The Spring Hill facility is a standalone two-story building with physician offices located upstairs and outpatient imaging and an emergency department on the ground level. With board-certified emergency physicians, diagnostic imaging and a full laboratory, the standalone ER has all the resources a traditional emergency department would, setting them a step above after-hours urgent care clinics. Volumes and wait times are significantly lower at Spring Hill ER compared to those at Centennial. This is typical of most freestanding ERs, which tend to serve smaller communities.
"We have all the equipment and supplies needed to take care of the most critical patients to the least critical patients," says Keri McKamey, director of the Spring Hill ER.
However, there is a limit to the services Spring Hill ER can provide in-house. So the facility has ready access to TriStar's medical helicopter. Should a patient need a higher level of care, such as surgery or services in a catheterization lab, pilots can reach Centennial in 15 minutes.
"If we have an active heart attack that needs to go immediately to a cath lab, we'll stabilize the patient and get them there," McKamey says.
From a design perspective, Spring Hill was built like a traditional ER, with a hub in the center for nurses and physicians to oversee exam rooms, the trauma center and the pharmacy. Because the facility stands alone on more than 100 acres, the entrance is significantly less crowded and easier to access by car than a conventional emergency room clustered on a campus-style hospital.
The emergency room also includes modern resources such as high-tech telemedicine "robots" that can wheel from bedside to bedside. Neurologists or other specialists at Centennial — or who are located anywhere, for that matter —can phone in and examine patients via cameras and attached stethoscopes. The ER also has a decontamination room and two "safe rooms" for patients that may hurt themselves or others. The safe rooms feature mechanic wall dividers that reconfigure normal exam rooms to be partially empty at the touch of a button.
With its own lab and imaging department, patients admitted to the ER or visiting the physician offices upstairs can have additional tests completed without leaving the facility.
"It's a central medical hub for the community, so anyone can come to it any time of the day or night," Scarvey says. "Whether you have a scheduled appointment with a primary care physician or if you wake up sick in the middle of the night, you can come here."
Scarvey says that TriStar continues to monitor the services Spring Hill ER provides and is exploring additional facilities and service lines.
"When patients need to be transported out, we evaluate the reasons why, and that will help inform our decisions regarding additional service lines," he says. "We have sufficient space here to continue to add services, and one day we expect to have a hospital here as well."