New North Liberty hospital sees ‘thousands’ of patients in week one

NORTH LIBERTY — University of Iowa Health Care for years has bemoaned its cramped emergency department and limited bed capacity — creating long wait times, lengthy ER stays and higher-than-average rates of would-be patients who leave without being seen.

The university’s new five-story, 469,060-square-foot hospital in North Liberty aims to offer some relief not only by housing UI orthopedics and sports medicine — freeing up its former space on the main Iowa City campus — but by debuting a new ER on the 60-acre site only a mile and a half off Interstate 380.

In the first week since opening Monday, dozens of patients received care through the North Liberty campus’ 18,400-square-foot ER — among the thousands seen in the new hospital’s orthopedics clinics, operating rooms and inpatient unit.

“This number is expected to increase as we enter the summer months,” UIHC spokesman Taylor Vessel said of traffic through the new ER — a 14-room, Level-4 trauma center outfitted with state-of-the-art X-ray, ultrasound, CT and MRI equipment.

Being a Level-4 trauma center — as opposed to Level 1 like the main campus ER and Level 3 like its Downtown ER, formerly Mercy Iowa City — means North Liberty’s ER has fewer trauma-care resources and might need to transfer some patients to Iowa City.

“All levels have the expertise and trained staff to stabilize trauma patients prior to transfer to higher levels of care, if needed,” according to a UIHC question-and-answer synopsis on the new campus. “The main difference between Level 3 and Level 4 is the presence of an on-call general surgeon at a Level-3 trauma center.”

And in an emergency, “The best emergency department is the nearest one,” officials said, highlighting a prime and strategic strength of the new hospital.

“Given the growing population in North Liberty and Tiffin, the emergency department at the North Liberty campus will increase access for these communities (as well as Coralville and surrounding areas) and provide emergency medicine closer to home,” UIHC officials said.

The most recent Board of Regents report on UIHC emergency room use showed wait times on the rise — up 40 percent from 2018 to 2022 — with the average length of an ER stay swelling from under 4.5 hours to as high as seven. In 2021, the average number of patients who were boarding in the ER overnight waiting on an inpatient bed swelled to 35 a day.

Today, typical ER wait time on the main campus can top three hours — with the average percent of patients who leave without being seen hovering at 4 percent.

In its first week, the North Liberty ER on most days at most times showed single-digit-minute waits, or no wait at all. That’s similar to times for the UIHC Downtown ER.

“With less than a week of operational data, it’s too soon to determine what sort of impact the new (emergency department) has had on wait times at UI Health Care’s two other hospitals,” Vessel said.

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‘Trash cans gathering rain’

But UIHC does expect more than 10,000 patients to come through its North Liberty ER this first year — potentially absorbing some of the system’s 54,110 total ER visits in 2024.

And the new campus’ ER patients will amount to just a fraction of the total traffic through that hospital — which boasts 36 inpatient beds, with room to add 12 more; 84 exam rooms; 12 operating rooms, with room to add four; two procedure rooms; one retail pharmacy with a 24-hour drive-through; and a large physical therapy and rehab gym visible to passersby behind a large glass wall imprinted with a Tiger Hawk.

The campus offers a walk-in clinic for same-day acute orthopedic injuries, clinical lab services, a cafeteria, a gift shop and dedicated space for teaching, research, and community education. It also has free patient parking and sweeping natural light.

“One of the cool things about this space is when you look into the exam rooms, they all have windows and natural light that comes in, which is not the norm in emergency departments,” UIHC Associate Chief Nursing Officer Emily Ward told reporters during a tour of the ER. “And we see that throughout the entire building — a lot of natural light in the patient care spaces.”

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Suspended by stainless steel cables above the heads of visitors entering the main atrium of the new hospital is a 27-foot-tall sculpture inspired by the anatomy of a single stem of big bluestem prairie grass — native to the hospital’s site — and informed by the “porous nature and growth of cancellous bone,” according to university officials. Its artist — Seattle-based John Grade — used all Alaskan yellow cedar wood for the piece, which was brought in as four sections and assembled on site.

“This facility, this parking, these clinics that physical therapy down there at the end, walk-in injury clinics — all of these things allow us to expand our care to a wider range of population,” Larry Marsh, chair of the UI Department of Orthopedics and Rehabilitation, said during a recent ribbon-cutting for the facility.

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Expanding and innovating, he said, “is really challenging when you're in the basement of a tertiary care center” — where the department previously was — “with the parking and the challenges for patients — not just us.”

“We call that the lower level,” UI Health Care Chief Executive Officer Bradley Haws joked during the ribbon-cutting about Marsh’s “basement” reference. “But I do remember taking tours, and often we would have trash cans gathering rain and other things that were leaking and occasional floods there. And, despite that, we still have more people that want to occupy the space that Dr. Marsh and his department are vacating.”

Although the university hasn’t shared publicly its plans for the former orthopedics home on the main campus, its state application to build in North Liberty aired intentions to create space for 65 to 80 more inpatient beds there.

“Operational plans are underway for the former orthopedics space,” Vessel told The Gazette. “Those plans will be presented to the Board of Regents in the near future.”

‘More Iowans need our care’

UIHC’s push to expand “to a wider range of population” was among the controversial aspects of the project when it first went before the State Health Facilities Council in early 2020 — and was denied a certificate of need to build.

Citing seven hours of testimony and 53 letters of opposition — largely from community providers accusing UIHC of veering outside its tertiary and quaternary-care lane and further into community health care — council members found UIHC failed to meet four factors required for a “certificate of need.”

Per the Iowa Legislature, applicants must show that less-costly alternatives aren’t available or practical; existing facilities are being used appropriately; alternatives like sharing arrangements have been considered and implemented to the extent possible; and patients will have serious problems getting care without the proposed facility.

“The letters and testimony established a lack of collaboration by the UIHC with local providers, that excess capacity exists at current facilities, that the UIHC is proposing to conduct procedures that could be provided by the community-based hospitals and ambulatory surgery centers in the area, and a substantial concern about the future viability of existing facilities if the UIHC is allowed to build the hospital,” according to the council’s written decision at the time, which also noted, “UIHC plans to hire 535 staff for the new hospital.”

“Noted by the opposition during testimony were concerns that the UIHC would actively recruit staff from Mercy Iowa City and other providers in the area.”

Mercy Iowa City, two years after the university eventually got the go-ahead to build in North Liberty, filed for bankruptcy following years of financial troubles. The university acquired it in a bankruptcy auction for $28 million.

Following the state’s initial North Liberty-project denial in 2021, UIHC resubmitted an application stripping any reference to orthopedics and focusing on its ability to treat the sickest of the sick.

“The requested construction and modernization to UIHC’s institutional health facility at Forevergreen Road will accomplish UIHC’s goal of serving unmet tertiary transfer demand,” according to the revised application, which eventually was approved. “UIHC acknowledges that there are available beds in the state of Iowa. Not all of these beds have the personnel and technology to serve patients that need tertiary care, and that is where UIHC’s lack of infrastructure to meet that need seriously harms patients.”

Conceding some of its tertiary-care expansion would happen on the main campus, UIHC in its application said “modernization cannot occur unless UIHC is able to decant some of its services to Forevergreen Road.”

In a recent online frequently-asked-questions on the new campus, officials also said, “More Iowans need our care and expertise — particularly in orthopedics and emergency medicine.”

“Patients also welcome the opportunity to get a prescription filled and/or have imaging done without needing to drive/park/navigate at the university campus. In short, they want greater access and greater convenience.”

After the state council in September 2021 approved the $230 million hospital piece of the North Liberty project, officials unveiled the full $395 million scope encompassing academic, research and clinical space. Then in July 2022 — citing industry challenges, inflation, limited materials and labor shortages — the Board of Regents approved a 33-percent budget hike to $525.6 million.

At the time, UI Senior Vice President for Finance and Operations Rod Lehnertz called the increase a “worst-case” scenario and hoped to return to the board with a “revised downward budget.”

In unveiling the new campus last month, UI President Barbara Wilson said, “We brought this building in on time and under budget.”

When asked for specifics, UIHC officials told The Gazette, “The total cost of the project has not been finalized, but leaders expect it to be under budget.”

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‘Future building expansion’

Staffing — and how the university planned to do it in North Liberty — was among the questions state councilors asked UIHC officials during the 2021 application process.

Officials said about 1,000 employees will work in North Liberty — including orthopedics faculty, staff, nurses, pharmacists, technicians, food and nutrition workers, and others.

“While we do not anticipate many direct impacts on staffing levels at our other campuses, certain areas may look a little different as we move certain orthopedic services to the North Liberty campus,” UIHC said in its FAQ.

UIHC as of Friday had 73 open North Liberty-campus positions. Across the university system, its jobs website listed more than 800 open health care related jobs, including more than 500 nursing or nurse-related roles.

In addition to the North Liberty site, the university is pursuing an 842,000-gross-square-foot inpatient tower on its main campus slated to cost more than $1 billion. That tower would be nearly double the 469,000-square-foot North Liberty hospital and be two-thirds bigger than the 507,000-square-foot Stead Family Children’s Hospital.

Additionally, officials noted in their North Liberty FAQ, “The 60-acre North Liberty campus allows for future building expansion.”

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com