University of Iowa expanding emergency room, building new parking ramp

IOWA CITY — The often congested University of Iowa Hospitals and Clinics emergency room is getting a much-needed $24.6 million expansion over the next two years — enabling progress toward the big-ticket items on UI Health Care’s 10-year master plan, including a new inpatient tower, ambulatory care center, and research facility.

A preliminary timeline for UIHC’s two-part expansion of its slammed emergency department has construction on its north side beginning in February and wrapping in November 2024. Construction on the south side would start in May and finish in April 2024, according to documents UIHC issued in June seeking proposals from construction managers.

The emergency room expansion — along with a $95 million “vertical expansion” of UIHC’s existing inpatient tower on the main campus, a new $65 million parking ramp, and a new $6.5 million academic building, all of which UI recently put out for bid — are cited in its master plan as initial or enabling projects for UIHC’s new tower, care center, and research facility.

Emergency expansion

But officials report the emergency department expansion is necessary in its own right, as “clinical volumes and patient needs have continued to grow.”

The average number of adults in the UIHC emergency room at midnight in 2021 was 35 — a 30 percent jump from the average midnight census of 27 in 2020 and 21 percent above its pre-pandemic average of 29 in 2019, according to Board of Regents documents.

“Patients boarding in the emergency department while waiting for an inpatient bed has dramatically increased,” according to a UIHC report to regents in April, noting inpatient occupancy is at “critical levels” and “more challenging than ever.”

For the 2021 calendar year, UIHC’s inpatient census averaged 97 percent — up from 93 percent in 2020 and 95 percent five years ago in 2017.

The cramped quarters have driven up the average number of hours patients requiring admission are lingering in the ER “due to delays in our ability to admit patients when the hospital is full.” Where the median ER stay for to-be-admitted patients was 5.3 hours in 2017, it bounced to 7.1 hours in 2021, UIHC reported.

“We’ve seen a significant increase in complex patients, including complex psychiatric patients, visiting the ED over the last few years,” according to a message UIHC administrators sent employees Friday, updating them on ongoing building projects. “To meet this need and improve the flow of patients through the ED, we are planning an ED expansion.”

The scope of the full ER expansion ties into other renovations and expansions — all while trying to serve the 50,000-some who come to UIHC annually needing emergent care.

“The north expansion will be the first phase constructed, with the south expansion to be the second phase,” according to project bid documents. “The emergency department is a 24-7 operation and thus construction work will need to happen in a strategic way to off-set disruptions and to keep the area secure and safe for patients and staff.”

The north-end ER expansion will create new behavior health exam rooms, allowing the relatively new Crisis Stabilization Unit — which opened in 2018 — to relocate to the first floor adjacent the ER and its behavior health exam rooms.

The south-end ER expansion will include additional exam rooms and support spaces.

The project — with an estimated total budget of $24.6 million, including $11 million in construction costs — also will involve new dedicated pediatric space with separate exam rooms and waiting area, and new technology.

North Liberty help

The expansion boom on the main UIHC campus in Iowa City comes as it builds a $525.6 million hospital campus in North Liberty.

That 469,000-square-foot project includes both an academic and clinic building and a hospital, which will offer an 18,437-square-foot emergency room — projected to need an additional 32 emergency department-specific full-time employees.

A statement of “assumptions” for the new North Liberty campus projects 11,156 emergency visits in its first year of operation in 2025, increasing at a 2 percent and 3 percent rate to 11,383 in 2026 and 11,725 in 2027, according to a UIHC application for state approval to build.

In that application, UIHC reported without more emergency room space, prospective patients will feel access constraints.

“In FY19, the average number of individuals who left without being seen from the emergency department was approximately 4 percent, increasing in recent months to greater than 11 percent at times,” according to the December 2020 application.

UIHC officials in their Friday message updated employees on other progress toward their 10-year goals — acknowledging, “The plans launched so far are the start of much more to come.”

New parking ramp

That includes a new “west campus parking ramp” — expected to cost $65 million.

That ramp, according to a request for qualifications from potential construction managers, is in the design phase and is expected to offer more than 900 spaces, including additional parking for employees.

Crews will erect the new five-story ramp on a chunk of existing paved parking immediately north of the West Campus Transportation Center — which sits across Evashevski Drive from Kinnick Stadium.

The ramp — which the university expects to start building in May — will involve a “pedestrian skyway extension to connect the new ramp to the existing UIHC skyway,” according to the RFQ. UI’s 10-year plan presentation to regents earlier this year directly tied completion of the new parking ramp to their ability to build a new inpatient tower, which could add more than 200 beds.

“We understand how important it is for us to improve parking for our employees, learners, patients, and visitors,” according to Friday’s campus message.

“It’s exciting to see progress toward our 10-year campus master plan vision, which will include a patient care tower, made possible by a $70 million gift from the Richard O. Jacobson Foundation,” according to the employee message Friday. “It’s also important to remember that we are very early in the process, and plans will continue to evolve. Many of the projects in the master plan relate to and rely upon each other, so there is much to work through to coordinate timing and campus impacts.”

Vanessa Miller covers higher education for The Gazette.

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