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Modern Marvel

The new LAC+USC Medical Center brings state-of-the-art care to the public
By Sara Reeve
Winter 2009
LAC+USC
The new LAC+USC Medical Center is highlighted in front of the historic facility it has replaced. Photo by West Coast Aerial Photography.
 

Nearly 15 years after the 1994 Northridge earthquake rocked Southern California and left Los Angeles County+USC Medical Center (LAC+USC) damaged beyond repair, the new replacement hospital is open for business. The 1.5 million-square-foot facility boasts state-of-the-art equipment and design features, and is home to one of the largest emergency rooms in the country with 136 beds.

“The University of Southern California has been affiliated with this hospital for more than a hundred years,” says Keck School of Medicine Dean Carmen A. Puliafito, M.D., M.B.A. “This tremendous new facility is very important to USC and very important to the community.”

Plans to replace “Big County” – L.A.’s largest provider of trauma services – date back to the 1960s, with more than 100 separate ideas being studied, but none were ever implemented.

Political negotiations between local, state and federal officials centered on balancing concerns about the cost of building a new hospital from scratch with the need to provide quality health care to Los Angeles’ neediest residents. The unrelated closure of several public health care clinics underscored the county’s need for a reliable hospital.
This need led elected officials to approve the new hospital – the largest hospital construction project west of the Mississippi River. The scope of the construction is unprecedented in Los Angeles County, with a total cost of $1.02 billion for construction and equipment.

“We thank the Board of Supervisors for the investment that ensures we can continue to provide excellent and timely care to the people of Los Angeles,” Puliafito said at an opening reception. “No other community in the United States has made this level of commitment to the health and safety of its people.”

Because the old County Hospital was damaged in the Northridge earthquake, the Federal Emergency Management Agency funded $500 million in 1996 toward the cost of the new hospital. Construction of the facility began in 1998.
At $431 per square foot, the replacement facility is a relative bargain compared to recent hospital construction projects in Southern California. For example, construction costs at the Kaiser Permanente Medical Center in Downey ran $612 per square foot, and at the UCLA Ronald Reagan Hospital, costs ran to $921 per square foot.
“The total is not a small amount, but that cost would be double if we were starting this project today,” says Carolyn Rhee, who served as project director for construction of the new building.

WHAT DO LOS ANGELES RESIDENTS GET FOR $1 BILLION? The hospital features a seven-story outpatient clinic tower hosting numerous specialty clinics, including psychiatry, ophthalmology, dentistry and orthopedics. The eight-story inpatient tower – the largest section of the hospital at 681,000 square-feet – houses the hospital’s acute care and intensive care units. And at the heart of the new hospital is the five-story diagnostic and treatment building, which contains several departments including the expanded emergency room, operating rooms and pharmacy.
“This is state of the art,” says second-year resident Catherine Lin, M.D. “I feel very privileged to provide care at LAC+USC.”

The reduction in licensed beds from 671 at the old hospital to 600 in the new has been a concern for doctors, staff and community leaders. However, officials believe that with 50 overflow beds at Rancho Los Amigos Medical Center in Downey, the hospital can operate successfully. LAC+USC’s emergency room continues to be one of the busiest in the country, caring for 400 adult and pediatric patients daily.

“County Hospital is the lynchpin of the Los Angeles County health care system. It has the biggest Level 1 trauma center in the United States. We receive the lion’s share of the County’s indigent and uninsured patients – that’s our purpose,” says Edward Newton, M.D., Keck School of Medicine chair of emergency medicine. “We relieve local private hospitals of the burden of uninsured patients, and help ensure access to emergency care for patients throughout Los Angeles.”

The new emergency room is three times the physical size of the old one, and the new design has streamlined care and treatment for emergency patients. The new helipad is located on the roof of the diagnostic center, which allows for direct access for the most critical patients to the emergency room. Radiology and surgery also are located in the building, easily accessed by swift new elevators.

Stephanie Hall, M.D., chief medical officer of LAC+USC and an alumna of the Keck School, describes the advantages of the new hospital in terms of a patient’s golden hour. “Treatment for a patient during that first hour is critical – to get that patient into the facility, have diagnostic tests done, and get them into the operating room as quickly as possible,” she says. With the design of the new hospital, “the timing and level of diagnostic capability is quite a difference.”

In addition to the physical improvements, doctors and staff have implemented new efficiency practices to decrease the time patients spend in the hospital. Average length of stay for inpatients was reduced from an average of 6.6 days in 2003 to 5.2 in 2008. Median boarding time in the emergency room – defined as the time between a patient’s admission to being placed in an inpatient bed – decreased from seven hours in 2006 to three hours in 2008. The amount of time patients spend being seen in clinics was also improved from seven hours to only two.

“The County and USC have had to work closely together to reduce the average length of stay of patients in order to maintain our current number of discharges while operating a reduced number of beds,” says Edward D. Crandall, M.D., Ph.D., chair of the Department of Internal Medicine, Hastings Professor and Norris Chair of Medicine at the Keck School of Medicine. “The new hospital has allowed USC physicians to manage inpatient length of stay and improve patient flow even more efficiently.”

The new medical center includes multiple design and technological upgrades that speed patient care, increase efficiency and ensure patient, physician and staff safety.

Wall-mounted ultrasound imaging equipment in the emergency room allows physicians to immediately get an in-depth look inside their most critical patients without having to transport them to the radiology department. Physicians also have easy access to specialized equipment and facilities. The replacement hospital features four computed tomography (CT) scanners, three magnetic resonance imaging (MRI) scanners, three linear accelerators, two cardiac catheterization laboratories, one lithotripter, and a combination positron emission tomography (PET)/CT scanner.

“This brand new facility is a beacon for the community,” says Adler Salazar, M.D., chief pediatric resident at LAC+USC Medical Center. “They know that the County is modernizing to provide the best care for them.”

Intra-hospital communication has been simplified with a pneumatic tube system and a state-of-the-art automated guided vehicle system that transports supplies between floors, saving staff time and effort.

The new medical center also has incorporated elements of “evidence-based design.” This concept states, in part, that the right physical environment can reduce the spread of hospital-acquired infection. Most rooms in the hospital are designed for a single patient, a big change from the multi-patient wards of the old County Hospital. This reflects a key component of the American Institute of Architects recent health care facility guidelines. The addition of several special rooms equipped with negative airflow pressure, as well as ubiquitous hand-washing sinks and alcohol hand-sanitizing dispensers, will help protect patients, physicians and staff from infection.

“This is beautiful,” said Keck School of Medicine alumnus Jerry Andes, M.D., class of 1960, during a Keck-hosted open house at the new hospital. “I have a private practice in Fullerton, but I’d rather practice here. This is superior in design and efficient. I’m proud of USC and what they’ve done and what I see here.”

Because earthquake damage resulted in the need to build the new hospital, earthquake safety was a major consideration in its design and construction. According to hospital officials, major portions of the new facility are designed to withstand earthquakes with a magnitude of up to 8.0, and can sway up to 23 inches in any direction. The hospital is intended to be completely self-sustaining for up to 72 hours in the event of a major earthquake or other disaster.

“This new facility provides an opportunity for the LAC+USC Medical Center to have a new shining image for the entire County of Los Angeles,” says Christi N. Heck, M.D., director, USC Comprehensive Epilepsy Program. “It means we can assure patients of all backgrounds complete, efficient and state-of-the-art care. It gives us all an opportunity to showcase our work and provide a sense of pride to the community for doing it.”

TRADITION OF MEDICAL SERVICE With all the new technology and gleaming facilities, USC faculty physicians, residents and medical students will continue their tradition of medical service to the community that began in 1885. Just seven years after the original County Hospital opened with 100 beds and six staff members, USC and Los Angeles County began their collaboration to care for patients in need.

The first intern at the hospital was hired in 1919, at a salary of $10 a month. That intern’s contract included a sentence that still rings true with many of the physicians, residents and students who teach and learn at LAC+USC: “The wealth of clinical material available in this hospital at all times is without doubt as great as that of any similar institution in the world.”

That quote is so relevant that Lawrence Opas, M.D., chief of pediatric services and director of graduate medical education at LAC+USC, uses it in his annual address to new County residents.

“The patients here at County have limited access to preventative health care,” says Opas. “The breadth of pathology that residents see here is unlike any other teaching hospital in the United States. County Hospital attracts doctors who have a passion for treating the underserved.”

The prospect of training at LAC+USC Medical Center is often cited as a key attraction for students enrolling at the Keck School of Medicine. Learning at a large public hospital in a metropolitan environment provides a variety of learning opportunities not often found in medical school.

“Upon walking into County, I knew that the Keck School of Medicine was where I wanted to be,” says fourth-year medical student Maria Reese. “I was excited by the opportunity to be an integral part of caring for and learning from County’s diverse patient population. I respected the faculty for not only being renowned in their fields, but also for serving as excellent role models of physicians serving the community, regardless of patients’ insurance status.”
The dedicated physicians and nurses care for some 39,000 inpatients and one million ambulatory care visits every year, while overseeing the training of more than 1,000 medical residents, fellows and medical students.

“Everywhere I go, when I tell people that I have something to do with the USC medical school, the discussion always comes back to the very special place that County has played in the history of USC medicine,” says Dean Puliafito. “So many of the physicians who live and work in California and throughout the United States were trained here.”

Amid the excitement of opening the new LAC+USC Medical Center, faculty and administrators agree that it is not a panacea for the strained Los Angeles County health care system. Nonetheless, physicians and staff working at the modern facility strive to deliver on its promise to provide the highest quality of medical care to Southern California patients.

That is a tradition that Heck believes is integral to her own practice. “I believe it is a true honor to advocate and care for the patients of the LAC+USC Medical Center because these are the patients and families who need us the most,” she says.