Where do you want to have your baby? Your face lift? Your back surgery? Hospital patients who have the luxury of time increasingly have the luxury of choices. As North County’s population has grown, so has the potential to check out the hospital you’ll be checking into.
In addition to considering the medical advice of their physicians, patients can also evaluate a hospital based on its ambience, its services and its cost. The right hospital might not necessarily be the one closest to home.
North County’s five hospitals:
* Tri-City Medical Center in Oceanside, the area’ largest and busiest.
* Palomar Medical Center in Escondido, the area’s only trauma center.
* Pomerado Hospital in Poway, attached to a 149-bed skilled nursing facility.
The Pomerado and Palomar hospitals are administered jointly by the Palomar-Pomerado Health System.
* Scripps Memorial Hospital in Encinitas, which says it’s putting hospitality back into hospitals.
* Fallbrook Hospital, the area’s smallest, but which has managed to produce its own baby boom.
As they scramble to attract and serve patients, the hospitals are offering a variety of new programs and amenities.
If North County’s hospitals are becoming more innovative, there is good motivation, according to George Belch, chairman of the marketing department at San Diego State University. “Everybody sees that it’s the growth area of San Diego and that the population is somewhat more affluent. Hospitals do strategy planning and market analysis like any corporation.”
Like all large institutions, hospitals can be bruised by bad publicity and can be aggressive in seeking good community relations. “It’s a competitive environment,” said Alain Jourdier, director of communications for the twin Palomar-Pomerado system.
The marketing budget last year for Palomar-Pomerado was $1.5 million--which included money for advertisements, brochures, health fairs and other promotions. Tri-City Medical Center spent around $400,000. Fallbrook’s budget for marketing was less than $200,000, and Scripps-Encinitas said it spent $88,000.
Scripps-Encinitas is a private, nonprofit institution, while the other four North County hospitals are public, meaning they were established by the community and are governed by boards elected by district residents in much the same way that school boards are. Local taxes usually provide only a fraction of a multimillion-dollar annual budget. Patient and insurance revenues, plus fund-raising monies, provide the balance.
All of the hospitals have either just completed expansions or have blueprints for growth in the works.
Scripps plans to build a major new medical center in San Marcos. Kaiser Permanente, which operates clinics in Carlsbad and Escondido, is considering construction of a 100-bed hospital somewhere between Escondido and Oceanside.
As the hospitals respond to the growing North County population--one that is, in general, insured rather than indigent--they are striving to distinguish themselves by the quality and quantity of services offered.
TRI-CITY MEDICAL CENTER
4002 Vista Way, Oceanside Calls: 724-8411 Beds: 451 Staff: 2,000
Annual admissions: 18,084
A room service program run by the hospital’s 700 auxiliary volunteers will deliver VCRs and videos and even help patients write letters.
Tri-City Medical Center prides itself on providing services like a posh hotel, according to Jennifer Velez, public relations coordinator.
A room service menu may be used by patients or their guests for hamburgers, chocolate chip cookies, herbal teas and other snacks. “Haagen-Dazs ice cream bars and popcorn are most popular,” said Velez. “The response has been great and the auxilians are very busy.”
So is the emergency room.
With more than 55,000 visits last year, Tri-City’s emergency room was the most hectic in the entire county. The 451-bed hospital also chalked up 18,084 admissions and delivered between 400 and 450 new babies each month.
Tri-City offers a cancer center, cardiac care that includes an open-heart surgery unit, a chemical dependency department, a rehabilitation center, a neonatal intensive care unit, and an alternative birthing center among other departments.
Tri-City has more than 2,000 doctors, nurses, administrators, technicians and others on staff. Its yearly payroll is about $87 million.
One of the hospital’s more innovative programs is its Day Treatment Center. The center, in a white clapboard house on Horne Street, is not a hospital setting, said Mary Wallace, manager of mental health services.
The center is staffed by a psychiatrist, social worker, psychiatric nurse, occupational therapist and a recreational therapist. It offers comprehensive counseling and a range of activities for those who have suffered a traumatic incident, like the death of a spouse, or who are fighting depression, stress or anxiety, Wallace said.
The hospital also offers Hospice Services, a program designed to allow terminally ill patients to live out their last months at home, rather than in the hospital. Hospice provides in-home medical supplies, nursing visits, pain medication, and arranges to give family members some time away from the house. Hospice can also arrange help with legal and financial matters as well as grief and bereavement counseling for the patient and surviving family.
In several departments at Tri-City, dogs are being used to make hospitalization a less threatening and intimidating experience. The animals, who are accompanied by their owners, are gentle, obedient and work with patients in the rehabilitation center, the mental health unit and with Hospice Services. Eventually dogs will be used in pediatrics, with cancer patients and in other departments.
Because the hospital is performing more outpatient surgeries, which no longer require an overnight stay in the hospital, Tri-City offers a free service that provides rides to and from the hospital. The service is also available for appointments other than surgery to any patient living in Carlsbad, Oceanside, San Marcos and Vista.
Expansion plans at Tri-City include a $20-million construction project that will triple the size of the emergency room by summer. A new central plant to supply heating, cooling and other technical needs will also be completed at that time.
Construction plans for 1992 include building a surgery center that will be twice the size of the present facility; renovating and expanding the women’s center; and building a 200-bed skilled nursing facility.
PALOMAR MEDICAL CENTER
555 East Valley Parkway, Escondido Calls: 739-3000 Beds: 341 Staff: About 1,800
Annual admissions: 12,000
Palomar is one of six trauma departments in San Diego County--it is the only one in North County.
A trauma department is different--and more aggressive--than a simple emergency room because the facility is always ready to give full immediate care, and the staff has been specially trained to deal with critical situations.
“It’s crucial that people know there is a trauma center here,” said Maureen Goehring, who directs the trauma department at Palomar.
Victims of automobile and motorcycle accidents, falls and assaults are often rushed to trauma centers.
Paramedics summoned by 911 to the scene of an accident or other medical crisis will evaluate a patient based on a “CRAN” score. CRAN stands for circulation, respiration, abdominal movement and speech. That evaluation helps determine whether a patient will be sent to a trauma center.
Before trauma centers were introduced to San Diego in 1985, emergency rooms were the only option. “If a patient was brought in at 9 p.m., you’d get pretty rapid care. However, if you came in at 3 a.m. and needed immediate surgery, a ruptured spleen for example, you’d have to get on the phone to find a surgeon at home and it could take from two to four hours. Patients were literally dying,” said Goehring.
In contrast, patients brought to the trauma center have the support of an emergency room physician, a trauma surgeon, an anesthesiologist, a control nurse who supervises and coordinates events and a support nurse. There is also a staffer called a scribe who takes minute-to-minute notes. In addition, a neurosurgeon, a respiratory therapist, an X-ray technician, CAT scan technician, a pharmacist and a social worker are on call in the building.
The trauma centers have reduced the preventable death rate in San Diego County from 36% to 2%, Goehring said.
Palomar has between 1,000 and 1,200 trauma patients a year.
Goehring said the members of the trauma staff are “adrenaline junkies. This is work that makes a difference in people’s lives.”
Palomar Medical Center and Pomerado Hospital together have an annual payroll of about $80 million.
A recent $50-million expansion program left Palomar with more beds, a larger emergency room and almost twice as many operating rooms, including open-heart surgery and spinal surgery facilities.
Palomar’s emergency room sees about 36,000 patients a year. The hospital has 12,000 to 15,000 admissions a year to its 341-bed hospital, and had about 3,600 births in 1989.
Its programs include a heart center where the cardiologist works with a physical therapist, dietitian, social worker and home health nurse as a team.
A birth center has 26 private “birthing suites,” rooms with pink flowered bed spreads and rose-colored curtains designed to provide the comforts of home.
Palomar also has a patient advocate service. Bob Crawford, director of marketing, said the patient advocate serves as “an ombudsman to interact, intercede and assure a patient of satisfaction.”
15615 Pomerado Road , Poway Calls: 485-6511
Staff: About 700
Annual admissions: 6,000
There are only private rooms at the 130-bed Pomerado, but patients are billed at semi-private rates, said Karen Barron of Pomerado Hospital.
“Our size is our advantage,” she said. “We provide state-of-the-art equipment in a very personalized setting.”
Among the options available to patients: the Rx Pets program, which allows dog visits to rooms.
Pomerado Hospital and Palomar Medical Center together have an annual payroll of about $80 million.
Some 20,000 patients visited Pomerado’s emergency room last year. There were about 6,000 admissions, 34,700 outpatients, and more than 1,600 births.
Villa Pomerado, a 149-bed skilled nursing facility, is attached to the hospital by a corridor. It serves as a transitional environment for those just released from the hospital, and it also provides physical, occupational and speech rehabilitation therapy.
The facility also offers respite care that allows home care-givers to take a break. A family member who is ill or disabled and needs support care can be temporarily checked into the facility while the primary care-giver is out of town or otherwise unable to offer care.
Since September, Villa Pomerado has filled another role.
It is now one of the only places in the county where rape victims receive treatment from specially trained nurses in a private environment.
Police from all over the county work with Pomerado’s sexual assault and response team, called SART. One room at Villa Pomerado is set aside for rape patients. “It is a lot less threatening an environment than an emergency room,” said Barron.
Six of Pomerado Hospital’s nurses have been trained in evidence gathering techniques in sexual assaults. A social worker also is there to help the victim deal with the emotional trauma.
624 East Elder , Fallbrook Calls: 728-1191 Beds: 50 Staff: 300
Annual admissions: 3,457
At just 50 beds, Fallbrook Hospital is the smallest in North County.
“The patient is not an account number, but an individual and is treated with dignity. That’s something that comes through,” said Don N. Larkin, Fallbrook Hospital’s chief executive officer.
Last year there were 10,793 emergency room patients, 3,457 admissions, 10,904 outpatient visits and 1,161 births.
Fallbrook, which has a high number of births for its size, recently built a new maternity unit.
In a $1.2-million addition completed last year, four new suites for labor, delivery and postpartum were added. Included in the project was an operating room and 12 nursery bassinets.
Fallbrook Hospital’s modest size lends it a flexibility that allows it to stay current, said Denise Stearns, chief marketing officer. As an example, she cited the pain management center that opened in October.
The program was started by two physicians who received special training in treating chronic pain.
The center outfits patients who have chronic pain, such as that caused by cancer, with a tiny pump that is placed under their skin and releases minute doses of painkiller directly into the spine. The amount of medication needed by using this method is much reduced and relieves the patient of many side effects.
The decision to open the center was swift, said Stearns. “It’s part of our mission to have a commitment to innovation. These are times in health care when you have to be ahead of the game.”
Other hospital programs include a diabetes support group, a sports injury clinic and a cardiac rehabilitation workshop.
The hospital has a staff of 300 and an annual payroll of $7.5 million.
Fallbrook’s 400-member auxiliary is active and offers free rides to and from the hospital and doctors’ offices.
354 Santa Fe Drive, Encinitas Calls: 753-6501 Beds: 148 Staff: 400
Annual admissions: 4,000
There is an atrium, mahogany furniture, flowers and open space in the lobby of Scripps Memorial Hospital-Encinitas. Other physical amenities: a secluded, comfortably furnished meditation room.
“Look at the root of the word hospital. It comes from hospitality,” said C. Michael Dabney, director of media relations. “Yet, often people have a negative impression of the idea of a hospital. There’s a lingering negative feeling, and so the more we can make the hospital seem like it’s exuding personal care the better.”
Some 4,000 patients checked in to the Scripps Encinitas hospital last year. About 16,254 were seen in the emergency room, and about 7,000 were treated on an outpatient basis. The 148-bed hospital has a staff of more than 400 and paid out some $30 million in wages and benefits last year.
Last January, Scripps completed a $17-million expansion that increased the number of beds from 93 to 146.
It has a new eight-bed cancer center and 30-bed rehabilitation wing designed for stroke and head injury recuperation.
A sauna and gymnasium help with physical therapy, and a transitional apartment is used to allow patients to relearn living skills, such as cooking and housecleaning.
A further $5-million renovation begun over the summer will increase the surgery department by two operating suites; increase the number of beds in the intensive care/cardiac care unit from 8 to 20; and improve facilities in a number of other departments.
Scripps is also planning to build a major medical complex in San Marcos.
So far, Scripps has purchased 36 acres and intends to purchase about 30 more before breaking ground on the project next year.
The first stage calls for construction of a clinic and doctors’ offices. Later, construction would start on the hospital itself.
The project will be paced according to the needs of the San Marcos community, according to Laurence Blagg, executive vice president of Scripps Hospitals.