Emek Medical Center, a regional care facility in northern Israel, seeks to build a new and advanced intensive care unit. With a top-tier quality of care ranking (99.5%), Emek is among Israel's most elite hospitals. Yet it has only six adult ICU beds to serve the 700,000 residents of its catchment area. National standards mandate that 5% of hospital beds should be in the ICU; Emek's adult ICU beds represent just 1% of its total capacity.
The new adult ICU ward would increase to 18 beds – triple the current number. Emek also plans to double its four pediatric ICU (PICU) beds to eight. It will move the neonatal ICU (NICU) close to the delivery rooms and obstetrics ward, minimizing the risk to the small neonates. Ten NICU cribs will bring the new total to 30. This compelling project will enable Emek to meet the national standard.
Emek is one of 14 hospitals that are part of Clalit Health Services, Israel's largest healthcare provider. As an academic medical center, it is a teaching hospital for the Technion Medical School.
The total project cost is $13.1 million. The adult and PICU beds will cost $9.2 million; Clalit has secured a 1:1 match for these two subunits, leaving $4.6 million to be raised. Separately, the NICU will cost an additional $3.9 million.
Why intensive care units are key to patient survival
An Intensive adult care unit is needed when the patient is not stable and requires additional, close care. She may need lifesaving procedures such as intubation, therapies for shock (low blood pressure) or for renal failure.
Children are likely to need a pediatric ICU because of trauma, car accidents or falls. They may have ingested toxic substances, suffer from seizures or need to be ventilated. Children may also be admitted to a PICU after major surgeries or to treat metabolic diseases.
Critically ill patients are more likely to die in a regular unit than in an ICU. Within 24 hours of transfer to a hospital bed, 25.4% of deteriorated patients died compared to only 5.5% of those in the ICU. In effect, dangerously worsening patients are four times more likely to die in an internal medicine ward than in the ICU.[1]
The thirty-day morbidity rate shows similarly dramatic results. In Israel, the mortality rate for critically ill patients was significantly higher in regular departments (36.4%) than in ICUs (28.7%)[2]
In regular departments, critically ill patients cannot receive the superior monitoring they require; nor is advanced and more specialized therapeutic equipment always available. For example, in the ICU, advanced monitoring means that treatment of shock can be more finely honed to the cause of shock, whether it be hypovolemic, cardiogenic or neurogenic shock
With so many ICU patients requiring ventilation, only the ICU has sophisticated capacities to match the type of ventilation to the patients' physiologic condition. With advanced specialization, intensivists can prevent the traumas that can occur when the wrong ventilation is applied. The intensive care unit is the only department capable of providing extracorporeal membrane oxygenation (ECMO – heart lung machines), continuous renal replacement therapy for hypotensive patients in acute renal failure.
Emek delivers quality care despite overcrowding and under challenging conditions
Located in Afula, Emek Medical Center is a 580-bed facility. It serves an area that stretches from Metula, on the Lebanese border, to the Ara Valley towards the south, and Tiberias and the Sea of Galilee to its east and north.
Emek is a periphery hospital, serving a unique community of Jewish, Druze, Bedouin, Arab and Christian residents. The medical center staff mirrors the region's population at all levels of skills and specializations.
The 700,000 residents in Emek's catchment area are less educated, poorer and in worse health than those who live in Israel's center. Israel's northern poverty rate is devastating -- 41% are below the poverty line, compared to 10% in Tel Aviv. Its population is expected to increase by 45% by 2040.
The northern population is also sicker than its counterpart in Israel's center. Using a standardized rate of defined needs, 28% of Israel's northern residents are in this category, compared to 19% in Israel's center.
As part of Clalit's healthcare system, Emek benefits from its economy of scale and outstanding expert and scientific resources.
Despite its location in the periphery, Emek's ICU is the only one in Israel to achieve zero infections for 1,000 days of a central venous catheter (also known as the central line). Among all Israeli hospitals, its quality of care ranking is at the top tier, at 99.5%
Beit Shulamit, Emek's new cancer center, will open in May 2022 and is designed to be a national center of excellence. This tertiary care facility will further increase the demand for ICU beds.
Because there are fewer health care facilities in the region, Emek is often over-capacity. Northeast Israel has 1.58 hospital beds per 1,000 residents while Tel Aviv has 2.49 beds per thousand. Emek is usually at 105% of capacity while some departments stretch to 110% capacity or more.
The current ICU is dangerously overcrowded
Emek’s current ICU is presents
formidable challenges to the medical staff, patients and their families. Housed in a small 1950’s facility – one of the
hospital’s original buildings -- the entire ICU is located along a single
hallway. The six ICU beds are all in a single room with tightly crowded beds.
This limits the use of technology and makes it difficult to maneuver such
vital equipment as x-ray machines and endoscopy equipment.
The Emek ICU is full between 130 and 180 days a year. And between 80 and 100 days each year, the ICU is so crowded that seriously ailing patients must be transferred to other hospitals, despite the difficulties and the dangers.
With only six adult ICU beds, gravely ill patients may be treated in regular departments. An Israeli study compared mortality rates for critically ill patients admitted to the ICU compared to those admitted to regular departments. Over a three-day period, patients in the regular departments were four-times more like to die than the comparable ICU patients. [1]
On a typical day – fully apart from the coronavirus – between ten and 12 patients are on ventilators in the internal medicine wards. Because of its overwhelming patient load, Emek has no choice but to care for many of them outside the ICU; nevertheless, this procedure goes against international standards of care (described above).
Emek's NICU is similarly inadequate. Now located far from the labor and delivery rooms, neonatals must be transferred to a NICU in a remote building. For a baby at 700 g or 1 kg, the move can cause bleeding in the delicate tissue that surrounds the ventricular of the brain and lead to permanent damage.
A vision for the new Emek ICU
Planned as the most advanced ICU in the north, Emek's new unit is designated as a tertiary (level 3) facility. Like other level 3 units, the Emek ICU is staffed by doctors and nurses with specialized training in acute care and are covered by staff 24/7. Nurse to patient coverage is 1:2. The multi-disciplinary team on call includes respiratory therapists, physiotherapists, pharmacists, nutritionists, and microbiologists. It serves as a teaching center and is active in clinical research.
The ICU will be moved to the hospital's newest building, near both the Operating rooms and obstetric departments. Reflecting the innovative concepts of ICU care[2], each bed will be in a separate room. The windowed and airy rooms will enable easy access to ventilators, dialysis machines and other specialized technology. Video cameras will enable the medical staff to monitor patient activity and needs. Some rooms will have negative pressure and other isolation features for those who require airborne precautions.
The unit will also have areas for mixing medications, cleaning and storing devices, seminar rooms and sleeping quarters for on call staff. There will be a waiting room for families and a quiet room for family meetings with the staff.
Timing and Cost
With funds in place, construction can begin by July 2021 and will take about two years to complete. With a plan of 3,113 square meters, the estimated cost per square meter at $4,208, totaling $13.1 million. The adult and PICU beds will cost $9.2 million; Clalit has secured a 1:1 match for these two subunits, leaving $4.6 million to be raised for them. Separately, the NICU will cost an additional $3.9 million.
Conclusion
Emek's new ICU is urgently needed to support lifesaving measures for Israelis in the northern periphery. In the truest and most direct sense of this phrase, your contribution to this critical initiative will save lives. When a patient's life is on the line, your gift can make all the difference.
Naming opportunities for the ICU/PICU and NICU separately in accordance with the amount of the donation and Clalit guidelines.
Emek Medical Center
A part of the Clalit Healthcare system, Emek Medical Center is a 580-bed tertiary care facility for Israel's northeast region. It is accredited by the US Joint Commission International and serves as a teaching hospital for the Technion Medical School. It is at the top-tier of Israel's quality of care rankings (99.5%),
Emek's catchment area includes the 700,000 residents of the Galilee. This fast-growing region is expected to grow by 45% by 2040, to over 1 million. The area stretches from Yokneam in the west to Tiberias and the Sea of Galilee to the east and north.
Over the course of the year, Emek's medical team performs about 12,500 surgeries. Its emergency department handles 130,000 visits and its beds are filled for 162,000 patient days. The internal medicine departments are routinely at 100% capacity.
Emek is the largest employer in the region with 2,580 on staff. Its staff includes 600 physicians and over 1,000 nurses. Some 130 physicians also have academic appointments.
To meet the increasing needs of the growing population, Emek expansion plans for the next five years include:
- The opening of the Beit Shulamit Cancer Center, a national center of excellence;
- The opening of a 10 new cutting edge operating rooms.
- Building a modern emergency department.
