More details are emerging about the huge, five-year capital investment Sacred Heart Medical Center & Children's Hospital is planning, including a price tag for a planned new cancer center and doctors' building, which could cost as much as $60 million.

Overall, the project, which is expected to get under way next year, now will total at least $370 million, including $220 million to $235 million in construction and $150 million for equipment. An earlier overall estimate of $325 million didn't include the joint cancer center-doctors' building.

The overall project will add 173 licensed beds to the 623-bed hospital, plus another nine unlicensed beds. When completed, it will give Sacred Heart a much larger emergency department, expanded intensive-care units, a better layout of services to streamline patient care, and enough room to meet growth needs until the year 2020, says hospital President Mike Wilson.

Sacred Heart, says Wilson, has essentially run out of space.

"Literally every square inch of this campus is used by someone for something very important," he says.

The hospital says it's running at about 85 percent occupancy, and admissions are growing about 5 percent a year. Volumes are soaring in its emergency department, where the average number of patients per room per year exceeds 2,000, compared with the national average of 1,600.

The area where the hospital currently projects the most growth is in services that the baby boom generation is going to need in coming years, Wilson says. Among those are cardiac care and orthopedic services, he says. He says the Spokane area already has a critical need for more intensive-care beds.

Based on the hospital's current growth rate, the planned expansion is conservative, says Wilson. It's based on projected growth of between 2 percent and 3 percent annually, he says.

"You don't want capital expenditures to get too far ahead of growth," Wilson says.

Last month, Sacred Heart filed a letter of intent with the Washington state Health Care Authority, saying it planned to file a formal certificate of need application to add 173 licensed beds. It expects to file that formal application soon. A decision from the state is expected on the application in March, and Wilson says that if the certificate of need is approved, work on the project will begin soon after.

Wilson says the certificate of need, however, is required only on the portion of the project that includes adding 173 licensed beds, or about $81 million of the construction project. The hospital plans to forge ahead with other parts of the overall project, including an expansion of the emergency department and the construction of four additional floors atop its parking garage at Seventh Avenue and McClellan Street.

A key piece of the overall project is a planned, five-story expansion of the hospital's seven-story "west tower," which Sacred Heart completed in 2004 and which houses the Women's Health Center and some new surgical suites. The other main project involves building a three-story, 54,000-square-foot facility that will connect with the current emergency department located just southeast of the main tower.

West tower

The hospital's west tower was designed to accommodate the planned five-story expansion, says Wilson.

The new fourth floor there will house 25 cardiac intensive-care beds, and a fifth floor will be a mechanical infrastructure floor. The new sixth, seventh, and eighth floors each will have about 25 patient rooms, he says.

The new fourth and fifth floors will come first, says Wilson, making the additional cardiac intensive-care beds as soon as possible. The remaining three floors will then be added over the next four to five years, with the overall project expected to be completed by 2014.

Part of that project calls for moving some offices and services from the west tower's third floor to other parts of the hospital, made possible by adding the additional floors. That will make room for the addition of 21 licensed beds to the hospital's neonatal intensive care unit, which has 40 licensed beds and five overflow beds and already is located on the west tower's third floor.

The west tower expansion will create a domino effect, allowing Sacred Heart to streamline hospital services as the hospital expands, easing patient care by combining related services on the same floor across the hospital, Wilson says.

One of the main patient-care areas that will be streamlined is cardiac care, Wilson says. Once the cardiac intensive-care unit is moved to the fourth floor of the west tower from its current location on the second floor of the main tower, Sacred Heart will move its regular cardiac unit to the fourth floor of the main tower from its current location on the sixth floor.

That will consolidate all cardiac care on the fourth floor of both buildings, allowing staff to care for those patients more efficiently by keeping related equipment nearby and allowing easier movement between related care areas, Wilson says.

The hospital has employed a similar approach with some of its other services, including by putting pediatric-related services on the third floor across the east, west, and main towers, he says.

Emergency department

Meanwhile, the emergency room expansion will enable the hospital to create a separate ER section for children, something it has planned for some time and already has taken some steps to achieve.

The 54,000-square-foot expansion will extend above a loading area on the east side of the hospital from the current emergency department parking lot. The new space will house a completely separate children's ER, which will create more room for adult emergency and trauma rooms on the main part of the current ER. It isn't clear yet how many additional emergency exam rooms will be created as part of the expansion, says Elaine Couture, Sacred Heart's chief operating officer.

Also housed in that expansion will be a new "observation" unit, which will be used for watching patients for about 24 hours. The hospital currently has 26 such beds on the ninth floor of its main tower. Those beds will be moved from the ninth floor to the second story of the three-story expansion, where an additional nine observation beds will be added. The move will enable the hospital to use more space on the ninth floor for orthopedic services, Wilson says.

The third floor of that expansion will be used for a number of purposes, including overnight sleeping rooms for resident physicians, administrative space, and perhaps simulation equipment used for emergency preparedness training, Couture says. She says that equipment currently is located on the ninth floor, as well.

Cancer center, doctors' building

The cancer center and medical office building plans are still preliminary and are being developed with a consultant from Omaha, Neb., named Judy Dierkhising, Couture says. The new cancer center will include at least one radiation oncology suite, and possibly two, depending on the needs of oncologists here, Wilson says.

Decisions such as that still need to be resolved and account for the variation in possible cost, he says.

Currently Sacred Heart provides all the components of a comprehensive cancer treatment program and conducts research in that area, but lacks a centralized location for those services, Wilson says.

Sacred Heart is looking off-campus for a site for the planned cancer center. Finding land for the center is a challenge, and the hospital is seeking proposals from private developers, but it's too early in the process to say where it might be built, he says.

The current 179,000-square-foot Sacred Heart Doctors Building, located at 105 W. Eighth, will remain in operation as is, he says.

As for the $150 million worth of equipment Sacred Heart plans to buy in the next five years, likely at a pace of about $30 million a year, all of the details about the equipment upgrades aren't known yet, says Couture. She says much of the equipment will be used to equip new patient rooms and for the emergency-department expansion.

Wilson says the hospital hasn't finalized design and construction contracts for the overall project, but is negotiating with two companies it historically has used for those tasks—Seattle-based Mahlum Architects and Bouten Construction Co., of Spokane. It hired the Portland office of Kurt Salmon Associates for the master planning.