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story.lead_photo.caption NWA Democrat-Gazette/DAVID GOTTSCHALK Chad Frederick, R.N., explains the operation of the robotic assisted surgery Friday, February 23, 2018, in the main operating room at Northwest Medical Center-Springdale. Northwest Health uses robots in several procedures and last year started using it for patients needing lung surgery.

Northwest Arkansas's health systems continue to add space and services to care for more people.

Mercy Northwest Arkansas, Northwest Health and Washington Regional Medical Center are all working on new procedures, expanding their locations and adding new ones in Benton and Washington counties. The three run dozens of facilities giving care for seemingly every biological system in the body.

The changes provide more primary and urgent care, the bread and butter for health systems, and branch into unexpected areas. Robots, for example, are being put to new uses in operating and patient rooms.

Expansions are happening outside the major hospitals as well. Arkansas Children's Northwest hospital in Springdale is a newcomer. Medical Associates of Northwest Arkansas, a network of clinics in multiple cities, plans to open two clinics in Rogers this year.

Health care leaders make a point to say their highest priority is best serving patients who need health care for their joints or hearts or brains, but the competitive mindset isn't far behind: Those leaders also are quick to note when they're the only one around offering a particular service.

The competition and improvements do nothing less than keep the region running and growing, said Graham Cobb, CEO of the Greater Bentonville Area Chamber of Commerce. He said health care is as essential as quality of life and affordable housing for keeping and attracting residents.

"If you don't have health care that can keep up with that, you simply can't get the best and the brightest, the smartest and most productive workforce," Cobb said. "I don't think you can have enough, when you look at how many people are moving here."

The U.S. Census estimates the Fayetteville-Springdale-Rogers metropolitan area grew by almost 12,000 people from mid-2015 to mid-2016 to surpass 525,000, making it the 22nd-fastest growing metropolitan area in the country by percentage.

Here's a rundown of the big three systems, what they provide and how they're changing.

Mercy Northwest Arkansas

Mercy runs its primary hospital in Rogers and is in the middle of a multi-year regional expansion, spending more than $200 million to beef up facilities and branch into Washington County and smaller Benton County cities.

Mercy opened a Pea Ridge primary care clinic last year, more than a decade after it closed a Pea Ridge office for lack of patients, said Eric Pianalto, president of Mercy Hospital Northwest Arkansas. The new clinic is busy enough that the system sent a nurse practitioner to join the physician.

Construction of a standalone primary and specialty care clinic near Interstate 49 and Elm Springs Road in Springdale, meanwhile, was delayed a few months to make the original design bigger. It'll have about 20 physicians on staff and more emergency department rooms.

Two other primary care clinics are set to open this year in Bentonville, while a seven-story tower at the Rogers medical center is slated to open next year with more than 100 beds.

Mercy has added such services as outpatient hip replacement, which wouldn't require overnight stays. A cardiac laboratory will replace heart valves less invasively than open heart surgery in emergency cases starts this year.

Pianalto said the three principles that are guiding what the system calls its growth are: making it easier to access health care services throughout the region, providing better care, and bringing services here that previously required patients to leave the area. He said the cardiac lab is among the first anywhere, for instance. And Mercy plans to expand telehealth and home-based programs.

"But I don't think any of that will replace the need for one-to-one care," he added. So the system is looking at adding offices west of the interstate corridor and planting more flags in Springdale, perhaps on the east side of town, in the next several years.

Mercy's Rogers hospital since 2014 has seen marked improvement in its Leapfrog Hospital Safety Grades, a twice-yearly survey and analysis from the nonprofit Leapfrog Group that compares hospitals throughout the country using federal data and hospital surveys.

The hospital went from a "C" grade in 2014 to an "A" last year, performing well on surgery safety, preventing medical errors and keeping enough nurses on hand. Certain infections and other issues were slightly more common than at the average hospital.

Michelle Bass, Mercy vice president for administration, said the system strives to proactively reduce risks like ulcers and falls and encourages employees to report safety issues in keeping with the system's mission for high-quality, safe care.

"The Leapfrog 'A' grade is a reflection of a lot of hard work from exceptional caregivers and is a great indicator of the safety and quality of our hospital," she wrote in a statement. "While this is nice, it's not the ultimate goal. We are doing what is right for our patients."

Northwest Health

Northwest has medical centers in Springdale and Bentonville and the Willow Creek Women's Hospital in Johnson. The system added several new or expanded services at those hospitals and clinics in the area in recent months.

Outpatient knee surgery started in mid-2017 at Physicians' Specialty Hospital in Fayetteville, which Northwest bought in 2016. Robot-assisted lung surgery in Springdale happened about the same time, which CEO Sharif Omar said was a first for Northwest Arkansas. The urgent care clinic in Siloam Springs added Sunday hours in August, meaning it and other urgent care clinics in Rogers, Springdale and Fayetteville are open every day.

Robot-assisted surgery uses several doctor-controlled arms to hold or guide instruments, Omar said. The machines can make smaller incisions in patients' bodies during procedures for gynecological, cancer and other treatment needs, often creating shorter recovery times and less pain to control with painkillers.

Northwest has also devoted more space to mental health, including expanding the mental health unit from 29 beds to 47 at the Springdale hospital that should open this month.

"That's a huge demand," Omar said. "We want to make sure we have the resources in the community."

A Bentonville primary care clinic near Airport Road opened in January, and Omar said the system's considering more urgent care locations to make it easy for someone to get an appointment. Northwest started online scheduling for urgent and primary care last year and has started using a smartphone telehealth app that can help patients take care of basic concerns without going to an office.

Northwest's Springdale and Bentonville hospitals earned "C" grades on the Leapfrog report last fall. The rating found the facilities performed above average when it came to surgery safety, such as not leaving objects in patients' bodies and preventing deaths from complications. They experienced some infections slightly more often than average and lacked specially trained intensive care unit doctors, according to the report.

Omar disputed parts of the report, saying Northwest isn't lacking intensive care unit doctors. Northwest spokeswoman Christina Bull said Northwest didn't participate in the voluntary survey portion of the report because the system is focused on quality improvement projects.

"Northwest Health is committed to providing safe, quality care for every patient," Bull wrote in an email.

Omar said Northwest has made surgery and other aspects of care safe by focusing in recent years on creating a workplace culture that emphasizes transparency, putting patients first and speaking up when a problem is noticed. The system partnered with a consultant who had worked with the nuclear-power industry and used tools like checklists to prevent missteps during surgery.

Washington Regional Medical Center

Washington Regional runs clinics for family medicine in the region but concentrates most services at its uptown Fayetteville campus. Many of its expansions this year and last center around that location.

The 66,000-square-foot William Bradley Medical Plaza opened less than a year ago across Appleby Road from the main hospital. It was named for longtime CEO who retired last year. The building started as a spot for urgent care and imaging services and now houses cardiac rehabilitation, endocrinology and other specialties, spokeswoman Gina Maddox said.

CEO Larry Shackelford said the facility's variety and location reflects Washington Regional's emphasis on convenience and keeping up with a growing population. Urgent care is an important investment to reduce some traffic to the emergency department by taking care of needs that don't quite reach the emergency level, such as allergies, ear infections and fevers.

After the plaza opened, Washington Regional began what it calls the core renewal project, renovating part of the hospital around the operating and emergency departments and adding 20,000 square feet. The project will add 20 critical care beds for neurological needs and pave the way for more comprehensive stroke care, Shackelford said. It should wrap up in the next year or so.

Board members in February said they were interested in the idea of an expansion to the expansion, adding a third level above the emergency department for more space for lab equipment, which analyzes and identifies infections and other health issues. Hospital administrator Mark Bever said the project could cost about $9 million and could meet the needs of more and more patients for a decade.

"No lab, no hospital," board member and pathologist Dr. Anthony Hui said jokingly during the board meeting, emphasizing the importance of the lab's work.

Shackelford said in these projects and others, his goal is to make Washington Regional the best place for providers to give care and for patients to receive it. Newly recruited surgeons and other providers specializing in cardiovascular and neurological care are set to begin working this year, for instance.

Leapfrog last fall gave Washington Regional a "B" grade, finding it did better than the average hospital in surgery safety, preventing errors and infections of difficult-to-treat organisms and fostering helpful communication between doctors and patients. It was below average on issues like bed sores and patient falls, which both happened to roughly one patient per 2,000 discharged.

The medical center recently added a pair of trashcan-sized robots that disinfect patient rooms using ultraviolet light. Officials have said the robots could do a more complete job to prevent infections than the most thorough human.

NWA Democrat-Gazette/BEN GOFF @NWABENGOFF McCarthy Building Companies employees work on the new tower at Mercy Hospital Northwest Arkansas in Rogers.

NW News on 03/04/2018

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