North Big Horn Hospital reports busy month, advances expansion planning

North Big Horn Hospital District trustees heard Tuesday night that the district is seeing strong patient volumes, continuing work on multiple construction projects and preparing for future growth, even as a decision on the next phase of potential hospital expansion was delayed.

The meeting opened with a patient safety story from a Michigan visitor who said the kindness of North Big Horn Hospital staff made a difficult experience in an unfamiliar town more manageable. In a note read to trustees, the patient said she had been “basically alone and scared” for a loved one but felt calm and cared for by the hospital team.

“Keep being so kind,” the patient wrote. “It’s contagious.”

That focus on patient care ran through a meeting that included financial, staffing, equipment, care center and construction updates.

Financially, the district reported a strong month. The financial committee said the hospital exceeded its budget by 5.8 percent, reporting $450,000 in income when the budget had projected a $250,000 loss. Expenses were under budget except for supplies and drugs, and administrators said strong patient volumes were reflected in the revenue figures.

Trustees approved the monthly payables and also approved medical staff privileges for Dr. Stephen Chan, Dr. Juan Escudero and Dr. Elizabeth Gauer.

Equipment purchases

The board also approved several equipment needs, including a facility-wide wireless upgrade. Hospital staff said the existing wireless system is aging and is no longer supported by the vendor. If the system fails, staff said, the hospital could be forced to rebuild the network from the ground up.

Trustees also approved the purchase of Vapotherm respiratory units. The equipment provides heated, humidified oxygen through a nasal cannula, offering patients a quieter and more mobile alternative to older mask-based equipment. Hospital staff said the units are particularly useful during respiratory illness season and when more than one patient needs the therapy at the same time.

Another approved item was ultrasound elastography equipment, which will allow the hospital to better assess liver stiffness and related conditions such as fatty liver disease and fibrosis. Staff said the service is currently being sent outside the community on a weekly basis and that they are seeing more liver-related concerns, including among younger patients. Adding the capability to the hospital’s existing ultrasound system was described as less expensive than buying a separate unit.

The district’s larger planning efforts, however, did not receive a final decision Tuesday.

CEO Eric Connell recommended that trustees select A&E/SMA Design for schematic design services as the district explores a potential hospital expansion. A&E/SMA and Plan One Architects both submitted proposals after the district revised and reissued its request for proposals.

Connell said the two firms were closely matched in price, and both had the personnel and qualifications to complete the schematic design work and remain involved if the district later proceeds with construction. A&E/SMA’s estimated long-term fee was 7.5 percent of total project costs, compared with 7.6 percent for Plan One.

“Both firms are qualified,” Connell told trustees, calling the decision “really splitting hairs.”

He said A&E/SMA held a slight edge because of its familiarity with North Big Horn Hospital District, its participation in the district’s master facility planning and its healthcare-specific experience. The firm has worked on recent NBHH projects, including the clinic and Bistro work, while Plan One most recently completed the hospital’s laboratory expansion.

The board did not vote after a trustee raised a possible conflict of interest that would require recusal. With other trustees absent, the remaining board members did not have a quorum to act. The decision was tabled for a future meeting.

Although the larger expansion question remains pending, work is already underway throughout the district’s campus.

Floor replacement at New Horizons Care Center is progressing in phases. Pods one and two were scheduled to be completed by the time of the meeting, with work then shifting to upstairs units, followed by the entry and central core areas. The care center portion of the project is expected to wrap up around Thanksgiving before flooring work moves to the hospital side.

Connell said the work has required residents and their belongings to be moved between areas, creating unavoidable disruption. He said staff members across the organization helped with the move, while some residents enjoyed the temporary change of scenery and others were eager to return to their regular rooms.

New Bistro underway

The Bistro construction project has completed structural steel installation, with demolition of a concrete masonry wall underway. Mechanical, electrical and plumbing rough-in is next. The clinic expansion has completed HVAC ductwork and is moving into wall framing.

Hospital leaders are also studying a relatively low-cost way to create additional infusion capacity near the oncology and hematology service area. The proposal would convert a small inpatient room adjacent to the current infusion space into two or three additional infusion stations.

Connell said a five-foot-wide coat rack currently separates the areas and could be replaced with a 42-inch doorway, providing a direct connection to the converted room. With new flooring already planned and modest upgrades to the aging ceiling grid, administrators believe the space could be renovated for a comparatively small cost.

The change would take one inpatient room offline, but Connell said the added infusion capacity is becoming increasingly important. Longer-term options may be addressed through master facility planning, but the proposed conversion could offer a timely solution to current demand.

Milestone reached

The board also recognized a milestone in the hospital’s surgical program. Dr. Camp completed her 100th robotic-assisted surgical case last week. Board members praised the achievement and the care the robotic surgery program provides locally.

Staffing remains a major focus. The district reported 277 employees, including 205 full- and part-time employees. August turnover was 0.5 percent, while year-to-date turnover was reported at 11.3 percent.

Open positions include radiologic technologist and sonography staff, care center CNAs and nurses, EMTs, lab technicians, an operating room manager and clinic nursing and medical assistant positions. The hospital is also recruiting several PRN positions, including respiratory therapists, paramedics and EMTs.

Current employees remain the district’s most successful recruiting source. Of the 127 application referrals reported from January through August, 72 came from current employees. Human Resources Director Kirsten Bryson said the hospital is interviewing for an operating room manager, has spoken with a radiology candidate and has hired or is in the process of hiring additional EMTs.

The district is also working to recruit specialty providers. Dr. Gauer is expected to provide cardiology support on a per-diem basis, helping serve cardiology patients alongside Kara Walsh, DNP. Administrators said cardiac rehabilitation has experienced strong volumes in recent months.

Two podiatrists are also under consideration. One recently completed a community visit and expressed strong interest in the Lovell area, while a second candidate with local ties was expected to visit. Trustees noted the demand for podiatry services in the region and the challenge of finding a provider comfortable practicing in a rural setting.

Strong survey results

New Horizons Care Center received encouraging feedback in its most recent resident survey. Forty-two surveys were returned in late July and early August, and 97 percent of respondents said they would recommend the care center.

Residents gave particularly high marks for staff kindness, respect, activities and facility conditions. Comments praised individual staff members and described the facility as a place residents would recommend to others. The survey also identified practical areas for continued attention, including meal quality and temperature, laundry and ensuring residents know what activities are available.

The district’s second-quarter risk management report showed no inpatient falls at the hospital. The care center reported 41 falls during the quarter, including 27 without injury, 11 minor injuries and two major injuries related to falls. Staff emphasized that the report covers an entire quarter and includes incidents that may involve the same resident or situations such as sliding from a wheelchair. The district reported no outstanding claims during the quarter.

North Big Horn Hospital District is also preparing for its 2026 audit and cost report. Administrators said DZA expects to present the final audit at the November board meeting, earlier than the district has typically received the annual report.

Trustees concluded the meeting by entering executive session to discuss personnel matters and a possible real estate transaction.