Cape Fear Valley Medical Center expansion hopes to alleviate emergency department wait times

One of the busiest emergency departments in North Carolina and the 15th busiest in the country might soon feel less hectic.

Cape Fear Valley Medical Center’s Valley Pavilion expansion, set to open the first week of December, nearly doubles the number of beds in the hospital’s Intensive Care Unit (ICU) and Step Down Unit, a unit to transition patients from the ICU to the general ward. 

The expansion cost $110 million. It is expected to create 187 full-time equivalent positions at the medical center.

“This expansion is really twofold,” Cape Fear Valley Health System CEO Mike Nagowski told CityView. “One: it’ll allow us to accept more patients from the region. Two: it should dramatically improve our wait times in the Emergency Department.”

“Intense” is how Dr. Michael Zappa describes the medical center’s Emergency Department (ED). As chief clinic officer and lead doctor in the ED, Zappa said he and his team see about 350 patients stream through the Trauma Level III department daily. Every patient in the ED is triaged, with physicians prioritizing them by how life-threatening their condition is. Critical patients receive care first and first claim to an available bed. 

“One of the main challenges is the limited availability of inpatient beds, often resulting in Emergency Department treatment rooms being occupied by patients awaiting admission,” Zappa told CityView. “This bottleneck impacts wait times.”

Currently, the ED has 41 ICU beds and 58 Step Down beds. The expansion adds two floors and 92 total adult hospital beds across the two units: 44 in the ICU and 48 in the Step Down Unit.

With its current capacity, non-critical patients can wait between 30 minutes and 2 hours in the center’s ED, though the upper limit varies depending on demand and case intensity, according to Zappa. If a patient is waiting a while, physicians will usually perform diagnostic tests to expedite treatment once they are seen, Zappa said.

Horror stories about wait times in the center’s ED have circulated in the community. Last year, Fayetteville resident Christina Williams waited 18 hours across two visits to the Medical Center’s Emergency Department, The Fayetteville Observer reported. Even after waiting all that time, she left before receiving care on both visits. 

“We are excited that the hospital’s expansion will soon add new treatment rooms, improving patient flow and reducing wait time for those in the waiting area,” Zappa said.

Each new bed is located next to the treatment room’s bathrooms to limit the risk of falls. Many rooms also feature patient lifts, devices to move immobile patients from their beds to places like stretchers and chairs without requiring a nurse to lift them.

Physician input was part of the designing process. For example, the addition of lifts was one of the many recommendations received by Brian Pierce, vice president of operations and development at Cape Fear Valley Health System, and his team. The layout of the new ICU and Step Down Unit floors is based on what physicians wanted, including a locker room and large break room, Pierce said.

Conference rooms were constructed as part of Cape Fear Valley Health System’s expansion into medical education. They will be used for physicians to discuss cases with medical students from the Methodist University Cape Fear Valley Health School of Medicine, which is set to accept its first students in 2026.

Beds weren’t the only thing added in the expansion. Two new helipads sit atop the now 161-foot and 3-inch tall Valley Pavilion — beating out the Dogwood State Bank for the tallest building in Fayetteville. The helipads can accommodate up to three smaller helicopters like the Airbus H125, a single-engine helicopter that can seat up to six passengers. The larger of the pair allows aircraft as big as Black Hawk, a 22,000-pound military helicopter, to land. Cape Fear Valley Health System invited CityView and other media to tour the helipads on Oct. 28. 

Brian Coy, a flight paramedic with Cape Fear Valley Health System’s LifeLink Air, said the old helipad located on the hospital’s front lawn required him and his team to go through “a maze” of doors, hallways and people to get patients to the ED and other departments. 

The two new pads eliminate that requirement as the elevators on the roof can take paramedics and patients directly to the ED, Heart and Vascular Center, ICU or operating room. Coy estimates the new helipads save about five minutes from landing to delivering the patient.

“When you’re having a heart attack, time is muscle,” Coy said. “When you’re having a stroke, time is brain. So, five minutes can mean you have a favorable outcome versus a non-favorable outcome.”

The helipads were built in the Netherlands by Bayards Helidecks, a division of a Norwegian company in industries from helidecks to aluminum construction to luxury yacht building. The hospital system’s helipads are the only two in America with a deck-integrated firefighting system that uses water before resorting to firefighting foam. 

Ryan O’Connor, U.S. sales manager for Bayard Helidecks, said it was important to eliminate firefighting foam from the helipads’ firefighting system because it can contain PFAS and other forever chemicals. However, because of federal regulations, the helipads are still equipped with firefighting foam in case water doesn’t extinguish the fire, O’Connor said.

Final touches, including putting hospital beds in all the rooms, are still needed before the Valley Pavilion expansion opens for physician and patient use in December.

CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.