The Maryland Shock Trauma Center can't get more trauma patients with billboards or bus signs.
Yet without more patients, says director John W. Ashworth III, the pioneering center, which closed 20 beds and cut 66 jobs last fall, would be forced to shrink again in the next few years.
So Ashworth is quietly laying the groundwork to get a larger share of the state's trauma patients. But Shock Trauma's gain would come at the expense of other trauma centers, at a time when Maryland hospitals - with 40 percent of beds empty - are competing fiercely.
Other trauma centers in the state say they can care well for the patients they get.
Like all hospitals, Shock Trauma has seen its beds emptied by pressures from HMOs and other dollar-conscious managed care insurers, which have pressed to make hospital stays shorter.
Over the last decade, the average length of stay at Shock Trauma has dropped from 17 days to 5] - and is expected to drop to four within five years. The result is that, although the number of patients has remained steady, revenue has been dropping and profits are razor-thin.
It's a trend, officials say, that can't continue if Shock Trauma is to retain its pre-eminence.
"The greatest trauma center in the world is going to stay the greatest trauma center in the world because we anticipated," Ashworth says. "I don't want to be sitting here and have an HMO tell me, 'We're going to do all we can to make sure patients don't come to Shock Trauma.' "
So far, the potential fight over patients hasn't surfaced as an issue. Ashworth has been quietly working to change the criteria under which emergency medical personnel decide which injured patients need to go to a trauma center and which center would be best for them.
His goal is to get the number of patients admitted to Shock Trauma, part of the University of Maryland Medical System, up from 5,376 in the fiscal year ended June 30,1996, to about 6,000 by 2000.
"This is a center that this state and this university have put here for the citizens of Maryland," Ashworth says. "With the extraordinary resource and the capacity we have, we should be using this resource to its maximum extent."
The state's emergency medical board, reorganized under 1993 legislation as a state agency separate from the Shock Trauma Center, is completing regulations for trauma care and recertifying the state's nine trauma centers, a process expected to take about 18 months.
