In the new intensive care unit at Howard County General Hospital - where the beds will give massages, visitors can sleep on folding sofas and nurses can chart notes on computers outside the door of each room - the financial problems dogging America's health industry seem far away.
The renovated ICU, which was previewed for the media this week and will open Tuesday, is the first phase of a $31.5 million expansion designed to meet the widely varying needs of the fast-growing county, including the growing number of senior citizens and the state's highest proportion of children younger than age 5.
Over the next two years, the Columbia hospital, a member of Johns Hopkins Medicine, expects to unveil a larger diagnostic imaging department and an emergency department that will be three times its current size.
"Numbers of patients we treat have been increasing pretty dramatically since 1998," said Mary Patton, the hospitals' director of public relations. She said admissions have risen 5.4 percent and emergency room admissions have increased 15.5 percent this fiscal year. "We are outgrowing our hospital," she said.
Patton said the idea for the new ICU initially was an offshoot of plans for the new emergency department. Shortly after the hospital merged with Johns Hopkins in 1998, Howard County General started devising ways to expand to serve a growing population.
Most have insurance
Most of the hospital's potential customers have health insurance or are otherwise able to pay their bills.
"The vast majority of people in Howard County have solid work-based [insurance] coverage," said Rick Wade of the American Hospital Association.
But Howard is not immune to the economic forces buffeting the health care industry, and the hospital's renovations reflect shifts in how medicine is practiced in the United States.
A shortage of nurses and primary-care physicians has led many people to seek help at emergency rooms when they have to wait too long to see a doctor, said Victor Broccolino, president and chief executive officer of Howard County General.
"Everyone talks about the nursing shortage, and it is the worst nursing shortage I've seen in 35 years," said Broccolino, "but it's also the first time I've seen a real primary-care physician shortage this serious. Unless you have a primary physician, it's really hard to get an appointment with a good one. And physicians are being crushed by the responsibility."
For demographic and financial reasons, hospital patients are getting older and sicker.
"The way insurance companies are these days, you have to be really sick to be put in the hospital," said Beth Plavner, a planning consultant for the hospital.
Planners decided to move the ICU from the second to the third floor of the hospital to make way for renovated labor and delivery and neonatal intensive care units. About the same time, Broccolino said, the ICU was becoming increasingly swamped and needed more beds.
"We realized that the number of patients in the ICU was increasing over the last three years," said Broccolino. "We were starting to experience gridlock."
Four beds have been added to the ICU's 12. The rooms are private, larger than the old rooms and have personal bathrooms, windows and comfortable chairs for visitors. Several rooms have love seats that fold into beds for visitors, and a waiting room for visitors has carpeting and a television. The wing is airy, spacious and full of sunlight, in contrast to the old second-floor ICU, much of which is dim, crowded and windowless.
The renovated floor also features beds that can apply pressure to various parts of the mattress surface to prevent bedsores.
"Many of the changes reflect the increasingly acute patients we see here," said Plavner, who noted that the ICU will have one nurse for every two patients when the unit is full.
The computer recordkeeping was also updated so that nurses in the new ICU can sit at stations directly outside the doors of the rooms and check lab results or files while keeping an eye on a patient. At the nurses' station, flat-screen monitors can display the vital signs of all ICU patients simultaneously.
"We talked to doctors and nurses, asked them about what wasn't working for them and what they would like to be able to do better," Plavner said.