Howard County General Hospital started in 1973 as a 59-bed short-stay facility in a county with about 62,000 residents.
The Columbia-based hospital now offers a wide range of care, including women's and children's services and sophisticated outpatient cancer treatment in a 187-bed acute-care facility, and it is planning a $50 million expansion that would increase its capacity to 230 beds within five years.
Managing that growth in a county that now has more than 265,000 residents is crucial to offering the best care and service, hospital officials say.
"We've experienced tremendous growth in the use of the hospital in the last few years," said Victor A. Broccolino, president and chief executive officer of the hospital, which is a member of Johns Hopkins Medicine.
"In 1992-1997, the growth of the population in Howard County actually outstripped the growth of the hospital, but [from] mid-1997 until now, we have exploded, growth-wise."
Howard County General reports admitting nearly 13,000 patients in fiscal 2002. Services included nearly 15,000 surgeries and the delivery of more than 3,000 babies. The hospital's emergency room handled more than 57,000 people.
The hospital has grown quickly, mostly because of changes in the way people have used health care in Howard County over the years.
Paul Gleichauf is the hospital's senior vice president of managed care, and planning and marketing. During the mid-1990s, he said, there were many alternatives to the hospital for people in Howard County.
By 1998, however, the urgent-care facilities that were often used in Howard County had closed for financial reasons, and many people turned to the hospital, which has changed drastically since then.
"Needing care somewhere, they went to the emergency room more," Gleichauf said.
As the county grew, so did the hospital.
"The result is that those patients who previously needed care [elsewhere] have come to the hospital," Gleichauf said. "It's stayed that way and continued to grow."
Broccolino and Gleichauf said the emergency room's rapid growth since 1998 has sparked the expansion plan. Gleichauf said about half of the patients admitted come through the emergency room, making it the largest source of patients for the hospital.
Dr. Harry Oken, the hospital's chairman of medicine, said the planned expansion would go a long way toward helping the busy emergency room and the rest of the hospital.
"Our emergency room is clogged, and even though we've done a recent expansion there, there can be long waits in moving the patient to a bed because of how crowded the hospital is," Oken said. "The emergency room is the barometer for how busy a hospital is. They are sort of engines for admissions to a hospital."
Debbie Daskaloff, executive director of the Howard Hospital foundation, the hospital's fund-raising arm, said keeping up with the county's growth is vital if the hospital is to give good care.
But raising money regularly is often difficult for any hospital.
"I've worked with the hospital for 18 years, and I've seen it grow and grow and grow," Daskaloff said. "We need the [community's] help and support to make things happen. A lot of people don't realize the financial constraints that hospitals are under."
Daskaloff said the not-for-profit business had a 1.3 percent profit margin last year, which went back into the hospital.
"We're not the type of business that can just go out and raise our rates to make things happen," Daskaloff said.
As the county continues to grow, it also grows older, something the hospital is trying to keep up with by providing the kinds of care that older people will need.
"We're going to feel an impact of this in the first decade of the century," Gleichauf said. "But we're going to feel an even bigger impact in the second decade."
Gleichauf said the hospital has started working with the Office on Aging, local nursing homes and assisted-living facilities so that the elderly can get the care they need when they need it.
The groups and the hospital have monthly discussions to share information on what the hospital and nursing homes can do to provide the best treatment.
"I've worked with two other hospitals," Gleichauf said. "But this one is far more communicative and involved with the community in trying to help."