Hopkins joins building boom for hospitals

Medicine: Prosperity and advances in technology fuel a nationwide burst of construction.

September 05, 2004|By M. William Salganik | M. William Salganik,SUN STAFF

For Johns Hopkins Hospital, where the cutting edge is commonplace, the construction project under way seems unexciting: four spindly cranes and scores of hard-hatted workers producing a prosaic parking deck, a loading dock and a heating plant.

But, like a shift of a chess pawn that makes more dramatic moves possible, the new parking and heating facilities will open up space on Hopkins' crowded chessboard of a campus for two tall clinical towers - an $800 million-plus project that will replace half the hospital over the next four years.

The Hopkins clinical towers - one filled with modern intensive care units, the other with children's services - will be, in dollar terms, the largest hospital project in Maryland history. The work represents an accommodation between the hospital and its surrounding communities, historically suspicious of what they viewed as an often-aloof institution expanding its footprint.

The remake of Hopkins is part of a larger hospital construction boom, nationally and across the state. It is being fueled by advances in technology, changing consumer preferences and an improved financial climate for the industry.

Maryland regulators are projecting $1.7 billion in hospital construction from 2003 to 2005, more than double the $734 million in projects approved from 2000 to 2002.

Nationwide, nearly $14 billion was spent on hospital construction last year, up from $9 billion in 1999, after several years of decline in the late 1990s, according to U.S. Census Bureau data.

As the population ages and managed-care insurers loosen controls over access, more patients are filling hospital beds. Maryland had 644,366 hospital admissions in the year that ended June 30, up 13 percent from five years earlier. The latest state estimates project a need for more hospital beds in the future, a stark reversal from two decades of state health planning that anticipated a bed surplus.

Like other hospitals with additions, renovations or new buildings, Hopkins will be, in effect, getting much bigger to stay the same size. Although the new towers will have only slightly more patient beds and operating rooms, they will be roughly half again as large as the buildings they'll replace.

Patient rooms and other facilities have grown to allow comfortable space for new equipment and approaches to treatment - particularly, encouraging the involvement of patients' families - that had been squeezed into old spaces.

"People used to think a 400-square-foot operating room was cavernous," said Michael Iati, director of architecture and planning for Hopkins hospital. "Now, we've looked at 750-square-foot ORs. That's a really, really nice 2 1/2 -car garage."

Around the state

The trend is evident in other projects around Maryland.

When Anne Arundel Medical Center opened a new hospital on the outskirts of Annapolis in 2001, replacing a century-old cramped facility downtown in the state capital, the emergency room almost tripled to 24,000 square feet from 8,561. The area devoted to critical and intensive care grew sixfold to 30,000 square feet from 4,822.

And in Hagerstown, Washington County Hospital is planning a replacement that will have inpatient rooms about the same size as in its current building - but the rooms will house one patient, not two.

Many hospitals are using more space per bed because they are converting from semiprivate to private rooms. The trend is driven not only by patient comfort but also by studies showing that single-patient rooms contribute significantly to infection control and better medical results.

Patient stays are getting shorter, with improved technology, more outpatient treatment and insurance pressures to hold down costs. Mary Towe, executive for nursing services at Washington County, said the average stay there has dropped to 4 1/2 days from 14 days during the past 30 years, meaning that patients are getting more intensive attention each day.

Advances in technology also require more space for equipment.

"Virtually every patient we have is hooked to some kind of monitoring device," Towe said, from ventilators to fingertip-pulse oximeters that measure oxygen in the blood. Even the administration of fluids intravenously has gotten more high-tech - and larger. "An IV used to free-flow from the pole," Towe said. "Now, there's a metered pump, and the average patient can have three."

Years ago, a community hospital planned on about 1,000 gross square feet of space per bed, said John Pangrazio, president of the American Institute of Architects' Academy on Architecture for Health. Now, it's up to 2,000 to 2,500 square feet per bed.

Although Hopkins hasn't completed the design of the new buildings, it has developed rough specifications for them. The two towers, Children's & Maternal Hospital and Cardiovascular and Critical Care Tower, will share some facilities at the base. Their total 650,000 net square feet of space will replace about 400,000 square feet.

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