A growth spurt for hospital

State approval awaited for new 4-story patient tower and extra parking

August 07, 2005|By Melissa Harris | Melissa Harris,SUN STAFF

Howard County General Hospital is awaiting state approval for a new four-story patient tower that would ease emergency room crowding and prepare the medical center for a surge in aging baby boomers, hospital officials said this week.

The $73 million project would give every patient a private room, add a 564-space parking garage and replace two operating rooms and the outpatient center with larger, state-of-the-art facilities by the end of the decade, the officials said.

The County Council has pledged $3 million to the project and may commit more, Chairman Guy Guzzone said. The hospital's owner, Johns Hopkins Medicine, will lend it $40 million. Operating revenue and community donations will cover the rest.

The 32-year-old Columbia hospital has been in a perpetual state of expansion during the past decade. The facility is cramped in some areas, but it has seen cosmetic improvements to older wings, the birth of new units and equipment upgrades.

"Most of the people who come here are very educated consumers," said Mary Patton, a hospital spokeswoman. "They have high expectations for this hospital and the service they get."

Pamela Barclay, deputy director of health resources at the Maryland Health Care Commission, said the 12-member board should vote on the new tower this fall.

Under the proposal, the hospital's capacity would expand from 187 inpatient beds to 227, in line with a nationwide boom in hospital construction that places a premium on space. Larger, private quarters are intended to allow more room for equipment, make overnight visitors more comfortable and help prevent the spread of infection.

"We had to limit the number of relatives in a delivery room to six because families were having mini-reunions in them," Patton said.

While hospitals have always known that luxuries keep them competitive, health care leaders have not always had the means to add hundreds of thousands of square feet to their facilities.

During the 1990s, managed-care insurers and improvements in technology reduced demand for some services and cut the length of hospital stays, which in turn reduced revenue.

But during the past few years, Maryland hospitals have rebounded. The state expects $2.7 billion worth of expansion requests from 2003 to the end of this year, compared with $734 million during the three previous years.

During the more recent period, a state commission permitted hospitals to raise fees for services, and low interest rates made it easier for hospitals to borrow money for capital projects, said Nancy Fiedler of the Maryland Hospital Association.

In Howard County, the most important driver of the construction boom is the country's aging population. Patton said the senior population will increase 30 percent by 2007 and 77 percent by 2020.

"We've become so successful at managing so many different diseases, such as cancer and asthma and heart disease, that we're extending life," Fiedler said. "But that also means that people will likely have multiple episodes of inpatient health care over the course of their lives."

From 1990 to 2003, annual admissions at Howard County General rose from a little more than 11,000 to almost 14,000, while emergency room visits more than doubled, to almost 64,000.

The problem is not the size of the emergency room, which expanded three years ago. It is that there often are not enough beds in the hospital for patients who must be admitted.

Uncooperative psychiatric patients also cause bottlenecks. Howard County General does not admit a psychiatric patient against his will. If a psychiatric patient refuses care, that person occupies a spot in the emergency room until a room at another hospital is found.

Victor A. Broccolino, president of Howard County General, said he hopes to begin involuntarily admitting psychiatric patients by the end of the year as part of a pilot program. And next year, he hopes to add four more psychiatric beds to the emergency room. "This should really help stabilize our ER," he said.

When a bottleneck forms, the emergency room goes on yellow alert, meaning incoming patients with conditions that are not life-threatening are routed to other hospitals if it takes less than 15 minutes to get there. From Jan. 1 until the end of July, Howard County General went on yellow alert 104 times, or every other day on average.

Lisa Myers, who monitors the state's hospital alert system, said that yellow alerts disrupt paramedics in Howard County more than in other areas because the county has only one hospital. Longer travel times to St. Agnes HealthCare or Laurel Regional Hospital mean that it takes more time for diverted ambulances from Howard to return to service.

"Nationally, studies have shown that when you have a crowded ER, it's usually a hospitalwide inpatient capacity issue," Myers said. "If you add beds, add staffing, manage patients more effectively, make housekeeping more efficient, or a combination of these things, which is what is usually required, it alleviates the problem."

Linda Hitzelberger, a member of the Hickory Ridge Village Board, said hospital officials have not briefed the board on the project, but the members hope that construction trailers will be hidden from public view. That has not been the case during previous expansions.

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