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Maryland Health Care Commission emergency certificates show behind-the-scenes surge planning

When the coronavirus crept into Maryland, hospital staffs and administrators started bracing for a potential surge, racing to prevent a situation in which patients seeking care outnumber available beds.

Since then, the state’s health department has reported that over 4,200 Marylanders have been hospitalized for complications related to COVID-19 since March. And that figure excludes the number of patients seeking care for other urgent matters, such as birthing mothers or those experiencing heart attacks or strokes.

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About 1,500 intensive and acute care beds are currently occupied by COVID-19 patients, according to state health officials, an increase of over 1,000% since the end of March. Early estimations of the state’s bed supply equated to about 9,400 total at the onset of the Maryland outbreak, based on the latest data provided by the state’s hospital association.

For small hospitals especially, a spike in contagious COVID-19 patients can overwhelm a finite supply of crucial, life-saving medical supplies, such as protective gear and ventilators. It can also force health care providers to rethink which patients qualify for beds and treatment based on an austere formula that evaluates chronic health conditions and life expectancy.

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Under state law, the Maryland Health Care Commission calculates how many beds to make available each year based on an average daily acute care inpatient census. Hospitals are typically not authorized to add beds at their own discretion. Rather, they can submit certificates of need that describe their vulnerabilities and recommend how supplies or facility additions could make a difference.

After Maryland Gov. Larry Hogan called for the addition of 6,000 beds throughout the state to accommodate patients over the course of the pandemic, hospitals and healthcare networks worked to find space to add these beds, repurposing existing space or building from scratch. In Prince George’s County, which leads all other state jurisdictions in total cases, a former hospital in Laurel will reopen to accommodate more patients in the area.

Other hospitals have documented their expansion plans via public emergency certificates of need, which outline how they could repurpose existing space to fill the void and how much it will cost.

Here’s a look at the emergency requests in the Baltimore area that have been approved by the state’s healthcare commission.

Mercy hospital building a new unit

Last month, Baltimore’s Mercy Medical Center made the first bid for a physical expansion, outlining the need for a 32-bed unit on its 17th floor in an emergency certificate of need. The hospital estimated the build-out to cost about $12.5 million and determined it could be completed within three months.



Northwest Hospital to add temporary beds in recently closed unit

Through two separate emergency certificates of need, LifeBridge Health’s Northwest Hospital sought approval from the commission to renovate and refurbish existing space within the facility’s previously closed sub-acute unit. The proposals called for the addition of 105 temporary beds, with a portion to be set up immediately and others “to be operationalized as needed, within three to seven days.”

The hospital also requested to add a fully outfitted tent with 10 beds. It estimated its costs at about $217,000.

Frederick Hospital takes over empty office building

Frederick Health Hospital first sought approval from the commission to add 100 beds to unused space inside the medical facility. Then, it asked for permission to transform a vacated business center across the street from the campus into a 72-bed facility for restorative care and for "lower acuity patients.”

The neighboring building once served as a nursing facility that then transitioned into office space. Hospital administrators said once they finished clearing out office furniture, the building “will need various equipment, including portable gases, suction, and sinks.”

The renovation project was expected to cost $2.5 million.

Salisbury hospital turns conference room, offices into ICUs

Peninsula Regional Medical Center, Inc., in Salisbury, requested 48 beds, offering to turn existing conference room and office space for a temporary intensive care unit for COVID-19 patients. It also asked to turn an existing 8-bed pediatric unit into an isolation unit.

The new unit would be known as the “Delmarva/Eastern Shore Regional Critical Care/Pandemic Unit,” according to the application. It involves the modification of about 19,800.

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The medical center also broke down its $3.82 million project budget, seeking $1.6 million for equipment, such as ventilators; approximately $550,000 in construction costs; $1.3 million for construction and relocation costs for the information systems department that currently occupies the conference space; and $375,000 for the isolation unit.


Kaiser turns patient care centers into bed spaces

Kaiser Permanente, an integrated medical insurance and care provider, requested 172 beds to be dispersed among its patient care centers in South Baltimore, Gaithersburg Largo and Kensington.

These spaces typically serve as primary care clinics but would be altered “to accommodate patients who require an inpatient stay but do not require the more intensive care that will become increasingly necessary at other hospitals,” according to its application.

Kaiser would use these added beds to treat COVID-19 patients as well as those dealing with other medical needs. It estimated its costs at about $150,00.


Harford Memorial Hospital plans for surge in behavioral health treatment

University of Maryland Harford Memorial Hospital sought to address a potential surge in those seeking acute psychiatric services by converting 13 beds at Klein Family Harford Crisis Center on Belair Road.

“The Klein Family Harford Crisis Center may also be used as an off campus dedicated emergency room for behavioral health patients if the hospital’s ED cannot meet the demand for emergency room care,” according to a letter sent by the Maryland Department of Health’s Office of Health Care Quality.

With approval, the Klein center can add five urgent care beds and convert eight other existing beds.

Doctors Community Hospital gets beds, ‘field hospitals’

Doctors Community Hospital in Lanham requested 128 beds to fill existing space in the hospital, including in its non-clinical area. It also asked for the licensure to set up three “field hospitals” in its parking lots, each one holding 10 beds.

The hospital will also convert 215 beds in the hospital tower, “through the conversion of private rooms into semi-private rooms, as appropriate, as well as through utilization of additional space in the hospital tower and surgical space in the North Building.” This, though, can be done without a certificate of need.

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Anne Arundel Medical Center converts cafeteria, offices

Seeking 162 additional beds, Anne Arundel Medical Center proposed expanding capacity by temporarily converting ambulatory offices, an unused cafeteria and conference rooms into inpatient rooms.

In all, the medical center calculated these ventures to cost about $1.5 million.

Adventist Fort Washington makes case for ‘modular buildings’

Adventist HealthCare Fort Washington Medical Center outlined its need for 46 additional beds, arguing “the FWMC Emergency Department is severely undersized for the volume of visits, both historically and as exacerbated by the COVID-19 crisis.”

It proposed adding three field hospitals, but noted it might be able to make use out of one or more once the virus abates to supplement the capacity of the emergency department.

“Each modular ICU building will be appropriately equipped with utilities and emergency power and will be constructed over the next few weeks,” Maryland health department officials wrote in a letter to the commission.

Carroll Hospital outfits auditorium, conference rooms

Carroll Hospital, operated by LifeBridge Health, request approval to convert an auditorium into a negative pressure room with space for 30 beds. It also looked to outfit six conference rooms with as many as 14 beds.

Overall, the hospital was on track to add 108 temporary beds to accommodate the surge, but needed licensure for 52 of them. The others were added in existing space with existing supplies, such as in the peri-operative unit, the post-anesthesia unit and the cardiac catheterization unit.

The costs were estimated at $237,000.

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