The line for radiology at Baltimore County General Hospital was keeping two patients waiting in gurneys in the main corridor. Two emergency room patients were waiting 12 hours after treatment to get into special-care rooms. The hospital pharmacy was cramped.
That, hospital officials said during a recent tour, is an ordinary day in a facility that the Maryland Hospital Association confirms has the fourth highest annual occupancy rate among the state's 52 acute-care hospitals.
Last year, for example, more than 36,000 patients came to the emergency department, which was designed to handle only about 22,000 visits in a year, hospital officials said.
These conditions have prompted the hospital to begin raising money for a $12.5 million expansion and renovation.
The hospital, on Old Court Road in Randallstown, has capital reserves and loans to pay for all but $3 million of the project's cost. Hospital staff, doctors, trustees, volunteers and other friends of the hospital have already pledged $1.3 million toward that. The rest is supposed to come from a public campaign, announced this month to run through February.
The expansion comes at a time when many hospitals are having to address the shift in emphasis over the years to outpatient diagnostic testing and treatment. With advances in medical technology, more surgery, testing and other procedures can be done on an outpatient basis, which avoids the higher cost of a hospital stay.
During the 1980s, health insurers began setting cost levels for the procedures they would cover. That trend put a premium on efficiency and the development of a wide range of outpatient services, so that the hospitals could provide care within the cost restrictions.
"The demand all over the city for outpatient care is growing rapidly," hospital president Robert W. Fischer said. Most hospitals in the Baltimore metropolitan area are feeling the same pressures and responding to them with similar expansion projects, he said, "because of changes in the way patients are treated."
"I have been at the hospital 25 years now," said Louise Duerr, the hospital's vice president of nursing services, "and we have grown each year."
The plan to cure all consequences of that growth includes: an outpatient treatment and diagnostic center; a cardiac catheterization laboratory, which diagnoses heart diseases through dyes and imaging equipment; a bigger emergency facility, to include eight new beds; expansion of the hospital pharmacy, which currently dispenses 3,000 doses of medication each day; and construction of a medical-records building.
The project is to relieve enough of the space pressure to allow the hospital to reclaim 14 rooms, previously converted to offices, as patient rooms.
Baltimore County General opened in 1964 as a 93-bed medical-surgical facility. Since its last major expansion in 1978, the hospital offers 240 beds, all of them in private rooms.
The interior layout of the patient wards is designed to reduce the time nurses often spend walking the corridors to gather supplies and medication. Outside each room is a nurse's closet with the supplies, medication and reports required for the patient.
Hospital officials are optimistic about meeting their fund-raising goals. And Richard Wade, spokesman for the Maryland Hospital Association, says they have reason to be, even though the state's economy is slipping toward recession. Philanthropy and volunteerism "seem not to drop off in a rough economy," Wade said.
That may be because hospitals ask for money irregularly, only when they need it for a big project, he said, and many communities are loyal to their local hospitals.
"The need for hospital care is real to everyone," he said.