With cheers and a burst of colored confetti, doctors and nurses at the University of Maryland Medical Center savored a long-awaited moment yesterday: the ribbon-cutting for the hospital's new pediatric and adult emergency departments.
The new space is four times bigger, with private rooms, state-of-the-art medical technology, even an airy waiting area with windows soaring two stories high.
The University of Maryland is the latest in a string of hospitals across the state to renovate or build new emergency facilities, a sign of their growing importance. For many reasons, more people than ever are packing these emergency rooms. They've become a key source of hospital admissions and, in a competitive marketplace, a way to stand out and draw more patients.
"There are more people seeking care, and more people are finding the emergency department to be a convenient and safe, efficient way to access medical care," said Dr. Brian Browne, Maryland's chief of emergency medicine. "It's a great resource."
But many of the new emergency departments fill up as fast as they are built. And with the trends in today's health care system, experts say enlarging them might be only a temporary fix.
First, busy primary care doctors and health maintenance organizations are routinely referring patients to ERs. Increasing numbers of psychiatric patients without anywhere else to go for care are showing up. At the same time, many ER patients need more time-consuming tests. And with hospitals often full and struggling with nursing shortages, emergency facilities get jammed, with patients waiting to be admitted.
"The problem driving crowding is a lack of patient beds, and building new EDs alone won't solve that problem. It will simply provide more hallways to park patients who should be upstairs," said Dr. Art Kellermann, chairman of emergency medicine at Emory University and a board member of the American College of Emergency Physicians.
60,000 patients a year
At the University of Maryland, the pediatric and adult emergency rooms now see about 60,000 patients a year. Half the hospital's admissions come from the emergency room, and officials say they are prepared to open up more inpatient beds to handle the expected increase in patients. Browne said people with urgent health problems shouldn't hesitate to come in.
"We are the silent partner in everybody's practice," said Browne. "Overcrowding is part of our own success. There are major problems with care in other areas. What is the other option?"
The hospital's old pediatric and adult emergency departments were on different floors, each in cramped quarters. The adult side had just one bathroom for all its patients and families. Medics rushed patients in through the waiting room. And with only curtains between them, patients in both emergency rooms had little privacy - and plenty of exposure to other upset patients.
The new building opens Sunday morning with 25 percent more beds, for a total of 54. There are isolation rooms and decontamination showers, as well as a psychiatric urgent-care area open during the day.
The children's side will be marked by a glittering tree sculpture more than a story tall. There'll be soundproof patient rooms and two play areas. All the families will be able to eat in the 24-hour cafeteria and use low-cost valet parking at the emergency department's new entrance near the Maryland Shock Trauma Center, at the corner of Penn and Lombard streets.
$150 million project
The nine-story building, named for major donors Harry and Jeanette Weinberg, will include 18 operating rooms, facilities for cancer patients, a new chapel and a cafeteria. The project cost $150 million, $65 million of it paid by the state.
Given the experience at other hospitals, Maryland's larger emergency department won't take long to fill up.
In June, Northwest Hospital opened a new emergency department with 10 additional beds, and the staff was deluged in the first month. Since Sinai Hospital opened its new facility in 1997, patient visits have increased by about 40 percent, to 73,000 a year.
All told, since 1997, about nine hospitals have completed new facilities; about 16 have submitted plans and 10 more expect to do so. Even with those expansions, in the past few years, crowded emergency rooms increasingly have had to divert ambulances to other hospitals.
The practice, called yellow alert, wasn't designed for the new reality, with so many emergency rooms overloaded.
"Now, everybody is in gridlock," said Dr. Bob Bass, the state's emergency medical services director.
The problem might be affecting the response time of ambulances, noted Bass. Medics can't leave a hospital until a patient is admitted to an emergency department bed, but there have been cases of four to five ambulances at a hospital, all waiting an hour or 90 minutes to unload patients.
Addressing the issue
State health officials have been looking at the whole issue. They expect to have data in January on who is going to emergency departments and what else should be done. They might conclude that expanding emergency departments is a good way to go.
"It's always good to have new facilities, in terms of state of the art and the care," said Barbara McLean, executive director of the Maryland Health Care Commission, "but the jury is still out on whether we need to grow more and more of these."
Starting Sunday, traffic near the new University of Maryland Medical Center emergency department will be permanently rerouted, to allow emergency vehicles to travel east on Lombard Street from Martin Luther King Jr. Boulevard to Penn Street.