It's not unusual for 50 to 60 patients to fill the waiting room at Anne Arundel Medical Center's emergency department, built less than eight years ago. Some are connected to intravenous units or holding icepacks but cannot get an open room.
"We moved into an emergency room that was already too small," said Dr. David Mooradian, a physician at the Annapolis-area hospital.
The same is true at Baltimore Washington Medical Center in Glen Burnie, where the emergency department was expanded in 1999. The staff there treats 90,000 people a year, 50 percent more than the capacity for which it was designed.
The county's two hospitals are in the midst of major expansions meant to meet growing demand by greatly increasing their capacity and offering new services.
AAMC is opening a parking garage with more than 400 spaces next week as part of its $424 million "Vision 2010." In addition to the new garage and an Ambulatory Services Pavilion, where many affiliated doctors will move their outpatient practices, the hospital will build a new emergency room and a seven-story tower with 50 private rooms and eight more operating rooms.
Martin L. "Chip" Doordan, president and chief executive officer of Anne Arundel Health System, the nonprofit organization that runs AAMC, attributed much of the growth to age demographics.
"The baby boomers are coming of age where they're going to require a lot more care," he said.
At the same time, more people are choosing to give birth at the hospital. AAMC is second in the state for annual births, with its 5,500 deliveries trailing only Shady Grove Adventist in Montgomery County. In addition to the $17 million neonatal intensive care unit built last year, the hospital is adding a pediatric care unit to its new emergency room.
Baltimore Washington Medical Center is adding an obstetrics unit as part its $117 million project to expand its emergency room, build a six-story glass tower and add 111 private rooms for a total of 40 new beds by next year.
A segment of the new emergency room with 17 new rooms will be completed next week, bringing the total number of rooms to 63. The entire expanded facility is expected to be completed by July.
"With the expansion of Fort Meade, a lot of new homes are coming. We saw the need for meeting the demand," hospital spokeswoman Allison Eatough said.
Both hospitals have had to adjust to avoid interrupting patient care.
AAMC has temporarily relocated its emergency room entrance and triage area, and Baltimore Washington Medical Center has built barriers to keep construction debris from contaminating patients' space.
"They've done a great job in containing the noise," said Dr. Neel Vibhakar, assistant director of the BWMC emergency room.
He said his staff has kept the waiting time low, at an average of 22 minutes per patient but that that the expanded facility, with an annual capacity to treat more than 100,000 rather than the current 60,000, will lead to major improvement.
"The expansion will tremendously help our patients in getting seen quicker," he said.
Construction at BWMC is slightly ahead of schedule, partly because of the mild winter, said Bruce Seeley, director of facilities engineering.
AAMC plans to do its work in stages. With the new garage open, it has churned up the old surface lot to make way for the Ambulatory Services Pavilion. In the final phase, it will add the tower and new emergency room along with more parking.
The hospitals have built flexibility into their expansions to prepare for additional growth. Some of the floors in each hospital's tower will be empty shells ready to complete when the need arises.
The state limits the hospitals' freedom to expand beyond their projected capacity, partly to guard against their drawing patients away from other hospitals.
"What we want to make sure of is that there is capacity to meet need, but we don't want more capacity than is necessary," said Pam Barclay, a director at the Maryland Health Care Commission.
Officials at both hospitals said they are drawing more people from the surrounding region, due to their specialty care and the quality of their emergency rooms. Neither emergency room turns away patients, regardless of their ability to pay.
"We are the safety net for the community," Mooradian said, adding, "Our volumes dictate what we do, we don't dictate our volumes."
Neither expansion will address the lack of cardiac surgery services in the county. Cardiologists at both hospitals can perform emergency angioplasty but must send patients with more complex needs to other hospitals, sometimes by helicopter. They also cannot perform elective heart surgeries, although Barclay said both hospitals are seeking approval to start doing them.
Doordan predicted the expansion process will continue both at the main hospital and through the diagnostics centers they are adding throughout the county.
"In the foreseeable future, there are a lot more needs of the folks than we possibly can take care of," he said.