County's booming population puts strain on health system

September 06, 2005|By TAMELA BAKER


About four years ago, administrators at Washington County Hospital started taking a hard look around.

What they saw was a surge in demand for services, particularly in the emergency department, despite projections from the state that the county's population would remain fairly static.

"We were either getting a lot of readmissions or the population projections were wrong," said James P. Hamill, president and CEO of Washington County Health System, the hospital's parent company.

In the emergency room, for example, the number of visits has been growing at 4 percent ? or 2,500 to 3,000 ? per year, Hamill said.


The ER was designed for 45,000 visits per year, he said. During fiscal year 2005, which ended June 30, the ER saw 69,206 visitors.

"If this continues, in three or four years, there will be 80,000," Hamill said, noting that wait times for patients will increase accordingly. "Overall, if you look at the total growth of the health system, Antietam Health Services (a division of Washington County Health System) is up 10 percent year-in, year-out."

Meeting the demand

When hospital officials considered their options for expanded hospital facilities to accommodate the demand, they took a number of steps.

One was to establish a satellite urgent care center at Robinwood Medical Center, also owned by the health system, to take some pressure off the ER.

The center opened in September 2002, and in its first full year tallied some 8,000 visits, Hamill said. In the last fiscal year, that number soared to more than 13,000, he said.

A second facility is planned for Pennsylvania Avenue in Hagerstown's north end.

If the center had not been opened, the numbers show that the ER likely would have been swamped last year with nearly twice as many visits as it was designed to handle.

The health system has committed to opening a third center in downtown Hagerstown when the new hospital opens.

Starting from scratch

Another option was to look at retooling to better suit services to growing patient needs.

In evaluating the existing hospital for a potential renovation, officials decided it would be better to start from scratch ? but after a two-year struggle to gain approvals for construction of a new hospital, the project still is awaiting final clearance. A certificate of need was granted earlier this year for the project despite challenges from Hagerstown city officials, who objected to the hospital's plans to build on a site near Robinwood Medical Center.

But because state building codes have changed since the plans were drafted, Hamill said architects and engineers now are working on a design review, due later this month. Cost projections based on the review are due in November, he said. Hospital officials also must gain zoning approval from the county government; that review has been "fast-tracked" by county officials.

As plans were developed for a new structure, hospital officials factored in the dynamics of population growth, as well as use rates for various services. While admissions for overnight stays hadn't varied that much, other services had. The health system has handled well over 1 million outpatient visits in the past five years.

The number of same-day surgeries, which was at 5,486 in fiscal year 2001, grew by nearly 1,000 by the end of fiscal year 2005, according to hospital figures.

But the real surge is in the number of emergency room visits. In 2001, the hospital tallied 61,939 ER visits. In fiscal year 2005, there were nearly 70,000 ? despite the 13,540 patients treated at the Urgent Care Center.

"It's tough to look at inpatient admissions and say that is a barometer of population growth," Hamill said. "They are growing, but not at the same rate as outpatient services."

Planning for the future

As a result, the design for a new hospital anticipates more of that kind of growth, he said. Emergency and outpatient care will be located on outer walls to make future expansions easier.

Hospital officials also anticipate pressure on pediatric care ? that's where Frederick County health officials first started feeling growing pains, Hamill said, although there's generally a lag time for obstetrics as new commuters often go back to their home physicians for pregnancy care.

The hospital design does include a larger Level 2 nursery that will provide more options for special-needs newborns.

"We have been sending a number of patients down the road for preemies," Hamill said.

The hospital also began a "hospitalist" program this spring, which provides a group of core physicians who concentrate only on inpatient care. Hamill said the hospital started the program as a result of growth, to meet the needs of patients who must be admitted, but do not have their own physicians.

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