By Scott Pruden

If you need evidence of how much the western Main Line is growing that doesn't involve housing statistics, just look at its hospitals.

Paoli Memorial, Bryn Mawr, Phoenixville and Chester County Hospitals are all on the cusp of major expansions and renovations to improve services, modernize facilities, and, most of all, make room for exponential increases in emergency-department visits and patient admissions.

Paoli, for example, is on track to add 126 private patient rooms, expand its emergency department, and add 14 operating rooms. Bryn Mawr, like Paoli part of the Main Line Health system, is renovating its emergency department at a cost of $20 million to add a dedicated pediatric section in partnership with the Alfred I. duPont Hospital for Children in Wilmington.

Chester County has announced plans to build a four-story tower for its cardiovascular center and new operating rooms, expand the emergency department, and build a 400-car parking garage.

Phoenixville will spend $75 million to $80 million in the next two years to add a four-story, 100,000-square-foot tower with all private rooms and a helipad; a three-story, 45,000-square-foot medical office building; and a 553-space, three-story parking garage. Phase two of the project, to begin two years later at a cost of about $20 million, will include expansion and renovation of operating and labor/delivery rooms and cosmetic refurbishment of older areas of the hospital.

"That's the next four years, basically," said Steve Tullman, the hospital's chief executive officer. "That's designed to serve us and give us enough capacity for 10 years."

Asked what is driving this surge, representatives of each hospital ticked off two major factors: explosive population growth and the rapid aging of that population.

"There's future population growth that we're trying to factor, and then there's the growth that's already occurred that we're trying to deal with," said H.L. Perry Pepper, president and CEO of the Health Network of Chester County Hospital. "We're really operating way above efficient levels of occupancy now."

As a result, much of the focus in hospital expansions has been on serving the youngest and oldest patients with expanded pediatric emergency services and improved inpatient facilities.

Also, with many emergency departments working far beyond their original capacities, expansions were required to improve service and plan for an increase in patients.

"You want to be able to get patients through the [emergency] process quickly, and you want to reduce wait times," said Brenda DeFeo, vice president of the Bryn Mawr Hospital Health Center. "The ER is sort of the front door to the hospital, so we really want to be there for the community and provide the services that they need."

In tandem with the growth of their patient base, hospitals recognize the need to upgrade their facilities and infrastructure after nearly a decade of the status quo, said JoAnn Magnatta, senior vice president of facilities for Main Line Health.

"Our hospitals within our system and other systems are basically looking at bringing facilities up to speed," she said.

Inpatient care is a primary focus at all the expanding hospitals, with a shift to private rooms based on data showing that having one patient per room dramatically reduces infection rates and medical errors. Private rooms also reduce waits resulting from same-sex requirements for semiprivate rooms.

Though private rooms also appeal to patients, "I think it's more based on that data and on safety . . . than about personal privacy," said Barbara Tachovsky, president of Paoli Hospital.

To make room for more patients, the hospitals have all extended their reach off campus with medical centers that house outpatient facilities such as imaging centers, medical labs, rehabilitation services and doctors' offices.

These "ambulatory" centers - so designated because patients can walk in and out - not only help free up space at the main hospital but also help extend the hospitals' reach into the community.

Bryn Mawr Hospital, which can no longer expand beyond its footprint, saw the value of these centers when its first was built across the street from the main facility, DeFeo said. "We hear from patients all the time that they love it."

The hospital now plans its first off-campus expansion, an ambulatory facility in Newtown Square. "Basically, our motivation there is to provide a better outpatient experience while making things better for our inpatients," DeFeo said.

Scott Pruden lives and writes in West Chester.