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The city's 11 hospital emergency rooms continue to be crowded, often too full to accept patients, keeping ambulance crews off the streets where they are needed as they wait for beds to open up.
But data released yesterday show that the major logjams of a year ago have not gotten worse -- and in some cases have improved slightly.
"It's still a very rough situation on a day-to-day basis," said Dr. Robert Bass, director of the Maryland Institute of Emergency Medical Services Systems.
Last year, there were major complaints from Baltimore ambulance crews and others about how slowly patients were being moved through city hospitals.
Emergency medical technicians often had to stay with patients upon arrival at a hospital because there were no beds. Ambulances were rerouted because there was no space at the nearest emergency room.
Crowded emergency rooms are a problem nationwide, experts say. The number of hospital beds in the United States declined by about 200,000 from 1993 to 2003, Bass said, even as the population was aging.
A task force made up of hospital administrators, public health and fire officials detailed the problems here a year ago, and yesterday's update showed signs of improvement. Bass credits officials working together to make changes.
The average waiting time for ambulances to return to service dropped nearly 10 percent last year, to 39 minutes from 43. The average in 2002 was 30 minutes.
The total hours hospitals spent on "red alert" status, meaning they had no cardiac-monitored beds available, increased by 4 percent, to 12,465 hours from 11,983. A year ago, the increase was 36 percent.
"This shows progress, but it also suggests there's more progress to be made," said Dr. Joshua M. Sharfstein, Baltimore's health commissioner.
He said hospitals have worked to implement recommendations outlined a year ago to reduce crowding. They include trying to increase access to primary care to cut unnecessary use of emergency rooms, working to improve early discharge policies and reviewing the scheduling of elective surgery.
Dr. Dick Kuo, medical director of the adult emergency room at the University of Maryland Medical Center, said improvement takes "a lot of little steps." The key, he said, is finding "the right combination."
