City Hospitals Reinvent Role of Emergency

The New York City emergency room — overcrowded, exhausting, sometimes terrifying — has long been a legendary circle of medical hell.

But now hospitals — public and private, large and small — are spending hundreds of millions of dollars renovating, rebuilding and expanding their emergency rooms. They are dividing them into treatment areas for the sickest patients with the most dire injuries and using quieter corners for the growing number of patients using emergency rooms for routine medical care.

And an increasing number are taking steps to bring civility and even hospitality to the emergency room, in part because, for all their turmoil, they remain vital points of entry for paying patients whose eventual admission accounts for needed revenue.

Montefiore Medical Center in the Bronx, the city’s busiest emergency department, has in recent years built two new emergency rooms, one of them for children, and renovated another. In August, the hospital announced that it was adding another 7,000 square feet, more doctors and nurses, and “comfort rounds,” which feature customer service representatives who offer patients extra pillows, free snacks and child care.

At St. Vincent’s Hospital Manhattan, officials recently spent $7.6 million to create what they call a “fast-track” option to speed the treatment of patients with more minor injuries. St. Luke’s-Roosevelt Hospital Center recently embarked on a $15 million project to double its capacity at the Roosevelt campus.

And the city’s public hospital system is projecting that it will have spent more than $100 million by 2011 to upgrade emergency rooms at six of its 11 hospitals.

“The amount of emergency room use in New York has always been a source of criticism,” said Kenneth E. Raske, president of the Greater New York Hospital Association, an industry group. “But you can’t say to eight million people, ‘Don’t do this anymore.’ ”

The familiar root causes of the crisis for the city’s emergency rooms have only worsened: the flood of uninsured patients, rapid population growth in the neighborhoods where the centers are located, a crippling shortage of primary care doctors and bankrupt hospitals closing their emergency rooms.

The situation is not exclusive to New York. Hospitals in cities from Sacramento to Minneapolis to Boston are starting their own efforts to meet the problem, with the national rate of emergency room visits soaring.

Governors and lawmakers from a number of states are also trying to find ways to get capital construction dollars for bigger hospitals and emergency rooms, even as the nation’s hospitals brace for potentially stinging cuts to their financial mainstays, Medicare and Medicaid, contained in President Bush’s 2008 proposed budget.

But the efforts in New York City — often termed the nation’s hospital capital — are striking, as officials rush to keep pace with demand, squeezing capital out of overstretched budgets and appealing for more private donations.

“We are all seeing enormous pressure at the emergency room door,” said Alan D. Aviles, president of the city’s Health and Hospitals Corporation, which operates 11 public hospitals with two million visits to the emergency rooms annually.

Mr. Aviles said that even with the planned upgrades for the city hospitals, he feared “we still cannot meet all the need.”

All told, emergency rooms in New York City handled more than 3.6 million visits in 2005, an increase of 6 percent over 2000. The rising number of visits — the citywide data from 2005 are the most recent available — have been strangling some of the hardest-struck hospitals.

More recent hospital records from St. Luke’s-Roosevelt Hospital Center on Manhattan’s West Side, for example, show that there were 105,000 visits to the emergency room last year, up from 59,000 in 1999. “I can’t foresee how we can keep up that pace,” said Dr. Dan E. Wiener, chairman of the hospital’s department of emergency medicine. “The overcrowding is just there — it’s the background noise of life. Some days things are O.K., it’s tolerable. Some days it’s over the top.”

Many New York hospitals are also contending with yet another new influx of patients who normally would have sought care at nearby hospitals that have closed, merged with other hospitals or will soon close. A state commission in 2006 ordered almost two dozen mergers or closings in an effort to shrink the state’s enormous hospital industry, because beds at some of them were going unused.

Other hospitals across the nation, sustaining big losses in their emergency rooms and depleting their charity care funding for the uninsured, have shut down their emergency rooms or even closed completely.

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