When the stand alone emergency center known as the Lenox Hill Healthplex, in the renovated O’Toole building of St. Vincent’s Hospital, opens at the end of June, what will be there and how will it serve the community? The overall plan has been described previously (WestView News, April 2014), but in order to get more details, WestView sent a group of people, including a few doctors, to tour the facility. Eric Cruzen, MD, the medical director, and Barbara Osborn, Media Relations Manager, guided the group through the construction site.
After donning hard hats and construction vests, the group began to wind its way through the active site. The entire first floor, and a little of the second, of the former O’Toole building has been gutted and completely renovated. Its 30,000 square feet will eventually contain 26 large individual patient rooms, each one with its own monitoring system but privacy from other patients. There won’t be stretchers next to stretchers with a thin curtain between them, as in many older emergency rooms. There will be 6 intake rooms so triage teams can evaluate incoming patients quickly and arrange for appropriate treatments. Although there is no separate paediatric ER, there will be an effort to keep children as separated from adults as possible. There will be two rooms for individuals with psychiatric emergencies and a separate area and entrance for victims of sexual assault. Extensive laboratory and radiology services will be available also.
As much as can be determined at this point, its ambiance will be more like a light and airy spa then a chaotic hell hole similar to so many other older ERs. The design and services will be state-of-the-art similar to other newly built or renovated facilities. For comparison, the recently re-opened Langone-NYU ER is reported to have 22,000 square feet of space and 40 individual rooms.
However, how will it actually function? Ambiance is nice, but performance is key. The Healthplex is projected to have 30,000 visits the first year, with an eventual capacity for 45,000. It will accept all insurance, including Medicaid. People seeking help will be able to walk in, or be sent by nearby doctor’s offices or even storefront walk-in sites. Many will be brought in by the city EMS ambulances after appropriate screening. What that means is that when an EMS team arrives in a person’s house they are not acting completely on their own. They are in radio communication with their home base, which is staffed by a physician, and so an initial determination can be made as to whether the patients is having a major heart attack, stroke, or life threatening trauma (auto accidents, assaults, shootings, etc). Those individuals would be taken to other higher level facilities and not come to the Healthplex.
Of those who do come, it is estimated that 90% would be treated and discharged with follow-up instructions to go to their own doctors, or information as to other clinics and services which could continue treatment. The remaining 10% might require hospitalization and, once stabilized, they would be transferred to an actual in-patient hospital of the patient’s choice. Ideally, stabilizing a patient’s medical condition means that treatment in the ER would make the vital signs of blood pressure, breathing rate, oxygen absorption, or temperature adequate enough so that the person could survive an ambulance transfer to an in-patient hospital. In some cases treatment might not stabilize these parameters and the person would have to be transferred even if unstable. Examples of this might be a person with mild chest pain on arrival who then has a massive heart attack, cardiac arrest, or respiratory arrest in the ER. Or, maybe a small bump on the head that the CT scan shows has caused bleeding in the skull and requires immediate neurosurgery. Or, a tiny knife wound that actually went deep and hit a major blood vessel, causing the person to bleed to death if not in surgery quickly. Or, a person who comes in with mild flu like abdominal cramps but actually has a life threatening ruptured aortic aneurysm. These people would need transfer to a higher level of care immediately.
These examples are not meant to make New Yorkers more paranoid then they already are, or to become frantic with every bump on the head or flu related sneeze. Yet, for some rapidly escalating emergencies even a state-of-the-art free-standing ER, such as the Healthplex, or an ER attached to a smaller community hospital, will only be able to initiate treatment, and rapid transfer will be needed. St. Vincent’s Hospital, in its prime, could handle all of these, but that is not what is available right now. How well the new Healthplex can handle its own patients, and how well it can coordinate with EMS and other area hospitals remains to be seen; and WestView will be following it.