South Nassau expanding emergency department

Workers are clearing a large machine room to free up 2,500 square feet for clinical space in South Nassau Communities Hospital’s emergency department.
Workers are clearing a large machine room to free up 2,500 square feet for clinical space in South Nassau Communities Hospital’s emergency department.
Photos courtesy South Nassau Communities Hospital

Walking from South Nassau Communities Hospital’s busy parking lot to its main entrance, visitors pass trees and shrubbery lining an inviting path to a lobby with polished floors, snug couches and floor-to-ceiling windows. It is a pleasant way in to one of the region’s largest health care providers, but many more enter from the opposite side.

Seventy percent of all admitted patients pass through the emergency department, according to Dr. Joshua Kugler, chairman of South Nassau’s Department of Emergency Medicine since 2004. The E.D. — last renovated in 2003 — was originally built for 35,000 annual patients, and now sees nearly 70,000 patients per year, he said. South Nassau has taken the first steps of its $60 million expansion project to better handle the influx of South Shore residents in need of care.

Kugler attributed the patient increase to the hospital’s growth in services. The 455-bed facility has more than 900 physicians, and provides care in oncologic, orthopedic, bariatric, pain management, mental health and emergency services. It is also a designated stroke center, an advanced cardiac center and the only Level II Trauma Center in southern Nassau County.

“What one person perceives as a problem, another person perceives as an opportunity,” Kugler said of the department handling more patients than initially built for. “I would say that this has been a great opportunity to have the trust of the communities in this organization.”

South Nassau Communities Hospital received roughly $170 million in Federal Emergency Management Agency funds after Hurricane Sandy severely damaged Long Beach Medical Center, which the hospital bought out of bankruptcy in 2014. Though $40 million is slated for a new medical arts pavilion in Long Beach, the other $130 million will go toward a four-story southwest addition to the Oceanside campus for new surgical suites and 14 more intensive-care beds. Using a majority of the funds in Oceanside, which was protested by many Long Beach residents since last year, was allowed under “alternative use” legislation introduced by U.S. Sen. Charles Schumer after Sandy.

“The improvements that we make in Oceanside benefit Long Beach and benefit all the South Shore communities,” said Joe Calderone, South Nassau’s senior vice president for communications and development, who said the hospital serves patients from Queens to Suffolk County.

Though parts of the emergency department’s expansion are included in the southwest addition project, much of the $60 million to bolster the ED’s size from 16,000 to 30,000 square feet is self-funded, according to hospital officials.

South Nassau, in the third year of its five-year campaign to garner $10 million of the total cost of the expansion through fundraising, has raised nearly $5.6 million. The hospital had its Casino Royale event on March 9, which last year netted more than $140,000 for the project, and will host a golf tournament on June 12.

The project is expected to implement bedside registration, larger and improved waiting areas, and establish dedicated treatment areas for behavioral health, pediatrics and geriatrics. The spaces will increase patient privacy and allow staff to better group patients based on their specific needs. The department is expected to accommodate roughly 80,000 patient visits per year once adding space and increases its number of beds from 35 to 60. But Kugler said quality of care is as important as quantity.

“Someone’s heart may have stopped,” he said. “That person is as important to me as the person who has a broken arm. They both are in acute need. They don’t know what the other person has. We have to meet those needs, and we have to meet them at the level that they deserve. We need to meet them compassionately.”

Currently, the department — shaped like a dumbbell, according to Kugler — lacks a line of sight between its two ends, which disrupts the staff’s ability “to see and feel what is going on in real time.” A machine room, which houses utilities integral to hospital operations, sits in the middle, which makes it harder to “line balance,” he added, or distribute the hospital’s resources — in an instant — to patients in need and changing situations.

Kugler elaborated on the term, comparing it to actions taken by Starbucks staff as a line of caffeine-seeking customers grows too long. “If the coffee maker is slow, they slide the person over and they make a second coffee maker,” Kugler said. “If the cashier is slow, they put a second cashier in there. It happens almost in the blink of an eye; that’s called line balancing. It balances it out so that they can get the end result accomplished. [Emergency departments] work the same way.”

Ten beds, separate from the 14 intensive care beds, should be completed in May to kick off the expansion, officials said. The hospital has also begun clearing the 2500-square-foot machine room — to be repurposed as clinical space — by moving the air conditioning, heating systems and other equipment to other areas, according to Andrew Triolo, assistant vice president of design, development and construction.

Hospital officials said the emergency department’s design is still being finalized, and though work will be done in phases to ensure smooth and consistent service during the construction, the number and details of the phases are unknown at this time.

“With an emergency department, you can’t shut it down,” Calderone said. “We’re obviously open 24/7 and we provide a critical service to the South Shore of Nassau County, so the tricky part is to do renovations while you’re still open for business.”

The medical arts pavilion in Long Beach, along with the southwest addition, which still needs to go through the state’s environmental review process, are projected to be complete by 2020.

“It’s not just a matter of having a box to see everybody in,” Kugler said. “It’s a matter of having a box that’s commachine passionate and commensurate with what the patient needs.”