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Since a 2006 nationwide report gave New Mexico's emergency room system a D-plus, the city's three hospital systems have been working to increase capacity and decrease turnaround time.

But despite nearly doubling the number of beds since then, city hospital emergency rooms are still crowded and waits are sometimes long and uncomfortable, said David Sklar, associate dean for graduate medical education at the University of New Mexico.

Sklar directed the board of the American College of Emergency Physicians that produced the 2006 report ranking ER quality nationwide.

"This crowding is definitely a continuous and serious problem in New Mexico. For Albuquerque, we have the added problem of Lovelace closing on Gibson," Sklar said recently.

The Lovelace Health System facility on Gibson Boulevard Southeast closed in 2007.

While three Lovelace emergency rooms remain open, other ER managers in town say they felt the effect of the Gibson facility closure.

"Since the Lovelace Gibson emergency department has closed, our emergency department volume at UNMH has increased significantly," said Judy Spinella, administrator and chief nursing officer at University of New Mexico Hospital.

From July through December 2007, her hospital's ER patient load was 15 percent higher than the same period a year before, she said. "We think that patients who were formerly using the Lovelace Gibson (emergency department) are now coming to the UNM Hospital emergency department," Spinella said.

Lovelace officials deny the Gibson closure has affected other area hospitals, citing a group that tracks emergency room visits, the New Mexico Hospital Association.

The higher volume helped increase the UNMH emergency room's length of stay — the time it takes for ER patients to wait, be treated and then either be released or admitted -- said hospital spokesman Sam Giammo.

The length of stay at UNMH topped out at 10.2 hours in June 2007, Giammo said.

At that time, UNM Hospital opened its new wing and ER, the Bill and Barbara Richardson Pavilion, which boosted the emergency room capacity from 48 beds to 81.

"Since June we have successfully lowered our average length of stay each month. As of December, the average length of stay was 6.09 hours," Giammo said.

The hospital's goal is to reduce length of stay time at or below six hours, he said.

Complicating that goal is that the university hospital is the metro area's only Level 1 trauma center, which means it gets the worst crash and assault victims. It also is the metro area's public hospital.

Lovelace Health System, meanwhile, is aiming for a three-hour wait time, though predicting and targeting wait times is difficult because patient loads differ with time of day, time of year and type of case, spokesman Chris Cervini said.

Lovelace hospitals' three emergency rooms have seen an estimated 20 percent increase in patient visits since 2005, according to patient numbers provided by Cervini.

"We believe that lack of specialty doctors on call in rural areas as well as the increased use of emergency departments for primary care has resulted in increased visits to emergency departments in Albuquerque," Cervini said.

The health system's Downtown hospital nearly doubled its ER beds from 2006 to 2007, from 17 to 32, at the facility on Dr. Martin Luther King Jr. Avenue Northeast.

In addition to the Downtown facility, Lovelace operates an ER on the city's West Side and a full-scale ER at Lovelace Women's Hospital.

The door-to-door time — from being admitted until being released — for all three Lovelace facilities is about 4 hours, 15 minutes, Cervini said.

That is slightly less than the length of stay at Presbyterian's Downtown hospital, which was four hours and 36 minutes as of December, said Todd Sandman, a spokesman for Presbyterian Healthcare Services.

Presbyterian spent $13 million at its Central Avenue facility, adding 26 beds for a total of 53. That expansion was completed Dec. 3.

Presbyterian's Rio Rancho emergency room has the quickest turnaround time in the metro area — 3 hours, 20 minutes.

Patient visits for Presbyterian's system have increased by 64 percent since 2002, Sandman said.

"And winter months show the heaviest burden on the emergency department," Sandman said. "This time reflects an entire course of care. It is not a wait time."

A person with chest pain would likely not wait to be seen, he said, but probably would spend several hours in a room waiting for observation and tests.

Sklar, who was on the panel that gave area New Mexico emergency rooms a D-plus in 2006, agreed that long wait times don't reflect a lack of care.

"The people who have to wait are people who aren't that sick," he said. "They may be in pain or discomfort, which we regret."

Throughout the United States, lack of health insurance also plays a role in emergency room crowding and wait times. Many people will visit an ER because they don't have a primary physician or waited too long for care.

"It's not that people are sitting in the waiting room hoping to get the flu shot they would get at the primary physician," said Presbyterian's Sandman.

"It's that they never got that flu shot because they don't have a medical home, and now they have a terrible respiratory infection and are in the emergency department."

While some patients — those suffering from illness rather than life-threatening trauma or heart attacks, for example — are bound to wait at any emergency room in town, the care the patient receives once seen is better than a D-plus, Sklar said.

"The care you get will be good," he said.

"But there are times where if you delay coming to the emergency department, the outcome will be worse: heart attack, stroke," Sklar said. "People shouldn't be afraid to go to the emergency department. They will get good care, and they will get care that is pretty timely."

Former Tribune reporter Stephanie Garcia Krenrich contributed to this story.