October 19, 2026
Key moments
The pressure on a hospital becomes real when a family member is waiting for a bed, a nurse is caring for someone in a hallway, or an ambulance is deciding where a patient needs to go. Kathy Parrinello sees those moments from the operations side of Strong Memorial and Highland hospitals. Her focus is on the space, people, and systems that make a difficult day work better for patients.
Parrinello joins Mark Siwiec and Corey James Moran for Episode 260 with a direct look at why Rochester hospitals feel so full, what is being built to relieve the strain, and what modern care now asks of a hospital. The conversation moves from hospital beds to ambulance diagnostics, insurance coverage, workforce training, and the practical uses of artificial intelligence.
Rochester has 1.68 hospital beds per 1,000 people, Parrinello says. The national average sits between 2.2 and 2.3, while New York State is closer to 2.4 and 2.5. Those numbers help explain why a busy emergency department can affect every part of a hospital.
The region once had seven hospitals. Four remain as full service hospitals. St. Marys now focuses on acute psychiatry and outpatient work. The former Lakeside Hospital is now Strong West, with an emergency department, imaging, surgery, and outpatient services but no hospital beds. Fewer beds funnel more patients into the hospitals that remain.
Parrinello describes a medical success story that comes with a capacity problem. Cancer and cardiac treatments let many people live longer than they could in the past. Those same patients can need frequent admissions for symptom management, follow up treatment, or complications from a condition that is no longer immediately fatal.
Corey shares a recent family emergency that puts the system in human terms. His father collapsed at home and was taken to Strong with a suspected heart attack. The emergency team found an arrhythmia, placed a pacemaker the next day, and sent him home the day after that. The story gives Parrinello a chance to point to the preparation behind a fast response.
Emergency medical teams can send rhythm data and other diagnostics from the ambulance to the hospital, giving clinicians a clearer picture before the patient arrives. Parrinello also highlights the mobile stroke unit. People can receive a head CT in the unit, learn if there is a bleed or blockage, begin the right therapy, and continue to the hospital with more information already in hand.
The point is not only faster equipment. It is a faster handoff between people who are already working on the same problem. That coordination helps a clinical team prepare for a patient instead of starting from zero at the door.
The first phase of the Strong Memorial expansion is scheduled to open in May. Parrinello says the completed emergency department will be about three times its current size. The plan separates a large trauma bay from a quieter critical care area for heart attacks, strokes, and other medical emergencies that require intensive care.
Families bringing a child to the hospital will enter the pediatric emergency department directly instead of walking through the adult department. The expansion also adds 112 new private rooms. Those rooms are part of a larger effort to move admitted patients out of the emergency department and into a bed more quickly.
Urgent care can help with many needs, but Parrinello explains why it cannot replace every emergency department visit. People are not always sure how sick they are. Emergency departments are open around the clock and they can connect a patient with a social worker, a chaplain, a meal, a warm jacket, or transportation home when those needs are part of the problem.
Those supports matter because health care is rarely just a test result. A person may need clinical care and a safe way to get home. The emergency department is built to handle both parts of that moment.
The conversation turns to the people who use an emergency department because regular care is harder to access. Parrinello explains that renewal paperwork, changes in coverage, and the cost of buying insurance on the open market can leave people without a realistic route to a primary care visit. The hospital employs insurance enrollers to help patients understand plans they may qualify for.
She also explains the financial side of providing care. Medicaid reimburses roughly 75 percent of the cost of care, she says, while Medicare reimburses in the low 80 percent range. Hospitals try to control costs through staffing, shared purchasing, and other operating decisions while still serving every person who arrives in the emergency department.
Highland Hospital is seeing the same demand. Parrinello describes plans under review by New York State that would expand emergency department space, inpatient beds, and observation care. Observation care gives patients a place for evaluation and treatment that can last overnight or two nights without creating the same need as a full inpatient stay.
Space at Highland is limited, so part of the long term answer is moving more outpatient services into accessible locations outside the hospital campus. Imaging, clinics, and outpatient surgery can be easier for patients to reach when they come with simpler parking and a shorter walk from the car to the door.
Nursing remains a major need, but Parrinello keeps the picture wider. Imaging, radiology, pharmacy, nutrition, social work, nurse practitioner, physician assistant, and physician roles all help a hospital function. Strong and Highland are working with Monroe Community College, their own school of nursing, SUNY Brockport, Fisher, and other local programs to create clinical placements and grow the pipeline.
Scholarships and loan forgiveness are part of that effort for technical disciplines. Parrinello also sees better physical space as a recruiting issue. People who work in health care want to give good care in an environment that lets them do their best work.
Parrinello is careful about artificial intelligence. She wants strong governance and a protected environment for patient data. The useful applications are practical. Imaging tools can flag a finding that needs attention. A clinical alert can point a provider toward a patient whose chart shows signs of sepsis risk.
Ambient listening is another example. A clinician can review a draft note created from a patient conversation instead of spending hours writing it after a full day in clinic. A protected system can also summarize years of medical history so a provider can focus on the details that matter for the problem in front of them.
Episode 260 is not a promise that hospital pressure will disappear. It is a look at the work happening behind the scenes to make care more responsive. More room helps. Better handoffs help. More trained people help. The goal Parrinello describes is straightforward: give patients and the people caring for them a better place to do hard work.
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