Hospital-based wastewater surveillance may complement community and clinical surveillance data in important ways, and may be useful in jurisdictions without community-based wastewater surveillance. From May 2024-April 2026, we analyzed weekly samples (n=190) from three hospitals in New York City using digital PCR to evaluate the sensitivity, specificity, and positive predictive value (PPV) of wastewater viral detection against facility SARS-CoV-2 and influenza A/B inpatient caseloads. Sensitivity was 38-42% for SARS-CoV-2 and 36-49% for influenza A/B, while specificity exceeded 72% for all pathogens. During respiratory seasons, sensitivity reached 81% for SARS-CoV-2 and 81% for influenza A; both had 100% sensitivity during peak case weeks. Notably, off-peak influenza detections occurred in hospital wastewater at all three hospitals in summer 2024 without corresponding hospital case detection, suggesting the presence of undiagnosed cases. These findings underscore the potential utility of hospital-based wastewater monitoring for tracking respiratory virus activity.