Health Facility Sees Benefits Through Early Collaboration
Cowritten by ACI Boland
We have found many benefits when our team collaborates early and often, especially when working in and around an operating hospital. When coordinating with the emergency department and hospital staff to ensure safety for all patients, visitors and guests, communication is critical at every stage of the project.
A recent project that required constant communication for it to excel is the Saint Luke’s East Hospital Flex Capacity Expansion. This project provides the hospital with additional patient rooms designed for multiple uses, transforming from emergency exam rooms to inpatient rooms on a moment’s notice. The expansion fulfills the health system’s long-term goals as the first project on campus to support the new 2025 campus master plan and, in the short-term, eases emergency department overcrowding and improves hospital operations.
Through early and frequent discussions, ACI Boland and McCownGordon worked with Saint Luke’s East Hospital to ensure the following:
- Flexibility for the hospital now and in the future
- Convenient access for emergency deliveries during construction
- Safe ambulance phasing for hospital and patients
- Site logistics to maintain traffic
- Coordination of primary utility service relocations while maintaining an active campus and expanding emergency power capacity
- Safety for all during COVID-19 pandemic
Design And Preconstruction
ACI Boland worked very closely with Saint Luke’s early in the process, spending 14 weeks in the schematic design phase to analyze multiple layout possibilities. The solution that best met the hospital’s immediate needs while still aligning with the overall master plan added an expansion to the back of the emergency department, wrapping around a center courtyard. A total of 24 patient rooms were initially designed for the addition to the hospital, all designed to transform from an emergency exam room to an inpatient room.
The design also provided space for future expansion of nine patient rooms with shell space that is strategically located based on the master plan and the ability to expand vertically by one floor. To prepare the campus for future projects identified in the master plan, the design also added parking, relocated the existing ambulance garage and helipad, and improved visitor traffic flow around the site. Approximately six months into construction, Saint Luke’s realized the need for the additional nine patient rooms, and understood the value and minimized disruption to build out these rooms during the initial course of construction. ACI Boland and McCownGordon quickly responded with design, schedule and cost analysis, providing Saint Luke’s with data to make an informed decision to proceed with the additional patient rooms, bringing the total to 33 patient rooms.
COVID-19 Impact midstream of construction
With the COVID-19 pandemic, the health system and the design team took a critical look at future hospital needs. The long-term usage of the new rooms located next to the emergency department drove a reconsideration of how these rooms could function during a pandemic. Fortunately, the team discovered this opportunity early in construction and made significant HVAC modifications at relatively low costs to provide a more isolated wing of patient rooms. Our team also collaborated with Saint Luke’s to institute onsite procedures and training following the CDC guidelines to ensure the safety of all individuals, including patients, staff and construction workers. From controlled access points to sanitation stations around the jobsite, our team quickly ensured safety for all. Our team enhanced communications and revisited the plans and procedures on a daily basis to adjust and modify our response as required to promote public health and safety.
Challenges On An Active Campus
For this active hospital campus, the team worked with hospital facilities to create a phasing plan that allowed hospital operations to continue throughout construction. Through a series of several temporary access routes, emergency vehicle traffic access to the ED was maintained through the active construction site. To further minimize the inconvenience, we created temporary access points from the new garage to the emergency department and accelerated the delivery of the new ambulance garage by three months.
The site logistics and overall construction footprint was planned in phases to maintain construction progress. The team coordinated with multiple primary service utility companies for relocations, worked with the hospital on ambulance access and provided safe entry points for staff through the construction site at all times. Constant communication between hospital staff and the design and construction teams maintained the complex site and schedule. The team held bi-weekly team meetings with the hospital staff to discuss any adjustments as work progressed.
Utility Relocations and shutdowns
Reliable power, data, water and sewer operation are critical to any hospital setting, and this project required all those services to be temporarily back-fed, relocated, and returned to service in a series of phases. This challenge was one of our primary focuses at the onset of the project. Through collaboration among the team and consultants, we developed a detailed sequence of operations for every utility which ultimately resulted in no errors or unplanned disruptions to the campus.
Emergency Department Waiting Room Expansion
The public emergency department is a high traffic area at any hospital. With a multi-phased expansion and renovation to the primary ED waiting room we took a very focused approach to understand how staff, patients and visitors would access the ED, remain restricted from secure areas, and other service lines that work with the ED during construction. Every entry point in and out of the ED, whether it was existing, temporary or new, was reviewed and modified for proper operation, security and access control during and after construction.
Originally, the team planned a route for patient traffic to go through part of the ED waiting room that was not being remodeled. But two weeks prior to starting construction, COVID-19 became a concern. Based on the original plan, patients potentially infected with COVID-19 would be in the ED waiting room. The team had to work in partnership with the owner to find the best patient route that would avoid the ED. After extensive discussions, the team developed a new entrance through the staff corridor. McCownGordon installed temporary doors to block construction and access to staff only areas to allow all hospital operations to continue.
The team’s early collaboration allowed us to address challenges and find solutions well before design was finalized and construction began. The coordinated effort among Saint Luke’s East, ACI Boland and McCownGordon resulted in value-based decisions for future flexibility, safe hospital access and operations through construction, a well-coordinated utility service relocation and a project that remains on budget and schedule.