Health care renovations pose special challenges to owners. Patient safety considerations are critical drivers in determining project schedules. Many times, renovations occur in hospital areas that must remain in operation, adding complexity to plans. Projects must be carefully coordinated with user groups, infection control personnel and facility maintenance staff to provide temporary services and to allow connections to critical systems. Projects often require multiple phases to accommodate these various requirements. Many times, the addition of new service lines require creative repurposing of space and systems. Owners must make informed decisions regarding codes, regulatory issues and best practices. In depth understanding of existing systems, which are often not well documented and have been installed in multiple projects over many years, is crucial to helping an owner spend limited capital funds wisely.

HVAC

Mechanical systems typically use large quantities of energy in a hospital. Beyond replacing aging infrastructure, equipment replacement projects should evaluate opportunities for installation of high performance systems that can offer a substantial impact on energy costs. Design strategies and technologies can be implemented to reduce energy use while still maintaining required ventilation rates, temperatures and humidities.

Retrocommissioning and continuous commissioning, especially of chiller and boiler plants, central station air handling units and HVAC controls, can provide facility managers with better performing mechanical systems that use less energy.

Electrical

Electrical systems in health care facilities have to blend many characteristics: they must be robust and flexible enough to handle changes in program, both department and equipment wise, while also being reliable and easy to maintain. They should also be arranged, protected, and regularly tested so that they can survive natural disasters. Some strategies employed to meet these goals are the use of closed transition automatic transfer switches to minimize interruptions when testing engine-generator sets, uninterruptible power systems to serve critical functions especially in operating and procedure rooms, strategically locating engine-generator sets so that they are not subjected to flooding, and providing distribution infrastructure that is sized not only for today’s load, but anticipates future loads. As recent events have demonstrated, the locations and protection of fuel system components is also vital to the survivability of emergency power systems.

Health Care Communications

Health care providers are faced with enormous challenges as they seek to comply with the Health Information Technology for Economic and Clinical Health (HITECH) Act, which mandates the use of electronic health record (EHR) technology for hospitals and other health care providers, with financial incentives for those providers who demonstrate the meaningful use of EHR. This technology is rapidly advancing as the EHR industry is adapting to develop interoperability standards. This will allow health care providers to choose the best of breed for their clinical technology systems, and have these integrated with their EHR to reduce data entry duplication and automate clinical data entry. Clinical systems and traditional facility IT are converging to deliver this technology.

EHR systems implementation requires integration of many information technology systems and can be taxing on existing infrastructure. While implementation of these systems in new hospital construction is difficult, it can be even more complex in existing health care environments. A health care technology specialist can assist in developing a migration plan to implement these technology systems. Network infrastructure, particularly for wireless, is a key area of concern. Most existing hospitals have some form of a wireless network but this may not be suitable for both the health care provider’s EMR devices and the bandwidth needed for use of personal devices by patients and family members.

Recent Experience

Mayo Clinic Jacksonville
Jacksonville, Florida
Perkins+Will, Architects
Phased expansion of two floors in the hospital tower to accommodate ninety-two beds.
110,000 square feet

Columbus Regional Health Care System
Columbus, Georgia
Stanley Beaman & Sears, Inc., Architects
A 200,000 square foot expansion of the Hughston Hospital including the labor/delivery area and the emergency department, a 53,000 square foot expansion of the John B. Amos Cancer Center, and a 100,000 square foot medical office building.
353,000 square feet.

Stringfellow Memorial Hospital
Anniston, Alabama
Helman Hurley Charvat Peacock/Architects, Inc.
An addition to the 125 bed hospital including an operating room suite with four operating rooms, a PACU, and a same day surgery suite.
24,000 square feet

Emory University Hospital Midtown
Atlanta, Georgia
FreemanWhite, Inc., Architects
Cooper Carry, Inc., Associate Architects
Health care communications systems for a twelve bed eICU, including structured cabling, paging and nurse call systems integrated with the automated patient monitoring system with visual dashboard and eICU components. The eICU includes high-definition video surveillance of each patient along with a patient monitoring theatre for real-time voice and video interaction.
12,000 square feet