Operating on medical and hospital projects
Engineers tasked with working on hospital and medical campuses find themselves tackling unique challenges: evolving technology, increased specialization, and maintaining operations while under construction. Here, professionals with experience on such facilities share advice on how to finish projects that report a clean bill of health.
Larry Anderson, PE, RCDD, CDT, Principal, TEECOM, Oakland, Calif.
Jeremy Jones, PE, LEED AP, EDAC , Healthcare Market Leader, Affiliated Engineers Inc., Chapel Hill, N.C.
Daniel S. Noto, PE, LEED AP BD+C, Healthcare Studio Leader-Southeast Region, exp, Atlanta
Eric Reuther, PE, LEED AP BD+C, Principal, McClure Engineering Associates Inc., St. Louis
Jonathan B. Slagel, PE, LEED AP, HFDP, Principal/Vice President York Office & Healthcare, Barton Associates Inc., York, Pa.
Bill Talbert, PE, BEMP, LEED AP, Senior Mechanical Engineer, MEP Associates LLC, Verona, Wis.
CSE: What's the No. 1 trend you see today in the design of hospitals and medical campuses?
Eric Reuther: We are seeing our hospital clients become more interested in providing redundancy for their mechanical, electrical, and plumbing (MEP) systems. This has ranged from more emergency power requirements to more demand for emergency cooling. We are being asked to provide additional redundancy in HVAC systems design so that spaces can remain functioning even throughout a power loss or equipment failure.
Larry Anderson: We continue to see the convergence and integration of technologies into the infrastructure of hospitals. For example, data from the nurse call system can be used to collect information on call times. The data can then be used to support a hospital's consumer assessment of health care providers and systems (CAPHS) score. There has been an increase in wireless communications infrastructure within hospitals to support connected medical devices along with patient and family mobile devices. Many connected medical devices can now directly populate the patient's medical record and the hospital's security systems.
Jeremy Jones: Health care systems are shifting everything they can to lower acuity, community-based care. We are seeing an increase in freestanding emergency departments (where allowed by local codes), ambulatory surgical centers, wellness centers, and the like. Hospitals aren't going away, but the main hospital is transitioning to handle the higher acuity needs, such as trauma, surgery, and intensive-care units (ICUs). We suspect that this is driven by changes in reimbursement criteria from the Affordable Care Act. Uncompensated re-admissions will go down if patients stay out of the hospital and/or can receive the care they need closer to home, but outside a heavily clinical setting.
Daniel S. Noto: The biggest trend throughout the health care industry is the move toward locating acute care that doesn't require an overnight stay to medical office buildings (MOBs). MOBs used to be filled with general practitioners, pediatricians, OB/GYNs, etc., but now we're seeing ambulatory surgery centers, cancer-treatment facilities, and imaging centers. Ten years ago, all of these were located in hospitals.
Jonathon B. Slagel: One of the most overarching trends we are seeing in the health care industry is the decentralization of health care services. Much of the health care development we have been seeing is investment in outpatient treatment and surgery centers and medical service complexes. While health systems continue to invest in their acute-care hospitals, we have seen that the bulk of that investment is focused on updating existing services or technologies. With the health care industry increasing focus on preventive and outreach care, we have seen a decline in projects focused on increased inpatient bed capacity and services.
Bill Talbert: We see resiliency of systems to maintain critical operations during disruptive events and adaptability of systems to meet changing needs over a building's lifespan.
CSE: What other trends should engineers be aware of for hospitals and medical campuses in the near future (1 to 3 years)?
Reuther: Imaging equipment seems to have a high turnover rate due to the growing technology. We are seeing replacement of magnetic resonance imaging (MRIs) and computerized tomography (CTs) in fewer than 5 years. We also are seeing a trend of services traditionally provided in a hospital going to outpatient services. This has included imaging services, lab services, etc.
Slagel: With some of the natural and man-created events we have experienced over the past several years, the health care industry continues to drive focus on disaster planning and preparedness. While much of this planning and training is focused on the health care and facility staff's readiness to respond, there is an increasing focus on the building's mechanical, electrical, and plumbing (MEP) infrastructure systems. We have been seeing an increasing trend of hospitals focusing on the expansion of emergency power systems to provide capacity beyond the required loads in the hospital. Many facilities are starting to look at installing generator farms that can support required life safety and critical patient services during short-term power outages as well as full power-service backup during extended power outages. These projects develop a more reliable infrastructure system that can better support hospital functions in the event of a catastrophic event.
Noto: From an engineering perspective, the No. 1 concern in all of our designs should be to prevent and control hospital-borne infections.
Anderson: Three years or less is too short of a time frame for hospitals. Some of the hospitals we have designed took up to 10 years to design and construct. In 10 years, there can be dramatic changes in technology. We see some technology systems, especially in the audio/video discipline, change every 6 months. Because of this, we must design flexibility into the building's technology infrastructure to accept new technologies that will be available at the time the hospital opens. One trend that we see is the integration of mass notification systems, which are now required by code. The voice-annunciation component of this system requires high intelligibility, like a public address system, but also needs to meet survivability and be monitored, like a fire alarm system. Today, there are systems available that can serve all three purposes for public address, fire alarm, and mass notification annunciation. Sound masking may also be added. Combining these into one system can save the hospital money and reduce the number of devices mounted to the ceilings and walls that would have been required by separate systems.
Jones: One significant trend is the increased role of technology and information technology (IT) systems in the actual delivery of medicine. This increase has been slowly taking place for decades, but is now growing exponentially. A hospital's CIO and IT team are now common participants in every stage of health care project planning. IT infrastructure requirements are exploding, and future expansion of this infrastructure must be understood and planned appropriately. We are also seeing an increase in building automation system (BAS) trending and record keeping. A facility engineer might be called upon to report on historical temperatures, humidity, and room pressurization that individual patients or individual operating rooms have experienced. This capability is much easier to plan at the beginning versus as a retrofit.
CSE: Please describe a recent hospital or medical campus project you've worked on-share details about the project including location, building type, systems engineered, team involved, etc.
Reuther: The surgery addition at Herrin Hospital, in Herrin, Ill., is currently under construction. An addition above the existing emergency department of the hospital will provide a new surgery suite with seven operating rooms. A three-phase project allows the hospital to keep its three operating rooms functioning throughout the construction until the project is completed. When the project is finished, all seven rooms will be opened along with a renovated and larger prep and recovery area, as well as four new procedure rooms. The project was designed by Lawrence Group Architects with McClure Engineering as the MEP consultant, SSE as the structural consultant, and Asaturian Eaton and Associates P.C. as the civil consultant. The project is being built by McCarthy Building Companies.
Talbert: I most recently provided sustainable-design consulting and analysis for the University of Minnesota Health Clinics and Surgery Center with my previous employer. This is a 5-story, 342,000-sq-ft outpatient facility located in Minneapolis. I am currently working on a complete air handling system retrofit for the Thomas E. Creek VA Medical Center in Amarillo, Texas. This is a 4-story, 120,000-sq-ft primary-care facility with surgery, ICU, imaging, laboratory, kitchen, and pharmacy services.
Jones: One project we are exceedingly proud of is the North Tower expansion to the Moses H. Cone Memorial Hospital. This project included a 225,000-sq-ft addition, which added 16 new operating rooms and 96 patient beds, relocated the emergency department, expanded central sterile and materials management, and replaced the existing central utility plant all while hospital operations continued without major interruption. Team members included Perkins + Will, Hammes Co., Brasfield & Gorrie, and Affiliated Engineers Inc, among many others. As the first project in our area to use active chilled beams for patient care spaces, the project received a lot of national attention. We measured the performance of many facets of this project over the 2 years following occupancy. Major successes include a reduction in historical infection rates (which were already very low) and a significant decrease in patients' temperature complaints. In addition, with the improvement in energy efficiency via new certified energy procurement professional (CEP), active chilled beams, solar hot-water heating, etc., the heating and cooling energy consumed by the facility actually went down despite adding 225,000 sq ft of conditioned space.
Anderson: The new 2.8 million-sq-ft Parkland Memorial Hospital-the largest public health care project in the country built in one phase-opened its doors August 2015 in Dallas. The new hospital, which encompasses 862 licensed beds, 96 neonatal intensive care unit rooms, and a 120-bay emergency department, has been hailed as a model of digitally supported health care. We planned and designed the integrated-technology systems that enable the hospital's innovative model of connected care. Our integrated-technology design services included telecommunications, security, audio/video, network, and wireless as well as onsite IT project management services. The integrated-technology systems we designed for Parkland Memorial Hospital captures and records data, enhances security, and enables efficient operation in many ways.
Slagel: Our firm recently completed work for a multiphased expansion/remodel of the surgery and central sterile processing departments in a central Pennsylvania hospital. The project included construction of 10 new operating rooms and one endoscopy procedure room along with new pre-operation and post-anesthesia care unit space. The project also constructed a new area for the central sterile processing department to locate it in closer proximity to the operating theater. One of the key drivers for the MEP systems on this project was high reliability. Each operating room was designed with a pair of isolation power panels, with each served by a separate transfer switch and central uninterruptible power supply (UPS) source to ensure continuous power supply via redundant pathways. The HVAC system was designed to use multiple air handlers serving the surgery department such that equipment failure of one system would only impact a portion of the suite, permitting staff to continue procedures in the remaining available spaces.