Hospital design trends focus on patient experience and energy savings

Health care insights

• Engineers face unique challenges in healthcare projects, such as ensuring continuous patient care during upgrades and designing systems for reliable power and flexibility during emergencies.
• Post-COVID, healthcare facilities are being designed for greater adaptability and energy efficiency, with an emphasis on flexible spaces.

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Respondents: 

• Cory Duggin, PE, LEED AP BD+C, BEMP, Principal / Senior Energy Wizard, TLC Engineering Solutions, Brentwood, Tenn.
• Benjamin Medich, PE, Vice president, HDR, Pennington, N.J.
• Daniel Noto, PE, LEED AP, Southeast market leader, Fitzemeyer and Tocci Associates, Alpharetta, Ga.
• Kevin Jayne, PE, LEED AP, Principal. Affiliated Engineers, Inc., Denver, Colo.

What are the biggest trends in hospitals, health care facilities and medical campus projects?

Cory Duggin: Health systems are looking for us to help guide them toward their emissions reduction goals as part of new projects, expansions and long-term infrastructure planning. There isn’t a one-size-fits-all solution to health care decarbonization. We have to look at the location, electricity grid conditions, climate and existing infrastructure to create a bespoke plan for each client.

Benjamin Medich: Emphasis on the patient experience is central to the design and delivery of 21st-century health care. Telehealth and virtual care are becoming key components of patient care offerings, especially since COVID-19. This drives additional technology integration and requires additional informational technology (IT) bandwidth to support the caregivers who are practicing both in-hospital and remotely.

What types of challenges do you encounter for these types of projects that you might not face on other types of structures?

Cory Duggin: The largest challenge and most important requirement for any health care project is to provide high-quality, continuous care to patients while implementing any upgrades and/or expansions. This can involve temporary backup equipment to feed existing loads while new equipment is installed and brought online. Careful planning and phasing for the construction to ensure no loss of facility operation is paramount.

Kevin Jayne: The complex nature of hospital operations demands design considerations far beyond those of less critical building types. A strict regulatory environment dictates programmatic elements such as departmental adjacencies and space types. At the same time, the engineering systems must carefully balance requirements for temperature, humidity, pressure relationships, device quantity and type. Health care design requires extensive coordination in support of patient experience, navigating a complex puzzle that addresses diverse stakeholder priorities.

Daniel Noto: In a renovation project, it’s critical that health care can be delivered with as little interruption as possible. A design must allow for renovation work to continue without disrupting critical spaces that could adversely affect the delivery of care. An example of this would be to run under-slab plumbing in non-critical areas (i.e., not above an operating room).

Benjamin Medich: Hospitals have an extensive requirement for generator-backed equipment, which is far greater than in most other building types. Ensuring reliable power to critical functions involves planning beyond first-level failure scenarios and often necessitates more sophisticated solutions than simple generator backups.

Additionally, hospital staff must be capable of manually operating systems during extended outages. This necessitates designing systems with flexibility for both automatic and manual load-shedding options. Furthermore, curtailment to save fuel must be implemented to maintain operability and reliability, which is a complexity not commonly seen in other less complex buildings.

What are engineers doing to ensure such projects (both new and existing structures) meet challenges associated with emerging technologies?

Kevin Jayne: Navigating a complex regulatory environment and an industry known for its escalated level of caution regarding any substantive change makes introducing and implementing emerging technologies a significant challenge for health care designers. As energy codes continue to raise the bar, they effectively mandate progressive technology adoption. The design engineer must present these innovations to the owner and diligently review and refine the design to ensure a successful initial implementation.

Daniel Noto: For me, the key to incorporating emerging technologies into a successful health care project is understanding the technology’s benefits and weaknesses. Blindly specifying the newest technology can lead to problems in performance and can cause long-term problems, including expensive replacements in the future. Meeting with product experts, taking factory tours and visiting other facilities with the technologies already incorporated are techniques that can aid in that understanding. Additionally, talking with the people who already have the technology installed is a great way to find out if the benefits are as advertised or exaggerated.

Are there any changes from the Covid-19 pandemic that are still impacting these kinds of facilities?

Cory Duggin: We are providing additional capacity for pandemic mode in the wings of new facilities to allow higher volumes of exhaust and outside air. All our health care clients want to be prepared for whatever the next challenge is. One way to do that is by allowing for greater flexibility and capacity in how hospital wings operate. This may include going to 100% outside air or making sure designated wings are able to operate at negative pressure compared to the rest of the facility.

Kevin Jayne: Given its unprecedented nature, the industry’s COVID-19 response was decidedly reactive. However, lessons learned have shaped consistent themes in preparation for the next disruptive event. Spaces must be flexible, adaptable and capable of shifting to alternative functions during emergencies or evolving patient needs. For example, standard patient rooms that can flex into double occupancy or accommodate higher-acuity patients. Acknowledging COVID-19’s airborne transmission, design engineers have begun incorporating surge mode capabilities that allow portions or entire patient floors to convert into negative pressure environments using exhaust systems to isolate hospital sections.

Benjamin Medich: Facilities are giving more consideration to the design of their isolation rooms, and the flexibility to implement rooms that are convertible to isolation rooms in the event of an outbreak. Furthermore, additional bandwidth is being incorporated into more robust IT systems to provide additional remote telemetry and telehealth capabilities, extending the reach of hospital-based clinicians.

What types of smart buildings or campuses are you designing for hospital clients? Outline the automation and controls, integration and any cutting-edge technology.

Benjamin Medich: Advancements in metering and control allow for much more precise operation and understanding of emergency power systems. With the latest metering and control packages, we can see where power is available and look at individual and composite metering to understand how adding loads will affect the local and overall systems operation.

Furthermore, smart systems, such as telemetry and real-time monitoring, allow for faster response to changes in patient data and environmental conditions.

Kevin Jayne: The modern hospital facility must balance competing energy use demands. Natural light enhances patient outcomes, but glazing also increases solar heat gain. Medical technology and equipment advancements require more electricity, often introducing additional heat to a space. Regulatory requirements for minimum air changes further amplify electrical demand by increasing fan power consumption. Addressing these rising demands while adhering to energy codes requires an opportunistic system approach, such as through heat recovery. Equipment such as heat recovery chillers capitalize on a building’s consistent year-round heating and cooling loads, utilizing the available heat to generate chilled water. Maximizing the run time of such systems optimizes efficiency.

How are hospitals, health care facilities and medical campus buildings being designed to be more energy efficient?

Cory Duggin: The biggest challenge in health care facility design is efficiently handling the heating, ventilation and air conditioning load created by the requirements of ASHRAE Standard 170: Ventilation of Health Care Facilities. ASHRAE 170-2021 added a column to Table 7-1 for which spaces are allowed to setback when unoccupied. Incorporating unoccupied setbacks to reduce the required air changes per hour when spaces are not in use will significantly reduce the cooling, heating and fan energy for those spaces. One space type we have been implementing this in already is operating rooms. Surgeries are largely scheduled, except for emergencies, so we have been able to show 15-20% energy savings in the surgery tower by reducing the minimum total air changes per hour from 20 to six during unoccupied periods, while still keeping a minimal number of operating rooms at full flow for emergency cases. Recovering all useful heat in the building is another simple strategy to increase building energy efficiency and lower emissions. Typically, we do this by adding a heat recovery chiller to remove heat from the chilled water loop and add to the hot water loop for reheat. In 2022, a requirement for heat recovery chillers was added to Section 6.5.6.3 of ASHRAE Standard 90.1: Energy Standard for Buildings Except Low-Rise Residential Buildings for in-patient health care.

Daniel Noto: Specifically, health care facilities are consistently having electrical reheat being removed and replaced with hot water reheat for variable air volume boxes. Having a central plant that produces either hot water or steam and using that for reheat takes much less energy and reduces costs, particularly in high-energy cost states. Additionally, selecting LED lighting in operating rooms and other high-demand spaces is a trend that we see continuing throughout the health care market.

Benjamin Medich: Designing hospitals, health care facilities and medical campus buildings to be more energy efficient involves navigating competing demands. On one hand, significant investments are being made in energy-saving measures such as LED lighting, advanced lighting controls and more efficient mechanical systems. On the other hand, the introduction of power-intensive medical equipment, like higher-resolution CT scanners and nuclear medicine rooms, has increased overall power demands. Despite these opposing trends, the total power consumption of health care facilities has remained relatively stable over the past 25 years. This stability, however, masks the underlying progress. We are achieving far greater capabilities and efficiencies with the same amount of power. Thus, while the net savings in power consumption may appear marginal, the advancements in medical technology and facility operations represent a substantial improvement in energy efficiency.

What future design challenges do you anticipate related to hospitals or health care facilities?

Benjamin Medich: The future of green energy will have a notable impact on health care facilities. Electrification is driving up power density, while on-site green energies, such as fuel cells and photovoltaics, are reducing the effect on the overall power grid. Ensuring a safe installation and maximum emission reduction requires more integration and increased coordination within the electrical system and with the serving utility. The ability to be flexible and adapt to new technologies as these become viable without disrupting the facility’s daily operation is a key factor in the overall economic viability of future facilities.

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