How to design medical buildings

Hospitals and health care buildings have become very sophisticated. Coordination among all parties, special attention to codes and standards, and a focus on patient comfort have each become highly important to engineers.



LEO A DALY provided comprehensive design services including fire and life-safety for Irwin Army Community Hospital in Fort Riley, Kan. The 577,988-sq-ft hospital and clinic opened in 2016. Courtesy: Kurt Johnson, LEO A DALYCSE: What’s the No. 1 trend you see today in the design of hospital, health care, and medical campus structures?

Randall Ehret: Similar to last year, we see that most stand-alone medical facilities are affiliated with a health care system. They are being used not only as a location to provide distributed care on an outpatient basis, but also as a feeder system for the parent hospital. To this end, branding has become important. This branding often dictates that certain design standards must be applied to the facility. These standards can cover a multitude of mechanical, electrical, plumbing (MEP), fire protection (FP), and technology (T) systems and often have not been refined to meet an outpatient-facility proforma. We are also seeing an increased interest from our clients for National Efficient Price pre-study site selection services. We are assessing potential sites and informing the owner as to language that should be worked into their lease agreements to best protect them.

Timothy Larson: A growing trend that we are seeing within the health care industry is the use of mixed occupancies in a single building, such as medical offices, ambulatory surgical centers (ASCs), and emergency departments. There is a transition shifting away from large, full-scale hospitals; instead, we’re seeing community-based sites add on an emergency department and perhaps a surgical center. These microhospitals don’t have full hospital functionality, but they can provide immediate care more locally in the community, which caters to those who want access to more personal care where they live.

Melisa Rodriguez: We are moving toward more modular options in design and modifications of fire protection systems through the use of flex heads for sprinklers.

Matt Volgyi: Increasing attention to energy efficiency and lifecycle cost. While infection control and patient comfort have remained the driving forces in hospital HVAC design, health care providers are increasingly looking at ways to improve the energy efficiency of their health care facilities caused by the cost growth of electrical, gas, and water utilities and their direct impact on profitability.

Mike Zorich: We are seeing more focus on outpatient facilities including clinics, ambulatory surgery centers, and stand-alone emergency departments. FGI 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities has specific sections pertaining to these outpatient facilities, but the level of patient care and safety remains the same as with inpatient facilities.

CSE: What other trends should engineers be on the lookout regarding these projects in the near future?

Rodriguez: The changing landscape of health care delivery is requiring careful vetting of codes and applicable separations in settings that combine ambulatory, outpatient, and inpatient spaces.

Volgyi: They should watch for increasing energy code coverage of health care facilities. There is a growing need to be able to measure the energy efficiency of health care facilities as compared with an established industry-standard baseline facility using current HVAC technology. Health care facilities are often exempt from energy code requirements, with patient and staff and visitor safety overriding energy considerations. Evaluating health care facilities with energy codes and energy-modeling software developed for office-type occupancies will result in unrealistic results and diminished savings. Also, look for increased use of variable air volume (VAV) systems in health care. OA

Ehret: As more stand-alone facilities are being developed, regulatory agencies will be looking closely at the suitability of the MEP infrastructure for the intended use of the space. This may dictate more in the way of generators, filtration, and medical gases. Uptime for electronic medical records is also more of a concern than in the past. As more care modalities are transferred from hospitals to outpatient facilities, buildings must be more adaptable to change. System-performance expectations/requirements vary greatly for different modalities.

CSE: Please describe a recent project you’ve worked on—share details about the project including location, systems engineered, team involved, etc.

Zorich: We recently completed the $150 million campus-integration project at Genesis Medical Center East Campus in Davenport, Iowa, with Flad Architects. We provided MEP/T services for the central utility plant upgrade and the 7-story surgical and patient-care bed tower. The main mechanical room that contained all the VAV air handling units (AHUs) was located between the surgical floor and patient floor. All supply- and return-air boxes for the 16 operating rooms (ORs) were located within the mechanical room above the surgical floor to allow staff easy access to the boxes without having to gown up to access the sterile area.

Ehret: One recent project was a replacement suburban hospital. This hospital was a recent acquisition to a health care system headquartered in a large metropolitan area. A lot of time was spent setting expectations between the infrastructure standards applied at the main campus versus the needs for the new suburban hospital. A complete smoke-management system was provided in lieu of a fan shutdown in fire mode. This allows the facility to more effectively continue to provide patient care during a fire event. An N+1 emergency power supply system (EPSS) including paralleling gear was used. A centralized uninterruptible power supply (UPS) was provided for all the imaging modalities on the project. A separate centralized UPS was provided for all the intermediate distribution frame (IDF) closets.

Larson: We recently worked on a 130,000-sq-ft health care facility; the main section is a medical office building offering outpatient services with an ASC suite. In a different part of the building, the facility will open an urgent care center, which will evolve into an emergency department in the future. The medical office building and the ASC are classified as B occupancies, generally used for medical offices or outpatient clinics. The urgent care center/emergency department, however, has an I-2 occupancy classification, which is used for medical, surgical, psychiatric, nursing, or custodial care on a 24-hour basis for more than five people who aren’t capable of self-preservation. Because of these occupancy changes and each facility’s requirements, we needed to develop three separate emergency systems powered by a single generator to comply with the code.

Volgyi: We worked on the St. Jude Medical Center NW Tower in Fullerton, Calif. The project used a 100% outside air (OA) handling system design for maximum flexibility and high indoor-air quality combined with runaround heat recovery to eliminate the otherwise resulting energy penalty. The building zoning was developed to allow partial shutdown of building floors, partially due to smoke alarm or AHU fan or motor failure, while all other areas in the building are unaffected. Also allowed the minimum of 10 of the 16 ORs to remain in uninterrupted operation during such events. Two-position airflow controls are provided for all ORs to allow airflow setback to 30% flow during unused hours for any operating rooms. The team involved McCarthy Building Companies, Taylor Design architects, and Southland Industries as the design-build mechanical engineer and contractor.

Rodriguez: LEO A DALY is currently designing a government clinic building in a major U.S. city. As part of our scope of work, we are providing life safety protection for the 3-story structure, which has an anticipated total of 157,000 sq ft. The clinic has outpatient-care facilities throughout the first and second floor as well as a portion of the third floor. The third floor also contains a number of surgical suites for performing same-day surgeries as well as radiology services. A portion of the third floor contains surgical and recovery suites and is large enough to meet the definition of ambulatory health care, thus triggering certain smoke control measures as directed in NFPA 101: Life Safety Code. The project requires careful coordination between the requirements from the International Building Code (IBC) and from NFPA 101. Also, LEO A DALY fire protection engineers and architects completed a Statement of Conditions Life Safety Assessment Survey for the VA Long Beach Health system located in Long Beach, Calif. The 1.4 million-sq-ft medical campus includes health care, ambulatory health care, and business occupancies. The project scope includes an onsite life safety assessment survey to identify life safety code deficiencies and the completion of the “Plan for Improvement,” which is required for the Joint Commission hospital-accreditation process.

CSE: Have you designed any such projects using the integrated project delivery (IPD) method? If so, describe one.

Volgyi: Temecula (California) Valley Hospital is probably the best example. IPD allowed the project to be designed, permitted, and constructed at a pace unmatched in the industry at a significantly lower cost than similar health care facilities.

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