CHARLOTTESVILLE, Va.—The University of Virginia (UVA) Health System’s new emergency department and in-patient bed tower completed earlier this year offers an enhanced and more dignified experience for patients and staff. Designed by global architecture firm Perkins and Will—and constructed by Skanska—the expansion of the state’s top-ranked hospital prioritizes well-being while maximizing the number of patients who can receive world-class care.

The expansion connects patients and staff to the calming effects of nature, reduces the building’s environmental impact, allows for greater flexibility in the way patients and staff use space, and accommodates evolving medical technology and best practices.

“This hospital isn’t just highly functional; it’s also beautiful. It’s a building that patients, families, and staff can feel good about, inside and out,” remarked Ralph Johnson, principal and global design director at Perkins and Will. “We designed the expansion to stand out, architecturally—to have its own visual identity—yet, at the same time, we made sure that it blends harmoniously with the existing hospital and surrounding UVA campus.”

Patients and family enter the new emergency department (ED) and bed tower through a landscaped, semicircular welcome area that curves outward from the building like outstretched arms. Once inside, they can marvel at a 28-foot-tall atrium with towering windows, which floods the space with natural light. Circular skylights spanning 12 feet in diameter, together with a constellation of recessed ceiling lights, lend a celestial feel to the space—as though one is looking up at starry sky. A light-colored wood ceiling, juxtaposed with white floors and ceilings, creates a feeling of brightness and warmth.

To create a more calming entry for guests, the design team located the hospital’s ambulance bays on a lower level. An elevator dedicated to patients arriving by ambulance ensures they can be swiftly transported to the appropriate care area of the hospital.

Designed to address critical medical and behavioral health needs for upwards of 70,000 patients annually, the new ED nearly doubles UVA Health System’s prior urgent care capacity, significantly reducing patient wait times. The prior facility’s 45 beds frequently filled so quickly that urgent care patients had to be treated on stretchers in hallways.

“It was so important to us that we give the extraordinary medical teams at UVA Health exactly the kind of spaces they need to deliver care in a constantly changing environment,” commented Marvina Williams, a senior medical planner at Perkins and Will who also happens to be a former ED nurse. “We designed for things you can’t even see—like distance over time. For example, when every second counts in an ED, how long does it take staff to cross a room, or to move from one patient’s bedside to the next? We designed efficiencies like these throughout.”

Among the new spaces in the new ED are 12 secure behavioral health rooms—separate from the hustle and bustle of the ED—that provide a safe, calming environment for patients in acute mental health distress. Bright clerestory windows in these rooms usher in natural light, creating a soothing effect.

Additionally, a dedicated pediatric check-in and waiting room welcome UVA’s youngest patients with bright yellow couches, child-sized seating, a playfully shaped ceiling light, and views to the light-filled atrium. An interactive wall depicting a topographical map of the Shenandoah Valley invites children to play with built-in animal figures that can be slid along tracks.

The new 400,000-square-foot bed tower includes 168 private patient rooms—each of which was designed to offer a range of care options tailored to an individual patient’s needs. This kind of flexibility accommodates emerging technologies, changing patient demographics, new clinical practices, and future growth opportunities.

To maximize patient privacy, the bed tower was designed with curved walls that graciously block direct views into the rooms of patients in the existing adjacent hospital. At the same time, the curves actually improve sight lines between medical staff and patient rooms. And, of course, they add an interesting aesthetic touch.

The second floor of the hospital is devoted to operating rooms, procedure rooms, and diagnostic facilities. Patients can be evaluated and treated in one room while care staff prepare another patient in the next. This reduces wait time, as well as the frequency with which a patient must move to receive treatment. In fact, UVA is one of the first hospitals in the U.S. to have a CT scanner on rails, allowing the scanner to move to the patient.

The flexibility of the design of the patient rooms also allowed the hospital to respond swiftly and effectively to the worst global health crisis in over 100 years: the novel coronavirus pandemic.

Over 25 days in late February and early March 2020, 84 rooms on three floors of the new bed tower that were originally scheduled to open by summer were seamlessly converted to negative pressure rooms. Negative pressure rooms reduce the risk of airborne transmission of viruses and other contaminants to medical personnel and other patients. UVA staff responded quickly, knowing they would need to accommodate an eventual surge of COVID-19 patients, and the flexible design supported their strategic efforts. The first COVID-19 patient was admitted April 3.

Ceiling-to-floor windows in the lobby, along with oversized windows and glass doors in each private room, brighten the hospital with natural light and offer spectacular views of the surrounding Blue Ridge mountains. Additional biophilic design strategies—which independent studies have shown can improve the rate of healing—include introducing botanical elements at every turn. A green roof adds verdure above the lobby on the second floor, and a green roof terrace brings nature a bit closer to occupants on the third floor, Even wayfinding signage features images of native flora and fauna—an aesthetic nod to the natural ecosystems of the Shenandoah Valley.

In addition to patients, care staff also benefit from an environment that supports their well-being. Break rooms, eat-in kitchens, and other “back of house” areas provide daylight and views to the outdoors. For surgical teams who spend hours on end in an enclosed operating room, an adjoining glass corridor—also with views to the outdoors—affords them respite between procedures. This is unique, as in most hospitals, operating suites are located in the building’s core.

For family and visitors, too, there are light-filled lounges on every floor where they can relax.

Additionally, the building was designed to meet high environmental performance standards. It employs net-zero water design strategies—highly unusual in a hospital—including a 50,000-gallon cistern under the ambulance bay that captures gray water for use in heating and cooling, and several green roofs that mitigate water runoff. Additionally, metal fins on the building’s exterior reduce glare and heat, lowering energy consumption.

Perkins and Will, an interdisciplinary, research-based architecture and design firm, has an international team of more than 2,700 professionals and over 20 studios worldwide.

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WEST COLUMBIA, S.C.—Lighting contractor Hubbell Lighting has stepped in with a unique lighting design for the 438-bed Lexington Medical Center expansion project—the largest hospital expansion project in the history of the Palmetto State. Hubbell’s work has enabled the hospital to conform to code when it came to lighting “performance metrics” included in the Recommended Practice (RP-29) Lighting for Hospitals and Healthcare Facilities.

Hubbell announced that in addition to tackling the requisite lighting levels for the interior of the healthcare facility, the contractor needed to evaluate lighting standards for individual components as they affected the quality of light: kelvin temperature, color rendering index (CRI) and correlated color temperature.

Representatives from Hubbell report that the lighting design was focused on “enhancing” the experience for patients, visitors and employees of the hospital located in the town adjacent to South Carolina’s capital city of Columbia.

As part of its lighting design, patient rooms, hallways and nurses stations were outfitted with MOD 4L LED Recessed Slot devices from Litecontrol, which can be dimmed as needed. DLC Premium Qualified LCAT units from subcontractor Columbia Lighting were installed in other areas of the facility, mostly notable in the hallways for all patient floors. Hubbell engineers also installed the company’s own patented NX Distributed Intelligence Specialty Switch Stations (NXSW-ORLO) for nurses and other medical staff to manually control the lighting levels in areas where they work. These smart switches can independently control various groups of different lights in several hallways or nurses stations. Furthermore, this system can be programmed so as to maintain enough illumination to adhere to emergency lighting requirements.

Also, in the hospital’s neonatal and maternity ward, Hubbell installed the MOD 3L LED Surface Direct and MOD 4L LED Wall Indirect/Direct models, whose lighting can be precisely calibrated to be at optimal level for expectant families. (The Lexington Medical Center welcomes over 3,000 babies per year and is recognized as one of the best maternity wards in all of South Carolina.) These two lighting options are utilized in other areas of the hospital as well.

The new tower for the Lexington Medical Center offers 11 classrooms and conference rooms, in which MOD 4L LED Recessed Slot lights have been installed.

The West Columbia campus needed expansion due to growth in the entire capital region of South Carolina. The expansion took three years and entailed 545,000 square feet of renovation work. In addition to the new patient tower, parking spaces for 950 vehicles were added, as was a 63,000-square-foot utility building.

General contractor Brasfield & Gorrie worked in tandem with architect Perkins and Will on the overall expansion of Lexington Medical Center. The medical facility is the largest part of a network of three community medical centers, two primary care centers, the largest skilled nursing facility in the Carolinas, as well as an Alzheimer’s care center. Over 6,500 health care professionals work at Lexington Medical Center, which also boasts cardiovascular and oncology care affiliated with Duke Health. The hospital treats approximately 85,000 patients per year, and some 20,000 surgeries are performed there annually.

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According to a statement, over 700 workers have worked a total of more than one million man hours on the project so far. As is tradition, the top beam had an evergreen tree and flag on it when it was hoisted into position. The evergreen tree symbolizes good luck, growth, longevity, and the construction crew’s pride in their accomplishment.

Initially, the hospital will open about 70 beds, with the ability to open more in the future. The new tower will include additional operating rooms, a relocated Labor & Delivery department, postpartum beds, newborn nurseries, additional intensive care and medical/surgical beds, and space for expanding clinical departments.

Lexington Medical Center delivers the second highest number of babies in South Carolina each year, performs more than 23,000 surgeries annually, and operates the busiest emergency department statewide. With the population of Lexington County growing quickly, Lexington Medical Center needs to expand its facilities to meet the needs of a growing patient base. The 438-bed hospital remains full, with steady growth annually.

Healthcare Construction + Operations News spoke with Brasfield & Gorrie Vice President and Division Manager Michael Byrd, who oversees the company’s Charlotte, N.C., office, regarding the construction of the new patient tower.

Q: When did construction of the project begin, what is the expected completion date, and what is the anticipated budget?

Byrd: Construction began in June 2016. We’re scheduled to complete the new tower in February 2019. The renovation project extends another year into March 2020. The estimated total construction cost is $293 million currently.

Q: Have there been any challenges to date on the construction of this project?

Byrd: Yes, there have definitely been challenges. We’ve experienced difficulty with weather conditions during the course of the job, including hurricanes. In general, the challenges of working on a site this large in the middle of an active hospital campus include having to work around patients, staff, and the public. In addition to the busy hospital, there are active doctor’s offices surrounding the site, furthering the need to consider public safety. Despite these challenges, the project is on schedule.

Q: What will be the key/notable design features?

Byrd: The expansion includes a 550,000-square-foot, 12-story tower and a 70,000-square-foot, freestanding central utility building. It also includes a new parking deck with more than 900 spaces, and 125,000 square feet of renovations to the interior of the existing hospital. We also installed a new bridge to connect the tower to the existing facility.

Q: How will this addition influence/improve patient care?

The expansion will provide more space and updated facilities, enabling Lexington Medical Center to treat more patients and provide the best care possible. The parking facility will support the traffic and parking needs related to increased patient load.

Q: What best practices did you implement while working on this project that you would suggest to others?

Byrd: At the project’s outset, we focused on addressing patient safety, patient access, and allowing staff to continue to do their jobs effectively amid ongoing construction. In the preconstruction phase of the job, we studied how to manage the flow of traffic, the procurement of cranes, and the delivery and offloading of equipment. Our orientation process has been extensive; every time a new employee is hired, they have to receive training so they know exactly what they’re doing, where they’ll be doing it, and what will be around them to ensure they have the knowledge necessary to do their job in a safe manner.

We have also prefabricated select components for this project, including patient room headwalls, select bathroom features, a tunnel that connects the central energy plant to the parking deck and patient tower, and various mechanical, electrical, and plumbing components. The use of prefabrication for these components has aided schedule, quality, and safety, allowing the team to maximize use of the skilled workforce on site. Prefabricating select components off site has also helped minimize traffic congestion on the active hospital campus.

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