The center, funded by a $50 million grant by hospital trustee Ronald O. Perelman, was designed to withstand harsh future weather conditions with floodwalls and significant infrastructure improvements.

“Since reopening the hospital, returning critical emergency services to New York City has been our top priority, and we are proud to introduce the Ronald O. Perelman Center for Emergency Services,” said Robert Grossman, MD, dean and CEO at NYU Langone, in a statement. “This comfortable, state-of-the-art facility gives patients from the community access to advanced adult and pediatric emergency care.”

The new facility features spacious treatment rooms and bedside registration;
state-of-the-art imaging facilities for quick testing and diagnosis; efficient intake and discharge processes to make treatment areas available sooner for incoming patients; a New KiDS of NYU Pediatric Emergency Care Center to provide a child-focused and family-centered environment; expedited service for non-acute patients; and direct access to NYU Langone’s Comprehensive Stroke Care Center.

New York Governor Andrew Cuomo spoke to the symbolism of resiliency in the emergency center’s renovation.

“For more than a year, New York has been rebuilding and reimagining itself for a new weather reality that affects all of us. I toured this site a couple weeks after the storm, and I believe that the work done on NYU Langone’s ED truly demonstrates the resilience and dedication of New Yorkers who come together in times of great crisis and emerge stronger than before,” said Cuomo said in a statement. “The storm left the entire region severely battered, but still our spirit was strong, and I am happy to stand here today and celebrate the opening of NYU Langone’s Perelman Emergency Center.”

The new facility incorporates flood mitigation. When the superstorm hit, generators, monitors and other equipment were destroyed. This forced hospital staff to transfer patients through dark stairwells. Now, vital equipment is placed on higher floors, reducing the risk of serious flooding.

“From day one, we’ve prioritized recovery and rebuilding for the New York City neighborhoods impacted by Sandy,” said New York Mayor Bill de Blasio in a statement. “Opening the Perelman Emergency Center is a great accomplishment for NYU Langone, and an even greater resource and comfort for the citizens of New York. I want to thank NYU Langone’s faculty and staff for continuing to provide necessary services to New Yorkers and visitors alike, even after the ED was forced to close.”

The new emergency department is triple the size of the old department. The 22,000-square-foot emergency services department offers 40 emergency care treatment spaces to serve the expected 50,000 annual visitors.

“NYU Langone is a critical pillar of New York’s hospital system that must be running on all cylinders for a healthy New York,” said New York Senator Charles Schumer in a statement. “From day one of the Hurricane Sandy disaster I worked with the hospital and FEMA to get the support needed for NYU Langone to come back better and stronger than ever — and today we have done just that. We are thrilled to restore important emergency care services to the people of New York City.”

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“The board approving this renovation and expansion recognizes that, as the Houston region’s only full-service health system, we must be prepared to stay ahead of the fast-growing advances in medicine, keep pace with the extraordinary growth of our medical staff and meet the health needs of our community,” said Dan Wolterman, president and CEO of Memorial Hermann Health System, in a statement. “When completed, the Memorial Hermann-TMC Master Plan will enhance our ability to provide the highest-quality and safest health care for our community for many decades to come.”

Construction on the master plan is expected to begin this summer with locally based WHR Architects Inc. serving as the architect of record for the project.

The new master plan is a continuation of the growth that has been taking place on the health campus in the past year. In 2013, the hospital board approved $50 million to address the short-term needs of the health care campus to better accommodate the growing patient population. The approved projects include a new observation unit, expanding the post-acute care unit and building out new inpatient beds and operating rooms.

“We recognize that our community will continue to grow and so will their health needs, so we’re designing the building with a forward-looking perspective to meet those needs,” Wolterman said.

The master plan will include the construction of a patient care building as well as a building that will include parking and additional space to support future growth. The expansion also will provide the campus with an additional 1.34 million square feet, an extra 160 beds, 71 replacement beds, 24 new operating rooms, 16 additional emergency room bays, 750 parking space and a 333-seat café. Additionally, six shelled floors and six shelled operating rooms will be constructed to accommodate future growth with the potential of adding 264 beds.

“Our buildings tell a remarkable story about our history, but it is our employees who truly define our legacy,” said Craig Cordola, CEO of Memorial Hermann-TMC. “With this expansion, we are building towards our future and investing in our people. It gives me great pride to be a part of this seminal moment in our hospital and system’s history.”

The hospital is also placing focus on recruiting up-and-coming physicians and innovators in the medical field. The hospital’s partnership with the University of Texas Medical School at Austin has recruited exceptional clinicians and has allowed the hospital to expand its services, Cordola said.

Cordola added that throughout construction patients will continue to be provided with high quality care.

“We are excited about our growth and future,” Cordola said. “But I want to assure our patients and the community that Memorial Hermann-TMC will continue to meet their needs now without disruption as we prepare to meet their needs in the future.

Construction on the project is expected to be completed in 2018.

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Situated on a 4.4-acre site, the new building will relieve overcrowding at the hospital and nearly quintuple the size of neonatal intensive care space from approximately 7,700 square feet to 36,600 square feet. The pediatric care unit will also triple in size and family education, living spaces and waiting areas, and an expanded play room will also be added. Overall, the neonatal and intensive care space at the new tower will add several private rooms and expand space from just 10,000 square feet to 50,000 square feet. The tower and master plan are led by HDR Inc, headquartered in Omaha, Neb.

While the building will hold great meaning to the medical center, which is in desperate need for additional and updated medical spaces, the design features symbolism derived from the Hawaiian culture and landscape, according to Jim Hohenstein, AIA, senior vice president at HDR Inc.

“Because much of the money to build the original Kapio’lani Maternity Hospital was raised through celebrations and luaus to create a link with the past, the new KMCWC was design to celebrate the natural features of the Aloha State and its people,” Hohenstein said. “The use of indigenous Hawaiian materials is meant to lend a familiarity to the families and patient that will use the facility. The use of symbols and imagery will pay homage to the island’s people, customs and traditions.”

The rock, ocean and landscape are integral to the Hawaiian environment and serve as metaphors for birth, life and health, Hohenstein said. The design expounds on this metaphor through various design details and features.

“The overall folded plate of the building exterior represents a seashell and the protective environment it provides for the living form inside, much as the hospital will do for its patients,” Hohenstein said. “The placing of the lei over a person’s head is a traditional Hawaiian greeting, so all who enter the facility will receive this spirit of aloha. An open lei built of simulated wood panels surrounds the front door for all to pass through.”

In undertaking the massive master plan, Hohenstein said he took away from the project the importance of remaining flexible and open-minded during the planning phases.

“This project took two major master planning efforts with numerous smaller iterations over a seven-year period before actual hospital construction took place,” he said. “HDR remained flexible and open to new ideas whenever the client’s criteria changed and we were therefore able to adjust a move with the punches. Locking in too early on master plan concepts and not being able to back off and take another look would have been detrimental.”

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“This is exciting news for our patients and their families as well as physicians, nurses and staff. The new surgical building will keep patients closer to home by enabling our LGH surgeons to perform more complicated procedures locally. Our patients will also have additional private, modern patient rooms which will promote a healing environment,” said Dianne Anderson, president and CEO of Lawrence General Hospital, in a statement. “We know this significant strategic investment will further enhance the quality of care provided to our patients. We will be well positioned to provide future health care needs of the communities we serve right here in the Merrimack Valley.”

The new multiyear master plan, which was developed after four years of planning, will significantly modernize hospital facilities. A $55 million, 42,000-square-foot surgical building will bring new preoperative and postoperative space and state-of-the-art operating rooms. A number of operating rooms at the current hospital are more than 50 years old, according to hospital officials. Additionally, approximately 26,000 square feet of inpatient renovations will increase private rooms, family space and waiting areas.

“We are extremely proud of our long history in serving the Merrimack Valley region and all we have accomplished recently, but we are even more excited about the hospital’s future,” said Matthew Caffrey, chairman of the Lawrence General Hospital Board of Trustees, in a statement. “As one of the fastest growing hospitals in Massachusetts, we are thrilled to be building on our emerging role as an important medical center and resource for the region. We believe we are the preeminent regional health system our communities deserve.”

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Increasingly, commercial spaces and offices are being renovated to serve as medical office buildings, outpatient clinics, wellness centers and other health care facilities, be it by construction companies in Bay area or elsewhere. It’s a task that may leave developers reaching for the aspirin. But leave it to the architects and engineers to come up with the solutions to the challenges lurking amid the structure while creating opportunities for more cost-effective operations and more efficient care.

Early Conversion Concerns

Medical buildings, even seemingly basic ones, can often use significantly more power, as well as heating, ventilation and cooling (HVAC) than a typical office building would require. The strength of the existing main electrical service and the distribution network should be carefully studied first for capacity.

HVAC systems may provide adequate supply, but may not have the ducted return air system required in medical spaces. Emergency or life safety systems may also need an upgrade based on the degree or frequency to which patients become non-ambulatory – or unable to move under their own power – while receiving treatment. An emergency light system will also have to be installed in case the building loses power and regularly inspected by using a company that specializes in Emergency Light Testing.

Margulies Perruzzi Architects (MPA), based in Boston, recently renovated an 80,000-square-foot office building in Woburn, Mass., to accommodate doctors from Winchester Hospital outpatient departments and affiliated physician suites. Part of the retrofit included new mechanical systems specifically used in medical spaces, ensuring a healthy environment for patients and staff starts with air handling systems that meet ASHRAE standards for fresh air ventilation, filtration and exhaust.
From Air Flow to Traffic Flow

No one wants to sit in a waiting room for hours or make multiple stops to complete things like diagnostic tests or blood work. Add in the Affordable Care Act with the soon-to-be surge of newly insured patients and the desire for efficiency and workflow fluidity in a medical office building is even greater these days among designers, providers and patients. From acute care to ambulatory clinics, health care architects at MPA and other like-minded firms focus on process refinement within healing environments. But when you’re converting from office to medical office, expect to tear down some walls – literally and figuratively.

The typical walled-off suites of commercial buildings will often need to be opened up during medical office conversions. Some of the newest, out-of-the-ground medical office construction features open, collegial spaces, as many individual providers now seek opportunities to collaborate with other practices or specialists. Renovations to existing buildings may be able to provide similar flexibility in layout. The new Winchester Hospital Outpatient Center features a lobby concierge station to direct visitors, a central registration area and a shared outpatient lab.

Within the actual doctors offices, employing the lean design process was also helpful to outline complex patient flows and develop a design minimizing travel and patient wait times. MPA utilized the lean design methodology of DMADV (Define, Measure, Analyze, Design and Verify) to understand Winchester Hospital’s former processes and develop future solutions. Using existing treatment rooms as mock-up spaces to test design solutions also incorporated evidence-based design strategies. This process helped the clinical staff envision the finished project in lieu of viewing plans.

Structural Sticking Points

Even the most raucous of office parties can’t shake the ceilings of a building the way an MRI machine or ultrasound device can. The presence of any form of medical imaging technology will have ramifications on the existing building structure. Some imaging equipment generates vibrations that must be isolated from other parts of the building, while other such equipment may be especially sensitive to vibration and therefore require special isolation design.

When moving from office to medical office, expect that you may also need to cut a hole in the side of your building just to move your equipment in by crane. The basic weight of some equipment items may be much greater than a typical office building was designed to support, triggering reinforcement of the structural frame. At the Winchester Hospital Outpatient Center, MPA was forced to redesign some floors to accommodate the weight of breast care imaging instruments.

Entryways & Pathways

The entrances so common to office buildings often need to be replaced by automatic sliding doors to ease access for patients in wheelchairs or hospital beds. These can be fitted and maintained/repaired by a company like Texas Access Controls (texasaccesscontrols.com/door-service/commercial-door-repair/). A multi-floor building may require a stretcher-sized elevator cab. Consideration should also be given to ambulance access to the main entrance. Full-scale renovations will likely trigger an upgrade to current accessibility codes, but even here, additional investigation is warranted. Stretcher access and the use of wheelchairs, walkers and other support mechanisms will require the installation of new Automatic Sliding Doors around the building, and all have to be factored into the route sof travel through the building. Other finishes like way-finding systems and emergency lighting are smaller but still important pathway concerns.
As architects and providers continue to navigate the intricacies of office to medical office conversion, expect both sides to take great care in discussions about best practices with the patient always top of mind.
Bradley Cardoso, AIA, is a senior health care architect at Margulies Perruzzi Architects, which services the health care, corporate, professional services, research and development, and real estate communities. For more information, please visit www.mp-architects.com.

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The project was designed by BSA LifeStructures, while McGrath & Associates served as the construction manager, with both companies operating out of their St. Louis offices. The facility was constructed in an area adjacent to the previously existing MRI rooms, which continued to function until the project was completed and the machines could be moved to the new site.

“Managing the project phasing was a challenge,” said McGrath Project Manager Jamie Gensits. “We made sure that the MRI staff could maintain excellent patient care throughout our construction process.”

McGrath installed a copper enclosure to prevent radio frequency and electromagnetic interference from penetrating the room. An MRI works by manipulating radio frequency fields in the body to produce a magnetic field that the machine can detect to create an image. This means outside sources of radio or electromagnetic waves can cause interference, limiting the clarity of the resulting image. Copper conducts electricity very effectively and tends to absorb rather than reflect it. This makes it ideal for keeping outside radio and electromagnetic waves from passing through the outer walls and penetrating an MRI machine. Other efforts included using an isolated electrical ground. Usually electricians can use one ground for multiple electrical devices, but the sensitive nature of an MRI machine makes this a bad idea, as electrical interference can result from connecting other devices to the same ground as the machine.

McGrath also employed electrical filters, which filter extra electrical frequencies that might be conducted by wiring and waveguides. This corrals electromagnetic waves and channels them through a narrow pipe. These measures were taken to make sure wires and cords don’t accidentally guide additional interference-producing waves into the machine.

The new machine also has to be supported in a way that eliminates vibration transfer between the structure and the massive magnet the machine relies upon. This stops movements in the structure, caused by shifting or a bus driving by, from being absorbed by the highly sensitive magnet, which would also cloud the picture.

McGrath used a special mixture of fast-setting concrete to speed the construction process, helping the project move from inception in December of 2011 to completion in June of 2012.

BSA LifeStructures is a design firm that specializes in health care, higher education and research institutions. McGrath & Associates is a general contracting company specializing in commercial, health care, industrial, institutional and pharmaceutical construction projects.

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The project will allow the 450,000-square-foot construction space to help Waukesha Memorial remain a state-of-the-art facility, according to Sandra Peterson, media relations for ProHealth Care. The project began one month ago and is slated for completion in 2015.

“Our patients tell us that what they like best about Waukesha Memorial is the personal care they receive,” said John Robertstad, president of ProHealth Care’s hospital division in a statement. “With this extensive renovation project, our entire facility will better support the outstanding care our people deliver everyday.”

The renovation plans also include updates to many clinical areas, such as intensive care, surgery, neurology, oncology, and general surgery. The work will include redesigning six rooms to be used for additional intensive care when required. Currently the hospital has 31 rooms for the ICU.

ProHealth Care has committed $18.3 million to the project to-date, and will commit more money as work continues with the funding coming from ProHealth Care’s capital budget.

Waukesha Memorial Hospital is one of 26 ProHealth Care locations and is a major tertiary-care hospital. The hospital was established in 1914 and has five Centers of Excellence: Neuroscience Center; Orthopedic Center; Regional Cancer Center; Regional Heart and Vascular Center and the Women’s Center.

“Waukesha Memorial Hospital has played a central role in the Waukesha community for nearly 100 years,” said Susan Edwards, chief executive officer of ProHealth Care in a statement. “With this new investment, we are ensuring that the hospital can meet the community’s needs for many more years to come.”

During construction, patients will continue to be treated and moved to areas within the facility that can help fulfill their needs while keeping renovations moving safely.

Services include birthing, cancer, children’s health, emergency/urgent care, men’s health, mental health, orthopedic, optometric, rehabilitation, senior’s health, women’s health and many more. The different healthcare services being provided will each be updated with new technology and systems during the renovations as well, such as this optometric management service for the optometrist’s wards, for example, as well as the others stated previously. These improvements will look to increase the care of patients, as well as how many patients the facilities will actually be able to handle running their day-today practices.

Currently there are 301 available beds at the facility, with 668 physicians on staff and 2,711 employees.

ProHealth Care has provided health care for nearly 100 years to those in Waukesha County and surrounding areas. Other care systems include Oconomowoc Memorial Hospital, the Rehabilitation Hospital of Wisconsin, ProHealth Care Medical Associates Clinics and more.

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Unlike any other type of construction, the ever-changing challenges of building today’s health care facilities are many. Accommodating specialized staff/patient needs from pediatrics to geriatrics requires health care and construction professionals to simultaneously think broadly and acutely. The multitude of facility requisites from equipment and emergency power to medical gas makes the unseen infrastructure of a medical office building a variable jigsaw puzzle of interconnected obstacles. Address all of these elements in an occupied high-rise building originally constructed in the 1960s, integrated in a larger medical campus on a tight urban site, surrounded by a historic neighborhood and you have a legacy project that demands so much logistical forethought that the physical act of building almost becomes secondary.

Located in Denver, Colorado is a 243,000-square-foot ambulatory services center providing a continuum of care that has been under renovation for almost two decades and is expected to continue to evolve for many years to come. Now midway through phase two of a three phase master plan, AP Healthcare, the Rocky Mountain Region’s number one renovation contractor, has been working the building owner’s trusted construction expert since the revitalization began in 1993. Comprised of hundreds of systematic area-by-area transformations, in total construction has included phased demolitions and renovations, mechanical/electrical/IT upgrades, boiler and elevator replacements, creating swing space, equipment installation, exterior improvements, parking garage renovations and even adding an entire floor to the top of the high rise building.

One of the building’s more intense renovations required a collaboration that stretched more than two years in the pre-planning stage. Those two years of planning came to fruition in just 21 days of construction with three crews working in shifts, non-stop over a Christmas holiday break.

Renovating an occupied facility, regardless of use, elevates the need for safety. Renovating an occupied health care facility with the possibility of construction increasing the risk of infections literally magnifies that need to a microscopic level. Maintaining maximum awareness and attention to the control of debris, dust, noise, vibrations and other environmental contaminants has been supported by a customized Health and Safety Manual detailing construction methods for infection control, cleanliness and interim life safety. The use of health and safety manuals is also advocated through the provision of workplace health and safety courses. If you would like to learn more about the importance of a Work health and safety course Melbourne and other major cities are home to some fantastic organizations that can train you in how to protect yourself and your team from permanent injuries. Ignoring the necessary health and safety precautions could result in detrimental outcomes for staff and patients and could also result in an HEB injury attorney opening up a lawsuit.

“It’s important to never give patients any sense that they are being treated in a facility that is under construction,” said Mark Stubits, AP Healthcare’s senior superintendent. “Whether they are in for preventative care or something serious, our presence should only be beneficially felt, when the work is done.”

Among the many unique strategies employed to keep construction moving while maintaining a minimal site profile was the addition of an exterior construction elevator, known as a skip. Since the building lacks a service elevator, the skip readily allows the team to move materials, equipment and people in and out of any floor without crossing paths with patients or staff.

Conscientious collaboration and communication have been the constant critical in all of AP Healthcare’s interactions. Working with the building owner and the design team as an integrated partner throughout the project development process, AP is providing vital insight on construction phasing, scheduling, costs, life safety and beyond. Considering the multi-dimensional impact of decision making on so many variables from disrupting areas above, below and beside construction activities and the need to maintain a constant balance of materials, resources and manpower to the long-range thinking required to envision a finished facility more than 15 years in advance takes a steady hand and surgical precision in planning. Mark Borik, an AP Healthcare Project Manager likened the process to the classic building block game Jenga.

“In every decision, our goal is to make sure that there are no surprises for the client and users,” Borik said. “We have to conceive and communicate a multitude of considerations before we take action. Construction activities on the 11th floor at 6 a.m. can impact tests taking place in the basement. In health care there is no room for error.”

When a project stretches across three decades, strong interpersonal relationships are formed. Over the course of hundreds of meetings, the line between client and colleague is blurred by life’s milestone moments – birthdays, anniversaries, successes and smiles. Likewise, the process of a continual floor-by-floor renovation, looking behind walls and above ceilings, imparts a familiarity with the building’s unseen intricacies that further shapes decision-making, saving time and money. The combination of both relationships – interpersonal and structural – imparts a tremendous sense of trust that ultimately decreases some of the complexity of the construction implementation process.

From a construction perspective though, a surprisingly important part of healthcare facility renovations involves choosing the most appropriate type of flooring. Put simply, clinic offices, hallways, operating rooms, laboratories, and imaging rooms are in constant use. Because of this, hospital floors see heavy foot traffic, as well as wheelchairs, hospital beds, carts, and machines twenty-four hours a day. Between the extensive square footage and the constant movement, it is, therefore, crucial to have flooring that contributes to the successful operation of the facility.

Accordingly, epoxy is the most widely used flooring system in hospitals. Not only does it meet necessary building specifications but epoxy floor coatings diminish slip and fall hazards by adding slip and skid-resistance. Additionally, epoxy floors offer UV-protection against color breakdown and deterioration. Correspondingly, this type of flooring also provides a germ-free setting, allowing hospitals to maintain sterility. Above all, epoxy floor coatings perform well in operating and patient rooms, bathrooms, and common areas. You can learn more about the benefits of installing an epoxy floor by heading to the Xpedite Coatings website.

Much has changed in health care, in construction and in design technology since the project started. Originally hand-drawn in the late 1950s, the architectural details communicated for the first phase of renovations in CADD files have since been transitioned to Building Information Modeling (B.I.M.) files that allow users to see intended renovations in three dimensions. Moreover, nowadays, it is commonplace for a property CGI/3D rendering specialist to create artist impressions in the early stages of a renovation project. The construction team recalled taping off sections of the parking garage in 2003 as a means of illustrating spatial dimensions so users could “walk” room mock-ups.

Today, virtual design simulations can be presented on handheld tablets complete with costs, schedule and the ability to rotate the rendering on any axis, all of which further enhances the team’s ability to communicate and instill confidence in decision-making. The seeds of change are often the roots of possibility. As health care needs and advances in discovery, treatment and care continue to evolve, so too has the process of occupied health care renovations. What has remained constant is the strong commitment of AP Healthcare.

“The sense of accomplishment, a passion to perform at our highest level and translate that into the better health care, improved and longer lives is reward in itself,” remarked Project Manager Jason Heustis, who along with Superintendent Mark Stubits, has been on site daily at the building since 2003.

On a project that has required years of long nights and weekends, for AP Healthcare, the driving motivation has been to provide the highest level of quality on the most complex kind of renovation without the patients ever knowing we are there.

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