TAMPA, Fla.—BSA LifeStructures (BSA), a nationally recognized architecture and engineering firm, continues to develop its Florida footprint by opening a joint studio offering architecture and engineering services.

The joint studio opened in September, and BSA will hold a private holiday event this week to commemorate the opening.

The joint studio comes following BSA’s acquisition of Carastro & Associates earlier this year. BSA has conducted business in Florida since the late 1980s, initially focusing on long-term acute care hospitals across the state. In recent years, the firm has expanded its presence, welcoming Melanie Harris as Principal and National Healing Practice Director in April 2020, and Tim Wagoner as a Learning Principal in early 2023.

The Tampa Studio now includes 28 employees, and with BSA’s other studios in Austin, Denver, Indianapolis, Raleigh, and St. Louis, brings the firm’s headcount to over 200.

“What’s exciting for us is that by building this studio alongside our new colleagues from Carastro, it speaks to the power of an integrated studio,” says Harris. “Taking what BSA is known for and placing it in Florida with local roots and expertise is a testament to our commitment to expanding our creative horizons.”

Founded in 1960 and located in Tampa, Fla., the former Carastro & Associates focuses on mechanical, electrical, plumbing, fire protection, and technology engineering design services. In the decades that have followed, their business has grown into a well-established firm known for its expertise and dedication to clients.

Paul Carastro, an engineering Principal with BSA, has designed electrical systems for over 35 years in the Tampa Bay and Central Florida areas. “My father started the Carastro firm out of our house when I was born, and the irony is that the first project that helped him establish the firm is one that we’d come back and upgrade the electrical systems on 40 years later.”

“The acquisition was just such a natural fit,” says George Stefanovici, the Tampa Studio Director and Principal at BSA. “The reason our team has blended together so well over the past six months is why it made so much sense in the first place, starting with our similar cultures, total dedication to our clients and focus on accountability.”

As a national, integrated design firm, BSA provides architecture, engineering, interior design, and planning services for spaces in healthcare, higher education, and science and technology. With this focus on local leadership and national expertise, BSA recently was awarded the engineering component of the forthcoming $260 million BayCare Manatee Hospital, which will be located at the northeast corner of Moccasin Wallow Road and Interstate 75. The hospital will provide northern Manatee County residents easy access to convenient, high-quality health care, including quicker, closer access to potentially life-saving emergency care.

BSA plans to continue to help shape lasting projects within the state, and serve current and prospective partners in healing, learning and discovery in alignment with its mission. “I have seen the incredible growth and excitement around the numerous projects that are expanding Tampa and the surrounding region,” says Stefanovici. “With this new sense of collaboration and identity, we’ll bring lasting facilities that benefit the greater Tampa Bay area, and beyond.”

“The opportunity to build on our Florida presence is truly exciting,” notes BSA CEO Tim Spence. “It means we’re able to expand on our mission to create inspired solutions that improve lives. Our work doesn’t just shape buildings; it transforms healthcare environments, educational spaces, and research facilities into places that promote healing, learning, and discovery.”

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According to the government policy watchdog website, TheHill.com, more and more governors across the United States are instructing state health officials to increase bed capacity to meet the expected surge in COVID-19 patients. As a result, many healthcare leaders are effectively working two jobs right now. Not only are leaders fulfilling their usual day-to-day responsibilities, but leaders are also focusing on how they’re going to modify their existing operations and facilities to care for COVID-19 patients.

Hospitals are looking for effective, efficient strategies and solutions that can be implemented quickly to keep patients safe and protect the caregivers and medical professionals on the front lines battling this disease. It’s important that our medical professionals are safe throughout this pandemic. With appropriate PPE clothing, doctors should be kept fairly safe. Additionally, distance tape should be used to help to keep people at least 2 meters apart at all times. Marking it out with this tape will help to remind people and make it clear where they should and shouldn’t be. As well as this, all people working in hospitals all over the world should have access to hand sanitizer at all times so they can kill any bacteria on their hands. Luckily, hospitals in the UK have strong supplies of hand sanitizer thanks to companies like phs Direct. For those who don’t know, phs Direct are the UK’s leading supplier of commercial wholesale hand sanitiser, helping to keep offices, workspaces and businesses as a whole up to vigorous hygiene standards. This is helping many people stay safe from COVID19. In contrast, hospitals in the US are only just starting to catch up with those in the UK. US officials are finally beginning to realize the problem that coronavirus is causing worldwide.

Here are several key issues to consider and strategies for leaders to address the unique aspects of the novel coronavirus.

Understand air handling issues regarding isolation spaces. As with any airborne infectious disease, COVID-19 patients need to be isolated to protect the health of other individuals in the facility. Since most hospitals only have a few isolation rooms, the influx of COVID-19 can be problematic. The air handling requirements to create additional isolation spaces fall into three categories, each with their own issues that are important to be aware of:

• First, 100% exhaust air is required. As with any airborne infectious isolation room (AIIR), the air in a COVID-19 patient room should not be recirculated. To conserve energy, most hospitals are designed to intake 25% of outdoor air and recirculate the remaining 75%. To achieve 100% intake of outdoor air poses a significant issue, as most hospital facilities do not have an infrastructure designed with this capability. It is important to conduct a thorough analysis of the hospital’s existing heating, cooling, fan output and controls. The total system impacts need to be understood and considered before attempting to increase isolation spaces. This is a difficult issue but one that is absolutely necessary in the case of COVID-19.
• Second, it is important to create a negative pressure in an isolation room to protect the other patients and staff in the hospital. Since the supply air to the room is typically designed to the code minimum, creating a negative pressure must be controlled through the exhaust system. Creating a negative space in the patient room on a temporary basis can be simple if the facility is willing to take out the window and put in what is basically a fan, blowing air out of the building. This will meet the code requirements for a temporary response. Creating a negative space is tricky because of the pressure relationship to certain rooms. If you make a change to one room, leaders could disturb other air change relationships.
• Finally, try to increase the amount of outdoor air to as close as 100% as possible. However, this poses issues. It is critical that leaders consider the ambient air temperature of outdoor air. If the air handlers are not sized appropriately to manage large intakes of cold air, they could freeze. Similarly, if the air is humid, and the air handlers do not have enough capacity, this may impact the ambient temperature within the isolation rooms as well.

Monitor. Monitor. Monitor. COVID-19 patients are in acute respiratory distress and require significant amounts of oxygen and medical gas supply for ventilators. As facilities start doubling up patients on ventilators, medical gas usage can increase significantly. It is important that leaders assign an individual to monitor the following on an ongoing basis:

• Bulk oxygen levels. When does the system need to be filled? Has this been scheduled?
• Med gas supply. Are there any supply chain issues? Are the current providers operating as usual, or has their delivery schedule been affected?
• Fuel oil levels. Are there enough fuel reserves to last a few days in case of inclement weather or if the facility has a power outage?
• Air filters. With the potential change in air flows, it’s essential to make sure all of the air filters have been replaced to limit the load on the air handler.
• Is there a sufficient supply of salt for the water softeners?
• Water treatment. Is the water treatment vendor able to maintain service?

Implement a formal checklist. The patient surge due to COVID-19 has changed how hospitals operate on a daily basis. Items that were once addressed on a weekly or monthly basis, now need to be checked daily. Keeping track of what leaders are responsible for can easily fall through the cracks, especially in light of quarantines and staff changes. Since there are still only 24 hours in a day, leadership does not always have time to focus on everything. A thorough checklist can be beneficial in times like this. Not only does it serve as a reminder for those in charge, but it also makes it easy to delegate individual tasks to others.

Limit the spread of coronavirus in surgical areas. As facilities are scrambling to create isolation units for COVID-19 patients, leaders are also preparing for other likely scenarios, such as how they perform surgery on an infectious patient. By code, operating rooms are required to be positive airflow. There are no exceptions to this rule. How does a hospital limit the spread of coronavirus if they have to put a patient in a room that is required to be positive, which is contrary to the current infection control measures? The following is a list of considerations:

• Do the procedure when no other surgeries are occurring in other operating rooms that are served by the same air handling unit (AHU).
• Use an operating room at the end of the OR suite corridor to contain the virus as much as possible.
• Put the AHU into 100% outdoor air mode if possible. If the unit does not stay on due to low limit temperature safeties, allow only as much return air as required to keep the AHU running. Operating room air handlers must have HEPA air filters. The CDC recommends not recirculating air unless it is HEPA filtered.
• If possible, put one of the temporary construction enclosures around the operating room door to the corridor and put a portable HEPA filter unit inside this enclosure.
• After the surgery is over, flush the air in the area served by the OR AHU for 60 minutes.

Recognize limits of HEPA filters. The CDC allows recirculated air as long as it goes through a HEPA filter, but it is important to remember that not all air handling units are large enough to push through a HEPA filter. There is some research that indicates that the coronavirus is small enough to pass through a HEPA filter. To err on the side of caution, consider blocking off access to areas where HEPA filters exhaust such as parking garages or spaces between buildings.

Communicate internally and externally. These are extraordinary times and call for extraordinary measures. The patient load at hospitals is changing daily, reaching unimaginable surge levels. While it is busy and lives are at stake, it is important that hospital leaders commit to a quick daily “huddle” with key departments to review status of key areas. Similarly, it is important to keep an open dialogue with all of the authorities having jurisdiction including the local Department of Health and the Joint Commission. To meet the surge requirements, many temporary renovations are being done, including some that may not be allowed by code. By keeping in continuous conversation with officials, explaining what measures have been taken, can help keep everyone on the same page. If hospitals have social media pages, then keeping the local community informed via those would also be a good idea. There are some recommendations on Violet PR that could be useful to many businesses, as well as hospitals.

In the modern era, the world has never experienced a time such as this. The global healthcare industry has been thrust to the frontlines of a viral pandemic battling an evasive and fast-moving enemy (COVID-19). The first quarter of 2020 may well be the greatest peacetime effort in innovative thinking the US, and the world has ever seen. The global coronavirus pandemic has affected everyone from teachers learning how to use e-learning full-time to everyone in the service industry learning how to work in isolation.

The industry is more equipped today than at any time in human history to handle such a battle with its enhanced technology, Lean operations, sophisticated air handling systems, and evidence-based medicine that facilitate life-saving care. The collective goal is to respond quickly – with Effective and Efficient COVID-19 Strategies… Right Now – so that we might stay ahead of this virus, reduce the spread, and allow modern medicine to save lives. Unfortunately, lots of people have contracted COVID-19 already, particularly in busy cities. For example, there are thousands of cases in NYC, which is why lots of people are choosing to contact places like this NYC COVID-19 Attorney. Seeking legal compensation is completely optional though. Just make sure you get the compensation you deserve.

Samuel Jackson, PE, LEED AP, is Director of Engineering with BSA LifeStructures. He can be reached at sjackson@bsalifestructures.com.

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During Part I of this two-part series, it covered the importance of transition planning during new hospital construction or renovations. Through the transition planning process, health care organizations receive invaluable intangible deliverables including the breakdown of department silos through increased appreciation for work in other departments, elimination of duplicative processes and cross-training of staff, as well as the benefits of change management and culture development.

Specific sequencing is paramount. There may be staff turnover from the original design teams to the phase of transition and activation.  New members and decision makers need to see and understand the reasons for design decisions and new standards.

One major process that comes up in almost every transition planning engagement includes more effective and better ways to deliver medications to patients while minimizing unnecessary steps for the nursing staff.  The patient needs to receive the right drug, at the right time, in the right dose and route, every time. From the nursing perspective, medications need to be easily accessible, as close to the bedside as possible and available when needed. Pharmacists are concerned about the appropriate storage, accurate dispensing and controls to the distribution point of care. Balancing the needs of these various group to find a solution that works for everyone is possible if the right processes are employed.

Testing new processes through mock scenarios and drills is also integral to effective transition planning.  These drills help to test the new processes to assure that they fit the design of the new facility.  Typically, mock drills and simulations are staged approximately two-three weeks prior to activation after all equipment and supplies are in place. Those processes with the most change are tested and simulated with staff to ensure correct understanding of location of critical equipment, supplies and flows of patients, visitors and staff.

At Castle Rock Adventist hospital, the transition team managed the process beautifully. “In working through transition planning for the opening of our new acute care facility, the Transition Team provided the detailed guidance needed in designing an operation plan,” says Vicki Mettlach, Project Manager/Director of Quality Resources.  “This involved creating policies and procedures, developing process flow and testing mock patient scenarios.  This was very beneficial to us in our preparations to open successfully and smoothly by keeping us on track and on top of the overwhelming details that could otherwise be overlooked.”

Lean tools are the root of effective transition planning. Without good tools, it is impossible to create customer value, eliminate waste, promote flow, or test processes, all steps that are instrumental in eliminating waste.  The process map is an important tool that transition teams employ to establish roadmaps and guides for decision making in multiple healthcare processes and procedures.

Enthusiasm, Energy + Improved Care Delivery

Working hard to ensure the smoothest transition, a large proportion of staff will have put in extraordinary time in the months prior to the move. Day one is a time to celebrate. But in the months and years that follow, real success will always be measured by the care that is given. How seamless that care is, and its delivery will depend on the work that was done in the transition planning phase from the old facility and to processes in the new. The net result – patient safety, patient satisfaction, and operational efficiency — is ultimately the chief goal.

Optimizing the value of transitioning with all attendant changes is a significant moment in an institution’s history, which can depend not only on unique talent and expertise, but also extraordinary levels of enthusiasm and energy. Health care leaders can decisively include transition planning in their project scope from the outset, leveraging the excitement as well as bringing clarity and improvement to new facility processes.

Terry Thurston is the Healthcare Operations Planner with Indianapolis-based BSA LifeStructures. She can be reached at tthurston@bsalifestructures.com or 317.819.7878.

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CHESTERFIELD, Mo. — St. Luke’s Hospital in Chesterfield held a dedication ceremony on Jan. 23 for its new outpatient services building after its completion in December 2016. The new facility was constructed to accommodate the growing needs of outpatient healthcare services on the hospital’s west campus and to provide flexibility for future department growth within the building.

The 106,000-square-foot, five-story building had a budget of $40 million. The architects on the project were BSA LifeStructures in St. Louis, with general contractor McCarthy Building Companies, also in St Louis. The new outpatient Center Building adjoins with St. Luke’s Mr. and Mrs. Theodore P. Desloge, Jr. Outpatient Center, and provides additional space for new physician offices as well as the expansion of St. Luke’s physical therapy and cardiac rehabilitation services. Additionally, the nutrition wellness and diabetes center, anticoagulation clinic, wound care and hyperbaric medicine services have all relocated into the new outpatient buildings since the completion of construction in January.

“The dedication of St. Luke’s new outpatient services building is a significant event for St. Luke’s Hospital and health care in our region,” said Christine M. Candio, RN, president and chief executive officer at St. Luke’s in a recent statement. “As our community grows and changes, we work to stay ahead of patient needs by continuing to provide convenient access to the highest quality care and services possible.”

The new outpatient center possesses a number of features designed to improve the overall patient experience, care and services, according to Ellen Post, interior designer at BSA LifeStructures. A single-loaded corridor creates a wayfinding element with multiple entry points, shortening the distance patients would travel while exposed to the outdoors, with large windows in the corridor allowing natural light to enter the clinic spaces. A number of design elements balance the physical and stylistic connection between the adjacent Mr. and Mrs. Theodore P. Desloge, Jr. Outpatient Center and the new outpatient center according to Post, such as an indoor walkway that allows patients, visitors and staff to travel inside, between the buildings.

“The interior and exterior design language of the Desloge Outpatient Center drove the aesthetic of the new facility,” said Carter Haas, designer at BSA LifeStructures. “The design embraces the natural fall of the existing topography, enabling a partial basement level to accommodate mechanical systems and a service and delivery zone.” The location of the partial basement and the distance from the street shapes the location of the core and main canopy drop-off at the new building, according to Haas.

Overcoming structural challenges in connecting the two outpatient buildings was one of the biggest obstacles that the design team faced on the project, but in the end these goals were achieved successfully, according to Haas. In an effort to improve overall efficiency and communication for the project, iPads and advanced construction software — including BIM 360, NoteVault and Bluebeam applications — were utilized by McCarthy and its design and construction team.

The new outpatient building is seeking LEED Core and Shell certification, and is currently being reviewed, according to Corey Black, project manager at McCarthy Building Companies. The new building is energy and water efficient, according to Black, and generated minimal construction waste throughout the duration of the project. The new facility integrates sustainability through the use of healthy, regional materials, and bioretention basins to slow and treat onsite stormwater runoff. Additionally, the building implemented CO2 emissions reduction and improved indoor air quality.

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The $31.3 million facility is designed by Indianapolis-based BSA LifeStructures and is located on the north side of the main hospital campus. It is designed to connect to an adjacent medical office building through the use of a pedestrian bridge located on the second floor of the facility.

The facility is designed with the latest technology and includes state-of-the-art cancer treatment technologies as well as amenities that serve patients and families who are required to spend an extended period of time inside the hospital. Some of the technologies at the cancer center include radiation therapies, PET C/T, nuclear medicine, infusion therapy, medical oncology, and supporting lab and pharmacy ancillary services, according to a statement from McCarthy Building Companies.

The first floor of the facility welcomes visitors and patients with a naturally lit lobby and registration area. The lobby also includes a retail space, a café, an education space and a community center. Once visitors walk past the lobby, they are greeted by a healing garden designed to provide a relaxing escape for patients and visitors. An infusion services and medical oncology clinic are located on the second floor.

One of the biggest challenges during construction was working on a construction site that was simultaneously being used to treat patients. That’s why the design-build (D-B) team worked closely with Phelps County Regional Medical Center to ensure that daily business would not be interrupted and all staff, patients and visitors would be safe.

“This project is a testament to the power of teamwork, efficiency and innovation,” said Justin Decker the project manager of McCarthy in a statement.

In order to meet the project’s deadline, the D-B team worked alongside Lean Construction Technologies (LCI), a nonprofit organization based in Arlington, Va., that provides strategies to help D-B teams complete projects ahead of schedule and below budget. One strategy employed by LCI included the use of prefabricated mechanical, engineering and plumbing (MEP) systems directly from the BIM model to reduce site waste, according to a statement.

All cancer treatment and support services will be housed in the Delbert Day Cancer Institute in an attempt to provide patients with up-to-date care in a centralized location. The institute will specialize in treating patients with lymphoma, bone cancer, breast cancer, cervical cancer, colon cancer, lung cancer, ovarian cancer and prostate cancer.

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