Attention to Detail
Patient Tower Additions Present Unique Difficulties
By Carrie Bui
Every building project comes with its own set of challenges, but healthcare facilities, especially patient tower additions, pose some particularly unique difficulties. Along with typical issues such as budget or site concerns, adding a patient tower to an existing hospital includes concerns about tying in the addition to the existing building; connecting the mechanical, electrical and plumbing components; and infection control.
S. M. Wilson & Co. has extensive experience in healthcare construction including patient tower additions. They spend months of pre-construction on these projects to ensure that the structures are built efficiently, effectively and safely. “There is a significant amount of planning that has to go in these facilities,” said Bill Wagner, Project Executive with S. M. Wilson.
The company recently completed a patient tower expansion for Alton Memorial Hospital in Alton, Ill., and they are currently working on a new parking garage and patient tower for Boone Hospital Center in Columbia, Mo with joint venture partner Reinhardt Construction. as well as a renovation and expansion for Community Hospital South in Indianapolis, Ind. Often, the project is more complex than building an additional structure on the hospital campus. When the construction team begins planning for a project, they look at constructability issues such as potential complications with basements or underpinnings, if there’s a need to relocate utilities, what types of materials can be used, cost impact and more, said Wagner. S. M. Wilson had to work through specific issues for each of these projects, such as how to tie in the tower to the existing hospital, connecting utilities, and balancing construction around a building that needed to remain in operation.
Community Hospital South
The Community Hospital South project is a four-year project consisting of a new five-story patient bed tower, six new operating suites with support area, a new power plant addition and renovation of much of the existing hospital. One of the most challenging issues with this site, said Garry Rollins, Project Executive with Rollins Construction Company LLC, a wholly owned subsidiary of S. M. Wilson & Co., was the need to relocate the major utilities feeding the hospital, including electrical, gas, water, fire protection lines and medical gas lines. The construction team tackled the challenge with plenty of upfront meetings to decide how to move new lines before disconnecting the old lines, and how to keep the switch occurring in as short a time as possible. “The electrical had to be switched back and forth from two separate feeders to keep the hospital in operation,” said Rollins. “We had to make sure all the services remained operational while we did the cutovers.”
Rollins Construction built a new power plant addition to support the new hospital additions and power the existing facility. This can be challenging for a construction team as existing ceilings are “usually pretty packed with mechanical and electrical,” said Rollins. Before any changes could be made, the building team needed to find the systems’ routes.
“We spent a lot of time looking at routes through the building for ductwork, pipe, electrical,” he said. The MEP effort required a lot of after-hours survey work, he added, and it all needed to be completed under strict infection control measures. Two new generators were also provided to replace the hospital’s existing ones.
Because of the size of these projects, construction becomes a significant presence on the hospital campus and usually interrupts hospital traffic flow. For the Community Hospital project, the existing front entrance needed to be rerouted to the other side of the building, ultimately allowing the two buildings to be connected from the ground floor to the fourth story.
“I think, like most healthcare construction, the priority is to get a quality healing environment, good value, delivered in a rapid cycle, all challenges that tend to conflict with one another,” said Mark Hayden, Senior Project Manager with Community Health Network.
Alton Memorial Hospital
S. M. Wilson provided construction management services for the new bed tower at Alton Memorial. The new bed tower is 78,000 square feet, has three stories and features 76 private rooms as well as an inpatient pharmacy, therapy areas and lab services.
Senior Estimator Paul Wilson said “the devil’s in the details” with complex projects such as these. Missing even the smallest detail can have a big effect on a construction project.
A small detail that is significant but often overlooked, added Senior Project Manager Brett Goodman, is what to do if water gets into the basement excavation. The Alton project included a full 22,000-square-foot basement, which required a 22-foot deep hole. The team considered the possibility of rain and planned ahead to determine the best way to drain water from the excavation. This was imperative, because the amount of water collected in the excavation would have overwhelmed Alton Memorial’s existing drainage system. Their solution was to put in a storm line that connected to the foundation drainage system.
“You always want to draw on previous experience when you approach these types of projects, and you don’t want to limit that resource to just S. M. Wilson,” said Goodman. “I like to get the subcontractors involved as well. The subcontractors have valuable experience in their areas of expertise that I like to tap into. That goes with the S. M. Wilson attitude to the whole project. It’s the team approach.”
As with every construction project, budget is an integral factor. Wilson said the building and design teams checked costs at each level of the drawings to determine a cost-value list. These drawing reviews helped the team to identify constructability and cost issues. “If you don’t watch each step of the way, it can get away from you,” he said. For the Alton project, they applied a design-assist method and 3-D drawings for the mechanical, electrical, plumbing and fire protection systems. These methods not only helped maintain budget, they also reduced conflict.
Safety for the building team and for the hospital’s staff, patients and visitors is also top of mind for S. M. Wilson. “We performed a new risk assessment each time building conditions changed, and then developed a new plan to mitigate that risk,” said Goodman.
Reinhardt/Wilson, a joint venture between Reinhardt Construction and S. M. Wilson, is the construction management agent on the new seven-level patient tower and a four-story parking garage for Boone Hospital. An enclosed, heated and cooled pedestrian walkway will connect the two buildings.
John Hunter, Reinhardt/Wilson Senior Project Manager for the Boone Hospital project, said their “first consideration” is the hospital and what effect construction procedures will have on the hospital’s operations. “It’s always thought out and planned way in advance when we enter a project in the hospital.” An example of how the contractor and the hospital worked in cooperation, said Hunter, is when the team was working on the roof above labor and delivery, there was a “direct link” between the head nurse and the construction superintendent. The team also posts a noise alert of anticipated activities each week for people who need to be informed and aware of construction.
Another significant coordination issue for Boone Hospital was that the building team needed to work on the roof, around the hospital’s helipad. “They could get up to six helicopter trips a day,” said Hunter. When a helicopter was coming through, the construction staff needed to secure their materials and leave the roof immediately.
Infection control policies are vital when working within a hospital facility, “to make sure we don’t bring anything in and we don’t bring anything out,” said Hunter. Multiple measures are taken to ensure the safety of the construction personnel and the hospital’s staff, patients and visitors. Partitions are used to separate construction areas from the rest of the hospital, negative pressure machines are used to push dust outside and not into the hospital space, and surgical booties are worn over shoes when entering hospital spaces so construction dust and debris are not tracked in by workers.
Adding a patient tower to a hospital is no easy feat. It is a task that requires sensitivity to the hospital’s activities as well as staff, patients and visitors. However, once completed, these towers allow the hospital to provide an invaluable service to the community more efficiently and more effectively. No matter how challenging these projects are, the team knows that all challenges can be resolved through extensive planning and cooperation among all team members.