legacy emanuel hospital -...

L E G A C Y E M A N U E L H O S P I T A L

RENOVATION OF AN OCCUPIED LEVEL 1 TRAUMA FACILITY

Jared Lewis

Principal

catena consulting engineers

Malcolm Brown

PM/Medical Planner

Zimmer Gunsul Frasca

Klaus Tilla

Sr. Associate

Mazzetti

• Gain insight into the challenges and successes of a staged

infrastructure upgrade of an occupied critical care facility.

• Organizing for future tenant improvements with an eye towards the

facility master plan.

• Balancing temporary construction phasing to maintain occupancy

and limit budget impact.

OBJECTIVES

FACILITY MASTER PLAN

Phase One: Children’s Hospital

• Parking Structure (418 spaces)

• North Utility Plant

• Randall Children’s Hospital

o 334,000sf

o Pediatric Acute Care: 96

Rooms

o NICU: 45 Beds

o PICU: 24 Rooms

• Decant Pediatric programs from

existing facilities

North Utility Plant

Randall Children’s Hospital

New Parking Structure

FACILITY MASTER PLAN

Existing Utility Routing

• Steam and chilled water

from south plant

• Chilled water from North

Tower

• Steam utilized to generate

all heating and domestic

hot water

Steam plant

Chiller plant

Penthouse chiller plant

FACILITY MASTER PLAN

Final Utility Routing

• Randall Children’s Hospital

added demand for

heating and cooling

• NUP provides chilled water

and steam to northern

campus

NUP, chilled water and heating hot water

Utility tunnel

Existing distribution remains

FACILITY MASTER PLAN

Phase Two: Adult Services

• Emergency Department Expansion

• Ambulance Dock and Canopy

• West Wing Backfill

o Adult Critical Care Units (36

beds)

o Adult ED Renovation

• New West Wing Trauma Elevator

West Wing

FACILITY MASTER PLAN

Phase Two: Adult Services

• North Patient Tower Backfill

o Adult TRACU 33 Beds

o Temporary Adult ED

o Clinical Decision Unit

• Align TRACU with West Wing

Critical Care

West Wing

North Patient Tower

FACILITY MASTER PLAN

Phase Two: Adult Services

• Emanuel Central Backfill

o Family Waiting/Support

o Conference & Consult

• Align Family Support Functions with

TRACU and Critical Care

West Wing

North Patient Tower

Emanuel Central

• Patient & family-centered environments

• Improve quality & safety

• Clarity& identity to points of entry & arrival

• Safe & comforting environments

minimizing stress

• Wayfinding & signage enhancements

• Optimize patient flow & staff efficiency

• Design flexible & adaptable space

• Promote healthy & supportive work

environments

• Areas of respite

• Unique & identifiable materials palette

GUIDING PRINCIPLES & INFRASTRUCTURE GOALS

• Voluntarily strengthen existing structure

• Limit impact to patient care

• Achieve enhanced structural building

performance

• Multi-phase construction solution

• Updated mechanical infrastructure

Proposed Adult TRACU Family Support

Relocate Adult TRACU

NORTH PATIENT TOWER + EMANUEL CENTRAL

Stacking Organization

• Backfill 3rd Floor vacated spaces

• Adult TRACU moves to 3rd Floor

• Vacated NPT 1st Floor for ED

Functions

• Provide shared Family Support

zone in Emanuel Central

Ancillary/Support

Mech. Mech.

Beds

Beds

Beds

Ancillary/Support

Ancillary/Support

Ancillary/Support

Support

1

2

3

4

5

WEST WING: EXISTING CONDITIONS

Stacking Organization

• Decant Pediatrics services to

Randall Children’s Hospital

• Assess current state of West Wing

infrastructure

• Identify phasing strategies

Pediatric Acute Pediatric ICU Mechanical

Mechanical

Surgery/Surgical Support

Trauma/Cardiac SurgeryEmergency Department

Labor & Delivery

ICU1

2

3

B

SB

NICU

I/R

WEST WING: EXISTING ROOF

Equipment Organization

• Equipment free current state

• Air intake to be removed after

infrastructure upgrades

• Skylights to remain above corridor

intersections

WEST WING: NEW AIR HANDLING EQUIPMENT

Stacking Organization

• Install AHUs prior to demolition of

existing floors

• Emergency power switchgear

room is constructed

Pediatric Acute Pediatric ICU Mechanical

Mechanical

Surgery

Trauma SurgeryEmergency Department

Labor & Delivery NICU

ICU

AHU AHU

1

2

3

B

SB

WEST WING: NEW MECHANICAL EQUIPMENT

Equipment Organization

• AHU 1 and AHU 2 installed prior to

demo

• Connect to risers in North Patient

Tower “bullet”

WEST WING: PHASE I DECANTING

Stacking Organization

• Randall Children’s Hospital opens

• 2nd & 3rd Floor demolition begins

• Next step: reconfigure MEP

systems

• Mitigate noise and vibration during

demolition

Pediatric

AcutePediatric ICU Mechanical

AHU AHU

Mechanical

Surgery

Trauma SurgeryEmergency Department

Labor & Delivery NICU

ICU

TO RANDALL CHILDREN’S HOSPITAL

1

2

3

B

SB

WEST WING: INFRASTRUCTURE ROUTING

Mechanical

Surgery

Trauma Surgery

Mechanical

AHU AHU

Emergency Department

Labor & Delivery

ICU

Stacking Organization

• North AHU

o Serves Basement thru 3rd Floor

o Serves north half of West Wing

• South AHU

o Serves Basement thru 3rd Floor

o Serves south half of West Wing

• Existing Surgeries served by sub

basement AHUs1

2

3

B

SB

WEST WING: PHASE I I DECANTING

AHU AHU

Mechanical

Surgery

Trauma SurgeryEmergency Department

Labor & Delivery

ICU

Stacking Organization

• Relocate 1st Floor Adult ICU beds

• Emergency Department phased

construction begins

1

2

B

SB

3

WEST WING: STRUCTURAL STRATEGIES

Concepts

• Shear walls?

• Braced Frames?

WEST WING: STRUCTURAL STRATEGIES

Concepts

• Shear walls?

• Braced Frames?

WEST WING: STRUCTURAL STRATEGIES

AHU AHU

Mechanical

Surgery

Trauma Surgery

Labor & Delivery

Stacking Organization

• Strengthening only available in

decanted areas

• Strengthening solution must retain

voluntary status

• Enhanced Performance Objective

1

2

3

B

SB

Stacking Organization

• 3rd Floor

o Adult Critical Care (24 beds)

• 2nd Floor

o Cardiovascular ICU (12 beds)

o Existing Labor & Delivery

• 1st Floor

o Adult Emergency Department

o Existing Trauma & CV Surgeries

• Basement

o Existing Surgeries

• Sub-basement

o Mechanical

WEST WING TODAY

AHU AHU

Mechanical

Surgery

Trauma SurgeryEmergency Department

Labor & Delivery

Adult Critical Care

CV Critical Care

Tra

um

a E

lev

ato

r (B

AE)

1

2

3

B

SB

•Minimize travel distances for staff

•Distribute care team and work

spaces

• Support team collaboration

• Increase efficiency

•Airflow Control for consistency

between new and existing systems

ICU PLANNING GOALS

WEST WING: EXISTING 3 RD FLOOR

Plan Organization

• Pediatric Acute Care Unit

• Pediatric ICU

• Mechanical Room (serving 1st, 2nd,

and 3rd floors)

Pediatric Acute Care Unit

Mechanical

PICU

WEST WING: UTIL ITY PATHWAY

Plan Organization

• Pre-renovation mechanical plan

• AHUs serve interior and exterior

zones

• Common exhaust for the building

• Five existing shafts serve areas

throughout the floors

• 3rd Floor IDF Room serves second

floor low voltage systems

WEST WING: UTIL ITY PATHWAY

Plan Organization

• Pre-renovation mechanical plan

• AHUs serve interior and exterior

zones

• Common exhaust for the building

• Five existing shafts serve areas

throughout the floors

• 3rd Floor IDF Room serves second

floor low voltage systems

WEST WING: UTIL ITY PATHWAY

Plan Organization

• 3rd Floor ACU/ICU demolished

• Utilized open floor to temporarily

supply existing shafts

• New shafts constructed per final

plan

• Connect distribution to the new

AHUs

WEST WING: STRUCTURAL STRENGTHENING

Solution

• Existing building structure

• Columns and slabs

• Non-linear Procedures

WEST WING: STRUCTURAL STRENGTHENING

Solution

• Existing building structure

• Columns and slabs

• Non-linear Procedures

WEST WING: STRUCTURAL STRENGTHENING

Solution

• Existing building structure

• Columns and slabs

• Non-linear Procedures

WEST WING: STRUCTURAL STRENGTHENING

Solution

• Existing building structure

• Columns and slabs

• Non-linear Procedures

WEST WING: STRUCTURAL STRENGTHENING

WEST WING: RENOVATED 3 RD FLOOR

Plan Organization

• 24 Bed Adult Critical Care

• Shared support zone in the center

of the floor plate

o Equipment Storage

o Staff lockers/lounge

• Access to new Trauma Elevator

• Horizontally aligned to TRACU and

Family Waiting

To

TRACU

To

Family

Waiting

• Maintain 33 patient rooms

• Minimize travel distances for staff

• Provide efficient distribution of

care team and work spaces

• Support team collaboration

• Increase patient satisfaction

• Improve patient room layout

TRACU GOALS

• Challenges

• Maximize room layout

• Floor-to-floor height

NORTH PATIENT TOWER: RENOVATED TRACU

Plan Organization

• 33 Bed Trauma Recovery & Acute

Care Unit

• Nursing core reconfigured to

support decentralized nursing

• Horizontally aligned to ICUs and

Family Waiting

To

Family

Waiting

To

West

Wing

ICU

To

Family

Waiting

FAMILY WAITING GOALS

• Design an environment that is

welcoming and inviting

• Create subdivided waiting to

provide privacy for families

• Provide active and quiet areas

within family amenity space

• Create better space by re-ducting

to accommodate low floor-to-floor

heights

• Baby Boomer building

EMANUEL CENTRAL: RENOVATED FAMILY WAITING

Plan Organization

• Shared Family Support Zone for all

Adult Services

• Family Lounge/Kitchen

• Family Resource

• Respite

• Consult/Conference

• Centralized location between ICU

& TRACU

• Rehab Gym supports TRACU

services

To

West

Wing

ICU

To North

Patient

Tower

TRACU

EMANUEL CENTRAL: FAMILY WAITING

Planning Principles

• Access to natural light

• Adaptive reuse of

existing/outdated inpatient

facilities

• Provide respite space for families

RENOVATED 3RD FLOOR

Plan Organization

• ICU & TRACU are now aligned

horizontally

• Shared Family Waiting & Support

Services between ICU and TRACU

WEST WING: EXISTING 2 ND FLOOR

Plan Organization

• Labor & Delivery to remain

operational during construction

• NICU to be relocated to Randall

Children’s Hospital

• Continue new mechanical shaft

construction and temporary supply

to active floors

Labor & Delivery

Neonatal ICU

WEST WING: RENOVATED 2 ND FLOOR

Plan Organization

• 12 beds

• Daylight into unit

• Decentralized care team stations

• Increased visibility of patient rooms

• Off stage utility and support space

• Direct access to trauma elevator

E M E R G E N C Y D E P A R T M E N T G O A L S

• Construction sequencing• Decrease door-to-provider time

• Improve patient satisfaction

• Improve patient safety

• Decrease the number of patients

who leave without being seen

• Decrease length of stay

• Increase volumes

WEST WING: EXISTING EMERGENCY DEPT. & ICU

Plan Organization

• Adult Emergency

Department

• Pediatric Emergency

Department

• Adult ICU ICUAdult ED

Pediatric

ED

WEST WING: EMERGENCY DEPARTMENT PHASING

Phase 1

• Completion of shaft terminations

• Electrical Room serving ED

• Program space renovations

• Use Pediatric ED spaces for swing

space during phased renovations

Phase 2

• Partial renovation of ICU & shaft

construction into basement

• Develop program spaces at

Behavioral Health

WEST WING: EMERGENCY DEPARTMENT PHASING

Phase 3

• Complete renovation of vacated

Pediatric ED

• Construct intake zone for Adult ED

• Develop lockers and future

shelled space for Hybrid OR

WEST WING: EMERGENCY DEPARTMENT PHASING

Phase 4

• ICU moves to second floor of the

West Wing

• Final phase of construction

WEST WING: EMERGENCY DEPARTMENT PHASING

Temporary Emergency Department

• Decant TRACU to the 3rd Floor of

the North Patient Tower

• Construct “tunnel” through existing

ED for gurney traffic

• Complete Adult ED renovation in

two phases:

o Phase 1: Clinical

o Phase 2: Public/Waiting

WEST WING: EMERGENCY DEPARTMENT PHASING

Plan Organization

• Direct access from ambulance

dock to Trauma bays and surgery

“corridor of life”

• Organized into care pods: Trauma,

ED, and Behavioral Health

• Staff support zones

• Immediate triage for walk-in

patients

• Results waiting area

WEST WING: RENOVATED EMERGENCY DEPT.

TEAM

LEGACY HEALTH SYSTEM

ZGF CATENA MAZZETTI STANTEC HOFFMAN

THANK YOU