architectural feasibility report a. need for the...

JJCAMemorandum Date: 4/20/2012To: Alisa Coleman - TriggCc: David Johnson - JJCAFrom: Linda Mark - JJCAProject: Trigg County Hospital (04415.40) - Miscellaneous Work (02)Owner Project #:Subject: Preliminary Architectural Feasibility Report

ARCHITECTURAL FEASIBILITY REPORT

I. General

A. Need for the facility

HospitalBecause of sub-standard surgery suite, Trigg County Hospital has not been able to providesurgery services for an extended period of time. Patients from Cadiz and the surroundingarea must go to Hopkinsville, Paducah or Clarksville for routine surgical procedures becausethere are no facilities at Trigg County Hospital that do surgery. This situation presents a realhardship for patients and their families and based on evidence based research would impactrecovery times and health outcomes. Endoscopy is being provided at Trigg County Hospitalin the old Post Anesthesia Care Unit (PACU). This area is only marginally capable ofperforming these procedures. There are no private rooms to stage patients before theirprocedure and afterward during their recovery period. There are no areas or places for thepatient's family to wait during the procedure. Staff has been doing all they can to preserveprivacy and enhance the patient's experience, but against significant obstacles.

Outpatient Physical Therapy and Rural Health Clinic BuildingThis need addresses two concerns.

First, because of limited space and difficulty accessing the space, Trigg County Hospital hasnot been able to adequately serve the needs of outpatient physical therapy patients in thecommunity. With the addition of surgical capability planned in the new surgical addition,even more capability will be needed to allow patients to remain in the community for theseservices.

Currently:Inpatients and outpatients are seen in the same spaces, utilizing a portion of theoldest part of the hospital designed as medical surgical beds.The unit is smaller than patient volumes require.Outpatient parking is limited.Part of the space Physical Therapy has is being used for staging and recovery ofminor procedure and endoscopy patients.

Johnson Johnson CrabtreeArchitects P.C.

4551 Trousdale Dr.Nashville, TN 37204

tel 615-837-0656fax 615-837-0657

4/20/2012Preliminary Architectural Feasibility Report

Second, the Medical Arts Clinic is located to the West of the Hospital and contains 4 officesuites for physicians. This building includes space for Women’s Services, Primary Care orRural Health Clinic, Dr. Brazil and the West Kentucky Surgical Clinic. There is a corridor thatruns across the front of the suites that provides access to waiting areas and public toilets. Thehospital physician recruitment plan as adopted by the board shows a need for additionalphysicians. A study of existing buildings confirms that the most cost effective solution is torelocate the rural health clinic from the current Medical Arts Clinic to a new facility to allowfor continued growth and use the current space for expanded specialty physicians. This planalso allows the hospital to add cardiac rehab services to outpatient physical therapy programand economically provide physician coverage.

B. Existing facilities

HospitalThe existing surgery suite is in the 1952 portion of the hospital and does not meet code.Furthermore, it cannot not be renovated to meet current codes for any cost. The floor toceiling heights in this building are too low to create the 10'-0" clearances necessary to meettoday's standards for operating rooms. The existing operating room does not meet minimumsize (square foot area) nor does it meet minimum clearances (20'-0") from side to side. TheHVAC, electrical, medical gas and plumbing systems are all substandard and would need tobe completely replaced. In some instances, the building can be used if stripped down to thebare structure and rebuilt with some savings, but in this case not even the structure can beused. The only opportunity that Trigg County Hospital has to retain the surgical cases thatare now leaving the community is to build a new Surgery Suite adjacent to the existinghospital.

The medical staff at Trigg County Hospital has been very supportive of this idea of retainingtheir surgical cases in the community and believes that visiting specialists are willing to do atleast their non-complicated, outpatient cases at Trigg County Hospital in the future WHENthere is a modern surgical suite to do their cases in. This would include both surgical (sterilefield) and endoscopic procedures supported by a modern PACU and private staging/recoveryrooms. With a modern surgical facility, the hospital would also be able to recruit surgeons tothe facility.

Outpatient Physical Therapy and Rural Health Clinic Building


As identified in the hospital master plan, relocating the Outpatient Physical Therapydepartment out of the hospital is the key to freeing up space to begin some of therenovations that need to occur in the existing hospital. Physical therapy does not need to bein a hospital setting for outpatient services. Key planning unit analysis based on departmentvolumes, shows the need for more space than is currently provided and functional practicesupports the need for its own building with an entrance that has additional parking in closeproximity.

The existing Medical Arts Clinic space does not allow for future expansion and there is aneed for at least two additional providers. The limited parking near the Medical Arts Clinic isa challenge for patients coming to the existing facility. Expansion of the facility wouldreduce parking when the expansion would require even more parking.

C. Proposed facility

HospitalThe project proposes to construct a new Surgery Suite with PACU, Ambulatory Care, LockerRooms, Procedures Suite and Central Sterile Processing support areas. Where this attachesto the building, existing space would be renovated to provide a new Family Waiting area. Infuture phases, the vacated spaces would be renovated for specialty clinic and office space,providing visiting specialists with facilities to encourage them to see patients and do morework at Trigg County Hospital.

The operational and design concepts in the proposed facility have been proven to beextremely efficient! The Surgery Suite can be run with a minimum of staff covering both theinitial staging, surgery or endoscopy, recovery and discharge. All clean up and sterileprocessing can be done after the procedures are completed, within an 8 hour shift, andeverything can be ready for the next day's work. The flow of patients, staff, supplies,instruments and equipment are designed to get the work done in the shortest possible time,with the maximum efficiency. Turnover times between cases save time for surgeons andstaff. Visiting physicians could do one or more outpatient cases, spend some time in thespecialty clinic and then discharge their surgical patients before the end of the day. Overtime, more complicated, inpatient surgery could also be done, especially if the workloadincreases to the point where a general surgeon can be recruited for the area. In addition, thelayout provides for future expansion if needed with minimal work.


The financial impact would be significant in a facility that is not doing surgery today. Anoperating room doing just one case a day, operating 250 days per year, can generate as muchas $1.5 to $2.5 million in new revenue for a hospital. At these volumes, the anticipated returnon investment should be realized in less than 5 years.

Outpatient Physical Therapy and Rural Health Clinic BuildingThe project proposes to renovate an existing church building located within 250 yards of theexisting hospital and relocate the Outpatient Physical Therapy from the existing hospital andthe Rural Health Clinic from the Medical Arts Building. The renovated facility would includeOutpatient Physical Therapy, Treatment Rooms, Occupational Therapy, Exam Rooms forRural Health Clinic and support areas.

The close proximity to the hospital would allow the therapists to move between the hospitaland the new facility when needed for treatment of inpatient and swing patients needingtherapy services.

A Cardiac Rehab services would be started in this new space to support current patientpopulation needs.

D. Building sitesa. Amount of land required

i. HospitalA. The Surgery Suite addition would require approximately 0.2 acres on

the existing campus.ii. Outpatient Physical Therapy and Rural Health Clinic Building

A. The property for the Outpatient Physical Therapy and Rural HealthClinic is 2.47 +/- acres with an existing building to be renovated.

b. Locationi. Hospital

A. The Surgery Suite is phase one of the overall campus masterplan. It isattached to the existing hospital on the southwest corner to allow forfuture expansion of this department and continued redevelopment ofthe hospital clinical departments. It is adjacent to the medical surgicalpatient wing and the emergency department.

ii. Outpatient Physical Therapy and Rural Health Clinic Building


A. The existing building on site would be renovated with additionalpatient parking provided.

c. Site Plani. Hospital

A. See attached Exhibit A for the existing site plan and Exhibit B for theproposed site plan for the Hospital.

ii. Outpatient Physical Therapy and Rural Health Clinic BuildingA. See attached Exhibit C for the existing site plan and Exhibit D for the

proposed Outpatient Physical Therapy and Rural Health ClinicBuilding proposed site plan.

d. Site suitabilityi. Hospital

A. The Surgery Suite addition is located on the existing campus andconnects directly to the hospital so additional support services withinthe hospital can be utilized.

ii. Outpatient Physical Therapy and Rural Health Clinic BuildingA. The Outpatient Physical Therapy and Rural Health Clinic are located

in a free standing building on a large site that has flexibility for futureexpansion of the building.

E. Cost estimateDevelopment and construction - $3,519,000Land and rights – Not Required.Legal - $13,000Architect fees - $715,000Interest – Not includedMedical Equipment - $1,160,000Contingencies - $751,000Refinancing - $700,000Other (describe)Materials Testing - $17,000Telecommunications Systems - $125,000

F. Annual operating budget


a. Income with rate schedule – See attached Exhibit K.b. Operation and maintenance costs - See attached Exhibit K.

G. Maps, drawings, sketches, and photographsa. Maps – See attached Exhibit E for the property map.

i. HospitalA. See attached Exhibit F and G for the existing hospital plans.

ii. Outpatient Physical Therapy and Rural Health ClinicA. See attached Exhibit H for the existing outpatient building plans.

b. Drawings and sketches – preliminary design and layout elevationsi. Hospital

A. See attached Exhibit I for the proposed preliminary plan designlayout.

ii. Outpatient Physical Therapy and Rural Health ClinicA. See attached Exhibit J for the proposed design layout.

c. Photographs

Typical Operating Room


Typical Procedure Room

Typical Clean Core


Typical Clean Work

Typical Decontamination Room


Typical PACU

Typical Physical Therapy

H. Construction problemsHospital


The masterplan was specifically created to allow this project to be completed with minimalinterruption to existing hospital operations. It is located on an empty piece of grass area.While the generator will need to be relocated, this generator is at end of life and will need tobe upgraded to provide for the new surgery suite regardless. Construction traffic will notinterfere with existing operations with medical surgical beds on the opposite of the buildingand noise will have minimal impact as well.

Outpatient Physical Therapy and Rural Health Clinic BuildingLocating these services in a separate building will allow for the construction to becompleted without interrupting the existing facilities in the hospital.

I. Conclusions and recommendationsHospital

Trigg County Hospital has served the community for decades. To continue to serve this ruralarea, the hospital must upgrade surgical services. The proposed addition is a cleanstraightforward attention with minimal impact on ongoing services. As part of a masterplan,the location does not limit future growth of either surgery or any other clinical department.While a new addition was completed in 1999 for the medical surgical beds, front entrance,and emergency department; the balance of the buildings are over 50 years old and do not lendthemselves to major clinical departments. The masterplan calls for new construction forsurgery and radiology and then the conversion of the older buildings with complete upgradeof systems to support spaces such as clinics, lab, and other support departments. Some ofthe oldest portions would be removed because they are not economical to remodel. As aresult, the plan does not create excess or wasted space. It is our opinion that no other optionexist that is more cost effective or flexible for the future than what is proposed.

Outpatient Physical Therapy and Rural Health Clinic Building


Relocating the Outpatient Physical Therapy and Rural Health Clinic to a free standingbuilding will allow for future expansion of these services as well as the opportunity to start aCardiac Rehab program. The space these services currently occupy could be used in futurerenovations of the hospital to expand other services as outlined in the board approved masterplan.

Existing Site Sketch

Surgery Addition

A1.0

Upper Floor Plan

Johnson JohnsonCrabtree ArchitectsCJJ A 4551 Trousdale Drive

Nashville, TN 37204P.C. faxtel

615.837.0657

615.837.0656

PROJECT NUMBER

DATETrigg County HospitalCadiz, Kentucky

04415.40

September 2010

AMERICANHEALTH FACILITIESDEVELOPMENT

Exhibit A

DN

XXSTAIR 1217 SF

XXCLEAN UTILITY

75 SF

XXPROCEDURE

230 SF

XXSCOPE92 SF

XXS/R 1

108 SF

XXS/R 2109 SF

XXS/R 3113 SF

XXS/R 4149 SF

XXOR

421 SF

XXCLEAN UTILITY

191 SF

XXPACU

111 SF

XXPACU

148 SF

XXJAN

48 SF

XXSOILED78 SF

XXTLT.

42 SF

XXN/S

232 SF

XXTRASH42 SF

XXE

42 SF

XXCLEAN

275 SF

XXDECONTAM

202 SF

XXSTERILIZERS

81 SF

XXSTERILE STORES

396 SF

XXTLT.

62 SF

XXTLT.

57 SF

XXWAITING317 SF

XXTLT.

52 SF

XXCONSULT

56 SF

XXEQUIPMENT

211 SF

XXANEST.

128 SFXX

J.C.42 SF

XXLOUNGE156 SF

XXOFFICE84 SF

XXCONTROL

56 SF

XXCORR

440 SF

XXCORR

531 SF

XXCORR

988 SF

XXVEST

97 SF

XXCLEAN UTILITY

116 SF

XXVEST

317 SF

XXLOCKER168 SF

XXLOCKER177 SF

XXTLT.

47 SF

1

1.1

2

3

4

5

AA.1BC

6

Surgery

CSP

PACU

ACU

Procedure

Surgery Addition

Site Plan Sketch

Surgery Addition

A1.0

Upper Floor Plan



615.837.0657615.837.0656

PROJECT NUMBER


04415.40

September 2010


Exhibit B

Exhibit C

Exhibit D

Trigg County Hospital254 Main StreetCadiz KY 42211

Trigg County Hospital Medical Office Buildingand surrounding property line.Trigg County Hospital Medical Office Building250 Main StreetCadiz, KY 42211

Trigg County HospitalBehavioralHealth/HumanResources Offices252 Main StreetCadiz, KY 42211

Trigg County HospitalOutpatient Building214 Main StreetCadiz, KY 42211

Trigg County HospitalOutpatient Building lot

Exhibit E

OUTPAT. REHAB ENTRANCE

M.P.

A.S.U. OUTPAT.REHAB.

PHY. SPACE

H.I.M.

STAFF ENTRACE

X-RAY

PHARM.

BUSINESSOFFICE

CHAPEL

G.S.

MAINENTRANCE

RT OFFICE

CEO

ADMIN. ASSIST

LAB CNO

MED/SURG UNIT

I.T.

I.T.

MED/SURG UNIT

AMBULANCE

E.R.

PROJECT NUMBER

DATE

615.

837.

0656

615.

837.

0656

Nas

hvill

e, T

N 3

7204

4551

Tro

usda

le D

rive

fax

tel

Faci

lity

Stu

dy fo

r

P.C

.C

rab

tree

Arc

hit

ects

Joh

nso

n J

ohn

son

ACJJ

FIRST FLOOR PLAN

EXISTING

E1.01

FIRST FLOOR PLAN

EXISTING

04415.40

December 2007

MASTERPLAN DRAWINGS - NOT FOR CONSTRUCTION

Tri

gg C

oun

ty H

osp

ital

Cad

iz,

Ken

tuck

y

04415.40

December 2007


Tri

gg C

oun

ty H

osp

ital

Cad

iz,

Ken

tuck

y

This drawing shall not be reproduced, published, stored in an electronic retrieval system, or used in any way without written permission of the Architect. Copyright 2005 Johnson Johnson Crabtree Architects P. C.

PROJECT NUMBER

DATE

615.

837.

0656

615.

837.

0656

Nas

hvill

e, T

N 3

7204

4551

Tro

usda

le D

rive

fax

tel

Faci

lity

Stu

dy fo

r

P.C

.C

rab

tree

Arc

hit

ects

Joh

nso

n J

ohn

son

ACJJ

Exhibit F

FOOD SERVICES

STAFFFACILITIES

STAFFFACILITIES

FOOD SERVICEDELIVERY

EDUCATION

LOADINGDOCK

STAFFENTRANCE

MAT. MGMT.

PHY. PLANT

AREA WAY

MECHANICAL

ELECTRICAL

FLOOR ABOVE

FLOOR ABOVE

PROJECT NUMBER

DATE

615.

837.

0656

615.

837.

0656

Nas

hvill

e, T

N 3

7204

4551

Tro

usda

le D

rive

fax

tel

Faci

lity

Stu

dy fo

r

P.C

.C

rab

tree

Arc

hit

ects

Joh

nso

n J

ohn

son

ACJJ

BASEMENT FLOOR PLAN

EXISTING

EXISTING

E 1.02

BASEMENT FLOOR PLAN

04415.40

December 2007


Tri

gg C

oun

ty H

osp

ital

Cad

iz,

Ken

tuck

y

04415.40

December 2007


Tri

gg C

oun

ty H

osp

ital

Cad

iz,

Ken

tuck

y

This drawing shall not be reproduced, published, stored in an electronic retrieval system, or used in any way without written permission of the Architect. Copyright 2005 Johnson Johnson Crabtree Architects P. C.

PROJECT NUMBER

DATE

615.

837.

0656

615.

837.

0656

Nas

hvill

e, T

N 3

7204

4551

Tro

usda

le D

rive

fax

tel

Faci

lity

Stu

dy fo

r

P.C

.C

rab

tree

Arc

hit

ects

Joh

nso

n J

ohn

son

ACJJ

Exhibit G

DOWN

UP

UP

D1.1

Tri

gg C

ount

y H

ospi

tal

Cad

iz, K

entu

cky

GENERAL DEMOLITION NOTES:

WALL TYPE LEGEND:

DEMOLITION KEY NOTES:

LOWER FLOOR PLANMAIN FLOOR PLAN - DEMOLITION

03/05/2012

Exhibit H

DN

XXSTAIR 1217 SF

XXCLEAN UTILITY

75 SF

XXPROCEDURE

230 SF

XXSCOPE92 SF

XXS/R 1

108 SF

XXS/R 2109 SF

XXS/R 3113 SF

XXS/R 4149 SF

XXOR

421 SF

XXCLEAN UTILITY

191 SF

XXPACU

111 SF

XXPACU

148 SF

XXJAN

48 SF

XXSOILED78 SF

XXTLT.

42 SF

XXN/S

232 SF

XXTRASH42 SF

XXE

42 SF

XXCLEAN

275 SF

XXDECONTAM

202 SF

XXSTERILIZERS

81 SF

XXSTERILE STORES

396 SF

XXTLT.

62 SF

XXTLT.

57 SF

XXWAITING317 SF

XXTLT.

52 SF

XXCONSULT

56 SF

XXEQUIPMENT

211 SF

XXANEST.

128 SFXX

J.C.42 SF

XXLOUNGE156 SF

XXOFFICE84 SF

XXCONTROL

56 SF

XXCORR

440 SF

XXCORR

531 SF

XXCORR

988 SF

XXVEST

97 SF

XXCLEAN UTILITY

116 SF

XXVEST

317 SF

XXLOCKER168 SF

XXLOCKER177 SF

XXTLT.

47 SF

1

1.1

2

3

4

5

AA.1BC

6

Surgery

CSP

PACU

ACU

Procedure

Surgery Addition

Upper Floor Plan

Surgery Addition

A1.0

Upper Floor Plan



615.837.0657

615.837.0656

PROJECT NUMBER


04415.40

September 2010


Exhibit I

DOWN

UP

UP

DOOR SCHEDULE

GENERAL NOTES

A1.1

Tri

gg C

ount

y H

ospi

tal

Cad

iz, K

entu

cky

KEY NOTES:GENERAL NOTES:

LOWER FLOOR PLAN

MAIN FLOOR PLAN - NOTED

WALL LEGEND - RATED WALL LOCATIONSALTERNATE 1

03/05/2012

Exhibit J

See Assumptions and Notes to Forecasted Financial Information WORKING COPY – SUBJECT TO REVIEW AND CHANGE – INTERNAL USE ONLY 4

Trigg County Hospital, Inc. A Component Unit of Trigg County, Kentucky

Forecasted Statements of Revenues, Expenses and Changes in Net Assets

Years Ending April 30, 2013 through 2017

2013 2014 2015 2016 2017Operating Revenues

Net patient service revenue beforeprovision for uncollectible accounts 13,343,012$ 14,305,973$ 15,834,585$ 16,657,520$ 17,534,521$

Provision for uncollectible accounts (1,138,739) (1,251,709) (1,422,867) (1,552,088) (1,692,546) Net patient service revenue 12,204,273 13,054,264 14,411,718 15,105,432 15,841,975

Other revenue 143,073 151,420 165,784 174,263 183,163

Total operating revenues 12,347,346 13,205,684 14,577,502 15,279,695 16,025,138

Operating Expenses Salaries and wages 5,800,354 6,099,393 6,497,125 6,780,459 7,075,002 Employee benefits 1,321,393 1,403,790 1,510,785 1,593,156 1,679,811 Purchased services and professional fees 1,487,704 1,572,304 1,706,563 1,803,293 1,905,521 Supplies and other 534,237 564,623 612,797 647,541 684,228 Physician fees 1,007,820 1,065,116 1,156,043 1,221,521 1,290,918 Depreciation and amortization 470,225 665,409 958,994 995,267 1,024,834 Utilities, food, drugs and insurance 1,041,303 1,100,469 1,194,455 1,262,198 1,333,776 Other 1,153,159 1,218,819 1,322,894 1,397,914 1,477,264

Total operating expenses 12,816,195 13,689,923 14,959,656 15,701,349 16,471,354

Operating Loss (468,849) (484,239) (382,154) (421,654) (446,216)

Nonoperating Revenues (Expense)Noncapital appropriations - Trigg County 633,054 633,054 633,054 633,054 633,054 Investment return 4,264 4,267 4,813 5,642 7,108 Interest expense (93,591) (186,414) (326,197) (313,674) (304,639)

Total nonoperating revenues 543,727 450,907 311,670 325,022 335,523

Change in Net Assets 74,878 (33,332) (70,484) (96,632) (110,693)

Net Assets, Beginning of Year 1,802,596 1,877,474 1,844,142 1,773,658 1,677,026

Net Assets, End of Year 1,877,474$ 1,844,142$ 1,773,658$ 1,677,026$ 1,566,333$

Exhibit K

architectural feasibility report a. need for the...

Documents