legacy emanuel hospital -...
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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