A hospital vertical expansion is challenging but is often the best (or only) option
A vertical expansion to an operating hospital is among the most complex types of healthcare construction, but with expert planning and management, your hospital can remain fully operational and maintain systems integrity. Layton follows sophisticated procedures, based on extensive experience, to meet the challenges of hospital vertical expansions. Some of those challenges include:
Daily and sometimes hourly communication with the hospital staff is essential to a successful vertical expansion. Noise, vibration, utility shutdowns, partial elevator shutdowns, parking, wayfinding, crane paths, temporary walkways, etc., all need to be coordinated on an ongoing basis. With constant communication, disruptions to patients, staff and visitors are mitigated.
"A vertical expansion is not like building a regular ground-up building," says Layton Senior Superintendent Marty Moore. "They are very challenging projects. Everything we do has to be focused on the operating facility. Communication is the number one thing. If you put the right effort into pre-planning and constant communication, then things go smoothly.
Why Expand Vertically?
Even though a hospital vertical expansion is highly complex, the net costs are usually lower than building on new ground, especially in urban and university settings, where land is at a premium.
Consolidation of Services
Vertical expansions improve efficiencies by allowing the same or related services to continue operations next to each other. This is convenient for all parties.
No Other Option
Sometimes there is nowhere else to go but up.
Recent Hospital Vertical Expansions
Patient Tower Expansion | Las Vegas, NV
2-Story plus Mechanical Penthouse
80,000 SF Expansion
Summerville Medical Center
Patient Tower Expansion | Summerville, SC
2-Story 48,000 SF Expansion
ICU Expansion | Reston, VA
2-Story 60,000 SF Expansion
Methodist Stone Oak Hospital
Patient Tower Expansion | San Antonio, TX
3-Story 84,000 SF Expansion
Grand Strand Regional Medical Center
Patient Tower Expansion | Myrtle Beach, SC
2-Story plus Mechanical Penthouse
50,000 SF Vertical Expansion
Los Robles Hospital & Medical Center
4th Floor Expansion | Thousand Oaks, CA
1-Story 38,000 SF Expansion
Woodland Heights Medical Center
OB Expansion | Lufkin, TX
1-Story 7,000 SF Expansion
Rocky Mountain Hospital for Children
NICU Expansion | Denver, CO
2-Story 77,000 SF Expansion
Mountain View Hospital
Campus Expansion | Idaho Falls, ID
1-Story 12,000 SF Expansion
College Station Medical Center
Campus Expansion | College Station, TX
1-Story 30,000 SF Expansion
Weatherford Regional Medical Center
Campus Expansion | Weatherford, TX
2-Story 46,000 SF Expansion
Banner Good Samaritan Medical Center
Women’s Center Expansion | Phoenix, AZ
2-Story 40,000 SF Expansion
University of Utah Hospital
Eccles Critical Care Pavilion | SLC, UT
2-Story 6,000 SF Vertical Expansion
2-Story Parking Structure Vertical Expansion
"The worst thing we could do to a facility is impact operations without them knowing about it ahead of time. As the job is progressing, I like to take the directors and nurses on a tour so they understand what we're doing beyond what we can convey in a simple conversation."
Your foundation and support columns may need to be strengthened prior to beginning a hospital vertical expansion. The enhanced structure is needed to support the weight of additional floors and increased wind load. In many cases, the new floors in a hospital vertical expansion are built of lighter, stronger materials than the floors below them. If engineered and built right, your building will be structurally stronger after expansion than before it.
Your existing roof is going to become the floor on the next level of your expansion. That means parts of the roof will need to be removed. We use systems that keep the floors below the roof sealed against weather, dust and debris as we expand. We may also temporarily relocate utilities, such as your air handling system, so that they can continue to function throughout construction.
"In terms of foundation work, many healthcare organizations have been building new buildings with vertical expansion in mind," says Moore. "But even with that kind of forethought, you still need to go through the as-built drawings and talk with the existing structural engineer. Questions will arise as you build and codes change."
"For instance, a building code changed a few years ago for the way insulation is wrapped around a building. The new code requires additional insulation which would add two inches to the exterior and you wouldn’t be able to keep the same plane going vertical. So you have to slide your interior walls in a few inches. You need to make sure the architect is aware so that the space meets code – for example an ICU may have specific square foot requirements for a room."
Mechanical, Electrical and Plumbing Systems
In a vertical expansion, you’re going to be adding levels to elevators in a vertical expansion and extending existing plumbing, electrical and HVAC systems. When it comes to tying into existing utility systems, we have learned to expect the unexpected. Although Building Information Modeling (BIM) has increased the accuracy of as-built models, there may still be conflicts when tying in. When there are conflicts, we use BIM to help create solutions to conflicts on the fly. Or we may perform a 3D scan of the top floor before construction if as-built plans are non-existent or incomplete. On a related note, your central plant may also need an upgrade to handle the increased capacity. One potential benefit of a vertical expansion is the opportunity to improve energy efficiency through upgraded materials and systems, including the building envelope.
"BIM is wonderful even on new construction, but on hospital vertical expansions, BIM is absolutely critical," says Moore. "It’s very common in hospital vertical expansions to be tying into adjacent buildings. For example, in one expansion there were some buildings we were tying into that were built in the early 1900s and contained quite a bit of asbestos. The abatement crew came in, we did the demo, they came back and we got the building stripped down to a structural element. Then we had a company do a 3D scan of the building, because the old buildings didn’t have the space above the ceilings for ductwork and utilities. Back in those days they used windows for air conditioners and radiators on the wall for heating. They didn’t need that space above the ceiling. So that allowed us to be successful with the ductwork and fabricate it for the existing space so the work didn’t need to be redone. Even though the scans cost $15,000-20,000, the cost and time savings were huge."
Noise and Vibration Problems
By nature, hospitals are full of sensitive populations and equipment that can be negatively affected by noise. We can’t eliminate all noise and vibration, but we deploy noise and vibration dampening and isolation systems to mitigate their impacts. We have built directly above and next to NICUs and PICUs without disturbing patients, staff or equipment.
"Work hours are another major consideration. You will likely have patients below or beside the facility you’re expanding, and the facility may not permit you to work before 8 a.m. or after 5 p.m. because they don’t want to impact the patients," says Moore. "This can be a change in thinking when you’re used to working a crew from 6 a.m. to 7 p.m. But if you set expectations and communicate up front, then even the occasional unavoidable noise impact is less troublesome because everyone knows what to expect."
As opposed to a greenfield site, vertical expansions inevitably mean limited laydown. This necessitates just-in-time delivery of materials and pinpoint scheduling.
"Laydown is always something that needs to be discussed far in advance of mobilization on the site," says Moore. "Once you’ve been awarded the job, the first thing you need to discuss with the facility is, 'Where do you have some space?' They may not have any space, and you need to plan for that during buyout with your subcontractors. You need to let them know in advance that there is no laydown and that all work will involve just-in-time deliveries. They need to know that when they’re bidding because it can be costly to them (and you) if they didn’t plan for that."
"Some sites can get really tight. Layton has had to put tower cranes in close proximity to other buildings and even next to an ambulance stop. Engineers may need to design a different crane foundation than is typical because of the crane placement. Another consideration with tower cranes is helicopters. Most facilities have helicopter ports on the roofs of existing structures, and you need to coordinate flight paths and even the type of lights to put on the crane to avoid conflicts. We always go above and beyond even FAA requirements to make sure the air med companies and their pilots are happy with our approach."
"In Denver, we were building over the NICU and PICU and close to the bone marrow lab, so everything we were working around was super critical," says Moore. "When you’re working around a NICU or PICU and those premature babies, you can’t slam steel together, you can’t slam decking down. Everything has to be really quiet. Even a loud pop can make those babies jolt, and that can hurt them.
"The hospital had three infection control nurses, and we met with those ladies every single day. I would sometimes get dressed out in the proper infection control gear and have a director or doctor take me through and take a picture of a premature baby in a bassinet and then show it to my crews. Construction workers may be the toughest, wooliest people in the world, but they've got the biggest hearts. Once you show them a picture, they all relate to it. Either they had a kid or niece or nephew, or someone they know had a premature kid. Once you get their buy-in, they’ll jump through hoops to keep from making any noise that could upset those babies.
"During our kickoff meeting in a boardroom above Presbyterian St. Luke’s. I said, ‘I give you my word as an honorable gentleman, that I’m going to protect your kids.' A year and a half later at the ribbon cutting, the CEO approached me and said, ‘I’m on the outside looking in, but I’ll never forget what you told us. I just want to shake your hand and say, thank you for keeping your word.' "
Protecting Vulnerable Patients at RMHC in Denver
Layton Construction completed a major expansion of the Rocky Mountain Hospital for Children located on the Presbyterian/St. Luke’s Medical Center campus in downtown Denver. The project included a two-story vertical expansion of an existing patient tower as well as multiple renovations throughout the hospital to expand the children’s services. Work was done throughout three buildings, which included patient rooms, offices, family spaces, pre- and post-natal delivery areas, as well as the NICU and PICUs.
The multi-phased expansion included:
- 40,519 SF (vertical addition)
- 36,895 SF (renovation)
- Tight urban site with limited staging
- Hospital remained open through construction
- Extensive MEP system upgrades
- Limited floor-heights
- Extensive ICRA & ILSM
Layton’s experienced healthcare professionals coordinated with hospital staff to ensure zero disruptions to the sensitive patient population on this complex construction project. This was especially important when working next to the neonatal intensive care unit (NICU) where premature infants could be severely impacted by lights, noise and vibration.
To keep patient disturbance to a minimum, Layton constructed sound isolation barriers, implemented low impact drilling and demolition methodologies and maintained diligent communication with all tradesmen. “I promised the owners that our team would keep the (premature) babies safe and create as little impact to the facility as possible; thanks to thorough pre-planning and a special Layton team, my promise was kept,” said Marty Moore, senior superintendent on the project.
“This was a very difficult project, complicated by working in an existing structure which was fully occupied by patients and staff,” said Mimi Roberson, President and CEO at Presbyterian/St. Luke’s Medical Center and Rocky Mountain Hospital for Children.
“Layton demonstrated constant awareness and respect for safety and protection. They kept all of us engaged and informed throughout the process. They were true partners in every sense of the word. To top everything off, the project was actually completed prior to the expected date - a rarity in the world of construction.”
Because this project was a vertical expansion over existing critical patient areas, Layton used advanced techniques to protect those areas. With the top of the building exposed, extensive waterproofing was done daily to prevent water from entering the hospital’s interior. When welding new steel onto the structure, Layton built protective shields to keep sparks from entering into the building.
Also, while erecting new steel, Layton coordinated with hospital staff to ensure that no one was ever underneath active work. Communication and scheduling was key to coordinating the movement of patients and other operations during active construction times.