Surgical Approach to Expanding a Hospital
Baystate Medical Center Surgical Operating and Interventional Suites | Springfield, MA
Strategically located on the second floor of the Mass Mutual wing, Baystate Medical Center centralized critical care services with the construction of the surgical operating rooms and interventional suites. This streamlined patient flow and decreased transport time from the Emergency Department, Intensive Care Unit and Heart & Vascular Center for procedures to improve the health and well-being of its patients.
Partners
Working Across
The Hospital
The 135,770-sq.-ft. of the second floor includes:
- 24 operating rooms, twice the size of the former rooms (four existing rooms renovated to match)
- 8 interventional procedure rooms including heart & vascular and neurology labs
- 80 surgical pre/post-anesthesia recovery units (PACU); 60 new units and 20 renovated
- Critical infrastructure including a chiller and new air handler unit (AHU)
- Staff support areas & faculty offices
- A new entry and lobby
ENR New England Best Health Care Project Award of
Merit
The Baystate Medical Center Surgical Operating and Interventional Suites was named an ENR New England's Best Health Care project Award of Merit recipient for 2023.
Prefabrication Moves
Construction Off-Site
Prefabrication opportunities minimized work onsite, expedited the schedule enabling work to run in parallel onsite and offsite, enhanced the quality of the construction, and ensured the program was designed with the future in mind. The team implemented the following prefabrication strategies:
- Interior walls with all of the medical gas piping and outlets; conduits and back boxes for electrical, fire alarm, nurse call, security, tel/data, and HVAC systems configured into each of the panels. The team was able to install 2 operating rooms and 10 PACU bays fully roughed in per day, far exceeding the months it would have taken onsite for a traditional stick built solution (shown below).
- Kit of parts flexible OR systems for 105 operating booms and eight interventional rooms that resulted in 50% reduction in cost and schedule.
- Medical gas zone valve boxes, located outside of the surgical operating rooms with seven lines feeding the boxes, which required 96 copper elbows. By modeling and determining the exact placement the piping teams were able to reduce the thickness of the wall allowing the rooms to be larger, while providing maintenance teams the ability to service the lines from the corridor.
The
Challenges
45 Areas Affected by Construction
With more than 45 areas across the hospital affected by construction, VDC was implemented to coordinate all the elements of the design, facilitate conversations across the trades, and plan for construction. Utilizing our field technology team, the floor was laser scanned to check existing MEP and architectural as-builts, which were incorporated into the model. The scans also provided valuable data on existing floor flatness. The medical equipment had extremely tight tolerances to ensure they would flow in unison. Floor grinding and leveling work was completed ahead of any trade mobilizing, thus allowing the most expeditious installation, and the most cost effective solution. This work took four weeks to complete, and because it was sequenced early, did not affect the schedule.
Limited Site Laydown & JiT Material Delivery
The second floor is only accessible through one window for construction materials coming in and going out. The window is 8-ft. wide x 8-ft. tall, and all materials will pass through it. A custom exterior elevator has been constructed to deliver material from the trucks to the construction site on the second floor. The site is constrained, with limited areas for laydown. Materials were delivered just-in-time for installation. Utilizing prefabricated components significantly reduced the volume of deliveries and material to site.
Weaving New Infrastructure Through Hospital
Significant infrastructure was installed throughout the hospital campus, connecting the critical services on the second floor with the equipment that will power and service the new spaces. The infrastructure was carefully fed through the floors above and below.
For example a dual height, dual tunnel air handling unit (AHU) was installed on the roof. The roof had a very small footprint available for the installation, and the maintenance team wanted maximum flexibility to service the unit and didn’t want the infrastructure to interfere with the future fit out of the fourth floor. In addition to coordinating with the adjacent departments, the team had to coordinate with the public and helicopter ambulance services, as they shut down parking lots and moved the crane around the site.
The
Challenges
45 Areas Affected by Construction
With more than 45 areas across the hospital affected by construction, VDC was implemented to coordinate all the elements of the design, facilitate conversations across the trades, and plan for construction. Utilizing our field technology team, the floor was laser scanned to check existing MEP and architectural as-builts, which were incorporated into the model. The scans also provided valuable data on existing floor flatness. The medical equipment had extremely tight tolerances to ensure they would flow in unison. Floor grinding and leveling work was completed ahead of any trade mobilizing, thus allowing the most expeditious installation, and the most cost effective solution. This work took four weeks to complete, and because it was sequenced early, did not affect the schedule.
Limited Site Laydown & JiT Material Delivery
The second floor is only accessible through one window for construction materials coming in and going out. The window is 8-ft. wide x 8-ft. tall, and all materials will pass through it. A custom exterior elevator has been constructed to deliver material from the trucks to the construction site on the second floor. The site is constrained, with limited areas for laydown. Materials were delivered just-in-time for installation. Utilizing prefabricated components significantly reduced the volume of deliveries and material to site.
Weaving New Infrastructure Through Hospital
Significant infrastructure was installed throughout the hospital campus, connecting the critical services on the second floor with the equipment that will power and service the new spaces. The infrastructure was carefully fed through the floors above and below.
For example a dual height, dual tunnel air handling unit (AHU) was installed on the roof. The roof had a very small footprint available for the installation, and the maintenance team wanted maximum flexibility to service the unit and didn’t want the infrastructure to interfere with the future fit out of the fourth floor. In addition to coordinating with the adjacent departments, the team had to coordinate with the public and helicopter ambulance services, as they shut down parking lots and moved the crane around the site.
The
Solutions
High Performing Team
The complexity of the project required an integrated team. The team advanced through design and preconstruction implementing Target Value Delivery (TVD) strategies; A3 decision making; and developed project requirements, target tracking systems, and risk mitigation techniques. Pull planning sessions were held to outline the design process, key state agency and required city approvals, and decision need-by-dates. This provided a road map that aligned them around their goal.
Space Simulations Minimize Construction Changes
DPR’s self-perform work teams built a full scale mock-up of the ORs, control rooms and PACUs. The mock-ups included wall framing, drywall, and ceiling grid, and finished with paint and physical electrical, low voltage, and med gas coverplates to understand their placement throughout the room, as well as full scale equipment. More than 40 users toured the space providing the design team with valuable information on the layout. The users touring the space were impressed by the level of detail and effort put into these pieces to make the experience as spatially real as possible.
“In-person activities like full-scale mock-ups allow hospital staff to get a real sense for how the final space will operate, providing us with invaluable insights during the design process,” says Ron Gorham, principal and healthcare practice leader in the Boston studio of Perkins&Will. “At the same time, we are always aiming to create a flexible and adaptable space that will meet Baystate’s future needs—our ultimate goal is to design a space that will support top-tier care now and for years to
come.”
Facilitating a Healthy Environment During Construction
The team created platforms to for the Hospital’s Engineering and Facilities Department and ISLM and ICRA teams to understand the phases of construction, and held weekly check-ins to discuss MEP shutdowns, changes to containment areas, review of existing MEP system or upcoming Life Safety Inspections.
There
were over 120 ICRAs at the project completion. Containments were fully sealed
floor to ceiling and negative air machines with HEPA filtration were installed
to ensure none of the air within the construction space was allowed into
patient airspace. A particle counter was used daily to take readings to ensure
the HEPA filter is filtering at 99% or better. A final deep clean was performed
ensuring that a sanitary space was returned to the hospital.
The
Solutions
High Performing Team
The complexity of the project required an integrated team. The team advanced through design and preconstruction implementing Target Value Delivery (TVD) strategies; A3 decision making; and developed project requirements, target tracking systems, and risk mitigation techniques. Pull planning sessions were held to outline the design process, key state agency and required city approvals, and decision need-by-dates. This provided a road map that aligned them around their goal.
Space Simulations Minimize Construction Changes
DPR’s self-perform work teams built a full scale mock-up of the ORs, control rooms and PACUs. The mock-ups included wall framing, drywall, and ceiling grid, and finished with paint and physical electrical, low voltage, and med gas coverplates to understand their placement throughout the room, as well as full scale equipment. More than 40 users toured the space providing the design team with valuable information on the layout. The users touring the space were impressed by the level of detail and effort put into these pieces to make the experience as spatially real as possible.
“In-person activities like full-scale mock-ups allow hospital staff to get a real sense for how the final space will operate, providing us with invaluable insights during the design process,” says Ron Gorham, principal and healthcare practice leader in the Boston studio of Perkins&Will. “At the same time, we are always aiming to create a flexible and adaptable space that will meet Baystate’s future needs—our ultimate goal is to design a space that will support top-tier care now and for years to
come.”
Facilitating a Healthy Environment During Construction
The team created platforms to for the Hospital’s Engineering and Facilities Department and ISLM and ICRA teams to understand the phases of construction, and held weekly check-ins to discuss MEP shutdowns, changes to containment areas, review of existing MEP system or upcoming Life Safety Inspections.
There
were over 120 ICRAs at the project completion. Containments were fully sealed
floor to ceiling and negative air machines with HEPA filtration were installed
to ensure none of the air within the construction space was allowed into
patient airspace. A particle counter was used daily to take readings to ensure
the HEPA filter is filtering at 99% or better. A final deep clean was performed
ensuring that a sanitary space was returned to the hospital.
The
Results
Representing the Community it Serves
With the community in mind, opportunities were created for both diverse trade partners and local workforce participation. DPR also employed local college co-operative students, and enrolled a high school student in its Build Up internship program. The team extensively participated in community outreach programs to educate the local youth about design, construction, and the project.
Consideration for Hospital Operations
As you look at the immaculate layout of the floor, it’s almost impossible to imagine the volume of conduit, piping and wiring running through the floors and ceilings. Teams spent months planning the layout, modeling the exact location of each piece of material and equipment, and figuring out how to connect it to the infrastructure that would support it with minimal interruption to the existing facility.
The project also entailed miscellaneous renovations across the existing space including a GE CT lab, ultrasound suite, locker rooms and staff lounge, lobby and greater area with elevators, green roof and wellness garden, and a connector bridge.
With 45 major areas of work across multiple buildings and multiple floors on the hospital campus. DPR met with hospital staff regularly to discuss the plan for work, access to areas, patient safety and provide clarity on the plan and movement of construction activities to ensure a continuously safe environment for healing.
Minimizing the Impact to the Patients
The project required meticulous planning and clear communication systems to ensure the safety of the patients. There were more than 40 phases of construction across nine different levels and three zones of the hospital. Noise, vibrations and disruptions to the healing of process was a key topic in the planning. For example, the ICU rooms above had a particular schedule for rounds, understanding when drilling would happen below was important or the Pediatric Procedure unit had certain hours their patients would arrive, the installation of MEP hangers were rescheduled to allow for a seamless check-in and prepping of patients.
Predictability in Project Costs
The final GMP came within 0.01% of the original estimate. We met the established GMP at completion, absorbing the cost of the one external change order, which was a programmatic change to add a new bridge connecting two bed towers together.
The
Results
Representing the Community it Serves
With the community in mind, opportunities were created for both diverse trade partners and local workforce participation. DPR also employed local college co-operative students, and enrolled a high school student in its Build Up internship program. The team extensively participated in community outreach programs to educate the local youth about design, construction, and the project.
Consideration for Hospital Operations
As you look at the immaculate layout of the floor, it’s almost impossible to imagine the volume of conduit, piping and wiring running through the floors and ceilings. Teams spent months planning the layout, modeling the exact location of each piece of material and equipment, and figuring out how to connect it to the infrastructure that would support it with minimal interruption to the existing facility.
The project also entailed miscellaneous renovations across the existing space including a GE CT lab, ultrasound suite, locker rooms and staff lounge, lobby and greater area with elevators, green roof and wellness garden, and a connector bridge.
With 45 major areas of work across multiple buildings and multiple floors on the hospital campus. DPR met with hospital staff regularly to discuss the plan for work, access to areas, patient safety and provide clarity on the plan and movement of construction activities to ensure a continuously safe environment for healing.
Minimizing the Impact to the Patients
The project required meticulous planning and clear communication systems to ensure the safety of the patients. There were more than 40 phases of construction across nine different levels and three zones of the hospital. Noise, vibrations and disruptions to the healing of process was a key topic in the planning. For example, the ICU rooms above had a particular schedule for rounds, understanding when drilling would happen below was important or the Pediatric Procedure unit had certain hours their patients would arrive, the installation of MEP hangers were rescheduled to allow for a seamless check-in and prepping of patients.
Predictability in Project Costs
The final GMP came within 0.01% of the original estimate. We met the established GMP at completion, absorbing the cost of the one external change order, which was a programmatic change to add a new bridge connecting two bed towers together.
The new surgical platform at BMC required some of the most sophisticated construction I have ever been involved with. The infrastructure required to support facilities and the logistics involved were very challenging. When DPR introduced us to the integrated team concept, target value delivery, and use of prefabrication, I had my doubts. But over the course of the project they collaborated with our team, listened to our medical staff, and delivered.
David Brown
Baystate Medical Center, Inc.
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