University of California San Diego Medical Center
January 26, 2010
Role of Planner is Critical in Successful Hospital Seismic Mitigation
Seismically retrofitting a hospital in California—mandated by Senate Bill 1953 by 2013, or 2015 with extensions—is like a complex game of chess, say hospital facilities planners familiar with the process. The law covering the non-structural performance category (NPC-3) requires safe evacuation of patients who have less than the capacity of ambulatory people to protect themselves. It's one thing to close down an administrative office or waiting room, but seismic mitigation of critical care areas, including ORs, NICUs, and SICUs, requires careful scheduling.
That's where planners such as Janice Davis come in. When the UCSD Hillcrest Medical Center spent $15 million for non-structural seismic improvements in 2008-09, Davis worked closely with Essrig Taylor Construction (ETC) of San Diego, specialists in healthcare construction, to minimize disruption. “We had to ensure there was a consistent amount of work each day to keep the project moving forward without adversely impacting the operation of the hospital,” Davis said.
UC San Diego Medical Center is recognized among the nation's best in Respiratory Disorders, Cancer, Kidney Disorders, Psychiatry, Rheumatology, and Urology, in the 2009 - 2010 survey of “America's Best Hospitals,” published by U.S. News & World Report. It includes rankings of 174 medical centers nationwide in 16 specialties.
The UCSD project specified NPC-3 seismic retrofit of all ceilings, piping greater than 2-1/2-in. in diameter, and critical equipment. The work was performed in critical areas such as Central Sterile, ORs, Radiology, Laboratory, Pharmacy, Cath Lab, MRI and Central Supply.
Often this meant moving the construction team from room-to-room, completing one area before opening up another. “Seismic retrofitting is like a moving target, constantly rotating through occupied areas, yet mindful of the unique challenges of working around sensitive lab equipment, infection control areas, and critically ill patients,” UCSD's Janice Davis said.
“We couldn't set a definitive construction schedule because of the requirements of our clinicians. Shutting an entire unit was not an option and there was often very little swing space available, which meant work had to be conducted on a piecemeal basis.”
Davis conducted on-going evaluations of the job as it progressed, making last minute scheduling changes to accommodate often unforeseen medical crises, such as a critical bed shortage during a flu outbreak, or an influx of injuries due to nearby wildfires that required skipping entire units and revamping the schedule on short notice.
Davis implemented UCSD's 20/10 noise rules - loud construction for only 20 minutes, followed by 10 minutes of quiet work. At times, retrofit activities could not begin until after staff completed their rounds, and never before 10 a.m. in the cardiac intensive care unit.
“Working from a great set of construction documents is always important, but so is flexibility on the part of both the contractor and the inspector of record (IOR), who was retained by the hospital and certified by the California Office of Statewide Health Planning and Development (OSHPD).”
One of the lead inspectors on the project says, “I can't think of a more difficult work environment for a construction firm than a site that by its very definition needs to be both quiet and sterile. Work areas can never truly shut down. They need to go back on-line often with less than 24-hour notice, especially during community emergencies.”
It is generally agreed that for this kind of project, it's best to have a self-performing healthcare construction team with back-up plans in place to keep crews working and the job moving along when work areas suddenly become unavailable.
Davis adds that communicating the entire process with hospital staff is critical. “They need to know that the work has to be done and that it has to be done within state mandated deadlines. You constantly have to communicate the intention of the project, what you're doing and why, and how you plan to complete the project with a minimum of disruption.”
Davis continues, “Seismic mitigation is a dynamic, moving target, especially in a hospital environment which has to keep operating, where you must plan for the unexpected. But the end result is a safer hospital that will remain relatively unscathed in an earthquake.”
For more information: www.ucsd.edu
Rady Children’s Hospital San Diego
Nov. 10, 2009
Seismic retrofitting requires specialists who self-perform
Rady Children's Hospital San Diego Suggests Key Selection Criteria
Neonatal Intensive Care Units are among the most challenging construction sites imaginable. Newborns, often in critical condition, are hypersensitive to loud noise, vibration, light and dust, not to mention susceptibility to airborne viruses. Then there are family members, usually experiencing one of the most stressful periods of their lives.
How can a hospital comply with California Senate Bill 1953, which established seismic readiness standards for over 450 California hospitals, while still remaining operational? Pharmacies, labs, operating rooms all need to continue functioning regardless of construction.
Tim Jacoby, V.P. - Facilities Plant Operations, Construction and Planning of Rady Children's Hospital in San Diego, recently supervised a seismic rehab that involved a design/build of the Central Plant (NPC-4) and (NPC-3) seismic retrofit of all ceilings, piping greater than 2-1/2-in. in diameter, fire sprinklers, and anchoring of medical equipment. The work was performed in critical departments such as Central Sterile (Surgery), Radiology, Laboratory, Pharmacy, Cath Lab, MRI and Central Supply.
As the sole hospital in the San Diego area dedicated exclusively to pediatric healthcare, Rady Children's is the region's only designated pediatric trauma center and is one of the nation's most elite children's hospitals according to the 2009 U.S. News & World Report's America's Best Children's Hospitals.
The facility is on the leading edge of what is expected to be a wave of seismic upgrades as hospitals struggle to comply by the deadline. Seismic mitigation at Rady Children's is being conducted in the 261-bed main building as well as the Central Plant which will also provide utility services to the new 84-bed Patient Care Pavilion, which will become the largest children's hospital in the state when it opens in 2010.
Jacoby offers advice to other California hospitals about to face structural and non-structural (NPC-3 and NPC-4) rehab.
Seek Contractors that Self-Perform
Companies that self-perform are high on Jacoby's list. “We required a specially-trained workforce from a company that specializes in healthcare construction. NICU's and operating rooms are particularly difficult and sensitive areas in which to be securing waterlines, medical gas systems, and lab equipment and furniture.
The typical NPC-3 project involves one primary contractor subbing out the infection control, detailed fastening work, drywall, electrical and plumbing. “In the end,” Jacoby believes, “that's a lot of untrained people traipsing through the heart of a hospital.
“A carpenter may know how to drive nails in a casino or strip mall, but not necessarily how to drive nails in close proximity to premature infants. They need to be well-versed in hospital operation,” Jacoby advises.
Rady Children's turned to Essrig Taylor Construction (ETC), a California-based company, because of their specialty in hospital seismic mitigation, and ability to self-perform. Rather than subcontract the work, the company trains its construction crew specifically for the demanding hospital environment.
ETC has a rigorous training and testing program that grants Seismic Bracing Institute of America certification to its hospital construction workers. “They might know how to drill concrete, but that's only 30 percent of the job. The other 70 percent is how they conduct themselves,” said ETC president and CEO Michael Essrig.
“We tour critical care units in advance to impress upon our workers the uniquely sensitive nature of the project. We drill into them HIPAA Privacy regulations to ensure that patient information remains uncompromised. Our trainers instruct how to handle the accidental discharge of sprinklers, how to erect negative air infection control barriers, dampen sound, and especially how workers need to conduct themselves sensitively and with compassion for people who are often facing the most critical days of their lives.
Essrig continues, “Our employees are even told to imagine that a member of their own family is lying in the next room.
“Since we train them well and pay them well, we have the lowest turn-over in the hospital construction business.”
Do They Offer Design/Build Services?
Jacoby suggests that hospitals seek construction firms that also offer architectural design/build services and are experienced in seismic mitigation. “The preference is a one-stop-shop. Otherwise you set yourself up for disaster. There's too much interpretation between designers and contractors, thus leading to delays, expensive change orders, and cost overruns.”
Jacoby adds, “We needed a firm that could begin work on a critical area by 10 p.m., finish by 7 a.m., have it inspected by 9 a.m. and be up and running later the same day. This is usually beyond the capabilities of a run-of-the-mill construction firm, particularly one not involved in the design phase.”
Consider Experience in Seismic Mitigation
Consider the company's experience in seismic mitigation. Above ceiling environments in hospitals are a maze of piping, tubing, and conduit, and the mandated work applies to just a portion of what is found there. Jacoby is impressed with Essrig Taylor because of its thorough phasing, detailed pre-planning and precise execution.
Jacoby also praises ETC for its human touch. The company handed out music players and headphones to patients that might be affected by noise, and transported its Quake Cottage, the world's first mobile earthquake simulator, to the site to train hospital staff about earthquake safety.
“Clearly, there's no good time to disrupt your clinicians as you prepare structural and non-structural areas for an earthquake,” Jacoby says. “But the law dictates that the work has to be completed by 2013. By retaining the right firm and relying on specially trained workers, the job can get done quickly, within budget, and with a minimum of disruptions.”
For more information: Rady Children's Hospital - rchsd.org
