Case Study: Tackling Overbuild Options and Obstacles A Deeper Look Array, in collaboration with a Midatlantic healthcare institution for four decades, is called on to study the overbuild options of a patient tower completed in 2003.
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EXISTING STAIR ROOF SLAB/PROPOSED ROOF 129' - 0"
SECOND FLOOR 113' - 8"
15' - 4"
FIRST FLOOR 98' - 4"
LOBBY LEVEL 83' - 0"
Preliminary Conceptual Elevation for Pricing
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EXTERIOR ELEVATION WEST 3/32" = 1'-0"
Targeted Service Line Expansion PATIENT TOWER OVERBUILD
PROJECT UNDERSTANDING
CHALLENGE
As advancements in orthopedics grow - treatment, surgery and recovery-wise - medical cam-
Within a campus footprint with no expansion opportunities, any extra space needs to be vertical.
SOLUTION
puses are enhancing their services to keep pace with demand. When a campus has nowhere to go but ‘up,’ overbuilds become creative and necessary options to consider. When Array designed the two-story emergency department / patient pavilion in 2001, the structure was designed to vertically expand a total of three stories. FEASIBILITY STUDY Array completed their Feasibility Study in 2018 and embarked on Implementation in early 2020. The physical structure as well as the engineering infrastructure is still viable for an
This $53M two-story overbuild will serve to expand an important and currently underserved service line.
overbuild, and a two-story option was deemed most valuable from a cost and timing standpoint. A volumes study determined a 100-bed addition would serve the facility well into the future and allow for additional service line expansion beyond the present effort. OVERBUILD IMPLEMENTATION The Medical Center prioritized an acute adult rehabilitation unit as the first to go into the overbuild space. This Unit will provide inpatient recovery space to support the increase in orthopedic surgical volumes.
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PROG
ADJACENCIES, FLOW AND ACCESS An important challenge the team had to overcome was the inconvenient access to the surgery suites located on the third floor of the adjacent main building. The differences in building and floor heights would require steep ramp and elevators, making transport from post-op to recovery floor tenuous. The team has envisioned a solution: using a new elevator and connector at level to surgery floor. This will make patient transport safe and provide the quickest route.
EVIDENCE-BASED DESIGN GOALS MAPPING THE IDEAL PATIENT UNIT The initial 13-week design phase was envisioned as laying the groundwork for designing a specialty patient unit that would thoughtfully take into consideration feedback from end users, value streams and the project’s steering committee. Over several workshops, the conceptual design for 35 orthopedic and 10 observation beds was conceived and approved utilizing Visual Programming. MOCK-UP OPPORTUNITIES In order to fully validate the program, the design team, in collaboration with the client, advocated for building a full-size progressive patient room mock-up, with several mock-up simulation sessions focused on different agendas. The first session’s agenda was to validate location of walls, doors and bed, with subsequent mockup sessions aiming to focus on the next layers of detail such as wall-mounted elements, then millwork finish and room lighting. We documented all specifics, such as the inherent nature of some inpatient spaces like orthopedic rooms which need to be larger than a typical med-surg room to accommodate the myriad of patient mobility equipment and frequent movement to and from physical therapy.
• Improve patient mobility and reduce falls: • Clearly define Patient | Family | Caregiver zones • Bathroom door visible from patient bed • Large bathroom door openings to accommodate patient, caregiver and equipment
• No equipment/obstructions in the path from bed to bathroom • Staff | Patient Layout : • Recessed corridor charting stations providing increased visibility to the patient headwall while minimizing perceived visual exposure from the corridor
• Patient room entry door has integrated horizontal blinds allowing maximum visibility for provider while doors are closed, while allowing for flexibility to become a solid lite when needed.
• Direct and short visual line of sight to patient from corridor/ decentralized nursing station (ability to see patient head)
• Space accommodation for patient handling/movement • Patient | Family: • Bed location/orientation to move patient head away from the door (without compromising patient visibility of staff)
• Family space/desk area positioned in staff line of sight • Family sleeper sofa with integrated worktop positioned at the exterior window
• Access to family areas outside of patient room, but in close proximity to patient room
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Elevation Exercises
Array’s planning and design team looked at the building from each elevation to assess any infrastructure and utility challenges as well as determine if any patient views would be obstructed. By detailing the potential exterior designs available for the overbuild, the team was able to investigate what materials would best serve the addition from aesthetic and sustainable perspectives. A panelized solution was conceived and tested, and will make a positive impact on the site constraints of this land-locked campus. As the team studied the multiple building geometries at play on campus in conjunction with the disparate renovation efforts throughout such a developed medical center and the need to relocate the helipad, they carefully evaluated how the structural integrity and interior functionality will be impacted and to what extent construction will require temporary, yet possibly stressful phasing of entrance and egress on the circulation roads and throughout the buildings. Connectivity is also an important facet of the team’s design exploration. Travel path studies of both patients and staff were conducted to ensure the proper adjacencies were maintained or incorporated.
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Who We Are
NATURAL LIGHT FOR HEALING
ARRAY-ARCHITECTS.COM
A center courtyard is optimally utilized to allow natural light to flood the units. By designing the Rehab Studio adjacent to the large windows overlooking the courtyard, patients and staff alike can take advantage of the sunlit space during daily physical and occupational therapy sessions. Two nurse stations per Unit also overlook the courtyard, giving staff working long hours both an opportunity for borrowed light to naturally brighten their space, but also help align their circadian rhythms by having a sense of dusk and dawn during overnight shifts.
We Are Healthcare Architects We are a team of architects and designers with unique backgrounds, but we all have one thing in common - we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most. This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a team center with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development. It is a deeper understanding, honed through relationships spanning decades. Together, we discover optimal solutions with our clients. It is our four decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.
COVID-19 COVID-19 mitigation measures have provided the Array team the opportunity to evaluate the buildings’ mechanical systems for optimal flexibility in patient surge situations, especially where considerations of negative-pressure air flow is concerned. Ever mindful of adverse cost overruns, the team is looking toward micro changes to the current design that will have the largest impacts and provide for MEP infrastructure that effectively supports the facility’s needs.
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Array’s Knowledge Communities We believe strongly in sharing our expertise and knowledge with others. We invite you to explore each of our thought leaders and share your thoughts with the healthcare design community. Click here to visit our Thoughts page.
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to view our thought leadership on overbuilds
Published: August 2020
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