In 2013, RPA Design was engaged by Caromont Health to do strategic facility master planning for Caromont Regional Medical Center. The purpose of the study was to evaluate the capital improvement needs and operational impacts of staying on the campus versus relocating to a replacement campus. This study would then facilitate a financial analysis by Caromont Health to determine how long the existing campus is sustainable. The catalysts for the master planning were a mixture of operational challenges of the facility and political challenges of the existing land lease. On the operations side, small patient rooms, distance between departments, lack of throughput, and cost of conditioning the space make the building inefficient to continue using. On the political side, the existing land lease with the city has limited options for Caromont Health, as the needs of the hospital do not always correlate with the desires of the City Commissioners. The combination of these influenced Caromont Health leadership to explore the strategic options they have to sustain their healthcare operations in Gaston County. Simultaneous with the master plan study, RPA Design was also engaged to develop an Emergency Department expansion and renovation to alleviate the throughput challenges of the existing emergency department. Because this was both one of the operational challenges and a major circulation impact, RPA Design evaluated and presented the Emergency Department options in conjunction with the facility master plan.
The master planning was conducted in several phased studies, and this booklet is divided accordingly: Study 1: Existing Conditions Study 2: Existing Campus Opportunities Study 3: Offsite Expansion Study 4: Greenfield Replacement Campus Study 5: Existing Campus Redevelopment Study 6: Phased Growth The first two phases considered the challenges and opportunities afforded by the existing campus. Phase 3 considered an option that could offload volume from the main campus such that the campus could then be decompressed. Phase 4 developed an option for a new campus that would meet the operational and growth needs of Caromont Health to allow for comparison of initial capital investment and long-term operational costs. The last two phases provided a more in-depth look at how the existing campus could be improved for long-term use.
Study 1 : Existing Conditions
RPA Design evaluated the existing conditions of the existing campus from both operational and technical perspectives. To begin the operational assessment, RPA Design synthesized existing understanding of the facility with new discussions with Caromont Health leadership into a list of primary goals and key issues to be resolved. The most immediate needs were improving the Emergency Department throughput and expanding the ICU capacity. RPA Design reviewed circulation routes, noted relationships between departments, identified areas that had been recently renovated, and highlighted the locations of departments which would be most costly to replace. One of the key influencers of the campus redevelopment was the existing site circulation. The campus has a clear separation of public circulation from staff and service circulation. However, the route of the public circulation is very long On the technical side, RPA Design engaged the assistance of consultant engineers who had worked with us on the existing campus and were already
familiar with the building systems. Structurally, there is only one portion of the building designed for vertical expansion, and it would likely only support one additional floor under current codes. Mechanically, the existing patient tower is using substantially more energy that necessary due to a high fresh air ratio. It would be possible to replace the HVAC system to reduce this waste of energy and money, but that replacement would be very disruptive to operations.
“The existing bed tower was identified
to be one of the biggest liabilities of the existing campus. It is inefficient in nursing operations, limited in other potential uses, and wastes a substantial amount of energy costs.
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The existing patient rooms are greatly undersized. Caromont Health rooms are 169 square feet, while modern rooms are between 280 and 320 square feet. RPA Design provided a comparison between the existing rooms and the new rooms being designed by RPA Design for another health system
RPA Design did some preliminary studies to evaluate how the existing inpatient floors could be renovated to create right-sized patient rooms. The conclusion was the patient rooms would either be substantially oversized, leaving an inefficient 7 beds per wing, or the patient rooms would still have inadequate clearances due to room width or columns in the room. From discussions with the structural engineer, there is potential to expand the building footprint by infilling new structural slab between the existing toilet room protrusions. This would require replacing the exterior faรงade with a lighter material. Though this expansion would help, it did not resolve the space issues.
Study 2 : Existing Campus Opportunities
With challenges of the existing bed tower in mind, RPA Design began evaluating the campus for opportunities to create a new bed tower. Four zones were identified and evaluated. Zones 1 and 2 maintained the access routes for the campus but were more restricted in land available. Zones 3 and 4 require substantial changes to site circulation and parking because the public access to the hospital would be flipped to the opposite side. Many of the studies looked at using the existing bed tower for outpatient services rather than inpatient rooms. For these concepts, RPA Design considered making separate outpatient and inpatient entry points. Many concepts were created, but RPA Design narrowed them down to three potentially successful concepts.
Study 3 : Offsite Expansion
Along with studies for the main campus, RPA Design considered how other smaller hospitals could be used to offload volume from the main campus and allow the main campus to be decompressed. Since Caromont Health was in the process of developing a freestanding emergency department, RPA Design took that as a potential backbone for the small hospital. RPA Design proposed the small hospital to offload 60 beds from the existing campus. Two options were developed that considered how much land would need to be acquired, how site and primary internal circulation could work and how ideal department relationships could be established.
Study 4 : Greenfield Replacement Campus
One of the main goals of the strategic master planning effort was to evaluate the existing campus against the cost of constructing a new campus. Therefore, RPA Design developed a concept for using a 291 acre site near the existing campus that could replace the hospital, the skilled nursing facility, and all ambulatory care and medical office functions on a single, well organized campus. The master plan for this new campus accounted for current needs and for long-term growth.
Study 5 : Existing Campus Redevelopment
Though the replacement campus concept was well received, Caromont Health leadership preferred the option of staying on the existing campus due to the ability to slowly implement rather than creating a large initial capital investment. With this feedback, RPA Design developed four concepts for the existing campus redevelopment that identified how the departments could be reconstructed to enhance operational efficiency and provide new right-sized patient rooms.
Study 6 : Phased Growth
Caromont Health decided to continue on the existing campus with the goal of implementing the needed changes overtime. The first phase of this change is the Emergency Department addition and renovation that was already being designed. Caromont Health wanted to work around that project, leaving opportunity to create a new bed tower in the future. RPA Design identified an opportunity to construct new ICU beds above the Emergency Department addition. This future vertical expansion would be a potential second phase of campus redevelopment. The ICU would be composed of new construction and renovation of two wings of the existing bed tower on one or two levels. The vertical expansion also could have offices for Emergency Department administration. The next phase of the campus would be a larger addition to the Emergency Department and a parking deck to replace parking lost for the expansion. A final phase would be the construction of a new bed tower which also would result in a new entry. This study did not result in a final solution for the campus redevelopment but rather a general direction to be pursued. Further study will occur as needed to
support the Emergency Department renovations and other future discussions with Caromont Health.