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HOSPITALS ARE REMODELING TO ACCOMODATE CHANGES IN TECHNOLOGY.

By Peter Downs

There is a hospital building boom in St. Louis, or more accurately a rebuilding boom ignited by age. Aged facilities need space and infrastructure to support new technologies, and an aging population needs more and more services.


McGrath & Associates was the general contractor for St. Louis Children’s Hospital’s Olson Family Garden.

Ten to 15 years ago, everyone was building up outpatient or ambulatory care facilities, as hospitals strove to cut beds and send more patients home after treatment. “Now, the cycle is coming back,” says John Reeve, president of Christner Inc., a St. Louis-based planning and design firm.

Thomas Rich agrees. “Des Peres, DePaul, Forest Park Hospital all gave pieces of their buildings over to other purposes when everyone was cutting beds, now patient censuses are going up and hospitals are looking for more space,” he says. Rich is vice president of McGrath & Associates, a St. Louis-based general contractor and design/build firm that focuses on the health care industry.

Not only do hospitals need more space, they need updating. “Many facility investments were made 20 to 40 years ago and are showing wear,” Reeve says. “We’re in a renewal cycle…We realize we have to reshape the hospital chassis to integrate information systems and new technology.”

From its base in St. Louis, Christner works with hospitals across the Midwest. “Our niche is planning on a strategic level to inform decisions on capital investments and facilities, to help health systems determine how to change to be more successful, competitive, and efficient,” Reeve says. Current clients include each of the three major nonprofit health systems in St. Louis: BJC, Mercy, and SSM; and hospitals in Chicago, Columbus, and Indianapolis.

Among the chief drawbacks of age are an inability to do things as swiftly or as easily as one’s younger counterparts. That’s as true for hospitals as people.


THOMAS RICH
vice president,
McGrath & Associates

Hospitals a generation ago were organized around technology just as much as a modern hospital is, but the technology was different. Imaging equipment, for example, was bulky, heavy, and expensive, and if they used computers they used a whole roomful. Diagnostic laboratories were large spaces packed with people straining to prepare samples by hand and analyze them by sight.

The size and expense of the technology was too large to be borne by one specialty. It needed support from many specialties and doctors. As a result, hospitals grew physically by adding and centralizing technical functions, such as imaging, that had application to a variety of physical ailments and conditions. For patients, that created a lot of traveling. Instead of going to a doctor for treatment, they went traipsing from one building to another, and back again.


"THERE IS A LOT OF NEW HOSPITAL CONSTRUCTION ON A 100-MILE RADIUS FROM ST. LOUIS, IN SPARTA, ILL.; SULLIVAN, MO.; AND CRAWFORD COUNTY, FOR EXAMPLE A LOT OF THOSE HOSPITALS WERE BUILT IN THE '50S AND '60S, SO THEY NEED MODERNIZATION OR REPLACEMENT."

Robert Zak
president, Zak Companies

The electronics revolution let manufacturers shrink machines and bring down prices, which in turn allows for the physical decentralization of the technology beneath modern medicine. That, Reeve says, means “we can organize types of treatment in ways patients recognize, for example heart services, so that a patient knows why he or she is going to the hospital. It is partly for marketing, but it is also to make care a more coherent service, and also to make it more convenient for the patient and the doctor.”


McGrath & Associates also completed work on Cardinal Glennon’s Children’s Hospital.

The Siteman Cancer Center at Barnes-Jewish Hospital and the new Cancer Center at St. John’s Mercy Medical Center are examples of organizing the hospital’s physical space around the treatment of disease instead of around technologies.

That patient-oriented approach to hospital organization is the key to the campus renewal plan for St. John’s Mercy Medical Center, which a hospital spokesperson estimates is worth $500 million.

Timothy Koenig, from Heideman Associates, explains that the campus renewal plan consists of five phases:

1) construction of the new 100,000-square-foot cancer center and an adjacent 1,700-space parking garage, which opened in September 2003;

2) construction of a new 62,000-square-foot women’s and infants’ center by adding two floors onto the top of the main patient tower, with the expected opening in August 2004;

3) construction of a 300,000-square-foot cardiac care center, which is currently in the design stages, and is scheduled for completion in July 2006;

4) construction of a new ambulatory surgery center in a 200,000-square-foot addition on top of the existing ambulatory diagnostic center; and

5) construction of a new 180,000-square-foot patient tower, with a new emergency room.

Heideman Associates is providing mechanical, electrical, plumbing, and civil engineering services for the renewal plan.


"WE'RE IN A RENEWAL CYCLE... WE REALIZE WE HAVE TO RESHAPE THE HOSPITAL CHASSIS TO INTEGRATE INFORMATION SYSTEMS AND NEW TECHNOLOGY."

John Reeve
president,
Christner Inc.

Even more challenging, from an engineering standpoint, is the effort to replace the infrastructure that supports the hospital. A new central utility plant will replace the separate utility areas for each building. There will be new sewers and parking, and a new loop road will encircle the campus.

While St. John’s is the biggest new hospital construction project in the metropolitan area, it is not the only one, says Robert Zak, president of the Zak Companies, the parent company of Heideman Associates. “There is a lot of new hospital construction on a 100-mile radius from St. Louis, in Sparta, Ill.; Sullivan, Mo.; and Crawford County, for example. A lot of those hospitals were built in the ’50s and ’60s, so they need modernization or replacement.”


TIMOTHY KOENIG
director/electrical,
Heideman Associates

So much construction is necessary, in part because, older hospitals are finding the very skeleton of their buildings precludes their ability to effectively take advantage of shrinking technology. As perverse as it may seem, their rooms are too small to take advantage of small technology. That is particularly true of operating rooms.

McGrath has been busy remodeling or building new operating rooms hospitals across the area, including Saint Louis University Hospital and Des Peres Hospital. The first change is to make the rooms bigger, Rich says. “As technology changes, there is a need for more equipment,” he says. “Now they are bringing imaging equipment into the operating room. For minimally invasive surgery, you need fiber optic cameras, microscopic tools, and a monitor for the doctor, so you need a bigger room....At SLU, they put a mobile MRI right into the operating room. It was the first one in St. Louis.”

BJC recently awarded a contract to manage the construction of 48 new operating rooms in the new South Tower at Barnes-Jewish Hospital. That is not to increase the hospital’s surgical capacity, but simply to “upgrade the platform to support technology,” says Reeve, whose company worked on the plan. As at SLU, upgrading the platform includes “putting imaging within the surgery to support less invasive surgery and robotic surgery.”


PAUL SHAUGHNESSY
president, BSI

At Barnes-Jewish Hospital, there is another reason for technology-driven construction: Washington University School of Medicine’s research agenda. BSI Constructors, for example, was awarded a $3.5 million job in July to expand the university’s genetic sequencing facility in only 120 days. “Washington University is in competition with a couple of other universities to be the research leader,” explains Paul Shaughnessy, BSI president.

Whether inside the university or out, David Volk Jr., vice president of Volk Construction, says new construction drives most of the health care jobs his company gets. However, there is more to a successful project than keeping up with technology, he says.

“This is kind of a specialized field,” he says, because of the number of things contractors have to control, and the unusual amount of coordination required with the owner. Contractors have to be able to control for infectious agents, dust, noise, and mold, he says, and they have to carefully plan and coordinate utility shutdowns and tie-ins, “because people’s lives are on the line.”

People’s lives are on the line, and St. Louis construction professionals keep that in mind every day as they competently handle the needs and challenges of health care design and construction.


Peter Downs is a St. Louis-based freelance writer.

 

 

 


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