The new four-story heart center (at left) was built directly into the existing Beaumont Hospital in Royal Oak, MI.
After 26 months of construction, William Beaumont Hospital in Royal Oak, MI, now has a high-tech facility acknowledged as Michigan's first heart center. Having ranked 15th on U.S. News and World Report's list of top hospitals for cardiology, the hospital's new four-story heart center is home to one of the largest interventional programs in the United States.

While all are now smiling and pleased with the 118,170-sq-ft facility, hospital personnel were unaware of the many obstacles they would face during the project's construction. Of course, the architects and engineers involved can say the same.

The true difficulty in hospital renovation is not necessarily the lack of space for distribution or the identification of existing utilities. The real issue can be maintaining the necessary level of infrastructure support for patient care. In the example of Beaumont's heart center, working around a neonatal intensive care unit made normal issues even more complex.

Watch Out, Baby

The facility was created to centralize Beaumont's cardiovascular services, support, and personnel, in order to enhance services and amenities for the hospital's 10,000 annual cardiac admissions. The $43 million addition and renovation includes a spacious waiting space for patients, exam rooms, cardiac catheterization laboratories, educational facilities, physician offices, and support space. Since 60% of cardiac admissions enter the hospital through the emergency center, elevator access was designed to link the emergency center to the adjacent cath labs and operating rooms.

The complex relationship between the heart center and its support services, in addition to a lack of buildable space on the campus, determined the selection of the site. The result was the creation of a four-story addition adjoining the existing hospital on floors one through three, as well as connecting to existing cardiac areas on floors six and eight through an elevator tower. This blueprint also allowed for the renovation of existing space and the upgrade of outdated mechanical and electrical infrastructure.

The primary concern with the proposed site centered on the location of the hospital's neonatal intensive care unit (NICU). The air-handling system servicing the NICU was located in a third-floor mechanical room scheduled to be demolished, while the air-handling unit that would ultimately serve the area was proposed for a new mechanical room located on the fourth floor. Realizing the fragile infants housed within the unit could not tolerate the mildest disruption, the challenge lay in providing a continuous air supply to the space, while protecting the babies in the NICU from construction noise and disruption.

In examining options, it was initially proposed to build the addition around the existing mechanical room, delaying its demolition. However, construction of core elements, mainly elevator shafts, would inevitably be postponed until the new air-handling unit was installed and connected. Therefore, an alternate solution to provide a temporary air-handling unit servicing the NICU was determined.

Shown is one of the new state-of-the-art cardiac catheterization laboratories inside the $43-million addition and renovation at Beaumont Hospital. (Photo courtesy of Justin Maconochie, c/o Hedrich Blessing Michigan.)

Team Meeting

In order to establish a game plan, Beaumont's representatives, the construction management (Centex Aim Construction LLC, Livonia, MI), architects, and engineers (Harley Ellington Design, Southfield, MI) met to ascertain issues related to building around an existing mechanical room. The following points were identified:

  • Construction around an existing fan room would generate problems providing a clean, outdoor air source for ventilation.
  • Upon demolition, the changeover to the new air-handling unit would be difficult and time-consuming.
  • Delaying construction of the structural framing for the elevator core would delay overall completion.
  • The new elevator core included an eight-story stairwell necessary for exiting the existing building. While the exit routes were needed during construction, the elevator and stairwell were required prior to project completion.

The design team concluded that the issues, particularly the delayed completion of construction, were significant enough to disregard this option. Therefore, the application of temporary air-handling systems, with an emphasis on dependability and quick transition, was agreed upon.

On With The Changeover

Adjoining the NICU was a space containing a roof area over the third floor. It was decided that as construction proceeded, temporary air-handling units would be located on the rooftop, replacing the demolished system. Complicating the situation, however, was the realization that the existing unit serviced not only the NICU, but also adjacent administrative areas. While a single supply and return branch administered the NICU, multiple branches served the administration space. Consequently, the duct tie-in points and the need to minimize airflow disruption drove the implementation of two temporary units.

The systems were designed with chilled-water cooling coils and steam heating for optimal control and reliability, while including integral return fans, final filters, and humidifiers. The supply and return ductwork was run exposed on the roof, where it connected into existing ductwork immediately outside the NICU. Steam and chilled-water piping were connected to existing piping and extended up three floors to the temporary units. Outdoor air intakes were ducted across the third-floor roof and into the fourth floor to minimize the risk of ingesting construction dust or fumes.

To streamline the installation process, the temporary units were pre-purchased. Following delivery, they were hoisted into place, and the appropriate ductwork and piping were connected. Prior to linking to the current system, the units were checked, tested, and started. Existing balance readings determined the airflow and pressure within the ducts at the point of connection; the temporary unit was then checked for its ability to duplicate the conditions.

It was projected that the demolition and reconnection of the new ductwork for the NICU could occur within a four-hour period. In reality, the changeover was achieved in less than four hours, with airflows matched to readings previously recorded.

The third floor drew the most hvac attention in the creation of Beaumont Hospital's new heart center. Complicating matters was the hospital's A) neonatal intensive care unit (NICU), which was on the third floor of the existing building. However, the air-handling system servicing the NICU was located in B) a third-floor mechanical room, which had to be demolished due to C) the heart center coming into play. The mechanical room and the air-handling unit had to be moved to the fourth floor of the existing building. At the same time, proper ventilation had to be maintained in the NICU during construction of the heart center, which butts up to the existing building.

Summary

In the example of Beaumont's new heart center, working around a neonatal intensive care unit made normal issues even more complex. While ventilation, temperature control, and maintenance of medical gas supply were maintained throughout this project, other construction issues had to be faced and quickly resolved.

For instance, construction on-site was often shut down due to noise and fumes from heavy equipment. Consequently, prior to final building construction, the babies in the NICU were temporarily moved to the special care nurseries. This decision was made relative to concern arising from excess noise and vibration. Such conditions can be life threatening for a frail premature infant who may be hanging on to dear life.

In retrospect, the success of the Beaumont project was the cohesiveness of a team familiar with the intricacies of hospital work - work that sometimes embraces the delicate handling of fragile new life. ES