January 6, 2016
By Bill Alexander, AIA, Vice President, HKS, Inc.

HKS recently worked with Emory Healthcare, engineering firm Newcomb & Boyd and program managers BDR Partners to complete an upgrade to Emory’s surgery department, which required surgical precision. 

Like many hospitals, the Emory facility has been expanded several times. The building includes sections built in five different decades, from the 1920s to 2005. To improve care and increase efficiency, the surgical department needed several upgrades.

I recently presented on this topic at the Healthcare Facilities Symposium and Expo with Arnold Barros, director of anesthesia services, Emory Healthcare; Lynda B. Herrig, PE, associate partner, Newcomb & Boyd; and Bradley Higdon, AIA, vice president, BDR Partners, LLC. 

Working within the substantial constraints of an aging infrastructure, the project team created new and larger operating rooms, including a biplane hybrid OR; added more pre-operative and post-anesthesia care (PACU) bays; co-located these services for better resource allocation; relocated endoscopy to the surgery floor, so that the hospital can more efficiently care for patients who receive anesthesia; infilled a portion of the roof and relocated a mechanical room on the surgery floor, to improve workflow in the redesigned space; and improved the department’s check-in and family waiting area. Throughout the project, which was completed on time and on budget, the department never stopped operating. 

The hospital’s existing ORs dated to the 1970s, with 13-foot floor-to-floor heights that matched those established for the original 1922 facility. The low floor-to- floor height limited the amount of space between the floor and the underside of the structure to just 11 feet, 6 inches. Given the OR’s 9-foot, 6-inch ceiling requirement, there was precious little above-ceiling space in which to install infrastructure components. Due to the space limitations, the project had to be designed so that ductwork never crossed — there simply wasn’t room. In addition, a former perimeter beam (the bottom of which was at 7 feet, 6 inches) had to be partially removed to provide space for ductwork and other systems.  Despite these constraints, the hospital’s HVAC system was upgraded to meet current codes and standards. Using fan-wall technology, it now also operates more efficiently. 

Shelled space above the existing Neuro ICU, a project HKS completed at the hospital in 2005, was critical in allowing the surgery upgrade to move forward. To solve internal circulation issues in the surgery department, the project team infilled the existing second-floor roof — a job that entailed evaluating and modifying the structure and relocating roof-mounted equipment — and relocated a mechanical room from  the surgery floor to a  new mechanical penthouse. This had the added advantage of streamlining new mechanical systems. 

An intricate, multiphase implementation plan ensured that, during construction, patient and staff safety was prioritized, that there was little or no impact to ongoing operations and that OR and pre-op/post-op capacity were not only maintained, but also increased. Impacts to other floors of the hospital were also carefully considered and coordinated. 

Highlights of the new, next-generation surgical platform include a 1,170-square-foot biplane OR that has additional control and teaching space. The new robot OR and neurology ORs are 750 square feet in size, with technology integrated into the hospital’s building systems. Three endoscopy rooms are sized at 400 square feet, and an ERCP room is 650 square feet (substantially larger than the old rooms) to accommodate Emory’s complex endoscopy cases. In addition, a new area was provided for  consolidation of scope cleaning and storage. 

The new pre-op area features private rooms, the PACU has new isolation rooms and both of these areas have increased capacity. Co-locating the pre-op and PACU areas has given the hospital greater flexibility in staffing the department. The check-in/family waiting area is now easier to find,and provides a more comfortable environment, with daylight views and a variety of seating options.

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