The Tufts University School of Dental Medicine expansion requires the relocation of eight cooling towers.

The “Health Belt” that stretches from New England down through New York and Pennsylvania, across the Midwest and down through most of the South is home to some of the world’s most respected healthcare facilities. Across the belt, hospital services are growing to meet the needs of clients. Urban campuses within these regions offer the opportunity for cross-pollination of research with other institutions, access to the next generation of medical practitioners in cities rich with colleges and universities, and the amassing of some of the greatest talent in medical practice in one confined city. With medical research and care forever advancing, the landscape of the urban hospital campus is dynamic and continues to change and expand with the needs of the population.

What’s an urban healthcare facility to do when its leading-edge treatment of patients and vitality of advancing medical research are compromised by a lack of usable space? This is a question that many metropolitan hospitals and healthcare facilities face at one time or another, and a new trend in healthcare construction has emerged: vertical expansion.

Urban settings have left facilities such as Tufts University School of Dental Medicine (TUSDM), Rhode Island Hospital, Children’s Hospital Boston and The Children’s Hospital of Philadelphia without any recourse other than to add floors on to their existing buildings to accommodate staff and patient needs. However, building vertically opens up a wealth of additional complexities that must be flawlessly managed with minimal disturbance to occupants. The complexities of working in such a sensitive environment and potential for such catastrophes as power loss, excessive noise and sanitation issues put the lives of patients at risk and require an exceptional level of expertise on the part of the construction manager.

Nowhere to Go But Up
With literally no available land in bustling city confines, and the need for increased patient capacity and services, urban hospitals are hard pressed to find innovative ways to maximize their available space. To keep the heart of their services and research vibrant, relocating a division of the hospital usually isn’t an attractive option. It divides the institution’s community, not only by geography and function, but by relevance and perceived priority.

An example of the complex nature of vertical expansions is TUSDM, a five-story addition currently under construction on top of an existing 10-story building in the heart of Boston. With buildings surrounding the school, minimal space for unloading or storing materials, and tight building access (the building offers one loading dock shared by the adjacent Tufts Medical Center and the School) the construction team is locating the project’s hammerhead crane to the top of the existing building. This will prevent shutting down the highly trafficked surrounding streets and consume the minimal free space available.

The crane will sit on the roof while the additional five floors are erected around it, and toward the final stages of the project, they will utilize another crane to remove it in pieces. Access to the roof for delivery of materials and staff is mitigated with a man and materials hoist supported by a steel and concrete pad on the street over the subway tunnel, which is just 18 inches below the ground’s surface.

An overarching trait emerges for the planners, administrators and construction managers when considering the intricacies of a hospital expansion: flexibility. Flexibility helps drive client satisfaction, positive clinical outcomes, an efficient work environment and financial expenditures. 

Considering Patient Care
Disruptions are a given in any construction project, and so phasing the work and finding creative ways with administrators to lessen the inconvenience are necessary. At TUSDM, clinic hours will be staggered as elevators are under construction. Two elevators will be up and running, while two will be out of service for up to six months. By staggering the elevator work, a bottleneck will be avoided during busy clinical hours.

Infection is a primary concern for staff and administrators, and, the potential for foreign pollutants to enter the sensitive environment is a critical issue that construction management teams must appropriately address. Implementing negative-pressure rooms equipped with a High Efficiency Particulate Air filter to extract particulate matter from the occupied area is crucial. Dust and debris are prevalent during construction and if not handled appropriately can cause serious health issues for patients inside the building.

Another concern lies in working on a roof while maintaining the integrity of the membrane as a barrier to the weather. Water infiltration is dangerous in a healthcare facility, where unattended moisture quickly becomes life-threatening mold. There is also the potential disruption to operations and revenue if a patient room or procedure room is compromised or put out of use for a period of time. Prevention is much more cost-effective and risk adverse than responding after the fact.

When thinking about patient care during construction, one of the most crucial components to consider in an occupied healthcare facility is mechanical, electrical and plumbing (M/E/P) integration. When working in 24/7 facilities, uninterrupted power is an absolute non-negotiable component of the process when sensitive research and medical procedures are taking place within the building. 

At TUSDM, eight cooling towers on the roof of the existing 10-story building need to be moved to the adjacent roof of the Proger Building at Tufts Medical Center. To achieve this, the project team has scheduled the work during times when the impact to patients and staff inside will be the least disruptive: overnight and during the winter months.

The towers are being moved in the course of three weekends – first two at a time and then on a third evening when the last three will be transported. This transfer of 7,000 tons is a definite challenge, but opens up space on the school for the hammerhead crane, which will sit on the roof for the duration of the project. The cooling towers, once relocated to the platform on the Proger Building, will be tied into the system of that building and restarted. The shutdowns have minimal impact on the occupants of the building – the largest impact being felt in the pharmacy and operating rooms – because the team has scheduled the work during the cold weather months when only two of the eight towers are being used  and working during off-hours, completing the work by 7 a.m. the following day.

Community Awareness
Proactive planning and community forums to communicate the impact a vertical expansion will have on the facility and its occupants are paramount. Community forums and steering committee meetings are a great means of communication between the project teams, administrators and building occupants. Creating a project Web site can assist hospital and construction staff in keeping the building’s occupants aware of what is happening. A regularly updated Web site where all of the community members can receive progress reports, find out when shutdowns will occur and get answers to questions is a very effective means of handling community concerns. Contributing to the facility’s newsletter is another medium that reaches a mass of relevant people.

The Sky’s the Limit
Thanks to the foresight of past healthcare administrators who laid the groundwork for this generation of healthcare leadership by designing hospitals to withstand vertical expansions, the skyline of the healthcare industry is growing. Patient care and service is the heart of the healthcare industry and expanding physical space offers the opportunity to increase and improve services.

With the option of rising upwards on urban campuses, healthcare facilities are able to add beds, increase their level of service, expand their staff and delve into new areas of research. With an eye to technical complexities, patient care and safety, and community awareness, a vertical expansion is a viable, community-strengthening, long-term solution to limited urban real estate.