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The Sky’s the Limit: Vertical Expansion for Healthcare Facilities

Written by: Jamie Booth

07.15.20

Vertical expansion, the process of adding levels to a finished building, is one of the most complex project types when it comes to healthcare construction. However, hospitals do not have the option of shutting down operations to complete an expansion. In addition, increasingly small sites that prevent traditional horizontal expansion mean that going vertical is often the only option. With expert planning and consideration of a few critical points, hospitals can remain fully operational during all phases of the project.

Existing Structure Evaluation

When considering a vertical expansion, the contractor and design team must meticulously evaluate the hospital in its current state. A strong focus on the existing structure and utilities helps to uncover potential issues and gives the project team a general understanding of what is needed to start moving vertically. Some aspects of evaluation include:

• Pre-construction Investigation: This helps the team capture the potential project scope and design gaps that can lead to costly rework and schedule impacts down the road.
• Structural Tie-Ins and Pre-Task Planning: This ensures that the existing structure was designed and is prepared for an expansion. Pre-Task planning is particularly critical for understanding the sequence and temporary measures needed to protect the existing roof.
• Roof Top Units & HVAC Planning: A plan for how to handle RTU relocation is critical to maintain hospital support functions. This involves working with the design team and engineers to relocate and maintain mechanical vents and exhaust ports necessary for operation during the construction.

Virtual Design and Construction Coordination

Involving VDC techniques early in the design process provides critical information up front that saves time and money. Outputs such as 3D models and virtual reality mock-ups inform the planning, design, and construction of the expansion. They also provide context for what a space will look and feel like. Some VDC technologies include:

• BIM Coordination: Design and building plan coordination using BIM reduces the amount of rework and integrates all aspects of the project early on. Not only does it save time and money, but the efforts can now be used to model and design prefabricated MEP stacks, head walls, and many other laborious applications.
• Laser Scanning: This technology ensures existing conditions and dimensions are accurate when coordinating new building tie-ins, as well as floor heights, making building transitions seamless.

Operations Consideration

During a large-scale renovation, it’s important to go beyond the building and structures to consider how occupants are affected. In a hospital setting, noise and vibrations can disturb vulnerable patients as well as staff. Vibrations from construction can also impact sensitive equipment such as CT scanners and MRIs. It’s critical to develop a detailed logistics plan to minimize these impacts. If a portion of the project will create a high level of noise, coordination with hospital management should take place beforehand to ensure it’s done at the least intrusive time.

Scheduling Flexibility

Vertical expansion is a complicated process, so expect the unexpected and add flexibility to the schedule early on. Additional measures free up space or allow hospital functions to resume away from high traffic construction zones. Some best practices include:

• Enabling Projects & Swing Space: Understanding a hospital’s master plan and what early enabling work looks like can be critical when developing a schedule for a large-scale expansion. Having the ability to move hospital functions out of a critical impasse to a potential swing space or external medical building provides flexibility for crews to work without disrupting hospital functions.
• Sequencing and phasing: Working alongside hospital coordinators and physicians is extremely beneficial when determining how best to sequence or phase aspects of any major expansion project. Coordination between vertical or horizontal tie-ins needs to be comprehensive and fully vetted in advanced to understand potential impacts. Additionally, phased construction can affect more than just the schedule or budget– it can also drive infection control procedures, containment methods, life safety variations, and a variety of MEP precautions.

The key to a successful vertical expansion is to plan ahead. Fully vetting existing structures and taking patient outcomes and potential scheduling setbacks into consideration allow for hospitals to maintain operations with minimal disturbance. With the planning and management of an experienced team, the sky’s the limit for healthcare facilities looking to expand.

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