Recently, the 10th floor of Bellevue Hospital Center, New York, underwent its own form of surgery—total renovation.
It was back in 1736 that patients first came to the Lower Manhattan healthcare facility with common maladies of the era, such as consumption or gangrene. The oldest public hospital in the United States, Bellevue Hospital Center has been a large part of local history. Bellevue Hospital has served as the medical facility for visiting presidents, injured police and firefighters, and diplomats from the United Nations.
It is the only hospital in New York City with concurrent designations as a Level-I Trauma Center, Heart Station, Microsurgical and Replantation Center, and Regional Center for Head and Spinal Cord Injury. It provides state-of-the-art healthcare services and
cutting-edge technology in an urban environment
Fast forward to 2006, “Better than Ever” is the perky new slogan as the hospital continues to grow. That growth has required some innovative renovation for its 30-plus-year-old hospital tower on First Avenue.
Electrical contractor Quantum Electric Corp., Long Island City, N.Y., joined New York City-based Turner Construction and architect Guenther 5 (G5) to make the 10th-floor Bellevue Hospital Intensive Care Unit (ICU) one of the more advanced centers for intensive healthcare in the country without any new construction. When the hospital consolidated four ICU centers into this single spot—10 stories up—it needed to upgrade equipment and lower energy costs. From the onset, the project goals were to reduce energy consumption, design for more natural light and, overall, provide a better experience for patients, visitors and staff members while in the trauma unit.
Before renovation, Bellevue Hospital’s ICU was scattered among numerous departments on multiple floors. With the renovation, Bellevue would become the only New York City hospital that maintains a fully staffed and equipped ICU in its emergency department. This unit would allow a more rapid response at the highest level for even the most serious disaster. To meet this high level, the design team put together a plan for one unit that would build on the commonalities of service among four units.
That design would allow the hospital to combine its various ICU services, including medical, surgical, neurosurgical and cardiac, onto one floor. The plan was to put the consolidated ICU with all the rooms around the perimeter, and bring light into the center of the floor, maintaining a connection with the outdoors—not just for patients and their families but for staff members.
“We wanted to have a more private, soothing environment,” said Fara Tabaei, Bellevue Hospital associate executive director for facilities management. “Our purpose was to have a flexible design.”
The Bellevue Hospital tower, built in the 1970s, sits on a 50,000-square-foot plate. That amounts to a floor plate so wide that sunlight could not reach the center space of each floor. Therefore, considerable lighting was needed to illuminate those center areas. G5’s principal architect and project manager Peter Syrett’s goal was to design a solution to “get daylight as deep into the plane as possible.” In addition, Syrett said the design was driven by statistics showing that daylighting has a positive effect on the healing process as well as a boost for personnel productivity.
The ICU was designed with 56 beds, each in its own room with ample windows overlooking Manhattan.
Renovation plans included state-of-the-art overhead boom medical delivery systems at each bed, an advanced nurse call and patient monitoring system, security and automated lighting. One unique feature was the universal patient room module, measuring 240 square feet. The room would use the overhead delivery systems to permit maximum flexibility in care.
Energy savings and daylighting
Daylighting in new construction is a growing area of interest, but doing it as part of a renovation offers many challenges, Syrett said.
“Hospitals are huge energy users,” he said. “They are constantly active and are equipped with a great deal of redundancy. Electrically, it is extremely complicated.”
Quantum Electric installed lighting, medical columns, nurse call systems and monitors as well as the main power to the unit. From the onset, this was not a typical project.
“There were a lot of hurdles that had to be overcome,” said Gregory Sobel, P.E. and project manager, Quantum Electric.
By the time Quantum Electric arrived at the site, the 10th floor was emptied for the construction crew. Its first task was to isolate and ensure no critical circuits were shut off.
The floor above included an active surgical suite, while the mechanical, steam and electric services were centered on the 13th floor. In addition, because there was so much ductwork in the ceiling, putting the galvanized conduit in that same space was a challenge that delayed the project by several months.
The building came with fire-rated walls that contain such an emergency. Working with fire-rated walls with double Sheetrock required extreme care so as not to disturb anything connected in those walls.
The 10th floor was designed to provide enough window vision area giving each room generous views. The rooms were designed with nurse stations in the center of the floor and windows on both sides of patient rooms that allow the staff not only clear views into the rooms of the patients, but also considerable natural light at any point on the floor. The ceilings slope up toward the perimeter of the building, which maximizes natural light.
The design includes one decentralized nursing station for every two patient rooms. Each room also contains a computerized patient charting system that captures and archives all vital signs, lab results, medical history, pharmaceutical orders and pictorial imagery on a bedside desk/computer unit.
G5 architects determined that because the floor is large and repetitive, they should apply principles of feng shui (a philosophy of placement to bring greater energy to a building) to color the four sides and arrange activities. The interior of the floor is maximized to support caregivers; spaces for supplies, medication storage, conference, office and on-call spaces are installed for convenient access. Ultimately, G5’s design was intended to blend the concepts of healing and quality space with the hospital’s resources and technology deliveries.
Some of the greatest challenges involved running conduit through crowded vertical space and ceilings.
“It was a challenge to get electric from the 13th floor to the 10th floor,” said Sobel. “To bring it down, we had to get a little creative.”
“Elevator access to the floor was tough,” said Sobel. Although workers had a freight elevator, the 10th floor construction crew members were not the only passengers using it. Occasionally, emergencies required that the workers get off wherever the elevator stopped.
Working in the clean environment of a hospital also posed challenges. When the contractors did work on the 11th floor—where the surgical units were located—they wore caps, gowns and surgical boots. Working on the ceiling of the 10th floor could also be disruptive to those in surgery on the 11th floor, so they had to time their work around the surgery schedule.
Quantum Electric installed the overhead delivery systems mount to a single arm in each room that can swing around the patient’s bed and offer all medical equipment and measuring tools such as outlets, emergency medical pumps, oxygen and vacuums, Tabaei said. Nearly every machine, measuring instrument and monitor is attached to the single arm that rotates 360 degrees from the ceiling, so doctors, nurses and family members can move freely around the beds.
The nurses’ stations offer all services that allow nurses to track their patients (most nurses have two patients at any given time) from vital signs monitors placed at their desks, over the door of the patient’s room, and from other places on the floor if the nurse has to leave the station.
Quantum Electric also wired the nurse call system, which allows for two-way communication between patients and nurses. It also installed an emergency code blue communication signal that illuminates a light above the patient’s door and signals an alarm at the nurses’ stations in the event of a life-threatening emergency. Nurses have a direct connection to on-call doctors. Quantum Electric also installed a recording device that allows nurses to record what is happening on the monitor such as heart rate and pulse.
Quantum Electric deployed an access control system as well as several security cameras that can be viewed from a central monitoring station on another floor. The workers installed medical gas detection alarms in the event of pressure changes.
State-of-the-art technologies and savvy electrical contracting were a winning combination for this challenging retrofit project at Bellevue Hospital Center. EC
SWEDBERG is a freelance writer based in western Washington. She can be reached at firstname.lastname@example.org.
Quantum Electric Corp.—Electrical contractor and retrofit integrator
Guenther 5 Architects—Architect of record
Turner Construction—General contractor
Kurt Versen Co., Lightolier and Winona Lighting—Lighting
Hill-Rom Services—Overhead delivery system
Diebold (Antar-Com)—Security systems
Philips Medical Systems—Patient physiologic monitoring system