World-Renowned Denver Rehabilitation Hospital Gets a Major Renovation
Doing major, invasive construction surgery without compromising sensitive treatment activities in a high-intensity, critical care hospital takes extreme planning and an immersive level of quality control, but so far, about halfway through a five-phase project in Englewood, Colo., the owners representative says the contractor "has made it work."
Since 1956, more than 30,000 people with spinal cord and traumatic brain injuries have been served by the patient-centered treatment and research of Craig Hospital in suburban Denver. Ranked by U.S. News and World Report as one of the top 10 rehab hospitals in the U.S. since 1990, its specialists receive patients from intensive care units and, a few months later, release them with state-of-the art therapies and new skills for living.
GE Johnson Construction Co., Colorado Springs and Denver, broke ground in March 2013 on a $66-million vertical addition to Craig's west building and a four-level, horizontal renovation of 84,000 sq ft. More than 120,000 sq ft is undergoing a complete renovation to provide 52 new private patient rooms, a two-story rehabilitation center, two therapy gyms and two rehabilitation swimming pools. The HVAC, elevator and electrical systems are being replaced in the west building.
Within the hospital, innovative technology will allow patients to use eye and motion controls to manage nearly every operable element of their suites, including TV, shades, lighting, audio and more.
The renovation and addition is being undertaken while the hospital maintains 100% patient occupancy. GE Johnson has compiled noise, vibration and communication protocols to minimize disruptions to sensitive-care patients and is providing a full-time onsite staff and patient liaison to monitor disruption issues.
Craig averages 80 patients at any given time; most are highly sensitive to noise and will spend all of their three- to six-month stay in a facility that is quite literally being taken apart and put back together before their eyes.
Immersion Planning
The original hospital was built in 1969, with additions constructed in 1983 and 1995. Craig started looking at rehabbing the infrastructure 10 years ago but couldn't imagine how to avoid disrupting patients in the process. GE Johnson's sequencing of the work helped to minimize disruptions.
When the current three-and-a-half-year, multiphase project is complete, the bed count will not have changed; however, the makeover shifts patients from rooms with two and three beds to 93 private rooms.
"Another of the main drivers of the project was to upgrade the mechanical systems in the patient rooms to provide more comfort," says Lee Means, Craig's director of engineering. Temperature control is a crucial element for patients recovering from traumatic brain and spinal cord injuries; they can easily spike a fever if the room is too hot and often cannot sense or regulate their body temperature.
"The last thing we want to do is to further inconvenience people who have already been so inconvenienced in life," Means says. "We realized we needed to build an outlet where we could move from an occupied space to a new space and start fresh."
While it would have been logistically easier to build a greenfield facility outside of town, Craig Hospital also relies on the support services contracted through the adjacent Swedish Medical Center. It didn't want to lose that connection, Means says.
"Craig [Hospital] is part of the history of Englewood—it's a landmark," adds GE Johnson project manager Theron Skidmore. "Finding the land to build an entirely new structure and let this one go just didn't make sense. This is their home, and they had the capacity to add on to it and stay right where they are."
One benefit of constructing the addition and remodeling in a fully functioning hospital is that the design and construction staff could observe the day-to-day workings of the atypical setting. "For this out-of-the-ordinary project, we felt it necessary to do an immersion," says Randy Thorne, an architect and principal with project designer RTA Architects of Colorado Springs. "Several of us spent a week living in the hospital. We observed patients learning how to steer their quad chairs for the first time," Thorne says. "We followed staff into the med rooms where there are literally hundreds of medications, with tech assistants helping with [the tremendous level of] checks and balances.
"It only took about an hour of walking around the hospital and observing and talking to patients who had just come through an incredibly traumatic experience trying to learn how to function for us to realize what an absolutely special international facility this is," Thorne says. "I became so attached to this project. We don't look at it as a hospital; it's really more like a university—a school for teaching people how to lead their lives."
GE Johnson's liaison acts as the conduit between Craig staff, the patients and the construction team to coordinate where noise will be happening each day, where materials will come in and how the building can be accessed. Project staff walk each nursing unit regularly, and the contractor publishes a weekly noise forecast. Monthly lunch meetings give hospital staff updates on the construction, and a website shares milestones and details about what's ahead.
Disruptive construction activities also are shut down for an hour or two every day. Hammering, drilling and other noises are stopped to give patients some rest time. Sometimes it happens on a moment's notice, and despite fears that carving a few minutes a day out of the schedule could delay the project, "amazingly, it hasn't," Means says. "GE Johnson has made it work."
Five Phases
The project was broken into five phases. During Phase 1, which finished in August, the four-story tower addition was constructed on the north of the existing west building. The core-and-shell of the fourth floor extends over the west building, taking it from three stories to four. GE Johnson delayed finish work to avoid disturbing patients on the third floor.
Phase 2 entailed a complete build-out of the fourth floor shell area, plus demolition and asbestos abatement on the newly vacated third floor. Elevators and stairwells were extended to the fourth floor. Elevators were shut down and disconnected from cables. The existing slab was demolished, a new machine room slab was created and the elevators were hooked up to new machinery in a time-consuming, tricky process, Skidmore says.
Phase 2 neared completion in mid-February, and second-floor patients soon will be relocated for build-out of the third floor. Work will continue, floor by floor, vacating each floor below as the previous phase ends to provide a layer of sound protection.
"The entire schedule and how we phased it posed challenges from start to finish," Skidmore says. The construction team hasn't been able to use nights and weekends to make up lost time that occurs during the day, so coordination—and flexibility—is key.
GE Johnson and its subcontractors "are sensitive to the wonder that's occurring [inside Craig], working around schedules, coming up with acoustic barriers that have never been used before, phasing the project to allow for an empty floor between any work and the traumatic brain-injury patients. "There has been an absolute coordination and communication with the staff about anything that might create noise or an outage," Thorne says.
Phases 3 through 5 will start in the first half of 2015, with final completion in August 2016. "The renovated portions will be like a new building when the project is done, with just a few mechanical rooms, basement space, offices and engineering left untouched. Everything else was gutted and replaced," Skidmore says.
Early in the project, Craig and the project team championed a key project milestone: working with the city of Englewood to permanently close the 3400 block of Clarkson Street to through traffic. Clarkson had always split Craig West from Craig East, and patients and their families had to cross it to get from one part of the hospital to the other. Now it's being incorporated into the hospital campus, redesigned with sidewalks and landscaping and shady spots for families to sit outside and enjoy the sunshine.
"This [entire project] is an example of collaboration worthy of emulation," Means says. "For people to leave Craig feeling good about the process and glad they came here for these services—when the building was under construction during their entire stay—that was our goal. We were able to maintain a high level of rehab services throughout the project. No patient has gone without any service offered—we found a way to provide it."
