Plug-n-Play Approach Aids Hospital Expansion

Six years ago, Presbyterian Healthcare Services included a plug-n-play chassis when it built its five-story Presbyterian Rust Medical Center Hospital in Rio Rancho, N.M. The state’s second-largest health care provider adopted the strategy so that, during anticipated expansions, crews could easily link new structural and mechanical systems to existing ones.

The plug-n-play method is facing its biggest test yet with the center’s 200,000-sq-ft fast-tracked addition. Construction of the $80-million facility began in May 2014.

“One of the primary reasons to choose plug-n-play is to avoid construction over an existing, occupied and fully operational acute-care facility,” says Lucas Ford, project director with McCarthy Building Cos.

The construction manager-at-risk built the original hospital six years ago, and is constructing the current expansion under an accelerated 18-month schedule. The strategy “has played out well,” he adds.

Designed to connect with minimal disruption to the original hospital, the expansion includes a six-story, cast-in-place reinforced concrete patient tower with 120 private beds and a penthouse suite. Sitting on 240-plus auger-cast piles 55 ft to 75 ft deep, the tower’s partial basement connects to the one in the existing tower.

The hospital’s original two-level diagnostic-and- treatment (D&T) center is also under expansion to add a pre-op room, four operating suites and a post-anesthesia care unit on the second floor and space for a future emergency department expansion on the first. The new D&T space also houses the addition’s air-handling equipment.

Further, the McCarthy team is adding elevators and parking, and expanding both the central sterile processing room and the central plant for new equipment. Total cost of the project, including furniture, fixtures and equipment, is $100 million.

The project was on schedule through early August for a November completion. Then, on Aug. 18, a 21-linear-ft section of a six-story exterior access scaffold collapsed on a building on the north side of the campus. One worker died and seven others were injured. The scaffold, erected by a subcontractor, was for window work and other items, says Patty Johnson, a McCarthy spokesperson.

The site was immediately closed pending an investigation by the New Mexico Occupational Health and Safety Administration office in Santa Fe, which declined to comment on the collapse. Rio Rancho authorities and McCarthy are also conducting independent investigations, Johnson says.

A portion of the site unaffected by the incident reopened to workers on Aug. 24. The remainder is still shut down.

Adaptable

The design team, led by architect Dekker/Perich/Sabatini, selected cast-in-place structural concrete for the new tower and the D&T center because the material is adaptable for expansion modules. Concrete also needs no fireproofing and resists vibrations.

The project sits within a seismic zone rivaling those in California, Ford says. “The structure itself with the new 2012 building codes has changed the way we had to approach this project early on,” compared with the original hospital, he says.

The primary difference is the reinforcing steel requirement, Ford says. The expansion has approximately 40% more rebar than the original structure.

The rebar diameter is greater and there is more rebar congestion in the beams, decks and walls to meet the 2012 requirements, he adds.

An enclosed pedestrian bridge connects the two towers at levels two, three, four and five. It was designed to create better circulation from the old to the new towers.

“It’s a free-standing structural steel bridge set between two concrete patient tower structures,” says John Laur, Dekker/Perich/Sabatini’s principal. “Instead of putting columns into the existing patient tower, we created a separate structure with cantilevered ends.”

The owner’s desire to synchronize the expansion with a major remodeling of its original 1960 patient tower on its main hospital campus in downtown Albuquerque drove the construction plan. This meant the new beds at the Rio Rancho campus were needed as quickly as possible.

To meet the tight schedule, McCarthy coordinated the drawings using building information modeling (BIM) and some aspects of lean construction.

“We are able to build the model and coordinate in real time as well as take the model into the field on iPad tablets to verify installations,” says Ford.

In the tower, three floors of patient rooms will be built out, and two levels of shell will accommodate the final 48 beds as needed. On the first floor of the tower, a 21,500-sq-ft cancer center houses a linear accelerator and space for a second unit. The linear accelerators have concrete walls and roofs, made from high-density aggregate, as thick as 6 ft.

D/P/S modeled the square-in-plan patient towers to ensure proper alignment of all the elements. “Without BIM, it would have become very difficult to visualize how these would all come together easily,” Laur adds.

“From the functional perspective, we wanted to keep the public and transport elevators in the same core but separate their user-access paths,” he says.

Modeling helped with plugging in the new patient tower to the D&T. The original master plan arrangement provided that as each patient tower was added, a connection point for it was required at the “spine” in the D&T block.

“In response to this, a first-floor extended area, next to the emergency department, was constructed to facilitate the tower connection but not built out internally due to lack of current need,” Laur adds. 

The plug-n-play concept should reduce challenges, says Eric Cornish, Presbyterian real estate and development project manager. “With power and other mechanical and plumbing infrastructure valved and sized for projected expansion, shutdowns that impact current operations should be reduced or eliminated,” he adds.

For example, existing electrical switchgear and distribution systems included provisions to add future generators and buildings as the campus grows, says Mike Dexter, mechanical engineer with Bridgers & Paxton Consulting Engineers.

“These same concepts were employed in [this expansion] to avoid disruption to existing facilities and implement a true plug-n-play concept,” he says.

McCarthy is using a lean construction goal-setting approach called pull planning. Under the approach, the team creates out a schedule by working back from the completion date for an element or a system. The idea is to ensure all team members are working together efficiently and as expeditiously as possible toward the same end.

“By using the pull-planning method, we are able to better plan manpower in areas, discuss predecessors, keep and update on deliveries, reroute emergency vehicular and pedestrian traffic, ensure safety on an occupied campus and address an issue before it causes unnecessary delays and, most importantly, track milestones to ensure an on-time finish,” Ford says. 

During an early pull-planning session, Bridgers & Paxton was told by facility personnel that high silica content in water was causing scaling in plumbing and kitchen equipment in the original buildings and causing some plumbing components to malfunction.

To solve the problem, “an innovative high-frequency water-conditioning device was installed as a test and proved beneficial in addressing these problems,” Dexter says. The expansion “implemented this solution on a wider scale.”

With an area population that is expected to double to almost 200,000 by 2035, a future third phase is planned. At build-out, Rust Medical Center will become a 300-bed facility with three towers.