University of California San Diego Medical Center
January 26, 2010
Role of Planner is Critical in Successful Hospital Seismic Mitigation
Seismically retrofitting a hospital in California—mandated by Senate Bill 1953 by 2013, or 2015 with extensions—is like a complex game of chess, say hospital facilities planners familiar with the process. The law covering the non-structural performance category (NPC-3) requires safe evacuation of patients who have less than the capacity of ambulatory people to protect themselves. It's one thing to close down an administrative office or waiting room, but seismic mitigation of critical care areas, including ORs, NICUs, and SICUs, requires careful scheduling.
That's where planners such as Janice Davis come in. When the UCSD Hillcrest Medical Center spent $15 million for non-structural seismic improvements in 2008-09, Davis worked closely with Essrig Taylor Construction (ETC) of San Diego, specialists in health care construction, to minimize disruption. “We had to ensure there was a consistent amount of work each day to keep the project moving forward without adversely impacting the operation of the hospital,” Davis said.
The UCSD project specified NPC-3 seismic retrofit of all ceilings, piping greater than 2-1/2-in. in diameter, and critical equipment. The work was performed in critical areas such as Central Sterile, ORs, Radiology, Laboratory, Pharmacy, Cath Lab, MRI and Central Supply.
Often this meant moving the construction team from room-to-room, completing one area before opening up another. “Seismic retrofitting is like a moving target, constantly rotating through occupied areas, yet mindful of the unique challenges of working around sensitive lab equipment, infection control areas, and critically ill patients,” UCSD's Janice Davis said.
“We couldn't set a definitive construction schedule because of the requirements of our clinicians. Shutting an entire unit was not an option and there was often very little swing space available, which meant work had to be conducted on a piecemeal basis.”
Davis conducted on-going evaluations of the job as it progressed, making last minute scheduling changes to accommodate often unforeseen medical crises, such as a critical bed shortage during a flu outbreak, or an influx of injuries due to nearby wildfires that required skipping entire units and revamping the schedule on short notice.
Davis implemented UCSD's 20/10 noise rules - loud construction for only 20 minutes, followed by 10 minutes of quiet work. At times, retrofit activities could not begin until after staff completed their rounds, and never before 10 a.m. in the cardiac intensive care unit.
“Working from a great set of construction documents is always important, but so is flexibility on the part of both the contractor and the inspector of record (IOR), who was retained by the hospital and certified by the California Office of Statewide Health Planning and Development (OSHPD).”
One of the lead inspectors on the project says, “I can't think of a more difficult work environment for a construction firm than a site that by its very definition needs to be both quiet and sterile. Work areas can never truly shut down. They need to go back on-line often with less than 24-hour notice, especially during community emergencies.” It is generally agreed that for this kind of project, it's best to have a self-performing health care construction team with back-up plans in place to keep crews working and the job moving along when work areas suddenly become unavailable.
Davis adds that communicating the entire process with hospital staff is critical. “They need to know that the work has to be done and that it has to be done within state mandated deadlines. You constantly have to communicate the intention of the project, what you're doing and why, and how you plan to complete the project with a minimum of disruption.”
Davis continues, “Seismic mitigation is a dynamic, moving target, especially in a hospital environment which has to keep operating, where you must plan for the unexpected. But the end result is a safer hospital that will remain relatively unscathed in an earthquake.”
For more information: www.ucsd.edu
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