The year is 2012, and the cost of microturbines has finally come down to make them a viable option for on-site power generation. In addition, there's been a tremendous proliferation of wireless technology to enable conveniences such as viewing medical records and x-rays on a projection screen right at the patient's bed.

But before a healthcare facility can start bringing in such new technology, cost and feasibility must be evaluated. A large part of this analysis is determining if the facility's infrastructure is robust and flexible enough to support such M/E advances. That question all goes back to how much foresight was built into the planning and design of the hospital's infrastructure.

For instance, a general rule of thumb applied by Heery International's Director of Engineering Richard Snyder when specifying an electrical system is to build in 30% additional capacity—simple, as opposed to going back to the main hub to upgrade electrical capacity for new equipment, which can be a very big expense.

Snyder's Heery colleague, Joe Gottardy, PE, mechanical department manager, Atlanta, adds, “When sizing ducts and piping, we try to add 20% additional capacity at the end of the run in order to easily accommodate new systems in the future.” Gottardy also recommends oversizing air filtration systems to accommodate increased air-flow rates since code requirements are always changing.

Engineer Clark Brenner, PE, director of healthcare, Arnold & O'Sheridan, Southfield, Michigan, advises, “Air-handling systems need to accommodate additional filtration technologies and infection control technologies, such as ultraviolet radiation, heat-recovery options, and germicidal, high-performance, low-pressure air purification systems.”

Another way Brenner's firm takes future needs into account is by anticipating that a hospital's requirement for controlling heat load generated by medical equipment and building systems will grow considerably over the years. Says Brenner, when designing the HVAC system: “We provide a central process water cooling loop that may be extended on each floor or tapped into to provide easy installation of process cooling equipment. This has proven to be very beneficial in many areas where additional cooling may be needed to offset the heat loads from new electronic equipment that was not planned for.”

Similarly, for the placement of mechanical and electrical equipment, Kirk Pesta, PE, associate mechanical engineer, Harley Ellis Devereaux, Detroit, recommends grated floors, as opposed to concrete, for mechanical rooms. “We want to always have a vertical element available to the hospitals, and grated floors make it easy to go in and add systems,” he explains. However, keeping in mind that the hospital may want to build on additional floors in the future, Pesta tries to avoid placing mechanical equipment on the roof.

On the electrical side, Pesta's colleague, Stephen Milz, PE, an associate electrical engineer with the firm, emphasizes the importance of working with programmers and space planners up-front to negotiate adequate closet space per floor for current and future low-voltage cabling, as well as ceiling space for running horizontal cable trays. He adds that, for the ceiling, the space must not only be sufficient for the cabling itself, but proper clearances are required by technicians for easy access to the trays.

One electrical strategy that Steve Yanke, PE, director of engineering, OWP/P, Phoenix, employs is putting switchgear on drawer slides, as opposed to bolting it onto the busway. This way, when circuit breakers need to be changed out, it's a simple procedure.

When all is said and done, though, when planning for the future, spacious design isn't simple—every square foot of real estate comes with a big price tag, notes Lou Irvine, PE, project electrical engineer, Bala Consulting Engineers, King of Prussia, Pennsylvania. James Moler, PE, manager of engineering systems for Turner Healthcare, Brentwood, Tennessee, concurs: “Facilities and budgets can't really withstand too many what-ifs. Things which are being done are very programmatic and for the short-term. In general, hospitals don't have the budget to support long-range futuristic designs. Planning has to be based on things that are pretty well known and already in the pipeline.” Joey Caldwell, PE, senior plumbing engineer, HSMM, Roanoke, Virginia, agrees: “It's impossible to program additional space not really knowing what technology will be coming into the hospital in the future.”

Even so, it behooves planners and designers to pay attention to certain trends, such as a fairly recent surge of interest in back-up power. “In the past, a little bit of downtime was acceptable, but there's been a total shift to zero tolerance for downtime, so that's how systems have to be designed,” explains Steve Yanke. Joe Gottardy points out that the codes don't require putting chillers on the emergency back-up system, and yet this is something most clients are now asking for, although in many cases, the original system wasn't designed with the capacity to take on a chiller or other non-essential systems.

In the experience of the Orlando-based firm TLC Engineering for Architecture, “We've actually had requests to back up the entire facility,” says Vincent Rea, PE, LEED AP, a senior electrical engineer. “So we need to provide for a future allocation of generation up front in the design.”

Back-up power aside, designers must also consider the sheer rate at which electrical apparatuses are increasing in hospitals. “In 2004, there were typically 50 to 52 electrical systems in a hospital and, in 2007, there a more than 100. That's a significant increase,” points out Vlad Torskiy, AIA, vice-president of HOK's healthcare business unit, Chicago.

As far as what to expect in the realm of trendy new technology, wireless tops the list. Even though a number of issues still need to be sorted out, such as security and formatting, the adoption of wireless is impending throughout healthcare, say the experts. Consequently, hospitals must brace themselves for supporting larger bandwidths and multiple frequencies to empower increasing numbers of mobile devices and robotics.

“As time goes on we will have more ‘smart’ devices in the field,” predicts Clark Brenner. “For example, microprocessors will be installed in anything from door hardware to bathroom sinks. Having the communications backbone that can absorb these additional devices will be important.”

Also, in the wake of the back-up power trend, more and more hospitals are expressing interest in getting off the grid. As a result, consulting engineers are being asked to look at things like fuel cells, photovoltaics, and microturbines. “While the cost of such technologies is still high, they should be coming down,” anticipates TLC's Rea.

This being the case, it's important to introduce such possibilities now because PV arrays or a microturbine farm require a decent amount of space, and that is something that must of course be planned for.

Regarding other technological advances, water re-use and energy-recovery systems that utilize waste heat will most likely be a trend, particularly since hospitals are some of the largest energy and water users in a city.

“Hospitals are huge energy hogs that exhaust a lot of air,” says Pesta. Brenner adds, “Many processes in healthcare, such as water conditioning systems, often dispose of thousands of gallons of usable water that could alternatively be used for nonpotable water applications. Plumbing systems should be designed to allow for the recovery of this water and engineers should plan on space to allow for gray water and storm water recovery systems.”

One piece of advice from TLC's Mark A. Gelfo, PE, LEED AP, principal and division director, Jacksonville: “One of the specific things we do to help prepare our hospitals to accept new technologies is to specify control systems with open communications protocols. This allows almost any new system or old system with a new intelligent controller to be tied to the building management system.”

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The World of Retrofits

Probably one of the most challenging aspects of healthcare design work is planning for retrofits. “I hate retrofits,” jokes Richard Snyder, director of engineering, Heery International, Orlando. “M/E/P systems typically get band-aided over the years, and you may be dealing with a 1930s part of the hospital where you have to figure out how to run new lines through congested systems.”

Similarly, Stephan Kemp, PE, principal and senior mechanical engineer, TLC Engineering for Architecture, Nashville, explains, “There's a world of difference between state-of-the-art then and state-of-the-art now, and the challenge is to make them compatible. That's a very serious challenge for us in achieving our goal of making a user-friendly building.”

A very common problem is that floor-to-ceiling heights in older buildings are a mere 11-to-12 feet, while today's patient floors are built at 15-to-16 foot heights and, for mechanical floors, as high as 20 feet. This means everyone involved with retrofitting these buildings is running into the situation of a significant lack of space. “Running additional cable in a neat, manageable way is very difficult,” says Kemp's TLC colleague Thomas Clevenger, PE, principal and senior electrical engineer at the firm's Nashville office. “You have to get pretty creative, not just getting into the space, but doing it in a way to make the cable accessible”

Ultimately, hospitals often have to give up some usable space—for example, accepting narrower corridors, waiting rooms or patient rooms in order to accommodate new M/E systems, according to Dave Holst, plumbing and fire protection engineer, Bala Consulting Engineers, King of Prussia, Pennsylvania. In other cases, it may be too difficult to update certain buildings on campus, and those facilities will have to be down-cycled to less critical applications.

Harley Elllis Devereaux recently worked on a hospital project where the design team was successfully able to accommodate new electrical distribution by taking over two patient rooms, according to Stephen Milz, PE, associate electrical engineer, Detroit. It was a necessary part of putting “digital- and computer-based 21st-century systems into a mid-20th-century hospital,” Milz observes.

Another big issue is phasing the work in order to minimize disruption to the hospital's operations. “One phasing strategy that we've utilized is working on one wing at a time, putting in new systems, ductwork, etc., bringing them on-line, and then moving on to the next wing,” says Milz's colleage Kirk Pesta, PE, an associate mechanical engineer with the firm. “We actually found this strategy to be very successful with one client and have been advertising it to other clients.”

As Pesta points out, it's much easier for an owner to put a “band-aid” on a system in order to keep it going, as opposed to paying for a 50-year solution. Of course, hindsight is 20/20, but the level of difficulty encountered during a retrofit can be well mitigated in a properly planned facility.

—Barbara Horwitz-Bennett

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Keeping Up With the Trends

Even though M/E/P technology is advancing at a much slower clip than medical technology, healthcare designers still need to be on their toes to bring the most up-to-date technology suggestions to their clients. So what's the best way to do this?

According to Vincent Rea, PE, LEED AP, senior electrical engineer, TLC Engineering for Architecture, Orlando, seminars, Webcasts, trade shows, trade magazines and serving on code committees are all great sources of information. For example, conferences such as HEALTHCARE DESIGN, as well as seminars organized by the American Institute of Architects (AIA) and American Society for Healthcare Engineering (ASHE), are recommended.

In Steve Yanke's experience as a principal and director of engineering with OWP/P's Phoenix office, constantly working with vendors and talking to owners has helped him keep up with technology trends. “The only way to stay abreast of the trends is to be actively involved in the design and to be in the trenches doing it,” explains Yanke.

For his fellow TLC designers, Mark Gelfo, PE, LEED AP, principal, Jacksonville, explains that active involvement in professional societies such as the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the American Society of Plumbing Engineers, the Illuminating Engineering Society of North America, and the U.S. Green Building Council, has enabled them to stay on the cutting edge of technology. Engaging in discussions and sharing experiences with TLC colleagues is also important.

In a similar vein, Heery International is now using E-groups in which the firm's 30 offices can share information on different market sectors, including healthcare, in a question and answer format online.

—Barbara Horwitz-Bennett