When examining options for a facility master plan, budget and schedule often become the two primary constraints keeping a hospital from choosing its “most preferred” plan. Reskinning older, existing buildings to incorporate them into the new architectural scheme can overcome budget and schedule hurdles and allow the hospital to achieve the master plan of its choice. This article examines several cases in which reskinning an older building served as a critical activity in fulfilling an overall master plan.

Multiple Objectives

Weather resistance was one reason Riverside Regional Medical Center in Newport News, Virginia, wanted to reskin a patient tower built in 1963. But beyond this, the project offers a look at the multiple objectives that can be achieved through reskinning.

“Riverside’s master plan called for a new patient tower to be built adjacent to its old tower,” says Sam Burnette, AIA, the principal designer with Earl Swensson Associates, Inc. (ESa), a full-service healthcare architectural firm based in Nashville. “We needed to give the building an updated look. By replacing the windows and reskinning the building, we not only achieved our aesthetic goals, but we also realized a dramatic increase in energy efficiency and sound transmission, and a reduction in moisture penetration.”

The solution to Riverside’s problem was not without challenges. “We had to maintain the structural grid, yet give it a very different look,” continues Burnette. “Unfortunately, the structure itself would not withstand any additional weight, which automatically eliminated adding any heavy skin elements, such as stone, brick, or precast materials. The owner was not receptive to stucco or an EIFS (Exterior Insulating and Finish System) because of the long-term maintenance issues often found with their use in the eastern United States.”

After evaluating a number of alternatives, ESa chose to use a series of metal panels combined with a lightweight curtainwall system compatible with the materials used on the new tower.

“Hospitals in general do their best to avoid tearing down an existing structure,” says Burnette. “Often, there is no land available, and the facility must remain functional during any renovation, which is always difficult.”

The metal panels were installed one strip at a time, allowing removal of components of the old cladding and installation of a new system on a section-by-section basis. With careful coordination between hospital staff and the building team, construction crews installed the windows from the exterior of the building to minimize interruptions inside. Before each patient room was scheduled for new windows, occupants were moved to usable rooms. As a result, the facility remained open and operating during recladding.

Riverside now greets patients and visitors in a new five-story lobby, surrounded by new landscaping, signage, and lighting. “In essence, we remodeled a 1960s rectangular bed tower to complement a state-of-the-art, 21st-century, major hospital expansion,” says Burnette. “The result is a patient-friendly, hospitality-type environment.”

At Riverside, early integration of design and constructability resulted in outcomes that satisfied both the aesthetic and structural challenges of the project.

Anchoring the New Master Plan With an Old Building

When St. John’s Mercy Medical Center in St. Louis wanted to vertically expand its existing seven-level hospital tower with two additional levels for private, postpartum maternity rooms as part of the Women’s & Children’s Health Center, it faced two major challenges: first, upgrading the tower’s steel structure to meet current seismic code requirements and, second, updating the building’s exterior to complement the planned heart hospital to be built adjacent. In addition to these challenges, the tower’s exterior was showing signs of wear and leakage.

Originally, new seismic bracing for the tower was designed in a K formation within the current building structure. The installation would be highly invasive and would need to be done from inside the facility. “The design-build project team observed that a change to external X-bracing on all four sides would allow installation from the exterior, eliminating the need to close patient rooms during construction and accelerating the overall project schedule,” explains John Reeve, president of Christner, Inc., the architect of record for the project.

The exterior bracing solution not only saved money and time, but it also provided the design team an opportunity to create a new exterior look for the tower. “To minimize the weight of two additional floors, we used lightweight glass curtainwall and architectural metals to reclad the exterior,” explains Reeve. “The two-story ‘pavilion’ became a signature design element, not only for this tower but also for all future patient towers.”

The cladding required to hide the structural bracing enabled the architects to visually marry the structure to the intended campus-wide building design elements. “Rather than it appearing to be perched on top of an old building, the ‘pavilion’ is beautifully integrated with the rest of the tower,” says Reeve.

By all measures, the design-build team was successful in creating design solutions that achieved the facility’s original business and strategic objectives. New architectural elements supplement existing building features and create a uniform identity with the rest of the Medical Center campus. Completed four weeks ahead of schedule and within budget, the tower now stands ready as the perfect complement to the adjacent new Heart Hospital, due to open in 2006.

Overcoming Initial Reservations

Reskinning an existing, operational hospital can require a certain amount of intestinal fortitude. Such was the case with the vertical expansion project at Presbyterian Hospital in Albuquerque, designed by Dekker/Perich/Sabatini. To meet structural needs and achieve the desired architectural appearance on this project, removing the existing skin would require extraordinary muscle and noise.

Presbyterian Hospital was originally built to accommodate a two-level vertical addition but, as one of the largest acute care hospitals in New Mexico, it required three more floors to handle current patient loads. To accommodate the weight of a three-story addition, the skin at the existing lower levels-made of heavy brick, block, and grout-would have to be removed and replaced with lighter materials, and normal hospital operations needed to be maintained.

Undaunted by the challenge, the team removed the old skin section by section using chipping hammers and sound blankets to insulate the noise. Continuous communication with the nursing staff let the construction team know when planned noise levels were reached, and construction operations were adjusted accordingly.

The new skin-a combination of brick, precast windowsills, and a glass-and glazing-wall shadow-box system that matches the existing structure-integrates the look of the existing building and its newly added floors into the architectural integrity of the overall campus.

As medical facilities continue to expand and existing structures require updating, integrating the overall look of these campuses will be paramount to positioning them for future success. In addition to achieving a desired face-lift, reskinning can improve performance and enhance energy conservation. Using a cohesive and experienced team that understands the challenges of reconstruction, reskinning, and renovation will guarantee a successful project. HD

Tom Birkemeier is Senior Vice-President-Healthcare for McCarthy Building Companies, Inc. McCarthy has more than 100 years of hospital construction experience and is consistently ranked among the nation’s preeminent healthcare builders.