Streamlining Valuable Ceiling Space within Hospitals

We can all remember the last big traffic backup we encountered on our drive to or from work. Too many vehicles on a road that seems too narrow can bring a normally swift commute to a crawl.

Like a bad traffic jam, above-ceiling spaces in healthcare facilities can face similar congestion problems. Just think back to the last time you tried to lift a ceiling tile in a hospital corridor and the challenges faced when the ductwork, piping, and other materials prohibited sufficient access. Whether brand new or aging, a hospital's ceiling space is usually the most convenient and practical area to run infrastructure systems for many different trades and associated equipment devices and systems.

As one would expect, because of the sensitive nature of a hospital's clinical and procedural areas, there is a low tolerance for disruption. Yet the constantly changing dynamics of the healthcare industry require frequent renovations, equipment upgrades, and construction of spaces for new services. As connectors of these spaces, corridors and hallways typically see the most activity when infrastructure upgrades are made. It's the ceiling space above where system after system, version after version of new and upgraded equipment is placed.

In many instances, this space becomes packed with materials that accumulate over time as old systems are abandoned and new ones are added in. As a facility ages or as renovations and upgrades continue to occur, it often becomes physically impossible to add in the pathways and components associated with new services. Eventually, maintenance crews must either remove the existing ductwork, piping, conduit and other construction materials and equipment; or install new systems and infrastructure on top of existing systems. Both approaches can be costly and time consuming.

From a representative sample of healthcare facilities across the United States, facilities and engineering personnel estimate that up to one-third of the above-ceiling materials, systems, or equipment in a typical 20- to 30-year-old hospital are spare, turned off, or abandoned. This creates a maze of active and unused ductwork, wiring, and other physical assets that, without significant effort or accurate records, are difficult to identify. This predominance of extra items in the ceiling spaces creates short and long term challenges for those associated with the design, construction, and maintenance of these facilities. Understanding what lies above is the first step towards optimizing this valuable space, thus saving time and money down the line.

What's up there?

Typical above-ceiling systems include fire protection and plumbing piping; mechanical ductwork and equipment for heating and cooling; large and small electrical conduits and cable trays; and pneumatic tube system pathways, to name a few. In addition, structural support components such as conduit racks, cross-bracing for light fixtures and equipment, and structural steel and concrete beams reside here as well. In most hospitals, the lowest floors (at times called “podiums” or “diagnostic and treatment blocks”) often have larger floor-to-floor heights because they are supporting departments such as emergency, surgery, intensive care units and imaging spaces that can require larger volume and higher ceilings. As a result, even more equipment and structure are often included in these ceiling spaces, such as additional structural support mechanisms for ceiling-suspended operating equipment and lights, plus more mechanical, plumbing, electrical, and technology systems to serve the departments' increased infrastructure needs. In short: these workhorse spaces offer even greater opportunity for above-ceiling areas to become congested.

How does it get so crowded up there?

The reasons for above-ceiling congestion are unique to each facility, and often lead to coordination challenges during construction as competing trades and systems all vie for the same small area above ceilings. Common to most, however, is a lack of planning during design and construction. Misplaced or missing as-built documents that would indicate existing conditions and recent installations add to the problem. Over time (and without the help of more recent electronic record-keeping tools,) facility managers lose the knowledge of their systems and spaces once key personnel move on. Frequently, the tangle of overhead systems reflect a compilation of many design drawing sets which occur over long periods of time, making it difficult for facilities personnel, designers, and contractors to accurately determine the exact purpose of each conduit or pipe.

In a working hospital, it is often too difficult and sometimes impossible to prepare certain systems to be shut off or diverted in order to perform necessary investigations above ceilings and in other concealed areas. As a result, unused equipment; abandoned or spare pathways; and even cabling stays put even as new equipment is added. The decision to leave this material overhead is usually made with the idea that the items will be reused for future work, but in reality, spare piping and conduit is rarely catalogued for use later on. Unless existing equipment is field-verified by a design team prior to a renovation or properly catalogued by the contractors, the existing equipment usually remains undiscovered. The surprise is usually revealed by a contractor arriving to perform new work, a facility engineer performing maintenance tasks, or a design professional documenting existing systems. And their discoveries are rarely celebrated.

Eliminating congestion and saving money

While operating costs represent a large portion of a hospital's budget, infrastructure upgrade costs are steep as well, and increase as the hospital ages. The cost of upgrading support functions such as mechanical, plumbing, and electrical systems; installing pathways for fire suppression systems; and introducing new communications equipment rises dramatically if the ceiling space is cramped and not easily accessible. Many times, installing new infrastructure in congested and inaccessible ceiling spaces requires more material and labor and is unfortunately necessary to circumvent the clusters of unused and unnecessary systems. Time and cost-not to mention frustration-become a needless factor.

Starting from scratch: Designing above-ceiling space for new construction

As with most all construction for any building type, it is certainly easier to keep above-ceiling spaces tidy and organized when dealing with new construction. When a completely new healthcare facility or department is built, there is great opportunity-especially in often-crowded back-of-house areas-to create zones and tiers in the ceiling cavity that allow for easy installation of equipment but also access for service personnel and contractors.

Installing systems in a hierarchical arrangement helps bring to the forefront the most often accessed and serviced systems while still retaining space for areas that need less attention. A space designed for convenient and intuitive access could resemble, from lowest to highest:

• Lighting zone

• Six- to 12-inches of cable tray

• Fire protection system piping

• Electrical and plumbing conduits

• Chilled water, hot water, rainwater, and sewer pipes, along with other large piping.

Common sense also is required during new construction. Developing zones in corridors and coordinating pathways ensures access to equipment. For example, avoid running large equipment over inaccessible ceiling materials such as gypsum wall board.

While many design and construction professionals employ traditional methods of coordinating ceiling spaces such as two-dimensional sections, elevations, details, and specifications/narratives, other facility designers and construction teams utilize leading-edge, three-dimensional design modeling to create new and effective ways for project team collaboration. These modeling systems provide much more flexible and creative ways for project teams to start “building” the space long before the first shovel hits the ground.

Whether space is designed and built with the aid of high-tech tools or traditional hand drawings, early planning to develop the spaces above the ceiling is an essential element of any successful design and construction project.

It is a routine occurrence and point of discussion among many hospital facilities personnel and design/construction personnel: walk down nearly any facility's corridor, pop up a ceiling tile, and it will often be nearly impossible to even take a peek inside because of the maze of equipment. But it doesn't have to be this way. It is possible to tidy up above-ceiling spaces while controlling project costs, recycling old materials and re-using space without requiring additional material.

Solving the problem

If owners, construction teams, and design professionals all make the time and spend the effort to understand exactly what is located above the ceiling-noting, for example, what equipment is spare and which conduits are empty-considerable time and money can be saved during future renovations.

Sending maintenance crews up into the ceiling spaces exclusively to document unused equipment involves time and cost that most facilities are unable to factor into a budget. However, when maintenance crews access ceilings on a routine basis to test fire smoke dampers, sprinkler valves, and pipe fittings, it is an opportune time to visually observe pathways, tag abandoned ductwork, and note equipment that could eventually be reused or removed. Then, when infrastructure upgrades occur down the line, work can be scheduled to include removal of the abandoned equipment.

Solving the crowded ceiling problem can also be addressed at a design level. Many mechanical, plumbing, and electrical design professionals will try to address a hospital's space issues early in a renovation's design phase by examining the facility's existing ductwork systems with the help of an in-the-know hospital engineering staff member. Taking a good look as a team before design even starts will help crews identify pathways, tag old and abandoned equipment, and pinpoint equipment that can possibly be reused. Then, design drawings can specify unused and abandoned systems. By the time the contractor receives the design documents, plans can be made to tag the unneeded items for removal or reuse prior to construction start.

Remove? Reuse? Recycle!

While much of the abandoned ductwork that lies above the ceiling is of no use in its present place, there may be opportunities to put it to use elsewhere in the hospital. If the material is still in good shape, consider reusing it on a future project. If the existing pathways are sound, perhaps they can be incorporated into your new project. If not, piping, metal, copper, wiring, and other equipment can be recycled off-site. Reusing or recycling material is a sound, sustainable practice. It often lessens construction disruptions and eliminates the need to purchase new raw materials.

In any building, real estate is at a premium and comes with a price. Nothing could be truer for a healthcare facility. Depending on where a facility is geographically located, hospital construction work could cost between $300 and $1,000 per square foot. Controlling costs is an ongoing challenge facing every facility in the nation, and by keeping ceiling spaces congestion-free on an ongoing basis, owners, designers, and builders will be able to facilitate growth, change, and further development without adding unnecessary equipment and systems. HBI