As part of the HEALTHCARE DESIGN.10 conference held November 13-16, 2010, in Las Vegas, attendees were invited to participate in one of seven tours taking place in new and recently renovated healthcare facilities around The Strip. One of those projects, University Medical Center of Clark County, Nevada, was featured in the Summer 2010 issue of Healthcare Building Ideas, a sister publication to HEALTHCARE DESIGN. To accompany our conference coverage, HEALTHCARE DESIGN is featuring the article in its entirety to allow those unable to make the tour the chance for an inside look at how the facility put a long-term strategy in place to not only continue existing services but replace outdated and inefficient spaces.

As a small hospital built in 1931, what is now University Medical Center (UMC) in Las Vegas, Nevada, boasted just 20 beds total, and a staff that consisted of only one doctor and one nurse for more than two years. Given its unusually small capacity, the facility was hard-pressed to serve the surrounding Las Vegas community that was rapidly growing in population size. In 1943, ownership of the small hospital was transferred to the Federal Works Administration that proceeded to invest more than $450,000 in new construction for the facility. Immediately following World War II, Clark County purchased the hospital from the federal government for $182,000.

Renamed Southern Nevada Memorial Hospital in the 1950s, the facility quickly began to expand-a $1.6-million, three-story circular wing and a $590,000 outpatient building were added to the hospital in the early 1960s. The 1970s gave rise to a six-story medical education center, a seven-story patient tower, a new obstetrics unit, and an enlarged burn unit. In 1986, the hospital's name was officially changed to University Medical Center of Southern Nevada.

Thinking ahead…

Fast forward to the 1990s, when UMC's ownership decided to give the dated facility a facelift, while unifying the overall healthcare campus with a more modern architectural style. The facility Master Plan, approved in 1999, outlined the development and construction of more than 250,000 square feet of new space, built in five different phases. According to Christopher Larsen, a principal with Dekker/Perich/Sabatini, the $86-million plan mapped out several key goals, including building in space to grow with future service demands; improving access and customer service; re-orienting facilities to improve overall operational effectiveness; developing a long-range growth plan; maximizing funds for patient care areas; and re-orienting the campus to provide for increased ambulatory care services to the county-owned facility.

“Although no specific style was determined during the Master Plan, the goal was to design new facilities that would complement the existing buildings that remain, as well as to create an improved image for the hospital that would help attract new patients,” Larsen says. “The existing campus included buildings and additions from the 1940s through the 1990s. The older, underutilized, one-story buildings were demolished as part of the implementation of the Master Plan.” The Master Plan encompassed five different phases, according to Larsen:

  • Phase One: The completion of a $4-million, 30,000-sq.-ft. outpatient clinic, as well as the addition of a generator building and the expansion of the Central Plant for a total of $2 million.

  • Phase Two: Construction of a $2-million, 172,000-sq.-ft. four-level parking structure.

  • Phase Three: A $16-million, 55,000-sq.-ft. Emergency Room/Intensive Care Unit/Critical Care Unit addition. This structure provides more than 50 new ER beds and/or exam rooms, which doubles the facility's original capacity. The ICU totals 16 beds, and the CCU totals 20 beds.

  • Phase Four: Completion of a $12.5-million, 35,000-sq.-ft. Ambulatory Surgery addition, as well as a remodel. This two-story addition includes six new surgical suites.

  • Phase Five: The $56-million, 175,000-sq.-ft. Northeast Tower and Southeast Expansion.

The vast size of the project and lengthy schedule to completion required extra effort on the part of the entire team to ensure existing patient care was not interrupted and the hospital staff was not inconvenienced. “The architect and contractor approached and carried out the work giving careful consideration to the continued operation of the hospital,” said William Karren, of Lochsa Engineering. “We cooperated and assisted as required during construction to facilitate their plans. The contractor accomplished this by following phasing of the construction and building certain areas of the building at scheduled times so that hospital operations could continue throughout construction.”

A new identity

Prior to the inception of the Master Plan, the UMC campus had been a mass assortment of different architecture styles added on over the course of decades. Phase Five of the plan in particular was designed to address the facility's need for a uniform architectural style that would be inviting for both patients and staff.

“One of the biggest criticisms of the Medical Center had been the lack of entry identity and a sense of welcoming,” says Larsen. “Hospitals are daunting places in themselves; however, when patients and visitors cannot find the appropriate entry and feel they are in a large, confusing place, a difficult experience is made worse.

“The new main entry, along with the new re-aligned central corridors, now provides a facility that is easy to navigate and understand for the patient and visitor. The maze of endless winding corridors along with random department placement has been eliminated,” he says.

To that end, Phase Five allowed the new entry established in the Northeast Tower/Southeast Expansion to follow an open mall-type design. “Designed as a mall concept, the lobby provides easy wayfinding for patients and visitors to the admitting department, the outpatient pharmacy, and a new cafeteria,” Larsen says. “Much like shopping at the mall, the visitor and/or patient can easily locate those departments most visited along the mall-like entry lobby.

“The new entry's design is a dramatic change from the old entry. The new entry is a light-filled, two-story space that includes not only large windows, but also skylights to bring light deep within the main entry. The use of the contemporary, large ‘mall-like’ signage, familiar to all visitors along with a line of palm trees that bring the natural landscape from the exterior inside, help make the space open and inviting. The color pallete for the new entry along with the entire addition is in warm beiges, greens, and rusts, a sharp contrast from the previous UMC color pallete of grays and blue.”

The varying ages of the hodgepodge of buildings on the UMC healthcare campus also posed additional challenges to the entire team on this project, from design, engineering, and construction perspectives. “This project had unique challenges because it was a hospital, and because the original structure had been modified and added to numerous times over the years. Some previous structures were so old it was sometimes difficult to find drawings. Several times we discovered that existing structure did not match what older drawings indicated and we had to make modifications as construction progressed,” Karren says.

To offset this problem, the team planned ahead and built in coverage within the overall budget. “We encountered many ‘hidden conditions,’ existing conditions that didn't m
atch hospital-provided record drawings-if they existed at all. We included contingencies in the budget to account for these uncovered conditions,” says Larsen. Another considerable test the design team faced on this project was the overall timetable itself given the Master Plan took more than 10 years to completely implement. “During that time, healthcare has changed and progressed. Additionally, department heads changed, as did thinking at the hospital. Thus, during the last few years, we have had to modify original department plans and designs to accommodate these changes,” Larsen says.

Unifying landscape

One unique element in the UMC project was bringing a landscape architect to the team very early on in the design process in an effort to use the outdoors as a means to further fuse the entire healthcare campus together, while cheering patients at the same time. “The intent of the landscaping is to complement the unifying of the buildings, as well as to enhance the appeal of the landscape by providing a landscape that has a common theme and that is water efficient,” says Richard Marriotti of MLA.

An array of different flowers was incorporated into the flowerbeds along walkways to greet patients, as well as a healing garden boasting a unique water feature that leads to the hospital's main entry. “One of the unique elements of the landscape is the addition of ‘happy flowers’ at the beginning or end of pedestrian walkways. These happy flowers are Day Lilys; we also selected a bright yellow color for an even more pleasant look. These flowers are placed in such a way as to be viewable to pedestrians, patients, and visitors as they walk and experience the landscape,” Marriotti says.

Minimal maintenance is always significant for any landscape and this project was no exception, according to Marriotti. “It has been said that a good landscape is like a three-legged stool, and all three elements must be in place for a good, healthy landscape-a good design, a good installation, and good maintenance,” he says. “We always design for ease of maintenance by spacing most of the plant material in such a way that when the plant is mature it will fill in its intended space and not need a significant amount of pruning to look good and function properly in the landscape. Even some of the plants that we have spaced a little closer together are intended to grow together to form an informal hedge.”

The five-phase UMC project was completed in December of 2009. HCD

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Healthcare Design 2011 January;11(1):44-50