It is no secret that healthcare projects, and new hospitals in particular, are some of the most complex buildings being constructed today. Even more complex is the coordination of all the working systems and technologies that help hospital professionals save lives. With the mechanical, electrical, and plumbing (MEP) systems accounting for a large portion of the cost of a new hospital, the trend toward increased MEP training and coordination is dramatically growing. This type of synchronization is tricky stuff, and it can quickly spook good contractors and their supporting subcontractors.

The goal of this article is to point out some of the most common MEP coordination issues and offer some ways to overcome their murky challenges. So, here is a “Top Ten List” of MEP mysteries that are common in healthcare construction projects.

1. Above-Ceiling Coordination

“The lines shown on the MEP plans are representative in nature and do not reflect the exact route of the piping, ductwork, or conduits.” As ceiling plenums get shorter and engineering time gets more compressed, the MEP, stud, drywall, and pneumatic tube contractors need to be locked in a room and not let out until they have routes, sizes, and elevations of everyone's equipment worked out. This seems dramatic, but it works. A month of coordination and CADD drawings is less expensive than multiple field crews negotiating every corridor on every floor. A formal above-ceiling coordination process with all trades involved will guarantee better serviceability, more energy-efficient systems, better as-built plans, and faster project schedules.

2. Motor Starters

These represent a recurring coordination issue. Which trade wires the motors is never the problem, but the arguments about who provides them seem to create a never-ending debate. One might think that because motor starters are electrical devices, the electrical contractor would be responsible for them. Many would also presume that electricians have better “buying power” over mechanical contractors who are simply supplying the pump or fan. The electricians also mount and connect to and from the starters. The problem that arises when electricians provide the starters, however, is that the exact horsepower and amperage have not been determined. This is because the mechanical contractors' motors are usually not determined until the submittal process; in some cases this occurs when the motors show up on-site. This is obviously long after the electrical pricing has been determined. In the end, the best advice is to have the mechanical contractor provide the motor starters.

3. Diesel Fuel

How much will 20,000 gallons of diesel fuel cost in two years? Healthcare's need for backup electricity and heat usually means at least one large diesel-fuel tank to supply generators and boilers. Toward the completion of a project, those tanks must be filled for the generators and boilers to be tested. If the electrician provides the fuel, how much will the mechanical contractor use during the boiler testing? Conversely, how much fuel will the electrical contractor use during the generator testing? To compound the issue, speculating the cost of diesel fuel two or more years in the future is a risky proposition. We have often found that the best solution is for the owner to purchase the diesel fuel. This eliminates unnecessary confusion because the owner will likely have an ongoing relationship with a fuel supplier.

4. Acoustical Caulk

With the increased attention to patient privacy, acoustical caulk around all wall penetrations is common in exam and patient rooms. The time it takes to caulk around a pipe is directly related to the hole that's been cut in the drywall—i.e., filling a " gap costs a lot less than filling a 2" gap. With walls and pipe commonly being installed simultaneously, quantifying the size and number of penetrations is more of an art than a science. In most cases, it might be best to have the person who cuts the opening in the drywall also caulk it.

5. Drywall Access Doors

Any equipment hidden behind drywall needs to have an easy access point should service be necessary. The common approach to this is to have the MEP contractors provide all drywall access doors for their systems. Hopefully, the access panels provided by all the different trades are identical in appearance and keying. The drywaller would then naturally install them, right? The short answer is yes. The long answer requires more questions. If the drywaller is to install the doors, how many access doors should be included in the estimate? How large are these panels? How many of the panels are fire-rated? In summary, ensure that the drywaller is involved with the MEP contractors when it comes time to specify any access doors.

6. Framing for Roof Openings

The exact location and size of all the roof penetrations will not be determined until the trades are coordinated and equipment submittals are approved. Once that's done, all roof penetrations need to be reviewed with the contractor requiring the opening, to determine whether additional structural framing is required. This also helps verify the orientation and size. When the size and location have been determined, make sure everyone knows who is to cut the opening, who is to temporarily protect the opening from weather, and who is to hire the roofer to make it watertight.

7. Fire Protection Alarms and Detectors

Healthcare buildings require more sophisticated fire protection systems to protect patients and expensive equipment from an accidental water discharge. “Pre-action” systems and “gaseous” fire suppression systems are interlocked with smoke-detection- and fire-alarm–system wiring. This is done to verify the need to activate the fire protection systems. The entire fire alarm system may need to be installed by the fire protection contractor in order to maintain UL listings and insurance requirements, depending on the code authority and local fire marshal.

8. Smoke Dampers in Ductwork

The HVAC contractor provides and installs the smoke dampers, but do they need 120-volt power to operate? Do the electrical plans show all of these power connections? Are they on the emergency power system? No doubt, this should all be checked and confirmed with both subcontracting entities before the work begins.

9. Specialty Electrical Systems

Nurse-call, infant abduction, closed-circuit TV, music and paging, and telemetry systems are often not designed at the time of the electrical bid and may only be shown as conduit rough-ins for a future system. The owner may contract directly with a vendor for some or all of these systems. Special care needs to be taken to clarify who is doing what, where, when, and how any time there are multiple electrical contractors on a project.

10. Owner-Provided Equipment

It is beyond the scope of this article to attempt to describe the selection process of healthcare equipment that medical staff use on a daily basis to save people's lives. We can say with confidence, however, that it is very involved. The exact rough-in information, weights, size, and sometimes even the brand, are subject to change right up to the day the equipment arrives at the job site. Equipment that the owner provides—such as MRIs, CT scanners, surgical lights, medical-gas booms, sterilizers, or televisions—affects virtually all of the trades. A delay in finalizing the exact equipment will have a significant effect on how the trades provide rough-in supports and utilities. Obviously, this affects the cost and schedule, as well.

There's a natural, symbiotic relationship between the MEP trades. Electrical gear needs cooling, plumbing needs heating, fire protection needs water, and everyone needs electricity— all while competing for the same hidden space above the ceilings and in the shafts. Many times the dividing line that defines where the work of one contractor stops and where the work of another continues is subject to debate.

As with anything in life that requires more that one person's involvement, leadership and communication are the keys. There is no substitute for complete and cross-checked construction documents, thorough inclusion and exclusion lists that accompany bids, detailed scope reviews of bids, and field coordination with experienced team leaders from all trades. These guidelines may not solve all the mysteries with MEP coordination, but they will most certainly help reduce the disorder that impacts everyone. HD