- THE MAGAZINE
In May 2008, Aspirus Wausau Hospital selected the team of Miron Construction, Inc., Plunkett Raysich Architects, LLP, and Henneman Engineering, Inc. to design and construct a newborn intensive care unit in a shell space one floor above and adjacent to the existing hospital Birthing Center. The existing NICU was constructed in 2004, and consisted of four beds located adjacent to a shared nursery space. Due to increasing patient volumes, the existing space was no longer able to adequately serve the community. The design build team was charged with creating a new patient environment that would become a state of the art model for the region, demonstrate sustainable design principles while pursuing LEED certification, and employ 3D visualization tools to encourage user input during the design process.
The project program consisted of 14 patient beds, staff support areas and public and family accommodations. The shelled space was L-shaped, determined by the footprint of the inpatient nursing unit on the floors below, and had panoramic views of Rib Mountain to the south. The use of existing shelled space had been originally planned for expansion of adult patient rooms. Creative design strategies resulted in an efficient, state-of-the-art floor plan that overcame predetermined locations of existing windows, columns, and mechanical shafts. In addition to providing space for expansion of the program, two rooms were designed with two headwalls, so that twins could be accommodated in the same room, and one of these rooms has a door to the adjacent single patient room so that the two rooms combined can serve triplets.
A single family room model was chosen to minimize risk of infection. Guidelines defined by LEED-CI were exceeded in many cases by following the draft guidelines of LEED for healthcare, which mandated interior finish materials with more stringent VOC limits complying with Greenguard for Children and Schools certification. Daylighting, typically considered an amenity, needed to be carefully controlled to not become detrimental to the development of the patients. Materials also had to be selected to maximize sound absorption, since a noisy environment can also be harmful and lead to long term negative health effects. A sound monitoring system was installed in order to ensure noise levels were minimized. Even the cubicle curtain track was specified based on its quiet operation. The soft color palette chosen was intended not only to be soothing for the newborn patient, but also for the family and staff involved in their care under stressful conditions.
In order to support an accelerated design schedule, the design-build team held a series of five – two day design charrettes with participation of hospital nursing, medical and facilities staff. The general agenda was to develop the project program, schedule, budget, interior finish selections and sustainable design approach concurrently with space planning. The floor plan was developed in Autocad and modeled using SketchUp. After the first day, the architects would refine the design so that user input on changes could be reviewed at the next day’s meeting. The SketchUp model was shared with staff to encourage user feedback as the design developed. Prior to start of construction, the entire floor plan was laid out with tape so that staff could visualize actual size and relationship of spaces. A patient room was fully mocked up in place so that views from the corridor charting station, headwall arrangement, position of fixtures and equipment in room could be optimized. These proactive strategies dramatically reduced owner requests for changes during construction. In fact, final project costs were 18 percent below original budget estimate, in large part due to efficient planning and execution of the work. Accepted change orders (excluding owner direct purchases) totaled 0.42 percent of the construction budget.
Whenever available, the design team specified products that were produced within 500 miles of the project site. This was not only done to meet the requirements of LEED-CI MR Credits 5.1 and 5.2 for regional materials, but also was intended to keep construction dollars in the local economy when possible. In fact, 35.26 percent of the construction value of materials was documented as meeting these LEED criteria, far in excess of the minimum 10 percent required to achieve this credit.
During the construction process, the exchange of electronic files for submittals accelerated the exchange of information, reduced errors, followed the sustainable mandate by reducing paper consumption and shipping, and reduced the need for long term paper record storage.
While overall energy performance is subject to performance of existing building enclosure and mechanical systems constructed in 2005, performance was optimized using individual room controls which are monitored remotely via the hospital’s building automation system. LED lighting was used in public spaces to reduce power consumption. The project is currently part of U.S. Department of Energy’s Building Technologies Program for Hospitals as a case study on methods to reduce water consumption at little or no increased cost to a project.
This project is the only NICU in the area to offer a private room model of care, and promotes a healing environment for baby and family by providing privacy, maintaining confidentiality, and encouraging parent – child bonding. Research has proven that this concept leads to improved outcomes for premature and critically ill babies. The unit’s environment offers natural light, but allows staff to control sound and lighting levels that can be over-stimulating to the patients. Feedback during post-occupancy surveys indicates a high level of satisfaction with the new unit and how it functions for the newborns, their families and staff. There has been no staff turnover since the unit opened. In its first fiscal year, Birthing Center deliveries increased 14 percent over projections, believed in part attributable to expectant mothers choosing the hospital because of the NICU in case of complications. Productivity measures are also improved, in that patient care staff levels formerly required in the four bed NICU are still sufficient to staff the new fourteen bed unit.
Project Team Members
Owner: Aspirus Wausau Hospital – Gary Wojciechowski – CHFM, LEED-AP, David Bosio – LEED-AP, Susan McDonald, BSN
General Contractor: Miron Construction Company, Inc. – Michael Murphy, Heather Stoffel – LEED-AP, Ted Siewert
Architect: Plunkett Raysich Architects LLP – Michael Scherbel - AIA, Michael Schaefer – AIA, LEED-AP, Renee Moe, Shane Fletcher
Interior Designer: Plunkett Raysich Architects LLP – Paulette Billington
Engineer: Henneman Engineering, Inc. – Jason Allen, William Peden, Erv Henke
LEED project administrator: Miron Construction Company, Inc. Theresa Lehman – LEED-AP