A Case Study in

Phased Hospital Renovation

Ted Kussow, PE, LEED AP BD+C – Applied Engineering Services

Jason King, DNP, RN, CENP – IU Health Morgan

Jeremy Putnam, CHC – F.A. Wilhelm Construction Company

Learning Objectives

• Learn the design and construction process that

enabled continuous occupancy of the facility

• Learn how communication between design

team, IU Health, hospital staff, and the local

community led to a successful project

• Understand how to upgrade a chemo mixing

room to USP-800 guidelines

Overview

• IU Health Morgan renovation from in-patient

hospital with ED to out-patient facility with ED

• Multiple departments/services renovated without

disruption of operation

• Improvements to exterior and interior wayfinding

Goals of Ambulatory Transformation

• Higher visibility of

high-use services

• Eliminate unnecessary

space

• Improve patient flow

Existing Site

North MOB

South MOB

Hospital

Ambulance Garage

Patient Tower

Facilities

Main Entrance

North

Original South Central Region Master Plan

New Ambulance Garage

North MOB

South MOBMain Entrance

Demo Building: Create Garden

North

New Concept: Phase 1B+2A

1st Floor

2nd FloorRelocate AdultPrimary Care

Relocate PediatricPrimary Care

3rd Floor

New Concept: Phase 2B

1st Floor

2nd Floor

Demo North MOB

Demo North MOB

New Main Entry, Façade, Urgent Care & Wellness

3rd Floor

New Concept: “Main Street”

New Concept: Improvements

• Creates a consolidated 1st Floor for Patient Services and

Primary Care

• Improves wayfinding and patient flow

o New main entry to the facility

o Creates central “Main Street” on the 1st Floor

• High visibility signage for Emergency Department entrance

• Eliminates North MOB and part of the Facilities Building

(30,000 SF)

• Consolidates Administrative Offices on the 3rd Floor

• New face and aesthetic for IU Health Morgan

• Addresses scope change of the elimination of Behavioral Care

New Concept: Site Plan

New Façade &Main Entrance

Demo North MOB

North

New Main Entrance

IU Health Morgan After:

IU Health Morgan Before:

Contractor / Owner / Design Team

Coordination

• Guaranteed max price

• Design meetings included the CM

• Owners meetings every other week

• Response time from A/E is critical

• Unforeseen items

Unforeseen Items

Project Phasing

• This project had multiple phases

• Patient flow is critical

• MEP systems must be designed accordingly

• Shutdowns/tie-ins scheduled with facilities

Phase Schedule

Air Quality / Negative Pressure /

Infection Control

• Infection control risk assessment

• Negative air pressure

• Dust control

• Dust walls – drywall vs. plastic

• Containment cart

Infection / Dust Control

Owner Move Scheduling

• Weekly meetings 4-6 weeks prior to

completion of each phase for each user group

• Produce responsibility matrix

• Detailed schedule for the move

• Re-use of existing equipment

Responsibility Matrix

ED Department Phasing

• MEP renovation and AHU replacement while

maintaining 24/7 operation

• AHU location

• Chilled water to new AHU

• ED expansion and temporary entrance

ED Department Phase 1

ED Department Phase 2

ED Department - After

Engineering Opportunities – HVAC

• Modernize and replace equipment

o Replace 26-36-year-old AHUs

o Change from constant volume to VAV

o Improved humidification

• Reuse equipment

o Existing duct that is reused is cleaned,

resealed, and reinsulated

o Owner equipment is moved and reused

Engineering Opportunities – HVAC

Computational Fluid Dynamics (CFD)

at the New Operating Room

Velocity Vectors – Laminar Flow

Computational Fluid Dynamics (CFD)

at the Glass Entry Tower

Engineering Opportunities –

Controls

• Modernize equipment

o VFDs on fans

o Web-based DDC controls

o Remove obsolete fire dampers

and smoke dampers

o Digital monitor of isolation and

operation room pressure

Engineering Opportunities –

Chemo Mixing Room

• USP-800

o Negative pressure requires walls to

deck or sealed ceiling

o Room with hood

o No HEPA requirement on room

exhaust

o Digital monitor of room pressure

Engineering Opportunities –

Med Gas

• Add WAGD to surgery and

relocate med gas nitrogen,

nitrous oxide, and carbon

dioxide to facilitate phasing

• Renovation plan allowed

existing duplex med gas

compressor and duplex

vacuum pump to be reused

along with much of the

piping system

• Separate equipment air

Engineering Opportunities –

Electrical

• Establish a separate life safety

and critical branch with new

electrical distribution

equipment to serve the

additions and renovated areas

• LED lighting

Project Energy Savings

• $63,000 annual energy cost savings for

18,000 SF reduction in building size

o ($52,000 electrical and $11,000 gas)

• $99,000 annual energy cost savings of

the completed building or 18%

o ($88,000 electrical and $11,000 gas)

Conclusion

• IU Health Morgan renovation from in-patient

hospital with ED to out-patient facility with ED

• Multiple departments/services renovated without

disruption of operation

• Improvements to interior and exterior wayfinding

• MEP systems modernized and improved

• Chemo mixing room upgraded to USP-800

Questions?

Ted Kussow, PE, LEED AP BD+C – Applied Engineering Services

Jason King, DNP, RN, CENP – IU Health Morgan

Jeremy Putnam, CHC – F.A. Wilhelm Construction Company