New Study Shows How Hospitals Can Reduce Energy Use by Up to 60% with Little Additional Capital Cost

Hospitals are the second most energy intensive building type on the planet. According to the World Health Organization, the U.S. health sector’s use of electricity adds over $600 million per year in direct health costs and over $5 billion in indirect costs. Research also shows that healthcare em-ployees, who often work long shifts in spaces divorced from natural daylight, face a higher than average risk for asthma and other respiratory-related diseases.

Energy reduction is one of the cheapest and easi-est ways for hospitals to achieve an immediate cut in healthcare costs. It also enables the retention and recruitment of top physicians by creating a healthier and more enticing facility to work and receive care in. However, hospitals interested in greening new facilities are often reluctant to implement significant energy reduction strategies because of the perceived risk that would result from infrastructure changes. This concern, along with a desire to profoundly lower carbon emissions in hospitals, led to a three-year study resulting in a series of design solutions that can reduce energy by 60 percent for less than two percent additional capital cost.

Through a process of energy simulations, iterative hourly load testing, prototyping, cost analysis and

peer review, researchers from the University of Washington’s Integrated Design Lab (UW IDL), NBBJ, Solarc Architecture and TBD Consultants identified a more maintenance friendly, cheaper and integrated process that can be incorporated into new hospital designs today.

This article is a snapshot of the key findings from the study, including an early project case study that illustrates many of these ideas in action. The goal of this research report is to provide hospital own-ers, architects and engineers with the latest tools available for moving energy efficiency goals forward with the ultimate goal of building carbon neutral hospitals. It was also our intent to provide rigorous research that high energy efficiency goals do not require substantially increased project capital com-mitments.

Healthcare Costs Dominate HeadlinesFacing steep budget deficits, hospitals around the world are asked to do more with less, and nowhere is this more true than in the United States, where Congress recently passed a law that could provide 32 million uninsured Americans with coverage. Yet the increased cost of medical care is not just a problem in North America. Governments from Europe to Africa see population growth and an ag-ing elderly community as a recipe for expensive care and emergency department overcrowding.

Duncan Griffin RA, LEED® AP

The healthcare architectural industry has attempted to help hospitals across the globe tackle this challenge by integrating high performance design solutions that increase through put and cut costs while maintaining the highest level of care. At NBBJ, we have consis-tently found that one of the cheapest and most im-mediate ways to do this is by reducing energy. In fact, the research team finds the aforementioned energy-reduction design solutions can save medium-sized hospitals in the Pacific Northwest over $700,000/year or nearly £450,000. Parameters of the StudyOur team of experts also includes Cameron MacAl-lister, Mahlum Architects and Mortenson Construc-tion. The most salient outcome of this study is the identification of an integrated process that brings together architectural, mechanical and central plant systems to deliver significant efficiencies (see accom-panying infographic). The biggest breakthrough was addressing the re-heating of centrally-cooled air. It is the largest contributor to wasted energy in hospitals, representing around 40 percent of annual heating energy usage. In order to reduce re-heat, a series of

integrated strategies are necessary to satisfy comfort needs. This bundle of strategies include solutions like solar and daylight shading controls, in-room environmental tempering, outdoor air supply and heat recovery, and wall and window values. These strategies also suggest other synergistic processes, like vacant room air control and thermal energy storage, which work together to lower loads and preserve recovered energy.

In this study, two architectural hospital prototypes were developed to a schematic level of detail. One prototype, “Scheme A,” has a post-war hospital form with a five-story patient room tower centered atop a two-story tall and very deep-plan block of diagnostic and treatment (D&T) spaces. The other prototype, “Scheme B,” has a thinner, more articulated D&T base platform, allowing greater potential for daylight, views and natural ventilation. Both architectural schemes were able to meet the 60 percent energy reduction goal for the 2030 Challenge. This research and design exercise has shown that there is little cost implication for high levels of energy efficiency with an overall premium of approximately two percent

of the total project cost, a premium reconcilable through the prioritization of project specific goals and outcomes at the schematic design phase, or easily recaptured in a short-term simple return on investment.

An Integrated Design Process Drives Results Many of these concepts require departures from standard design and operations practices in hospitals, but they are not necessarily new design ideas, just new to commonplace hospital design. What makes the strategies novel is the way they are bundled together using an integrated design process. After several years of research we have come to realize that significant energy savings are only possible through close and continuous integrated efforts from the earliest stages of project planning, with involvement from core planning,

Daylight And Solar Control

Wall & Window Insulation + Tightness

100% Filtered Fresh Air, Warmed/Cooled With Departing Air

60%ENERGYUSEREDUCTION

Reduced Air Supply/ Lighting In Vacant Rooms

Separate, DistributedAir Supply and Heating/Cooling

Heat Recovery Equipment

Ground-SourcedHeat Exchange

design, construction, public utility and facility operation team members. When everyone is around the table, from the very beginning, we can leverage the full spectrum of perspectives to create a holistic approach that decreases energy and avoids added risk for the lowest capital cost.

A New Hospital Benefits – Saves Energy and Money at No Addi-tional CostThe University of Washington Medical Center Montlake Tower project in Seattle, Washington consists of a number of site modifications and an ultimate building construction of an eight story ad-dition to the south side of the existing medical cen-ter. The project also includes a seamless expansion to inpatient imaging and the surgery department; a 50 bed private room NICU; a 30 bed oncology unit; and three shelled floors designed for a future build out of up to 32 medical, surgical or ICU beds per floor.

Montlake Tower was one of the first projects to implement these strategies, even as they were being developed. The team worked collaboratively to develop an approach consistent with the care of acutely ill patients served by this facility. Patient comfort was addressed through the re-orientation of patient rooms, with sunshades on windows to reduce heat gain and glare, and a very efficient environmental comfort system. To address energy use, the most significant savings came as a result of the use of heat recovery chillers, along with the use of LEDs as the primary lighting source in patient rooms and reduced air conditioning and lighting in vacant rooms, with particular attention paid to operating rooms.

The UWMC expansion project is expected to be completed in July 2012 and at ultimate build-out will outperform Seattle’s energy code by 30 percent, and the national baseline code (ASHRAE 90.1) by 33 percent, saving the UWMC approximately $200,000 or £130,000 in annual energy costs.

Next Steps: A Nationwide Model for Building Healthier HospitalsIn June, our team was awarded a $1.2-million grant by the U.S. Department of Energy to take our initial findings and build a nation-wide model for reducing energy across six climate zones. We anticipate our next phase of research will lend itself to significant energy reduction in not only these U.S. cities, but other cities across the globe with hospitals in similar climate zones.

As we move forward with our research and continue to build a portfolio of successful projects, we antici-pate these integrated strategies will become more and more mainstream – eliminating the fear of unknown risks and validating the expected benefits. Hospitals are an essential community resource and this study offers a way to keep these critical enterprises viable by cutting bottom line costs and improving patient and staff environments. It’s a win-win scenario for patients, their providers, and our planet.

The study was presented at the annual CleanMed conference in May 2010. Download the executive summary at www.nbbj.com

Duncan Griffin is a senior associate at NBBJ, a global architecture, planning and design firm with offices in the Unit-ed Kingdom, North America, the Middle East and China. Its healthcare practice is consistently ranked among top five in the world by Modern Healthcare and has collaborated on six of the top 10 US News and World Report Honor Roll Hospitals. Across 5.7 million square feet of healthcare facilities currently in design, NBBJ is on track to save clients a projected $3,845,000 in annual energy costs upon facility completion.

Duncan Griffin

RA, LEED® AP

Utilizing local utility incentives, the reductions were achieved for zero additional capital cost.