Medical Construction & Design

JUL-AUG 2018

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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MCDM AG.COM | J U LY/AUGUST 2018 | Medical Construction & Design 55 the only choice was to place the imaging department on an upper fl oor. The ground fl oor of the existing building was only a few thousand square feet be- cause it was designed on stilts to allow for ground-level park- ing. Only the main lobby and check-in could be located in the available space. In addition, the fl oor-to-fl oor height would not allow for the healthcare-sized mechanical ductwork to be installed around the shielding. The unconventional decision was to place the imaging center on the top fl oor of the four- story building, which allowed the roof to act as the mechani- cal plenum with the ductwork running on the outside and the quench vents subsequently shortened to a single story. The MRIs were installed on vibra- tion pads and special insulation and ceiling materials were used on the fl oor below to prevent sound transmission. The happy consequence of these structural and facility decisions was that the space had high ceilings, with bright windows and a beautiful view of the surround- ing landscape. The MRI rooms themselves have windows and natural light. During the design process with the Cancer Center at Beth Israel Deaconess Hospital- Needham in Massachusetts, it was important to the director of the cancer program that the on- cology and radiation treatment occur on the same level, so that real-time communication be- tween both types of treatment could be off ered. Typically, the linear accelerator used for radiation treatment is located on the ground fl oor or base- ment level. The infusion bays, however, are usually located on a higher fl oor to take advantage of the natural light and garden view. Moving the infusion bays to the ground fl oor was not an option because of the patient- focused design that both the owner and architect wanted to achieve, so the architect sug- gested the unthinkable: that the LINAC be located on the upper level, directly adjacent to the infusion bays. To allow for this unconven- tional decision, an above-grade LINAC vault was designed with three- to six-foot-thick poured concrete walls and a seven-foot- thick concrete slab to provide the necessary shielding. While the space below was not usable due to the seven-foot clear- ance left over after the slab was installed, the trade-off was worth it in the end. The design created a Lean and positive patient experience and the time saved during each appoint- ment allowed the facility to see additional patients each day. Although this was a cost item to the budget, the center soon started recording outstanding patient satisfaction. Going mobile Another typical installation solution for heavy MRI equip- ment is to locate them in a mo- bile trailer accessed via a bridge or mobile stairs. These move from site to site if not required for use every day. This solu- tion, however, is not ideal long term in a large hospital with regard to patient satisfaction and effi ciency. Offi cials at Lahey Hospital and Medical Center in Burlington, Massachusetts were looking to install a fi xed MRI to improve this situation for their patients. To achieve this on schedule, they needed an unconventional solution that did not necessitate a lengthy zoning and permit process for a new addition. Rather than adding on a new MRI space, they sunk the existing trailer into a pit that lowered the fl oor to be level with the main hospital. A heated concrete slab was required for snow melt in the hearty New England winters, but the benefi ts of this solution far outweighed the unusual requirement. Sometimes, the design solution to a potential issue can seem so simple, yet take time to reveal itself. In the case of Addison Gilbert Hospital, which was built adjacent to a Civil War-era cemetery in Gloucester, Massachusetts, the scenery was the issue. For some patients and visitors, depend- ing on what room they were in and on what side of the hospital they were located on, their view gazed out on the well- maintained yet still foreboding graveyard — not quite the view one usually wants to picture, especially as an oncology pa- tient. However, through some thoughtful but straightforward design modifi cations, the place- ment of the infusion chairs was repositioned so that the angle of the view was raised just slightly, enough that instead of the cem- etery, people gazed at the idyllic coastline of the North Shore of Massachusetts. The "given" solution is not always best in a healthcare environment where a greater emphasis is put on the patient experience and Lean methods. An unconventional design decision implemented at the beginning of a project can have a lasting impact over the many years that a facility is serving the community. Tony Cavallaro (president), William Epp (associate principal) and Susie Festel, NCIDQ (lead designer, associ- ate/interior architect), all represent JACA Architects. At Winchester Hospital Imaging at Unicorn Park in Woburn, Massachusetts, the unconven- tional decision was made to place the imaging center on the top fl oor of the four-story building. The decision to move the linear accelerator (pictured here) at the Cancer Center at Beth Israel Deaconess Hospital-Needham to an upper level was unconven- tional, but resulted in outstanding patient satisfaction. > Left: An existing mobile MRI trailer was sunk to be level with the main hospital at Lahey Hospital and Medical Center in Burlington, Massachusetts.

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