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As COVID-19 started sweeping across the country and flooding emergency rooms with severely ill patients, hospital systems from coast to coast had to take swift action to deal with the immediate influx of people as well as plan for the potential of overcrowded facilities. 

CoxHealth  

With the rapid spread of COVID-19, CoxHealth in Springfield, Mo., approached JE Dunn to explore options to expand capacity should they experience a surge in ICU patients. From converting empty shell space in the hospital tower all the way to giant tents in the parking lot and possible existing parking garage space, the team walked through a variety of options and ultimately landed on using the fifth-floor shell space. “We walked the facility with the team to determine what not only worked best, but also to get an idea of timeline for each option,” said Senior Project Manager Mike Trehey. “Ultimately, it was determined that utilizing the existing shell space would serve more patients and be the best option for the facility’s staff.”

Once the team decided to move forward with converting the shell space, we took existing site conditions and dropped them into a floor plan and determined that we could accommodate 51 ICU beds in a ward setting, each with a dedicated headwall. Because of the speed and urgency of the project, the team worked from a floor plan rather than architectural drawings, creating some unique planning challenges. “Work literally changed by the hour, as everything was very fluid,” said Trehey. “We huddled with doctors, nurses, engineering, IT, and other groups every morning to determine the plan for that day—and that was bound to change as the day progressed. It wasn’t uncommon to change course while someone was swinging a hammer, as we were all working in real time.”

Outfitting the space with headwalls, beds, and other equipment was not the only piece of the puzzle; systems required upgrading and the easy transmission of the virus had to be considered as well. In addition to upgrading the existing mechanical system and bringing medical gases into the space, the team installed exhaust fans on the roof to create a negative environment to prevent infectious diseases from getting outside of the Covid unit and potentially migrating to other sections of the hospital. “The project required extra considerations due to how easily COVID-19 is transmitted. The ICU space itself was set up in a ward-style layout, but we also incorporated hand-washing stations and specialized group work rooms, staff showers, PPE station, soiled rooms, etc. where they could wash off and leave contaminated materials before exiting the unit,” said Trehey.

From start to finish, the project took 14 calendar days to complete, but this would have been impossible without buy-in from the State of Missouri and the City of Springfield. The city assigned the project a dedicated inspector who came first thing in the morning and again each afternoon, allowing the team to make immediate adjustments if necessary to keep things progressing quickly. “The frequency of the inspections was integral to completing this project so quickly,” said Trehey. “The effort and collaboration between the hospital, trade partners and the work of all the men and women who helped make this happen was impressive as well.”

Together, the team installed more than 30,000 lineal feet of electrical wire; 40,000 feet of low-voltage cable; and over 6,000 lineal feet of medical gas piping—all braised, pressure tested, and certified within that 14-day timeframe. CoxHealth CEO Steve Edwards walked the project with Missouri Governor Mike Parson, who repeatedly praised the hospital for its efforts and emergency response. The governor mentioned that seeing the team build the new ICU in a matter of weeks confirmed in his mind that the state had a fighting chance against the outbreak. “I think it gave us all relief. That was one of those ‘wow’ moments,” said Parson. Hospital staff and project team members shared that wow moment and admiration for the team that worked together to keep the community safe. Trehey shared, “The numbers and turnaround time are impressive, but the fact that most of the work was done at cost or with donated materials is a testament to the amazing partners and their commitment to the community.”

Allina Health 

The leadership of Abbott Northwestern Hospital, part of Allina Health, along with their emergency planning teams recognized early on that the approach would be outside the normal process in that what would normally take weeks, if not months, of planning had to transpire as quickly and safely as possible to prepare their facility spaces. To achieve this, Allina Health in Minnesota took a different approach at the hospital to prep for the COVID-19 surge, though the end goal was the same—more ICU-capable rooms in a rapid timeframe. Like the response from other health systems nationwide, the response had to be swift and it had to incorporate plans for multiple facilities while following guidelines to keep staff and patients safe. Abbott Northwestern Hospital already had multiple major construction projects underway and recognized that it was necessary to re-allocate the expertise and resources of the general contractors and subcontractors to shift their focus to the virus response. Along with their in-house facility staff and engineer consultants, their project management team engaged construction partners to implement the quickly developed plans, schedules, and budgets to add additional ICU and Medical Surgical room capacity and modify the HVAC systems to provide negative airflow to protect our medical staff and patients.

The team started early March the 642-bed facility was equipped with 74 ICU rooms with 17 set up for negative isolation, so rather than convert new space or erect temporary overflow, Allina elected to outfit current rooms with the proper equipment and setup. Starting with 12 rooms in one of the octagon-shaped pods of the West Main Building, the team began by running new critical power electrical circuits and making aluminum window panels where they hooked up negative HEPA filter air machines and exhausted filtered air directly to the outside. “In addition to upgrading materials to prevent further infection, each room required pressure sensors at the door,” said Superintendent Jim Schneider. “We made each room negative pressure as well as the main core area to prevent any contaminated air from circulating to other areas of the hospital.”

From initial meeting to review options to conversion of 12 rooms, the first project took 8 calendar days. The team then moved on to the Piper Building to transform 30 more rooms. “The floor was set up as five different six-bay pods,” said Schneider. “We went one by one to make the rooms negative pressure and ICU capable. In a matter of 6 weeks, we converted 144 rooms in 4 different buildings —100 ICU with negative pressure and 44 negative pressure rooms for testing.”

While crucial to handing an influx of patients, the rooms were not the only areas that required preparation. The emergency department located in the Heart Hospital had nine negative pressure rooms, so the team added eight more, nearly doubling their capacity for intake in the ED. In addition, the team converted conference rooms near the main lobby to negative pressure areas. “They will use the main lobby as a triage overflow corridor to get to the overflow triage rooms. JE Dunn will install Starc wall panels to separate the main lobby area that will be used as a Covid corridor from the rest of the main lobby with negative pressure. “So the public is always protected,” said Schneider.

Using a measured approach not only allowed the team to methodically equip each area based on their needs, but it also allowed trade partners and the client to determine a plan of action quickly. “These projects were unprecedented in both their speed as well as process,” said Project Manager Matthew Ecklund. “That speaks to the importance of our trade partners as well as the client, because we can’t do this alone; their trust and willingness to approve the plan are why we were able to complete these projects as fast as we did while following guidelines for infection prevention during construction and turning over spaces that improve safety and outcomes for patients and staff.”

The Ranch 

Building out shell space and converting current space are generally the best solutions in existing healthcare facilities when anticipating census increases, but when faced with all regional healthcare facilities potentially being over capacity, the US Army Corps of Engineers needed a statewide solution. In need of overflow space and in anticipation of the need for COVID – 19 care exceeding Colorado’s existing number of hospital beds, the Army Corps of Engineers began exploring empty buildings in the region for suitability to build an Alternate Care Facility.  They decided to convert The Ranch Events Complex in Loveland, Colo., a multi-facility complex that supports everything from AHL Hockey and rodeos to concerts, 4-H competitions, and car shows into a 1,600-bed temporary care facility for ambulatory COVID-19-positive patients. They opted to use the First National Bank exhibit halls, McKee 4-H building, indoor horse arena, and rodeo pavilions. The indoor arena came complete with the dirt floor—called footing—which presented one of the first challenges of removing the footing and pouring a new concrete floor.

When tasked with responding to an RFP in 24 hours requiring a proposed team, labor rates, and a technical approach, AECOM teamed up with JE Dunn, Apollo Mechanical, and Encore Electric to submit a proposal for the Army Corps of Engineers. “Once we were awarded the project, the team had 24 hours to mobilize onsite with the core team to commence work,” said Vice President Jason Oltman. “We walked the site with representatives from the Corps and approximately 50 individuals from AECOM, JE Dunn, and our trade partners and immediately started putting a plan in place to install 1,600 care units in 21 days.” The Corps of Engineers’ initial assessment outlined a narrative of bed space requirements including complete medical gas system, nurse call, clean storage, pharmacy space, resuscitation rooms, staff and patient restroom and shower facilities, all requiring emergency power back up. “Our team went from introductions in the parking lot on a Thursday morning to working hand in hand on a design/build plan that afternoon; I have never seen anything like it.”   

The first task was to remove the dirt floor in the arena and prep it for concrete. Larimer County and employees of The Ranch removed four inches of the footing for storage and replacement on the first day. Upon removal of the footing, the team poured a 60,000-square-foot concrete slab on grade; almost 900 cubic yards in two days. “We made a phone call on Friday and had a concrete crew, pouring that Saturday and Sunday of Easter weekend.” Room layout and material procurement started immediately with all racing to acquire building materials before the holiday weekend. With the leadership of the Corps of Engineers, a fully integrated and collaborative design process, and hard work from the team and skilled trades, nearly 200 beds were approaching substantial completion by the following Thursday in the First National Bank exhibit halls after just one week of design and construction time.

With the ongoing evaluations of the state healthcare system’s ability to accommodate the impeding surge of COVID -19 patients, it was decided to hold the project to 400 beds, reduced from the original 1,600. Although an accelerated and unconventional project, the team was still able to fine tune the headwall prefabrication process and was on track to complete all 1,600 beds when the scope was reduced.  The Corps of Engineers and the construction team stands ready to complete additional beds, which will hopefully never be necessary. “In a strange time when we define work to be essential or not, this really felt essential,” said Oltman. “It’s the first time in my career I have ever built something that I hope never has to be used.”

SLAC 

The COVID-19 pandemic forced companies and owners to quickly determine contingency plans as a reaction to the impending crisis. One, however, switched gears to join the fight as part of the solution. When many construction projects had been shut down in the state of California, SLAC National Accelerator Laboratory reallocated resources to help. The Department of Energy asked SLAC to perform research studying how cells react with COVID-19 proteins to better understand the virus at hand.

In order to use the new technology, some existing systems required an upgrade. “The current arrangement would not support the specified of equipment the lab was getting, so we had to upgrade the electrical infrastructure to power the instruments,” said Project Engineer Sam Hughes. Scoped and priced in three days, the team mobilized immediately and completed the vital project in three weeks. “We’re extremely proud to team up with an institution like Stanford to support research of this global pandemic,” said General Superintendent Scott Pashman. “Understanding how this virus works is essential to finding a cure that will ultimately save lives, so it’s very rewarding to be involved in such an important undertaking for the sake of public health.”

Prepared for the Future

Though different, all responses have a common undertone—dedication to communities and a commitment to getting through the crisis together. The pandemic hit the US quickly, but the response was equally as fast and impressive thanks to the resolve of owners and contractors, leaving a more prepared health system in its wake.