Add a Lesson Learned

Month: July 2020

Virginia State Inspection Process

Facility name: Reston Hospital Center

Project name: RESTON-Administrative Support Space Reno & Dining
Location: RESTON, VA
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 0854000033
Lesson Learned number: 99
Impact: Schedule, Quality


Lesson Learned/Best Practice

VDH/CMS inspection process throughout the course of the 2 year project at Reston Hospital has varied. During construction of the vertical expansion it was indicated that a state fire marshal inspection was only required if the construction was tied to additional beds, or a CON. Toward the end of construction of the bi-plane project the facility indicated VDH/CMS would need to come in for an inspection even though it did not meet the previous criteria. While the inspector was onsite, he indicated they needed to come out for an inspection during any construction project whether clinical space or not.


Suggested Actions for Future Projects

Suggest a conference call with facility and state contacts they work with to determine what is required per project. Identifying too late in the construction process can often impact turnover to the facility and rework for construction to re open ceilings for inspector if already past that point.


Keywords

inspector, inspection, fire marshal, Virginia, DOH, AHJ, permitting, state

Temporary Lightening Projection

Facility name: North Florida Regional Medical Center

Project name: NRFLMC-032018M-South Tower Vertical Expansion
Location: GAINESVILLE, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3091600012
Lesson Learned number: 97
Impact: Cost, Schedule

Cost impact: $9,000


Lesson Learned/Best Practice

On a vertical expansion job there is a need to jump exhaust fans from existing roof  to the new roof before the final roofing has been installed, therefore temporary lightening projection needed to be coordinated in advance.


Suggested Actions for Future Projects

As part of preconstruction/MOP note the need for protection in order to coordinate necessary trades.


Keywords

coordination, lightening, temporary, MOP, preconstruction, fan, exhaust, roof top, safety, dry-in

Duct Leakage

Facility name: P-SL Medical Center

Project name: PRSTLK-022017P1-Surgery Renovation
Location: DENVER, CO
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 2720000020
Lesson Learned number: 94
Impact: Cost, Schedule


Lesson Learned/Best Practice

The OR’s that Layton is renovating did not meet the required air exchanges before the renovation started. The engineer suggested that Layton take traverse reading to identify duct leaked, however, demo had already begun, and the duct work had already been isolated. Taking traverse reading before demo started would have saved time and money. 


Suggested Actions for Future Projects

During design of the space the EOR must specify exactly what duct, diffusers, equipment, etc must be verifed for the contractor to complete a test and balance survey of the space.  No work of any kind should commence prior to confirmation of the T&B for this space.


Actions Taken / Current Status

Issue has been considered in the EDI improvement team initiative and added to the checklist to insure clear responsibility for this activity


Keywords

traverse, readings, duct, leakage, OR’s, test and balance, T&B, TAB

Behavioral Health Card Reader

Facility name: Tristar Division Office

Project name: TRISTR-032018M-New Freestanding Behavioral Health Hospital (Maury)
Location: BRENTWOOD, TN
Project classification: Hospital – New
Project type: Psych
Project number: 3103000003
Lesson Learned number: 92
Impact: Cost, Quality, Safety


Lesson Learned/Best Practice

Team worked to identify a product during construction that was a vandal resistant, ligature resistant card reader and keypad combo unit. The keypad adds an additional layer of security if a card reader is stolen or grabbed from a staff member.


Suggested Actions for Future Projects

Include critical design decisions, lessons learned and HCA approved specs as part of the Behavioral Health Guidelines currently under development


Keywords

behavioral health, card reader


Related files. Click to view/download.

File 1:
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Behavioral Health Patient Unit Size

Facility name: Tristar Division Office

Project name: TRISTR-032018M-New Freestanding Behavioral Health Hospital (Maury)
Location: BRENTWOOD, TN
Project classification: Hospital – New
Project type: Psych
Project number: 3103000003
Lesson Learned number: 91
Impact: Scope


Lesson Learned/Best Practice

Based off feedback from facility clinical leadership a contiguous 42 bed adult unit is on the larger side and can present some operational challenges on options to separate varying levels of acuity in the unit.

 


Suggested Actions for Future Projects

Include critical design decisions, lessons learned and HCA approved specs as part of the Behavioral Health Guidelines currently under development


Keywords

behavioral health, patient rooms, acuity

Coordination of project plans with facility low voltage system vendors

Facility name: Rose Medical Center

Project name: ROSEMC-032018M-Women’s Center Renovations
Location: DENVER, CO
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 2730000012
Lesson Learned number: 90
Impact: Cost, Schedule


Lesson Learned/Best Practice

There should be early front-end coordination with Vendors and Elect/LV trade partners.  With the “minor renovation” scopes, identifying all low-voltage systems and who is responsible can be challenging and lack of early front-end coordination can impact schedule and costs when bringing systems back online.


Suggested Actions for Future Projects

Existing equipment coordination would need to be managed between the GC and the facility DFM/ Director of IT&S.  Sugguested action would be a site walk of the area being renovated with the GC PM/Super and the Facility DFM/ITS Director.


Keywords

coordination, low voltage, rework, demo, renovation, medical equipment

Submittal process for prefabricated headwall units

Facility name: P-SL Medical Center

Project name: PRSTLK-022017M-Pre-Op & Recovery
Location: DENVER, CO
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 2720000019
Lesson Learned number: 89
Impact: Schedule


Lesson Learned/Best Practice

Start the submittal process for prefabricated headwall units at the start of the project.  Headwall units were not submitted and approved by the time they were ready to be installed resulting in out of sequence work for the patient bays. Because the headwall units are required when walls are being framed they need to be submitted and approved as soon as possible because they have a significant lead time.


Suggested Actions for Future Projects

For trade fabricated headwalls, trade subcontractor must coordinate with the design team upon award to ensure that shop drawings are developed, submitted and approved in a timely fashion to avoid schedule delays.


Keywords

submittals, prefabricated, headwalls, facility, design team

Facility system shutdowns during construction

Facility name: P-SL Medical Center

Project name: PRSTLK-022017P1-Surgery Renovation
Location: DENVER, CO
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 2720000020
Lesson Learned number: 88
Impact: Quality


Lesson Learned/Best Practice

On past shutdowns at the facility, not everyone was clear on who was responsible for shutting systems down and exactly how to shutdown systems so that only the areas where the work is taking place was affected.  Walk all MOP/Shutdown’s with the facility.


Suggested Actions for Future Projects

All MOP’s/Shutdowns moving forward should be walked with all parties involved so that everyone is clear on responsibilities and what is required for the shutdown. MOP’s will also be submitted and walked well in advance so that there is enough time for the information to be passed along to necessary personnel.


Keywords

shutdowns, MOP, EDI, utility, phasing

Construction noise impact on hospital operations

Facility name: Regional Medical Center Of San Jose

Project name: RMCSAJ-052017M-ASC(OP Surgery)
Location: SAN JOSE, CA
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 0838500026
Lesson Learned number: 83
Impact: Schedule


Lesson Learned/Best Practice

Prior to bidding, find out distances to other departments to see if there are undisclosed noise sensitivities.  Even better would be for this to be part of schematic design, and have it be accommodated in the construction documents.  Have the designers review this during schematic design.


Suggested Actions for Future Projects

Determine in design phases if measures need to be taken for noise and vibration mitigation due to work associated with the current project. Design will ask the Architect and Engineer to engage appropriate consultants to preform this work and will be submitted as a DCA. In renovation work assure that sound attenuation is addressed per applicable codes


Actions Taken / Current Status

Sent to EDI improvement team for consideration


Keywords

noise, hospital operations, schematic design, sound, vibration, sound attenuation

Vent stack coordination with BLOX bathroom pods

Facility name: UCF Lake Nona Medical Center

Project name: Lake Nona-102018M- New Hospital
Location: TALLAHASSEE, FL
Project classification: Hospital – New
Project type: Acute Care
Project number: 2689500001
Lesson Learned number: 75
Impact: Cost, Schedule, Quality


Lesson Learned/Best Practice

Four inch vent stacks were noted above third floor toilets in area C on labor and delivery BLOX-made bathrooms, however walls of BLOX bathrooms are framed with 3 5/8″ studs that could not accommodate a 4″ pipe.


Suggested Actions for Future Projects

 Review vendor drawings against existing conditions or other design drawings to verify coordination of connections and dimensions.


Keywords

vent stacking, pods, BLOX, early design involvement, EDI, Neopod, plumbing, riser