Add a Lesson Learned

Month: December 2020

Keying and Coring

Facility name: Woman’s Hospital Of Texas

Project name: WMHOTX-122018M-LDR, C-Section & Support Space Renovations
Location: HOUSTON, TX
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3431900019
Lesson Learned number: 169
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

Existing facilities keying/coring system did not match the Allegion master specs. Required replacing levers and cylinders to integrate with facility’s existing keying system.


Suggested Actions for Future Projects

Review with facility during design prior to issuing Construction Documents. Design team to confirm with Design Manager direction.  Incorporate existing keying requirements in the specs on the front end should HCA determine that is the best course of action.


Keywords

Doors, Hardware, Keying, Schedule, Allegion

Nurse Call Discrepencies

Facility name: Woman’s Hospital Of Texas

Project name: WMHOTX-122018M-LDR, C-Section & Support Space Renovations
Location: HOUSTON, TX
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3431900019
Lesson Learned number: 168
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

Facility and Division Nurse Call standards differed from HCA corporate standards.  There is no published document detailing division or specific facility standards.


Suggested Actions for Future Projects

Input from Division and Facility is required during design to determine which standard to follow.  Design team should confirm with HCA Telecommunications Manager prior to issuing drawings.  Consideration should be given to any future Nurse Call system replacement projects that may be done at the local level.


Keywords

Nurse Call, Telecommunications, Standards

Finish Upgrades Scope of Work

Facility name: Woman’s Hospital Of Texas

Project name: WMHOTX-122018P1-5th Floor Ante-Partum Buildout & Renovation
Location: HOUSTON, TX
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3431900010
Lesson Learned number: 167
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

Scope not clearly defined on plans but required to perform specified activities; drywall touch up/finishing, removal of existing electrical devices to remain, plumbing fixtures needed to be removed prior to new flooring install, grab bars, mechanical grilles, sprinkler head relocations to accommodate new ceiling layout.

Finish plan shows new ceramic tile flooring and wall tile at existing patient room bathrooms. However, demo plan did not provide specific notes to remove all existing fixtures and division 10 items and reinstall for new finishes.


Suggested Actions for Future Projects

At a minimum, provide more detailed notes and callouts on construction documents, particularly on the demo drawings, where removal/reinstallation of existing items to remain should be picked up.  Best practice would be to walk each area and create a specific detailed plan showing all items and their locations for further detail and clarity.


Keywords

Finishes, Renovation, Demolition, Minor, Cosmetic, Fixtures, Existing to Remain

Oxygen Park Vendor Coordination

Facility name: Orange Park Medical Center

Project name: ORPKMC-102018M-Kitchen Expansion & Renovation
Location: ORANGE PARK, FL
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3091300034
Lesson Learned number: 166
Impact: Quality


Lesson Learned/Best Practice

Design team is typically asked to work with the O2 vendor when replacing the existing O2 park. However, the vendor does not work for the design team and is not typically willing to assist in a timely manner. 


Suggested Actions for Future Projects

If there is a need to replace the O2 park and the design team and facility are not getting timely responses from the vendor, HCA Engineering and DFM should be asked to step in and help facilitate the process.


Keywords

O2 park

Kitchen Exhaust Hoods

Facility name: Orange Park Medical Center

Project name: ORPKMC-102018M-Kitchen Expansion & Renovation
Location: ORANGE PARK, FL
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3091300034
Lesson Learned number: 165
Impact: Quality


Lesson Learned/Best Practice

Careful attention should be considered regarding the design of the exhaust hoods for kitchen equipment. Typically this scope of work is handled by an outside vendor that designs the system. We have experienced one of our hoods over the serving line Grill, that does not fully exhaust the heavy hamburger smoke, causing small amounts of smoke to roll out of the corners of the exhaust hood and out into the open serving area. Months of investigative efforts have resulted in adjustments/modifications to the system to correct this.


Suggested Actions for Future Projects

Any large smoke producing equipment should be kept against a perimeter wall that goes full height up to the exhaust hood. This approach is likely to reduce the possibility of a similar issue. 


Keywords

kitchen exhaust, smoke producing equipment

Central Energy Plant (CEP) Temporary Plant

Facility name: Orange Park Medical Center

Project name: ORPKMC-102018M-Kitchen Expansion & Renovation
Location: ORANGE PARK, FL
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3091300034
Lesson Learned number: 164
Impact: Cost, Scope

Cost impact: $64,000


Lesson Learned/Best Practice

Air-cooled chiller rental agencies have their own operational standards for their equipment which do not always match manufacturer operational standards. A temporary variable primary chilled water system was the basis of design for this project to match the existing chilled water plant configuration. The design team worked with the temporary unit manufacturer to ensure proper operation was being met. However, the rental agency would not allow for the operation of the chillers in a variable primary system. This resulted in added piping and pumps. In addition to this, the rental agency did not provide a control interface for the rental units. This caused for additional control wiring/sequencing for the temporary units.


Suggested Actions for Future Projects

When providing a temporary chilled water plant that utilizes rental air cooled chillers, provide a primary/secondary pumping configuration. Additionally, provide the temporary control system sequence as part of the design. Review the system configuration with the contractors and rental agency to ensure that their internal operational standards are being met and controls can be accomplished.


Keywords

temporary chilled water plant, rental

Power in the Slab

Facility name: Woman’s Hospital Of Texas

Project name: WMHOTX-122018P1-5th Floor Ante-Partum Buildout & Renovation
Location: HOUSTON, TX
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3431900010
Lesson Learned number: 163
Impact: Cost, Schedule


Lesson Learned/Best Practice

Power was identified in the slab when scanning for coring after walls were framed. Required relocating walls, plumbing fixtures and rework of overhead sheetrock activities.


Suggested Actions for Future Projects

This facility is unique in that most of its normal power circuits are run in the floor slabs.  During planning/EDI efforts, it would be beneficial to scan particular areas of the floor plan to determine if power is present prior to finalizing floor plans.


Keywords

Rough-In, Scanning, EDI, Floor Slab, Electrical

Rooftop Piping Across Existing Structures

Facility name: Orange Park Medical Center

Project name: ORPKMC-102018M-Kitchen Expansion & Renovation
Location: ORANGE PARK, FL
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3091300034
Lesson Learned number: 162
Impact: Scope


Lesson Learned/Best Practice

Pipe routing seems to often be left to the installing contractor.  When rooftop piping is used, the support frames are done by the installer as a deferred submittal, but the underlying structure has to be reviewed by the design team. Field investigation should be performed to identify/incorporate existing structure components/limitations into the design documents. 


Suggested Actions for Future Projects

Large diameter piping being routed over existing roof sections needs to have those existing roof sections surveyed prior to the completion of design. The survey should identify the structural make-up of each roof section, so appropriate routing and pipe stands can be coordinated/designed into the construction documents with the structural engineer’s approval. 


Keywords

Pipe racks, Roof piping, Bar joists, pipe supports

Central Energy Plant (CEP) Replacement Coordination and Phasing

Facility name: Orange Park Medical Center

Project name: ORPKMC-102018M-Kitchen Expansion & Renovation
Location: ORANGE PARK, FL
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3091300034
Lesson Learned number: 161
Impact: Cost, Schedule, Scope

Cost impact: $15,000


Lesson Learned/Best Practice

During construction the team was able to coordinate the installation of the new utility lines in a way that minimized the overall duration of the temporary CEP services. During this process multiple phasing plans were developed to tackle the existing utility layouts that were uncovered. A complete mapping of the existing systems would have prevented the back and forth of multiple phasing plans and expedited the overall underground installation process. 


Suggested Actions for Future Projects

How to minimize the duration of a temporary CEP:
– A complete interior and exterior mapping and phasing plan should be developed prior to construction. This is advised in order to reduce potential impacts once construction begins.
– How much existing roadway/sidewalk will need to be removed/replaced to accomplish the phasing of both demo and replacement? 
– Schedule of when each existing and new item is to be removed/installed.


Keywords

CEP, Temp Equipment, 3D Mapping

Facility Protection Protocol

Facility name: Ocala Regional Medical Center

Project name: OCALMC-092018M-Vertical Bed Expansion
Location: OCALA, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3092700031
Lesson Learned number: 160
Impact: Safety, Scope


Lesson Learned/Best Practice

Vertical Expansions are high risk regarding patient environment of care and to the physical care of the facility itself. Inspections and checklists should be reviewed constantly as the jobsite and structure are continuously changing at a rapid pace. One of the biggest, if not the most risk on any Vertical Expansion projects is water intrusions. From the moment you set the first column, you have the potential to expose the facility to water. 


Suggested Actions for Future Projects

We have developed numerous forms and checklists that cover all trade accountability and ensure that we leave the site knowing we are protecting patients and faculty. 

Along with the facility checklists and permits, we developed the Facility Protective Measures (FPMs) and Temporary Roofing Measures (TRMs).

Facility Protective Measures  – (Pre Task) This form lists out work being completed below the Vertical. It lists out the subcontractor performing the work, specific work to be completed, if work will affect patient care, department head approval, facility manager approval and a pre-task checklist before work is to be performed. (Post-Task) This form follows the work completion described in the “pre-task”. General Contractor and Subcontractor managers in charge sign-off sheet to verify that there are no hazards to the facility. 

Temporary Roofing Measures -This form lists trades working on the rooftop, weather conditions on site for the day, expected weather conditions for the following day, Close of business signoff check list includes rooftop and existing operational floor. This form is monitored and signed off by an onsite manager for all subcontractor managers and the general contractor manager.


Keywords

water intrustion, incidents, checklists, vertical expansion