Add a Lesson Learned

Facility Operations Impact

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

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

Landscape design

Facility name: Medical City McKinney

Project name: MCMKNY-102017M-BH & Rehab Relocation
Location: MCKINNEY, TX
Project classification: Hospital – Horizontal Expansion
Project type: Psych
Project number: 3833300011
Lesson Learned number: 147
Impact: Cost, Quality, Safety


Lesson Learned/Best Practice

BH concerns with Landscaping design and coordination with camera location to take into consideration – tree locations, rose bushes, camera views, very specific to behavioral facilities


Suggested Actions for Future Projects

Include final landscape design, to include specific types of vegetations, sizes and not just locations, and overlaid with final security camera locations.  Key considerations; potential camera review by landscaping for potential obstructions, possible patient safety or elopement considerations due vegetation sizes and location. Required attendees for review, corporate security, designated facility point of contact, design team including landscape architect.


Keywords

Behavioral Health, landscaping, security cameras

Creative solution for maintaining agricultural exemption

Facility name: Medical City McKinney

Project name: MCMKNY-102017M-BH & Rehab Relocation
Location: MCKINNEY, TX
Project classification: Hospital – Horizontal Expansion
Project type: Psych
Project number: 3833300011
Lesson Learned number: 144
Impact: Cost


Lesson Learned/Best Practice

JEDUNN came up with an innovative solution for agricultural exemption that the facility was going to pursue. The innovative solution was to introduce bee hives for honey harvesting. This allowed the facility to maintain farm exemption on track of land that was diminished in size due to hospital expansion.


Suggested Actions for Future Projects

Pursue with facility to come up with innovative solutions for any exemptions the facility is pursuing. Inform the facility of this type of action when a facility expands into an existing agricultural area.


Keywords

Exemptions

Sign-off for Shutdown Process

Facility name: Aventura Hospital & Medical Center

Project name: AVENTU-New Tower
Location: AVENTURA, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3092000015
Lesson Learned number: 139
Impact: Quality, Safety, Scope


Lesson Learned/Best Practice

Ensuring that all existing utilities are up and fully functioning after shutdown is complete


Suggested Actions for Future Projects

Add line items on MOP form/paperwork for facility approval and completion of work. Prior to the shutdown occurring walk existing space with facility management personnel and have form signed at the beginning of the shutdown. After the work is complete and GC/sub believe the hospital should be back up and running re-walk all spaces with facility management personnel to confirm and have them sign off on the form saying they have walked and verified that the work is complete

Sufficient Pre Test and Balance

Facility name: Swedish Medical Center

Project name: SWEDIS-052018M-Hybrid OR Renovation
Location: ENGLEWOOD, CO
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 2710000029
Lesson Learned number: 134
Impact: Cost, Schedule


Lesson Learned/Best Practice

As part of EDI, include sufficient Pre-T&B of existing equipment as well as additional investigative work when tying into existing older equipment and ductwork.


Suggested Actions for Future Projects

Ensure that not only are flows adequate from the mechanical units and chillers, but also that adequate CFM or flow is available when adding capacity to the existing system.

Ensure there are no existing obstructions or improper existing valve orientations that will delay commissioning of the system or proper design operation.

If there are existing systems that feed a space, obtain air readings prior to the start of construction in order to have air comparisons after final TB is conducted. In addition to traverse readings, it is necessary to test the entire system at all diffusers, VAVs, and even AHU itself for pressure testing, air exchanges, and sound levels. This is inclusive of all areas associated with the same air system, even outside the construction space. This is an important step in Design Development but even more crucial throughout each Phase of a project to obtain readings in locations that would not have been accessible during EDI. It shall also include verified air exchanges per hour.

 


Keywords

Pre-T&B, Pre-Test & Balance, Site Investigation, EDI, Air Changes, Air Exchanges

Existing Security review

Facility name: North Austin Medical Center

Project name: NRTAUS-022019M-Rehab/Peds Relocation
Location: AUSTIN, TX
Project classification:
Project type: Acute Care
Project number: 0822400025
Lesson Learned number: 128
Impact: Cost, Scope


Lesson Learned/Best Practice

Perform Site-Walk / Audit to determine adequacy of infant abduction system, door hardware, and security shown on drawings.


Suggested Actions for Future Projects

Owner’s infant abduction vendor needs to get involved during design phase if possible or as early as possible and verify that all systems integrating to the system are designed to function with the system. Coordination with facility to verify that each door is secured as needed would be beneficial.


Keywords

security, infant abduction system

Backflow Preventor in EVS Room

Facility name: Mountainview Hospital

Project name: MTVLAS-102018M-Rehab Expansion
Location: LAS VEGAS, NV
Project classification: Hospital – Shell
Project type: Rehab
Project number: 3281900024
Lesson Learned number: 109
Impact: Cost, Quality, Scope

Cost impact: $1,725


Lesson Learned/Best Practice

At time of user move-in, Sunrise Hospital Engineers requested dedicated backflow preventer to the soap dispenser in the EVS room, so the mop sink and faucet only gets turned on when the mop sink is being used. When this was presented to HCA as a change order they asked Layton document as a Lesson Learned so that HCA design and construction could implement as a standard. The Mountain View project was designed before the lesson learned was documented at Sunrise. The attached picture is what was recommended for the MountainView project and was accepted by the Design team and the facility.


Suggested Actions for Future Projects

Make sure that a backflow preventer is added to the soap dispenser in EVS room for future projects. 


Actions Taken / Current Status

HCA comment:  This practice only applies to facilities that have the soap dispenser in line with the main water system.


Related files. Click to view/download.

File 1:
11725EVSRoomSoadDispandBackflow1.pdf

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