Add a Lesson Learned

State AHJ (e.g., AHCA, OSHPD, etc.)

AHCA – Medical Equipment Cable Separation

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: 156
Impact: Cost


Lesson Learned/Best Practice

AHCA requires that all cabling located within an OR boom must be separated based on the voltage rating. 


Suggested Actions for Future Projects

Equipment vendor should provide jacketing for each type of cable within the boom to ensure all proper separation is maintained.


Keywords

AHCA, Medical Equipment

Mock State Health Inspection Rehearsal

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: 141
Impact: Schedule, Quality


Lesson Learned/Best Practice

Run mock state health inspection that simulates the final inspection to ensure team is fully prepared and rectifies any issues prior to the inspection day. 


Suggested Actions for Future Projects

Team to determine appropriate time for mock inspection to allow enough time to resolve any issues that come up prior to the inspection.  Coordinate who from HCA, the facility, construction and design team will be present for the actual inspection and ensure key members are involved in the mock inspection.  Team to develop a checklist of items the inspector will be looking for during the actual inspection (ie fire/life safety system, nurse call system, FGI requirements, accessibility, C of O, flame spread data, and all required paperwork/documentation).  Facility to confirm equipment is properly placed and in alignment with FGI requirements.  Contractor to ensure nurse call vendor is available for inspection.  Architect and facility to review functional program and plan review comments submitted to the State.


Keywords

Mockup, State, Health, Inspection, Rehearsal

VA Coverage Letter

Facility name: CJW Medical Center

Project name: CJWCHP-122018M-OR Expansion
Location: RICHMOND, VA
Project classification: Hospital – Horizontal Expansion
Project type: Acute Care
Project number: 3463200012
Lesson Learned number: 138
Impact: Schedule


Lesson Learned/Best Practice

Cannot begin site excavation until the State of VA coverage letter is in hand. In addition the Building Permit will be withheld until the coverage letter is in-hand.  However we can begin storm drainage and all utilities after the City of Richmond has issued their RSMP (Richmond Storm Water Management Plan) Approval


Suggested Actions for Future Projects

Track submission of documents to state and follow up on receipt of letter, meet with inspectors onsite to start storm drainage and utilities prior to letter in hand.

State Recertification Requirements for Renovations

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: 130
Impact: Cost, Schedule, Scope

Cost impact: $7,000


Lesson Learned/Best Practice

Better define within the  project documents what the state requires for documentation & recertification of existing systems in spaces with only finish upgrades. THHS inspector required several systems which had not been touched to be recertified.


Suggested Actions for Future Projects

Confirmation with the state, stating precisely which state requirements will be applicable to the project, including recertification of existing systems not within project scope, if applicable. Include clarification in bid documents. Discuss with state during Feasibility Conference. Verify with local AHJs as well.


Keywords

Recertification

AHCA – Aiphone Power Supplies

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: 126
Impact: Scope


Lesson Learned/Best Practice

AHCA requires that any piece of electrical equipment that is preassembled carry a UL listing or be field listed. Aiphones do not carry a UL listing and cannot be field listed without a Class “2” power supply. A Class II power supply is not permited.


Suggested Actions for Future Projects

Low voltage subcontractor should carry cost to swap out power supplies from Class II to Class 2 for any projects in Florida.


Keywords

AHCA, Aiphone

AHCA – Med Gas Pedestal Requirements

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: 121
Impact: Cost, Scope

Cost impact: $25,000


Lesson Learned/Best Practice

AHCA requires that any OR space that does not have medical gas on the surgical boom must have the med gas outlets “convenient to the bed”. (within 6′) If the center of the bed does not fall within this 6′, a med gas pedestal must be added at the center of the room.


Suggested Actions for Future Projects

Any OR project in the state of Florida where a surgical boom is installed without med gas, special consideration should be given to incorporating a med gas pedestal.


Keywords

AHCA, OR Booms

Fire Alarm Code Issues

Facility name: Kendall Regional Medical Center

Project name: KENDAL-New Tower
Location: MIAMI, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3594100019
Lesson Learned number: 112
Impact: Cost, Schedule


Lesson Learned/Best Practice

During the permitting process the following items arose.

  • High rise requirements for fire alarm systems.
    • Initially the AHJ required the Kendall fire alarm system be upgraded to cover high rise guidelines. A building is considered a high rise if any floor above 75′ is continually occupied. ICT and the AHJ discussed this and finally came to the conclusion that the building did not have to be upgraded. 
    • Though this did not require a re-design (which would have been costly), it did delay the permitting process.
  • Pull station at helipad vestibule was required.
  • Smoke evacuation system is controlled by the fire alarm system and needed to be added. However, the design is by the mechanical controls contractor. 
  • The review process itself is slow.

During inspections a couple of items arose.

  • Pull station at helipad vestibule was required.
  • Spacing between smoke detectors was exceeded in some instances.

Suggested Actions for Future Projects

Bringing the fire alarm vendor on at EDI would allow them to assist with design and code verification. The fire alarm vendor could then produce shop drawings during the EDI process that could be included as part of the CD set. This would make the shop drawings part of the initial building permit application and not a separate application after the permit is obtained. Therefore speeding up the fire alarm system local jurisdiction approval process. 


Actions Taken / Current Status

HCA comment:  The best practice is to bring the Fire Alarm vendor in during the EDI process at the appropriate time based on the design schedule for a given project.

Penetration Fire Caulking

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: 106
Impact: Cost, Schedule, Quality


Lesson Learned/Best Practice

Due to penetrations not being fire caulked as they were being roughed-in, some penetration became blocked by ductwork and fire caulking was missed or had to be re-caulked.


Suggested Actions for Future Projects

Fire caulk all penetrations as they are made instead of at the end of the rough-in stage.

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

Up to date cut sheets from equipment vendors

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: 65
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

OFE data is sometimes out of date, especially in states with lengthy AHJ approval processes (e.g., OSHPD) .  Reach out early to the equipment vendors to make sure that the cut sheets we’re given are still current and correct.


Suggested Actions for Future Projects

Reach out early to the equipment vendors to make sure that the cut sheets we’re given are still current and correct.