Add a Lesson Learned

Planning

Vibrocompaction Footing Size Change

Facility name: Lawnwood Regional Medical Center

Project name: LAWNWD-062019M-New Tower and CEP
Location: Fort Pierce, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3093200010
Lesson Learned number: 185
Impact: Schedule, Scope


Lesson Learned/Best Practice

In EDI, we found that the original specified vibro-compaction and smaller footings directly adjacent to the hospital would cause too many issues with the existing facility, so we wrote an RFI to change the footings to larger ones and eliminate the vibrocompaction at those footings. This is to avoid the effects of the vibration to the hospital. Footings are oversize to remove need for vibro underneath.


Suggested Actions for Future Projects

When planning to use vibro-compaction, consider proximity of existing facilities.


Keywords

Vibro, Vibrocompaction, footings, foundations, existing


Related files. Click to view/download.

File 1:
501735.pdf

Improvements in Third Party Owned Buildings

Facility name: Ogden Regional Medical Center

Project name: OGDNMC-012020M-New Rehab Unit
Location: OGDEN, UT
Project classification: Hospital – Shell Buildout
Project type: MOB
Project number: 3441500009
Lesson Learned number: 182
Impact: Cost, Schedule, Quality, Scope

Cost impact: $65,000 Schedule impact: 10 days


Lesson Learned/Best Practice

For HCA Tenant Improvement Projects located in 3rd Party Owned Buildings, verify existing construction is suitable to allow work to start and avoid schedule delays.


Suggested Actions for Future Projects

HCA Design and Construction, the Design Team, and the Contractors should walk the area as soon as access is available to review the existing construction conditions.

At any point during planning, design, or pre-construction that a non-compliant issue arises, it should be communicated to all parties so solutions can be determined prior to planned construction start.

Example

New 3rd Party Owned Medical Office Building utilizing Fiber Mesh Concrete Reinforcement in slabs which lead to severe cracking and fiber “residue” in existing slab. Cracking is a structural issue that needs review by a structural consultant. “Residue” of Fibers on the face of the slab affects flooring installations and required a planned solution.


Keywords

3rd Party Owned Buildings, Severe Slab Cracking, Fiber Mesh Reinforcing Residue, Renovation

Minor Renovations

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: 179
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

“Minor Renovation” OR rooms become full demo rooms if more than cosmetic upgrades are performed.


Suggested Actions for Future Projects

Determine during design if Minor Renovation OR rooms are truly appropriate/desired, because if anything other than cosmetic upgrades are required, the cost impact will meet or exceed a full renovation.  Replacing/relocating existing HVAC equipment, adding new lights, and installing a stainless steel package requires a tremendous amount of demolition.


Keywords

Planning, ORs, Renovation

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

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

Exterior Demolition Drawings

Facility name: Menorah Medical Center

Project name: MENORA-092018M-Bed Tower Expansion
Location: OVERLAND PARK, KS
Project classification: Hospital – Horizontal Expansion
Project type: Acute Care
Project number: 0972300007
Lesson Learned number: 159
Impact: Cost, Schedule


Lesson Learned/Best Practice

On future projects requiring demolition provide drawings indicating extent of work at each level.  The scope of the demolition spanned across four levels but no demo drawings were provided for the roof, only Level’s 01-04 and some exterior elevations.  The demo indicated on the drawings occurred but it was quickly identified that there were multiple discrepancies on the drawings at the roof level, and the extent of demo was not clear.  This resulted in multiple RFIs to understand the scope required, structurally and architecturally.  Due to the lack of drawings there were multiple RFIs and cost impacts associated with the extra demo.


Suggested Actions for Future Projects

For each level requiring demolition provide a drawing indicating the extent of demo required.  This will minimize RFIs and potential cost impacts. 


Keywords

Roof Demolition

LDR Light Supports

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: 151
Impact: Scope


Lesson Learned/Best Practice

Typical LDR Birthing lights have the option to utilize either unistrut supports or chain supports. Given the often congested space above ceiling in these spaces a chain support provides much more accessibility to the space.


Suggested Actions for Future Projects

Chain supports for LDR birthing lights should be used whenever possible.


Keywords

LDRP, Lights

AHCA – Medical Equipment Drawings

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: 150
Impact: Cost


Lesson Learned/Best Practice

AHCA requirements for Imaging equipment varies with each “team”. Typically, the specific details required by AHCA are not included in the site specific vendor drawings resulting in added scope and rework during the inspection process.


Suggested Actions for Future Projects

Medical Equipment vendors should incorporate known AHCA requirements for each specific team in the vendor documents for the project. 


Keywords

Medical Equipment, AHCA

Evolving HCA standards

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: 148
Impact: Cost


Lesson Learned/Best Practice

With HCA’s ever evolving design standardization there needs to be a fixed point where design is frozen for each specific project. 


Suggested Actions for Future Projects

Document date and version of HCA standards utilized within CD drawing set,  validate HCA standards with planning manger, design manager, HCA engineering and construction manager.


Keywords

HCA Standards, MEP guidlines