Add a Lesson Learned

Existing Conditions (Div 02)

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

OR Ceiling Height

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: 180
Impact: Cost, Scope


Lesson Learned/Best Practice

Renovations involving OR hard lid ceiling prevent the ability to review above ceiling conflicts in advance.


Suggested Actions for Future Projects

Account for more contingency room due to unknown ceiling conditions. Where existing structures are cast in place, above ceiling existing structure should be evaluated before establishing finished ceiling heights.


Keywords

OR Ceiling, 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

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

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

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

MEP PreAudit

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: 131
Impact: Cost, Schedule, Scope

Cost impact: $10,000


Lesson Learned/Best Practice

Perform audit of all mechanical, electrical, plumbing systems & security systems., including complete T&B audit prior to start of any work in renovation areas. This will help ensure full scope of mechanical renovations is captured early


Suggested Actions for Future Projects

Perform a pre-audit of any MEP systems that are to remain in place. Should be completed during design phase. This can weed out issues such as water not heating up quick enough or security systems not working. Conduct an audit of mechanical systems during design phase if possible. At a minimum, conduct measurement of existing systems prior to starting work.

Coordinate with the design team to verify connections and capacity capability of existing equipment (VAVs, etc) will support proposed design.  


Keywords

Test & Balance, Exiting utilities, Air changes, Air Exchanges

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

Partial Demolition of Casework

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: 129
Impact: Cost, Quality


Lesson Learned/Best Practice

Partial Demolition of Casework not preferred and usually provides no cost savings.


Suggested Actions for Future Projects

NICU drawings showed partial demolition of casework & solid surface top but were not clear on extent of demo/existing to remain. If partial demo is still preferred, would like the architect to better define the drawings and provide an elevation drawing showing how the modified casework should look at completion. Post-laminating & modifying casework does not achieve as good of a result as replacing with new and also does not necessarily save money because the field labor to post-laminate is expensive and time consuming. Full replacement of casework is often the same or less expensive and provides better results.


Keywords

Casework, partial demolition