Add a Lesson Learned

Existing Conditions (Div 02)

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. 


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

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

Med Gas Capacity

Facility name: CJW Medical Center

Project name: CJWJWC-122018M-ORTHO/NICU Expansion (Johnston Willis)
Location: RICHMOND, VA
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3463200010
Lesson Learned number: 102
Impact: Cost, Schedule, Safety


Lesson Learned/Best Practice

Design/facility/vendor review of capacity of med gas tank farm to accommodate expansion per projects.


Suggested Actions for Future Projects

Confirm vendor (Airgas/PraxAir) will certify the system at current capacity with the addition of med gas added per project.


Actions Taken / Current Status

HCA comment: When adding additional service to the existing medical gas system  the design engineer is to review the scope of project with vendor to verify capacities.


Keywords

expansion, oxygen, addition

Analysis of complete vs. selective demolition

Facility name: Memorial Health UMC Savannah

Project name: MEMSAV-032018M-Children’s Hospital
Location: SAVANNAH, GA
Project classification: Hospital – New & Renovation (Blend)
Project type: Acute Care
Project number: 2696000002
Lesson Learned number: 62
Impact: Cost, Scope


Lesson Learned/Best Practice

During the pre-construction and bidding process, selective demolition and pour back of an existing 4″ slab on grade was priced to account for plumbing and electrical underground systems. The process of selective demolition, as well as trenching for underground MEP systems, resulted in areas of cracked or unusable slab, which required additional demolition and pour back on a T&M basis. This additional work had minimal to no schedule impact, but did have a cost impact as described below.

5,000 SF of selective demolition and pour back was captured in the original scope of work at $17,242. The additional selective demolition and pour back totaled $23,752 for a cumulative scope cost of $41,476. Conversely, complete demolition and pour back of the entire slab (23,453 SF @ $3.55/SF) would total $83,258. While this cost analysis indicates that selective demolition and pour back is the most cost efficient process, we propose that an allowance be captured in the bidding phase to account for cracked and unusable slab following demolition and installation of MEP underground systems. Factoring such an allowance at the bidding phase will allow for competitive pricing to work in the Owner/GC favor, as T&M work may exceed competitive bidding costs.


Suggested Actions for Future Projects

Perform a cost analysis of complete versus selective demolition on existing slab on grades during the design/bidding process, and if selective demolition is found to be most cost efficient (as is the case here), include an allowance for additional selective demolition in the competitive bidding process.

Existing Conditions – Sprinkler System

Facility name: St Mark’s Hospital

Project name: STMRKH-032018P1-5th Floor Ortho Renovation
Location: SALT LAKE CITY, UT
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3440700014
Lesson Learned number: 58
Impact: Cost


Lesson Learned/Best Practice

Investigate existing conditions as soon as possible.

Where the penthouse sits on the roof of the 5th floor the ceiling steps down roughly 8′ for all of the existing mechanical equipment in the penthouse. This large step in the roof/structure means that when we demo the entire 5th floor and have to turn our sprinkler heads up we will have several location where the ceiling will be nearly 15′ tall which will require additional sprinkler pipe and bracing. This will also need to be coordinated with the other MEP trades.


Suggested Actions for Future Projects

Investigate existing conditions as soon as possible.