Add a Lesson Learned

Existing Conditions (Div 02)

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.

Planning Construction Barriers

Facility name: Regional Medical Center Of San Jose

Project name: RMCSAJ-052017P1-IP Surgery Dept. Reno
Location: SAN JOSE, CA
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 0838500028
Lesson Learned number: 53
Impact: Cost, Schedule


Lesson Learned/Best Practice

When a new construction phase overlaps into an existing room, where at all possible, take that entire room rather than subdividing it with a new temporary wall.  Maintaining or upgrading existing partitions is cheaper and faster than building a new wall, and those impacted rooms are rarely left with enough function to be usable when subdivided.


Suggested Actions for Future Projects

Review construction phasing with an eye to trying to utilize existing walls wherever possible, rather than constructing new temporary walls.

Coordination with Utility Companies on power shutdowns

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: 47
Impact: Schedule


Lesson Learned/Best Practice

Based on early discussions with Kansas City Power & Light (KCP&L owner/operator of charging stations), the team was advised there would not be an extensive shutdown required for the relocation of the existing charging stations.  The week prior to relocation, KCP&L surprised everyone that a 1-2 day shutdown would be required.   Lesson learned was to anticipate a minimum of a one day shutdown when relocating existing EV charging stations.


Suggested Actions for Future Projects

Ensure better communication between KCP&L, owner and GC to understand impact to EV service.  The right people should be engaged sooner to ensure that everyone understands the scope.

Considerations for planning temporary walls

Facility name: Methodist Texsan Hospital

Project name: METHTX-112016M-Master Plan ED & Lab Expansion
Location: SAN ANTONIO, TX
Project classification: Hospital – Horizontal Expansion
Project type: Acute Care
Project number: 2610900001
Lesson Learned number: 40
Impact: Quality


Lesson Learned/Best Practice

When planning and building temporary walls for expansions/renovations, if possible place them where you can build the new scheduled wall in front of it.


Suggested Actions for Future Projects

Plan for the depth of the permanent wall and try to locate the temporary wall to accommodate building one side of the permanent wall in front of the temporary on so as to not have to take down the temporary wall and disrupt patient care twice (once to build temp wall and once to take temp wall down while patient care space is still needed).


Actions Taken / Current Status

We agree this makes sense if site conditions can accommodate it.

Existing room dimensions verification

Facility name: Doctors Hospital Of Augusta

Project name: DOCAUG-112017M-New Tower(Surgery Expansion)
Location: AUGUSTA, GA
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3100300014
Lesson Learned number: 35
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

1.  Design team to field verify existing room dimensions at new building to existing building tie-in locations and GC to confirm dimensions on existing room as early as possible by conducting field measurements as soon as possible.  The accuracy of as-built dimensions should not be assumed and all as-builts should be field verified.
2.  During phasing discussions, portions of the facility which would be preferred to remain in operation should have plans in place in case unforeseen field conditions dictate the preferred portions need to be relocated/ taken out of operation.


Suggested Actions for Future Projects

Confirm dimensions of existing rooms at exterior walls focusing on locations of building tie-ins for future construction. Possibly develop plan early to relocate existing specialty rooms to other locations in the facility if feasible.  Facility should maintain up-to-date as-built drawings and field verify for confirmation.