Add a Lesson Learned

Thermal & Moisture Protection (Div 07)

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

Florida – Roofing Schedule

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: 157
Impact: Schedule, Quality

Schedule impact: 25 days


Lesson Learned/Best Practice

Roofing NOA/FPA requires that any TPO roofing system installed on a structural slab with poly iso board must be mechanically fastened every 18″ o.c. If this installation is performed during the “rainy season” (May – Sept), roofing installation progress is significantly reduced.


Suggested Actions for Future Projects

LWIC should be utilized wherever possible. If this is not feasible, special consideration should be given to the time of year in which the roof is to be installed and appropriate installation durations should be included.


Keywords

Florida; Roofing

Florida – Roofing Schedule

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: 157
Impact: Schedule, Quality

Schedule impact: 25 days


Lesson Learned/Best Practice

Roofing NOA/FPA requires that any TPO roofing system installed on a structural slab with poly iso board must be mechanically fastened every 18″ o.c. If this installation is performed during the “rainy season” (May – Sept), roofing installation progress is significantly reduced.


Suggested Actions for Future Projects

LWIC should be utilized wherever possible. If this is not feasible, special consideration should be given to the time of year in which the roof is to be installed and appropriate installation durations should be included.


Keywords

Florida; Roofing

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

Roofer During EDI

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: 143
Impact: Cost


Lesson Learned/Best Practice

Most of the exterior skin trade partners were involved during the EDI process.  One that was not involved was the roofer.  After bringing a roofer on board and reviewing details there were a few discrepancies noted leading to added cost.  Bringing a roofer in to the EDI process would help to make EDI an even more successful process as any discrepancies, or gaps, in the drawings and details could be identified at that time.


Suggested Actions for Future Projects

Ensure that a roofing trade partner is selected to participate in the EDI process.


Keywords

EDI, Roofer

Exterior Skin Finish

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: 137
Impact: Cost, Quality


Lesson Learned/Best Practice

During EDI two different finish types were selected.  Precast concrete was selected for the lower level and EIFS was selected for the upper levels in order to reduce cost.  Both finish colors were selected to closely match the existing building however, with the two different skin types, the different finishes stand out.  There is a texture difference between the two skins as the precast has a rough finish and the EIFS is smooth finish.  Now that both skin elements have been installed it is apparent how different they are raising concern from the facility on the appearance.


Suggested Actions for Future Projects

We recommend that in future tie-in expansions, where the goal is to match existing finishes, that only one skin element is used.  This will help to give the match a consistent look.

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.

Exterior Finishes Selection

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: 103
Impact: Cost, Schedule


Lesson Learned/Best Practice

During the EDI process there was a lot of emphasis put into the main skin finish selection, for precast and EIFS, while the metal panels, louvers, curtainwall, and misc. finishes were not selected.  The intent was for the exterior finishes to match the existing building but was not noted as such in the Construction Documents.  This caused the GC and architect to spend a lot of time reviewing samples in order to find the appropriate color for the exterior finishes.  The result of this process was added cost, and lead time for material procurement, due to selecting a custom color.


Suggested Actions for Future Projects

When new construction is tying into an existing building exterior finishes should be selected during design.  For an accurate color match, and to appropriately account for associated cost, the CDs should indicate the manufacturer and color to match.


Actions Taken / Current Status

HCA comment:  The preferred method is the design team details matching or coordinated colors with existing building exterior finishes for the new finish details when possible.

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

Water Intrusion Prevention

Facility name: North Florida Regional Medical Center

Project name: NRFLMC-032018M-South Tower Vertical Expansion
Location: GAINESVILLE, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3091600012
Lesson Learned number: 42
Impact: Cost, Scope


Lesson Learned/Best Practice

Water intrusion prevention plan (WIPP) should include more permanent “dog house” enclosures from field verification (survey) through dry-in to ensure minimally runoff prevention from primary rain systems.  Teams should work with roofing contractor and steel fabricator to develop a system that is further developed than cut and patch systems.  This would also apply to stub columns.


Suggested Actions for Future Projects

At time of steel survey have a “dog house” construction plan to be installed.


Actions Taken / Current Status

Sent to HCA Construction Management team for consideration and follow-up action.