Prep Work, Coordination Vital to Providence ER Expansion

AGC Spring Prep Work Coordination Vital to Providence ER Expansion

Anyone familiar with home improvement projects can attest: Sometimes the prep work is the hardest part of the project.

A mountain of prep work has been a fact of life for James Murrell, project manager for Davis Constructors & Engineers, the company building Providence Alaska Medical Center’s new emergency room. But before the emergency room can be updated and expanded, first conference rooms, administrative offices and another emergency department had to be moved. In some cases, that meant gutting the new location and completely rebuilding it.

The main purpose of the $12.9 mil-lion project is to expand Providence’s overloaded emergency room, adding a children’s emergency room and boosting the number of emergency room treatment rooms from 37 to 50. Ten of those beds will be dedicated to the pediatric treatment area and two will be trauma rooms, according to information from Providence.

“Having an emergency treatment area for children will help reduce anxiety for children and curtail stress parents feel when having to visit an emergency room,” said Dr. Richard Mandsager, chief executive of Providence Alaska Medical Center. “Additionally, this expansion ensures we have the emergency department capacity to continue providing trauma care to Alaskans across our state.”

Mandsager said the emergency room currently might see more than 225 patients in a busy 24-hour period. Seven of those patients might be treated on beds in the hallway instead of in a typical ER room simply because the demand for services is greater than the space available.

“This should make (using hallway beds) infrequent. I would expect that it would still happen late in flu season, but on a regular night, it shouldn’t happen anymore,” he said.

Adding a pediatric treatment area helps both children and their parents, Mandsager said. Fewer people will be in the waiting area because children can be taken more quickly back to an examination room to wait. The hospital will also have a full-time child life specialist on staff to help children and parents understand and cope with illnesses and injuries.

Adding a second trauma room is also important. Providence is a nationally recognized trauma center, but, due to overcrowding, one of its two trauma rooms in the emergency department was often in use by nontrauma patients.

“The standards for trauma centers require that we always have a second trauma room available for use,” Mandsager said.

What’s the difference between trauma and ER use? Think severe vehicle accident versus the flu. A typical ER room has a bed, a chair for a family member, some equipment and a workstation. A trauma room is more than double the size of the average ER room, with space around the bed to accommodate five to 10 adults so complex interventions can take place.

A multifaceted project

The ER expansion is the goal of the project, but along the way several other spaces in the hospital are getting upgrades — that’s the mountain of prep work Murrell and the Davis team are facing. Unlike some projects, the hospital can’t shut down operations during the project, so departments must be shifted into other spaces until the new space is ready.

With all the interdepartmental moves taking place, the project is broken into six phases, the last of which is construction of the new emergency room department.

“We started off with the relocation of two conference rooms,” Murrell said. That project began in January 2016.

The Fireweed conference room and the hospital’s backup Emergency Operations Center were moved from Tower E to the basement of Tower A. Making the move required replacing the Tower A air-handling system, while keeping the building operational for patients and staff, and running miles of cables from the basement to the roof of the building.

“Pretty much anything you could use to communicate with the outside world,” along with backup information for the hospital, is available in the EOC, Murrell said.

The conference room and Emergency Operations Center relocation wrapped up in April, Murrell said, bringing Phases 1 and 2 of the project to a close. Phases 3 and 4 involved relocating the Trauma and Operating Room administrative offices from the first floor to the third floor of Tower E.

“Those were pretty straightforward,” Murrell said. The third-floor space had previously been administrative office space, so the area was repurposed and updated fairly easily.

Murrell said his team is now hard at work on Phase 5, building a new Psychiatric Emergency Room department. The seven-room facility won’t be expanded, just shifted to another side of the building. It will also see significant upgrades, said Providence’s chief operating officer, Robert Honeycutt.

“With the technological changes over the last 15 years, it will be a little more safe in terms of suicide prevention,” he said, and the facility will also be safer for staff if a patient becomes combative.

This phase of the project involved gutting the entire floor plan of the new Psychiatric ER and rebuilding.

“We took out every single wall stud and all the infrastructure,” Murrell said.

As a psychiatric department, the area had to be rebuilt to “pretty enduring standards,” Murrell said, meaning all the walls are plywood instead of sheetrock, and components had to be installed in such a way that wires could never be pulled out enough to allow someone to harm themselves.

Construction projects in occupied buildings often require adjustment on the part of both the work crew and those living and working in and near the renovated area. The only difference with this project, Murrell said, is that instead of other businesses or residents, those living nearby are residents of the Intensive Care Unit.

“It makes for a lot of coordination amongst trades,” Murrell said. “You can’t just go in there and start nailing track up on the concrete deck. There are folks right above you that need sleep.”

Murrell said there were several ways his crew worked around the needs of the patients upstairs.

“Sometimes it’s adjusting to a timeframe where patients won’t be in a certain room. Sometimes they relocate a patient or we wait for someone to be discharged. You kind of have to wait until you can jump on it,” he said.

Murrell said he expects his crew to finish the Psychiatric ER project by April. Then the equipment will be moved into that new space and the Davis team will put temporary walls up and get to work on the Emergency Room renovations.

Making sure the construction zone is both safe for passersby and not adding dust or debris to the space outside the project area is important for any project, but perhaps even more so in a hospital setting.

“We have to make sure nothing we do negatively impacts the surrounding areas,” Murrell said.

Generally, that means a lot of coordination between the construction crew and hospital staff. But that frequent collaboration and the scheduling changes that result have become second nature to Murrell and his crew. Davis has completed several projects for Providence in the past decade or more, he said, including building two new operating rooms, renovating eight operating rooms at the hospital and, a few years ago, completing the Generations project, which updated the hospital’s neonatal intensive care unit, labor and delivery unit and mother-baby unit, among other spaces.

If everything goes according to schedule, Murrell and Mandsager say the project should wrap up at the end of this year, with the new ER fully operational by January 2018.

Rindi White is a freelance writer who lives in Palmer.