Critical Care Brought to New Heights
Barbara Horwitz-Bennett, Winter 2012 Download PDF
More than just a state-of-the-art critical care building, St. Joseph’s newest facility addition is helping to revitalize the sleepy suburb of Paterson, New Jersey.
The new St. Joseph’s Regional Medical Center Critical Care Building is not only breathing new life into Paterson, new Jersey, but putting St. Joseph’s Healthcare System back on the map. Now boasting the region’s largest helipad north of Washington, D.C., the center was designated the back-up emergency location during a visit to the area by President Obama in the aftermath of Hurricane Irene flooding.
“At 183,00 square feet, the building’s footprint is the size of a football field,” explains William A. McDonald, President/CEO, St. Joseph’s Healthcare System. “We went from 72,000 emergency room visits in 2004, to 130,000 visits this year, so the new building has come along at just the right time to serve our patients.”
Featuring separate yet connected pediatric, geriatric, and adult emergency departments; 12 systems-integrated operating theaters with pre-operative, post-operative, and surgical waiting areas; and 56 new patient critical care rooms, the building’s glass curtainwall facade gives the hospital an all-new level of visibility from nearby Interstate 80, linking up Paterson with the New York City metropolitan area.
As part of a larger master plan that includes a new lobby, which opened in 2010, a future upgrade of the patient rooms in the main hospital, and consolidation of women's and children's services-along with community plans for a new park, community center, two apartment towers, a luxury Hyatt hotel, a medical office building, and an already completed parking garage with retail space-St. Joseph 's is actively working with local partners to revitalize the surrounding area and enhance the cityscape.
The right approach
It all began around 2004, shortly after McDonald and his staff came on board. At that time, an extensive clinical service evaluation was conducted, leading to a new clinical service plan. Architectural firm Francis Cauffman was then brought in to perform a complete systematic assessment and develop a strategic plan, which was approved at the end of 2005.
McDonald's team got to work procuring the financing, and 2007 marked the beginning of several facilities projects with the new critical care building as the master plan's centerpiece.
"Because the planning was very comprehensively done, many infrastructure impacts were noticeable from the start," recalls Clare Broderick, PE, LEED AP, operating officer, building systems engineering division, Birdsall Services Group, whose Eatontown, New Jersey-based firm provided the MEP, structural, civil, environmental engineering, and environment consulting on the project.
"We were contracted right at the beginning and keeping in mind energy efficiency, ongoing code compliance, and continued operations, we were able to provide a comprehensive matrix of each of the buildings affected, and inform the infrastructure and site impact right up from," she explains.
Consequently, with the engineer on board so early in the process, a number of infrastructure design options were reviewed with the most optimal and reliable solutions clearly emerging.
Circulation and layout
Perhaps one of the more unique attributes of the new center is the way in which separate circulation paths have been carved out for patients and their families, and medical and support staff.
Consequently, "the space is not what people would expect from a hospital. It creates a more social atmosphere and a pleasant patient experience because each group gets its own space, yet the proximity is quite good," says Jim Crispino, AIA, NCARB, president, Francis Cauffman, New York. "Patients and families are seeing a light-filled, contemporary healthcare environment, while the staff has quiet places to work. We were able to achieve this by putting in an internal corridor, which is separate from the public elevators on the nursing floors."
Furthermore, ambulances and emergency vehicles have their own separate entrance to the emergency department.
Another interesting space layout decision, which actually informed the building's shape, was a unique nursing floor configuration enabling nurses to be no more than 15 feet away from each critical care patient. Similarly, because the hospital wanted to have some flexibility with aggregating patient populations, the building form took the shape of two circular structures connecting together. This way the patient floors are able to function as a single unit or two smaller units.
This theme also carries over into the emergency department, where separate areas have been designated for pediatrics, adult, and geriatric care, as mentioned. "When you're talking about designing a new ED-and a high volume one-you need a certain level of modularity, flexibility, and access," Crispino says. "The magic of this ED is it gives everyone his or her own access point."
For example, geriatric patients often necessitate more extensive visits, requiring a fuller evaluation of their medications, medical history, current living situation, and so on. Consequently, a quieter environment with more private rooms is important.
On the other hand, the pediatric ED features strobe light-type systems with changing colors to create a bright and lively atmosphere.
At the same time, the ED also can condense itself into a smaller footprint during off-peak hours to maximize service efficiency.
More than a pretty face
As with any healthcare campus addition, the architects were challenged to create a modern, attractive facade that also coordinates with older existing buildings. In addition, Crispino says, "Our mandate from St. Joseph's was to design a transformative project to embody the idea that the hospital is a forward-looking, contemporary institution."
And with the new facility's location on the northwest quadrant of the campus, making it highly visible from I-80, the architects chose a glass curtainwall with blue and grey metal paneling to create a bold and fresh look.
"We thought that the transparency of the glass curtainwall, combined with the warm blue color, would contrast nicely with the red brick of the surrounding older buildings," Crispino says.
Furthermore, the intersecting elliptical shapes are quire striking, while the form helps modulate the building's scale yet also makes it prominent from a distance. The patient floor rotundas also intersect with a metal-panel-covered square block where the ED is housed, creating a discrete identification of the building's different functions.
Although the hospital chose not to seek LEED certification, the HV AC systems were designed to meet LEED criteria. This includes high-efficiency motors and a highly efficient, variable volume, DDC chiller system. In addition, a multi-compressor condensing unit backs up the operating rooms, and the building automation systems are programmed to maximize chiller and pump operation, according to Broderick.
From an architectural standpoint, the mechanical systems had to be housed within an envelope that would nor disrupt the building's facade. Consequently, right-sizing the equipment was essential.
As for lighting, "we worked to maximize the value of natural and decorative light with a low energy cost, which is always a challenge in healthcare," Broderick says. "With multiple levels of lighting control, dimming and light-blocking shades, the lighting design exceeds both lighting and energy codes."
The hospital also invested in very robust, sophisticated communications infrastructure to accommodate a wide variety of communications devices and, subsequently, support various emergency personnel-including police, fire, emergency medical technicians, and disaster relief agencies-particularly in the event of a major emergency or disaster.
The critical care building also is outfitted with the infrastructure to support a large telemedicine program with HDTV capabilities.
In terms of supporting ongoing hospital operations during construction, the new building's location was strategically determined to minimize any impact on patient care. "In order to protect the healthcare environment while we demolished buildings and moved fuel ranks, etc., we monitored air ducts in 15 different HVAC locations, sealed windows in existing facades, and pressurized those spaces," Broderick says. "It was a huge challenge and the hospital was very concerned about it, bur we were able to maintain the environmental conditions required for critical care."
The big picture
While the new critical care building is expected to play a significant role in increasing St. Joseph's reputation as a state-of-the-art institution, it's also part of a larger vision to re-invigorate a struggling community.
"Paterson has never been viewed as a destination point, so we are working with the city and private developers to re-develop the area around the hospital to help stimulate the community and make it a more attractive place," McDonald says.
Included in this effort are current discussions with New York Medical College about the possibility of establishing a campus in the area.
Taking a step back, the building team views what's going on at St. Joseph's and in Paterson as a true community effort.
"Back in 2005, we were looking at a distressed medical center in a distressed area. Most people didn't think the place would be around much longer. Yet in 2011, St. Joseph's was chosen as the designated center for the president during his recent visit to the area," Crispino points out.
Similarly, Broderick says, "I think that the vision and approach was always comprehensive in terms of what the hospital wanted the new building to do for the community. We were very fortunate to be part of such a team."