Hospital Upgrade

Expanding and Renovating for Growth in New Jersey

by Natalie Keith

The Community Medical Center in Toms River, N.J., is in the middle of a $150 million expansion program aimed at meeting the needs of a growing community. The 44-year-old center is Ocean County's largest health-care facility.

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"Ocean County is the fastest-growing county in New Jersey," said Vincent Delladonna, director of planning and design for St. Barnabas Health Care System, which owns the medical center. "The project is the implementation of a master-plan study to increase patient care due to the rapid growth."

The program, which is being completed in five phases, began in 2000 when the hospital hired New York-based Barr & Barr Inc. as construction manager for the projects. Construction began in 2002, and several facilities have already come on line. Full completion is expected in the second or third quarter of 2008, Delladonna said.

Projects completed thus far include:

• Renovation of the cardiac catheterization lab suite and noninvasive cardiac lab.
• A one-story, 24,000-sq.-ft. addition to the obstetric department atop the existing fourth-floor patient wing. The new floor provides an additional 27 postpartum rooms, new nursery facilities, a new eight-room labor and delivery suite, and two new Caesarean-section suites.
• A project to renovate the outpatient elevator lobby and add two new elevators.
• The first and second phases of a major interior renovation of the cancer center, including relocation of the outpatient infusion suite. The project team is currently working on the third phase of the renovation with a fourth and final phase planned in the coming months.

The majority of the current work in the program involves expansion of the emergency department. A new, 129,000-sq.-ft., five-story facility will include a new emergency room entrance, operating rooms, materials handling areas, and administrative space, said Keith Stanisce, executive vice president of Barr & Barr.

The emergency room addition is a structural steel building with concrete decks. The façade is a curtain-wall system with brick and an exterior installation and finish system, or EIFS.

The program also involves building an 18,000-sq.-ft., two-story addition for critical care and medical surgery beds and a 30,000-sq.-ft. renovation to the existing structure. Adjacent to the addition will be a new 175-space parking structure.

The first and second phases of the emergency room project are expected to finish this summer with the third, fourth, and fifth phases expected to be complete in 2008. Work also begins this summer on a one-story addition to another parking garage on the campus, Stanisce said.

Barr & Barr is construction manager on all of the projects, but there were several architectural firms. Array Architects of King of Prussia, Pa., designed the five-story emergency room addition, and Philadelphia-based Vitetta designed the two-story critical-care addition. New York-based Desman Associates designed the parking garage addition, while Granary Associates of Philadelphia drew up the remaining projects.

Stanisce said the projects have required a great deal of strategic and logistical planning, partly because the hospital has remained open during the work.

"One of the challenges we identified early on was trying to minimize disturbance to the existing campus," Stanisce said. "This has been particularly hard because we aren't just working on one section of the hospital."

To minimize disruptions to hospital operations, the project team met with representatives from all of the hospital departments impacted by the work, along with the architects on the job. In addition to devising infectious control barriers aimed at preventing construction dust and debris from migrating to patient areas, the project team has to maintain safe access to the hospital, Stanisce said.

"We had a safety officer on duty to make sure the infectious control barriers were not penetrated," he added.

The project team also had to install a new mechanical system to service not only the addition but the existing structure as well. "We had to have all the mechanical systems installed, tested, and running," Stanisce said. "Then we began the switchover to the new system in the existing structure. This was a three-month process, but it went smoothly."

The projects are introducing several programmatic improvements to Community Medical's design and flow, said Lisa Naide Lipschutz, a principal for planning and design at Array. On the emergency department design, she said hospital administrators wanted separate zones for staff and the public to circulate. The result is a series of pods created by curved rows of exam rooms that form a buffer between spaces for staff and support services on one side and spaces for the public - patients and family - on the other.

"To have this rather large emergency department not feel so big, we designed these dual travel patterns around the exam room," Lipschutz added. "There are going to be quiet, calm, peaceful corridors even though it's for emergency care."

In addition, the pod system allowed for the creation of separate areas to handle different emergencies, such as a "fast-track" zone for patients who can be treated within an hour.

Another design goal was to make the public spaces of the emergency department more welcoming by eschewing the traditional white-walled, long corridors in older hospitals and instead introducing wood tones, ceramic wall tiles, and assorted wall coverings and colors, said Valerie Smeltz, an interior design project manager at Array. She said "wayfinding" was an important design concern, with the ceramic wall tiles and colors offering easier markers to navigate the hallways.

"I think they're going to look pretty, but also be useful for the people who use the hospital," Smeltz said.

Key Players

Owner: St. Barnabas Health Care System, West Orange, N.J.

Construction Manager: Barr & Barr Inc., New York

Architects: Array, King of Prussia, Pa.; Desman Associates, New York; Granary Associates, Philadelphia; Vitetta, Philadelphia

Structural Engineer: O'Donnell & Naccarato, Lawrenceville, N.J.

Mechanical Engineers: Highland Associates, Clarks Summit, Pa.; Schade Engineering, Ardmore, Pa.

Civil Engineer: Dewberry, Parsippany, N.J.

Concrete: Scarano Masonry, Matawan, N.J.; Advanced Coring & Cutting, Freehold, N.J.

Structural Concrete: High Concrete Structure, Denver, Pa.

Structural Steel: S&R Steel, Linden, N.J.

Plumbing: Central Jersey Mechanical, Long Branch, N.J.

HVAC: Binsky Snyder Inc., Piscataway, N.J.; Gerard Sheet Metal Fabricators, East Brunswick, N.J.

Electric: EJ Stewart Electric, Parsippany, N.J.

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