Tricky Expansion

Logistics Loom Large in Manhattan Hospital's Addition

by Debra Wood

Increasing demand for orthopedic, rheumatologic, and rehabilitative care has led the Hospital for Special Surgery in Manhattan, one of the country's highest-profile specialty facilities, to embark on a $260 million, multiyear expansion.

First-phase work has started on additions to two wings of the main hospital facility on the Upper East Side campus, which also houses a separate research building.

"We have maxed out on our surgical volume, and we continue to grow," said Ralph Bianco, vice president of operations for the hospital. "We have faced the problem of canceling surgery because we don't have beds."

Physicians at the hospital, a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, perform more than 16,000 surgical procedures annually. Between 1995 and 2004, the hospital's admissions grew by 50 percent and total surgical volume rose by 59 percent.

But expanding the tight campus hemmed in by the Franklin Delano Roosevelt Drive to the east, other buildings to the west, and 70th and 71st streets on the north and south, has required creative design and construction techniques, such as platforms over the highway and additions to existing buildings even as the hospital stays in operation.

During the initial $64 million expansion phase, which includes a $36 million construction budget, the hospital is adding 85,000 sq. ft. of space and renovating another 100,000 sq. ft. The project team, led by Turner Construction of New York as general contractor, began working in May 2005 on the first phase, and is slated to wrap up in September.

On the eastern wing, the facility is adding a new ninth floor, which will house 30 new patient beds. On the western wing, the addition of two infill floors and three new floors will create space for a new eight-room ambulatory surgery center and a central sterile supply space, while a new mechanical penthouse will house chillers and cooling towers.

Cannon Design, based in Grand Island, N.Y., prepared a master plan for the expansion. It includes a new room layout for the ninth-floor addition that has a door enter the center of the room and positions patient beds on either side to face windows with views of the East River. The layout eschews the traditional hospital room format that has one bed by the door and another near the window, both facing a wall, said George Santos, project manager for Cannon.

Cannon also designed the ambulatory surgery center as a ring of rooms with separate corridors for patients and staff and creates private rooms where family members can stay with patients awaiting a procedure. In addition, the design places new elevators in a former stairwell.

Ysrael A. Seinuk - a New York firm that was structural engineer for the original steel-framed east wing built on a platform over the FDR Drive in 1995 - is now providing engineering services for the new steel addition. The highway remains a primary logistical challenge, said Mark Manning, project manager for Turner.

"The FDR Drive passes directly below the building that we are adding a floor to, so there are challenges in public protection," he added. "Over the road, we put in a netting system [that stretches] from above the area where we are working down to a floor or two below."

Turner used similar protection to prevent debris from landing on a jogging path.

"We also had to shut down the FDR on a number of occasions to install precast, windows, and other items," Manning said.

The full closures took place during early morning hours on weekends. At other times, the project secured partial lane closures on the highway or adjoining streets to allow crane access and deliveries.

The west wing addition will have an exterior of glass curtain wall, brick, and metal panels. The east wing expansion will have precast panels - fused with granite to match the existing building - and ribbon windows.

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Minimizing Patient Care Disruptions

The hospital has remained in operation throughout the effort, including providing patient care on the floor below the one-story addition to the east wing.

"The construction company is working very closely with us to ensure noise and dust levels are kept to a minimum," Bianco said.

Turner meets with the hospital staff to map out plans for each week. It schedules some office relocations over weekends, putting everything back in place by Monday morning.

Crews also have used saw cuts instead of chopping to decrease noise levels. Even so, work planned during daytime hours sometimes requires rescheduling when the medical staff determines that it could disrupt hospital operations, which are subject to fast-changing conditions as emergencies and other unplanned activities arise.

"We get stopped, repeatedly," Manning said. "We start most tasks that involve noise later at night or on weekends. That works in some areas. Some areas are patient care, which is 24-7, so there's no good time."

With much of the work taking place in and around spaces that remain in use, the design team could gather only limited data about existing structural features. As the project team begins to knock down walls, it is finding unanticipated elements, such as structural steel that did not match initial drawings in one area where crews are building a new elevator shaft.

"We called the structural engineer and within 24 hours we had a steel redesign," Manning said. "We gave that information to the steel sub and went back into fabrication."

That elevator is a critical part of the first phase. It will only stop on floors housing existing surgical spaces and inpatient operating rooms, new ambulatory surgery suites, and the central sterile supply area. The hospital will use the elevator to deliver sterile equipment to the operating rooms and return soiled items.

"This elevator is a giant dumbwaiter," Santos said. "You can operate it without [riding it]. Staff can load it up with a cart, press a button, and it will deliver it to the respective floor."

The next phase in the $260 million plan will entail renovations of diagnostic space, the addition of two magnetic resonance imaging machines, and expansion of the inpatient surgical services unit, with more operating rooms and a 14-bed post-anesthesia recovery area. It will grow into the space that the existing central sterile supply unit will vacate after the current expansion phase finishes this summer. Bianco said he anticipates that the new work will start in late summer or early fall.

The hospital is seeking approval from the New York State Department of Health for the program's final phase, an arthroscopy and sports medicine center. Bianco said that approval might arrive by the end of the year.

The hospital has yet to select the last-phase contractor, which may be asked to erect the new structure on a platform over the FDR Drive and connect it to the complex's Caspary Research Building.

Key Players

Owner: Hospital for Special Surgery, New York

Construction Manager: Specialty Management, New York

General Contractor: Turner Construction, New York

Architect: Cannon Design, Grand Island, N.Y.

Structural Engineer: Ysrael A. Seinuk, New York

Steel Fabrication: Weir Welding, Carlstadt, N.J.

Steel Erection: Cross Country Construction, New York

Concrete: M&R European Construction, Woodside, N.Y.

Electrical: Rigid Electric, Brooklyn

Plumbing: Cardoza Plumbing, Jamaica, N.Y.

Mechanical: Nelson Air Device, Maspeth, N.Y.