Hospitals building to remain competitive

To see the future of Women & Infants Hospital’s neonatal intensive care unit, you can look at the architects’ drawings, or you can peer into a hidden corner of the current NICU.
Tucked away from the babies and their families, in a former conference room, is a mock-up of one of the 70 private NICU rooms being built just across the driveway, complete with all the medical equipment, a bassinet with a premie-size baby doll, and a sofa bed for the mother.
Walsh Brothers, which is managing the project, built the mock-up almost two years ago to ensure all the designs worked well in real life – from the position of the staff call buttons, to the door hardware, to the light fixtures, to the color scheme, to the furniture.
“They ripped it out and rebuilt it again four different ways, so that we would know when we actually built the room, it would be the room we all wanted,” said Kimberly Silvestri, director of facility development and space planning at the hospital.
“We had people sleep in the [sofa] bed,” she added. “We had staff run through sample scenarios, bring the equipment in, try all the equipment, everything. … It’s absolutely the best thing you want to do for a project like this. You want to build one of these before you make any mistake – or 70.”
The $76.8 million, five-story addition that will house Women & Infants’ new NICU is the biggest construction project the hospital has undertaken and one of two major hospital projects going up within a stone’s throw of each other in South Providence.
Nearby, on Eddy Street, Rhode Island Hospital is finishing the second part of its Bridge Building. The first part, a $70 million project completed in 2005, included a new 51,000-square-foot emergency department, operating suites, and a 254-space parking garage.
This phase, initially valued at about $60 million but now expected to cost an extra $8 million, includes three more floors for general medical/surgical inpatient units, a coronary care unit and a coronary step-down unit for recovering patients, all slated to open next month, as well as still-to-be-done upgrades of older facilities in the main and Jane Brown buildings.
For both hospitals, these construction projects are essential to remain competitive in a regional market still dominated by Boston’s academic medical centers, and to keep up with advances in medicine, both technologically and in what is considered state-of-the-art space.
The typical life cycle for a hospital building is about 25 years, and technology needs to be replaced every seven to 10 years, so to keep up, a large hospital will always be upgrading, said Fred Macri, executive vice president and chief operating officer of Rhode Island Hospital.
In reality, serious budget crunches left many local hospitals too cash-strapped to maintain and update their facilities for several years.
Rhode Island Hospital alone approved a 10-year plan in 2000 that pumped more than $420 million into the physical plant in the first five years alone, including the new ED as well as the $13.5 million Comprehensive Cancer Center and the $33.5 million Coro Center.
For both Rhode Island Hospital and Women & Infants, a dramatic increase in research – mostly in conjunction with Brown University’s Warren Alpert Medical School – has required substantial investments in new facilities.
And while inpatient volume has not been particularly strong statewide, both these hospitals have faced space crunches: Women & Infants’ NICU, built to accommodate 41 babies at a time, has been operating at more than 50 percent above capacity for several years, and its obstetric beds have also been in high demand.
Private rooms, which were once considered a luxury, are also the new standard. All the new rooms at both hospitals are singles – which for the NICU is a particularly dramatic change, since the current facility is one big room divided into bays with multiple bassinets.
Women & Infants’ NICU will be among the first in the nation to have all-private rooms, said Silvestri, and the reason for the investment is that research suggests it will reduce the risk of infection, reduce noise, and allow for better lighting and temperature controls, not to mention how much more comfortable and private it will be for the babies’ families.
Patsy Trine, senior associate for health care at HOK, the firm that designed Rhode Island Hospital’s new facilities, also cited infection control as a key reason to build single rooms, as well as the need to comply with federal privacy laws. With this addition, which includes 110 inpatient beds – 55 new ones and 55 replacing beds in older units – Rhode Island Hospital will have 62 percent of its inpatient beds private.
Some of the other upgrades involved in these construction projects are not about medicine per se, but about making hospitals more … hospitable.
Women & Infants’ new building will have a new café, a new gift shop and new spaces for patients and their families to spend time on their own or meet in groups. And the new 30-bed obstetric unit, geared to women with difficult pregnancies who may have to spend several weeks in the hospital, includes a massage area, a hairdressing station and laundry facilities.
Both projects have been stung by the worldwide construction boom of the last couple of years, Macri and Silvestri said, which affected the price of steel, copper and other crucial materials and pushed the building costs well beyond their original budgets.
In that sense, the economic slowdown has been a good thing. Macri said recent bids have come in “right on budget.” The Women & Infants project, for its part, came in $12.8 million over budget and was delayed by several months in the design phase, but now it’s “on budget and on time,” Silvestri said, slated to open next summer. •