A Healthcare System Adapts Its Facilities Strategies to the Times

March 3, 2006
Modernized and new facilities at Sentara Norfolk General Hospital meet the demands of physicians, nurses, and patients

In 1888, the 25-bed Retreat for the Sick opened in Norfolk, VA, addressing the city’s dire need for a new hospital. With this facility’s construction, the seed for today’s renowned Sentara Norfolk General Hospital (SNGH) was planted, as well as for the entire Sentara Healthcare system.

From that tiny 25-bed facility, the hospital moved to a new location in the city and grew to 100 beds in 1896. In 1904, the hospital moved again.

This site still houses the sprawling, contemporary Norfolk General Hospital complex - which includes two additional, separate entities: the Eastern Virginia Medical School (EVMS) and the Children’s Hospital of The King’s Daughters, another non-Sentara teaching hospital affi liated with the medical school, as well as a 10-story medical offi ce building. The original 1904 hospital structure is long gone, razed as the current healthcare complex expanded and modernized.

Sentara Healthcare, a not-for-profit healthcare provider, is the largest integrated healthcare provider in southeastern Virginia and northeastern North Carolina, serving more than 2 million residents. The 1.1-million-square-foot, 569-bed Sentara Norfolk General Hospital is one of the system’s six acute-care hospitals. It is the region’s main tertiary care center and the primary teaching hospital for undergraduate and graduate education at EVMS.

Special services include the Nightingale Air Ambulance, which serves the hospital’s Level 1 Trauma Center. The hospital also has an active kidney transplant service, as well as on-site programs in sleep medicine, epilepsy, and oncology.

In February 2006, it opened the Sentara Heart Hospital at Sentara Norfolk General Hospital. The 6-story, 324,000-square-foot addition is connected to the existing SNGH facility and centralizes all cardiac services.

It features all private rooms with 112 licensed inpatient beds and 45 pre-/post-procedural rooms dedicated to patients undergoing interventional cardiac procedures. Its five cardiac rooms are designed to accommodate 2,000 procedures each year, while six cardiac catheterization labs will accommodate 7,200 annual procedures. A digital, wireless environment allows doctors and staff to be closer to patients’ bedsides.

The Old and the New
Sentara Norfolk General’s modern incarnation took root in 1956 with the construction of the facility’s “B wing.” This wing houses the hospital’s rehabilitation services, mental health services, a sleep lab, and patient-care beds. It also houses “guest services,” a 20-bed hotel for families and visitors. Part of the women’s health department and laboratory services alsooccupy this wing.

“Everything in the B wing has been renovated in one way or another over the past 7 or 8 years,” says Joseph Savala, Sentara Norfolk General Hospital’s director of facilities. Upgrades and renovations include several major HVAC infrastructure changes and electrical updates, including converting out-of-service elevator shafts into utilities shafts.

In 1964, Sentara added the hospital’s “A wing.” Savala describes these older buildings’ layout as a “T.” The B wing is the top of the T, while the A wing is the leg, he says. The hospital used to also have C, D, E, F, and G wings, but those have been demolished over the years to allow for expansion of more modern spaces for the landlocked Sentara Norfolk General, King’s Daughters, and the medical school.

Other additions to SNGH, besides the newly opened heart hospital, include the following:

  • 1971 - The BB wing, featuring the cafeteria and dietary services on the first floor, and women’s health and cardiac services (which have since moved to the new heart hospital).
  • 1975 - Radiation oncology.
  • 1981 - The Kaufman Pavilion, a 7-story structure that has patient-care areas on floors 4 through 7; intensive care on the third floor; physical therapy and the primary mechanical on the second floor; and radiology, the emergency department, and administrative areas on the first floor.
  • 1987 - The Horseshoe Pavilion, named after the horseshoe-shaped drive that it replaced. It includes the cancer center, transplant clinic, more intensive care, and the main operating rooms.
  • 1991 - The Raleigh Building, featuring support services. The third floor houses laboratory administrators and educators, and ER physician offices. The second floor has all the laboratory services. The facilities department occupies the entire first floor.The building also features the hospital’s Brickhouse Auditorium, a facility that it shares with the Children’s Hospital.
  • 1993 - The River Pavilion, a 6-story building with patient beds on floors 4, 5, and 6. The third floor houses outpatient operating rooms. The second floor has physician office space and the Lion’s Club Eye Bank. The first floor houses the breast health center and outpatient chemotherapy.

Merging Mechanicals
A growing campus has implications on HVAC infrastructure - more buildings mean the need for a larger, more sophisticated physical plant.

In 1997, Sentara built its Central Utility Plant (CUP), which underwent a physical expansion between 1991 and 1993 to support the addition of the River Pavilion and the expansion of the Children’s Hospital of The King’s Daughters. Sentara operates the plant, but it is used in a consortium between SNGH, EVMS, and the Children’s Hospital.

The current plant has 11 cooling towers and eight chillers. Chillers 1 through 6 are 1,250 tons each. Chiller 7, at 1,750 tons, is the newest addition and supports the heart hospital. An eighth chiller, an ice chiller, is 1,550 tons. The plant’s four boilers are each rated at 30,000 pounds of steam per hour and operate on either natural gas or No. 6 fuel oil. “As we have added buildings, we have had to run major utility lines and piping throughout the campus,” explains Savala.

Building infrastructure also has been upgraded over the years, according to Carl Fuller, manager of facilities. “It has been significant to get rid of the 1950s and ‘60s air-conditioning technology,” he says. “Back then, they were tickled to death to maintain an 80-degree F. room. That’s not acceptable today.”

Modern Technologies
In the competitive healthcare marketplace, it takes more than updated HVAC to remain competitive.

“There’s always renovation going on to get the latest and greatest,” Savala says. “We have ‘smart’ ORs, and we’re looking to convert other rooms into ‘smart’ ORs. We’re always upgrading our cath labs to the newest technologies. Our MRI and CTs are state of the art. Even if space is tight, we fi gure out a way to make it work.”

One of the biggest technological challenges is to update the hospital’s IT infrastructure. Today, 90 percent of the hospital’s IT staff and mainframes are off campus in two locations, which serve all six Sentara system hospitals - soon to be seven - as well as its whole array of integrated services, materials management, homecare services, life-care facilities, nursing homes, and assisted-living offerings.

The other challenge is creating IT infrastructure in vintage buildings. Savala says the facilities team has worked with the IT department to create IT closets on different floors to accommodate modern cabling. The group has also strategically located power sources. New buildings have 10 to 15 receptacles, and older rooms are constantly being upgraded.

The heart hospital represents the biggest push into IT technology. Mentioning the all-antenna system for wireless capabilities, conduit in walls, multiple receptacles, and built-in printer ports as a few of the high-tech features, Savala says, “We’re still built for paper today, [but] we're really trying to push the envelope.”

Robin Suttell ([email protected]), based in Cleveland, is contributing editor at Buildings magazine.

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