When One Is Better Than Two: Carilion Roanoke Memorial Hospital

It's one thing to build a new hospital on a nice, clean, unobstructed site. It's quite another to consolidate two healthcare facilities at one location, even adding a new structure atop one of the existing buildings. To make it real fun, throw in a flood just before construction starts.

That's the situation that confronted a Building Team led by the Roanoke, Va., office of architect/engineer HSMM AECOM, architect/medical planner HOK, and contractor Skanska Building USA. In 2003, this design-build group completed a major expansion to Carilion Roanoke Memorial Hospital (CRMH), the only tertiary-care hospital in the region, serving some 225,000 patients annually. The next year, officials at CRMH's Carilion Clinic brought the team back to consolidate the organization's CRMH flagship with its sister community hospital under one site at the CRMH location.

The team was tasked with building 300,000 sf of new construction, renovating 150,000 sf of the 1.5 million-sf CRMH campus, realigning all the patient and ambulance entrances, expanding the central energy plant and utility systems, and making modifications to almost all the site access roads and parking areas.

So far, so good. But in September 2004, just as major site work was about to begin, the nearby Roanoke River flooded to within a few feet of the main entrance to the 15-story hospital, whose lowest level was located in the 100-year floodplain. Undaunted, the team erected a temporary flood wall to protect the CRMH during construction. Later, a removable flood wall system that can be installed quickly in the event of future flooding was built near the main entrance.

Founded in 1899, the main hospital had gone through numerous renovations, expansions, and additions over the years. One of these, the south tower, had been designed in 1992 to permit a vertical addition, but by the time the consolidation scheme was gearing up, seismic and wind regulations had changed. The Building Team conducted an extensive study to verify that the existing structure could support a five-story addition and a new heliport on the roof. The existing building's slabs were x-rayed to confirm the location of rebar and determine how to core through the slabs for new systems in order to minimize noise from jackhammers. Two hundred concrete-encased couplings on the original roof then had to be uncovered to permit the connection to the new columns.

All but the top floors of the 15-story south tower had to remain fully operational during construction. To get trade workers to the job site, a lift was attached to the side of the tower. Two construction cranes hoisted structural steel, concrete, and other materials from below. Concrete pours atop the south tower were conducted at night and on weekends to minimize disruption to the working hospital below.

Extending the elevators to the new addition was not easy. The two construction cranes could not lift the elevator machines atop the existing building up the shafts. Instead of removing the machines, building new shafts and mechanical rooms, and replacing the machines, the entire extension was built with the elevators in place. The machines were temporarily shored while the mechanical rooms were moved up the additional floors. The machines were then winched from the mechanical room roof to the top of the extended shafts and placed back into service. Extreme coordination was required to schedule the shutdowns of electrical, mechanical, plumbing, and elevator service during these maneuvers.

As is to be expected in a project of this complexity, the activities of virtually every one of Carilion Clinic's 5,000 physicians, nurses, and support staff were disrupted by the construction work. To reduce the impact, the Building Team asked department heads and managers to identify project “ambassadors” to participate in design charrettes and progress meetings and carry the word back to their respective units.

Individual departments cooperated in the many moves that were required to allow for renovations, tie-ins, and the establishment of new departments. With the hospital's engineering and maintenance staff, the team developed a risk assessment plan for contamination, noise, vibration, and traffic. Workflows were scheduled to meet special needs, especially with regard to operating room schedules, emergency department peak flows, and the neonatal ICU.

The consolidated facility, now the second-largest regional community hospital in Virginia, was completed on time over a three-year period at a cost of $105 million, $15 million less than originally anticipated.