| Project Name / Atrium Medical Center Location / Middletown, Ohio Owner / Atrium Medical Center Total Floor Area / 747,873 square feet Number of Floors / Hospital—5, plus a partial basement; medical office building—5; cancer center—2; behavioral health pavilion—3 Number of Beds / 250 in hospital; 25 in behavioral health pavilion Project Cost / $243.5 million Construction Cost / $200 million Groundbreaking / June 2005 Opening / December 2007 |
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In the wake of Middletown Regional Hospital’s recent facility replacement project in Middletown, Ohio, everything at the hospital is new, including its name. The newly christened Atrium Medical Center opened in December with what Douglas W. McNeill, the medical center’s president and CEO, calls “an entirely new platform.”
The name change reflects the fact that the project entailed more than simply replacing the existing building. After 90 years at a landlocked, residential site, the hospital has relocated to a 200-acre medical campus along the Interstate 75 corridor between Cincinnati and Dayton. The added space enabled the hospital to hire more staff; significantly expand cardiology, cancer, surgery and trauma services; and create partnerships with several other facilities on the Premier Health Campus—Middletown, as the new site is known.
‘Health care hub’
Atrium Medical Center comprises four adjoined buildings designed by Nashville, Tenn.-based Earl Swensson Associates Inc. (ESa)—a 250-bed hospital, a medical office building, a cancer center and a behavioral health pavilion. The medical office building is owned by health care developer Equity Inc., Worthington, Ohio, and the behavioral health pavilion is operated by Diamond Healthcare Corp., a behavioral health care management and consulting company headquartered in Richmond, Va.
The campus is also home to an outpatient care center owned and operated by The Children’s Medical Center of Dayton and a freestanding outpatient surgery center that is a joint venture between Atrium Medical Center, Dayton Children’s and area physicians.
Other health facilities being built on the campus include a skilled nursing community to be operated by Otterbein Retirement Living Communities of Lebanon, Ohio, and a YMCA. In 2009, a health science academy is scheduled to open on the site.
The campus provides a central location for area residents to meet their health care needs—from exercise and health education to surgery and long-term care. The campus setting also fosters collaboration between health care organizations.
“We’ve shared people, programs and facilities with all our major partners on campus and produced services that on our own we probably couldn’t,” says McNeill. “In a sense, we’ve created a health care hub.”
Design consistency
The medical center structures are designed to complement one another. “That was one of the reasons we insisted on the same architect for all four buildings,” says Marilyn Noll, MT (ASCP), the medical center’s director of new facility planning and site development.
Two colors of jumbo-sized bricks make up the buildings’ exteriors. Each of these bricks measures 4 inches by 16 inches, as compared to a standard brick dimension of 4 inches by 8 inches, says Craig Holloway, AIA, ESa architect and project manager. He explains the oversized bricks lay up faster, bringing a great deal of economy to a project of this size.
The buildings’ interiors share a consistent style that was fine-tuned for different purposes. For example, says Ken Bowman, IIDA, ASID, ESa interior design manager, the designers used more intense and lively colors in the rehabilitation and medical office areas and more soothing colors in the cancer center.
Service integration
Atrium Medical Center’s emphasis on service integration is clear from its design. As patients and visitors approach the medical center’s main entrance, the hospital and medical office building appear to be a single building. All of the center’s services can be accessed from the light-filled main lobby.
“One of the keys to the design was that as you enter the building, essentially you should be able to see to every destination that you need,” says Todd Robinson, AIA, senior designer and principal with ESa. From an information desk near the front door, staff and volunteers can point out the location of services like registration and preadmission testing, outpatient imaging and cardiology and the surgery waiting area. Amenities such as the hospital’s café, gift shop and chapel, as well as the elevators up to the inpatient units, are all easily accessible from this open area.
A concourse along a large interior courtyard connects the medical office building and cancer center to the main hospital lobby. The courtyard allows natural light into the concourse and provides space for outdoor dining and relaxation. This area also functions as a wayfinding mechanism, as views of the courtyard enable visitors to orient themselves when traveling between buildings.
Interior elements
The openness, natural light and natural color palette of the lobby continue through the entire facility. Bowman says hospital leaders asked for a design that was natural and light and, of course, efficient and affordable. To achieve these qualities, the designers used materials throughout the building that mimic the look of natural materials. For example, they used plastic laminate in lieu of wood for certain casework and wall areas, wood-look vinyl flooring and porcelain tile that resembles limestone. These design elements were easy on the project budget and are easier to maintain than their natural counterparts, Bowman says.
Attractiveness and ease of maintenance also drove the selection of carpet tile with a multidirectional pattern for some of the hospital’s waiting areas. These tiles can easily be lifted out and replaced as necessary with minimal interruption to the overall flooring pattern.
Internal alignment
A four-story North Tower and five-story South Tower make up the hospital’s diagnostic and treatment area. These towers are adjoined on floors two through four. Each floor of the North Tower is also directly linked to the medical office building.
As McNeill explains, the second floor of the medical center functions as a heart hospital, with cardiac care provided on this level of the medical office building and both hospital towers. “All the inpatient and outpatient cardiac services are there, from the cath lab to other diagnostic areas to the ORs to the CVSICU. Patients and families can go to one place,” he says.
Open-heart surgery, catheterizations and angiography are performed in the hospital’s surgical services department on the second floor of the North Tower. The cardiovascular surgery intensive care unit is located on the second floor of the South Tower, as are the other cardiac care units.
These hospital services are aligned with the cardiac care center in the medical office building, which includes a heart failure center and areas for outpatient cardiology, nuclear cardiology and cardiac rehabilitation care.
The hospital’s medical and surgical patient rooms are on the fourth floor of both the North and South towers. Each tower has 48 rooms that are clustered in three pods of 16 rooms each. A central core in the middle of each pod provides convenient supply and medication storage, as well as clean and soiled utility rooms.
Charting alcoves along the corridors of the patient units give caregivers space to work near patient rooms. In non-critical care units, windows brighten each alcove. A film applied to the glass helps protect patient privacy by obscuring the view of the computer screen.
Computers are also located on the headwall of each medical-surgical patient room. The footwalls are accented by a vinyl wallcovering inset in natural tones of blue, green or terra cotta. The floors are covered in wood-look vinyl. Sofa sleepers, a small table and wireless Internet access are provided for family members who wish to stay with patients.
The fifth floor of the South Tower houses a rehabilitation department that includes two independent living apartments designed to re-acclimate patients with daily living routines. Each apartment is a certified patient room with a private bedroom and bathroom arranged in a suite formation, with one room devoted to a living room, kitchen, dining and laundry area.
“It looks like a two-room apartment,” Holloway says. “It helps patients train to be back on their own again.”
Traffic control
The new hospital’s emergency department was designed with distinct areas for fast track, trauma and intermediate care, with separate entrances for walk-in patients and those who arrive by ambulance. An observation unit in the emergency department can be used for emergency patients as needed. The department also has dedicated imaging rooms, including X-ray and computed tomography technology, for quick access to diagnostic imaging.
The imaging department is positioned to provide good traffic flow for emergency, inpatient and outpatient care. Patient and public circulation routes are kept separate. For example, staff and patient transport elevators located behind the hospital’s public elevators allow patients to be taken directly from the emergency department onto the patient units without crossing paths with the public. One of these elevators is oversized to accommodate trauma heart patients and the attendant medical staff and equipment these patients require.
The staff and patient transport elevators are also used to bring patients down to the imaging department or to be discharged. A separate discharge canopy at the rear of the building, near the emergency department walk-in entrance, enables patients to leave the hospital without traversing the main lobby.
For patients’ convenience and privacy, each of the medical center buildings has its own entrance, although each facility is connected to the main hospital building—the medical office building and cancer center through the public concourse and the behavioral health pavilion through a restricted hallway.
Map for growth
The entire medical center is also designed for future growth. “One of the things Doug McNeill told us over and over again is, ‘Let’s create a good road map for how we grow in the future. We don’t 100 percent know where we’re going to go in terms of size, or what program is going to grow first, but we need to have that process set up,’” says Robinson.
The center is designed so that additional buildings can be added in the future. The major clinical areas of the current buildings are located around the perimeter of the center to facilitate horizontal expansion. The hospital’s surgery department can be expanded over the top of the behavioral health pavilion, and the pavilion’s patient rooms meet the standards for medical-surgical patient rooms, should the hospital wish to convert them to that purpose. Patient units or other services can also be added in three more floors on the hospital’s North Tower and two more floors on the South Tower.
The hospital’s infrastructure is designed to support this growth. For example, when the new floors are built out, three more elevators can be added to the hospital’s central elevator core to handle the additional elevator traffic. The hospital also has extra conduit space for future electrical and data support, as needed. Mechanical systems were built internal to the building, rather than placed on the roof, so they would not need to be moved for the construction of new floors. “From a design perspective, we wanted to have a facility that not only met our immediate needs, but was designed in such a way that it was flexible enough to adapt as time goes on,” Noll says.
Vertical expansion played a part in the design of the tower element at the front corner of the medical center. The hospital’s logo is prominently displayed on this tower, which is visible from the interstate and serves as an icon signifying the medical center’s location.
In designing the tower, the architects considered how it would look in proportion to the rest of the building, both in its current configuration and in the future once the additional floors are constructed.
McNeill reports the hospital is already considering planning options for the first expansion of the new facility. Since the medical center opened, “our volumes have just skyrocketed—actually testing our capacity,” he says. “The good news is that we can literally almost double the size of the medical center. We can build up and we can build out in all four directions.”
Clean sheet design
With the current health care facility taking up only 70 acres of the 200-acre site, the hospital still has ample room for growth.
“We have a lot of flexibility on this campus that we really haven’t had before,” says McNeill. “To be able to start on a greenfield, on a clean sheet of paper here, is pretty fantastic.”
Amy Eagle is a Homewood, Ill.-based freelance writer and a contributor to Health Facilities Management.
| Sidebar - Coordination with vendors helps ensure success |
The unique complexities of a state-of-the-art hospital’s mechanical, electrical, plumbing, information technology and communications systems make this type of facility a challenge to build, says Steve Risner, project director for construction of the new Atrium Medical Center in Middletown, Ohio. But early planning to coordinate building design with the installation of owner-furnished equipment (OFE) minimizes the potential for major problems in the final phase of the project, helping to ensure its overall success. Atrium Medical Center’s construction management team, a joint venture between Skanska, an international construction firm, and Ohio-based Shook Construction Inc., began working with the hospital’s management team, architects, design consultants and OFE vendors early in the pre-construction phase of the project, to integrate building design, infrastructure and OFE installations into final construction drawings. Skanska/Shook made OFE vendors a part of the design and scheduling process. “In the past, OFE vendors typically did not become involved with the project until the building had been designed and was well under construction,” says Risner. “This always resulted in design oversights and change orders to subcontractors to make the infrastructure compatible with OFE installations. There are always coordination issues with OFE installations involving structural support and plumbing, mechanical and electrical systems.” Risner emphasized the importance of this proactive approach to construction management with OFE vendors, who he says generally prefer to begin their interaction with the project when the actual installation begins. “Making them a part of the design and scheduling process at the project’s inception improves their installation efficiency,” he says. He adds that most of the OFE vendors thanked the project team for the coordination effort, saying it was the smoothest transition of equipment installation they had ever been involved with because major design coordination issues had been resolved up front.—A.E. |
| Sidebar - Spec/Sheet |
/ Project Team / Owner: Atrium Medical Center Architect: Earl Swensson Associates Inc. General contractor: Skanska-Shook joint venture Interior designer: Earl Swensson Associates Inc. Mechanical/electrical/plumbing engineering: Phoenix Design Group Structural engineering: Structural Design Group Cabling: Kastle Electric Co. Medical equipment planning: Centex Resource Group Furniture consultant: OstermanCron Inc. Landscaping: Hodgson & Douglas / Principal Design Materials / Carpet: Shaw Industries Group Inc. Ceiling: Armstrong World Industries Inc. Curtain wall, entrances and storefronts, glass and glazing: JMD Architectural Products Inc. Door hardware: Yale Security Inc. Doors: Metro Door (hollow metal doors) Exterior insulation and finish system: Sto Corp. Facade: Belden Brick Co. (brick) and Arriscraft International (custom cast stone accents) Flooring: American Biltrite Inc., Mannington and Teknoflor Insulation: Owens Corning Paint: Sherwin-Williams Co. Roofing: Carlisle SynTec Signage: FMG Design Inc. Tile: Crossville Inc. and Dal-Tile Corp. Wall coverings: RJF International Corp. Wall protection: InPro Corp. Window treatments: MechoShade Systems Inc. and Standard Textile Co. / Principal Furnishings / Behavioral health unit high-use furniture: Nemschoff Inc. Cafeteria seating: Spec Furniture Emergency department side chairs: Fixtures Furniture Inc. Lounge seating: Jasper Group, Nemschoff Inc. and Nurture by Steelcase Inc. Office furniture: KI (seating), Kimball International Inc.'s National Office Furniture unit (desks, files and shelving) and Kimball Office unit (files and shelving) Patient beds: Hill-Rom Inc. Patient room seating: Nemschoff Inc. and Wieland Systems furniture: Kimball International Inc.’s Kimball Office unit Tables: SurfaceWorks (cafeteria and conference tables) and Magna Design Inc. (conference tables) / Major medical equipment / Communications equipment: AT&T Inc. Defibrillators: Zoll Medical Corp. Imaging equipment: Siemens Corp. Linear accelerator: Elekta Nurse call and wireless communication devices: Vocera Communications OR booms: Skytron OR integrated IT system: Stryker Corp. Patient bedside cardiac monitors: General Electric Co. Patient education and television system: LodgeNet Interactive Corp. / Infrastructure / Building controls: Automated Controls Inc. Elevators: ThyssenKrupp Elevator Fire safety: Dalmation Fire Equipment Inc. HVAC (misc.): Midwest, Temtrol and Thomas J. Dyer Co.
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This article first appeared in the September 2008 issue of HFM.
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