A facility master plan typically addresses items related to patient care, and the corresponding space and medical equipment requirements needed to provide that care. What is sometimes overlooked in the process are the mechanical and electrical systems that are required to support this additional space and equipment.
Upgrades to mechanical and electrical infrastructure are often viewed as a necessary evil in the execution of master plan improvements. However, properly planned and phased upgrades to mechanical and electrical systems are as important as any other part of the institution. They also provide opportunities for implementing large-scale changes that otherwise might not be possible.
The mechanical/electrical/plumbing (MEP) system evaluation and master plan is therefore an integral primary step in the process. Viewing the systems as a whole and tying the location and configuration to needed improvements in other departments can be the best way to approach facility renewal. Indeed, if properly executed, the MEP master plan can serve as a driver for the overall facility plan.
Coordination at the start
An MEP master plan is ideally performed in conjunction with the architectural master planning and programming effort. While it is possible to complete the MEP plan after the architectural planning, it is far better to integrate both planning activities so coordination can begin at the very start of the planning effort and the overall priorities can be adjusted to include necessary MEP upgrades.
Thus, the identification of shortcomings in the MEP infrastructure is determined up front, avoiding time-consuming revisions and potentially costly changes. Ordinarily, a facilitywide MEP master plan is prompted by the recognition of an impending major addition and/or renovation. But even minor upgrades to existing spaces may strain the infrastructure and building systems if they are running at or near capacity.
The goal of the master plan is to establish a comprehensive strategy for accommodating the present and future needs of the facility. The plan must provide for maintaining the necessary reliability, redundancy and flexibility of all systems to allow for phased implementation of upgrades, without reducing the key functionality of the systems or making inordinately large and untimely investments in infrastructure.
All aspects must be balanced with the life cycle costs of the proposed solutions and impacts on the current facility operations. In some cases, planned system redundancy can be utilized as extra capacity in the short term in order to move forward on a facility expansion. However, it is important that the replacement of planned redundancy be incorporated into the long-term plan to maintain the reliability of the systems.
A master planning process also provides the opportunity to focus on assessing compliance with ever-changing codes and standards. Not only do current code requirements need to be addressed, but anticipated code changes should also be reviewed.
The real world
A construction project that won an American Society for Healthcare Engineering Project Team Vista Award in the "Infrastructure" category a couple years ago provides a good example of these considerations.
As the result of a facility master planning process, the 570-bed Banner Good Samaritan Regional Medical Center in Phoenix identified several phases of expansion and renovation totaling 500,000 square feet to increase the capacity of targeted services, including ambulatory care, diagnostics, cardiology and women's health services. With the expansion came the need for an upgraded chiller plant to support the new facilities.
To increase capacity, redundancy and reliability, while reducing repairs/maintenance and energy consumption, the engineering team worked closely with the facilities director, manager and staff to develop and operate four building options, ultimately deciding to build the new chiller plant on a readily available piece of land adjacent to the existing cooling tower and central plant.
While communication between the engineering team and hospital staff was important, communication with local authorities having jurisdiction was just as vital. Phoenix is one of several municipalities that has adopted the National Fire Protection Association's NFPA 5000 as its building code. During the early phases of the project, the MEP engineering team met frequently with local officials to review the impacts that this change would create.
The facility master plan included necessary system capacities to address building several planned additions in compliance with NFPA 5000 requirements, and also sufficient capacity to retrofit the existing portions of the hospital at some future date with code-compliant systems.
The planning process
While MEP master planning is a complicated process consisting of many elements, it can generally be divided up into three stages:
* Evaluating existing conditions. The first step in any master planning effort is to identify, document and assess the facility's existing conditions. This effort starts with gathering existing documentation, such as operations and maintenance manuals, test reports and as-built drawings, and continues with surveys of installed systems.
Major equipment locations are mapped out. Capacities are noted, along with the general condition and age of equipment. Determining current loading of equipment is also vital when trying to address facility expansions. The existing conditions survey should include sufficient testing of existing systems needed to determine this loading.
The main distribution runs should be verified and documented. Identifying major distribution runs is important to ensure continuation of service during expansion and renovation projects.
Health care facilities are often built in segments via small expansions over time. Older portions are demolished to make way for the new. Central plants that were once located at the perimeter of a facility become surrounded. This results in systems that often cross boundaries.
It is important to identify a situation where a feeder that serves one building section may be routed through another that is targeted for demolition early enough to phase the replacement appropriately.
* Implementation planning and financial considerations. Before any proposed recommendations are made, a set of criteria should be established against which the acquisition and installation of new equipment can be measured. The criteria will generally consist of age and condition of equipment and systems that should be replaced, but can also include such things as spare capacity and redundancy goals, flexibility or interchangeability of generation equipment, or energy efficiency.
Needed expenditures can be compared to resources to ensure the funds are available when needed. Systems that have reached the end of their useful lives can be targeted and their replacement rolled into larger projects to take advantage of the economies of scale. Downtime associated with replacement can be coordinated with the renovation of the same areas they serve. Planned replacement can be performed before equipment failures occur that may force untimely and more costly repairs.
* Developing a final report. A fully formed MEP master plan report will describe all new equipment and systems that are required to support the health care facility, as well as identifying existing equipment and systems that will remain, and design parameters for proposed future systems.
Cut sheets of the proposed equipment are often included, providing a visual aid for better understanding. The routings of major distribution lines are identified. These main runs are coordinated with planned expansions and demolitions.
Provisions should be considered to aid in connecting to the existing systems when the new additions are brought on line, avoiding costly revisions and operational disruptions because of system shutdowns.
Often, when major equipment--chillers, power plants and generators--are being acquired and/or relocated, comprehensive cost-benefit analyses are performed. These are done in collaboration with one or more of the local utility companies comparing types of equipment and locations.
The use of gas, electric or hybrid systems can be evaluated to determine which is best currently and for the long term. The hospital's energy buyer can then use this modeling as a resource in negotiating the best prices with suppliers.
Master plan in action
Again, the Banner Good Samaritan Medical Center project provides an example of an MEP master plan in action. The initial master plan study allowed for the early identification of the shortfalls in the existing systems. Specifically, it was noted that the normal and emergency electrical systems were limited in their ability to serve future or additional loads.
The existing chillers were also in need of costly maintenance upgrades that would have enabled them to continue operating for only the next few years. Additionally, it was noted that the existing location of the chillers was not optimal. The MEP master plan then identified that significant additional capacity was also needed to support the planned growth.
As a result, a new freestanding chiller and emergency generator plant became the first phase of the project. The plant was sized to provide capacity for existing facilities and long-term future additions. However, in order to save capital, only the capacity for existing facilities and the first phase of additions was installed.
Space was allocated in the plant for more chillers and generators to be installed when needed, and distribution systems were configured to allow the expansion of delivery capacity. This allowed the hospital the ability to increase capacity incrementally over time and defer capital costs until a later date.
During the early planning phases of the new plant, numerous location options were reviewed and an optimal location chosen. The chosen location not only minimized site disruptions and optimized the reuse of equipment to manage costs, but also removed the central plant from valuable centrally located real estate that could then be utilized in the future for revenue-generating pursuits.
The hospital also gained the added benefit of being able to install, start up and fully operate the plant while the existing systems remained on line, thus working out any unexpected bugs prior to the building additions being completed.
A structured approach
Consideration of the MEP systems is as important as any other aspect of the facility, and an MEP master plan provides a structured approach to upgrading aging and overextended equipment.
But, most significantly, the plan provides an assessment of the existing state of a facility and the tools and information necessary to make informed decisions about needed upgrades to the infrastructure.
The timing and breadth of the review and planning effort can vary, but the need is unquestionable. The benefits will be apparent today and into the future.
Scott P. Kesler, P.E., is director of electrical engineering at OWP/P Engineers in Chicago. He can be reached at skesler@owpp.com. Daniel Fagan, P.E., CIPE, is director of mechanical engineering at OWP/P. He can be reached at dfagan@owpp.com.
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