CSHE High-Tech - Old Infrastructure

HIGH-TECH - OLD INFRASTRUCTUREInstalling a state-of-the-art Robotic OR suite in a 60 year old hospital

AGENDA

1 Goals & Challenges

2 Design Process

3 Best Value Contract Award

4 Team Building/OAC Meetings

5 Working in a Live OR

6 Shutdowns

7 MEP Coordination

8 Summary

9 Questions

PRESENTERS▪ Tom Peterson, Architect The Design Partnership

▪ Sean Wilkins Ray L. Hellwig Mechanical

▪ Craig Moore Ray L. Hellwig Mechanical

▪ Rick Schaffel, Contractor TCB Builders, Inc.

▪ Bruce Mace, Director UCSF Medical Center Facilities

DESIGN

Existing infrastructure

New OR ceiling 9” below beams

GOALS & CHALLENGES

1

Goals

▪ Create a state-of-the-art robotic OR

▪ A model for the future at UCSF

▪ On time and on budget

Challenges

▪ Don’t disrupt existing infrastructure

▪ 12’-0” between floors, 10’-2” to bottom of beams

▪ Raise ceilings to 9’-6”

▪ Seismic upgrades required

▪ Integration of all systems

DESIGN PROCESS

Phase 1

▪ Replace HVAC

▪ Reorganize storage

2

Phase 2

▪ Built 600 sf/ft robotic OR room

▪ Reconfigure storage areas

▪ Added scrub room, & soiled holding

DESIGN PROCESS

2

DESIGN PROCESS

2

Phase 3

▪ Rebuilt OR 1 (Cysto Room)

▪ Demo and replace main desk

▪ New staff toilets

▪ Move corridor & rebuild storage

DESIGN PROCESS

Phase 4

▪ Finished two offices and removed barriers

2

building consensus

LISTEN TO EVERY USERTOUR SIMILAR FACILITIES

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existing conditions

EXISTING OR 1

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existing conditions

EXISTING FRONT DESK SPACEEXISTING OR 11 SPACE

laser scanning to validate the model

EXISTING MECHANICAL SYSTEMS

med modelingEXISTING OR SUITECase carts in corridorsStorage in all empty spacesPicking done in the OR

PROPOSED OR SUITEAdditional robotic OR

Redesigned central corewith modular storage system

Added storage on floor above

MedModeling simulated operations

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med modeling

16Kavinsky Consulting, LLC 10/31/07 - 16

Number of Times each Preference Card Item was Used between 5/1/06 – 4/30/07

■ 776 items picked were never used during the year and should be eliminated from inventory.

■ 2467 items picked were only used 1-10 times / year and should be evaluated for staying in the inventory.

■ All preference cards need to be evaluated and updated based upon item usage data and physician input.

Number of Instrument and Supply Items Number of Times Items Used Breast GS GU Gyn GynOnc OHNS Ortho Pla RadOnc Other Total

0 40 113 83 107 91 99 103 72 3 65 776 1 - 10 98 385 344 241 287 255 480 131 30 216 2467

11 - 25 19 69 81 44 49 49 37 18 7 30 403 26 - 50 18 54 49 36 29 26 38 11 3 15 279

> 50 41 121 129 43 37 48 67 8 32 20 546

Total 216 742 686 471 493 477 725 240 75 346 4471

med modeling

central core remodeling

BEFORE

central core remodeling

AFTER

3d modeling

CONSTRUCTION

▪ Prequalification

▪ Bid Job – Bids Remain Sealed

▪ Submit Best Value Questionnaire Response Package – With MEP

▪ University to evaluate and score best value packages

▪ Sealed bids are opened

▪ Project is awarded on lowest dollar amount per point

BEST VALUE CONTRACT AWARD

3

best value results

TEAM BUILDING/OAC MEETINGS

▪ Team ownerarchitects

engineerscontractorkey subs

facilitiesvendorsmedical professionals medical support staff

▪ Team creation of schedules

▪ Real time meeting minutes

4

WORKING IN A LIVE OR

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▪ Dust/infection control

▪ Noise mitigation

▪ Night and weekend work

▪ Hourly schedules

noise mitigation

WORKING DIRECTLY WITH OR STAFF

night and weekend work

WARMING CABINET INSTALLATION

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hourly schedules

abatement conditions for demo

field verification/existing conditions

SHUTDOWNS

6

▪ 187 shutdown requests

▪ Communication (communication, communication, communication)

▪ Investigation, research and field visits

▪ Isolation and verification

▪ MOP – develop/review & verify/sign off

▪ Perform flawlessly

▪ SF-2 – shutdown and replacement

that which does not kill us… only makes us stronger

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187 shutdown requestsNEW OLYMPIC AND WORLD RECORD!

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shutdown requests

▪ Project number & descriptor

▪ Full contacts & emergency

▪ Request reasoning

▪ Type of request

▪ Location and description

▪ Attached photo documentation

▪ Estimated duration

▪ Target date & time

▪ Blue copy (internal)

▪ Scheduling (internal)

BOTH RECORDS STILL STANDING…

THE MOST IMPORTANT TOOL ON YOUR BELTcommunication

investigation60 YEARS, 2 BUILDINGS AND A LOT OF HISTORY

So tell me, punk… do you feel lucky?

investigation

isolation & verificationEVER SEVERED A LIVE FEED TO AN INTERVENTIONAL RADIOLOGY PROCEDURE?

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method of proceduresINEXPENSIVE INSURANCE TO PROTECT EVERYTHING

perform flawlessly

▪ Do your homework thoroughly

▪ Don’t skip steps

▪ Communicate the plan with everyone and their mom

▪ Contingencies and redundancies as back-up

▪ Enforce the rules – prevent “creep”

▪ Safety is no accident

▪ Weekends & night time are your friends

▪ Communicate some more

▪ Trust, but verify

▪ In spite of all this – be flexible within the safety of your larger plan

PROPER PREPARATION PERMITS PERFECT PERFORMANCE

sf-2 shutdownRIPPING THE GUTS OUT OF A LIVING OR SUITE OVER THE WEEKEND

MEP COORDINATION

▪ Conventional drawing process

▪ BIM drawing process

▪ Clash detection

▪ BIM and facilities management

▪ BIM object information

▪ Importance of BIM

▪ Benefits of BIM for Facility Managers

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▪ Created in 2D, on paper

▪ Multiple drawings required to represent 3D views

▪ Redundancy and open to errors

conventional drawing process

▪ Building and objects drawn in 2D and 3D

▪ 3D model easier to interpret and visualize

▪ Information attached to objects in the model

▪ 4D BIM – project scheduling incorporated into model

bim drawing process

clash detection

clash detection

MODELEDBUILT

OR11

bim and facilities management

OR1

bim object information

importance of bim

importance of bim

benefits of bim for facility managers

▪ Improved space management

▪ Efficient use of energy

▪ Streamlined preventive maintenance

▪ Economical retrofits and renovations

▪ Enhanced lifecycle management

SUMMARY

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▪ BIM works – even for remodels

▪ Have a contingency plan

▪ Worked as a cohesive team

▪ Maintained communication and sensitivity

▪ Project finished ahead of schedule

▪ Project was under budget

QUESTIONSThank you for your time!

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VIDEO & TOURSThank you for your time!

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