High-Tech vs. Old Infrastruction


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Installing a state of the art Robotic OR suite in a 60 year old hospital. Topics include BIM, A presentation delivered to CSHE in March 2011

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  • Welcome and thank you for joining us tonight. How many in the room are facility engineers?How many have had trouble squeezing a new system into an old building?We’d like to show you some tools used to solve problems of too little space.
  • Our agenda covers the processes our team used.Each issue was dealt with in unique ways.I hope our experience will be of value to you.
  • Tom Peterson -My experience spans 25 years as a high-tech medical planner designing surgeries, radiology departments, and radiation oncology installations. I’ve worked at institutions across the country like Mayo Clinic, Johns Hopkins, and Wallace-Kettering Medical Center. I seem to see the same problems in every institution when it comes to complex systems going into old buildings.Rick Schaffel is a Sr. Project Manager with TCB Builders who’s been in the San Francisco bay area for the last 30 years.  Rick heads up TCB’s healthcare division and has completed 30 plus projects at UCSF while at TCB.  Rick specializes in radiology projects, operating room renovations, and highly specialized construction.  Rick is adept at managing complex OSHPD projects with difficult logistical challenges.  His understanding of infection control procedures, patient safety standards, and project impacts on health care providers and patients is outstanding.Bruce Mace came to UCSF Medical Center in the role of Capital Projects Construction Coordinator. He has a background in architecture, planning, construction and a heavy dose of regulatory compliance. He enjoys supporting the providers who are passionate about caring for patients who are dependent on the built environment. After learning to love the hospital environment Bruce recently moved into the position of Director of Facilities where he found a niche that suits him well. Sean Wilkins HVAC Detailer / Coordinator has over thirty-two years of construction experience in the HVAC and sheet metal trade, of which the past twenty years has been with the Hellwig Companies. He’s been involved in MEP design and coordination on various projects using computer aided 3D drafting and modeling software for the past 16 years. Completed projects include semiconductor manufacturing, clean rooms, pharmaceutical and health care facilities, including the Mt Zion OR project.Craig Moore is a Sr. Project Manager with Helwig Mechanical. He’s been in the HVAC industry for 32 years and has worked on a full range of HVAC projects, fast track and critical schedule, industrial, hospital, public works, commercial, bio-tech and semi conductor. Craig started his career as a Sheet Metal Local #104 apprentice, journeyman, field foreman and detailer/coordinator. Craig moved into estimating and management 17 years ago and has been with Hellwig Mechanical for the past five years. 
  • I am going to review some of the teams design challenges.The process was traditional in that we had a program and a space to work.This project was to be one of the pilot studies on “Best Value” Contractor SelectionUCSF’s Design & Construction Department even gave us the layout that they wanted, which worked well.Our first look at the space however showed us we had a long way to go.
  • The goal to add another OR while not disrupting operations was a difficult challenge. We began with a 60 year old building so full of systems we had no idea what it all was.Ceilings had to be raised to 9‘ 6“ to accommodate new systems. Everything was to be squeezed so tight there was no room for guesswork.Of course it had to come in on time and on budget.
  • The 1st phase was to empty out the space and build a new HVAC system.A new storage system was installed in the core and additional space was built on the floor above.The HVAC unit was replaced over a long weekend.
  • In the 2nd phase We built a new 600 SF robotic OR with an attached robot garage.The new waste holding room and stair access was installed.A temporary front desk was installed to redirect traffic during phase 3.
  • 3rd phase Shut down the front desk and rebuilt the existing cystoscopy room. Shift the main entry corridor and added storage spaceTwo staff toilets, offices for anesthesia, and scheduling office was added.
  • In the 4th Phase We completed the connecting work, removed the barriers and added two managers offices.
  • The project began like many others with touring similar facilities to develop a “ baseline” of expectations. Recent OR remodeling at the Parnassus campus was evaluated. We heard a lot of “don’t do that again” !Bringing together the OR staff for input was important to building consensus.
  • CLICK ONCE* We hired a laser scanner to build a 3D “point cloud” of everything above the ceiling.This information was then imported into our 3D Building Information Model.Our initial drawing was adjusted and accuracy was within ¼”.We found columns off by 3” and some ductwork in need of major repair.Our specifications included allowances for repair work that we knew would be required.
  • The new OR meant a 20% increase in surgical volume which would be impossible to support.We did a computer simulation to study the before and after using Med Model software.Our findings helped find more space in the OR suite.
  • The central core was a mixture of old and new storage systems.Most of which was inefficiently utilized. . . and not flexible.By reconfiguring it we were able to gain the space necessary to build an additional OR.
  • The new core is flexible, modular and can be changed out quickly.Some of the inventory was moved back to SPD in the basement.Some little used material was stored in a new store room on the floor above.This expense had a payback of less than a year by reducing time spent setting up cases.
  • When we laid out each space we did not waste space.Each solution was tested to make sure that the parts fit together well,And the choreography was well thought out.On the left we tested the operation of bringing in a patient to the new room on a full sized bed.3D gave us a tool to “sell” our concepts to the staff and surgeons.Shutdowns, phasing and weekend work was tested and documented in the drawings and specs.When the planning was complete we turned the process over to a “ Best Value” Contractor
  • Thought we should show a couple of cool demo shots – Highlight Wood framingUC Facilities Team received certification to enter the abatement area for field instructionsRight after demo there are 2 main priorities.Get the field verification of the existing systems for modelingGet the shutdown notifications in to facilities to start the investigations
  • After Demo there are 2 main items:Start of BIM ModelingStart of notification of shutdownsLead in to Bruce
  • Previously design and construction of buildings has relied on 2d drawings for representing the work to be done, and used to manage the facility afterward. The limitations of 2d drawings are: (1) they require multiple views to depict a 3D object in adequate detail for construction, causing redundancy and possible errors; (2) they are stored as two dimensional documents that are only interpretable by some people and they cannot be interpreted by computers.The past method of designing a building once for contract drawings, then developing a set of detailed drawings for shop fabrication is being recognized as a considerable amount waste and inefficiency.MEP or Mechanical, Electrical and Plumbing drawing coordination may begin in the 2d stage, before the building envelope has been completely modeled, MEP software creates objects in 3d, which are then referenced into the building model.There may be multiple building models if there are multiple phases of construction to be done.Coordination of the MEP drawings in 2d involves overlaying of the drawings say on a light table then manually examining and identifying clashes or conflicts. This process is very time consuming.
  • Computer modeling has reached a level of sophistication, that allows “virtual” construction of plans and graphics. These plans can be precise and can include graphicallyinteractive depictions of a building and its properties in multiple dimensions (3d) before being constructed.These capabilities also facilitate much improved coordination and collaboration. Building models tremendously facilitate this process. A 3D model is easier for all parties to interpret and visualize. Design or fabrication work can be coordinated in person or at a distance using web conferencing tools such as Webex and GoToMeeting and virtually walking through the 3D model.Building models save costs, construction time, and support better building performance and control. BIM can beneficially impact all parties in the construction process - designers, engineers, contractors, owners, as well as facility operators. (NOT USED BELOW THIS)Once the project is completed, this same information can be handed off to Facility Managersand Engineers for operation. Design-build and other forms of architect-contractor teaming have been recognized as more efficient - in terms of cost, time, and for reducing the potential for litigation.
  • Design-build and other forms of architect-contractor teaming have been recognized as more efficient - in terms of cost, time, and for reducing the potential for litigation to all parties.(Do Not Use Below This)Let me ask with this question? Who has been involved in a BIM project or projects, small or large?How was it?Would you say it was a success?What would you like to do different next time?
  • BIM is taking the place of conventional architectural drawings and the associated print and digitized documentation. BIM allows for a more complete handoff of building information to facility executives for improved quality operations and maintenance.BIM is able to meet the overlapping needs of not only design and construction but also the Facility Managers.Why BIM is Important?As a building representation, BIM technology is far superior to drawings. As this technology becomes more mainstream, the value will be apparent.
  • High-Tech vs. Old Infrastruction

    1. 1. HIGH-TECH - OLD INFRASTRUCTURE<br />Installing a state-of-the-art Robotic OR suite in a 60 year old hospital<br />
    2. 2. AGENDA<br /> 1Goals & Challenges<br /> 2Design Process<br />3Best Value Contract Award<br />4Team Building/OAC Meetings<br />5Working in a Live OR<br />6Shutdowns<br />7MEP Coordination<br />8Summary<br />9Questions<br />
    3. 3. PRESENTERS<br />▪Tom Peterson, Architect<br /> The Design Partnership<br />▪ Rick Schaffel, Contractor<br /> TCB Builders, Inc. <br />▪ Bruce Mace, Director<br /> UCSF Medical Center Facilities<br />▪ Sean Wilkins<br /> Ray L. Hellwig Mechanical<br />▪ Craig Moore<br /> Ray L. Hellwig Mechanical<br />
    4. 4. DESIGN<br />
    5. 5. GOALS & CHALLENGES<br />Goals<br />▪Create a state-of-the-art robotic OR<br />▪ A model for the future at UCSF<br />▪ On time and on budget<br />Challenges<br />▪ Don’t disrupt existing infrastructure<br />▪ 12’-0” between floors, 10’-2” to bottom of beams<br />▪ Raise ceilings to 9’-6”<br />▪ Seismic upgrades required<br />▪ Integration of all systems<br />Existing infrastructure <br />New OR ceiling <br />9” below beams<br />1<br />
    6. 6. DESIGNPROCESS<br />Phase 1<br />▪Replace HVAC<br />▪Reorganize storage<br />2<br />
    7. 7. DESIGNPROCESS<br />Phase 2<br />▪Built 600 sf/ft robotic OR room<br />▪ Reconfigure storage areas<br />▪ Added scrub room, & soiled holding<br />
    8. 8. DESIGNPROCESS<br />Phase 3<br />▪Rebuilt OR 1 (Cysto Room)<br />▪Demo and replace main desk<br />▪New staff toilets<br />▪ Move corridor & rebuild storage<br />
    9. 9. DESIGNPROCESS<br />Phase 4<br />▪Finished two offices and removed barriers<br />
    10. 10. building consensus<br />LISTEN TO EVERY USER<br />TOUR SIMILAR FACILITIES<br />
    11. 11. existing conditions<br />11<br />EXISTING OR 1<br />
    12. 12. existing conditions<br />EXISTING FRONT DESK SPACE<br />EXISTING OR 11 SPACE<br />12<br />
    13. 13. laser scanning to validate the model <br />EXISTING MECHANICAL SYSTEMS<br />
    14. 14. med modeling<br />EXISTING OR SUITE<br />Case carts in corridors<br />Storage in all empty spaces<br />Picking done in the OR<br />PROPOSED OR SUITE<br />Additional robotic OR<br />Redesigned central core<br />with modular storage system<br />Added storage on floor above<br />MedModeling simulated operations<br />
    15. 15. med modeling<br />15<br />
    16. 16. med modeling<br />Number of Times each Preference Card Item was Used between 5/1/06 – 4/30/07<br />■ 776 items picked were never used during the year and should be eliminated from inventory.<br />■ 2467 items picked were only used 1-10 times / year and should be evaluated for staying in the inventory.<br />■ All preference cards need to be evaluated and updated based upon item usage data and physician input.<br />16<br />10/31/07 - 16<br />Kavinsky Consulting, LLC<br />
    17. 17. central core remodeling<br />BEFORE<br />
    18. 18. central core remodeling<br />AFTER<br />
    19. 19. 3d modeling<br />
    20. 20. CONSTRUCTION<br />
    21. 21. BEST VALUE CONTRACT AWARD<br />▪ Prequalification<br />▪ Bid Job – Bids Remain Sealed<br />▪ Submit Best Value Questionnaire<br /> Response Package – With MEP <br />▪ University to evaluate and score best<br /> value packages<br />▪ Sealed bids are opened <br />▪ Project is awarded on lowest dollar<br /> amount per point<br />3<br />
    22. 22. best value results<br />
    23. 23. TEAM BUILDING/OAC MEETINGS<br />▪Team owner<br /> architects <br /> engineers<br /> contractor<br /> key subs <br /> facilities<br /> vendors<br /> medical professionals medical support staff<br />▪ Team creation of schedules<br />▪ Real time meeting minutes<br />4<br />
    24. 24. WORKING IN A LIVE OR<br />▪ Dust/infection control<br />▪ Noise mitigation<br />▪ Night and weekend work<br />▪ Hourly schedules<br />5<br />
    25. 25. noise mitigation<br />WORKING DIRECTLY WITH OR STAFF<br />
    26. 26. night and weekend work<br />WARMING CABINET INSTALLATION<br />
    27. 27. hourly schedules<br />27<br />
    28. 28. abatement conditions for demo<br />
    29. 29. field verification/existing conditions<br />
    30. 30. SHUTDOWNS<br />that which does not kill us… only makes us stronger<br />▪ 187 shutdown requests<br />▪ Communication (communication, <br /> communication, communication)<br />▪ Investigation, research and field visits<br />▪ Isolation and verification<br />▪ MOP – develop/review & verify/sign off<br />▪ Perform flawlessly<br />▪ SF-2 – shutdown and replacement<br />6<br />
    31. 31. 187 shutdown requests<br />NEW OLYMPIC AND WORLD RECORD!<br />31<br />
    32. 32. shutdown requests<br />BOTH RECORDS STILL STANDING…<br />▪ Project number & descriptor<br />▪ Full contacts & emergency<br />▪ Request reasoning<br />▪ Type of request<br />▪ Location and description<br />▪ Attached photo documentation<br />▪ Estimated duration<br />▪ Target date & time<br />▪ Blue copy (internal)<br />▪ Scheduling (internal)<br />32<br />
    33. 33. communication<br />THE MOST IMPORTANT TOOL ON YOUR BELT<br />
    34. 34. investigation<br />60 YEARS, 2 BUILDINGS AND A LOT OF HISTORY<br />
    35. 35. investigation<br />So tell me, punk… do you feel lucky?<br />
    36. 36. isolation & verification<br />EVER SEVERED A LIVE FEED TO AN INTERVENTIONAL RADIOLOGY PROCEDURE?<br />
    37. 37. method of procedures<br />INEXPENSIVE INSURANCE TO PROTECT EVERYTHING<br />37<br />
    38. 38. perform flawlessly<br />PROPER PREPARATION PERMITS PERFECT PERFORMANCE<br />▪ Do your homework thoroughly<br />▪ Don’t skip steps<br />▪ Communicate the plan with everyone <br /> and their mom<br />▪ Contingencies and redundancies as back-up<br />▪ Enforce the rules – prevent “creep”<br />▪ Safety is no accident<br />▪ Weekends & night time are your friends<br />▪ Communicate some more<br />▪ Trust, but verify<br />▪ In spite of all this – be flexible within the safety of your larger plan<br />
    39. 39. sf-2 shutdown<br />RIPPING THE GUTS OUT OF A LIVING OR SUITE OVER THE WEEKEND<br />
    40. 40. MEP COORDINATION<br />▪ Conventional drawing process<br />▪ BIM drawing process<br />▪ Clash detection<br />▪ BIM and facilities management<br />▪ BIM object information<br />▪ Importance of BIM<br />▪ Benefits of BIM for Facility Managers<br />7<br />
    41. 41. conventional drawing process<br />▪ Created in 2D, on paper<br />▪ Multiple drawings required to represent <br /> 3D views<br />▪ Redundancy and open to errors<br />
    42. 42. bim drawing process<br />▪ Building and objects drawn in 2D and 3D<br />▪ 3D model easier to interpret and <br /> visualize<br />▪ Information attached to objects in the <br /> model<br />▪ 4D BIM – project scheduling incorporated <br /> into model<br />
    43. 43. clash detection<br />
    44. 44. clash detection<br />MODELED<br />44<br />
    45. 45. clash detection<br />BUILT<br />
    46. 46. bim and facilities management<br />OR1<br />
    47. 47. bim and facilities management<br />OR11<br />OR1<br />
    48. 48. bim object information<br />
    49. 49. importance of bim<br />
    50. 50. importance of bim<br />
    51. 51. benefits of bimfor facility managers<br />▪ Improved space management<br />▪ Efficient use of energy<br />▪ Streamlined preventive maintenance<br />▪ Economical retrofits and renovations<br />▪Enhanced lifecycle management<br />
    52. 52. SUMMARY<br /> ▪ BIM works – even for remodels<br /> ▪Have a contingency plan<br /> ▪Worked as a cohesive team<br /> ▪Maintained communication and sensitivity<br /> ▪Project finished ahead of schedule<br /> ▪Project was under budget<br />8<br />
    53. 53. QUESTIONS<br />Thank you for your time!<br />9<br />