New construction calls for advanced planning

Patient safety, operations efficiencies top priorities

A hospital construction project is never easy for staff, patients, or administration, but as a facility in suburban Atlanta is demonstrating, planning ahead and focusing on details can help minimize the impact on patient care and safety.

Work has just begun on a project that will more than double the capacity of the emergency department (ED) at Rockdale Hospital in Conyers, GA.

The expansion will add more than 18,000 square feet to enhance treatment of minor care and major illnesses and injuries; eight minor care rooms will be added to the current four, and 10 rooms will be added to the 10 existing rooms in the acute care center. In addition, a 14-bed, 23-hour observation unit is under way.

Despite the extensive nature of the construction work, hospital officials anticipate that the ED will remain fully operational throughout. The uninterrupted flow in care will be due in large part to the fact that the staff became involved in the construction planning process approximately 18 months before work started on the ED expansion.

"It’s very important to have everybody’s participation," notes Kay Neal, RN, clinical nursing director for the Rockdale ED. "That means not only the ED staff but administration, the lab, radiology, pharmacy, materials management, and the facilities department."

When the ED first became aware of the planned expansion, a planning team was organized with representatives from both the day shift (supervisors) and night shift (charge nurse) as well as staff physicians. "For a while, we were meeting every two weeks," she recalls. "Our biggest concerns were the safety of the patients and having as little interruption to patient flow as possible."

To that end, the team provided input not only on the layout of the department, but on each of the rooms, indicating how patients would move through the system.

Once their portion of the construction plans was finished, the team turned to the issue of staging the construction in such a way as to optimize safety. This called for regular meetings with the contractor, Batson-Cook Co., whose Atlanta office had extensive experience with hospital construction.

"We would meet weekly with Batson-Cook to talk about the staging of construction," Neal says. "Facilities management and infection control conduct a hazard vulnerability surveillance prior to each staging of construction."

Potential hazards, she notes, include such things as dust, which patients must be kept from inhaling, to the creation of inclines that might be too steep for some patients.

The ED’s interface with Batson-Cook will be an ongoing and very necessary process until construction is completed. "Take patient flow," Neal says. "We have created many new operational efficiencies that have been incorporated not only into the new plans but into the staging as well. For instance, we have identified the fact that for a nurse to be able to assess patients in triage, you need more than one nurse during that process. Accordingly, Batson-Cook will build us a temporary second triage room during construction, so we can begin to benefit from this new efficiency even before the construction is done."

As part of the process, the ED’s ambulatory entrance is going to be moved. The team had discussed with Batson-Cook where the new entrance would be, and how the staff must have visibility of that entrance so they can see patients arriving and give them assistance getting out of their cars if it is required.

"We also planned the construction to where we won’t have to shut down any rooms," Neal adds. The new areas will be built first, the staff will move in there, and then the older space will be renovated before staff move back in. "The connection between the two areas will be the last thing Batson-Cook does, so it won’t affect patient care at all," she explains.

Hospital/builder interface is critical to optimizing patient safety and quality during any construction project, Neal says. "We will continue to have weekly meetings throughout the process," she notes. "In addition, the construction supervisor and I will have two-way [telephone/walkie-talkie] communications every day. So for example, if they are doing work that is making a lot of noise when a physician needs things to be especially quiet, I can call him and ask him to stop that particular work for 15 minutes or so. It saves me from putting on a hard hat and running out to find him."

For other safety and quality professionals facing new construction work, Neal has this advice: "I just think it’s important that when you do construction, you keep patient safety and your employees in mind, and think of operation efficiencies — how you can maintain them during construction and enhance them even while construction is ongoing."

Need More Information?

For more information, contact:

  • Kay Neal, RN, Clinical Nursing Director, Emergency Department, Rockdale Hospital, Conyers, GA. Telephone: (770) 918-3053.