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It's for the Kids
New Children’s Hospital near Denver elevates children’s care to world-class status
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| The new Children’s Hospital on the booming Fitzsimons medical campus in Aurora, Colo., contains 1.44 million sq ft of space. (Photo © Terry Shapiro) |
hen the children’s hospital decided to build a new facility in Aurora, Colo., on the new Fitzsimons medical campus to replace its aging Denver location, the board of directors knew two things: They wanted it to be world class and it had to open by October 2007.
A health-care project of this magnitude—costing more than $450 million—had never been built in Colorado, and when the preconstruction process began the owners were still figuring out how they wanted to distinguish their institution from others.
What they created differentiates itself by size alone: 1.44 million sq ft, almost twice the size of the existing Children’s Hospital; 270 beds and 48 emergency room beds; 25 operating and procedure rooms; 18 family suites, compared to only four at the old site, and a sprawling 48-acre campus that includes 2,341 parking spaces.
Hospital features include a jaw-dropping, four-and-a-half story atrium with a terrazzo mosaic floor and glass sculptures suspended on the east wall that depict natural features such as snowflakes, ladybugs and columbines. The atrium includes a coffee and ice cream shop that is open around the clock and glass elevators that may make visitors feel like they’re passing through an aspen grove because elevator partitions are etched with trees.
“The guiding design principle was to provide clarity in the building,” says Sharron van der Meulen, architect in the Portland, Ore., office of Zimmer Gunsul Frasca, one of the lead designers on the project. “There can be a lot of anxiety when you’re dealing with children and illness. We wanted the space to be welcoming and understood quickly. But we also wanted a design that doesn’t talk down to children.”
“Teddy bears and ducks are no good for teens,” says Eloise Damrosch, art consultant on the design team.
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| The new hospital houses 270 beds and 48 emergency room beds, 25 operating and procedure rooms, 18 family suites on a sprawling 48-acre campus that includes 2,341 parking spaces. (Photo © Terry Shapiro) |
To avoid a Disneyland atmosphere, plenty of amenities were designed for older patients as well. A teen lounge offers a 110-in., high-definition television with Dolby surround sound and a cafeteria with wood-fired pizza, fruit and salad bars and take-out. Patients can order meals directly from the cafeteria using an interactive room-service menu on their TVs.
Visitors looking for respite from the patient rooms can find it in a stroll through the series of gardens and sculptures that connect the cafeteria and the front entrance.
“Often, you have healthy siblings and worried parents, so it’s important to have a destination for them to take a break with their child,” says Damrosch. “This gives them a space to take a child to tell them a story or be distracted or interact verbally or physically.”
Patient rooms feature a 32-in. flat-screen TV, private bathrooms, Internet access and in-room foldout beds for family members to spend the night. “We’re taking care not just of the child, but of their entire family,” says Jim Shmerling, TCH president and CEO.
Cooks in the Kitchen
Getting to the finished product wasn’t easy. Preliminary planning began in 2001, but it wasn’t until the beginning of 2004 that workers turned dirt on the project.
During the launch of design and preconstruction, the TCH contracting team, led by joint-venture partners Gerald H. Phipps Inc., Denver, and St. Louis-based McCarthy Building Cos. knew they had to get creative to meet the tight schedule. The project was further complicated by the sheer magnitude of the hospital, the need to maintain a strict budget and a client who insisted that decisions be made by consensus.
“Initially, the [hospital] board told us up front, ‘We’re consensus driven,’” says Sue Stewart, McCarthy’s senior vice president of preconstruction. “I remember times when I would sit down and think, ‘How are we going to get anything done?’ There were a lot of cooks in the kitchen. It made it difficult at times to get decisions made.”
“We worked backward from the end date, with seven major bid packages,” says Scott Wittkop, McCarthy’s onsite construction manager.
The CM/GC contract was based upon what Wittkop calls “just-in-time” design. “If we had waited until it was 100% designed to start building, we’d be waiting two more years to open,” he says.
The team broke individual pieces of the project into separate bid packages. While the architects were still working on concepts for the interior, the contractor was digging the foundation. Builders asked for drawings of floors two through five while the architects finalized details of the lower levels, Stewart says.
Phipps-McCarthy bought certain items, such as steel, rebar and concrete, even before the details about how they would be used were complete. Just as the hospital was breaking ground in early 2004, steel prices soared, climbing nearly 200% for some products.
“When you build a structure before the design of mechanics are in place, you run the risk of something not fitting,” Wittkop says. But Phipps-McCarthy purchased steel early enough to avoid the steepest price jumps and saved TCH hundreds of thousands of dollars, he says.
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| Visitors move through the atrium with its maze of color, and their eyes are drawn by the glass facades of natural features suspended on the east wall. (Photo © Terry Shapiro) |
Structural Work
The hospital’s enormous excavation, encompassing an area the size of 2.6 football fields and approximately 22 ft deep (below finished floor, with 19-ft perimeter walls), took three weeks to accomplish. The sprawling building footprint encompasses a total of 14.2 acres. Three hundred caissons drilled as much as 42 ft into bedrock (62 ft below grade) anchor the complex.
“The elevator-and-stairwell core is as large as any that I have ever built,” says Bruce Schneider, senior superintendent on the project and a 30-year veteran at Phipps. “The core includes 10 shafts, nine in active use, with one reserved for future expansion, plus the stairwells.”
Four secondary stairwell cores and three concrete shear walls provide extra rigidity and help dampen vibrations. Anchored in the basement and extending up through the tenth floor, the shear walls are tied into each concrete floor with rebar.
“X-brace systems contribute additional strength and resiliency,” says Troy Fornstrom of Denver’s S.A. Miro, the structural and civil engineer on the project. “The remaining above-ground structural framework consists of steel beams and columns with concrete slabs poured atop metal decking.”
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| The main floor contains all the amenities a family might need, including the cafeteria, resource library, gift shop, ice cream and coffee bar, and the chapel. |
Altogether, the TCH buildings boast 34,000 cu yd of concrete containing seven-million lb of reinforcing steel, primarily in the foundation and elevator cores. Floors range from lightweight concrete, 6.25 in. thick to up to 11.5 in. thick in high-load bearing areas such as the fifth-floor mechanical room and critical-function spaces—surgery, prenatal intensive care, and neonatal intensive care, where no vibrations can be tolerated.
The 35-ft-high mechanical floor, housing the main double-stacked air handling units and miles of duct work and conduit, had to be spanned by a separate framing system to support the exterior walls independent of the main structural columns.
The use of structural steel not only makes future modifications relatively easy, but it goes up faster. Concrete would have taken “way too long,” Schneider says.
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(Photo © Terry Shapiro) |
Expansion & Upgrades
The staff and visitor parking garages are cast-in-place, post-tensioned concrete built with expansion in mind. Currently topped out at three stories, they are designed to go to six, doubling the capacity to 2,200 cars.
Historically, TCH has performed numerous upgrades to its physical plant in order to provide the most advanced technologies and offer patients the finest care available. The new hospital is designed expressly to accept those sorts of future improvements as they become necessary.
Knock-out walls spanned by I-beam transoms in the basement on the north and east sides of the main hospital building can accommodate three additional wings. And a newly remodeled one-story building on the east, currently home to the Children’s dental clinic, sits on a large plot earmarked for a future multistory building. Surface parking lots may someday be converted to office and research facilities.
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| Workers fit the atrium’s terrazzo floor, which contributes to the open design of the hospital. HVAC systems are housed on mechanical floor that has 35-ft floor-to-ceiling height. Its size required a separate framing system to support exterior walls independent of main structural columns. (Photo © Terry Shapiro) |
High-Tech Holdouts
To maintain its world-class status, TCH radiologists wanted to wait until the project neared completion before buying equipment to ensure they could get the latest, most-advanced technology available.
“The radiologists wanted to wait until six months before move-in,” says Ron Berge, TCH VP of facility development.
But the high-tech needs of the doctors bumped up against the builders’ need to configure the radiology department to fit cumbersome equipment, identify where power outlets should be installed, doorways should be cut and whether the equipment needed to be recessed into the floor.
Designers chose to go with “worst-case scenario” equipment standards, requiring the highest voltage and largest space, Berge says. By creating the maximum capacity that might be required, radiologists were able to wait until one year before the October 2007 move-in date to purchase their equipment.
Construction managers created a system for budgeting that allowed them to take a concept request from the customers, such as expansion of the neonatal ICU, and price it out, Stewart says.
“Our primary concern was to get estimates as early and as accurately as we could, so we could start getting a handle on the project,” Berge says. “The scope was pretty accurate, and we came in pretty close to what the contractor estimated.”
A Healing Environment
Creating a healing environment was the overall design goal for the hospital. But the task was formidable: How to make a massive, high-tech hospital feel inviting and healing to very sick children and their families.
“It was problematic to take the hard-core, mechanical aspects of the hospital and integrate the human qualities needed,” says Bob Packard, managing partner with ZGF, the design architect. “We found the best way to marry those elements was through the use of space.”
Focus groups provided input for the design, assuring that patients and their families would have their needs met from the beginning.
“We started with the patients and families because they are at the heart of what we wanted to accomplish with this new hospital,” says Susan Koch, director of clinical planning and development for TCH.
“Working on children’s hospitals is special, and everyone catches onto that quickly,” says Mike Ossian, principal-in-charge of the project for H+L Architecture, the Denver-based firm that is the architect-of-record. “Our mantra all the way through was, ‘It’s for the kids.’”
Building a hospital for small people requires a small-scale perspective. Windows are lower and toilets and tubs are lower to accommodate pint-sized patients. But as every parent knows, decorating for the smaller set is a tricky proposition.
“It was a challenge with the aesthetic elements because we treat patients from newborns to people who are almost 30,” Koch says. “And a 14-year-old doesn’t really want Mickey Mouse in his room.”
Designed to reflect the Rocky Mountains, patient and treatment rooms are decorated with nature motifs. “The connection to nature through outdoor gardens and the use of natural light just makes a person feel better,” Koch says. “We created a lot of spaces for kids to get out of the room: play areas, gyms and outside space. Being outside helps kids stay connected to the real world.”
Designed by Denver-based EDAW, the gardens surrounding the hospital provide a place for contemplation, distraction and respite. “The idea was to build a hospital in a park,” Ossian says. “We wanted to take advantage of Colorado’s 300-plus days of sunshine to provide families a break from the stress they’re dealing with.”
“There’s an increasing body of knowledge saying that the environment plays a role in the healing response of the patient, and with pediatrics, that is all magnified,” Packard says. “TCH recognizes and deals with that phenomenon. We thought about the patient’s experience all the time, not just at the front door or in the playroom.”
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