New Rady Children’s Hospital Acute Care Pavilion Becomes First Critical Care Hospital in California to Blend Both Mandates

Published on : March 01, 2011

New Rady Children’s Hospital Acute Care Pavilion Becomes First Critical Care Hospital in California to Blend Both Mandates

New Rady Children’s Hospital Acute Care Pavilion Becomes First Critical Care Hospital in California to Blend Both Mandates

San Diego County parents with children who require critical care now have available to them a pediatric hospital facility unlike any other in the country – a whimsical, healing oasis that harmonizes earthquake safety with sustainable design.

Built by McCarthy Building Companies, Inc., and designed by Stantec, the new $260 million Rady Children’s Hospital Acute Care Pavilion is the first acute care facility in California to meet the rigorous standards for quality and safety mandated by the Office of Statewide Health Planning and Development (OSHPD), while also exceeding the level of occupant health and environmental sustainability needed to earn it LEED Certified status.

Construction of the 279,000-square-foot, five-story facility was completed in late June 2010, 15 days ahead of schedule, and the hospital was equipped, furnished and ready to receive patients by mid October.  The U.S. Green Building Council (USGBC) awarded official LEED certification of the building in February of this year.

California’s Seismic Requirements

OSHPD oversight of California hospitals was born of the 1971 Sylmar earthquake, which caused several hospitals to collapse, endangering the lives of hundreds of patients and hampering the hospitals’ ability to provide emergency care to the injured. In 1973 the state of California passed the Alfred E. Alquist Hospital Seismic Safety Act and, ever since, all hospital construction has been governed by this legislation. The standards not only help enforce patient safety during the earthquake, but also ensure that facilities can continue to function and care for the injured following earthquakes.

As a result, OSHPD is responsible for overseeing all aspects of construction for general acute care and psychiatric hospitals, as well as multi-story skilled nursing homes and intermediate care facilities in California. Construction oversight of OSHPD facilities adds a heightened level of complexity to already complicated healthcare construction projects in California, based on the state’s strict criteria for project inspections as well as reviews and approvals of any and all changes of construction materials or methods.

For the Acute Care Pavilion, Rady Children’s Hospital employed an onsite inspector-of-record and three field inspectors who were bound to the letter of the law. McCarthy had the integral role of working through all construction issues, developing proactive solutions, documenting every discussion and construction activity, and gaining the confidence of OSHPD inspectors, who visited the site three times a week. Not a single detail of the project could afford to be overlooked, down to the torque of each bolt.

Rod Tie-Down Operation

To seismically secure the new Acute Care Pavilion, McCarthy chose a Micro-Pile application of a “Dywidag” tie-down anchor rod system.  Considered a novel approach in the healthcare design world, a tie-down prevents the building foundations from uplift during an earthquake.  The Uniform Building Code requires that the foundation of structures be designed to resist the upward force of a seismic event.

It is not unusual for structural foundations to be supplemented with caissons or driven piles, should the soil conditions dictate the need to literally “float” the building with the assistance of these foundation elements and secure the foundation to the bedrock layer below.  This insures the solid embedment of the foundation supports and makes sure that any building settling will be minimal and uniform.

For the Acute Care Pavilion, the problem was not how to “float” the building foundation, but how to hold it down. To complicate the problem, the need to add tie-down anchors was determined late in the pre-construction process, requiring the structural engineer to either redesign the entire foundation, or come up with an acceptable hold-down alternative. The project team analyzed the problem and selected the “tie-down” technology as the most effective solution for keeping the project on schedule.

The installation of the tie-downs required McCarthy’s team to drill individual 60’ deep holes that were only 8” in diameter for each tie down rod.  Each rod, made of 2-1/2-inch diameter solid steel, was hoisted by a crane and lowered into its respective hole.  All holes were then filled with grout to secure the anchors and allowed to cure.  An initial pull test was conducted on the anchor rod.  Then a sleeve was placed over the exposed rod, and the foundation section was formed and poured with concrete.  Once the foundation section was cured, the anchor rod was prepped and finally tested, and an anchor plate and a hex nut were then tightened down on the foundation section and torqued to specifications.

Making sure the building was well connected to the bedrock below the structure was important, since the bedrock gives the building the most secure possible connection to the earth. This keeps the building tied together and anchored to solid ground. The entire foundation system, structural steel bracing system, and the interior sheer walls are designed to allow the building to resist the forces generated in an earthquake, while allowing the structure to move as necessary.

There are 144 of these anchor rod tie-downs installed in the foundation of the Rady Children’s Hospital Acute Care Pavilion to meet the unique seismic hold down requirements of the building’s five-story structure.  This innovative solution not only kept the project on schedule, but also provided the necessary seismic uplift restraint required for the building.

Mission: Green

Rady Children’s Hospital is the only dedicated pediatric medical center in the San Diego region whose demand for services had outgrown its existing facilities. The new 279,000-square foot Acute Care Pavilion was built on a tight, 148,650-square-foot site at the southeast end of the hospital campus, adjacent to the existing Rose Pavilion. Second- and third-floor bridges and a ground-floor walkway connect the existing facility to the new four-story building.

The Acute Care Pavilion houses a much-needed surgical center, 84 medical-surgical beds, a neo-natal intensive care center, and a cancer center. It also provides 16 operating rooms with associated support departments, a 28-bed hematology and oncology unit, a 10-bed bone marrow transplant intensive care unit, a 32-bed neo-natal intensive care unit, and 84 acuity adaptable medical surgery beds.

The facility’s exterior features a glass-fiber reinforced, precast concrete exterior; integral-colored plaster; storefront and curtain wall glass systems with colored accents; and metal panels, railings and canopies.

For many years, Rady Children’s Hospital has been committed to green practices throughout its operations, so when it came time to expand, it set on a mission to become the largest children's hospital in the state with a world-class LEED Certified facility.  Marrying a world where patients and operations are paramount with that of an eco-friendly environment would challenge the project team, but also represent a significant construction milestone.

A Knowledgeable Approach

To properly address the LEED aspects of the project and carry through the facility’s sustainable design in a thoughtful, practical manner, McCarthy employed a dedicated LEED professional and, during the course of the project, 10 of the construction team's members became LEED APs. Construction execution required rigorous tracking and monitoring to ensure compliance with the credits. Where there was so much as a shadow of doubt, the project team took extra precautions at every turn.

More than anything, success of the project required trust on the part of the owner that the project team members would work cohesively with OSHPD, the USGBC and one another, always with the hospital’s and patients’ best interest in mind. Tim Jacoby, vice president of facilities for Rady Children’s Hospital, led the triumphant collaboration.

Working in accordance with LEED 2.1, the project team achieved 31 points, well exceeding the 26 points needed for LEED certification. Since beginning the application process for this project, the USGBC has rolled out the LEED 3.0 for Healthcare Green Building Rating System, which has made it more enticing for hospitals to seek certification since the requirements are more specific and applicable to healthcare facility issues.

Whimsical Healing Gardens

The project team earned an “Innovation in Design” credit for the introduction of a series of healing gardens that utilize sustainable design principles and embrace the hospital’s healing arts program, which was originally developed in 1993 in conjunction with the Rose Pavilion construction. The program seeks to enrich the experience of patients, families and staff via works of visual and performing arts, and through healing gardens that draw on artists’ talents to transform normally lackluster courtyards into whimsical, outdoor retreats.

In synchronicity with the hospital’s healing arts program, the new Rady Children’s Hospital Acute Care Pavilion provides an environment focused on the needs and imaginations of children – one that is also intended to help relieve the stress of families with sick or injured children. Central to the theme of the building is the “River of Life”, manifested through an immense, four-story mineral panel that incorporates a kinetic lighting system, which radiates a rainbow of vibrant colors through the front entry curtain wall.  A mosaic tile version of the "River of Life" flows from the mineral lobby wall, through the lobby, and out to the first-floor courtyard.

Called "Carley's Magical Gardens”, these landscaped courtyard areas were designed through the collaboration of local artists T.J. Dixon, Kim Emerson, Albert De Matteis, and James Nelson. The first floor garden off the main entry, intended for parents and siblings, sets the stage for the whimsical themes experienced throughout the facility.

Located on the second floor off the hematology and oncology unit, the primary healing garden features a giant tiled bird with a place for patients to deposit their wishes, which staff later collect to better understand the children’s wants and needs. A life-size bronze figure of a young girl sitting at an eight-foot-long table is the centerpiece of the second-floor healing garden, and provides a place for organized activities and family gatherings. Other whimsical objects include a mosaic tile and concrete tree playhouse, privacy bench, performance stage, and interactive garden screens and gates. A divided basketball playing area accommodates both regular and immune-deficient patients.

On the third floor is another landscaped bamboo garden with a rubber-surfaced playing area for patients and a retreat area for staff. A vast ground-floor outdoor terrace, strictly for staff use, features large Jacaranda trees, light posts and bike racks.

Greater Green Means

The Rady Children’s Hospital Acute Care Pavilion’s energy efficiency level is 23 percent better than ASHRAE 90.1, utilizing the LEED Energy Cost Budget methodology. This was achieved by incorporating the following sustainable design features:

  • Occupancy sensors in operating rooms to reduce the ventilation rate by 60% when unoccupied, yielding a 45% annual energy savings;
  • variable frequency drives on air handling unit motors to adjust the fan speed due to filter loading;
  • carbon dioxide monitoring for high occupancy areas to reduce ventilation rates, based on the number of occupants;
  • a supply air temperature reset strategy, which saves energy by adjusting air temperatures based on load;
  • a 24,000-square-foot cogeneration plant that provides free heating and high temperature water, and contains two 700-ton natural gas-fired absorption chillers; and
  • variable frequency drives on cooling tower fans and hot water pumps.
  • The project also utilizes recycled and locally obtained steel, concrete and other building materials; low VOC-emitting paints, glues, carpet, and wood; water-efficient landscaping; abundant daylighting; and a dedicated bicycle storage area. A reflective concrete "cool roof" system helps minimize heat gain and control rainwater run-off, while painted steel screens conceal rooftop mechanical systems.       

Nearly 80 percent of construction waste materials at the job site was recycled. A thorough flush-out of the building was performed upon construction completion and again immediately before receiving patients. The project team went above and beyond the LEED requirements by declaring the entire hospital campus a “no smoking” zone.

Inspiration from Rady Staff

Working next door to the existing Rady Children's Hospital and observing everyday trauma there greatly affected the minds and hearts of McCarthy’s construction team members, who were inspired by the passion and commitment of the Rady Children’s Hospital staff.  After all, this was no ordinary construction project, but rather a life-saving mission on behalf of parents and their critically sick or injured children.

About the Author:

Bonnie Kutch, principal of Kutch & Company, is the San Diego media representative for McCarthy Building Companies, Inc. McCarthy is the nation’s 10th largest domestic general contractor (Engineering News-Record, May 2010) and has been ranked among the top five healthcare builders in the nation and among California’s top five green contractors (California Construction, May 2010). In Southern California, the firm has completed over $2.4 billion in healthcare work for the region’s most elite healthcare institutions.  In addition to San Diego, McCarthy has offices in Newport Beach, Sacramento and San Francisco, Calif.; Phoenix; Las Vegas; Dallas; Houston; St. Louis and Atlanta. McCarthy is 100 percent employee owned. More information about the company is available online at Ms. Kutch can be contacted at [email protected].