Our Copperas Cove office of EVstudio recently completed the architectural and engineering design service phases for the USMEDCOM Community Based Clinic located in Killeen, Texas near Ft. Hood, Texas.  The facility is approximately 13,ooo square feet, on a two acre site, and is designed to accommodate a staff of 35 US Army medical personnel.

The facility has 18 exam rooms, a fully equipped treatment room, an on-site laboratory, pharmacy, behavioral health unit, dedicated pediatric practice spaces (including an immunization room), 2 group practice areas, multiple triage areas, and administrative spaces.

In addition to the features that would be expected in most private sector clinics, the USMEDCOM facility also incorporates many of the same AT/FP (anti-terrorism / force protection) considerations that would be found in facilities located on a US Army Installation.  EVstudio worked directly with the US Army Corps of Engineers and the staff of the US Army Medical Command to insure this facility met all the crucial design criteria standards established for this facility type.

The Killeen, TX Community Based Clinic has been designed to meet LEED Certified standards.  We have incorporated numerous energy and water saving strategies into this facility along with site development considerations and a focus on indoor environment quality.

EVstudio takes great pride in designing facilities that will provide a better quality of life for those men and women, along with their families, that serve our country.

Originally posted 2010-12-29 00:43:50.

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• The use generally requires a fully accessible building. This can be an issue for older buildings that may need to be retrofitted.Space must be found on an accessible route.
• In many jurisdictions the parking requirements can be higher. If the building was planned with a lower density use, the adequacy of parking may need to be addressed with the zoning department. There may also need to be adjustments to the number of handicapped parking spaces.
• Hazardous materials must be accounted for like oxygen and nitrous. These will generally need to be stored in rooms with venting to the outside and fire ratings.
• Lighting, mechanical and power needs are generally greater than a standard office. Existing systems may need to upgraded and additional space allotted.
• Careful attention must be given to sound attenuation and privacy both for patient comfort and to meet HIPAA regulations.
• Surfaces and casework need to be more carefully thought out for cleaning and function.

Originally posted 2009-09-23 11:29:02.

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Pros:

• It can go faster because it moves the design time for MEP into the construction phase.
• There may be cost savings on the engineering fees when they are bundled with the install
• The contractor will attempt to pick their most cost effective solution

Cons:

• The biggest con is that contractors are pricing a guess and the bids are not easily comparable
• You may be getting a price for the cheapest system rather than the right system
• If the systems require changes to the architecture you'll face additional services
• Some jurisdictions will not allow it

I think that both delivery methods have their place, you just need to make sure that you're picking a delivery method that is in line with your priorities.

Originally posted 2009-11-14 00:01:08.

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As an example, the table lists 100 gross sf per occupant in a business occupancy. If you have a 1,000 sf office then you are designing for 10 occupants.  However, the 10 really functions as a minimum rather than a maximum. You must design adequate exiting and fixture count for 10 occupants.

If your space is actually designed for more occupants that's absolutely fine as long as you are following all of the code provisions for more occupants. In this example if your 1,000 sf is a call center with 25 people, then you need to make sure your exiting, plumbing, mechanical and so forth are designed to handle 25. You just have to make sure you don't exceed 1 person per 7 square feet, that's an absolute maximum and very tight quarters. I've never seen it, but the code official can ask you to show a diagram for your increased occupant load.

On the other end of the spectrum, you can actually design for less that the maximum occupant load, but only with approval of the building department, and I've never seen this happen.

The code section uses the phrase "design occupant load" and that is really a more accurate phrase.

Originally posted 2009-09-26 00:01:19.

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Perception of light level also depends on the color temperature. The more blue-white the light, the higher the perceived light level, even when foot candles are the same. Warmer color temperatures are often perceived as a lower light level. This is useful when considering task versus ambient light; cool task lighting can provide more visually perceived light (helping the care provider), while slightly warmer ambient light can feel less intimidating (helping the patient).

High levels of contrast tend to portray excitement, but in the medical environment, can cause confusion for patients with aging eyes, and work against eyes of all ages as the eye's adaptation from dark to light takes time, and decreases with age; thus, the lower light level areas often feel dark, and the higher light level areas, painfully bright. We should strive for good uniformity in the medical care environment, especially at low light levels.

In a patient care setting, we need to consider two very different needs and experiences.

First, let's consider the needs of the care provider. There must be adequate light to examine skin color and texture, and shadows are important to see variation in skin, depth of lesions, etc.! That means that totally indirect light sources don't work for care providers doing critical exams unless there's also daylight. 3000-3500K (halogen color temperature) is typical, but I believe it's wise to mockup exam rooms with color temperatures ranging from 3000-4100K and let the practitioners give input on their preferred color temperature. It's feasible to have a portable exam light or local task lights such as recessed ceiling fixtures that are on during the critical part of the exam. The rest of the time, these lights do not necessarily need to be on.

Second, we must consider the patient experience. Indirect, lower level lighting that is warmer in temperature offsets the perception of a sterile, institutional exam room. With reasonable uniformity, the light levels won't seem low to the patient while they're waiting for the practitioner, and during any initial discussion. For patient purposes, low level 100% indirect light, like fluorescents over the exam cabinets reflecting onto a white ceiling, are soothing.

Let's not forget context. Corridors and halls are often dreadfully overlit. Realistically, between 5-15 footcandles, depending on the users, can get the job done, especially with good uniformity. When you go from a corridor that has 5-10 footcandles to an the adjacent space with 25-30 footcandles, the perception is WOW! This place is well lit! However, when you have 30 foot candles in the corridor, an exam room with similar average illumination feels dim, especially if that light is all on horizontal surfaces. By sensitivity to context, we increase the perception of brightness by keeping adjacent spaces at a lower light level as much as feasible.

We also need to consider the light reflectance value of the space's finishes. Lighter colored finishes create more of an overall perception of brightness.

As with all well-designed lighting solutions, there is not a one-size-fits-all approach.  We need to provide flexibility in controls that allow the lighting to be used in varying capacities, such as during the critical portion of an exam, versus when the patient is awaiting the care provider's arrival.  Flexibility and user control has been proven to decrease energy consumption and increase user satisfaction.  For that to be successful, the users must be "active users" and engage with the capabilities designed into the lighting system.

Originally posted 2010-07-22 00:42:23.

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Construction Cost Per Square Foot for Medical Office Buildings

Year over year from our previous post on this project type, construction costs are inching higher across virtually all markets. However, in the most expensive market, New York, the increase is only just over 1% while the least expensive market advanced only .2%. The median increase hovers right around 1% in most markets.

Medical Office Buildings are in a subclass of office buildings that has become a specialty within EVstudio in recent years. For more specific information regarding the cost of an individual medical office building to suit your requirements, please contact us and we can help to scope all of the parameters that make your project work.

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The data for these charts is courtesy of RSMeans, the world leader in construction cost estimating

Among the two property categories set out in the charts below, it is most expensive to build a two-to-three-story hospital. The dollar-per-square-foot cost drops 12% for the next most expensive type of structure, a four-to-eight-story hospital.

Construction Cost per Square Foot for 2 to 3 Story Hospital

Not surprisingly, for both hospital sizes, New York ranks the highest for the region to build while cities in the South are among the lowest cost for construction. The median for a 2-3 story hospital falls around $320 per square foot while the median for a 4-8 story hospital falls around $280 per square foot.

Construction Cost per Square Foot for 4 to 8 Story Hospital

The economy of scale is evident in the taller structures, and this often drives decision making at the outset of a project. It is also important to note that facility management and operation costs are also less for taller hospitals than for fewer stories.

Every facility is different, however, and has a wide variety of specialties that set it apart from other buildings. For example, Some hospitals are well known for their technologically advanced resources while others may be more focused on long term care, pediatric or therapeutic care, which could have lower cost requirements for those facilities.

If your group is considering a new facility, or a renovation of an existing facility, we would be happy to discuss your project with you and help to outline a program for understanding the major impacts to your project budget, and ultimately assist in providing award winning architecture and engineering to realize your project.

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Construction Cost per Square Foot for Nursing Homes

The construction cost chart illustrates that the most expensive city to build is New York, with the Southern Cities having lower costs per square foot. The Median cost per square foot for Nursing homes falls around $160 per square foot.

These costs are indexes based on averages across a wide variety of projects with various programs. Long Term Care facilities have a wide range of programs and functions that can drive costs. For example, therapy gyms, swimming pools, spas and various other high tech amenities for residents available in higher end facilities can push the costs per square foot higher.

EVstudio has extensive experience with these kinds of projects and the cost impacts of various aspects of the program. We would be happy to discuss your project with you and help to outline your specific program and how it informs your project budget.

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When designing an HBOT facility it is important for the architectural and engineering design team to have a very clear understanding of the functional and spatial requirements of the equipment, the technology that supports the equipment, and the aesthetic considerations for the space accommodating the hyperbaric chambers.

EVstudio is currently working with clients to develop an HBOT facility in Killeen, Texas.  The HBOT facility will be part of a proposed 12,000 square foot Wound Care Center.  We have completed the programing process and are in the early stages of Schematic Design with our clients.  We have studied several different design scenarios and are quickly closing in on what will most likely be the approved SD floor plan.

As we continue through the design process on this project we will discuss the construction budget, facility specific maintenance requirements,  code requirements concerning the storage and use of medical gas, and overall facility design strategies.

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The Care Center in Pueblo features five courtyards and a Therapy Garden.

An Illustration by John Olson of an Employee Courtyard of the Care Center.

EV Studio recently finalized and submitted construction document drawings for the Pueblo Care & Rehabilitation Center in Pueblo, Colorado.  The project is a retrofit to a building and site originally constructed in 1962 in South Pueblo.  The primary focus of the project for the client is to make major structural and functional updates to the interiors of the building.  Currently the building endures settling and flooding.  The flooding issue is caused by poor drainage in the courtyards of the Care Center.

Along with the civil engineers of EV Studio, we managed the storm water with infiltration areas in the courtyards where rainwater is utilized to supplement the landscape rather than the typical solution of piping the water off-site as soon as possible.  Another key feature of the renovation is the new Therapy Wing on the southwest side of the building.  The therapy wing is envisioned to be an outpatient facility for the city of Pueblo as well as the residents of the Care Center.  Accompanying the therapy wing, a therapy garden is incorporated into the landscape.  The therapy garden features a wide variety of plant material providing year round landscape interest to the sense of its users.  Multiple walking surfaces are planned to be a part of the therapy treatment.  Conventional concrete is complimented by brick paver bands, a brick paver seating area and breeze walking surface through the plant material.

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