Designer Forum - February 2013

By Kris Kirchner

Last year, K2J Inc., a Georgia based healthcare design firm, saw the completion of a project for Tanner Medical Center, a regional community hospital located in Carrollton, Georgia, that included a brand new, state-of-the-art emergency department addition, coupled with an extensive renovation to the operating room (OR)/sterile support services. Tanner Medical Center’s patient demographic is as varied as the community it serves, pulling from a diverse regional expanse across West Georgia, including Carroll County, which grew 96% between the 1980 census and the 2010 census.

The construction of this 120,534 square foot project included the addition of a new emergency department, new urgent care offering and dedicated radiology services, as well as an outpatient surgery facility, which became the new front door to the hospital. Renovation for this project provided better patient flow and facilities for the OR, short stay, post-anesthesia care unit (PACU) and central sterile/OR support services, assuring an exceptional patient experience.

When a new building is added to an existing hospital, a number of unique challenges arise that are not normally found on new construction sites. This project required the new emergency room/outpatient surgery departments to connect to the existing hospital building and provide a consistent visual to the previous major expansion completed in 2007. Elements of the previous addition were the cornerstone of the design for this expansion project. However, the variation in project program requirements presented the project team with unique design challenges. K2J worked closely with Nashville-based ESa, the project architect, to create a strong, consistent design solution. The design strove to use low maintenance finish materials, update facilities for improved patient safety and comfort, and introduce lighting selections and clinical amenities for superior patient assessment.

Early in the design process, it became clear that each of these departments would have different user groups with significantly different flooring requirements. The challenge was clear: the entire facility had to work together as a single cohesive design, reflecting the same themes and same overall design aesthetic, while at the same time each separate department had to have its own diverse set of function and maintenance needs met. One consistent goal was to provide no-wax flooring solutions throughout the space. The measurable savings on floor care and manpower made this a mandatory component of the new addition, especially given the harsh clinical environments that are part of the new space.

New construction areas were tied to the existing hospital by an internal patient corridor, linking the outpatient services lobby to the hub of the previous addition. This corridor provided the design team an area to create a hospital history display, a unique way to illustrate the legacy of the Tanner Health System experience. An expansive new display, with artifacts and information, presents the story of how the region’s first hospital originated and came to be what it is today.

The central element of this addition was a two-story atrium, which now serves as the main entrance to the hospital, setting the tone for the organization’s commitment to quality and outstanding patient care. The warmth of the wood paneling and custom designed, user-friendly patient registration areas suggest a concierge-like feel to patients and their families.

In the atrium, a durable yet aesthetically pleasing flooring material was critical. The success of Floor Gres’ Stonetech through-body porcelain tile, utilized in the previous addition, was an easy choice for the waiting area flooring design. However, the volume of the space necessitated more thought to the acoustical solution. Therefore, the tile was used to create a pathway from the main entry to the crossroad corridors, leading to the hospital and parking services. All patient care and visitor service elements radiate from this central path. Due to the concern for moisture, crack suppression and moisture membranes were utilized to prepare the on-grade flooring substrate and assure a viable base for installation of the large format tile design. Large unit tile sizes meant fewer grout joints. Installers from Atlanta-based Carpet Concepts were able to provide minimal 1/8” grout joints, adding to the visual success of the installation.

Public seating areas off this walkway utilize carpet tile to aid in the acoustical needs of this space. The design team wanted these waiting areas to be comfortable environments that reduced the stress of a family waiting for the surgical outcome of a loved one. Patcraft’s Modern Geometry carpet tile was selected to provide a backdrop to the more impactful architectural elements. Curved ceiling canopies were created over each major service desk-greeter, registration and outpatient surgery, and served as visual anchors to the space. Family seating groupings were positioned throughout the space. The Patcraft carpet was selected for its simple pattern with dark background color and strong visual accents of green and blue, illustrating the facility’s dominant marketing hues.

An updated bistro off the atrium area doesn’t just serve your average cup of hospital joe. The new café, Bistro ’49, named for the year the hospital was opened, serves Starbucks coffee and includes lounge spaces with complementary Wi-Fi, providing added comfort to visitors. The burl pattern introduced in the porcelain floor tile provides a visual uniqueness adding to the hospitality of the bistro. Although the café is open to the atrium areas, the border tile defines the space, which has easy access from all entry points. Lighting is subdued, and the seating inviting.

Extensive renovations to the current OR facilities created 11 new trauma rooms and three endoscopy suites, which proved to be a project management feat, as the construction team of Robins Morton/RKR was challenged to keep OR/central sterile services fully functional during the construction effort. This required 12 phases of construction and demanded camaraderie between the client and all project consultants, orchestrating efforts and assuring no down time.

It was vital that the flooring selection for the operating suites stand up to the use of harsh surgical chemicals. Reviews of several flooring products coupled with a tight project budget led to the selection of a homogeneous sheet vinyl flooring solution from Johnsonite. This mainstay for clinical areas was visually enhanced by adding design insets, successfully installed by Atlanta based Spectra Flooring. Work fields within the OR rooms were defined with a two-tone design solution, utilizing a circular visual element. This look was reiterated in the OR clinical corridors with circular flooring designs mimicking light fixtures at corridor junctures, which provided the illusion of skylights. Soft arcs of varying flooring colors were introduced in the clinical corridors, giving staff a visual break from the stressful demands of a workday. Wall protection wainscoting by Altro was utilized with a big thumbs-up from infection control personnel.

The PACU department utilized Armstrong’s Rejuvenations sheet vinyl in a dark wood look to provide a visual anchor to this active environment. Clinical in nature, this flooring selection provides staff and patients with the stress-reducing warmth of real wood. Armstrong’s recently reengineered product offering provided an easily cleanable, no-scuff solution to this demanding, high traffic environment.

Sterile processing presented an individualized flooring challenge. Due to high wheel traffic, coupled with constant high temperature and wet conditions, epoxy resin flooring was the go-to flooring solution for this backbone area of support to the OR department. State-of-the-art sterile processing equipment, including a full cart wash system, necessitated a monolithic flooring installation capable of withstanding high PSI loads, standing water, high slip resistance and effortless cleanability. Poured epoxy resin flooring with a light grit texture and integral base was the answer.

ER department patients enter the facility in a state of high anxiety, so the design strategy was to create a safe, warm and welcoming environment. Tanner Medical System/Carrollton sees about 50,000 patients each year through its ER department. With the addition, the hospital was able to increase the number of emergency exam rooms to more than three times as large as the current emergency department.

The emergency department includes a new waiting room, triage processing and consult rooms, exam rooms, four trauma rooms, new ambulance entrance and EMS services, and dedicated radiology services. Expanded staff support areas complete the ER project addition. Connected urgent care facilities feature ease of access to the outpatient and emergency departments for expedient patient processing for minor emergencies during off hours.

The emergency department entry/waiting areas follow the design parameters of the other entry points, utilizing through-body porcelain tile. Seating selections are organized in family gathering centers, including a custom bench solution to outfit the rotunda. Durable seating selections feature metal frames and all vinyl upholstery options.

The focal point of the waiting area is a 1,100 gallon, museum quality freshwater aquarium and turtle habitat, featuring waterfalls, ferns, vines and other natural elements, installed by habitat design firm Just Add Water. The exhibit includes a variety of unique, colorful, playful fish and over 100 baby turtles. Children who were in the neonatal intensive care unit as babies were invited to name their own turtles during an initiation ceremony.

A no-wax solution was a must for these high traffic, nonstop departments, as the standard strip and wax processes for VCT flooring would not accommodate these must-need, high turnover areas. Luxury vinyl tile solutions were the answer, and the design team turned to Centiva, Amtico and Armstrong for its flooring selections. Design concepts centered on an inviting wood look plank in the exam rooms. Clinical support areas utilized Armstrong Rejuvenations products, this time in tile format, for ease of repair. A checkerboard design pattern was accented with a solid product color choice that mirrors the ceiling soffit design.

Utilizing varying manufacturers’ products requires the design team to ensure that the installation process considers the varying thicknesses of products, so that a flush, smooth finished surface is obtained. This can be accomplished through floor prep or the buildup of trowelable adhesives. The project was also saddled with known concerns related to the building site, which included high water table/moisture control issues for on-grade facilities. Moisture remediation was necessary for the original installation due to RH testing results and the tightly phased project schedule. Standard one-part adhesive was utilized in most areas that were remediated. However, due to high wheel traffic and rolling loads, two-part epoxy adhesive was utilized in all OR clinical areas.

This highly successful project also turned out to be emotionally challenging. Just prior to opening, a malfunction with the fire suppression system flooded the newly completed spaces. However, this unfortunate situation provided a heartwarming result—an immediate and inspiring level of local support that wonderfully illustrates the importance of a true community hospital.

The design team was tasked to rebuild, re-order and re-install all finish materials, STAT. The outpatient surgery department opened in late November and the emergency department in late January 2013.

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