Commissioning In Healthcare

Transcription

1 Commissioning In Healthcare Joseph Lorino, PE, LEED AP, NewYork-Presbyterian Hospital Evan Wyner, PE, CCP, Strategic Building Solutions 21 st National Conference on Building Commissioning

2 AIA Quality Assurance The Building Commissioning Association is a Registered Provider with The American Institute of Architects Continuing Education Systems (AIA/CES). Credit(s) earned on completion of this program will be reported to AIA/CES for AIA members. Certificates of Completion for both AIA members and non-aia members are available upon request. This program is registered with AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product. Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation.

3 Presentation Description This presentation will describe the hospital-specific priorities related to risk, patient care, early planning, codes and standards, stakeholder involvement, and commissioned systems. The discussion will review the balance of equipment redundancy and capacity, infection control, equipment failure, planned shutdowns, and risk assessments that are specific to healthcare facilities. The additional requirements affecting commissioning authorities that are imposed by state and local codes, accreditation agencies, TJC, and hospital performance criteria beyond typical energy-related systems will be detailed.

4 Learning Objectives At the end of this session, participants will be able to: 1. Understand the specialty issues related to healthcare 2. Investigate and apply relevant codes, standards and legal mandates for healthcare commissioning projects 3. Establish systems and equipment commissioning priorities to meet redundancy, capacity and risk requirements

5 Specialty Issues Patient Care Priority Safety Physical Infection Control Comfort Temperature Noise

6 Specialty Issues Commissioned Systems HVAC Fire smoke dampers Electrical Lighting Plumbing Pneumatic tube Medical gas Nurse call Fire alarm Security Fire protection Vertical transportation Fire Stopping

7 Specialty Issues Early Planning Adjacencies Shared utilities Tracer Construction access

8 Codes, Standards, and Mandates Building Codes Building Mechanical Electrical Plumbing Energy New York City Building Codes website hosted by the ICC

9 Codes, Standards, and Mandates Standards NFPA Owner FGI

10 Codes, Standards, and Mandates Standards Guidelines ANSI/ASHRAE/ASHE Guidelines for Design and Construction of Health Care Facilities

11 Codes, Standards, and Mandates Standards

12 Codes, Standards, and Mandates Mandates TJC/CMS Elements of Performance

13 Codes, Standards, and Mandates Mandates EC items Tasks Policies Procedures

14 System and Equipment Priorities Redundancy Equipment failures Maintenance Single point of failure Bifurcated unit

15 System and Equipment Priorities Capacity Design vs. peak load Expansion Patient Surge Rate of change Radiation Oncology

16 System and Equipment Priorities Risk Cost affect decisions Not 100% redundant Likelihood of failure Personal decisions Pediatric Trauma Room

17 NewYork Presbyterian Hospital Program Overview Ranked #1 in NYC Columbia University Medical Center Weill Cornell Medical Center Morgan Stanley Children s Hospital Allen Hospital Westchester Division

18 The NYP Program Why Design review sessions Utility capacities Unplanned shutdowns Construction deficiencies High cost of repair Inaccessibility Delayed inspections DOH Pre-Occupancy Inspections Mandates after construction Impact to patient care

19 Different Project Expectations Facilities Operations Patient Design & Construction Contractors

20 Bridging the Gap

21 The NYP Program The Process RFQ Interviews Selection Cx costs Assignments Ongoing

22 Non-traditional Commissioning Beyond ASHRAE Guideline 0 Assist in DOH Pre-occupancy inspections Barcode assets Develop equipment PM program Inspect rated wall penetrations & firestopping Phasing coordination Decanting of space

23 The NYP Program The Projects Renovations Infrastructure Major Projects New Building

24 The NYP Program Renovation Radiation Oncology Expansion Not included in Cx Program Incomplete systems Inaccessible equipment Delayed NYSDOH Pre- Occupancy Survey Delay in patient care Revenue loss 9 Months behind schedule 10% over budget CxA to coordinate effort

25 The NYP Program Major Project Adult Emergency Department Multi-phased 4 ½ years Decants & traffic routes Mechanical Room Air handler for redundancy Steam & chilled water routes Underground ductwork Ceiling access Shut-offs Maintenance Cx to coordinate

26 The NYP Program Infrastructure Boiler Plant Service Life Extension NYSDEC 2014 RACT Economizer replacement Flue gas recirculation (FGR) Conversion No. 6 to No. 2 fuel Fuel tank remediation No unplanned steam loss!

27 The NYP Program New Building Ambulatory Care Center $1 billion project 450,000 SF (720,000 future) 3D BIM all trades Construction trade managers (MEP) Off-site module construction Trade union PLA s Goal: NO RFI s NO change orders NO shop drawings

28 Healthcare Commissioning Making the Case Specialty requirements Codes, standards & mandates TJC Best Practice Patient care focused Beyond traditional Cx Higher costs Buy in from all parties

29 THANK YOU Joseph Lorino, PE NewYork-Presbyterian Hospital Evan Wyner, PE, CCP Strategic Building Solutions, LLC