The Leaflet Article
JOPLIN REBUILDS After the Storm
After the EF-5 tornado of May 22, 2011 landed a direct hit on the St. John’s Regional Medical Center in Joplin Missouri, Sisters of Mercy Health Systems determined to re-build, on a new site, a new facility, to replace the one devastated by the tornado. Groundbreaking for the 260 bed facility took place in January of 2012. The new hospital will open for patients in the first quarter of 2015. With the lessons learned from the devastating storm experience, Sisters of Mercy Health Systems and its design and construction teams gathered together to begin planning the new design. The team included representatives from Mercy – the hospital owners, McCarthy Builders – the contractors, Heidemen Associates Inc. – the MEP design engineers and HKS Inc. –the architects. As a result of those design discussions the new facility will incorporate many new technologies and design features.
One such technology in the new facility is a distributed antenna system (DAS) that will be the backbone for several important communication systems for the hospital. Local cell phone providers will use the DAS to distribute their systems though ceiling mounted antennas. Using this system, cell phone service is available throughout the hospital alleviating zones where calls cannot be made or received using local cell towers.
Local area first responders will also use the DAS antennas to communicate with each other in the facility utilizing radio gear built into their helmets. The system will be available for local fire fighters and police with the ability to expand to other agencies in the future.
The DAS system back bone will also carry the GE patient monitoring. DAS is a “smart” system with the ability to continually monitor itself and send alerts if any of the system is not responding.
Often in local or regional emergencies when all other forms of communications are down, ham radio operators may be the only opportunity for contact outside of a disaster area. For that reason, amateur radio antennas are to be purchased and installed on the hospital by the local “ham” radio club. There will be two antennas, one a repeater for the ham radio club operators and one that will be connected to a radio station in the hospital for staff use. The staff radio station is located at the incident Command Center, strategically located in the basement of the facility. The dispatch and monitoring center, also in the lower level of the hospital will be the communication center for the facility with its ability to constantly monitor security cameras and other systems and will be the center of communications in case of any emergency. This will be the area that will take security calls and dispatch security where needed.
Access control of protected openings (exterior doors and doors to sensitive rooms) will be monitored at the dispatch and monitoring center. The center will also be connected to the entire Mercy system. In case of an emergency, the Joplin facility can be controlled from one of the other Mercy facilities in Springfield or St. Louis. The dispatch and monitoring center and its systems could be accessed from an I-phone or IPAD while staff from other facilities are in route to deal with an emergency.
Another technology is voice evacuation notification in the building and the parking areas. There are various “blue phones” available in the parking areas for direct contact with security for anyone needing assistance in an emergency. These phones contain the speakers that can broadcast evacuation notification to the parking areas at the time of an immediate emergency.
With the use of amour jacket cable and multiple redundancies built into the layout, the various communication systems are designed with the lessons learned from the 2011 tornado in mind. The underlying catalyst for design considerations for communications for the new facility was unfortunate, but the outcome for a more thoughtful and functionally designed facility in an emergency was the result.
As part of the Sisters of Mercy Health Systems mission to deliver a transformative healthcare experience, new technology is incorporated into the patient care areas as well. In the patient rooms, the nurse call pillow unit is integrated with the IT based interactive TV system. The pillow unit has the typical functions of nurse call and watching TV, but also incorporates customized patient training and information that can be broadcast to the patient over the TV in their room.
The interactive TV system also facilitates telemedicine, allowing calls to healthcare providers and video conferences with the patient from facilities throughout the Mercy system. The system can alert the staff to patient episodes. Staff can monitor patients from the nurse station prior to direct viewing at the bedside. Remote monitoring of patients (telemedicine & EICU): electronic ICU monitor and camera at the footwall allow for remote monitoring of patients. The facility will have a remote monitoring center as well as a dedicated monitoring room in the facility for continuous staff monitoring of high risk cardiac patients.
Another technology that will be utilized in the facility is RTLS, or radio frequency real time location system. This system provides real-time tracking of the staff and their interaction with the patient. Staff can focus on patient care rather than the logging and timing of interactions. The system leaves an audit trail which will validate the time spent with each patient.
Using an IT based phone system allows the phone devices carried by the staff to also be integrated into the RTLS. When staff are not available or outside of the unit, the system will know to forward calls to backup staff providing consistent and continuous communications between patients and staff.
The RTLS system can also be used for tracking equipment. Staff can quickly locate needed pieces of equipment. Clinical engineering will have a real time overview of locations of all pieces of medical equipment throughout the facility at a moment’s notice.
The EPIC system that was purchased for the Joplin hospital supports not only electronic medical records for patients throughout the hospital – exam, ED, patient rooms, but will also be a system that can support telemedicine throughout the Mercy system. The EPIC system is part of all in-patient and out-patient clinic areas.
Part of the planning for the new facility centered on evaluating the latest in medical equipment technologies and capabilities. Noteworthy new medical equipment that will be in the new Joplin Mercy facility will be the linear accelerator, hybrid OR (operating room) and PET (positron emission tomography) CT (Computerized tomography).
The linear accelerator is a Versa HD, the most advanced linear accelerator on the market. Elekta’s Versa HD is a system that has a high dose rate of treatment delivery and the most advanced beam shaping technology available anywhere. This beam shaping called a multi-leaf collimator is nearly three times faster than any other product on the market. High dose rate and rapid beam shaping technology will allow more patients to be treated per day. Equally important, shorter treatment times will enhance patient comfort. The Versa HD will allow Mercy Hospital Joplin to offer stereotactic radiosurgery to brain tumors and tumors in other parts of the body with exceptional targeting accuracy.
The new hybrid OR will combine the imaging function of C-arm X-ray equipment within the operating room. Patient-centered treatment in the surgical environment is facilitated with the ability to keep the patient in the same room for both surgery and imaging services. Surgery can continue uninterrupted by bringing real-time imaging into the operating room. This technology empowers the physicians’ ability to view the surgical procedure. It reduces patient transfers and offers the opportunity to consolidate procedures that normally would have been segmented. Consolidating procedures can reduce the risk of hospital acquired infections and can reduce the overall length of stay.
Advanced medical imaging will be possible with the inclusion of a PET CT in the new Mercy Joplin Hospital. The PET CT creates more precisely aligned images with both two and three dimensional image reconstruction through the use of computer software with the CT image and the PET image combination.
The Mercy Hospital Joplin lab will have the traditional lab functions improved and optimized with a lab automation system. The lab automation machine allows less staff to produce higher volumes of services and testing for the hospital by automating manual tasks. The automation process helps to reduce variability and steps in the testing process and to streamline and standardize the processes.
Other technologies incorporated into the new facility seek to make the building more sustainable and make the physical facility a model of energy efficiency. The MEP design engineers for the project, analyzed the systems to determine the energy savings and ROI for each of the new technologies considered.
One such technology that is incorporated into the building automation is a proprietary system, CP010, for the chillers. The system optimizes chiller run times and water temperatures based on loads which result in overall energy savings. The ROI is calculated to be 2 years.
Another energy savings measure is boiler exhaust heat recovery. The exhaust heat from the boilers is used to preheat boiler heating water, thus saving energy.
Using fan wall technology in the outside air units is another technology used in the building. Using several smaller fans with reduced motor sizes, as opposed to one large fan expedites maintenance. Using many small fans provides redundancy in case of individual fan downtime. The use of the fan wall with many smaller fans, allows each fan to operate at peak fan efficiency for an overall savings in energy for air moved. The fan wall also requires a smaller foot print for the fans. By using this technology the plant foot print could be reduced for a savings in square footage constructed.
Heat wheels are incorporated into the 100% outside air units. The heat wheel removes heat from the return air in the winter and uses that heat to reheat the incoming supply air. Using this technology saves energy on reheat costs for the cold supply air. The heat wheel also works in the summer months to remove heat from the incoming supply air thus reducing cooling costs in the summer.
LED lighting is used for the parking lot fixtures, interior down lights, and under cabinet light fixtures. The exterior fixtures are programmable for setback at specific times. The LED’s use approximately 2/3 of the electrical power of typical exterior lighting fixtures.
Daylight harvesting is used in the building in the main atriums as well as the dining area. This allows the building to take advantage of natural light rather than expending electrical energy when the sun can provide enough lighting. The public dining area is situated along the exterior of the building with 270 degree views of the exterior and is one of the spaces designed to capture sunlight in lieu of reliance on artificial lighting of the space. The atriums are other spaces that capture natural light.
Lighting controls are integrated though a Watt Stopper system that is infinitely programmable. Areas within the building can be set back, or turned off as needed.
Motion sensor light controls are installed in staff or non-patient areas which turn off lights when the spaces are not being used.
Battery backup was provided to the emergency lighting in the building in addition to the lighting that is on the emergency generators. This was added due to lessons learned from the 2011 tornado. The tornado instantly destroyed the generator leaving the entire building in darkness while evacuations were in progress after the storm. With Battery backup, lighting is instantly available in the event of a power outage – while the generator takes at least 10 seconds to come on line. Battery backup was also provided to light fixtures in the operating rooms, stairwells and safe areas.
Another new technology that is incorporated into the major electrical elements of the project is arc flash mitigation. Arc flash mitigation studies were undertaken for the major electrical gear. With the studies done, the proper protective gear can be determined that allows personnel to work on electrical equipment without shutting it down. This is a process that is new to the industry, and should significantly reduce downtime of electrical systems due to routine maintenance.
When plans were made for the new facility, patient experience was a guiding philosophy for the new design. Architecturally the new building has separate entries for the patient tower, clinics, oncology and emergency department. This concept assists the patient and visitor in wayfinding. The concept carries though to the parking areas as well, with the main spines leading directly to the entries. These areas along with the entry areas are also the most intensely landscaped, another clue to the visitor that they are on the correct path to the entry of the building.
Once inside, internal gallery spaces on two levels bisect the building, with hospital functions on one side and clinic spaces on the other. Amenities such as retail, the chapel, dinning and a coffee shop are easily accessible from the gallery space. Off this central spine are vertical transportation elements and vertical design elements, called “lanterns” which allow daylight and views, orientation and way finding as well. Major design elements near the “lanterns” are the monumental terrazzo stairs that connect the gallery levels of the main spaces. These are the “healthification“ stairs, which encourage walking and taking the stairs by staff, patients and visitors. This is part of Mercy’s efforts to integrate healthy lifestyle elements into the new facility for the community it serves.
The oncology infusion area is located in the building to take advantage of views to a landscaped garden area. The area also has TV’s placed for comfortable viewing along with an aquarium and a fire place.
A Ronald McDonald house is planned on the sixth floor providing space for families to stay close to patient family members. Amenities such as a sleep room, toilet, washer and dryer, kitchen and living areas are planned in the suite.
Med Surge patient rooms and ICU patient rooms are designed to be flexible to accommodate both types of patients within the nursing units. All patient floors are designed with readily available supplies and meds required to save staff walking time. Private NICU rooms with rooms for accommodating multiple births in the same room are a part of the NICU suite.
And finally, in the chapel, large slabs of marble and a Stations of the Cross stone sculpture that were rescued from the wreckage of the old St John’s hospital is displayed again in the new chapel, giving a sense of place and history to the new facility.
In 2015 the new Mercy Joplin hospital will have a facility focused on the patient experience, replacing the one lost in 2011. It will offer the community exemplary patient care in a building constructed with many new technologies, and thoughtful design features, some as a result of the difficult lessons learned from the May 2011 tornado.
Sisters of Mercy Health System
14528 South Outer Forty, Suite 100
Chesterfield, Missouri 63017
McCarthy Building Companies, Inc.
1341 North Rock Hill Road
St Louis, Missouri 63124
HKS Architects, P.C.
Dallas TX 75201
Planning and Design Consultant:
143 W. Clinton Place
St Louis Missouri 63122
Heideman Associates, Inc.
13545 Barrett Parkway Drive, Suite 200
St. Louis, Missouri 63021
138 West Clinton
St. Louis, Missouri 65804
1525 East Republic Road, Building B, Suite 100
St. Louis Missouri 65804
7722 Big Bend Blvd.
St. Louis, Missouri 63119