Project Spotlight: Mercy Health - St. Rita's Medical Center

In 2017, Mercy Health – St. Rita’s Medical Center (SRMC) in Lima, OH decided to move forward with a design and construction project to add an electrophysiology (EP) and cardiac catheterization lab (Cath Lab) suite and retained DC to provide architectural, engineering, and interior design services. The new EP/Cath Lab 4 suite is located on the second floor of the hospital adjacent to their existing suite of cath labs and the cardiology outpatient clinic. On the surface, this project may appear to be straight-forward in terms of space planning, infrastructure support, construction, and implementation. However, much like the human body, when you look inside it is highly complex and intricately assembled. And, from start to finish, this endeavor required input and expertise from a large team representing healthcare providers, management, technicians, facilities, information systems, life safety compliance, environmental services, infection control, architects, interior designers, engineers, contractors, and equipment manufacturers. As with any complex healthcare project, success is dependent on everyone involved coming together and working towards primary goals; providing an excellent environment of care for the patient, and providing an efficient and effective workflow for the caregivers. This project was no exception, and there are many things to celebrate about it!

WHAT HAPPENS IN THE EP/CATH LAB 4?
The primary use of the EP/Cath Lab 4 at SRMC is for conducting electrophysiology studies on patients who may have abnormal heart rhythms (arrhythmias). Abnormal heart rhythms can occur due to heart attacks, aging, and high blood pressure, which may cause scarring of the heart. If scarring does occur, this can change the electrical signals that travel through the heart, causing it to beat in irregular patterns. These studies allow specialized physicians to test the electrical activity of the heart to locate the source of the abnormal heart beat. The physician will insert about 3 to 5 specialized electrode catheters (tiny, flexible tubes) into blood vessels that lead to the heart. The electrode catheters will send electrical signals to the heart, which can then be recorded and analyzed. Certain interventions and treatments can be conducted during the EP study such as testing the effect of medicines, catheter ablations (destroying the small area of the heart with abnormal electrical signals), or determining if a pacemaker or implantable cardioverter defibrillator is needed.
The EP/Cath Lab 4 can also be used for cardiac catheterization which involves minimally invasive procedures to diagnose and treat cardiovascular disease. ”The procedures performed in a cardiac cath lab almost always involve tiny, flexible tubes, called catheters, which can be used instead of surgery, to access the heart and blood vessels. A cath lab has special imaging equipment used to see the arteries and check how well blood is flowing to and from the heart. This information helps the care team to diagnose and treat blockages and other problems in the arteries.”[1]
CHALLENGES = OPPORTUNITIES
Most renovations in any building type have their unique challenges and unforeseen conditions, and this project was no different. However, through a very collaborative process of clinical staff, facilities staff, designers, contractors, and stakeholder’s working together, the difficulties became opportunities for creative solutions. The location of this project within the hospital presented several challenges for all involved. Here are a few key challenges that impacted the design and construction of the project:
  • Occupancy Type Conversion
The area on the second floor of the hospital designated for the new EP/Cath Lab 4 suite was classified as a business occupancy. For the type of procedures being performed and to permit access for inpatients, the project area had to be converted to a healthcare occupancy. This was achieved by construction of two-hour fire rated walls around the perimeter of the suite. Some of the walls were existing non-fire rated walls which were upgraded to achieve the required fire rating. Modifications to the existing HVAC, electrical, and fire alarms systems were also necessary to support healthcare occupancy requirements.

  • Intersection at Multiple Building Additions
The project area was located where three different building additions to the hospital intersect. One of the key issues this condition presented was a difference of 12 inches in floor elevation from the new EP/Cath Lab 4 suite (Building K) and the adjacent Cath Lab suite to the south (Buildings A and E). The clinical staff needed to be able to move quickly between both areas. The solution was to construct a new landing and steps in the existing east-west corridor between the two areas which allows clinical staff direct access from adjacent control rooms.

  • Bare Minimum Ceiling Space (HVAC Gymnastics!)
To make things really interesting, the roof structure directly above the EP/Cath Lab room was only 10’-0” high above the floor. The EP/Cath Lab equipment manufacturer’s required minimum mounting height for their ceiling mounted lab equipment is 9’-6”. With less than 6 inches of clearance between the new ceiling and the bottom of the structural roof steel, routing HVAC ductwork to condition the room was a major challenge, especially directly above the patient table. DC engineers digitally modeled this area in great detail to verify that the new ductwork could be routed around and between the roof steel members as well as allowing space for the EP/Cath Lab equipment mounts and lighting.

MEDICAL EQUIPMENT & SPECIALTY SYSTEMS
The EP/Cath Lab 4 features some of the latest technology in interventional cardiac and vascular testing and treatment. The Philips Azurion 7 C12 image-guided therapy system was selected and installed which provides the specialized physicians and staff state-of-the-art technology for effective diagnosis and treatment of heart related health issues. DC architects and engineers worked closely with SRMC clinical and facilities teams as well as the Philips planning and installation team to plan and coordinate the structural and electrical infrastructure necessary for the system to function properly and effectively. As mentioned earlier, this coordination effort was especially complex given the limitations of the existing space and structure.

END RESULT
After approximately nine months of construction including three separate phases, the EP/Cath Lab 4 went live with the first patient at the end of January 2020. While the design and construction of this project had its challenges, the primary goal of providing an excellent and efficient environment for specialized cardiac patient care was achieved. This new suite and technology expands the capability of SRMC to provide innovative cardiac care to their community and throughout the region. The DC team is grateful for the opportunity to play a role in helping SRMC to continue to deliver on their mission of improving the health and well-being of their communities and at the same time continuing the DC mission of Improving People’s Worlds.
[1] http://www.secondscount.org/treatments/treatments-detail-2/what-is-cardiac-catheterization-lab#.Xk1CRChKiUl

Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP
Senior Associate, Director of Healthcare Design