Modular components, flexible space and broader use of advanced filtration are some of the major trends in health care facilitiesconstruction in New York City, where the COVID-19 emergency offered asignificant proof of concept.

That could mean a large volume of work aheadusing innovative practices.From 2020 through2023, total construction spending will increase by 38% over the prior 4-year period to $9.4 billion,according to aNew York Building Congress forecast in a July 20 report. The assessment, called NYC Checkup: An Examination of Healthcare & Life Sciences Construction, notes the rapid renovations of existing facilities in the first half of this year to handle an influx of infected patients. The authorsNew York Building Congress Healthcare and Life Sciences Committee, Nancy J Kelley & Associates, New York City Economic Development Corporation, Partnership Fund for New York City, Urbanomics andDodge Data & Analyticsanticipatespending will increase as hospitals and healthcare providers adapt to the next normal and prepare for a potential resurgence of COVID-19.

Two important parts of that readinessalong with readiness for other healthcare needsare upgrading air filtration systems and creating patient rooms that can be adjusted for pandemics, increased acute care needs and more.

Improved air supply

Paul Schwabacher, senior vice president of facilities management for NYU Langone, says one of the biggest trends will be"buildings that are adaptable and flexible. For example, he notes that at the $1.4 billion, 830,000-square-foot Helen L. and Martin S. Kimmel Pavilionrecipient of this years ENR Best Project award for health carepatient rooms had flexibility to operate at ICU level of care, so we could rapidly flex up, which is what we ended up doing for COVID-19. At peak, the hospital was at 105% capacity, Schwabacher says.

Every infection-isolation room at Kimmel has vestibules that protect hallways from contagious patients.E-glass turns opaque on demand for privacy, or can remain clear so that nurses and doctors can constantly view a patient without having to enter the room and expose themselves to contagion.

These kinds of rooms may become the norm, says Carlo Scissura, president and CEO of the Building Congress. Moving forward, the primary considerations for healthcare facilities will be resiliency, scalability and flexibility, he says. COVID-19 will likely lead to the construction of more [rooms] with ICU capabilities and flexible patient capacity, such as larger medical gas connections, additional power and emergency power.

The rooms at Kimmel are also equipped with negative-air-pressure controls to reroute infected air away from other patients and staff. Hospital-wide, HEPA systems filter air at the same high rate most hospitals only require for operating roomsup to 12 air changes per hour in patient care areas. Older buildings have much lower change rates of less than half, Schwabacher says, except in their critical care areas.

NYC Health + Hospitals, the municipal health care system with more than 70 facilities including 11 hospitals and five long-term care facilities, is planning to upgrade filtration and other sanitizing systems. The Building Congress report says the city allocated $931.6 million for NYC Health + Hospitals fiscal year 2021 capital budget. Over the next four years, the system has committed $3.2 billion in capital spending, with $1.1 billion expected in 2020.

As we look to the future, we need to enhance our air quality systems, Christine Flaherty, senior vice president in the office of facilities development, said in a July 7 online lecture for Columbia Universitys Center for Buildings, Infrastructure and Public Space. There is a definite need for long-term investment in increasing our air exchanges, further enhancing our systems with filtration, UV lighting, [and] having more controls on negative and positive air pressure capabilities in many of our areas.

All this, Flaherty said, represents approximately half a billion of dollars of need.

Upgrading air filtration systems in existing buildings costs much more than building top level systems into the structures from the start, Schwabacher explains. To retrofit would be incredibly expensive, he says, because HEPA systems require more space for components like bigger fan motors, and air handlers.

Building in such systems up front costs more, he concedes, but it is by no means 50% [higher]its much less than that. Thepricier systems and features are demonstrating their payoff. As the crisis in New York City has stabilized, healthcare institutions see the value in investing in preventative infrastructure, pandemic preparedness and new technologies, Scissura says.

Modular saves money, increases quality

Another trend in health care construction in the city will help teams lower costs. Modular construction is being used to shorten build time, reduce construction costs and minimize disruption to active hospital operations, according to the Building Congressreport.

While a projects superstructure is being erected, the mechanical space, building envelope and standardized elements, such as patient rooms, operating suites and bathrooms, can be simultaneously built offsite, Craig Miller, healthcare practice leader at Jacobs is quoted in the report. Significant cost saving advantages are realized due to the increased productivity, reduced material waste and lower safety risks.

Group PMX LLC successfully used modular construction on several projects, including a 2,800-gross-sq-ft trauma center and a 2,500 gross-sq-ft mechanical equipment room, the report said.

To be sure, the citys licensing and jurisdictional issues can limit modular construction methods. Multiple municipal agencies must approve the movement of prefabricated units on city streets, and construction sites must also have enough space to stage the modules before placing them on the superstructure.

But the benefits are clear when looking at the Kimmel Pavilions construction. Patient rooms bathroom pods with a toilet, sink, shower and bedpan washerso pans dont need be carried awaywere prefabricated in New Jersey and installed before the fit out. It was an economical option that also made it easier to go quickly, Schwabacher says. Also, the prefabbed loos provide better quality control and better consistency so for long term maintenance its easier because theyre all the same.

Flaherty said that during initial surge work in the midst of the pandemic, which ate up millions of trades-workers'hours, NYC Health + Hospitals didnt find as many opportunities as we wouldve liked for prefab because it was just sourcing [materials] in the moment. But she emphasized, its definitely an area we do want to look at as opportunities to be more innovative.

So, it seems, do all health facilities developers in the city. Scissura says, Future-focused healthcare facilities are being reimagined around patient experience, operational efficiency and seamless integration of technology.

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$9.4B For 'Innovative' Health Care Construction Forecast in New York City - Engineering News-Record