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Chicago Hospital Raises the Bar
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Exterior rendering of the 10-story, 1.2 million sq ft Center for Care and Discovery in Chicago
The 10-story, 1.2 million sq ft Center for Care and Discovery in Chicago covers two full city blocks, each floor encompassing 100,000 sq ft. © Thomas Rossiter

The Center for Care and Discovery on the campus of the University of Chicago features a patient-centered design that lifts the equipment—and the lobby—off of the ground floor, challenging the engineers to control vibrations.

January 29, 2013—Gary Mundinger, the executive director for design and construction of the new Center for Care and Discovery in Chicago, recalls the hospital’s architect, Rafael Viñoly, FAIA, IntFRIBA, describing the building: “At one of his presentations, Rafael said, ‘If you can envision your medical facilities as a navy, then [this] is your aircraft carrier.’ And that’s exactly what it is. It’s the highest, most complex technology we have on the medical center campus.”

Indeed, the new academic hospital building, a 10-story, 1.2 million sq ft behemoth, towers over the historic Gothic quads on the University of Chicago’s campus. Spanning two city blocks, the $751-million building, which opens to patients at the end of February, is 570 ft long by 157 ft wide. From some angles it does resemble a massive vessel docking amidst much smaller ships.

The University of Chicago Medical Center first envisioned the complex more than 10 years ago with a plan meant to “radically change the physical plant and the facilities of the University of Chicago and the Biological Sciences Division—and the hospital,” says William Huffman, the vice president for design, construction, and operations for University of Chicago Medicine.

 Exterior of building featuring seventh-floor, glass-enclosed lobby

Variances in the building’s cladding break up the mass of the
enormous structure, as does the seventh-floor, glass-enclosed
lobby. ©
Thomas Rossiter

The new hospital joins an existing adult treatment hospital, a children’s hospital (built in 2005), and an ambulatory care center, and is near new science and research labs. Huffman says the concept for the hospital changed several times. Initially it was to be a surgical pavilion, then an expanded specialty care center. “That morphed,” he continues, “into a 240-bed facility with capability for 28 ORs.” 

Among the firms that competed for the contract, Viñoly’s plan was “the most visionary,” says Mundinger. Others were pitching a building half the size with a more vertical orientation. Viñoly convinced hospital leaders to push the building out horizontally, straddling Maryland Avenue, reminding them that they had one opportunity to prepare their medical campus for the next 50 years.

The long building—each floor about 100,000 sq ft—has enormous implications for everything from design to circulation of patients, physicians, and staff. Chanli Lin, AIA, LEED-AP, and a partner of Rafael Viñoly Architects, New York City, says Viñoly was inspired by Chicago’s Merchandise Mart, the enormous Art Deco edifice overlooking the Chicago River downtown—something “very blunt, very direct,” as Lin puts it. But the façade clearly articulates the interior program and helps break up the imposing mass.

Surgical and diagnostic procedures are handled on the fifth and sixth floors; floors three through six are clad in shiny metal panels to express the machinelike precision of the medical work inside. The top three floors are clad in textured precast concrete and serve as the “residential” portion of the hospital, with 80 private beds per floor. At the top of the building is a two-level “penthouse” clad with louvers that conceal the mechanical systems. 

Sandwiched in between the intervention suites and the patient beds is a recessed, transparent sky lobby, which will house patient intake, as well as waiting areas and dining areas, and features dramatic views of the campus, Lake Michigan, and downtown Chicago. The sky lobby was developed as a response to Maryland Avenue, which cuts through the first floor of the building with one lane in each direction. Rather than determining which side of the road on which to place the lobby, Viñoly Architects opted to allow patients to enter the hospital from either direction and then take elevators up to the seventh floor sky lobby.

Typically with hospitals, “you enter the ground floor and you’re in this maze,” Lin says. “You don’t have a sense of where you are with respect to where you came from. We tried to bring back some sense of orientation.” Coming up to the hospital’s sky lobby is meant to help patients orient themselves both within the city and within the building, and give them a clearer sense of where they are, reducing their anxiety.

Interior rendering of seventh-floor lobby

Visitors enter the hospital from either direction of a street that
bisects the structure and take an elevator to the seventh-floor
lobby, which offers views of the city and ease of navigation.
©
Thomas Rossiter

“When you talk about the patient experience … this is truly an amazing gift to Chicago,” Huffman says. “You’re seeing visions of Chicago that you’ve never seen before.”

The seventh floor also houses support and prep areas for physicians. Instead of dedicated offices, the hospital features dozens of “hoteling” offices, small work spaces that can be shared by physicians.

Flexibility is a key theme of the building. The modular spaces can easily be reconfigured. Additionally, two floors—the third and fourth—are currently just a shell; Huffman says planning is under way to determine how best to utilize the space, but it’s likely the floors will eventually include more beds.  

The center will open with 21 operating suites and has room to expand to 28. While typical surgical suites are no bigger than 400 sq ft, these will be between 600 and 900 sq ft to accommodate larger surgical teams working in concert, as well as such large equipment as magnetic resonance imaging (MRI) machines so patients don’t have to be sent somewhere else for radiology. “The quality of care and patient safety dictated that these rooms get larger,” Huffman says.

The suites must also accommodate educators leading charrettes or feeding videos of procedures to a production studio. “These rooms are more than operating theaters,” he adds. “In some cases they’re part of the teaching enterprise—the mission of UCM.”

Interior view for one of the hospital's operating rooms

The hospital’s operating rooms are far larger than the average,
affording room for larger surgical teams, in-person and video
education, and in-room radiology. ©
Thomas Rossiter

Just as much care has gone into the patient and visitor experience. Lin says the hospital’s deep floor plates allowed designers to separate patient and family traffic—situated on corridors at the perimeter of the building—from back-of-house functions, which are moved to a central corridor, to create a more serene, patient-friendly experience. The building also provides separate elevators for patients, physicians, and sterile materials.

Each room is equipped with patient lifts that can descend from the ceiling to help lift heavier patients onto wheelchairs or gurneys, providing a safer and more dignified experience for them. The rooms can also be negatively or positively pressured. For patients with suppressed immune systems, the room is positively pressured so nothing from outside the room can get in. For infectious patients, the room is negatively pressured, so nothing gets out.

Room pressurization is only one way the hospital has been aggressive about trying to fight infection. Every air-handling unit is equipped with high-efficiency particulate air (HEPA) filtration. The ductwork—much of which was fabricated off-site and then shrink-wrapped for delivery—was inspected during construction every day. “Anything wet or breached was taken down,” Huffman says. 

The center limited the use of products with volatile organic compounds in the building by stripping all the furniture out of its packing containers and airing it out before moving it into the building. The hospital established mold migration and mitigation controls, and conducted exhaustive air-quality tests. The building also uses water-resistant drywall (sometimes called greenboard due to the color of its water-resistant layer).

Huffman, a building engineer by training, is pleased with what he calls the building’s “inherent redundancy.”

“We fought for that,” he says. “We didn’t value-engineer that out.” All of the mechanical systems have plenty of spare capacity. All of the patient beds, which are electronically adjustable, have enough surge capacity to be utilized as more energy-draining intensive-care unit beds, if needed. The building also has two wireless networks: one for guests and one for private patient information. The hospital is even equipped with chillers that cool not only the hospital but two adjacent facilities as well.

Interior view of the hospital's patient care rooms, which is located along the perimeter of the building

Patient care rooms are located along the perimeter of the building
while operations remain in the center. Engineers devised ways to
limit vibrations from one section of the floor to the others without
using expansion joints. ©
Thomas Rossiter

Given the relentlessly rectangular grid, the engineering of the building would appear to be pretty easy. “That would be true if we didn’t have MRIs on the fifth floor, and we have a high-dose radiation room on the sixth floor,” says Mundinger. “There are some elements in the building that required some very heavy structure.”

Hospitals are just now beginning to put sensitive diagnostic equipment like MRIs and computed tomography (CT) machines above grade, where they are more susceptible to extremely subtle levels of vibration. On grade, vibrations are easily controlled, according to Carol Post, P.E., S.E., LEED-AP BD+C, a principal in the Chicago office of the engineering firm Thornton Tomasetti. “Vibrations amplify as you go up,” she explains.

Engineers at Thornton Tomasetti worked with Viñoly and other consultants to study vibration around the building and within the building to figure out how to mitigate it to the level that diagnostic machine manufacturers require.

Diagnostic suites were stiffened with thicker concrete and heavy plate girders to dampen vibrations, because, Post says, even from “someone walking in the hall, you don’t want that vibration sneaking in.” Further, columns supporting the entry plaza on the ground floor, where cars drop off patients, were separated from the main structure. “We didn’t want vibrations from car traffic to vibrate up through the rest of the building,” she explains. The layout is also a boon to patients, who don’t have to travel as far from the bed floors to the diagnostic floors.

Despite the building’s length, it was constructed with no expansion joints. Lin says expansion joints are structurally useful, especially in a city with huge temperature swings, but they can also be “your worst enemy” in a complex building, as they require pipes that cross the joints to be fitted with expansion loops, and patients and staff are constantly walking over those joints. “I know they can make them very smooth these days, but going across the expansion joints can be a potential hazard.”

While one or two joints are common for a building this size, the architects worked with Post and her engineers to calculate stresses in the frame and create a building with no structural separations. What they realized is that with a little structural reinforcement the hospital could work without expansion joints as long as its internal temperature remains consistent (around 72 degrees).

There was one added aesthetic benefit, as well: a more seamless design. “You don’t have a zipper on the face of your building,” Lin says.


 

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