Off-Site Construction - Delivering Excellence In Emergency Care
The
new Acute Admissions Unit at Watford
General Hospital
is now one of the highest performing emergency care services in the country. Here, David Johnson, Director and General
Manager of off-site specialist, Yorkon, looks at its construction challenges.
Constructed as part of a £25m ProCure21
contract awarded to Medicinq Osborne, the new Acute Admissions Unit (AAU) for
West Hertfordshire Hospitals NHS Trust was built off site by Portakabin
subsidiary, Yorkon. It is now the UK's largest
acute admissions unit and has one of the lowest re-admission rates in the
country.
The facility is being used to pioneer a new
model of care for emergency cases with rapid assessment and consultant-led
diagnosis. This approach dramatically reduces the long-term effects of serious
conditions such as strokes and heart attacks.
Designed by Murphy Philipps Architects, the
AAU provides 120 beds for emergency admissions, two cardiac catheterisation
laboratories, diagnostics including x-ray, ultrasound and CT scanning, and a
new hospital pharmacy with robotic dispensing.
A
New Generation of Acute Admissions Units
According to Graham Ramsay, Medical
Director at the Trust, "This is the largest of a new generation of acute
admissions units and forms part of the Department of Health's new ‘Model of
Care' initiative. Early indications are
showing that the service provided in the new AAU at Watford
is having a very positive impact and patients have been really enthusiastic
about the environment and the service they are receiving."
The building comprises 142 steel-framed modules, which were manufactured and
substantially fitted out off site, reducing the programme time by around six
months and minimising disruption on this very busy hospital site. It was craned into position at the rate of
ten 14m-long modules per day in less than four weeks, for the final stages of
fitting out.
Programme
- The Key Driver for Off-site Construction
The key driver for the Trust for this
project was time. The programme from
date of order to Medicinq Osborne to handover was just 47 weeks, meeting the
Trust's requirements for commissioning, relocation and staff training. It also generated significant savings on
construction preliminary costs.
The off-site approach enabled manufacturing
and fitting out the new AAU to begin before demolition works had been carried
out on site. This parallel working
reduced the programme by around 50 per cent and allowed the existing building
on the site, a postgraduate teaching facility, to remain in use for much
longer.
The modular building design was developed
to accommodate specialist equipment required for CT scanning and cardiac catheterisation. Innovative solutions were provided to deliver
a reverberation factor of 1 for these departments, and for the M&E
installations to meet the requirements of the new model of care.
The
Construction Challenges
It was essential to minimise disruption
both to patient care during the build programme and to the surrounding
neighbourhood, despite the site being located adjacent to a fully operational
A&E department, in a busy residential area, and in close proximity to the football
ground.
A blue-light ambulance zone adjacent to the
site had to be maintained at all times, a traffic management scheme was
implemented and the hospital car park had to be reconfigured to accommodate
work on site.
Careful planning and close co-operation
between the Trust, Medicinq Osborne, Yorkon and the local highways department
ensured the smooth, phased delivery of the modules.
In order to minimise disruption locally,
three modules per day were delivered to site before 7am, avoiding the rush hour
and accommodating transport restrictions in place within the M25 before
10am. The remaining modules then arrived
on site at hourly intervals.
Detailed
Logistics Planning
Key to the successful installation of the
building was a detailed logistics survey which was carried out at an early
stage. A plan was then agreed and
maintained with constant communication so the Trust could be advised of
impending activities.
The success of the logistics programme can
be measured by the lack of complaints from local residents, including those
immediately adjacent to the hospital, during the module delivery period.
An
Exemplar Project for Fast Track Solutions
This was a large, highly complex building
required to accommodate specialist medical equipment, and linked to the
existing traditionally-built hospital at two levels.
It was handed over on time and on budget,
and since its completion, it has further improved the image of modular
buildings in the healthcare sector and is being shown within the NHS as an
exemplar project for fast track solutions.
Feedback and evaluation from the Trust following
its 100-day review indicated that the building has provided significant
benefits in the quality of care and the working environment for staff,
demonst
rating that:
- Lengths of stay reduced from 7.3 to 5.4 days (average)
- Reduced readmission rates are now 4.2% (peer group 6.5%)
- Key performance measures were maintained and in some cases improved
- Staff turnover reduced from 16.3% to 12.8%
- Complaint numbers reduced
- Emergency admissions increased by 10%
- Emergency attendances reduced by 4%.
According to Sarah Wiles, Director of
Strategy and Planning at the Trust, "We have achieved a fantastic building
which it was said would not be possible in the timescale."
Lesley Harrison, Senior Sister in the AAU,
concludes, "Patients and staff are very pleased with the new building. The unit
is light and airy - a pleasant environment that is much easier to keep
clean. There is lots of space around
patient beds which is hugely beneficial when clinical staff are carrying out
interventions. Patients love the bright
colours and have even compared it to a hotel!"
