By Jon Richey, Contributing Writer

What does it take to modernize a Level 1 trauma center? For Grady Memorial Hospital in Atlanta, the answer was design-build, a method that delivered a 52-bed intensive care unit (ICU) renovation completed in less than eight months. For its innovative design and impressive timeline, the effort received the Design-Build Institute of America's 2024 National Design-Build Project Award in the healthcare category.

The work reflected community needs. When the nearby Atlanta Medical Center closed, Grady became Atlanta's only Level 1 trauma center. To meet its new patient load, Grady undertook a rapid renovation to provide 200 ICU beds totaling $130 million. WSP’s scope included two 26-bed ICU expansions on separate floors.

The project is complex because of the ICU's location on the 10th floor of an active hospital, its complex overlapping systems and the building’s age as significant challenges. Success depended on speed, innovation and effective cash flow facilitated by the design-build method, which helped set a new benchmark for the delivery timeline of healthcare facilities.

Integrated team delivers speed? 

This project deployed design-build, a project delivery method in which one organization — the design-builder — is responsible for design and construction. This approach contrasts with the traditional design-bid-build method, where design and construction services are split between separate entities.

Design-build fosters a more collaborative and integrated experience, resulting in a shorter timeline and lower costs as a result of extensive collaboration among all subcontractors, thorough initial planning and close cooperation with the owner.

Forming teams in record time, initial feasibility and concept design was completed in two weeks. Meanwhile, the general, mechanical and electrical contractors began preparing cost estimates while the architects and engineers focused on their interview presentation. Design and interviews that typically take three months were accomplished in one.

Innovative design-build projects like Grady require high levels of collaboration among the owner and a variety of dedicated partners to understand goals and budget constraints. This collaboration ensures the final package is not merely a proposal but a well-developed design concept. Teams that invest time and do their homework in early stages establish a solid foundation for adding services in the future.?

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Once construction began, the team was able to maintain an expedited timeline by leveraging detailed designs, allowing it to circumvent many issues that can arise with less thorough planning.

Innovative solutions

Challenges always arise during construction, but the design-build approach also facilitated more rapid and innovative solutions. For example, the team discovered that the lower floor could not accommodate a traditional plumbing system due to its location above the neuro ICU, which serves highly sensitive patients.

The design-build team and the owner decided on a vacuum pump system, which allowed them to put the waste lines in the ceiling instead of the floor. The vacuum pump system prevents leaks and potential contamination of patient rooms on the lower, high-risk floors, minimizing maintenance challenges and reducing water waste.

To ensure the engineers, technicians and custodians working on the system could properly install and maintain it, they flew to California and learned from experts at the system manufacturer. 

Another major enhancement included the installation of exhaust fans in the infectious disease isolation rooms. The fans remove air from the rooms, minimizing the spread of airborne contaminants and venting air outside the hospital via the roof. But because of the helipad on the roof, careful coordination with the architects and the Federal Aviation Administration was necessary for the safety of patients and aircraft.

Minimizing disruption? 

The team completed the project in one-half the time that similar renovations have taken in the past while costing a comparable amount. Grady’s ICU was not closed for an extended period, minimizing disruption to patients as well as potential revenue loss. The design-build method’s shorter time frame allowed for minimal staff transitions and focused attention, further increasing efficiency. The compressed timeline and tight deadlines required this intense design and construction.

Design-build delivery is not standard in the healthcare industry. But Richey says that after Grady ICU’s success, from the innovation to the economic model and relatively few disruptions to patient care, he believes it will become more common in the healthcare industry.

Jon Richey is lead engineer and senior consultant at WSP, an engineering, environment and professional services firm.