On Second Thought, a LEED-certified Hospital

by Tracy Ostroff
Contributing Editor

How do you . . . pursue LEED certification in the design development phase and still stay within the original project budget?

Summary: Schmidt Associates was in the design development phase when their client, Community Hospital South, started asking what it would take to achieve formal LEED® certification for the Indianapolis health-care facility. The firm, well into the $9 million addition and expansion to the existing emergency department, looked at how to honor the institution’s request. Turns out, it wasn’t such a daunting request for Managing Principal Ron Fisher, AIA, LEED-AP, and his team because of what the firm terms the “Schmidt 30”: 30 LEED points they work to incorporate into every project, whether they are specifically asked to pursue the certification process.

The project is now on track to become the first LEED-certified health-care project in Indianapolis (“high Silver or Gold, Fisher reports”), and completion of the project sets the stage for the potential pursuit of LEED for Existing Buildings (EB) certification for the existing hospital facility, the architects note.

“It’s already what we do,” Fisher says of his firm, which has placed an emphasis on educating firm principals and project managers—who have the most interface with decision-making owners and clients—on sustainability. Nineteen of about 100 staff members across all disciplines are LEED accredited. He says the design team had already programmed many of the points because of their material selections and requirements for indoor air quality and ventilation, lighting, as well as other life-cycle investments. Some of the specific LEED points include:

• Underground storm water retention
• Low-flow water closets and automatic water faucets throughout the project
• White TPO roof membrane
• Enthalpy wheel recapturing energy from exhausted air to precondition the ventilation air
• Ventilation air monitoring to assure proper ventilation at all times
• Daylighting supplemented with dimmable fluorescent light fixtures
• Variable frequency drives on all supply and return fans as well as on the supply pumps for hot water heating.

“We were already at the point where we could begin to incorporate or capture practices that happen during the construction management phase. The firm worked with the construction management company to get their input on how to capture LEED points on that side of the project,” Fisher says.

Building optimization
The firm’s clients include many institutions, including health-care facilities, colleges and universities, and K-12 environments, and Fisher says many ask themselves the same questions about the cost effectiveness of the time and money it takes to pay for the documentation it takes for LEED certification.

“In the Midwest, with the cost of energy a real economic concern, there is a social benefit and a benefit to the pocketbook” to employ sustainable practices, Fisher notes. “Our own institutional clients are starting to ask, and we are starting to see it even on RFP responses.”

The firm’s commitment to sustainability goes beyond design. They also work with clients after occupancy to optimize building use, make adjustments to building systems, and modify controls so they function to their best capacity.

Design details
The story of Community Hospital South is also in the details that speak to the owner’s desire to create efficiencies for staff and patients through the design. With a significant number of inpatient admissions entering through the emergency department, the architects added a new canopy in a bold and clean statement at the emergency entry drive that more clearly marks it as a front door to the facility. The addition expands the existing department from 10,000 square feet with 15 semi-private beds to 32,000 square feet and a total of 26 private beds.

Architecture graduate Brandon Fox notes that in the linear design, the main lobby leads back to a triage area where doctors treat patients more quickly in a "fast-track client service area.” Other treatment and surgical areas feed off the main lobby area. The architects say they took care to make the finishes similar in all the rooms and consistent with the lobby, so there is no drop off in the specialized treatment areas. Daylighting and clerestory windows help illuminate the areas, and several stages of waiting areas reduce visitor travel (and presumably anxiety) so they can be in closer proximity to treatment rooms. An aviary and fish tank soothe visitors and distract children.

The addition allows for the waiting and triage areas to be larger to accommodate the anticipated increase in patient populations—from 26,000 to 42,000—as well as a new bay for four ambulances. The centralized hub of nurses and physicians encourages increased communication and reduced travel for staff. Additional satellite nursing stations, centralized supply and storage rooms, administrative suites, and staff break and quiet rooms reduce the amount of travel and increase staff satisfaction. Same-handed universal rooms may help reduce errors, and computers on wheels and bedside charting cut down on wait times.

Construction began July 2006 with the addition constructed as Phase I and opened for patients in August 2007. The hospital renovation and new ambulance bay constituted the second project phase and opened in March.