Carteret Health Care

CARTERET HEALTH CARE MOREHEAD CITY, NC

ENTRANCE PHOTOGRAPHER Jim Roof @ Jim Roof Creative COVER PHOTOGRAPHER Dale Ferrell @ Ferrell Photographics

CARTERET HEALTH CARE

OWNER: Carteret Health Care LOCATION: Morehead City, NC DATE COMPLETE: July 2017

SIZE SQUARE FEET: 122,000 SF Expansion BEDS: 73 private acuity-adaptable patient rooms

A NEW VISION: FROM CARTERET GENERAL HOSPITAL TO CARTERET HEALTH CARE Welcome to Carteret Health Care’s newest expansion, a Specialty Pavilion delivering a range of extended services including a cancer center, a patient tower, an expanded surgical center, a renovated emergency department and behavioral unit, and a new central energy plant. Nestled in the seaside community of Morehead City, NC the expansion provides access to exceptional care while highlighting the breathtaking views overlooking the Crystal Coast, considered “North Carolina’s Gem.” Founded in 1967, Carteret Health Care has served as a civic pillar of healthcare for the Carteret County citizens. With the system’s long-standing history, the new facility has provided the anticipated platform for the system to not only continue to grow, but thrive, including a refreshed brand and image propelling them into the sustaining success story they are today.

ARCHITECT Earl Architects LLC PROJECT TEAM

CONSULTANTS

PARTNER-IN-CHARGE Rick Earl, AIA

INTERIOR DESIGNERS Maregatti Interiors

PROJECT ARCHITECT Scott Meade, AIA

STRUCTURAL ENGINEER Professional Engineering Associates

SENIOR ARCHITECT Dan Roberts, AIA LEED AP BD+C

ELECTRICAL ENGINEER K.M. Armstrong Associates, Inc.

DESIGNER Hillary Earl Crosby, Assoc. AIA

MECHANICAL ENGINEER Shultz Engineering Group CIVIL ENGINEER Stroud Engineering, P.A.

CONTRACTORS Rodgers Builders

T.A. Loving Company

INTRODUCTION

WHERE THEY ARE TODAY

HOW THEY GOT THERE

Carteret Health Care is a not-for-profit 135-bed community

After years of incremental growth, Carteret General Hospital

hospital, “designed to embrace the future of health care,

was confronted with inefficiencies and patient care challenges.

wrapped in the spirit of the people of Carteret County.” Their

Earl Architects was initially engaged to develop a Facility Master

core mission is “to provide top-quality care to the community

Plan (FMP) to provide various solutions, through stake-holder

we serve,” through offering acute care, diagnostic, and

input and consensus, with the intent upon improving efficiency,

outpatient services.

cost-effectiveness, and the patient experience.

Their list of achievements contains various awards and

Ever sensitive to the current economic climate, the Master

accolades including:

Facilities Plan focused on efficiency and flexibility by suggesting the reutilization of existing space and/or the promotion of

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• •

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Receiving Healthgrades “Outstanding Patient Experience

smart growth. Using industry bench marks and best practice

Award,” and ranking in the top 5% in the Nation for Patient

strategies, emphasis was placed on providing safe and

Experience

inviting environments that gave the potential to exceed the

Recognized as one of the Best Hospitals by Business North

expectations of the patients, visitors, staff and the community

Carolina

at large.

Truven Health Analytics, a healthcare analytics company that publishes the 100 Top Hospitals Report, named the

The purpose of the Facilities Master Plan was to assist the

system as having more rapid improvement than 80% of

Hospital in making strategic capital improvement decisions,

hospitals nationwide.

prioritizing not only the immediate but long-term needs.

They were the only North Carolina Hospital recognized as a

Several options were presented that suggested varying degrees

Top 100 Rural & Community Hospital in the US by iVantage

of reutilization of existing space, expansion and/or renovation

Health Analytics.

to emphasize the importance of aligning services, minimizing

Multi-recipient of “A” Hospital Safety Score by The Leapfrog

the magnitude of change while maximizing the value of the

Group

dollars spent.

MAKING THE CONNECTION IDENTIFYING THE NEEDS The methodology for conducting the FMP study included meeting with the Executive Committee that consists of the senior management team for the Hospital, review of past, present, and projected workload statistics, site visits to the facility and comparison of the facility with codes, standards and “best practice” initiatives of comparable medical facilities.

Floor plans of the existing facility which displayed departmental boundaries and internal circulation were collected and analyzed. A conceptual space program was developed for key departments that indicated significant needs for improvement.

These space programs and other industry standard benchmarks were the basis for planning studies that suggested reutilization, expansion, or renovation.

PROBLEM-SOLVING THROUGH ARCHITECTURE From the space programs and multiple onsite and offsite expansion studies, the East side expansion option adjoining the current facility proved to be the preferred choice as it established: •

Good patient access and visibility from the frontage roads creating a New Public Entrance

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Allowed for direct expansion potential

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Provided the best connectivity to existing patient care areas, eliminating duplication of services and staff

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Maximized existing space, expansion potential and underutilized space

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Minimized impact on daily operations not only during construction, but once completed, bridging needed service and staff connections

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Growth can occur incrementally

HISTORY AND DESIGN NARRATIVE Carteret county was founded in 1722 by settlers migrating

the new entrance for the hospital, and serves as a navigational

from the Northern American colonies to the North Carolina

aid and welcoming signal to the community. Much like a

coastline. These settlers established Carteret County’s economic

lighthouse, we felt the Rotunda should serve as a beacon

foundation as a port and fishing community, both of which still

of strength and metaphorically light the way forward into

play active roles in its commerce today.

navigating the future of healthcare. The sweeping tiered waves

In addition to attracting global trade, the infamous pirate Blackbeard was known to frequent its shoreline. His ship, named Queen Ann’s Revenge, sank along Beaufort Inlet while attempting to harbor after terrorizing Charleston, SC. The shipwreck ultimately lead to his short-lived surrender and accepting a royal pardon. The county also served an active role

embracing the Rotunda represent the rise and fall of the tides and are a nod to the passage of time and the community’s rich history. Serene views of masts, sails, and rigs of sailboats and fishing boats harbored along the Crystal Coast inspired the structure and materiality of the canopy shown along the rotunda’s entrance.

in both the Revolutionary and Civil War, with various battles and naval skirmishes occurring within the county limits. In its more

The exterior skin enveloping the design are cues borrowed

recent history, the area is recognized as a tourist destination for

from the familiar local vernacular. The glass in the glazing

not only its historical value, but its beautiful beaches and clear

system is inspired by the clear blue water of the Crystal Coast.

waters, rightfully earning its name as the “Crystal Coast.”

The exterior tile wrapping the rotunda columns resemble driftwood. The architectural block used closely favors a

When designing the new Specialty Pavilion Expansion, our

historical building material called tabby concrete. Consisting of

team drew inspiration from the surrounding coastal landscape,

lime, water, sand, oyster shells, and ash, tabby was commonly

unique maritime culture, and captivating history. The main

used in colonies settled along the Southeast coastline.

architectural geometries include the Rotunda, tiered curvilinear waves, and specialized canopy design. The rotunda signifies

PHOTOGRAPHER ABOVE: Brad Styron @ Styron Photo/Video

1 Lobby 2 Cancer Center Emergency Department Healing Garden Courtyard Chapel & Gift Shop Area

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Med/Surg Bed Unit Post Partum Bed Unit Outpatient Surgery

9 Progessive Care Unit 10 Critical Care Unit

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LEVEL 3: 0

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7 DN

3 4 5 6 7 8

LEVEL 2:

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5 3 4

LEVEL 1:

TEAM COORDINATION & CONSTRUCTION ALL HANDS ON DECK Transitioning from the FMP to design and construction services, Earl Architects assisted in guiding the Owner towards finding a project delivery method that best suited their needs, along with serving as support through the construction management team selection process. Using a Construction Manager at Risk (CMAR) project delivery method, Earl Architects established a Guaranteed Maximum Price (GMP) which was maintained from the initial budget shared with the Facilities Master Planning through Construction. This budget was roughly half the cost of what previous architectural firms had quoted for a proposed expansion project.

Before construction even began, the design team and general contractor used Building Information Technology (BIM) services to create a to-scale 3D replication of the facility.

Through virtually combining this information, conflictions

were identified and solved early in the design process, aiding

between all teams through real-time updates occurring in the

to less change orders in the field, preserving the construction

field via handheld smart tablets. Weekly coordination meetings

schedule, and considerable cost-savings for the Owner.

were held to assess progress and address time-sensitive issues.

Upon the pavilion’s completion, the project was finished ahead

Through the 18-month construction duration, various efforts

of schedule and delivered under budget.

were made in managing the schedule and accessibility to the site. Strategic phasing was implemented to minimize

The project was awarded the ABC National, Excellence in

disruption of services to the existing facility while also

Construction, Pyramid Award and the ABC of the Carolinas

maintaining needed access to the main entrance and

Excellence in Construction Eagle Award.

emergency department. BIM technology also continued to aid in the collaboration, coordination, and quality control efforts

PHOTOGRAPHER ALL: Muriel Collins with Rodgers Builders

LEVEL 1 ROTUNDA LOBBY ENTRANCE The Lobby, located in the first floor of the three-story Rotunda,

The soothing palate of blues and yellows coupled with familiar

is the architectural flagship representing the rebranding of

textures of driftwood planking, sparkling glass tile reminiscent

Carteret Health Care. Serving as the new entrance and main

of seashells, and sandy textures are found integrated

connection for the campus, the interior composition invites

throughout the facility. The custom light sculpture suspending

feelings of hope and well-being through a design vocabulary

from the intersecting propeller-like structure of the rotunda

catered to the Carteret community.

serves as a positive distraction for the waiting areas. The nostalgia of glass fishing floats inspired the glass sculpture, as

Upon entering the facility, patients and visitors are greeted by

they were originally used to keep fisherman’s nets afloat. In the

a circular reception desk centered within the clerestory space.

evenings, the light sculpture glass orbs can be seen from the

Public elevators linked to the Rotunda establish way-finding

exterior, appearing as if they are floating within the space.

as guests travel from floor to floor, through using views of the Crystal Coast horizon as orientation.

PHOTOGRAPHER LEFT: Jim Roof @ Jim Roof Creative

ABO VE: Dale Ferrell @ Ferrell Photographics

REGISTRATION & BISTRO Moving from the Rotunda into the first “wave,� visitors following along the curve will find a direct connection to a new Registration location, Gift Shop, and Bistro. These services support the feeling of a new entrance, while centralizing services important to newcomers.

The Registration bays feature glass sliding doors to allow for visual and audial privacy. The Starbucks Bistro compliments the food services offered in the original facility, creating a touch down ancillary location offering light food and beverages with access to indoor seating and outdoor patio seating.

A panoramic view of Cape Lookout Lighthouse, a popular destination located in the southern portion of the Outer Banks, is featured along the curved wall serving as a positive distraction and wayfinding leading to the Bistro.

PHOTOGRAPHER RIGHT/ABOVE: Dale Ferrell @ Ferrell Photographics

CANCER CENTER Displayed above the fireplace as patients enter the nationally

the planning stage for the new center, thanks to the KWLA and

recognized Cancer Center, the generously donated original

Mr. Saylor, we now have an inspiration for the colors and décor

painting ‘Along the Shore of the Cape’ by artist Jack Saylor not

that will be used. This new space will be soothing and tranquil

only serves as a peaceful centerpiece, but also inspired the design and create a more positive healing environment for oncology of the Oncology Department. CEO and President, Dick Brvenik,

patients and their families.”

upon receiving the donation from the Big Rock Keli Wagner Lady Angler Tournament said, “The key, signature element included as part of our expansion is the Cancer Center. While we are still in

PHOTOGRAPHER ABOVE: Dale Ferrell @ Ferrell Photographics

CANCER CENTER The multi-disciplinary Cancer Center offers both infusion and

Design elements throughout the center encourage places for

radiology treatment, imaging services, along with clinical trials

reflection and integrates principles of biophilia, defined as the and access to telehealth for additional patient care planning. The inherent human inclination to affiliate with nature. A healing center is a partner with both UNC Lineberger Comprehensive meditation garden is centrally located between infusion and Cancer Care and UNC Cancer Care and has recently received

national accreditation from the Commission on Cancer (CoC) through a review of quality care standards.

The Center includes sixteen infusion areas, three private

radiation services, offering a place of solace through views to nature and the soothing sounds of the water feature. Infusion areas have access to natural daylight, as well as views to an additional linear meditation garden. The linear accelerator

infusion rooms, a dedicated infusion pharmacy, and one

ceiling provides a positive distraction through an interactive

linear accelerator with expansion capability for a future vault.

lighting system resembling the night sky and stars.

PHOTOGRAPHER LEFT/ABOVE: Dale Ferrell @ Ferrell Photographics

THE CHAPEL The chapel is located along the west end of the first “wave,� providing a private place for serenity and reflection. The floor to ceiling glazing system welcomes filtered natural light to enter into the space. Spiritually inspired artwork centered within a laminate wood planking serves as the feature wall for the visitors.

PHOTOGRAPHER RIGHT: Dale Ferrell @ Ferrell Photographics

CONFERENCE CENTER Located along the first floor wave of the Specialty Pavilion, the Conference Center encompasses an administration board room, and two large classrooms. The classrooms are separated with a moveable wall partition for flexibility to create one large conference area when needed. Providing a conference center benefits not only the staff and administration for hosting internal meetings and continuing education courses, but also provides an assembly space available to the community.

PHOTOGRAPHER LEFT/ABOVE: Dale Ferrell @ Ferrell Photographics

LEVEL 2 ROTUNDA OVERLOOK & BALCONY Moving to the second floor of the Rotunda, a Mezzanine overlooks the voluminous space and features impressive views of the coast. Waiting space for the patient tower and surgical services occurs along the balcony and promotes organic wayfinding.

Filtered natural light enters the space throughout the day. A

In addition, daylight harvesting sensors gauge the quality

virtual day lighting study performed during the design phase

of light entering the space and activate additional lights

simulated the sun’s path throughout the year via building

when needed. Significantly lowered energy use and costs for

information modeling (BIM) software. Through this study, the

heating, cooling, and lighting the space are direct benefits from

precise placement and tailored design of a louvered system for

implementing these sustainable design features.

the exterior skin was finalized to assist in deflecting glare, as well as regulating solar heat gain within the Rotunda.

PHOTOGRAPHER ABOVE: Brad Styron @ Styron Photo/Video

INPATIENT CARE The new Patient Tower includes a 16 private patient room Med/Surg Unit, a 30 private patient room Progressive Care Unit, and a 14 private patient room Intensive Care Unit. The Intensive Care Unit is located above the new Surgery expansion, and directly adjacent to the Progressive Care Unit to provide enhanced connectivity to all related services while reducing the steps of staff. Joint and Spine Therapy and Inpatient Beds are also centrally located to the ICU unit for improved delivery of patient care and recovery needs. Strategically located neighboring the ICU, the Progressive Care Unit can ebb and flow as the need arises, reducing redundancy of services within the Unit and floor. The Med/Surg Unit occurs along the second floor of the Patient Tower, alongside the Surgery Department and Women’s Services.

All Units include ADA Accessible and Isolation rooms. All patient rooms allow for adaptable acuity levels through implementing an evidencebased supported universal patient room design, including decentralized nurse observation areas adjoining each room. The patient rooms are “right-sized,” optimizing designated areas for patient, staff, and family zones for elevated patient and family experience and reducing staff stress through ease of orientation from room to room.

To further compliment the connection to nature as well as distance the patient from the stress associated with the traditional clinical environment, large windows provide access to natural daylight and views to nature. Rooms located along the curve feature views to the Crystal Bay. The interior finishes of the headwall and footwall incorporate warm wood tones and integrate needed medical equipment in addition to patient wardrobe and display functions into a clean modern design.

PHOTOGRAPHER LEFT/ABOVE: Dale Ferrell @ Ferrell Photographics

WOMEN’S SERVICES Located on the second floor of the patient tower, the Women’s Services improves the connection from the existing Women’s Department to the new Surgery expansion and includes ten new Postpartum patient rooms and two Labor and Delivery patient rooms to their existing four LDRs. A back-of-house connection is made directly from the new Women’s Services patient tower into the Surgery Expansion, which includes a designated C-Section room, and in turn, significantly reduces steps and time when transporting patients. Also included in the new program, a consultation room is provided for educational services and a dedicated private waiting area is located at the new department entrance.

Centralized and decentralized nurse stations are strategically positioned throughout the unit to accommodate needed clinical observation, while minimizing disruption to the patients and family. The Postpartum patient rooms are also designed using the Universal Patient Room design concept, including a family zone with a recliner and a sleeper sofa for the comfort of overnight guests and/or new parents.

PHOTOGRAPHER RIGHT/ABOVE: Dale Ferrell @ Ferrell Photographics

SURGERY CENTER The new Surgery Center expansion occurs over the existing

additional privacy and positive distractions throughout the

Emergency Department, joining the Specialty Pavilion to

department, while also expanding needed specialty services

the existing surgery tower, and serves as the new entrance

within the community.

for outpatient surgical services. The expansion includes two Consultation rooms, ten private Prep and Recovery rooms, two Procedure rooms, an Endoscopy suite including two

Connecting to the existing Surgery Tower, the expansion

Endoscopy Procedure rooms plus a future location, and a

equips staff with the necessary access and efficient

dedicated C-section room and future C-section room.

circulation from the Central Sterile Supply, to the Operation Rooms, to the PACU and Prep & Recovery rooms to

Surgical Services offered include general surgery,

encourage Lean work-flow principles. In addition, the

orthopedic, thoracic, vascular, ENT, ophthalmologic,

neighboring Intensive Care Unit and Progressive Care Unit

urologic, dental, OB/GYN, podiatric procedures, and plastic

support the adjacent network of services.

surgery. The new programmatic functions and design allow for an enhanced patient experience through providing

PHOTOGRAPHER LEFT/ABOVE: Dale Ferrell @ Ferrell Photographics

GRAND OPENING The Grand Opening of the Specialty Pavilion Expansion hosted the community, staff, doctors, and patients for the ceremonial ribbon cutting, taking place on the second floor of the rotunda balcony. The event also provided an opportunity for the community to tour through the facility, as well as learn about the expanding services the Specialty Pavilion will help deliver.

“The exceptional work, detailed planning, and high level of expertise exhibited by Mr. Earl and his colleagues in effectively working with our Board of Directors, Administrative Team, and departmental leadership has resulted in the development of a long range Master Facilities Plan addressing many areas of need for Carteret General Hospital. It is without reservation that I wholeheartedly recommend Earl Architects for any project which you may be considering.�

Richard A. Brevnik FACHE/ President Carteret Health Care

ENTRANCE PHOTOGRAPHER Jim Roof @ Jim Roof Creative

Earl Architects 301 N Main St. 17th Floor Greenville, SC 29601 www.earlarchitects.com