A NEW HOSPITAL TENDS TO THE HEALTH OF ITS PATIENTS and THE ENVIRONMENT “The feedback we have received regarding the new campus from our community, employees and medical staff has been extremely positive...responses we received were not only extraordinary but also touching and heartfelt.” — Mike Karuschak ARMC Chief Executive Officer quoted from ARMC’s Health Happenings
24200.00 amery regional medical center Amery, Wisconsin Architecture, Interior Design, Engineering Sustainable Practice
Nestled on the Apple River is the small town of Amery, Wisconsin. Its hospital, a 25-bed critical access facility, was built in the late 1950s and was no longer able to adequately serve the growing community. When the hospital administration decided to build a new facility, they set out to achieve three goals—be as environmentally responsible as possible, provide an exceptionally high level of care and foster an environment of both emotional and physical healing.
As a leader in the local community, Amery Medical Center wanted to set a strong example of being environmentally responsible. With the guidance of the GS&P design team, the project became a Green Guide for Health Care* pilot project. The Green Guide for Health Care represents a growing movement in support of sustainable design that acknowledges the challenges hospitals face when trying to balance environmentalism with the unique demands of a healthcare facility. The program provided guidance and tools for design and construction and, in the case of Amery, also provided a vehicle for GS&P’s unique multidisciplinary approach to project design. Maintaining a connection between the facility and the natural surroundings was one of the first concepts developed by the design team. In order to incorporate this idea into the building design, a regional stone was used to construct low planting walls as well as a large two-story fireplace in the central lobby. To Jane Skelton, CSI, CDT, LEED AP, IIDA, Associate ASLA, interior designer on the project, the hearth is representative of the spiritual center for family and community and is an unmistakable symbol of the hospital’s relationship to the town. Being a visual reminder of Amery’s unique sense of place, the hearth creates a central point for the physical environment as well as a spiritual pivot point for the community *The Green Guide for Health Care™ is the healthcare sector’s first quantifiable, sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities. For more information, visit www.gghc.org.
Low IMpact development
Above An example of one of the types of bio-rentention used on the site to help storm water filter safely into the soil. Low Impact Development (LID) techniques were used to create elongated bio-retention areas that allow storm water to enter the ground in a natural way, nurturing the soil for native plantings and rain gardens. Top Right The new facility’s adjacency to the Apple River provides visual, health and recreational benefits, but also meant measures had to be taken to ensure storm water containment. Middle Right A walking trail integrated into the public river walk system encircles the perimeter of the site and allows users a connection with the nearby river. Bottom Right The central lobby boasts a two-story Kasota Stone fireplace that serves as a destination point or a quiet introspective area.
of patients, visitors and staff within the building. The firstfloor hearth area serves as a welcoming aspect for larger groups of people, while the second-floor hearth provides a more intimate setting for smaller groups. Smaller seating areas are also provided at the ends of the patient corridors that are suitable for groups of one or two people. In addition to using natural materials to stimulate patients, the layout of the hospital and use of standardized patient rooms aim to eliminate confusion in wayfinding, increase staff efficiency and reduce the possibility for medical error. To get people outside enjoying nature, pathways were designed to intersect existing walking trails along the river, and an osprey nest was built on the river bank in hopes of re-establishing the osprey population in the area. Native grasses were also introduced in the open areas surrounding the facility.
It is this close connection to the natural environment and surroundings that drove the team to incorporate many of the sustainable initiatives in the design process. The new facilityâ€™s adjacency to the Apple River, in spite of providing visual and recreational benefits, mandated measures to ensure storm water containment. Low Impact Development (LID) techniques were used to create elongated bio-retention areas that allow storm water to enter the ground in a natural way, nurturing the soil for native plantings and rain gardens. Green design and sustainability initiatives also went into the heating and cooling aspects of the facility. A team of GS&P mechanical engineers designed a heat recovery system that used tested technology in an innovative way. In the most basic terms, air conditioning works by taking heat out of a building so that the only air being circulated is cold. Ameryâ€™s system captures some of the heat before it leaves
Conventional A hospital has independent heating and cooling systems that operate simultaneously. The temperature inside of the hospital is maintained to satisfy the needs of the occupants and to maintain a safe, reliable environment for healthcare delivery. Heating All of the heating demands for space temperature control, including reheat, are met by fuel-fired hot water boilers. Cooling All of the heat generated inside the hospital by the lighting, equipment and people, along with the energy used to cool the outdoor air for ventilation, is transferred outside through a refrigerant-based cooling system.
HEAT RECOVERY System The heat recovery system links the conventional heating and cooling systems together to capture waste heat and redirect it to heat the hospital. Heating The hot water storage tank acts as the first source for heat to meet the buildingâ€™s needs. The building automation system and boiler control work together to use the recovered heat first, before resorting to burning fuel in the boilers. In the winter, when the cooling system is not operating, the building automation system and boiler control adjust and provide all required heating, assuring comfort and clinical conditions are met. Cooling Heat recovery condensers take advantage of the refrigeration cycle to draw highgrade heat (120 degrees or higher) off the cooling system and store it in a hot water storage tank.
Left Nurse stations incorporate recycled materials such as agrifiber substrates and recycled rubber flooring. Right Standardized patient rooms provide repetitive device locations in order to reduce medical error. Over 50,000 square feet of green roof was installed on the first-floor roof to mitigate storm water runoff and improve patient views.
the building and stores it in a heat-reclaiming dispenser until it is needed. “If you think of a cooling system as catching buckets of heat and throwing them out,” said project engineer David McMullin, P.E., LEED AP, “we’re saving some of those buckets to use when we need them.” The alternative to this heating system is to turn on a boiler, fire it up with fossil fuels and reheat the air by pumping it through a water coil in the air duct. “All the heat we save in the new system is an in-kind reduction in the amount of fossil fuel that we don’t have to burn,” said McMullin. Because it was designed into the building’s control structures, all other mechanical coordination can take advantage of this heat recovery system. In partnership with this innovative technology, a roof garden on the first floor also increases energy efficiency by allowing the temperature in patient rooms to be controlled within 1.5 degrees Fahrenheit with even less environmental impact. It also enhances patient views and reduces storm water runoff.
Every aspect of the planning, architectural and interior design programs reinforces the hospital’s determination to be both good stewards of the environment and diligent, effective caregivers. GS&P planning experts worked with hospital staff members to achieve ideal patient, material and process flow. Modern technologies as well as progressive strategies for patient and staff safety were also infused throughout the design. Interior and exterior finishes include sustainable recycled content as well as regional materials. Door and casework substrates are made of agrifiber, an easily replenished material with low levels of formaldehyde, and floors throughout the outpatient clinic are rubber, increasing longevity and reducing staff fatigue. Amery Regional Medical Center’s CEO, Mike Karuschak, praised GS&P’s client-centered processes, “GS&P’s unique design approach and ability to understand our objectives helped shape a facility that exceeded the expectations of our community, patients and staff.” ■
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Published on Sep 26, 2013