Indiana Orthopaedic Hospital
Fast-Track Treatment Prescribed for Expansion

by Jeffrey Steele

At one stage in the building of the Indiana Orthopaedic Hospital in Indianapolis, the construction team faced a delicate issue.

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Building the facility to the south of an existing ambulatory surgery center, contractors' work took them to within a few inches of an operating room and magnetic resonance imaging facility in the existing building.

"There's a magnetic field that expands out of the MRI center," said Brian Chase, the former project manager at Indianapolis-based Pepper Construction Co. of Indiana, the construction manager on the project. "And if heavy metals such as structural steel enter that field, they can disrupt the image that's being created.

"That [work] involved close coordination with the MRI schedule, which resulted in night, weekend and Sunday work. It also affected us in terms of having the magnetic field barricaded at all hours to prevent steel from entering the field."

About 12,000 sq. ft. of the existing two-story, 50,000-sq.-ft. outpatient facility, called Northwest Surgery Center, is being converted into clinic space as part of the project, said Rob Schoeck, principal with Indianapolis-based BSA Life Structures, the architect.

The surgery center ties in with the new hospital, a 138,000-sq.-ft. facility built of structural steel with masonry, curtain wall and metal panel cladding. It features 10 operating rooms, 42 pre- and postoperating rooms, 16 recovery beds and 37 patient rooms.

OrthoIndy, a 42-year-old private orthopedic practice with 52 doctors, owns the buildings. Budgeted at $28 million, the project on the northwest side of Indianapolis was slated to be complete in February.

Improving Service

OrthoIndy is building the hospital to provide a wider array of orthopedic services to patients and more efficient health-care delivery.

"Orthopedic surgery consists of a variety of different problems, including knees, hips, arms, shoulders and also spinal problems," said Dr. John Dietz, chairman of the board of managers of Indiana Orthopaedic Hospital and secretary of the board for OrthoIndy.

"Of all those different problems, perhaps 75 percent of the surgeries we do for people can be done on a same-day basis. But for bigger surgeries, such as total knee replacement, total hip replacement and spine surgery, patients must stay in the hospital for three to five days. Our purpose in creating the hospital was to expand our ability to take care of people who need to stay in the hospital for several days.

"In the past, we've done these surgeries at local general hospitals."

A Fast Track Project

In 2002, when the board of OrthoIndy voted to convert its Northwest Surgery Center, OrthoIndy established another company, Indiana Orthopaedic Hospital, because the hospital had to be a legally separate entity for reasons of licensure and accreditation, Dietz said.

Because this is a revenue-generating facility, the project was fast tracked, with the timetable compressed from 24 months to 20 months.

"We were beginning sitework and foundation work even before the rest of the building was designed," Chase said. "The design was issued in a series of five bid packages. We were erecting steel before interior walls were even located."

Has 'Laminar Flow' Rooms

Another distinctive aspect of the structure is that four of its 10 operating rooms are "laminar flow" rooms.

In operating rooms, the air that emerges through the supply diffuser is 99 percent pure, Schoeck said. Typically, that pure air is distributed through the ceiling above the operating table, and is returned in the low corners of the room, to provide a kind of "draping" action over the patient.

In laminar flow rooms, air is distributed through the wall, blows across the entire room and provides for a higher level of sterility, Schoeck added.

But the direction of air movement is not the only quality that sets laminar flow rooms apart. Such rooms are characterized by a continual change of air, with more than 100 changes per hour, Dietz said. By contrast, many operating rooms have 22 air changes an hour, and the most modern conventional operating rooms have about 40 changes an hour.

"It's the volume of air changes that keep the airborne bacteria counts low," and bacteria is of particular concern in especially invasive procedures like spine surgeries and total hip replacements, Dietz added.

OrthoIndy chose to make four of 10 operating rooms laminar flow rooms because it felt invasive surgeries would represent about 40 percent of surgeries performed in the hospital.

Vertical Transportation

The design team faced a number of hurdles, and one was vertical transportation in the hospital.

After surgery, patients will go from the operating rooms to the Post Anesthetic Care Unit, where they will be stabilized. They then will be moved upstairs on elevators to patient rooms. That elevator system had to be separated from the vertical movement of staff, and both had to be kept apart from movement of food service and supplies.

"We tried to have that segregated so you didn't have a crisscross of people and things you didn't want commingled," Schoeck said. "We spent a lot of time on that."

The design team also needed to situate the building addition and the associated parking on a tight site. In addition to the new structure itself, architects had to accommodate physician, patient and visitor parking, as well as room for trucks to maneuver around the loading dock.

"We put the back of the hospital, the loading dock, oxygen tanks and other mechanical equipment we wanted to conceal at the remote end," Schoeck said. "We had to replace the parking that the new building displaced before we began construction. The first thing we did was build a new parking lot on one of the parcels [OrthoIndy] had purchased. If we ever had a net loss of parking, it was minimal.

"Keeping the existing facility operational while construction proceeded was an important goal."