Tag: Healthcare

The Toronto Zoo constructs a new Wildlife Healthcare Facility

The Toronto Zoo is Canada’s premier zoo and home to over 5,000 animals, including invertebrates and fish, representing 460 species from a variety of geographical regions around the world. Encompassing approximately 710 acres, the Toronto Zoo is Canada’s largest zoo and is divided into seven zoogeographic regions, ranging from the Americas, to Africa, Australasia and Eurasia.

The campus includes numerous support facilities dedicated to animal care, operations, maintenance and veterinary services. With the existing veterinary facilities dating back to 1974, the Toronto Zoo recognized the need for redevelopment and expansion. The mandate for the new Wildlife Health Centre is to provide a state-of-the-art facility for veterinary services, that will further the Toronto Zoo’s commitment to wildlife health, nutrition, species survival research, conservation and education.

Planning for the new centre commenced in 2011 with Diamond Schmitt Architects, in collaboration with animal healthcare specialists Design Level, leading the team and preparing the architectural design for the new facility.

With a total gross area of 32,000 sq. ft., the new two-storey building would be located in the centre of the Toronto Zoo’s existing animal support complex and would be constructed in the footprint of the existing veterinary services building. Adjacent service buildings, including the existing Research, Animal Holding, Quarantine, and Conservation and Biology facilities, would connect to the new Wildlife Health Centre.

Design considerations

The functional program for the new centre would have to meet a variety of objectives, including: meeting the needs of the different animal species, taking into account diverse environmental requirements for the various habitats, providing a layout that promotes the effective delivery of ongoing healthcare services and meeting the requirements of the veterinary professionals who perform these services. Eric Lucassen, Project Architect at Diamond Schmitt, notes, “Working with the Toronto Zoo to create functional programming that supports animal healthcare, while meeting the unique habitat requirements for the various animals, involved a detailed planning process.”

The facility program for the Wildlife Health Centre is split over two floor levels and consists of animal treatment and surgical areas, diagnostic imaging, an intensive care unit, laboratories, animal holding areas, offices and support spaces, and a public viewing area. Animal holding areas are further divided into spaces for small and large animals, which require ceiling-high caging to provide safety for the staff.

Surgery and diagnostic imaging spaces are centrally located and are accessible via wider corridors to facilitate the easy transport of animals into these areas. A garage is located adjacent to the surgery area, and an electric hoist and hoist beam runs from the garage to the surgery area to help the transport of larger animals.

The majority of two-storey rooms have large clerestory (windows just below the ceiling) around the perimeter of the spaces. This architectural feature allows a significant amount of daylight to enter the interior of the building and creates the feeling of being in an open, natural environment. Laboratories and support spaces are located in close proximity with animal care areas to minimize travel distances for support services.

Mechanical considerations

Given the varying functionalities and diverse environmental requirements of the different spaces, a number of innovative applications of mechanical and electrical systems were incorporated in the building’s design. The holding area for fish and reptiles required that tropical temperatures be consistently maintained throughout the year, maintaining 100% relative humidity. Electric heat tracing cable, specifically modelled for the application by Tyco Thermal Controls, was installed in the slab to ensure that the temperature in the area would be maintained during winter months. While the electric heat tracing cable maintained a heat pad for reptiles, additional radiant floor heating was used to maintain the environment and create general floor comfort for animals.

Ventilation systems in animal care areas throughout the facility rely on a continuous 100% fresh air supply, with no return air, to ensure that contaminants and excrement are not circulated through the ventilation system. A heat recovery system was provided on the exhaust air system to increase energy efficiency. Animal surgery areas utilize a dedicated supply air system, which incorporate air change requirements and filtration comparable to the requirements for a human healthcare facility. By utilizing a separate, dedicated supply air system for surgery areas, energy efficiency is maintained in areas that require fewer air changes per hour.

Other energy efficient elements in the design included the use of low flow plumbing fixtures, roofing and landscaping features that promote heat island reduction for the site and the use of insulated glazing that provides an optimal balance between daylighting and heat transfer.

Electrical and lighting requirements

Unlike hospitals where patient care equipment is standard and there are prescribed standards for electrical circuiting requirements, animal care areas have speciality equipment items, and require multiple dedicated circuits and receptacles. Additionally, animal care areas were considered wet environments, due to the frequent washing that occurs after animals are returned to their habitats.

Ground fault circuit interrupter (GFCI) receptacles were used in these areas to maintain electrical safety. Lighting fixtures throughout the facility were selected to provide both illumination requirements for animal care and were vapour tight, to maintain infection control practices and protect luminaires from inadvertent spray during cleaning.

Occupancy sensors and multiple light switches were used throughout the facility to give users a wide range of automatic and manual lighting control, which allow lights to be turned off when there is enough daylight present through windows and clerestory.

To avoid interference with full height cages, architectural clerestories, and to minimize the likelihood of interaction with animals, overhead mechanical and electrical services were routed outside of animal care areas and confined to corridor spaces. This created several installation coordination issues that were resolved by the contractor, via the creation of detailed interference drawings during the construction phase of the project.

Nearing completion

The project was competitively tendered and awarded to Gillam Group Inc., with construction commencing in February 2015. The new building is in the final phases of construction and is scheduled to be complete during the first quarter of 2017.

Working on an animal healthcare facility designed to accommodate a variety of different species, with diverse requirements, proved to be a unique challenge.

While healthcare standards are readily available for hospital construction, there are minimal design and construction standards available for this type of animal care facility. Environmental standards established by the Canadian Council on Animal Care and general healthcare design experience contributed to the overall design.

Furthermore, involving the users throughout the project was critical in identifying the unique needs of various animal groups. Eric Lucassen notes, “Having the Toronto Zoo’s veterinary staff provide input into specific design requirements at every step of the project helped the design team develop innovative solutions to provide an enhanced animal care environment.” CCE

 

Philip Chow, P.Eng., P.E. is a senior project manager at H.H. Angus & Associates Ltd., Philip.Chow@hhangus.com

 

Hospital redevelopment projects provide a unique opportunity to build for the future

The increasingly critical role of technology in patient care has resulted in a dramatic increase in demands on communications and information technology infrastructure in hospitals, but aging facilities pose significant challenges to the staff who support and maintain these systems. Many hospitals in Canada were constructed well before the emergence of modern information technology, which typically means telecommunications equipment is squeezed into undersized spaces without sufficient power or cooling to ensure these important systems stay operational.

IT spaces added as an afterthought to existing construction In older buildings, telecommunications spaces have gradually expanded as the systems grow, creating a
number of challenges:

  • Locations are often chosen based on what space is available, rather than what is appropriate, meaning that the size and shape of the rooms may not properly support the equipment, or the site may be adjacent to
    wet piping or sources of interference.
  • Addition and removal of equipment over many years often results in an inefficient layout and lack of appropriate cable management or identification, making maintenance more difficult.
  • Supporting services, including power and cooling, may not have the appropriate capacity or redundancy for IT loads, and equipment shutdown for maintenance and repairs can impact the availability of these services.
  • Limited ceiling space in older facilities can impact the ability to add services (i.e. chilled water loop) or new communications cables.

Limitations have a significant budget impact
All of these challenges can have a significant impact on operational and capital costs, and can add up to multiples of what is typical of a new installation with properly designed spaces and systems.

The greatest impact is seen in operational costs, where limitations make the systems more difficult to maintain, support and upgrade. From a user perspective, network performance can be affected by things such as heat or interference, which can create unnecessary delays in accessing information or even unplanned network downtime – a condition which critically impacts patient care across the entire facility. However, capital costs are not immune to these conditions either; overheating, dust and vibration can reduce the lifespan of equipment, meaning it must be replaced sooner.

Redevelopment with the future in mind
Hospital redevelopment provides the opportunity to build new IT systems that can withstand the test of time, and to address issues with existing systems in order to support expansion. While no one can predict the needs of technology decades from now, the following principles will help avoid creating similar challenges in the future:

  • Engage users early on in the planning process, and design IT systems to align with the technology vision for the hospital. This approach facilitates adoption later on and helps ensure IT systems can support the
    unique needs of the facility.
  • Consider the facility as a whole when implementing new IT systems and infrastructure; design decisions for new spaces can have a significant impact on existing IT infrastructure, and a gap analysis can help prevent unpleasant surprises later on.
  • Provide additional capacity and flexibility in infrastructure, spaces and supporting systems so they can be adapted as technology progresses.
  • Aim for consistency in services throughout the facility. Differences in system performance or user experience can impact adoption, staff satisfaction and, in the case of clinical life safety systems, even patient safety.

It is also worth investigating which challenges can be addressed in place and which would benefit from a “greenfield” solution. For example, building a new data centre in a newly constructed area of the building is often less complex and cheaper than mitigating issues with the existing location. Many redevelopment projects use this opportunity to create a space that is properly sized and designed to support critical IT systems for the entire facility. The practicality of options should be evaluated as part of the planning process.

Ultimately, redevelopment projects are a chance for hospitals to create efficient and cost-effective IT systems capable of supporting the critical nature of technology in healthcare, and support the highest standard of patient care.

Author:

Kim Osborne Rodriguez,P.Eng., RCDD
kim.osbornerodriguez@hhangus.com
Published June 2016 in the Canadian Healthcare Engineering Society website

On January 13, Toronto’s Emerging Leader Forum (ELF) hosted an engaging discussion on Digital Health focused on informing young leaders in healthcare. The event was led by Dr. Darren Larsen, Chief Medical Information Officer at OntarioMD, who facilitated the discussion with:

  • David Denov, Senior Manager, National Health Services at Deloitte
  • Dr. Trevor Jamieson, Virtual Care Lead, Women’s College Hospital
  • Laurie Poole, VP, Telemedicine Solutions at Ontario Telemedicine Network
    Throughout the discussion, key themes of patient-driven care, improved outcomes, reduced cost and better coordination of care emerged as central drivers for the adoption of digital health.

What is Digital Health ?

Digital health is empowering people to better track, manage, and improve their own and their family’s health, live better, more productive lives, and improve society. (Wikipedia)

 Despite having a relatively straightforward label, the concept of digital health encompasses a complex set of ideas that differ greatly between sectors and people. While many associate digital health with smartphone apps and telehealth, Dr. Trevor Jamieson is quick to differentiate between virtual health and digital health, noting that “how you use data to drive better decision making” forms the core of how digital health impacts how we care for patients. Many would agree that data has become critical in the delivery of healthcare across varying sectors from acute to primary care, and the ability to manage and apply data efficiently will likely become future differentiators for providers in the healthcare market. 

Unfortunately, one of the primary challenges of delivering on this definition of digital health is a lack of interoperability and integration both within and between healthcare organizations, which means that data cannot be leveraged to maximize its value. It’s not just enough to have astronomical amounts of data; it has to be delivered to the right person at the right time.

What’s holding back the adoption of digital health?

A combination of limited funding and a conservative approach to technology seem to be the biggest obstacles to the adoption of digital health in Ontario, but Laurie Poole is optimistic: “Technology used to be an afterthought, so there has been a big shift from even four years ago.”
However, funding models that reward physical presence rather than virtual care, and privacy legislation that limits how organizations store and share data are two big barriers noted by David Denov and Dr. Jamieson. “Hospitals and providers have convinced themselves that change has to be incremental, and that disruption is undesirable,” says Dr. Jamieson. “You will never have innovation without a bit of risk.” Clearly innovation needs to be balanced with the risk and potential consequences for patients and their data.

How can Canadian hospitals become leaders?

Looking to other health systems that have achieved widespread adoption of technology and digital health, it appears that that big changes have to be driven (or at least strongly supported) from the top down – and not just within the hospital, but from health systems or regional leadership in healthcare. Poole points out that integrated health systems in the US have leveraged their power as a closed system with a single HIS to drive mainstream adoption of virtual care, but that a lack of integration in Ontario has been a key challenge in achieving the same adoption. Many G8 countries are facing similar challenges of constricted spending, limited infrastructure and an aging population, and consolidating leadership at a regional or provincial level may help coordinate adoption. “Every [Ontario] hospital has an independent board of directors,” Dr. Jamieson adds, which may contribute to the challenges in achieving widespread adoption.
This might imply that Ontario hospitals are stuck in siloed information systems without a strong mandate from provincial leadership, but momentum is building and there are a number of initiatives which are working towards broader integration. Initiatives such as ConnectingGTA and the current [as of 2016] provincial hold on new Hospital Information System implementations may be the first step towards standardization.

Where do we go from here?

From the patient perspective, there is a growing expectation of digital health integration throughout their healthcare journey regardless of care location. Many of our Ontario hospitals have been able to leverage digital health effectively within their own organizations and work with healthcare partners on a community level, but growing pressure from patients will likely continue to push for provincial and even national initiatives which improve on inter-organizational integration. It is certainly clear that digital health has the opportunity to transform how care is delivered to the patient – from improved data analytics & big data to driving better patient outcomes through 360-degree healthcare coordination, digital health is becoming an essential part of effective healthcare.

 

Author: Kim Osborne Rodriguez, P.Eng., RCDD

The information technology needs of health care institutions are rapidly expanding, which makes it critical that the communications infrastructure is planned strategically.

Authors: Kim Osborne Rodriguez, P.Eng., RCDD | Megan Angus, RN, MBA, Lean, EDAC
Published September 2015 in the Canadian Consulting Engineer Magazine

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