Investment in increasing side room capacity at Huddersfield Royal Infirmary in support of the ability to isolate Covid positive patients, accommodating increased numbers through the winter period and aiding patient flow through A&E was essential.
An Infection control benefit of being able to isolate these patients particularly where aerosol generating procedures are being administered was highlighted.
A modular build was considered however the existing estates carries significant back-log maintenance which created an opportunity to lower the back log burden and increase the patient experience with high quality finishes.
Without this facility to adequately isolate patients the trust would not have the ability to receive all non elective patients causing pressure on the wider system. If patients were accepted into non isolated facilities there is an increased risk of infection spread which could include out of hospital risk.
What we did
The project delivered a 15-bed isolation ward, with spacious ensuite bedrooms, within a 12-week programme. The ward includes a comfortable staff room with a coffee machine and TV, separate staff WCs, a ward office, and two nurses’ touchdown points. There is also a fully enclosed reception area, two store rooms, a separate utility rooms. The new ward provides additional capacity to respond to the COVID 19 pandemic.
In addition, a new air handling unit has been installed with dedicated ventilation to the side rooms, providing up to ten air changes per hour. Improvements have also been made to the fire compliance of the existing building by completing a full survey of fire stopping within ward 18 and then rectifying any existing penetrations through fire walls that were not compliant.
Challenges
Timeframe
The new ward was delivered within a 12-week fast-track programme. To achieve this, 24/7 working was implemented where possible and additional resource were allocated by the contractor for site management and quality control. The contractor arranged the programme to ensure that activities ran concurrently where possible; activities were phased to commence at one side of the ward and flow through in a rolling programme. Daily co-ordination sessions were held and these fed into weekly programme reviews. This enabled early identification of project risks and allowed mitigations to be implemented quickly to recover potential time lost. Overall, this ensured that works were completed safely, on schedule, and to a high standard.
Stakeholder management and wider engagement
The project involved a range of stakeholders including the Estates team, Infection Control, Clinical Directors, Nursing Staff, Facilities, Patients and Visitors. Regular meetings were held with key clinical representatives, including daily co-ordination calls with the Trust project team. This ensured stakeholders’ priorities were well-represented and any issues were resolved efficiently. Regular site visits with clinical staff and infection control enabled their concerns to be picked up early and addressed immediately, minimising design changes and snagging.
Live hospital environment (noise control)
The refurbishment of an existing ward within a live hospital environment posed significant challenges. Measures were taken to ensure that patients in adjacent wards were not affected by the noise of the works, especially during demolition. During demolition, the planned 24-hour works were reduced to 7am-10pm and quieter activities were planned for the evenings. Patients were also given additional support during the day. There was regular communication with surrounding wards and clinical staff to ensure any issues regarding noise were addressed. To safeguard the patient experience, distraction techniques were implemented on occupied wards including activities and music.
Live hospital environment (access)
Strategic access arrangements were required to avoid disruption to staff and patients, especially given enhanced COVID-19 measures. This was addressed by providing an external staircase and hoist access for site operatives to minimise the impact of their activities on hospital operations. Strict procedures were put in place to manage dust and ensure it did not enter patient areas.
“Firstly, our sincere thoughts go out to all those that have lost loved ones during this terrible pandemic and by following the Gov guidelines we can protect 1000s more lives. The ward 18 development is a testament to human resilience, collaboration and dedication of our local community and partners. On behalf of CHS I’d like to thank IHP, Lendlease, our local SMEs and colleagues from within the NHS for delivering this very high quality ward refurbishment within an unprecedented 12 week programme, a fantastic achievement for all.”
- Chris Davies, Previous Head of Estates -
Lessons learned
Standardisation
This was the contractor’s first project with the Trust which meant that they needed to quickly familiarise with the hospital site. Likewise, the team needed to understand the Trust’s requirements and standards to make sure the ward was delivered on time and to the Trust’s expectations. There were issues with the specification proposed by the Contractor and Architect not meeting these requirements. We have subsequently created a Standardisation Document which details the products CHS use, including fixing and fitting, paint, flooring and doors. For future projects, this document can be provided to the contractor to outline the Trust’s expectations for components and materials. This makes the design process more efficient by ensuring at an early stage that the hospital specification is met and the design is consistent with other wards and clinical areas.
Design review
The design review with the Clinicians was very brief due to the timescales on the project. This caused issues in terms of ensuring the various areas within the ward met the sizing and clinical requirements. On future projects alternative approaches will be taken to communicate the design information to key stakeholders, especially those who are not familiar with construction, as drawings can be difficult to understand. This could include photographs, 3D-models and visualisations. This will help people understand the configuration and practicalities of the space. It is important to implement a structured process for design review and approvals and ensure the correct people are involved from the beginning.
Snagging
More organisation is required around the snagging process to ensure that this is sufficiently allowed for in the programme. Complete rooms which are protected and access controlled, could have been made available for CHS inspection and sign-off. This would have made the process more efficient.
Clear communication between parties
A main point of contact for the Contractor, Estates team and Trust is vital to efficiently delivering a project. There was an understanding of this at the beginning but it became more fundamental as the project progressed.
