Oncology Hospitals - Best Practices

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Best Practices - Oncology Hospital Construction

Best practices for building an oncology hospital include designing treatment rooms around specific and complex cancer therapy equipment, designing for radiation shielding, and controlling dust and noise. Hospitals should also design for resiliency and resolve compliance issues early to avoid additional costs. These are outlined below.

PROTON THERAPY CONSTRUCTION

  • Gilbane Building Company, a global construction and facility management firm, published its best practices for building specialized cancer care centers with proton therapy facilities.
  • Proton therapy creates a beam of protons to target a cancerous tumor with a high dose of radiation while minimizing damage to nearby cells.
  • One best practice is to design the facility around a specific proton therapy equipment rather than the other way around.
  • Gilbane recommends selecting a proton therapy manufacturer first, then determining the building structure according to shielding requirements, mechanical and electrical connections, and patient treatment considerations.
  • This is to help builders avoid undefined costs in the construction bidding process as proton therapy and its equipment are complex in nature.
  • Another best practice is to be familiar with the proton therapy device's requirements for tolerance, shielding, concrete embeds and dimensions early in the construction bidding process.
  • This is to help plan for added capacity levels should existing site utilities fail to support the proton therapy equipment.
  • Lastly, all system upgrades to the proton therapy equipment should be defined including those that will affect underground utilities.
  • This is to ensure adequate protection of nearby facilities from heavy load transfers during proton equipment delivery.

RADIATION SHIELDING DESIGN

  • Gilbane also identified designing for radiation shields as a best practice when constructing oncology specialty hospitals.
  • Healthcare Design Magazine published the following best practices for radiation shielding design in specialized cancer facility construction, specifically carbon-ion therapy centers.
  • Based on studies of existing cancer centers utilizing carbon-ion therapy, treatment rooms should be maximized by building the patient immobilization functions outside together with spaces for changing and sub-waiting.
  • As carbon-ion therapy requires greater shielding than most therapies, entry to treatment rooms should be designed in a maze to minimize radiation leaks.
  • The right amount of thickness for radiation protection (typically between 6 to 10 feet) should be based on calculations made by shielding consultants.
  • However, pre-engineered modular blocks made of concrete can be considered for flexibility in construction and design.
  • The article also stated that in basement areas, earth can also be considered as a natural and economical radiation shield.

NOISE, DUST AND VIBRATION

  • Gilbane also identified controlling dust, noise and vibration as best practices for cancer treatment facility construction projects.
  • The National Center for Biotechnology Information (NCBI) featured Synergy Health and St. Joseph’s Hospital's book discussing best practices for minimizing noise in hospital construction.
  • The hospital had established a National Learning Lab after consultation with national leaders from healthcare administration, research, hospital quality improvement, and authorities in hospital quality accreditation and architecture.
  • Among the Lab's best practices was to reduce noise by separating walls between rooms, using airspace insulation and decreasing transfer noise.
  • The Lab suggests that optimum materials in mechanical, plumbing and electrical systems should be leveraged to dampen noise.
  • The book also reported that vibration noise was reduced using isolation and dampening devices.
  • A 2018 study in Cancer Journal for Clinicians states that hospital construction planning need to comply with requirements for indoor-air quality from an internal committee.
  • The study stated that project contractors are required to have containment plans for dust within and without the construction site.
  • The researchers added that construction activity releasing harmful dust should be conducted within institutional guidelines.
  • In addition, certain cancer treatment rooms should have specialized ventilation systems with high efficiency filters to catch 99.99% of particulates.

RESILIENT DESIGN

  • The 2018 Hospital Construction Survey from the American Society for Healthcare Engineering (ASHE) identified resilient design as a top priority and current best practice among hospital construction projects.
  • The report defined resiliency as a design that resists natural and manmade disasters.
  • ASHE also stated that resilient design incorporates the capability for quick recovery.
  • The majority (89%) of the 274 facilities professionals interviewed across the US said resiliency is integrated into their design strategies.
  • ASHE suggested using a hazard vulnerability assessment to help define resiliency design for hospital construction projects.
  • A featured project was the Texas MD Anderson Cancer Center, which successfully implemented resiliency design after suffering from Tropical Storm Allison.
  • The oncology hospital installed storm gates, flood walls, watertight compartments, and hurricane-force window glasses which helped it successfully withstand Hurricane Harvey.
  • The key priorities for resiliency design in hospital construction projects include infrastructure and measures against fire, winter storm and power outages.

EARLY RESOLUTION OF COMPLIANCE ISSUES

  • The 2019 Hospital Construction Survey from the American Society for Healthcare Engineering (ASHE) also identified early resolution of compliance issues as a current best practice in hospital construction projects.
  • The survey stated that healthcare construction leaders resolve compliance issues by partnering with consultants, having regular conversation with authorities, and taking early action on potential problems.
  • One example is Tushar Gupta, principal of the architecture firm EYP. Gupta said that early action and regular communication with authorities helped resolve numerous compliance issues in their health care construction projects.
  • Another is John Wilson, director of construction for Parkland Health & Hospital System. Wilson said that regular conversations with authorities helped resolve compliance issues for their $1.3 billion replacement hospital project.
  • According to the survey, compliance issues due to improper interpretation of code construction cost 10% of hospital construction spend on average.
  • Proper compliance with construction code is crucial especially for cancer centers designing facilities around specialized therapy equipment including proton and carbon-ion therapy equipment.

RESEARCH STRATEGY

We have provided best practices surrounding construction of oncology specialty hospitals using industry surveys, whitepaper, trade book, studies and trade media articles. As resources detailing best practices specifically for oncology specialty hospitals were not very prevalent, we had to use sources older than 2 years to address the request. While our major sources were the 2018 and 2019 Hospital Construction surveys as well as the list from leading global construction firm Gilbane, we used other resources to corroborate and supplement our findings. This included a 2008 book featured in National Center for Biotechnology Information (NCBI) which gave rationale and practical steps for minimizing noise and vibration disturbances, supporting the list from Gilbane. This was also the case for Gilbane's whitepaper detailing best practices for constructing specialty oncology hospitals housing a specific and complex therapy equipment. We have outlined our findings above.
Sources
Sources

Quotes
  • "Resilient design takes center stage as a top project consideration for health care facilities"
  • "The largest medical complex in the world, home to The University of Texas MD Anderson Cancer Center, was decimated by the storm that dumped more than three feet of rain, flooding buildings throughout the complex. "
  • "When the storm cleared and the hospital was back to full capacity, hospital leaders immediately began planning to incorporate lessons learned during Allison into a resilient design to help the hospital withstand the next massive storm."
  • "MD Anderson is among the growing number of hospitals that are factoring resiliency planning into their overall design strategy, according to the 2018 Hospital Construction Survey, conducted by the American Society for Healthcare Engineering’s (ASHE’s) Health Facilities Management (HFM) magazine."
  • "The survey, which included responses from 274 facilities professionals at hospitals across the country, showed that 89 percent of respondents consider resiliency — a design style that resists a variety of natural or human-induced disasters and aids in quick recovery — when designing and building new spaces. "
  • "KEY Fire, Flooding, Winter storm, Power outage, Earthquake, Hurricane, Tornado"
Quotes
  • "Correcting compliance issues that were caused by conflicting or improper code interpretations costs 10 percent of a hospital’s construction spending, on average, according to the 2019 ASHE Hospital Construction Survey conducted by ASHE’s Health Facilities Management magazine."
  • "How do health care construction leaders deal with the compliance problems? For one thing, they pay consultants. "
  • "Tushar Gupta, managing principal in the Houston office of architecture firm EYP, has dealt with many compliance issues in his career in health care architecture. He believes that jumping on problems early, and having frank conversations with the AHJs, can help."
  • "“The earlier you can get on a problem, the better,” Gupta says. “The key is communication."
  • "John Wilson, AIA, CHFM, SASHE, director of planning, design and construction for Parkland Health & Hospital System in Dallas, experienced constant compliance issues while Parkland built a $1.3 billion replacement hospital across the street from their existing building. He practiced what Gupta suggests: regular conversations with the AHJs about compliance issues."
Quotes
  • "Noise interferes with communication, creates distractions, affects cognitive performance and concentration, and contributes to stress and fatigue. Particularly sensitive are mental activities involving working memory."
  • " In addition, the walls between rooms are separated and insulated with airspace, minimizing transfer noise. This was designed into the structure early in the building design. "
  • "The mechanical, electrical, and plumbing systems were designed to use the optimum materials for minimizing noise. This included using vibration isolation/dampening devices wherever vibration could be a factor."
  • "The process began in April 2002, when leadership from SynergyHealth St. Joseph’s Hospital met with national leaders representing health care administration, health services research, hospital quality improvement and accreditation, hospital architecture, systems engineering, medicine, nursing, and pharmacy."
  • "Using personal experience, human factors principles, health care research, and research from other industries, it was agreed that a National Learning Lab, would be used to develop recommendations for facility design, define and create a roadmap for safety by design, including safe design principles, make recommendations for changes in care processes, and enhance safety culture for hospitals through facility design focused on patient safety."
  • "9. Reduce noise."
Quotes
  • "All construction planning must comply with indoor air‐quality requirements specified by an internal committee, and project contractors are required to provide personnel and equipment to contain and clean up dust and particulates in and around the work area, including dust mops, wet mops, adhesive walk‐off mats, mop buckets, HEPA‐filtered vacuums, and clean rags for removing dust inside and outside the construction site and from equipment."
  • "At our center, any activity that disturbs existing building features, possibly causing the release of harmful dust, warrants specific institutional precautions. "
  • "Guidelines for health care facilities that house HCT recipients recommend specialized ventilation systems, including the use of laminar air flow units capable of 12 air exchanges per hour and high‐efficiency particulate air (HEPA) filters. These filters maintain compliant indoor air quality by filtering 99.99% of particulates in the work area. "
Quotes
  • "As a national leader in the construction of proton therapy facilities, Gilbane is prepared to help you identify and evaluate your options with respect to cost, schedule (speed to market), and construction impact on your proposed site. "
  • "Proton therapy utilizes a precisely controlled beam of protons to treat a cancerous tumor, most often in the cases of prostate cancer, brain tumors and pediatric cancers. "
  • "BEST PRACTICE: Select the proton therapy equipment manufacturer first, then design the structure around their specific requirements for shielding, building size and dimensions, mechanical and electrical utility connections and patient treatment concerns. Due to the complexity of this equipment it is best to design to a specific piece of equipment, rather than leaving some costs undefined in the bidding process."
  • "BEST PRACTICE: Capture the proton therapy equipment vendor’s specific requirements for tolerances, dimensions, shielding, concrete embeds and utilities early in the process. Include the specific requirements within the construction bid documents. During the design phase for a single treatment room in an existing building, the project team must review the as-built site utilities and current capacity levels of the adjacent existing surroundings to determine if they will support the added proton therapy equipment. "
  • "BEST PRACTICE: Define any system upgrades in the bid documents, showing connection and tie-in points to existing utilities. Include as-built underground utility drawings in the bid documents for locations of existing utilities so they may be adequately protected from the heavy loads of the proton equipment during delivery. "
Quotes
  • "Gilbane has unparalleled experience planning and building cancer and proton therapy centers. Our healthcare experts understand the business drivers behind the design and operations of cancer treatment facilities and ensure that our construction expertise is put to use in evaluating constructability, cost and schedule options, balanced against a clear understanding of the facility’s operational needs and budget."
  • "In the rapidly advancing field of cancer care, the flexibility to incorporate the latest technologies and the patient experience are critical elements. Cancer care facilities are also often multi-functional, offering treatment, but also engaging in research. "
  • "We’ll apply our extensive proven best practices for optimal cancer center construction, including approaches for radiation shielding designs, noise/dust/vibration control, vault construction and installation and proton therapy configurations."
Quotes
  • "Studies of existing carbon-ion therapy centers show that the utilization of a treatment room can be maximized by locating the changing, sub-waiting, and patient immobilization functions just outside. The planning of these patient spaces is based on the type of radiation beam used."
  • "The heavy carbon-ions also require greater shielding as compared to other forms of radiation. The entry to the treatment rooms is usually designed as a maze to avoid leakage of radiation. "
  • "The number of turns in the maze depends on the amount of shielding required, making it either a single- or double-maze entry—both equally common in existing facilities. "
  • "Utilizing the earth as a natural radiation shield in the basement areas can be more economical, as well."
  • "The wall thickness for radiation protection is based on calculations by shielding consultants and can range between 6 to 10 feet."
  • "In fact, pre-engineered modular concrete blocks are becoming the new trend. They’re easy to construct and also reduce wall and ceiling thickness compared to regular concrete, and they allow adaptability and flexibility in design to keep up with technology upgrades."