From the Heart

A cardiac-care facility survives two near-fatal incidents, thanks to the efforts of a dedicated Building Team
August 11, 2010

Describing the efforts of architects, contractor, and owners to bring the new home of Houston's Texas Heart Institute (THI) to life prompts any number of medical metaphors: the grafting required to attach the new Denton A. Cooley Building to the existing St. Luke's Episcopal Hospital (co-owner, with THI, of the new facility); the systemic knowledge needed to address programmatic requirements of four distinct building functions in a fast-tracked design; most dramatically, the emergency surgery necessary to repair extensive damage that threatened the very life of the project.

A coalition of three architecture firms, two owners, and a general contractor has won this facility a 2003 Grand Award for institutional construction in Building Design & Construction's 6th annual Building Team Project of the Year competition. The final product combines advanced research labs, state-of-the-art surgical suites and patient rooms, public gathering areas, and high-end administrative offices under a single roof, creating a world-class facility equal to the reputations of its two illustrious owner institutions.

The Texas Heart Institute is one of the world's leading heart-research organizations. Founded in 1962 by pioneering cardiovascular surgeon Denton A. Cooley, the institute's professional staff have performed more than 100,000 open-heart surgeries and more than 850 heart transplants. Long housed within St. Luke's itself, the heart institute had been seeking its own home for more than a decade when it found its relocation plans aligned with St. Luke's own expansion needs.

But determining mutual need was just the beginning of the work required to bring this project to life. Architects and contractors faced the challenge of packing disparate functions, each carrying specific design requirements, into a site of shoebox proportions located in the core of the densely developed Texas Medical Center. In addition, construction planning had to address both difficult site conditions and the need to maintain an exceptionally clean job site, to limit potential health hazards for future facility patients.

Responsibilities for the two primary architectural teams — RTKL and Morris Architects — split along functional lines. Morris, as architect of record, was responsible for designing the building's elliptical shell and its public and administrative spaces. RTKL developed the master plan and took on the St. Luke's spaces, which included surgical and patient facilities, along with THI's research labs. A third firm, Carter Design Associates, concentrated on certain office interiors.

The architects say it was the variety of facility users, not the multiplicity of design partners, that gave them headaches. The new building had to serve visitors, patients, researchers, and administrators equally well. In addition, site constraints necessitated a vertical solution, rather than a spread-out, horizontal approach that might have made the project easier to deliver.

To meet these needs, RTKL's master plan splits functional areas into vertical zones. Public areas form the foundation, and research labs top off the structure, with surgical, administrative, and patient-care floors coming in between. Physical connections to St. Luke's Episcopal Hospital were established on the second floor — location of the cardiovascular surgery suite — as well as on patient-care floors.

Grouping areas with similar users helped establish logical traffic flows. However, it didn't make the designers' job any easier when it came to delivering building systems tailored to specific functional needs.

"The biggest challenge had to be the difficulty of stacking so many different functions with so many requirements," says RTKL vice president Wayne Barger. "Patient rooms have a certain range of column grids that's optimal. The same with operating rooms. All of this is stacked over a column-free auditorium area."

The solution to this structural design problem began with two 56-ft.-long, post-tensioned transfer girders, fitted in a V-formation above the basement-level auditorium. This design provided structural support for the nine floors above, while freeing the auditorium itself of any visual obstructions. Establishing a columnar grid that met the competing requirements of subsequent floors entailed a great deal of back-and-forth between the two primary architecture teams.

Meeting varying HVAC requirements posed complications as well. Operating rooms are sterile environments and demand dedicated air supplies. Rooms for heart-transplant patients with suppressed immune systems have similarly demanding needs. Because of potentially noxious fumes, research labs generally cannot recirculate inside air and require sophisticated exhaust systems.

Designers for the Cooley Building captured space above and around the third-floor surgical-observation rooms for air-handling units dedicated to surgical needs. (The new structure lacks a fourth floor, to maintain even floor plates with adjacent St. Luke's.) Each patient floor has its own dedicated air-handling unit, and the researchers' top-floor location limits the possibility that their exhaust could cross-contaminate air supplies of floors below.

The 'hole' solution

As logical as RTKL's zoned arrangement was programmatically, it did raise some practical design considerations. Floor plates for the public areas at the bottom and research areas at the top would have to be larger than those for the intervening medical and administrative floors. What would designers do with the resulting "hole"? In response to this question, Morris Architects created one of the building's most compelling spaces.

"Taking a building with floors that have small floor plates sandwiched between floors that have large floor plates — that's really what drove the creation of the interior atrium," says Chris Hudson, the firm's president and CEO. Reaching four stories high, the space provides comfortable seating areas for patients' families to gather, as well as space for private contemplation. A water feature adds soothing background noise to buffer patient rooms that overlook the atrium from surrounding traffic noise. This solution also provides a place of respite both owner institutions hoped to create within the new facility.

"They wanted a space where patients, staff, and patients' families could have a meditative moment," Hudson says. "A healing, contemplative space. Something both unique and important to the building."

Construction-planning complications matched those faced by designers. The Texas Medical Center is a 700-acre facility, with more than 100 permanent buildings, and it receives 50,000 visitors a day—more than Disneyland gets. The Cooley Building is sited in a prominent corner location, immediately adjacent to St. Luke's Episcopal Hospital, with little room to spare for storage.

"It's as dense as any downtown facility would be," says Bill Scott, senior vice president at the GC/CM firm Linbeck Construction. "We had to have just-in-time delivery — there was virtually no lay-down area."

All of St. Luke's major building utilities were rerouted during construction, requiring the installation of temporary cooling equipment for a period. Linbeck planners built their schedule so that this disruption occurred when cooling demand was at its lowest. Complicating this planning process, just-in-time delivery requirements left little room for schedule adjustments to deal with unexpected construction complications.

Procedurally, Linbeck took great care to ensure the cleanliness of the building as it was constructed. No food or drink was allowed in the building — workers could get fired for violating this edict. Ductwork was shipped to the site sealed at both ends, then resealed on arrival at the job site, to minimize dust infiltration. As ductwork sections were installed, all open ends were sealed. Biocides and other bacteria-retarding chemicals were sprayed on drywall, between walls, on painted surfaces, and in buried areas to inhibit mold or bacteria growth. No drywall was hung until the building was enclosed and the air conditioning for that floor had been brought online, to limit moisture infiltration in Houston's humid climate.

A steamy setback

All these measures proved for naught when, early one Sunday morning — after drywall had been installed on almost six floors — a steam gasket failed. Raw, superheated steam was pumped throughout the facility for several hours before the problem was noticed, condensing on the ductwork as it rose and creating its own little weather patterns. "When this steam event happened, we contaminated all of that," Scott says. "It was actually almost raining inside the building."

Fourteen thousand panels of installed drywall had to be replaced. All ductwork and wiring had to be inspected for moisture infiltration. Dry air heated to 94 F was forced through temporary ductwork to each floor to bring the relative humidity back down to 20-40%. Within 61 days, the project was back on schedule, and the event had no material effect on the delivery date, Scott says.

Then came Houston's disastrous June 2001 floods. Although the Cooley Building suffered no damage, adjacent St. Luke's was flooded, taking out all building utilities, including emergency power. Linbeck, with 17 years' experience as St. Luke's construction manager, shifted Cooley Building crews to St. Luke's, bringing the hospital back on line in 11 days.

Because a fast-track approach was used, design sometimes struggled to keep up with construction, raising the specter of expensive change orders as the building progressed. "We recognized early on that managing communications was key," Scott says. "As we discovered things, we had weekly meetings where we'd discuss them. Many times, changes could be effected at lower cost."

The patient-care areas of the Cooley Building represent just the first element in a three-phase expansion effort planned by St. Luke's. However, Building Team members have set a high bar for themselves as they move ahead in this endeavor. In successfully addressing the needs of researchers, clinicians, and patients, they've helped both the Texas Heart Institute and St. Luke's Episcopal Hospital further enhance their already world-class reputations. As Michael Jhin, THI's president and CEO, puts it, "This building is unlike any facility in the world."

Construction Costs

General conditions $5,507,596
Earthwork 801,375
Concrete 1,530,980
Formwork 2,288,589
Reinforcing steel 1,496,574
Cement finish 253,400
Structural steel 1,119,132
Precast concrete 828,266
Masonry and stone 257,063
Roofing and sheet metal 643,659
Waterproofing 350,923
Rough carpentry 48,597
Miscellaneous metals 1,171,211
Building specialties 810,474
Millwork and casework 2,597,474
Doors, frames, hardware 790,566
Walls and ceilings 6,213,353
Painting and wallcovering 477,427
Floors 1,743,283
Glass 4,140,767
Electrical 9,934,995
HVAC, pluming, fire protection 14,694,237
Conveying systems 1,247,528
Sitework 703,435
Demolition 453,925
Equipment 138,573
Miscellaneous 399,976
TOTAL $60,578,048