The University of Cincinnati (UC) Medical Center plays a critical role in its academic and healthcare communities as the only Level 1 adult trauma center in the Cincinnati region. When it came time to revitalize a portion of the medical center’s main campus in late 2019, the mission was clear: Create a new emergency department (ED) and expand surgical capacity to advance healing in a modern space designed to deliver world-class care.

The project represented the largest construction effort in the medical center’s history, completed over three years including through the pandemic. Completed in spring 2023, the addition delivered an emergency department with 32 patient rooms, 10 shock resuscitation units, four triage rooms, 10 nurse stations, a flex intensive care unit (only one of a handful of its kind in the United States), an expanded ambulance canopy that can hold up to nine ambulances, and a garden.

Additionally, a new four-story surgical expansion adds operating capacity with eight state-of-the-art operating rooms,13 perioperative exam rooms, and 12 post-anesthesia care unit pods, transforming the entire process of how patients come into the building and ultimately move into surgery.

The project team—including CannonDesign (New York), Messer Construction Co. (Cincinnati), HEAPY (Dayton, Ohio), The Kleingers Group (Uniontown, Ohio), THP Limited Inc. (Cleveland), and Hplex Solutions (Powell, Ohio)—collectively kept the focus on maintaining care for Greater Cincinnati’s most critical patients throughout the entire project.

Minimizing disruptions to patient care

Because the existing ED and surgery spaces needed to remain fully operational throughout the expansion, meticulous planning and coordination were prioritized to ensure patient care and capacity were not impacted by construction activities.

In addition to proactive communication and weekly meetings with hospital leadership, the project team employed several strategies to minimize disruptions, including:

  • Re-routing traffic to maintain patient and ambulance access.
  • Employing a sheriff 24/7 to direct traffic.
  • Re-routing seven exit points.
  • Maintaining helipad clearance and communicating directly with emergency medical services (EMS) to ensure the tower crane did not interfere with air care.
  • Completing especially disruptive work, such as installing deep foundations near the MRI suites and transitioning the hospital’s main oxygen feed to a temporary supply, during off-peak hours.

This attention to detail was put to the test and thrust into the spotlight in January 2023 when 23 million viewers witnessed NFL athlete Damar Hamlin suffer a cardiac arrest and collapse on the field at Cincinnati’s Paycor Stadium. Hamlin was transported to UC Medical Center, where he received critical and comprehensive treatment. This medical intervention occurred amid construction and serves as a testament to the hospital’s physicians and the entire project team’s commitment to maintaining the highest level of patient care.

Managing intricate site logistics

Patient care considerations also drove the team’s approach to coordinating work on a busy site situated in the center of an urban neighborhood. The team had to construct the new surgical addition between six existing structures with limited access points, as well as demolish three existing buildings that were connected to or adjacent to buildings that remained operational during construction.

This required constant communication to schedule construction work around the hospital operations. For example, the project team would cease rock excavation activity near an active operating pavilion for 30-minute periods so patients could be treated without demolition-related vibrations interfering.

Demolishing one of the operating pavilions was especially tricky for two reasons. First, it was connected to a historically significant surgical amphitheater dating back to the 1930s that had to be preserved. Second, it was adjacent to a central lab building that had previously been constructed as infill space and, therefore, didn’t have its own exterior skin. When the operating pavilion came down, the project team had to install an air vapor barrier, insulation, and rain screen to protect the lab building, which functioned as a vital COVID-19 testing facility.

Setting up utilities on a healthcare campus

Additionally, a significant part of this project’s complexity involved determining how to route UC Health’s utilities from the central utility plant (CUP) on the neighboring University of Cincinnati campus to serve the new ED and surgical building. Notably, these were power plant-sized utilities atypical for a hospital, and the piping had to be installed manually due to limited crane access.

Seven options were evaluated by UC Health, designers, engineers and design-assist subcontractors before choosing a breezeway route through an existing tunnel.

The work spanned 10 months and included executing an overnight switchover from the main oxygen system to a temporary setup during the height of the pandemic. Construction leadership completed a 40-step process to ensure this was safely done without interrupting service.

The existing tunnel was not in an ideal location to align with the new surgery and ED floor plans, so it had to be disassembled and put back together without disruption, including 99 successful mechanical, electrical, plumbing, fire protection, and low-voltage system shutdowns over 71 working days. Now, patients, visitors, and staff can flow between the two buildings.

Time-saving strategies

The project leveraged prefabricated HVAC systems, lighting, surgical equipment, headboards, airframes, and walls/structure panels to simplify ordering, delivery, and installation in ED patient rooms and surgical suites.

The walls, structure, and exterior-skin prefabricated panels were ordered in advance for on-time delivery and installed with easy joint seals. The production of prefabricated items ran concurrently with on-site construction, and all the necessary fixtures arrived together, saving time within the project schedule.

For project documentation and visualization, the construction team deployed 360-degree cameras in every space for daily photography, providing a detailed visual record of the spaces while monitoring the installation of MEP systems, walls, and other components within each room.

Following owner walkthroughs, the 360 images served as a point of reference for Messer to review existing components and make adjustments based on end-user feedback (e.g., changing the door placement without interfering with a plumbing stack). Then, those adjustments were applied to and replicated on the rest of the rooms—minimizing the need for rework while ensuring consistent and synchronized progress.

Benefits of virtual modeling

The images were also turned over to UC Health as a resource for any changes/additions they want to make throughout the life of the building. Additionally, 3D models supported MEP and framing coordination to enhance the project’s efficiency and precision.

By using virtual modeling, the team was also able to detect potential clashes (e.g., MEP systems running into each other in the ceiling) and solve problems virtually before they became a problem in the field.

In addition to operating room mock-ups via a virtual reality headset, the project team also leveraged full-scale, foam mock-ups so hospital staff and leaders could experience a tangible preview of the final emergency department layout. The detailed mock-up encompassed patient rooms, providing a realistic visual representation that facilitated informed decision-making and seamless collaboration among stakeholders.

The customization allowed for more true testing, better feedback loops, and enhanced evidence-based design. Stakeholder suggestions were incorporated overnight, allowing approval the next day and enabling work to begin before finalizing construction documents—correlating to cost and time savings in the long run.

Strategic approach to procurement

Adaptability was key to successful procurement amid unprecedented supply chain disruptions caused by the COVID-19 pandemic. The design and construction teams collaborated closely to create forward-looking procurement packages that yielded several benefits.

For example, schedule management was enhanced by expanding the number of bid categories from 50 to 128 for components such as flooring, interior/exterior glass, wall protection, and pump/place/finish concrete work. This made certain bid packages more attainable to smaller minority- and women-owned business enterprise (M/WBE) subcontractors and suppliers and helped drive inclusion on the project with 48 percent of total project spend going toward more than 40 local M/WBE subcontractors.

Additionally, early procurement of critical materials such as concrete, rebar, and steel resulted in a substantial reduction in cost escalation that saved UC Health money on the project.

Despite nationwide construction delays—including port strikes on the East and West coasts that threatened to impact the on-time delivery of crucial materials such as the terracotta used on the building skin—the project team met the completion deadlines established pre-pandemic.

Project team collaboration

The surgical building was turned over in February 2023 and the ED opened in May 2023. Dr. Arthur M. Pancioli, the Richard C. Levy Chair of the department of emergency medicine at the UC College of Medicine and a UC Health physician, played a pivotal role in the project planning of the new emergency department.

He says the new ED is more than a new medical building; it’s a beacon of hope and healing for the entire Cincinnati community. “The ED itself is the culmination of a fabulous collaboration between caregivers, designers, architects, and construction management teams that has created a space, which allows this dedicated team to define a new standard of healthcare, one patient at a time.”

Andy Schultz is senior project executive at Messer Construction Co. (Cincinnati) and can be reached at [email protected].