Medical Equipment Planning and the Design Process

Healthcare design projects vary widely in scope, from equipment replacement to clinical space renovations to new construction.  These projects can be as short as a few months or they can span years of work.  They also often encompass a huge range of complex medical equipment.  To streamline the design process, many healthcare systems choose to engage a Medical Equipment Planning team.  Many times, this team includes both medical equipment planners and BIM equipment placement specialists.
The healthcare design and construction process is complex.  It takes a full design team to transform basic requirements into a fully functional facility.  Medical equipment planners bring important information, gained through experience, to the design team.  This article will walk you through the medical equipment planning team’s role in the process.
During Pre-Design, the Owner gets funding for the project and hires an experienced Architect to complete the design.  The Owner also hires a Medical Equipment Planning firm (ideally prior to beginning Schematic Design).
Phase 1: Schematic Design (SD)
Schematic Design is the initial design phase in any project.  The goal of this phase is to create initial building plans that meet basic client requirements, such as number and function of rooms.  One of the important outputs of this phase is an initial cost estimate for the project.  At the end of SD, the project team presents preliminary design documents to leadership for approval to proceed.
During this phase, the architect conducts a series of user group meetings.  They start with departmental adjacencies and finish with a preliminary floor plan.  This article explains the process nicely.
Equipment Planner:
The equipment planner gathers information and compiles a preliminary medical equipment list.  At the beginning of the phase, the list is based on typical room contents and room functions.  As the user group meetings continue, the planner refines the list based on client standards and workflows.  When existing equipment is part of the project scope, the equipment planner conducts a capital equipment inventory and assessment.  The purpose of the inventory is to identify standard models and existing equipment.  This refines the list and provides a more accurate cost estimate.
BIM Planner:
Early in Schematic Design, room sizes and locations are very fluid.  It makes little sense to add equipment to the drawings.  As design progresses, the discussion drills down into more and more detail. Typically, by the end of
SD, the floor plans are ready to begin placing equipment.  The BIM planner begins to populate typical rooms in the Revit model with the equipment at the end of SD.

Phase 2: Design Development (DD)
As the team moves from SD into DD, the focus shifts from departmental adjacencies to room layouts.  One way to explain the progression is that walls move in SD and doors move in early DD.  By the end of DD, the only thing that should be moving is power, data, and minor coordination items.
During Design Development, user group meetings continue, but focus on the details within each room.  By the end of DD, workflows have been defined.  All furniture, fixtures, and equipment are assigned to designated locations in the floor plans.
Equipment Planner:
The equipment planner provides full medical equipment specifications to the Owner and Architect. In an ideal world, the equipment planner was on board from the start.  The “preliminary” list has already been scrubbed for client standards and workflows and the list is 80% complete.  When this is true, the medical equipment planner focuses discussions on location and workflow rather than reviewing a list.  During DD, the equipment planner also begins working with vendors to collect site-specific drawings.  These drawings show detailed placement, structural, and utility requirements for more complex equipment.  Some examples of equipment that require vendor drawings are ceiling mounted patient lifts, sterile processing equipment, and OR integration.
At the end of DD, the equipment planner issues an architecturally significant equipment (ASE) document with room-by-room equipment lists and manufacturer specifications to the design team.
BIM Planner:
By the end of DD, the design team has addressed every room with user group input.  The required casework, fixture, furniture, and equipment layouts have been determined.  As the equipment planner updates the list, the BIM planner updates the drawings.  The BIM planner also incorporates vendor drawings into the model.  The design team uses the resulting equipment model to start CDs with all the equipment information they need.
Phase 3: Construction Documents (CD)
During this phase, all details required to construct the building are documented.   This requires in depth coordination between the Architect, Engineer, Owner, and Equipment Planner.  When the 100% CD documents are issued, the design is considered “complete”.
In CDs, the design team clarifies all outstanding questions and adds tremendous detail to the drawings.  Minor adjustments are made to the plan as casework moves, conflicts are identified, and specifications are examined in detail.
Equipment/BIM Planner:
During CDs, the medical equipment and BIM planners play a supporting role.  They answer questions and facilitate coordination with vendor teams.  They update specifications and equipment placement drawings and provide clarification as required.
Phase 4: Construction
Once the regulating authority has approved the design, construction begins.  From this point on, the design is modified only as required by the Owner or to provide clarification to the Contractor.  Some equipment installations will occur during this phase (ex: OR booms, ceiling mounted patient lifts).
During construction, the architect collaborates with the contractor, answering RFIs and providing clarification as needed.  They also monitor progress and participate in OAC (Owner, Architect, Contractor) meetings.
Equipment/BIM Planner:
On most projects, the equipment planner attends at least a handful of OAC meetings.  They answer RFIs and coordinate vendor installations.  They communicate construction timelines to the vendor teams and help to identify when the site will be ready for installation.  They also communicate the vendor’s installation requirements to the contractor and notify the vendor of schedule slips.
The equipment planner may also participate in box walks.  When necessary, the contractor will rough-in or mock-up the utilities and wall-mounted equipment in an area.  They then invite the design team and clinicians to confirm the layout.  This way, any concerns with the layout are identified early and addressed at a lower cost.  One area where this step is common is patient headwalls.
Most of the equipment procurement happens during construction.  Large vendor-installed equipment and other “long lead time” equipment is purchased first.  Depending on the project timeline, some POs may have been issued during DDs.  The equipment planners collect quotes, coordinate deliveries, and schedule installations.
What happens if your equipment planner starts late in the process?
The preliminary layout can be done without the involvement of an equipment planner. Sometimes this poses some issues later in the design process.  This is because by the time the equipment planner starts using project specific equipment, the rest of the design is being finalized.  Design changes happen when equipment won’t fit in spaces as originally planned.  Some services (plumbing, data, power, HVAC, minimum floor to ceiling heights) needed for equipment to function are non-existent or haven’t been considered.  In some cases, the layout of the equipment is not ideal for the workflow of the users. Sometimes, non-facility standard equipment must be substituted to fit the space, which can complicate a flexible design.  Changes are easily accommodated early in the design process; they become much more disruptive as plans get more detailed.
The same idea applies to BIM planning. The BIM planners are aware of current best practice for layout and placement of equipment. They have the latest BIM Library with project specific equipment. They can easily identify potential conflicts in equipment and the designed space or services provided.   The BIM planner enables the entire team to understand the impact of changes during the design process without losing time.  They should be included in all user group meetings.  This gives them firsthand knowledge of users’ preferences and context on the decisions made in those meetings.
In a healthcare design project, there are many stakeholders involved in the decision-making process.  Including a Medical Equipment Planning firm in the design team adds an important source of information. The medical equipment planner’s experience brings insight into the “nitty-gritty” aspects of the equipment involved in a construction project.  They bring to the team an understanding of both product-specific issues and broad-scope implications of equipment selection.
Please contact us to learn more about how our medical equipment planning and BIM equipment placement teams can add value to your next healthcare design project.

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