The Children’s Hospital at Erlanger in Chattanooga has recently opened its new Outpatient Center, a $29.5 million project that adds substantial capacity and healthcare services to the area. The three-story, 90,000-square-foot Children’s Hospital Outpatient Center (CHOC), which also serves as the hospital’s new entrance, is just the first phase of a dramatic expansion plan initiated by Erlanger Health System – a Chattanooga based multi-hospital system named as the 10th largest public health care system in the United States in a 2018 survey.

The Children's Hospital is the only pediatric facility in the region that offers a Level 4 NICU, pediatric transport, and trauma center with surgical suites for kids. Ninety percent of area children who are fighting cancer are treated at Erlanger’s Comprehensive Cancer Center.

Today, more children are treated in outpatient services for many illnesses/diseases that used to be deemed chronic and serious. Currently, outpatient services provide over 100,000 children a year, and with follow-up appointments averaging two to three times per year. The new Outpatient Center, designed with input from patients and their families, utilizes design elements meant to reduce anxiety and keep children positively engaged. The facility – which houses 72 rooms and services including pediatric imaging, lab services, pharmacy and pediatric specialty clinics such as cardiology, neurology, genetics, gastroenterology, and orthopedics – will serve as the hub of pediatric health care for a 50,000-square-mile service area.

Designed to Be Family-Friendly

McCarthy Building Companies’ Atlanta office provided general contractor services on the Outpatient Center project. As Kevin O’Keefe, McCarthy’s Southern Region Project Superintendent, explains, “The center was designed and built to be a family-friendly facility that would engage children by distracting them from their illnesses as well as meeting the complex needs of families and physicians. CHOC is now home to an array of services including 21 pediatric specialties; the region’s only certified pediatric genetics counseling; centers for child psychology, physical therapy, and hypertension; and the HEAL (Healthy Eating Active Lifestyle) Center to address pediatric obesity.

“Inside the building the environment was created to heal, teach, and play.  There is an 1892 steam engine sitting in front of the building.  The first-floor lobby has a model train, and an old BMW Isetta.  Level two has a tow truck and video on roadway safety.  Level three has a fire truck and a video game system that projects onto the floor.  And then – just because it is a health care facility – there are state of the art X-ray systems and uniquely designed exam room pods that feed the cohesive team environment and streamline the process for the patients.”

O’Keefe reports that McCarthy Building Companies was initially awarded the project in November 2014. There were a series of planning sessions, with pre-construction paralleling the planning. Once the GMP was executed in April 2017, the project moved quickly to a groundbreaking in June 2017. The project was completed in November 2018. The designer of the facility was HKS Architects, whose Outpatient Center design was recognized with an American Institute of Architects Richmond Honor Award of Excellence in Architecture. Other project partners include structural engineers Walter P. Moore and Associates, Inc., civil engineers March Adams & Associates, Inc., and mechanical/electrical/plumbing engineer WSP.

Advanced Technology Ensures High Level of Care

The new Outpatient Center is impressively equipped with advanced technology and facilities to provide the region's highest level of pediatric care (see sidebar).

One of the most significant examples of the CHOC's use of cutting-edge technology is its EOS imaging device. EOS imaging generates full body, weight bearing scans that yield high definition images with significantly lower radiation than traditional radiographs. Typically, the process would require a child to be still for 15 to 20 minutes, often a difficult task. The equipment at the CHOC can basically take an X-ray of a child's entire skeleton, including spine and legs, in 20 seconds. This device, the first of its kind in the region, also reduces the amount of radiation to which patients are exposed.

Two of the of the Center's most innovative features are on its exterior – specially designed concrete panels and glass. O’Keefe explains, “There was extensive use of VIEW Glass, which automatically changes the window tinting according to the sun’s intensity; this eliminates the need for blinds and increases energy efficiency. It can significantly impact the life cycle costs of a building by controlling the heat gain from direct sunlight.”

Patients, Families, Community Collaborate in the Project

According to O'Keefe, the two main challenges in building health care facilities are coordination and meeting code/design requirements. “The standard building systems in healthcare are more robust and must be coordinated with additional systems like medical gases, nurse call, infant protection and patient-monitoring systems, to name a few. All of this makes the overhead coordination of the utmost importance and very challenging. Additionally, each room is designed for a very specific purpose, making in-wall coordination much more critical. Things like receptacle locations and med-gas outlet locations have a huge impact on the overall functionality of the spaces. In some instances, a few inches can make all the difference.

“The second challenge is keeping up with all codes/design requirements. In a health care facility, each department has its own codes/design requirements that you need to know and understand. Codes change frequently as new research and technology is implemented. Construction teams need to keep regulations in mind and be prepared for inspections and the potential for new requirements introduced throughout the project.”

He adds that while the project was a stand-alone building and interaction with existing facilities was very minimal, this is an active campus – so the contractor maintained its site fence and coordinated sidewalk closures to minimize the overall impact.

“Another important facet of the project was keeping the excitement of the community, patients, and staff up during construction,” O'Keefe comments. “To achieve this, we had several tours of the building.  We also utilized a 3-D video camera to create videos to share with patients in the hospital and their families, using Google cardboard glasses to allow them to be immersed in the construction.

“In addition to the 3-D camera and Google cardboard glasses, we used VR mock-ups for the users to get a feel for the spaces early, during preconstruction.  We also built a mobile mock-up that was moved two or three times for different groups to review and refine the design of the patient rooms.  We used 3-D overhead coordination and tested it with Augmented Reality for inspections/review of work in place.  We utilized laser scanning during slab placements to achieve FF/FL numbers.”

One of the unique challenges of the Erlanger CHOC project was coordinating and lifting donated items, including a restored 1950’s tow truck, a fire engine cab, and an 1891 steam engine and tinder that serve as interactive elements on each floor. These installations were accomplished through coordination with service providers that included Chattanooga firm B&B Crane Rental.

Providing a Welcoming Atmosphere

In addition to the fire truck, tow truck, and train, the Children’s Hospital Outpatient Center has many other features which contribute to its family-friendly environment. Visitors are surrounded by abundant color when entering and walking through the building. Throughout the center, patients and guests experience discovery zones, multiple murals, local artwork, drawing stations, a café and an outdoor patio. Outside is a “secret garden” for which children must search to find the button to the door.

The center also features a Woodmore Memorial – the stone monument is dedicated to the victims of the 2016 bus crash that killed six local students.

“The hospital will attract the best medical talent to Chattanooga and serve as a catalyst in developing a new Wellness and Innovation District,” says O’Keefe. “Additional jobs and health care offerings will bring more people to the area, spurring new residential and retail development in downtown Chattanooga.”