Monroe Carell Jr. Children's Hospital at Vanderbilt Vertical Expansion
Blair + Mui Dowd Architects, PC
Monroe Carell Jr. Children's Hospital at Vanderbilt Vertical Expansion
Blair + Mui Dowd Architects, PC
Awards Category : : Healthcare
Monroe Carell Jr. Children’s Hospital at Vanderbilt is middle Tennessee’s only freestanding children’s hospital and the region’s only comprehensive, nonprofit pediatric health care provider. The 250,000 sf vertical expansion provides capacity for VUMC to meet the growing community need and to dramatically advance the size and scope of the hospital’s pediatric healthcare programs. The LEED Silver project adds four new inpatient floors on top of the hospital’s existing nine-story structure; two floors are fully fit out and two floors are shell space, with an additional 158 beds in a universal room concept.
The Monroe Carell Jr. Children’s Hospital at Vanderbilt is one of the nation's leading children's hospitals, and the largest in the Southeast. With a population explosion impacting Nashville and surrounding communities, an expansion was necessary to serve the healthcare needs of the region’s families. After evaluating several scenarios—including new construction and alternate sites—the most efficient, economic, and sustainable option was to expand vertically, above the active hospital. Four new inpatient floors were added, the existing penthouse was expanded for new clinic space, and all floors of the existing building were partially renovated to accommodate two new elevators. Each new inpatient floor adds 40,000 sf and 38 inpatient beds, bringing the hospital’s total footprint to more than 1 million sf with 339 beds.
Expanding over an operational hospital required careful consideration during design and construction to minimize impact to the life-saving services provided below. The existing building footprint provided challenges to developing a state-of-the-art, flexible inpatient unit. Originally designed around the concept of cohorting patients by age, each existing inpatient floor included three isolated and independent care units organized around a central core. Enlarging the floorplates in the vertical expansion allowed more functional flexibility and operational continuity, enabling providers to flex unit size and cross-staff more efficiently. The additional floorplate area cantilevered 30’ over an eight-foot connecting corridor, modifying the existing exterior into a glass curtainwall that visually slips from the punched opening façade to provide additional light-filled space for new inpatient bedrooms and denote interior enhancements. The new floor plan emphasizes operational continuity, enabling providers to flex unit size and to cross-staff more efficiently.
To meet VUMC’s goal of enhancing the family-centered care approach, each new inpatient bedroom is designed to be acuity adaptable for PICU, NICU, or acute care patients, and sized to allow parents and infants to room together. Utilizing the more stringent FGI requirements for each type of patient room provided additional sentient benefits, including improved acoustic privacy by incorporating the STC and NRC requirements of a NICU. Circulation on each floor was organized to facilitate an “on-stage; off-stage” concept, with a separate corridor for staff to access equipment storage, clean and dirty linen, and other ancillary services, all out of view from patient rooms and the provider core.
Date of Completion: October 2020
Client: Vanderbilt University Medical Center
General Contractor: Turner Construction
Consultants:
Structural Engineer: Structural Design Group
220 Great Circle Road, Suite 106
Nashville, TN 37228
TEL. 615.255.5537
MEPFP Engineer, Communications Design & Energy Modeling Consultant: Smith, Seckman, Reid, Inc.
2995 Sidco Drive
Nashville, TN 37204
TEL. 615 383.1113
MEPFP Peer Review Engineer: Phoenix Design Group
104 Woodmont Blvd, Suite 218
Nashville, TN 37205
TEL. 615.345.0900
Civil Engineer: Barge Waggoner Sumner & Cannon, Inc.
211 Commerce Street, Suite 600
Nashville, TN 37201
TEL. 615 254.1500
Landscape Architect: Hodgson Douglas
120 29th Avenue South
Nashville, TN 37212
TEL. 615 327.4447
Lighting Consultant: Anita Jorgensen Lighting Design
100 Lafayette Street, Suite 604
New York, NY 10013
TEL. (212) 343.0454
Acoustical Engineer: Shen Milsom & Wilke
417 Fifth Avenue
New York, NY 10016
TEL. (212) 725.6800
Elevator Consultant: Lerch Bates
8089 S. Lincoln, Suite 105
Littleton, CO 80122
TEL. 720 283.8182
Equipment Planner: Balfour Resource Group
535 Marriott Drive, Suite 625
Nashville, TN 37214
TEL. 615.872.1136
Sustainability Consultant: GreenStudio
127 Third Avenue South
Nashville, TN 37201
TEL. 615.329.1399
Building Enclosure Consultant: Heitman & Associates, Inc.
14500 South Outer Forty Rd, Suite 110
Chesterfield, MO 63017
TEL. 314.439.1944
Heliport Consultant: FEC Heliports
5298 River Road
Cincinnati, OH 45233
TEL. 513.621.5260
Code Consultant: Jensen Hughes
360 W 31st Street, Suite 900
New York, NY 10001
TEL. 212.695.6670
Roofing Consultant: Clement and Associates
240 Foxboro Drive
Madison, TN 37115
TEL. 615.870.0808
Photography Credits:
01 – Photo by Sterling E. Stevens Design Photo
02 - Site Plan: After completing feasibility studies for adjacent sites on the VUMC campus, a vertical expansion was proposed to maximize density without significantly expanding the footprint of the existing building. Located on a prominent site, the new pediatric hospital meets Vanderbilt’s increasing demand for services while maintaining access to adjacent medical center facilities, outdoor space, and public transit. Drawing by Blair + Mui Dowd Architects, PC. Photos by Aerial Innovations.
03 - Typical New Inpatient Floor Plan and Vertical Expansion Axon: The shape of the new floor plate maintains the general form of the existing bent cruciform floors below, but adds two cantilevered infills, connecting all three units to allow flexible units sizes. Construction of two additional elevators and new utilities was challenged by the existing, diagonal post-tensioned structural grid and 24-hr occupancy of the building. Close coordination between construction, owner and design teams, including utility shutdowns and temporary circulation routes led to a successful project completion. Drawings by Blair + Mui Dowd Architects, PC.
04 - Building Section: The completed addition provides four new inpatient floors (totaling 152 beds), expanded mechanical space with adjacent clinic, and a new helipad roof. Each new bed floor has its own color identity, which continues from the interior finishes to the exterior window frames. To reflect the hospital modernization, the existing two-story main entrance and lobby were fully renovated with new interior palette, two additional elevators, and donor recognition areas. Drawing by Blair + Mui Dowd Architects, PC.
05 – Before + After: The existing 8-story hospital sits on a highly-visible site on the main VUMC campus. Rather than continuing the existing granite veneer, the new exterior has metal panel cladding and colored glazing to relate to the existing palette with modern materials. For durability, the new building envelope was built with a custom 3-coat, Duranar 70% PVDF coating on metal panel cladding. To maximize energy efficiency, insulated glazing with thermally broken frames were utilized, and solid walls were designed to optimize thermal performance through computer modeling. Before Photo by Blair + Mui Dowd Architects, PC. After Photo by Sterling E. Stevens Design Photo.
06 - Main Entrance and Lobby Interior Renovation: The existing hospital lobby and feature stair were part of an iconic, whimsical design. Renovation to the entrance lobby, mezzanine, and elevator lobby on each floor to accommodate two additional elevators was a complex, technical endeavor that required the lobby’s interior features and spaces to be maintained. Photo by Sterling E. Stevens Design Photo.
07 - Main Entrance and Lobby Interior Renovation: The featured space comprises the area around the feature stair from the first-to-second-floor lobbies and elevators. The renovated floor plans illustrate the repositioned stair, expanded balcony for new donor area, improved visitor visibility and wayfinding, and additional elevators. Drawings by Blair + Mui Dowd Architects, PC. Before Photo by Blair + Mui Dowd Architects, PC. After Photo by Sterling E. Stevens Design Photo.
08 - 10th Floor Check-in Area: The new patient units in the vertical expansion continue the child-friendly aesthetic of the existing building, including use of color, lighting, form, and playful motifs. Each floor’s identity is designated by a unique color - blue, red, green, and yellow, which aligns with the hospital’s logo. Photo by Sterling E. Stevens Design Photo.
09 - 10th Floor Corridor: The expansion employed a number of automated and passive energy efficiency strategies. To meeting current energy code, occupancy sensors and 50% controlled receptacles are required in conference, office, storage, and circulation areas, with automatic daylighting controls in corridors and daylight harvesting in visitor elevator lobbies and waiting rooms. Strategic locations of glass partitions and open areas resulted in 45% of the floor receiving natural light. Photo by Sterling E. Stevens Design Photo.
10 - 10th Floor Nursing Pod: Patient rooms, nursing core and supply rooms are planned based on an “on-stage; off-stage” concept in which visitor traffic is visually and physically separated from service and patient transport. Photo by Sterling E. Stevens Design Photo.
11 - 11th Floor Nurse Sub-Station and Patient Rooms: Satellite nurse stations and connecting doors between pairs of patient bedrooms support the centralized stations. Nursing staff have a clear line of sight and direct access to their patients, improving the level of care provided. Photo by Sterling E. Stevens Design Photo.
12 - Mobile Nursing Station: Mobile Crash Carts are banked in alcove areas of the administrative core for easy access and storage. Half-height glass partitions at clinical support rooms ensure staff visibility while maintaining patient and staff confidentiality in administrative and equipment areas. Photo by Sterling E. Stevens Design Photo.
13 - Universal Patient Room: The universal room concept ensures that all new rooms in the vertical expansion meet code requirements for NICU, PICU, and Acute care populations, along with isolation cases. This enables the rooms and patient pods to flex from one cohort to the next as populations grow or contract and as institutional goals evolve. Photo by Sterling E. Stevens Design Photo.
14 - Universal Patient Room: The vertical expansion features universal patient bedrooms that enable flexing of bedrooms and nursing pods, in addition to improved operational efficiency through cross staffing. The new daylight-filled rooms also feature flexible, built-out spaces to accommodate patient’s families and visitors. Photo by Sterling E. Stevens Design Photo.
15 – Photo by Sterling E. Stevens Design Photo