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Five key successes from delivering in an acute care hospital

Deploying Intelligent Solutions in a Devon healthcare environment

Just before the project started, the existing Emergency Department at the Royal Devon and Exeter Hospital saw around 104,000 patients a year; an increase of around 25% since the last time the department’s buildings saw major changes.

This demand increase, reflective across the country, is a large contributory factor in serving up more capacity for the hospital to serve its community.

We caught up with the Hospital's Capital Projects Manager, Marc Thornton, and Morgan Sindall Constructions project manager for the scheme, David Pearce, to understand the successes they've delivered so far.

Demand on the services is generally increasing, so there are real challenges we face. This scheme increases our capacity and means we can continue to meet the needs of the catchment area.
Marc Thornton, Capital Projects Manager, Royal Devon & Exeter Hospital

Five key successes

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What are the team delivering?

The new Emergency Department project, procured through the SCF framework, involves the construction of a concrete framed three-storey extension that houses 8 new resus bays, theatre space and a plant room, with new ambulance bays, a pedestrian entrance and newly configured hospital roads.

In and around this, a new fractures department has been created, a new generator base, a temporary modular waiting room installed, the existing boiler house demolished and a number of knock-through and reconfiguration elements that bring together the whole of this complex project. The scheme’s consultants are Stride Treglown, ClarkeBond, Hoare Lea and Peninsula Projects.

Flexibility around a changing NHS landscape

Despite the clarity around what needed to be delivered, it wasn’t all plain sailing, as Morgan Sindall Construction’s project manager on the scheme, David Pearce, explains; “A lot of work had been put in by all parties prior to the pandemic, but when COVID-19 hit the UK, that changed everything. Priorities understandably changed and we had to redesign the scheme and the phasing sequence in order to make the project workable for the hospital.”

Flexibility has been an important factor in the success of getting the project off the ground, and careful organisation of the phasing, especially during the pre-construction element was absolutely vital too.

By re-working the scheme, the team undertook enabling works first, the fractures department refurbishment and the installation of the temporary modular waiting room – all three of which were key phases to unlock future areas of work. A trend that has continued throughout the scheme, with temporary ambulance bays installed as well before the bigger extension works took place.

The phasing here is complex, but it’s vital to the scheme. Even towards the end it will mean the resus bays are completed before outside is finished, so that we can then unlock the next element for the team to complete. Marc Thornton

Patient first planning

Delivering any project on a live acute care hospital site is a challenge, but at the Royal Devon and Exeter Hospital, the integrated team are having to lean heavily on communication and collaboration.

The project is sandwiched between the hospital’s Emergency Department, Intensive Care Unit, its main operating theatres, as well as various other wards. In addition, the site resides right underneath the air ambulance helipad and directly on the blue light route. It is just about in the busiest and most sensitive place a project could happen.

We’re very focused on making sure everything we do here, takes into account the needs and impact on the patients and clinicians around us. Being right next to the window of ICU, where we know there are really poorly patients, really does bring a perspective to what we’re doing. Every ward sister has my mobile number and we’ve stood down works in a matter of minutes out of respect to patients whenever required.
David Pearce, Morgan Sindall Construction
David Pearce, Project Manager, Morgan Sindall Construction

David goes on to explain that this patient-first communication mantra becomes part of the site DNA. Weekly meetings which involve department heads, the Trust and consultant partners help steer works and keep everyone updated.

They’re constantly working with the air ambulance as well to be mindful for when helicopters are coming into land over the site accommodation.

During the initial phase of installing a temporary modular waiting room, the team even had to extract groundworks from a landlocked courtyard, right through the main hospital street (pictured).

This meant wheelbarrow loads being walked through the hospital, one-by-one, so specialist electric plant was used and the team employed a banksman and a cleaner to follow every single load in and out of the hospital to help protect the patient experience.

Both Marc and David also explain that visiting the wards, to discuss how works specifically impact them, and what solutions will minimise that impact, makes a huge difference on the experience:

Communication is vital. Especially with the hospital staff. For example, before we commenced the Fractures clinic refurbishment portion of the project, we visited the staff together and spent quality time on their ward talking through the works – this helped build relationships. Even once this piece of work had been completed, there has been times over the last 18 months, where disruption was seen, yet the staff there are still so accommodating. All clinical service adjacencies have been accommodating, even during smaller knock-through’s we again visited the theatre, having conversations with the matron, Infection Control and the Trusts Health and Safety Team to discuss how and when works would take place, to understand the disruption and give confidence to the clinical team that their service would not be affected by the works. In fact, it’s often these little things that go unnoticed that are real success stories of working in such a complex environment.
Marc Thornton, Royal Devon & Exeter Hospital

Solutions for services complexity

As you might imagine, the mechanical and electrical elements of the works are amongst its most complex. Aside from the challenge of connecting into many of the main districts on site, it is the unknown which has required the most innovative of solutions.

During excavation works for the new extension, it became clear that the level of unmapped services buried in the ground was extensive.

To continue with a traditional style of excavation was too risky for the project. There are services here that if interrupted, could affect live operations for example. With that in mind, we worked with the Trust to bring in a machine called a VACEX. In simple terms this acts like a ‘hoover’ carefully sucking up the ground around services, making sure they remain uninterrupted.
David Pearce, Morgan Sindall Construction
Specialist services supply chain partners have been absolutely vital

It’s a more expensive and slower solution, but the risks involved of interrupting services are too high – so this intelligent piece of equipment is quite literally safeguarding hospital operations with every second it works.

Alongside this solution, the team have captured back some of the time by changing the foundation solution. Instead of traditional foundations, the team has used a step-up block system, which has helped them raise ground levels up to the new ED entrance, 40% quicker. The hollow blocks are installed much faster, filled with rebar and concrete and have been also used for the retaining walls.

The team here, they get it. They're conscious that they're not in their little bubble, they know that eyes are watching and that it's a big, important scheme. They know what's going on outside their world and within the hospital, and that's so important.
Marc Thornton, Capital Projects Manager

Five key successes

Whilst the project continues on to its finish at the end of the year, there has definitely been some key learnings – something the team will take on to the next acute care project:

  • Patient first, always | Working next to ICU, theatres and wards mean that understanding patient priorities is key. From implementing sensitive foundation solutions, patient privacy screens and stand down communication lines, the team remain patient-focused
  • Clear and constant communication | from liaison with the air ambulance and blue light routes, to explaining knock throughs to theatre matrons, keeping clear lines of communication with multiple stakeholders is vital
  • Specialist equipment | equipment such as the VACEX to safeguard excavations have been vital here – it provides peace of mind that services remain uninterrupted across the hospital
  • Flexibility and resilience | Be prepared to constantly flex schedules of works, programmes, and even design where required – COVID showed us that plans can and must change sometimes
  • Building trust | Learning curves on acute care jobs can be steep – that’s why it is so important to bring in an experienced team, including specialist consultants and supply chain, who can build the levels of trust needed to succeed in a hospital