by Kayla Sloan
According to the USRDS annual data report from 2019, the standardized rate of ESRD patients has held steady, and even slightly decreased, between 2011 and 2017, so much so that the rate in 2017 had not been matched since 1997 (1). Although the rate remains high, one could say that the stable count allows dialysis providers time to evaluate their station count and determine whether their time and money are well spent increasing station numbers, renovating outdated clinics, or both. It is especially important to keep clinics within a reasonable distance of the ESRD population, and at times there may not be quality real estate available in the area to relocate or build a new facility. If the current location serves the population well, the property is owned by the provider or they are within a long-term lease, renovation seems like a more reasonable approach. This can be a tricky situation as renovating a clinic requires high levels of coordination, but in some circumstances, it is the only option.
Renovations seem to be on the rise lately, and one renovation that proved to be complex in the beginning design phases was DCI Mt Pleasant. The existing clinic had outgrown its original 5,100 SF lease space, and was looking to expand into an adjacent lease space to bring the grand total to 7,100 SF. The original station count of twelve was also to be increased to sixteen along with a new home training suite. These additional spaces at minimum size add an additional approx. 660 SF, leaving about 1,340 SF to work with for general expansion. At first glance, this seems like a very reasonable, straight forward approach; you are given over one-thousand extra square feet to provide the same program. However, during construction, it was imperative that the clinic keep operations ongoing as there were no other clinics within a reasonable distance to transfer patients to, and during this time, these two functions had to be completely separated as if one or the other were not occurring, utilizing separate entry doors and contained spaces.
To provide a seamless transition, the new treatment floor had to be finished, approved, and licensed by the State to begin operations before the existing treatment floor could be shut down, signaling the need for a phased construction approach. To further complicate the matter, the existing treatment floor was located in the exact center of the entire lease space. Combine this with the existing location of entrance and delivery doors which were to remain, there was not much space left to place a typical large, rectangular treatment floor. Water processing equipment also had to continuously serve the existing treatment floor during construction, so the existing water room had to remain operational until the new water room was up and running. You can see in the phased floor plans below the approach we decided to take.
In Phase 1, the new addition to the lease space, which was already separated from the existing lease space, was built out with support areas, including the new water room. During this time, a temporary water line was installed on the existing treatment floor connected back to a temporary tank. Enter Phase 2. During this phase, the existing treatment floor ran off the temporary water set up, while the new L-shaped treatment floor was constructed and connected to the new water treatment room. Once the connection was complete, the lines and equipment were tested, and approval processes took place with the State. Finally, Phase 3 was ready to begin. In this final phase, the staff support spaces were constructed, consisting of offices, a break room, conference room, toilets, and home training suite, bringing the complex project to an end!
As you can imagine, coordination with the client is extremely imperative during design to plan for coordination during construction. No heavy renovation like this can progress smoothly without constant communication between the contractor and the local staff, but in the end, you end up with a new, beautiful clinic!
Citations:
United States Renal Data System. 2019 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2019