North Carolina Baptist Hospital (NCBH)
New Emergency Department/ICU Building
Ardmore Neighborhood Association Follow-Up
Below are answers provided by WFUBMC to questions asked by Ardmore residents at the January 16 and April 12, 2007 meetings.
Answers are provided by the following groups:
Brasfield & Gorrie: Pre-construction General Contractor
ED: Emergency Department – James Bryant, Director
Engineering Tectonics: Site/Civil Engineer
HKS: HKS, Inc. – Architect
Stimmel: Stimmel Associates – Landscape Architect
WFUBMC: Wake Forest University Baptist Medical Center
WSA: Wilbur Smith Associates – Transportation Consultant
1. Why are we doing this?
Our current emergency department (ED) does not have the capacity to meet the ever-increasing community demand. We saw 85,000 patients last year, yet the current emergency department was built to accommodate 55,000 patients per year. The proposed expansion will accommodate a maximum of 129,000 patient visits per year.
The proposed ED design includes a number of state-of-the-art elements that will improve the ED function, space, and efficiency. Additionally, the ED has several design features that will maximize staff productivity and patient flow throughout their visit.
Regarding the ICUs, there is a growing consensus among health care providers that physical environment can contribute to improved patient outcomes, improved family support, patient satisfaction, and more effective staff performance. Another development in the industry is the increased recognition that visitors to the ICU should have access without limitation in order to provide additional support and potentially improve patient outcomes.
The current ICUs were built in 1989 and are an open ward configuration and do not allow privacy nor will they accommodate family members staying in the room.
The proposed ICU room design includes a private or closed room for every patient. Priorities in infection control, patient privacy, and reduction in sensory overload make this the design choice for most ICUs today. The rooms are designed with access and visual observation from room to room for nurses to be efficient and accessible at all times. Additionally, the building’s design optimizes the amount of natural light in patient rooms, which is demonstrated in improving the healing process. Increasing the number of ICU beds will allow NCBH to appropriately accommodate the critical population treated at NCBH and meet the current and future demands for intensive care services.
Patient care has been and always will be our first priority. As our population increases and ages, demand for these critical services will continue to grow and we are committed to providing the needed services with the highest regard for excellence and patient safety.
2. Why does it have to be located at the proposed site?
Facilities Planning and three architectural firms explored six different possible sites and this is the only site large enough to accommodate the needed space. The project is planned for the site that is currently occupied by the Meads Hall, GCRC and PCU buildings. As a result, the occupants of Meads Hall, GCRC and PCU will be relocated to other existing space on and off campus and these buildings will be removed to prepare the site for construction. This site was selected due the age of the buildings, its location on the corner of campus, and the opportunity to create new clinical space on campus. In addition, the existing AirCare Memorial on the proposed site will be relocated to a dedicated green area as part of the new project.
3. Will there be increased noise from ambulances?
EMS ambulances will turn off their sirens when they exit I-40 or approach from the south on Hawthorne Road, as currently practiced. Only ambulances transporting adult patients will be entering the new Emergency Department. Currently, 16% of the patient visits to the Emergency Department arrive by ambulance (2006 data – 13,206 adult arrivals or 87%, 2,006 pediatric arrivals or 13%). The pediatric patient traffic will remain in the current Emergency Department location, as WFUBMC will not move the Pediatric ED.
4. Why does the ED entrance have to be at Hawthorne Road rather than the main hospital entrance?
Ambulatory patients will be entering the ED from the main hospital (west) entrance. This will enable visitors to park in the existing visitor parking decks directly across from the new ED entrance for visitors. For traffic, safety, and security reasons, it is strongly desired to physically separate the visitor and ambulance entrances.
5. Why does there have to be a helipad on the new building?
A touchdown helipad will be located on the top of the building so adult trauma patients can quickly and safely be off-loaded with easy access to the ED.
NCBH is the only Level I trauma center in the western half of North Carolina and receives the most trauma and acutely-ill patients. It is imperative that these critically ill patients have fast access to emergency care.
NCBH is considering purchasing a new AirCare helicopter. The new helicopter will not have a tail rotor and is quieter than the current one. The new helicopter also has an eight (8) second shut-down of the engines which will speed access for patient care.
6. Will we be renaming Queen Street?
7. Will Queen Street be closed during construction and/or realignment?
No. Before the current Queen Street is relocated, the new roadway will be created parallel to the old. At some time there will be a “change-over’ to the new road location.
8. Where will construction crews park and be housed?
This has not been decided yet but every effort will be made to create the least amount of congestion. Construction offices will most likely be located in currently vacant buildings west of the Medical Center.
9. Will overhead signage remain on Wake Forest University Baptist Medical Center property frontage?
All current signage, overhead or monument signs will remain as is or be relocated to property owned by WFUBMC.
10. Concerns of pedestrian crossings at Hawthorne.
All new intersections will be appropriately marked for pedestrian crossings as required by City of W-S regulations.
NCBH is in the process of submitting documents to the City Secretaries Office for the street closure (relocation) of Queen Street. The petition will be reviewed/approved through City Council. This process takes approximately four (4) months.
11. Street closure/Abandonment process?
Approximately 480 linear feet of Queen Street will be relocated to accommodate the building expansion. A petition to formally close and abandon this section of right of way is to be filed with the City Secretary. The petitioners are Wake Forest University Health Sciences and North Carolina Baptist Hospital. Currently, only the petitioner’s property frontages will be impacted by this closure and relocation. The process, through the City Council, will take approximately four months.
12. Zoning lot limit changes?
The existing Wake Forest University Health Sciences parking lot property on the south side of Queen Street is currently zoned Campus – “Special Use“ (C-S). A section of the relocated Queen Street will be encroaching on this property. As the property is “Special Use“ zoning a petition to amend the zoning will be filed with City / County Planning. The process, through the City / County Planning Board, will take approximately three months.
13. Rerouting of water/drainage lines?
Approximately three acres of drainage area south of the hospital campus is currently collected and piped beneath Queen Street into campus storm water systems. This off-site drainage area, a section area of relocated Queen Street, and approximately half of the new building expansion are to be collected and routed through a new underground storm pipe system beneath Queen Street, east of the expansion site. The new storm system will cross beneath Lockland Avenue and discharge on WFUBMC property into the branch of Peters Creek which runs from south to north. A storm water study for improvement has been requested by City Public Works and is pending.
14. Why must ambulances enter the emergency room from Hawthorne Road instead of Queen St?
An access point to the ambulance deck from Queen Street would preclude the new drive under the ambulance deck. This drive is needed for access to the morgue (out of public view), access to Hospital lab functions, and to provide a covered/sheltered area for mass decontamination/treatment in case of a large disaster in the community.
There will be three traffic lanes for the ambulance to potentially use in making the initial left turn from Queen Street onto Hawthorne Road. Traffic should yield to an ambulance with lights flashing. Once on Hawthorne Road, the ambulance will have four traffic lanes, with one lane being a dedicated left turn lane into the ambulance deck. Emergency vehicle preemption for this left turn is being considered in the signalization design.
15. Decision for location and possible alternatives
a. Is this a done deal?
WFUBMC Response: Design Development drawings have been completed and we will be proceeding with City of Winston Salem review process within the next few months.
b. Why change the entrance to the emergency area from where it is?
HKS Response: Based on the volume projections, there is not enough available space in the existing ED to expand the ED and provide vehicular and pedestrian access. The current drop off area is already confined and congested. Moving the adult ED out, allows the pediatric ED to stay and expand in place. This solution allows both EDs to grow and leaving the pediatric ED is more cost effective than moving both. In addition, one of the primary functional relationships in the hospital is to have the ED close to intensive care beds. In its planned location at the bottom of the new ICU bed tower, it is a direct elevator ride up to these beds.
c. Is it feasible to shift other hospital services into this space to free up space in other areas of the campus that would allow expansion of the existing emergency room, which is a more logical location for cars and speeding ambulances going in and out 24 hours a day?
HKS Response: The existing ED is separated horizontally from the rest of the hospital by the loading dock and receiving functions. Vertically, it is sandwiched between the kitchen below and the dining room above. These are all spaces that functionally need to remain where they are. This leaves the current ED landlocked with no room to expand.
d. As for the idea of having a separate children’s ED, why can’t there be one big emergency room with two entrances?
HKS Response: If there were no existing space impediments, this could be a viable alternative.
ED Response: The Queen Street location did not allow for the entire department to be placed on one level, this may have required elevator travel for emergency patients that was not in the best interest of these patients. In looking at our long range plans for Brenner Children’s Hospital and similar hospital within a hospital models, the Medical Center had an opportunity to build an emergency department as an integral part of the children’s hospital. The concept allows staff and the building to be designed exclusively for children and their parents. It would be unique to our region and appeal to parents, children and their physicians.
e. To eliminate need to realign intersection, why can’t land be taken away from the hospital and keep current alignment at Queen & Hawthorne?
HKS Response: The proposed realignment squares the intersections, providing the opportunity for a signalized intersection into the ambulance deck. It also allows the secondary entrance off of Medical Center Blvd. for morgue and lab deliveries.
WSA Response: The proposed intersection design also provides shorter delays and queues along Hawthorne Road than what is currently experienced.
f. Have you look at other hospitals that have evolved within existing neighborhoods…like Johns Hopkins in Baltimore?
HKS Response: We have not looked at this specific facility, but this is a fairly common situation.
ED Response: Having worked at Johns Hopkins they are struggling with the same challenges. JHU has purchased over 40 blocks of downtown Baltimore with plans to invest over 2.0 billion dollars in new construction. These plans were met with considerable public opposition due to the removal of hundreds of “row houses” deemed historic and featured in the HBO series “The Wire” based on the best seller “ The Corner” but city leaders have endorsed the project including a multi-million dollar bio-tech campus.
g. Current location causes the least amount of traffic issues as well as being as close as possible to Bus-40. Moving the entrance to Hawthorne is going to be catastrophic as far as traffic problems; Hawthorne is already congested. Option of Medical Ctr. Blvd doesn’t seem much better because then ambulances will be contending with the people looking for the entrance to Janeway and Reynolds towers for their clinic appointments.
HKS Response: We agree that combining the main entry drive with ambulance traffic is not the ideal solution. The original ED had the ambulance deck off of the main entry drive and that was changed years ago.
WSA Response: The relocation of the main ED access to Medical Center Blvd is expected to have a minimal effect on traffic operation outside of the hospital campus, as the regional traffic patterns to and from the hospital will not change. Any traffic-related impacts from general public accessing the ED should be contained within the hospital campus. WSA has worked extensively with the WFUBMC to ensure that the main access point is designed and signed appropriately to provide safe and efficient ingress and egress to the main ED entrance and to provide for safe and efficient movement of ambulances into the ambulance entrance on Hawthorne Road.
16. New buildings and location
a. How tall will the new buildings be?
HKS Response: The majority of the building face along Medical Center Blvd. is about 34’ above grade. The stair towers at the ends of the new bed towers are about 115’ above grade. For reference, Meads is currently 42’-8” tall at the street face and steps up to 58’-8” at the mechanical penthouse.
b. Please provide additional renderings that will provide street views of the new buildings (also a request to make those available online).
WFUBMC Response: Available building images to be presented at April 12th meeting.
c. Can the hospital do anything to camouflage the new towers (like plant trees that will eventually grow to provide a barrier / transition between neighborhood and hospital)?
Stimmel Response: There will be street trees planted along Queen Street to soften the building. Also there will be a minimum 15’ Type II Bufferyard required adjacent to the residents on Hawthorne Street to transition and buffer the neighborhood from the hospital.
HKS Comment: The design currently shows lines of Bosque Elms on either side of Medical Center Blvd. in addition to other lower plantings. These elms grow quickly and have a mature height of 50-60 feet. There are also landscape buffers at both the north and south corners of Hawthorne and Medical Center Blvd. Landscape plan will be presented at April 12th meeting.
d. Where will drive traffic park for the new ED? Concerns they may start parking near Craig St., which has limited parking.
HKS Response: The public traffic for the ED is planned to park in Parking Garages A&B. The public drop off lane has been aligned with the entry drive into Garage A for direct access. There will also be valet parking provided at the public drop off.
17. Ambulance entrance off of Hawthorne Rd.
a. Traffic queued up on Hawthorne, difficulty yielding to ambulances.
WSA Response: Simulation analysis of the realigned Queen Street / Medical Center Boulevard / Hawthorne Road intersection indicates that the queues along Hawthorne Road will be less than what is currently experienced, particularly for the through volumes. Additionally, the vehicles traveling through the new intersection will, on average, experience less delay with the proposed design.
b. Traffic queued up on Queen, difficulty yielding to ambulances.
WSA Response: As with Hawthorne Road, the queues along Queen Street are also expected to be lower under the new configuration than what is currently experienced.
c. Difficulty for cars to see ambulances approaching intersection if sirens are off (which has been promised). Will ambulances be able to control stoplights?
WSA Response: The new signals at the realigned intersection can be designed with emergency vehicle preemption. This option is being explored.
d. Opportunity to end illegally parked cars on Hawthorne Rd, blocking driving lane.
WSA Response: WSA has recommended increased enforcement of illegally parked cars on Hawthorne Road to alleviate traffic congestion on the area.
e. If morgue entrance is off of Queen St., can ambulance and morgue entrance be switched?
HKS Response: No, they cannot be switched. The morgue entrance will have a very small amount of traffic. The ambulance entry, which will handle more traffic, has been aligned with a signalized intersection.
a. Concerns over significant increase in traffic and noise.
WSA Response: Any traffic increases in the area outside of the hospital campus would be tied to increased use of the ED and hospital in general over time, as stated before WSA has worked extensively with the hospital to address traffic issues throughout the campus.
b. 13206 adult arrivals in 2006…projected increase?
ED Response: Emergency Department volumes are currently expanding at a rate of 5% annually, this would result in additional ambulance transports for our patients. Arrivals expected to expand proportionally.
c. Are there peak times of day for adult ambulance?
ED Response: Peak hours are after 5:00 p.m. for EMS traffic but volumes increase beginning at 3:00 p.m. and continue until just after 10:00 p.m. and decline over the reminder of the night.
d. Please share results of traffic study.
WSA Response: To present/comment at April 12th meeting.
19. Storm water runoff to Lockland Park
a. Where will new drains empty?
Engineering Tectonics Response: The proposed storm drainage systems will not drain to Lockland Park, rather discharge of storm water is planned northeast of Queen Street and Lockland Avenue intersection (Graphics were shown at April 12 meeting).
b. What will be impact current flooding issues around Lockland Park?
Engineering Tectonics Response: None.
c. Will realignment of intersection and/or regarding of land impact direction of flow of storm water from current conditions?
Engineering Tectonics Response: Yes, currently approximately 7 acres of off-site (non WFUBMC) storm water runoff enters onto the Campus from Queen Street. This runoff is piped beneath the North Tower and continues to run in a piped system to the north until it discharges into the Peters Creek tributary running parallel to Cloverdale Avenue. Supporting graphics to be provided as requested by WFUBMC.
20. Construction phase
a. Location of trailers / offices / daily parking – has a decision been reached?
Brasfield & Gorrie Response: No, but most likely towards Business 40 or in current/future hospital offices.
b. Debris removal – time of day? Routes?
Brasfield & Gorrie Response: Will occur during normal business hours (7am-5pm). Route will most likely be away from the hospital towards Business 40.
c. Housing for workers? – potential for crime/trash/etc plus possible abuses for illegal rooming houses – How will this be policed?
Brasfield & Gorrie Response: The majority of workers will be local Winston-Salem residents.
a. Additional noise
HKS Response: The planned flight path will be the same as it is now, from southeast to northwest. It will land considerably higher than currently, which will help with the sound. Existing helipad is approx. 40’ above grade (assumed to be 875.5); the new helipad will be 111’ above grade.
ED Response: At the time of occupancy the Medical Center will have upgraded our existing aircraft with a smaller, quieter and more fuel efficient model. Pediatric patients and those going directly to the OR will continue to use the existing helipad.
b. Is rezoning required?
Engineering Tectonics Response: Yes
22. Bus Stops
a. Will city or school bus stops be temporarily or permanently moved?
Engineering Tectonics Response: Bus stop on Hawthorne just north of project site to remain as is. Bus stop on Queen to be relocated to one side of Queen Street and Main Access Drive intersection. (Graphics to be provided as requested by WFUBMC).
23. Pedestrian Crossings
a. How will current employee pedestrian traffic be accommodated?
HKS Response: The employee pedestrian traffic will be similar to how it is now. However, the reworking of the intersections will make them more square and will make crosswalks more direct.
WSA Response: Pedestrians will continue to be accommodated at the realigned intersections via crosswalks on Hawthorne Road north of Queen Street and South of Medical Center Boulevard (i.e.: not between the realigned intersections) and on Medical Center Boulevard west of Hawthorne Road and Queen Street east of Hawthorne Road. Signal timing will be designed with adequate crossing time for pedestrians.
b. Baptist should consider ways to keep pedestrians from crossing Hawthorne from the employee parking lot to the main buildings.
See above response.
c. Concerns about safety for school children walking to Brunson or Wiley, both during construction phase and afterwards, with increased traffic.
WFUBMC Response: Pedestrians traveling north on the east side of Hawthorne will cross Lockland as they are now with a signal and crosswalk.
a. Have any studies been done about potential increase in crime, with more walk-in traffic being shifted closer to the neighborhood homes?
HKS Response: No, there will be manned security stations at each ED entry as there are now.
b. Potential for construction phase reducing traffic or creating dead-ends in certain sections and creating less safe conditions for walking traffic (Example – recent attacks in West End).
HKS Response: The intent is to not shut down streets or create dead-ends.
25. Other questions
a. How much money are government agencies going to spend to make this construction project possible? Please include all sources of revenue such as Winton-Salem taxpayers, N.C. taxpayers and U.S. taxpayers.
WFUBMC Response: There is no expected government or taxpayer funding associated with the project. We thought through all potential revenue sources, and neither our internal reserves or the planned bond financing would be considered a use of governmental funds.
b. Did NCBH or WFUBMC have any influence in the purchase of the 2 homes on Hawthorne that “Ronald McDonald” purchased in Nov, 2006 for over double their tax value?
WFUBMC Response: Early on WFUHS did have some discussions with Ronald McDonald staff regarding some property swaps which would enable the Ronald McDonald program to expand. The Medical Center remains committed to working out a viable plan to enable expansion of Ronald McDonald House.