Touring Enloe’s new tower

If you ask Bill Seguine for the square footage of a room—any room—in the new five-story, 191,000-square-foot Enloe Medical Center expansion, he’ll give you the answer off the top of his head. That’s how well he knows the building.

As the man who for the past three years has overseen construction of the $170 million Century Project, which doubles the size of the hospital, he knows it inside out. A mechanical engineer by training who specializes in building large medical facilities, he’s enthusiastic about the project and enjoys showing off its many state-of-the-art features.

On Friday (Jan. 7) I joined him and Christina Chavira, from Enloe’s Marketing and Communications Department, on a tour of the facility. From the outside it appears nearly completed, but inside it’s still very much a work in progress and won’t be finished until the end of this year.

The steel framing is up and most of the wiring, plumbing and ducting are in, but few of the rooms have been drywalled, none of the acoustic ceilings have gone in, and there are no lights other than construction lights.

Actually, it was a good way to see the building because so many of its state-of-the-art elements—fiber-optic cables, sophisticated air-management system, overhead operating-room booms—that otherwise might have been hidden inside walls were visible.

Few buildings are more complex than a modern hospital. As Seguine put it, “There’s only one kind of building that’s more highly regulated than a hospital, and that’s a nuclear power plant.”

The people who use a hospital, from patients and their families to nurses, technicians and physicians, see it in different ways and want different things from it. Balancing their needs and desires is part of the art of designing a superior hospital, Seguine explained, as is what he called “future-proofing” it—that is, anticipating changes, especially in technology, and being prepared for them.

That’s why they’re putting in Category 6 fiber-optic cable, which in networking environments has the highest transmission capacity. And it’s why they’re installing complete operating-room integration that allows instantaneous sharing of any visual image, from a patient record or an image seen during a laparoscopy to an X-ray or a televised image of the OR taken from a room camera.

During an operation, for example, an image of a tissue sample taken during a biopsy can be sent to the pathology lab for instant analysis, “and nobody has to go anywhere,” as Seguine said. By the same token, each OR is set up for video teleconferencing with experts outside the room, including physicians at other hospitals, even during the middle of a procedure.

This ease in communications is matched by ease in the use of operating tools. Each OR’s standard equipment, instead of being on wheels on the floor, is suspended from overhead booms, leaving the floor area largely free of potential physical obstacles and making the operating team’s ability to move around more fluid.

The designer and general contractor of the Magnolia Tower, as the new building is called, is St. Louis-based HBE Corp., a design-build company that specializes in health-care facilities. But Seguine and Enloe CEO Mike Wiltermood made sure to involve the facility’s eventual users in evaluating and then tweaking the original design.

Major changes have been made, chief among them a decision to complete the fifth floor. Originally it was to be left as a shell for later expansion, but there were problems with that. Seguine pointed out that construction to fill it in would force shut-down of the fourth floor, home of the maternity ward. And Wiltermood and the doctors thought the new operating rooms were too small, given the amount of high-tech machinery now commonly used in surgery.

The recession enabled them to contract for the expansion into the fifth floor at a cost that was only one-third of what it would have been during better economic times, Seguine said, which made the choice easier to make.

So they increased the size of the 13 new operating rooms on the first floor, which caused other services—intensive care, the med-surg and step-down units—to be bumped upward. Now the fifth floor will be used for treating ill patients who don’t require surgery—those with acute pneumonia, for example.

One result is that the new facility has more patient rooms than originally planned—224, with the capacity to go to 314 beds by converting some rooms to double occupancy. “I’m glad the [Enloe] board [of trustees] made the decision [to complete the floor] because it will help ensure we have private rooms for a long time,” said Wiltermood, interviewed by phone later that day.

That kind of privacy, combined with greater quiet, is important to healing, Seguine said. And Wiltermood noted that separating patients improves hospital infection rates, always a major concern.

Indeed, one of the more sophisticated elements of the new building, Seguine pointed out, is an air-conditioning system that controls the direction in which air flows through rooms. In a room housing an infectious patient, for example, the system maintains negative pressure, which keeps air from escaping into the rest of the building and instead ducts it to the outside.

Other rooms maintain positive pressure, which keeps air from the rest of the hospital from entering a room housing, for example, an immune-suppressed patient.

“This system allows us to accept more patients who are highly infectious” without endangering other patients, Wiltermood explained.

There is also a room designed specifically for what Seguine called “bariatric patients”—that is, those who weigh 500 pounds or more. It includes a hoist attached to the ceiling that can be used to move these patients, whether for linen changes or trips to the bathroom.

Many of these features can be found in any large, modern urban hospital, but with the Century Project Enloe is clearly making a concerted effort to be the regional hospital that offers more services to more patients than any other.

This extends as well to the non-medical amenities. The lobby of the new building is designed to look and feel more like a nice hotel than a medical facility, and there will be a lounge, a “garden café,” a gift shop and even a “meditation and reflection room” donated by Judy Sitton, a longtime trustee and supporter of the hospital, and her husband, Gary.

Such attention to comfort is part and parcel of Enloe’s emphasis on patient-centered care, and it extends to the new Nettleton Mother and Baby Care Center on the fourth floor, named after Steve Nettleton, the former supermarket magnate who has contributed generously to many local projects. The center will contain eight labor-and-delivery rooms and 18 post-partum rooms, all set up to accommodate family members who wish to keep the mothers company during delivery and afterward.

The center also has six neonatal-intensive-care rooms that contain sleeping surfaces for parents.

When construction on the new tower is completed, work will begin on expanding the emergency room, which will more than triple in size from 7,000 square feet to 24,800 square feet, Seguine said. After that, the old Enloe tower will be renovated and the historic original one-story hospital building will be converted into offices and clinics.

Patients are a hospital’s customers, of course, but so are physicians. Enloe’s trustees realized several years ago that they needed to upgrade the hospital in order to attract more doctors to town.

“We’re recruiting now and will be into the future to replace doctors who are retiring,” Wiltermood said, “and having a state-of-the-art facility is a huge help.”

That, combined with new seismic-safety requirements that come due in 2013 as well as long-term projections for population growth in the region, convinced the trustees that an expansion was critical to the survival of this unique stand-alone, community-controlled nonprofit hospital.

But it’s not cheap. Total cost will be “$170 million when it’s all in,” Wiltermood said. The addition of larger ORs and additional larger patient rooms “added a considerable amount over the original design.

“But if it attracts more patients to the facility, it will pay for itself.”