For decades, hospitals have been defined by the number of beds they have. But, if the Mount Sinai Hospital System (MSHS) and its CEO, Dr. Kenneth L. Davis, are correct, in the era following the implementation of the Affordable Care Act, hospitals will instead be defined by the number of patients they treat. By refocusing from a treat-and-admit inpatient mindset to a treat-and-release ambulatory-care platform, MSHS is aiming to keep patients out of hospitals, but until recently it didn’t have the appropriate venue to fully embrace its forward-thinking perspective.
Enter Davis Brody Bond, the firm MSHS selected, following an invited design competition, to expand and modernize its physical plant and clinical offerings at its Mount Sinai Queens facility. “At the interview, we presented a comprehensive solution to MSHS’s needs, founded on a concept vetted by the project’s major players,” says David Williams, AIA, a partner with Davis Brody Bond. “It was the first time I can remember the potential benefits of IPD [Integrated Project Delivery] clearly being on display. We presented an approach that was a clear departure from what they were expecting. To validate its legitimacy, we developed a construction schedule, a construction budget, a massing model, and a site plan. The only element missing was an image of the building—somewhat unusual for an architectural firm, don’t you think?”
Davis Brody Bond’s alternate approach focuses on how to deliver the project rather than what it will look like, which brought new life and a new momentum to what, at the time, was a stagnating project. The firm beat out four competitors for the contract.
Part of the architecture firm’s process involved reexamining the ingress and egress of the Mount Sinai Queens emergency department. Other architecture firms proposed a single entrance for patients arriving by ambulance and by foot, but Williams and his team knew this would not solve the existing facility’s inefficiencies and overcrowding. Instead, they devised a layout with separate entrances for vehicles and walk-in patients, encouraging greater patient throughput. “This concept was based on the positive outcome and feedback [we] received from a pediatric emergency department we had recently completed in NYC,” Williams says.
Moving forward with its idea, Davis Brody Bond developed a plan for an ambulance drive-through along the eastern perimeter of the Mount Sinai Queens campus. The move would relocate the ambulances, which would otherwise queue up in front of the hospital on heavily traveled commercial streets, to the interior of the site, with immediate access to the department. The concept evolved out of the methods envisioned to construct the building and the need to keep all construction equipment and activities off an adjacent residential street.
Mount Sinai Queens was still concerned with how ambulances would be able to come in off the streets because the existing hospital is landlocked, located on a corner lot, and surrounded by both low- and midrise residential properties. In response, Williams pointed out that the hospital owned two 18-foot-wide, 100-foot-long brownstones that were being underused, and Davis Brody Bond’s plans called for the demolition of the two structures to make way for the drive-through. “It was fate, the way those two buildings lined up with the service lot behind the existing hospital, immediately adjacent to the Annex Building,” Williams says.
Davis Brody Bond’s suggested changes were in line with Davis’s vision, and when completed, the renovated Mount Sinai Queens will boast an ambulatory-care platform that will transform the hospital into a one-stop health-care-delivery facility. “It’s analogous to the multiuse buildings being delivered elsewhere in New York City, but instead of incorporating commercial program uses, the facility is dedicated to different health-care programs,” Williams says.
Upon arriving at the Ambulatory Care Pavilion (ACP), patients will be able to see their primary-care physicians as well as specialists, whose offices are also in the building. The ACP will be supported by a dedicated outpatient advanced-imaging department and diagnostic-lab capabilities. And, with an integrated digital medical-records system already in place, the hospital has eliminated the need to schedule more appointments at different times in different buildings—it’s simply one appointment.
The ACP, with a constrained footprint of 19,000 gross square feet, had to be organized vertically—unlike most hospitals, which have a more horizontal makeup. The hierarchy of the ACP’s levels reflects the process a patient would routinely follow from admission to discharge. The first floor is devoted to the emergency department, where the majority of admissions occur; the second floor is programmed to be an advanced imaging center and urgent-care center; the third floor will house an ambulatory surgery department, including seven 600-square-foot state-of-the-art operating rooms with IR expansion capabilities; and the top three floors will be devoted to post-discharge spaces for the private practices of various Mount Sinai faculty. In the event that a patient requires admission, the new facility will connect to the existing hospital and its 200 inpatient beds.
The implementation of these changes won’t be without challenges. Foremost among them will be those presented by renovating an existing and fully operational hospital, cladding its entire exterior enclosure system with stone, and replacing its window air-conditioning units with a central HVAC system. Additionally, the hospital cannot close, even for short periods of time, because the borough of Queens has already seen multiple hospital closures over the past several years, giving Mount Sinai Queens a patient census of more than 90 percent annually. It’s one of the most heavily used emergency departments in the state of New York, with more than 60,000 visits in a mere 8,000 square feet of space, so the idea of limiting or eliminating services is not an option.
“Aesthetically, senior administration insisted on a clean break from the past, fervent in their desire that there should be no remnants of the 1940s red masonry apartment building which symbolized the existing building,” Williams says. “Visually, the ACP and the existing hospital buildings need to function as a campus, with an iconic aesthetic reflective of [Mount Sinai Queens’s] rebirth.” The logistical issues of installing large 750-pound cast-stone panels across an existing solid masonry façade, whose window openings are irregular in shape and misaligned vertically, will require particular care.
The project has been a truly collaborative effort so far; Davis Brody Bond has worked with Mount Sinai Queens throughout the process—as well as with NK Architects, which was responsible for the planning of the ACP’s clinical spaces. Daily, the firm communicates with the project’s construction manager, Skanska USA, for feedback regarding site logistics and installation procedures.
In two short years, Davis Brody Bond will complete a renovation that Mount Sinai Queens has been working toward for the past seven. The project is rapidly becoming a reality, and when it’s finished in 2016, Davis Brody Bond will take satisfaction in knowing that it helped to spearhead a new standard of health-care delivery in both the borough of Queens and the New York metropolitan region.