达特茅斯希区柯克医疗中心(DHMC)是新罕布什尔州唯一的一级创伤医院, 为新罕布什尔州和佛蒙特州的患者提供初级和专科护理. 尽管DHMC的技术人员有能力支持该地区最复杂的病例, 他们的设施不能满足病人的需求，而且常常超负荷, forcing DHMC to turn away hundreds of patients per month.
In 2018, the DHMC board approved the construction of a new, 六层240,000 square foot Inpatient Tower, 通过增加64张最先进的住院床位和外壳空间来扩大服务和容量，以供未来灵活扩展.
该设施的设计采用了跨学科和“面向未来”的方法. Patient rooms provide flexibility to serve as med/surg, 降压, or even critical care options, depending on need. 每个房间都是私人的，并为游客提供空间与他们的亲人在他们逗留期间. 和, technology is at the forefront, with integrated patient dashboards, MyChart床边, and telemetry units, 让病人用指尖与他们的医疗团队互动.
The Challenge: Location-based Labor Shortages
The Upper Valley is a collection of small, quintessential New England towns along the Vermont/New Hampshire border. The area is large, but the population is low, and DHMC is the only hospital within many miles for these residents.
DHMC对上山谷居民的优先事项和义务超出了他们提供的护理. 对医院来说，让上山谷参与到这个重大的建设项目中来是很重要的, and to the extent it was possible, keep the labor and vendor base local.
百家乐软件对新罕布什尔州分包商市场和能力的了解为他提供了一个深思熟虑的策略, ultimately keeping over 50% of the project spend with local firms.
The Solution: Thoughtful Procurement & 有意的
预制构件
Keeping the Work Local: 百家乐软件团队对该项目的规划和买断进行了全面的考虑:确定哪些范围区域可以由当地分包商和供应商提供支持, 然后确定哪里有机会引入创造性的解决方案，比如 预制构件 材料预购——这将为项目注入更高的效率.
开始, the team mapped out all local subcontractors with the size, 能力, and experience to take on a project of this scale and complexity. 分包商被邀请参加一个开放日活动，在那里他们可以更多地了解这个项目, meet the 百家乐软件 team, and get a sense of the expectations and timing for bidding.
“Our plan was to use local labor whenever we could, and when we maxed out that avenue, 我们探索了可以增强项目整体交付的创造性解决方案,里基·加拉说, Senior Project Manager.
预购买 Equipment for Schedule Certainty: During Design Development in February 2020, 百家乐软件和设计师HDR积极制定材料采购的决策截止日期, advising on workarounds wherever possible. 这是百家乐软件在所有项目中采用的风险管理策略, but it proved critically important and timely at DHMC as COVID hit.
As the world was facing unprecedented uncertainty in early 2020, 百家乐软件的DHMC团队正准备在人们期待已久(也是非常需要的)的住院病人塔上破土动工. 而不是, their focus shifted toward forecasting looming material shortages, supply chain issues, 边境的关闭, and astronomical price increases.
“From the beginning of the project, well before COVID was ever heard of, 我们计划这个项目尽可能地按时完成，并尽可能地适应劳动力需求……然后大流行对这种方法进行了压力测试,” said 百家乐软件 Director of 预制构件 Bill Seery.
百家乐软件在成本飙升之前确保了钢铁价格，并从新罕布什尔州的一家钢厂购买，以避免潜在的美国关税.S./Canada border issues. All M/E/P equipment was pre-purchased, 锁定早期定价，以避免升级和绕过漫长的设备交货期, getting materials to New Hampshire well before they were needed.
It also provided other benefits, like allowing the M/E/P equipment to be designed into the building, 所有的结构板要求和电气都可以提前充分协调, eliminating clashes and field re-work.
This proactive approach extended to commodity items, too. 管道, 绝缘, 屋面, and drywall were prioritized; subcontractor onboarding was expedited, submittals and reviews were fast-tracked, and materials were ordered. Warehouse spaces in Nashua, 恩菲尔德, 和西布鲁克, NH as well as Windsor, VT用于存储材料，直到项目后期需要它们. 事实证明，这种快速采购方法至关重要，因为在疫情期间，许多商品的交货时间增加了近500%.
到2020年4月, the 百家乐软件 team had locked in its subcontractor and vendor base, pre-purchased materials, and had a solid plan going into the Inpatient Tower groundbreaking, 定于2020年7月.
“如果我们不积极主动地处理这个项目的采购和预制方式, we would’ve been caught on our heels when COVID hit,加拉说。. “We weren’t reacting to a problem and trying to change course. We planned the project in the most efficient way possible, and when the pandemic hit, we were in the best possible situation to take it head-on.”
看看百家乐软件的设备和商品预购策略是如何在COVID来袭时保护项目的, and lead times skyrocketed.
预制构件 for Enhanced Delivery: “The way we go about pre-fab…it’s very systematic. We think from the site all the way through the M/E/Ps and finishes,” explains Brian Hamilton, 百家乐软件’s Vice President of 医疗保健 & 生命科学. “When you approach pre-fab as removing labor from a jobsite, it opens up people’s minds; they aren’t just thinking about the standard 预制构件 elements.”
Every aspect of the DHMC 预制构件 approach was deliberate. 所选择的范围需要为完成的项目或交付的方式增加价值. From the smallest solutions like pre-installing hardware on doors, 到大规模的改进，比如结构转向螺栓连接, or driving the exterior design for 预制构件, the decisions had to improve quality, increase speed of delivery, 省钱, 或者取消现场劳动，以减少校园干扰，使工地更安全.
百家乐软件在进入这个项目时就知道预制的价值和优势. When HDR had roughed out a conceptual massing diagram, 整个DHMC项目团队开始集体挖掘我们想要预制的工作元素,” continues Hamilton. “It was really important that we started this out of the gate, because in some cases, it changed the way we approached the building.”
通过预制系统直接影响护理交付和患者体验, items like headwalls, 医用气体架, 湿墙, 百家乐软件 and the client team were able to inspect early and often, 确保组件符合DHMC的确切规格和护理标准. 它还通过减少在打孔期间需要修复或更换的缺陷和不合规的风险来帮助保持计划的一致性.
“通过进入住院病人塔项目，意识到这些潜在的延迟陷阱,的前期规划, pre-procuring, 预制都是用来减轻和减少这些风险的,西瑞说。. “我们对每个项目的目标都是通过密集的预先规划来消除风险, and the results at DHMC showcase the fruits of that effort.”
看看下面的视频，看看什么是预制的，以及它为DHMC病人塔项目增加的价值.
Turning Over the Tower
三年前，COVID对DHMC期待已久的项目的可行性提出了质疑, the Inpatient Tower is opening its doors to the Upper Valley community, 提供近距离的家庭护理和患者体验，可与波士顿和波特兰的邻居相媲美.
达特茅斯希区柯克医疗中心最先进的塔楼使医院的重症监护病房容量增加了228%, 额外的两层外壳空间可灵活扩展，可容纳64张床，装修后容量可增加356%. The main entrance to the hospital is welcoming, with a comfortable lobby, 美丽的教堂, easy-to-access amenities and services like food and beverage stations, 哺乳室, and an expanded discharge lounge for DHMC patients.
这家曾经太小的医院现在是上山谷初级和专科护理的地标.