NHS Ayrshire & Arran
Ayr Hospital ED and CAU
The Emergency Department (ED) and Combined Assessment Unit (CAU) development at University Hospital Ayr provides a fully integrated “front-door” for urgent and emergency services at a large general hospital. The project was delivered as part of NHS Ayrshire & Arran Board’s ‘Building for Better Care’ programme of investment in response to the Scottish Government’s requirement to modernise “front door” facilities at both University Hospital Crosshouse and University Hospital Ayr to improve effectiveness and efficiency of service delivery in line with new models of care and up to date working practices. The development at Ayr encompasses extension and refurbishment of the existing hospital building to provide Adult and paediatric Accident & Emergency (A&E), Minor Injury unit, Doctors-On-Call services, additional imaging. The development adds a CAU, providing a 12place ambulatory care area and 29 in-patient bedrooms, consolidating and relocating existing assessment functions adjacent to the ED to facilitate a single point of access to unscheduled care at the hospital. A future phase will provide a new Critical Care Unit.
Challenge & Solution
The main portion of the works comprised new build extensions built out from the existing A&E accommodation into the main hospital car park and adjacent roads/ ground. The project was delivered in two phases: Phase 1 - Development of the new ED adjacent to the existing A&E; Phase 2 - A&E decanted to ED and CAU created through refurbishing and extending the vacated A&E to form new ambulatory and in-patient assessment accommodation. Areas of existing courtyards were also partially infilled.
Maintaining continuity of clinical service during construction was a key driver in the design. The works took place within a live hospital environment and included significant alterations to the main hospital access road which required temporary alterations to hospital site traffic flows and ‘blue light’ emergency services routes.
H&S of patients, staff, contractors and members of the public was an over-arching priority. A clear strategy was established for the continued operation of the building services during construction. The contractor maintained close liaison with hospital estates and staff representatives. Regular ‘huddles’ were undertaken during construction to ensure that site users were fully briefed and informed of upcoming activities and any operational implications. An efficient plan form had to facilitate key functional adjacencies whilst working around existing constraints including maintenance of hospital user communication routes and departmental emergency escape.
Innovation & Added-Value
The ability to re-use the vacated A&E shell delivered significant benefit and value to the client and end users. It had originally been intended to fully demolish and re-provide this part of the building to meet current day standards. Through an early feasibility study, we were able to demonstrate that the A&E shell could be successfully developed as patient bedroom accommodation with a small extension to achieve the full accommodation requirement. The original hospital buildings were a mixture of steel and reinforced concrete frame with tiled timber trussed roofs. The works required all existing internal partitions to be completely stripped out. New partitions were installed – existing drainage was re- used where possible. Acoustic transfer between rooms proved a major issue. It was not practical to take new partition walls up through trusses to the underside of existing tile roofs. This was solved by innovative use of acoustic bats in suspended ceilings. The facility to develop within exiting construction ensured considerable savings on project costs and programme.
Interfacing with the existing construction was complicated by existing traditional pitched roofs and the requirement to install new fire compartment lines where the existing construction had not been fully recorded or determined.
Low and zero carbon technology incorporated into the project included high efficiency gas boilers and heat recovery. At the time of the project, NHS Ayrshire and Arran were considering a range of LZCT measures for the Ayr Hospital site including installing a bio-mass fueled energy centre and a wind turbine.