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The Benefits and Challenges of Hospital Retrofits

As the demand for health resources increases and energy costs skyrocket, health care facility managers must keep pace to support the best patient care possible while optimizing hospital operations. To do this, facility managers must look for new avenues to be efficient and cost-effective.

The answer is retrofitting, says Alan Whitson, who is on the board of advisors for the IFMA Healthcare Institute and president of the Corporate Realty, Design & Management Institute in Portland, Ore. “Money is tight, so hospitals have had to retrofit to keep existing facilities up to date,” Whitson says.

To increase patient satisfaction and remain competitive, facility managers must maximize the efficiency, sustainability and cost-effectiveness of their operations, even while stretched budgets limit hospitals’ ability to do new construction.

Increase HVAC Efficiency

Paul Florkey, director of plant operations at Detroit Medical Center – Sinai-Grace in Detroit, Mich., recounts a major overhaul project that included retrofitting the HVAC system with new energy-efficient chillers, air handling units and control systems. It cost the hospital $12.5 million. If that sounds like a big investment, consider this: the retrofit project cut utility costs by 33 percent, and Florkey estimates a 10-year payback at about $1.5 million in energy savings per year.

“The old chillers worked fine,” he says. “But they used 1.05 kilowatts per ton of refrigeration. The new chillers use .56 kilowatts. It’s the same air conditioning for half the cost.”

And in the same spirit of conserving energy, Florkey overhauled Detroit Receiving Hospital’s control system, which monitors the temperature throughout the hospital. The new system allows facility managers to view a blueprint of the floor that is color-coded and labeled with encircled numbers, which indicate the temperature of different parts of the building. “If the circle is red, it’s too warm,” he says. Facility managers are then able to accurately pinpoint areas that may be wasting energy.

“Control systems are overlooked,” he says. “Very often they’ll do energy retrofits and will catch lower hanging fruit. Long-term, there’s a lot of money to be saved in control systems.”

Replace Energy-Draining Lights

There are plenty of simple changes that can have a major impact. That includes replacing old incandescent bulbs with LED lights or transitioning from T12 lights to T8. Although this retrofit is more obvious, Florkey estimates that depending on the size of the hospital, facility managers can expect to see payback in about a year and a half. 

Even though LED lamps are initially more expensive than traditional incandescent lamps, it’s important to look at the bigger picture and consider the life cycle cost, Whitson says. He estimates by using LED lamps, you typically recover the initial costs of purchasing a more expensive bulb within six months, making the net economic value about $508 per lamp on a present value basis, if it lasts 10 years. “That’s because a high-quality LED lamp will last for 45,000 hours compared to 5,000 hours for the incandescent lamp,” Whitson says, “and reduces energy use by 78.5 percent.”

Conserve Water

With sinks in each patient room and more being installed in hallways to improve workflow and hygiene, excessive water use can become a major problem.

Florkey recommends installing new flush valves on toilets that use about half as much water. Low-usage sinks and fixtures can also be installed to limit the amount of water a sink or shower is able to draw. Waiting for water to heat up, too, is another way water is being wasted.

“It’s not uncommon for a nurse to come into a room and run the faucet to get hot water,” Florkey says. Installing instant water heaters on each sink saves water and energy because they only run when water is flowing and heat up instantly.

Prioritize Patient Safety

Most retrofits or renovations, no matter how small, require working around patients — and every precaution must be taken to ensure their safety and comfort. Even if you’re just installing new lights, Florkey says, the nursing staff will have to reserve blocks of rooms so the lights can be replaced without disturbing patients.

If you’re doing something more extensive, like installing new sinks or changing the layout of a space, dust control is a critical consideration, Florkey and Whitson both say.

“A lot of people don’t understand that the fine dust generated during construction goes everywhere and it is nasty stuff even if you’re healthy,” Whitson says. It can easily damage electrical and mechanical equipment. Without proper protection, phasing of construction and staging equipment, both the cost of the operation and the patient’s health are jeopardized. 

“In health care, it’s one of those things,” Woodin says. “At the end of the day, somebody’s life depends on the quality of the work you do.” 

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