Building Blocks of Good Health

On the grounds of Cedars-Sinai Medical Center in Los Angeles, hard hats and tool belts have become as common a sight as surgical masks and stethoscopes as the prestigious medical facility undergoes an extensive renovation and expansion.

Construction activity at Cedars-Sinai and other area medical complexes is partly to meet more stringent government seismic safety standards, but also to adapt to new technology and changes in health-care practices. Upgrading medical facilities is costly and complicated and, in the case of nearly century-old Cedars-Sinai, will take more than a decade and about $620 million to complete.

Rebuilding requires medical officials to gamble hundreds of millions of dollars on future demand for hospital services, the emergence of new treatments and other health-care trends. A losing bet could prove costly, perhaps saddling a hospital with too many empty beds or too little space for outpatient services.

“It’s a challenging environment because medicine is changing so quickly and technology is changing so quickly,” said John Law, Cedars-Sinai building committee chairman.

In many cases, new construction will not create a significant increase in hospital beds. In east Hollywood, for example, the $500-million overhaul of Kaiser Permanente’s Los Angeles Medical Center on Sunset Boulevard at Vermont Avenue will reduce the number of beds by about 10% to about 450 but increase the number of operating and delivery rooms, said spokeswoman Roberta Tinajero. The project includes a new outpatient surgery center and is scheduled to be completed this year.

New facilities boast features that hospital officials say will make stays more comfortable for patients and their families. At UCLA, an $800-million medical center designed by noted architect I.M. Pei will include more single-patient rooms, larger windows and daybeds for guests. Patients and staff were involved in planning the complex, scheduled to open in 2005.

“In the midst of all this high technology and dealing with very ill patients, we are trying to make the hospital a more humane and a more pleasant place to be,” said Gerald S. Levey, UCLA Medical Sciences provost.

At Cedars-Sinai, one of Southern California’s largest and best-known medical centers, officials have been planning the current expansion and renovation since the early 1990s. Those plans expanded in size and scope when the 1994 Northridge earthquake prompted state officials to beef up seismic safety standards for hospitals. In fact, the earthquake struck on the day Thomas M. Priselac assumed the job as president of Cedars-Sinai.

Priselac and other employees have worked countless hours on the hospital’s most extensive construction effort since the 1970s and one that will eventually involve nearly every building on Cedars-Sinai’s 24-acre campus on Los Angeles’ Westside.

In addition to seismic retrofits of existing structures, the construction project will produce four new structures, including a 150-bed hospital tower, a diagnostic and treatment center, an expanded central plant and the $83-million S. Mark Taper Foundation Imaging Center & Department, a 125,000-square-foot facility scheduled to open in October.

The program will expand the hospital’s capacity beyond 1,000 beds and allow staff to increase the number of annual surgeries to 30,000 from 18,000.

Planning and design for the buildings taking shape at Cedars-Sinai reflect input from a wide range of hospital staff and patients. The building committee, for example, has 25 members. The process is “much more inclusive” than it was in earlier expansions, Priselac said.

Hospital officials also spent much time trying to identify trends that will influence future demand for rooms and treatment. Among them is the advancing age of a large segment of the population.

As baby boomers move into their 60s and beyond, the “near-term results are increased incidents of orthopedic [problems],” Priselac said, “but in the future, cancer and cardiac disease become more common.”

Cedars-Sinai planners also determined that new buildings would have to be more efficient and flexible than older generations of hospitals.

Neurosurgical operating rooms, for example, will include imaging equipment that will allow medical staff to conduct an MRI scan on the spot instead of having to transport patients to a different part of the hospital and return them to the operating room.

“There is a lot of effort to build facilities that have a lot of versatility in them far into the future,” Priselac said.