Healthcare Design - January 2015 - 54

Among the many changes executed in
workflow and campus redirection, the
restructuring of the Legacy Building's emergency department stands out as one of the
most dramatic shifts, a shift that made Kari
Houser, director of construction and project
management for Gundersen, quite nervous.
"Our prior ED was a perimeter of exam
rooms and in the center, it was basically air
traffic control," she says. "From an outsider's perspective, it was absolute chaos.
It was noisy, and you didn't know who was
doing what or who had what patients."
That layout and design, which dated back
to 1970, included 16 exam rooms, each no
bigger than 100 square feet.
The new department features 44 exam
rooms designed on a pass-through (or open
core) model. Each room has two doors, one
for public access and the other for staff and
caregivers. "The public circulates around
the perimeter of the treatment rooms, and
the staff is located in the center [of the unit],"
says Matt Sanders, associate principal and
senior design lead for AECOM. "There's no
big waiting area; waiting areas are distributed equally throughout this continuous
pathway that meanders around the emergency core." Most of the rooms are in the
120- to 140-square-foot range now, partly
to accommodate the two doors. The bigger
footprint of the unit as a whole, Sanders
says, means that patients are more spread
out, "but it's a non-issue. Technology helps
that, with integrated new systems, nurse
call, and security cameras everywhere."
"It was a pretty big culture shift," says
Houser. But after spending time in the
new unit and talking to staff, she found her
nerves eased. "What used to be a loud
mixing and mashing of staff and family and
patients is now this very quiet, very calm,
disbursed group of staff doing their jobs. I
think that's a huge win for what I felt was a
pretty big design risk."

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A 300-ton heat pump was installed
along with 156 wells, each buried about
400 feet beneath the lot. At that depth,
the ground stays at a relatively constant
temperature of around 48 degrees. Basically, the energy (heat) transfers between
the earth and the water, which is then
used to either heat or cool the hospital
building, depending on the season. It's a
much more efficient method of temperature control over burning fossil fuels, and
it will save Gundersen 70 to 80 kBtus per
square foot annually.
The team investigated other options
(solar, chilled beams, other types of heat
exchanges), "but none of it really worked
for us," Sanders says. "We had to be able
to measure its impact and cost. Everything had to be within a five- to 15-year
payback." The geothermal solution is projected to earn its $4 million price tag back
in less than 10 years. (For more details on
Gundersen's energy and sustainability efforts, go to gundersenenvision.org.)

Top and above: This rooftop
terrace, one of two, relies
on pedestal planters for its
greenery in order to protect
the sophisticated technology
in the operating rooms and
labs on the floor beneath.

Riding the current
The exterior design of the Legacy Building
satisfied Houser's request for something
that would tie all the disparate campus buildings together
and improve the patient experience from both a practical
and aesthetic sense. "We never had a front door!" she
says with a laugh. "Something like 60 to 70 percent of our
patients are coming from a rural area outside La Crosse
and Onalaska. And you're looking at this big collection of
buildings, and you have to go to one side for the clinic,
another side for the hospital, and a whole different part of
the building for the ED." Now, she says, "[The designers]
took a very thoughtful and intellectual approach to how
the building would fit-not just with the buildings they're
attaching to, but with the community and the region."
The exterior of the Legacy Building is defined by a
sinuous façade of glass and locally sourced stone. The

GUNDERSEN HEALTH SYSTEM (ROOFTOP TERRACE TOP); AECOM (ROOFTOP TERRACE bOTTOM); DON F. WONG (ED)

Controlling the chaos

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Healthcare Design - January 2015

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