Work on a $65-million expansion and renovation of the emergency department at Brigham and Women’s Hospital is on track for completion in early 2022, but later phases are not likely to be as harrowing as the recently completed first phase—built at the height of the COVID-19 pandemic.

First phase work involved building a 25,000-sq-ft addition as hospital staff scrambled literally next door in the existing space to treat coronavirus patients. “We could just coordinate on what we could do to minimize disruptions” and noise traveling throughout the connected buildings, said Bryan Northrop, head of general contractor Skanska’s building operations in Boston. There were “no real off hours” to schedule work, he added.

Expansion construction was also performed atop the hospital’s lower-level radiology unit, with CT scan and MRI machines doing tests around the clock. Subcontractors Commonwealth Plumbing and Sullivan & McLaughlin Electrical drilled 170 openings through the floor to run plumbing for new exam room sinks and bathrooms and for electrical lines to nurse stations. The subs cored holes on the first floor of the project through concrete and steel sandwiched in the floor for the plumbing and electrical lines that had to run in the ceiling of the space below—with a lot of coordination between the construction team and the BWH radiology staff.

The project also involved 19,000 sq ft of infrastructure upgrades on the roof and throughout the emergency department during the first phase. Roughly $13 million of the project involved infrastructure, such as adding air handlers or replacing existing air handlers with larger units.

Permission To Move Ahead

The first phase was about half finished when COVID-19 hit. Brigham was one of the first hospitals in the city to start taking coronavirus patients, and Boston Mayor Marty Walsh was the first big city leader in the country to shut down all but emergency construction. Northrop and the project team huddled with Brigham officials and sought city permission to move ahead.

Skanska met with infectious disease specialists at the hospital to help hammer out a plan for safely restarting work while keeping infected workers off the site. After a two-week pause to get input from stakeholders, including subcontractors and unions, Skanska restarted the project.

The first roadblock emerged immediately—the number of workers on site was limited to about 25 at a time, down from 70. The project team compensated by working two and sometimes three shifts a day, and adding weekend shifts as well. The team required workers to go through a certification process before coming in for their shifts, attesting that they were free of any signs of the virus, with Brigham handling that part.

Skanska rerouted some duct work away from areas where construction was taking place, while also bringing in clean room filtration equipment to offset concerns about the virus potentially spreading from construction crews to the rest of the hospital.

Skanska mandated testing for all workers, a necessity given that access to the jobsite required walking through an active section of the ED. Workers on the project were given access to the same rapid COVID-19 testing the hospital had established for its own employees, with the same screening protocols, said Douglas Carney, senior vice president for real estate, facilities and operations at Brigham. “We gave them all the same support we gave to our own employees.”

Brigham’s doctors, nurses and other medical staff recently moved into the new addition, freeing up the original emergency department for renovation. The project is now two-thirds complete. When completed, the ED will include space for 87 patients, up from 53. Beds can also be closed off and isolated from each other, another key advantage in the COVID-19 era, Carney said.

Carney called the expansion “critical,” noting, “The volume we were seeing in the old ED was exceeding our capacity, and that was before COVID. As a result of COVID, the volume only increased.”