I came across this earlier this week while making my rounds through the hospital.  Some workers on the construction project had found a handy spot in the stairwell to leave a few items out of sight.  They were doing a few things right.  1.  They cleaned up after themselves and 2. They had a fire extinguisher handy.  Other then that, what were they thinking!  Storing items in a stairwell is a huge problem that violates the Life Safety Code (NFPA 101).   Specifically it prohibits anything that has the potential to interfere with egress. Not to mention any possible ICRA concerns.  

I quickly called the project superintendent and got everything moved.  He then trained the workers again on the importance of working within the approved area, and being mindful of creating hazards to staff and patients.  


We’ve all heard the timeless rhyme “If at first you don’t succeed, try try again!”  Whoever said it first very well could have been referring to utility shutdowns at inpatient hospital facility.  

Last night I had one of those experiences where we didn’t succeed at first.  I hope we only have one try again to be successful with it.  We are renovating space in a hospital tower that has surgery rooms, labor and delivery, ICU, as well as normal patient rooms all located within it on different floors.  When the facility was built there were very few valves installed on the water risers.  We’ve got an east riser and a west riser.  The contractor has work to relocate some of the lines on the east riser.  Due to the lack of valves, this work requires an outage and will take down water to one half of the tower.  

The outage was scheduled several weeks in advance, with the hospital going on “divert” for the inpatient areas about 12 hours in advance of the outage to allow the rooms to empty out.  Also, the scheduled outage was to begin at 10 PM, to reduce impacts on the patients as most are done with showers and toilet use by that time and are headed to bed.  A 6-8 hour outage  would mean water was restored prior to patients waking, morning showers, and breakfast time. 

In addition to the required work, the facility manager determined that installing additional valves on each floor at the mains from the riser, allowing each floor to be isolated, would be prudent.  

I showed up early ahead of the outage to check with each department and the status of their patients.  Even though they were on divert, sometimes expectant mothers show up to deliver their babies or critically injured people arrive in the Emergency Department needing surgery.

The first stop was the Emergency Department.  Oh-oh.  Two potential surgeries.  I checked with the other departments and the charge nurse at each gave a green light.  I met with the contractor and explained the situation.  

We determined it would be best to wait for an hour to see if the surgeries were needed or not.  The hour dragged slowly by.  It was kind of like sitting in traffic, we were unproductive and all had things we would rather have been doing.  We checked with the Emergency Department again.  They still were doing their final tests and evaluations on the two patients, and in the hour that had lapsed, another potential surgery patient had come in.  This was not our night!  

Even if we were to wait until all three patients were stabilized, we still were fighting against the clock.  If it was after midnight when we could start the outage, we would run into morning and definitely begin impacting the few patients that hadn’t been discharged.

We huddled up one more time, and I passed my regrets to the contractor.  On this night there would be no outage.  It was the right decision.  

As I walked out to my car at 11:00,  I glanced over my shoulder at the red ambulance lights flashing outside of the Emergency Department.  It was not a good night for more than myself and the contractors.  I said a prayer for those needing care that night.  We made the right decision to postpone the outage.  I hope next time we’ll be able to do the outage and get this work behind us.

The past several weeks have been trying ones on one of the construction projects at my hospital.  The contractor has subs going steadily with plumbing, electrical, gyp board, sheet metal, insulation all occurring in various places on the job site.  There is time dedicated to clean up the work area, but they always seem to be behind the curb.  The past few weeks they have upped their housekeeping game with dedicated laborers focused on housekeeping, as well as each sub dedicating someone to cleanup.  It’s making a difference, but the difference has been small compared to the level of effort.  We had a discussion today about safety, cleanliness, etc.  In fact, we’ve had several of these discussions recently.  
Let me rewind a little bit. In order to reduce the impact on the hospital, the contractor removed a window on each floor early on in the project.  This allowed demolition debris to be removed from the floor, without sharing a path with patients or staff.  It also allows materials to be brought in, again without interfering with the hospital’s flow.  Great idea!  This results in an overall smaller effect of the construction project, and reduces the chances for construction related infections.  We’re now at a stage in the project where the vast majority of demolition is complete and many items have been brought in for installation.  The removal of the windows has served its purpose.  
Move forward back to where we are- construction moving along, yet housekeeping remaining a problem.  The meetings today had a few new faces as some upper management from the contractor were in attendance as they were on site to survey progress.  Housekeeping efforts came up in the meeting.  In the ensuing discussion, an alternate perspective was offered.  Our problem with housekeeping is not a housekeeping problem at all, instead it’s a logistics problem.  With the floor space taken up by stacks of gyp board, piles of ducts, bundles of conduit, boxes of insulation, and other construction materials the work space is overly congested.  This impacts housekeeping as well as the ability to work unimpeded.  The problem isn’t with the housekeeping, it’s with the logistics planning.  In seeking to reduce the effects on the hospital by advance staging supplies through a removed window, an unintended consequence was created.  Too many items were brought in, this manifested itself as a housekeeping problem.  Instead of being the root-cause however, the poor housekeeping was a symptom of the logistics planning not fully considering the impact that lots of materials has in a limited space.  
The contractor is now considering what changes they need to make in material staging and storage in order to address their housekeeping struggles.  We’ll see what they can figure out.
Sometimes a fresh perspective can make quite a difference.  Other times experience gives the edge needed.  Good ideas sometimes can have unintended consequences, and being able to properly identify the root cause is the surest way to a timely resolution.