To that end, the architects incorporated soothing colors, soft music, an atrium garden and copious natural light, in addition to therapeutic amenities chosen by the client such as quiet/meditation rooms. Its most visible and dramatic evidence-based design gesture is a cylindrical, low-E glass-enclosed atrium. According to the center, the glazing allows for 68 percent visible light transmission with winter nighttime U-Value of 0.29 and a solar heat-gain coefficient of 0.38. In this way, the volume brings in daylight both as a healing element and as an energy-saving feature, yet its coated glass enclosure significantly reduces energy costs associated with heating and cooling the building.

In another example of evidence-based architectural amenities, a recent project designed by Perkins+Will at MidState Medical Center in Meriden, CT, employs a vertical water feature in its main lobby. Built as part of a $45 million, 100,000-square-foot expansion that opened last October, the lobby welcomes visitors and patients to a new emergency department with 53 private treatment rooms, an additional 28-bed inpatient unit and new medical office space. To make the most of MidState's new "front door," the serene, minimalist lobby was planned with comfortable seating and a "soothing and peaceful water wall," according to the hospital, to offer "an atmosphere for relaxing… that greets visitors as they enter or exit the elevators."

A frameless assembly made of stainless steel and tempered glass, the water feature measures more than 20 feet tall and about 25 feet wide. Rather than trickling down the face of the glass, the water runs down the back of the glass panels, to eliminate exposure of the water and to avoid splashing or human contact, which would contaminate the water. An integrated rolling ladder, attached to ceiling brackets and concealed in a 24-inch opening to the side, was included in the design to ease maintenance.

Integrated Solutions

The atrium of the expanded UC Davis Medical Center in Sacramento was designed with seismic-rated structures and fire-protective and fire-resistant glazing to comply with Senate Bill 1953, which requires life-safety upgrades for hospitals. Photo courtesy of SAFTIFIRST

At Weill Cornell Medical Center, for example, fire-rated glazing was incorporated into a 2-hour-rated exterior wall leading from the lobby to a parking garage in order to increase transparency and visibility. Photo courtesy of SAFTIFIRST

Often, hospital upgrade projects add amenities in this way while also making changes as needed to meet new state or federal regulations and related evaluations by The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, which reviews hospitals for compliance. This was the case for the UC Davis Medical Center in Sacramento, which recently undertook an expansion that would also assure compliance with Senate Bill 1953, which requires seismic upgrades for Structural Performance Category 1 buildings, such as hospitals, which could sustain significant casualties in an earthquake.

Central to the project's design by Stantec Architecture in San Francisco was a large skylight over an atrium area and other light wells throughout the building. To bring daylight into more interior spaces, the design team specified glass partitions, which had to meet a 2-hour fire rating in atria and other building openings per the standard ASTM E-119. A fire-resistive glass wall was employed in the light wells and on atrium perimeter walls. In addition, architects used fire-rated glass in the facility's patient waiting areas for a relaxed, open feel-and even for a decorative art-glass wall in a prayer-and-reflection area.

New door frames used for healthcare door openings have factory-installed gaskets and other features for controlling infiltration of smoke, air and water, in compliance with such codes as NFPA 80. Rendering by TIMELY Industries

In other healthcare projects, simpler challenges are resolved using fire-rated glazing. At Weill Cornell Medical Center, for example, the architect required fire-rated glazing in order to build a transparent 2-hour exterior wall leading from the lobby to a parking garage.

Another solution that is increasingly employed is the use of prefabricated and pre-engineered building assemblies that speed construction and improve life-cycle performance. As an example, several hospital facilities directors report using high-strength, light-gauge-steel door frames, which are anchored around the full doorway perimeter. As compared to common hollow-metal products, the steel frames offer a very high load-bearing capability, which is ideal for the rigors of hospital operations. For example, while a 16-gauge hollow metal door with wood studs can handle a load of about 254 lbs. plus the door weight, a 20-gauge steel frame with steel studs can carry almost double the load-about 500 pounds and the door's weight.