Green Buildings

Daylighting Your Facility

May | June 2008

By Diane Laux, ABC

Northside Hospital in Atlanta is known for its babies. They deliver, on average, 50 babies every day. Because it has a Level III NICU, parents of multiples often choose to deliver at Northside. Business was booming.

By 1999, Northside expanded their facility by building a Women’s Center at its main campus. But just a few years later, they were running out of space. Plans were drawn to expand again, adding floors 4 through 7 atop the existing building. The original plans called for the 4th floor to house the newly expanded NICU, with capacity for 80 critically ill newborns.

“The previous NICU was built when it was thought the babies’ environment should replicate the womb. The generally held opinion was that they needed darkness to thrive,” said Marci Biel, MSN, RN.C, Clinical Nurse Specialist, Special Care Nurseries at Northside. “But it’s not just the babies who are present in the NICU. It’s also parents, and staff, and physicians, and all the other people who help the babies get better.”

Because of that, the question was asked: Can we make the new NICU less like a cave and m ore like home? Grady Dale Lee, AIA, Senior Designer, Howell Rusk Dodson Architects (HRD) was the project architect for the new construction. HRD was responsible for both the original design and the recent expansion.

“We spent time with the staff in their existing space, understanding their requirements and discussing ideas,” said Lee. New research was emerging on the benefits of natural lighting, and the NICU staff wanted daylight for the infants and their caregivers. “So we moved the unit up to the top floor and studded the ceiling with large skylights. It was the perfect way to flood the space with light, without direct sunlight falling on the babies.”

The skylights are enormous and punctuate the corridors. The entire unit is spacious and bright. However, each infant has a distinct space that can be darkened by drawing curtains.

“We wanted to infuse the area with a natural light that provides a healing environment for our patients and a calming environment for families and staff,” said Biel. “Families and staff do not need to feel that they are trapped indoors all day.”

Lee explains that research suggests the natural cycling of daylight and darkness is beneficial to all patients, even the tiniest. They gain weight faster and sleep better. And the families love it. He says there are anecdotal reports that lengths of stay in the NICU are shorter in the new unit than they were in the prior setting, and that the mothers are producing more milk, crucial for these fragile new - borns. The daylighting concept proved so beneficial that Northside is replicating it at another campus in its system.

LEED Scoring and AIA Guidelines

The current LEED standard allows up to two points for daylighting or about 8 percent of the points needed for certification. Under the revised healthcare-specific guidelines currently under consideration, the section on daylighting and views has undergone extensive reworking. If the proposed changes are adopted, more points would be available for daylighting initiatives, amounting to almost 14 percent of the total needed for LEED certification.

The American Institute of Architects (AIA) publishes Guidelines for Design and Construction of Healthcare Facilities which are closely followed by healthcare architects. The current Guidelines, published in 2006, state that each patient’s bed needs to have visual access to the outdoors. Currently there is no specific requirement for how much glazing each room must have, but changes have been proposed for the 2010 revision cycle that would set a lower limit of 8 percent of the room’s floor space be provided in windows. It’s clear the industry is moving toward the light.

Lighting in Loveland

Russ Sedmak, Vice President of Heery International, was the design team project director for the Medical Center of the Rockies (MCR) in Loveland, Colo., which opened on Valentine’s Day 2007. The hospital had determined it would attempt LEED certification and built that expectation into the RFPs sent to the architectural teams bidding on the project.

Sedmak said, “Achieving full-scale daylighting in hospitals is one of the greatest challenges in sustainable design, especially when aiming at LEED credits. It’s difficult to get daylight to three-quarters of the space, which is required to earn the point.”

Sedmak explained that hospitals typically require deep footprints to efficiently accommodate diagnostic and treatment functions, such as surgery, imaging, and lab. These areas function best when they are fairly compact and situated near each other.

But such design tends to yield interior rooms, with little or no daylight penetration.

That wasn’t going to work at MCR. Sedmak and his team designed many of the fundamental diagnostic and treatment areas with abundant natural light. Even the lab was situated at the southeast corner of the building and designed so that 50 percent of the light they need streams through exterior windows.

Electrically powered window shades can control the amount of daylight that enters the space. A circulating corridor runs along half of the operating suites, and light spills across it to enter the ORs. Surgeons, nurses, techs, and other professionals no longer have to work under artificial light all day.

Patient rooms have oversized windows with small, operable sections within them. Patients and their families can actually open the window and take in the fresh, mountain air. This is a departure from many high occupancy buildings, whether or not they are in the healthcare sector. At one time, the AIA’s Guidelines for Healthcare Facilities required operable windows in patient rooms for ventilation and smoke evacuation, although modern HVAC systems have made that regulation obsolete in the United States. Many designers have eliminated operable windows entirely, because they don’t want screens to interfere with the aesthetic of the building, and because they are afraid that an influx of outside air will play havoc with the HVAC systems.

But in many other countries fresh air is considered a positive, both as a help to energy conservation and as a patient amenity. At MCR, the operable windows allow not only light and fresh air, but also the sounds from the water features in the courtyards below.

Racetrack versus Crosshall

Ray Pradinuk, MAIBC, LEED AP, Principal, Leader Healthcare Research and Innovation at Stantec, is passionate about daylighting healing facilities. “Not only do we need more light,” he says we need more light at the right time of day.”

Pradinuk is adamant that daylighting almost all of a healthcare facility is possible, even if it’s not particularly simple. For example, many patient towers or wings are designed with a racetrack configuration. This means that patient rooms are located on both sides of a wide hallway. In the center of the hall are nursing stations, bathrooms, offices, meeting rooms, medication rooms, and so on. The travel pattern forms a racetrack around the outside of the central core. The original concept was to keep things nearby, to reduce the number of steps staff take throughout their day.

However, daylight can’t penetrate deeply enough into the space to light it. When you work in a racetrack configuration, you can lose the subtle cues about time of day. Additionally, more artificial light and therefore, energy consumption, are needed.

Pradinuk offers instead a crosshall concept. In this approach, the hallway is much narrower and functions strictly as a corridor. Support spaces are moved to other areas. Because there are no obstacles in the halls to walk around, steps are actually reduced. In addition, the crosshall option occupies a smaller footprint, so it is less costly both to build and to maintain.

And all daylight is not considered equal. A study done by the University of Oregon’s Daylighting Lab with ZGF Partnership found that daylighting and views could be served well by different openings in the structure.

Typical windows often produced uncomfortable amounts of glare for the people inside the room. Clerestory windows, those placed high on the walls, produced vast amounts of daylight in patient rooms.

With these in place, view windows can be smaller and shaded, to control the glare. The closer the patient’s bed is to the view window, the smaller the window can be. Attention should be paid to the height of the window as well. View windows should be oriented below eye level, remembering that eye level for a patient in bed is different from eye level for a standing staff member.

Also, the study found that room geometry affected daylighting a great deal. Rooms with higher ceilings offered deeper daylight penetration. Wide and shallow rooms yield more daylight than deep and narrow ones.

Although the final consensus on daylighting has not been reached, it seems evident that daylighting can pay healthy dividends for all patients, and the families and clinicians who care for them.