Article in Brief
- A major healthcare transformation: Bartlett Cocke General Contractors helped transform approximately 400,000 square feet of the existing downtown San Antonio hospital campus into a contemporary children’s hospital with 195 beds and highly specialized clinical environments.
- Construction had to work around patient care: The project required carefully phased construction as critical hospital functions remained operational, making sequencing, coordination and communication essential.
- Existing conditions shaped the work: Renovating an aging healthcare facility required the project team to address existing infrastructure while integrating modern imaging, surgical, intensive care and other specialized systems.
Renovating a hospital is fundamentally different from building on an empty site.
When that renovation encompasses approximately 400,000 square feet of an existing downtown campus, includes highly specialized pediatric care environments and must account for ongoing hospital operations, the construction strategy becomes as important as the finished building.
That was the challenge at CHRISTUS Children’s Hospital of San Antonio, formerly known as Children’s Hospital of San Antonio.
Bartlett Cocke General Contractors worked with CHRISTUS Health and the design team to transform the existing campus into a contemporary 195-bed children’s hospital. The work modernized patient areas, infrastructure and specialized clinical spaces while navigating the realities of construction within an existing healthcare environment.
Renovating an Existing Hospital Is a Sequencing Challenge
Large healthcare renovations rarely offer the clean construction sequence of a new building.
At CHRISTUS Children’s Hospital of San Antonio, the project team was working within an existing hospital where patient care and critical services had to be considered throughout construction. That meant the transformation could not simply move from one floor to the next without regard for what was happening elsewhere in the building.
The work was carefully phased. Departments could be relocated into completed areas, creating space for subsequent renovation phases while allowing hospital operations to continue.
For owners considering a major occupied hospital renovation, that sequencing can have implications far beyond the construction schedule. Temporary conditions, access routes, infection control, utilities, staff movement and the timing of departmental transitions all become interconnected.
The earlier those requirements are incorporated into preconstruction planning, the more opportunities the team has to identify conflicts before they reach the field.
Modern Healthcare Systems Inside an Existing Building
Existing healthcare facilities can present another challenge: what is behind the walls does not always match what is shown on the drawings.
During planning and construction at the San Antonio children’s hospital, the team had to account for existing structural and building-system conditions as the facility was modernized. Contemporary healthcare environments also place substantial demands on mechanical, electrical, plumbing and technology infrastructure.
That complexity increased as the project incorporated specialized spaces throughout the hospital.
The completed transformation included 195 beds as well as new patient wings and clinical environments supporting:
- Emergency care
- Surgical suites
- Pediatric intensive care (PICU)
- Neonatal intensive care (NICU)
- Hematology and oncology
- Bone marrow transplant care
- Labor, delivery and recovery
- C-section surgical services
- Post-anesthesia care (PACU)
- Nuclear medicine
- Angiography
- Cardiac catheterization
- Sleep medicine
- Pediatric and internal medicine
- Advanced diagnostic imaging
The imaging suite alone incorporated sophisticated equipment including 1.5T and 3T MRI, CT, ultrasound and X-ray systems.
These are not simply rooms that receive specialized equipment after construction. The equipment, utilities, structural requirements, clearances, access and supporting systems must be coordinated as part of the building itself.
Using BIM and Field Technology to Understand Existing Conditions
Renovation projects become more predictable when project teams have a better understanding of what already exists.
On the CHRISTUS Children’s Hospital project, Bartlett Cocke used laser scanning and Building Information Modeling (BIM) to help document existing conditions and coordinate construction. Digital field technology also gave project teams better access to current project information during construction.
For an existing hospital, that visibility can be especially valuable.
A conflict discovered digitally during coordination can often be addressed differently than one discovered after demolition begins. Understanding existing structure and utilities earlier gives designers, builders and trade partners more information for routing new systems and planning installation.
Technology does not eliminate the uncertainty inherent in renovation. It helps teams identify more of that uncertainty before it becomes a field problem.
Building Around the Needs of an Active Healthcare Environment
Healthcare construction adds another dimension to phasing: the building is part of patient care.
Emergency, intensive care, neonatal and other specialized hospital functions cannot be treated like typical occupied spaces. Construction teams must consider how work affects patients, clinicians, visitors and hospital operations.
That can influence everything from demolition sequencing and temporary partitions to infection-control measures, noise, vibration, construction traffic and shutdown planning.
Bartlett Cocke’s healthcare teams approach this type of work with a focus on patient safety, infection control and operational continuity. At CHRISTUS Children’s Hospital of San Antonio, those considerations were part of the larger challenge of transforming an existing facility while critical hospital functions continued operating.
For healthcare owners, one of the most important questions during preconstruction is therefore not simply, How quickly can this space be renovated?
It is: How can each phase be built while the hospital continues doing its job?
A New Chapter for a Historic San Antonio Healthcare Campus
The project was more than an interior renovation.
The downtown campus has a long healthcare history in San Antonio. CHRISTUS traces the site’s roots to 1869, when the Sisters of Charity of the Incarnate Word opened the city’s first hospital.
Transforming an existing campus allowed that history to continue while creating modern environments for pediatric medicine.
The completed hospital established contemporary spaces for services ranging from neonatal intensive care and pediatric surgery to cancer treatment and advanced diagnostic imaging. Patient-care areas were also redesigned around private rooms and the needs of children and their families.
For CHRISTUS Health, the completed facility became a new benchmark for its expectations around healthcare quality.
For the project team, it demonstrated something equally important about healthcare construction: successful renovation requires understanding both the building that exists today and the care environment it needs to become tomorrow.
What Healthcare Owners Can Take From the Project
Large hospital renovations are ultimately exercises in managing dependencies.
Clinical operations affect phasing. Phasing affects temporary infrastructure. Existing conditions affect design. Specialized equipment affects utilities and structure. Shutdowns affect scheduling. Each decision can create consequences elsewhere in the facility.
For owners planning a hospital renovation or expansion, several priorities become especially important: investigate existing conditions early, involve construction expertise during design, build operational requirements into the phasing strategy and coordinate specialized systems before installation begins.
The CHRISTUS Children’s Hospital of San Antonio transformation shows why those decisions matter.
In an occupied healthcare facility, the best construction plan is not simply the one that builds the project. It is the one that allows the facility to keep fulfilling its mission while the project is being built.
