OK, so your facility is getting older and your source equipment is nearing the end of its life expectancy. What are you to do? Your facility is located in Any Town USA; it is a Level 1 trauma center with 400 beds. Your medical gas source equipment is nearing the end of its life. Your facility’s medical gas verifier, who performs your annual testing, has notified you that your equipment is showing signs of failing. You need to investigate replacing it.

Where do you start?

First, you need a scope and budget: 

• Equipment costs. How much will a new unit cost?

• Contractor costs. How much will a contractor charge you to install new source equipment?

• Engineer costs. Do you need an engineer? Most likely, the answer will be yes. How much will his fees be?

• Verifier costs. After the installation of new source equipment, you need it verified safe for patients. How much are verifier fees?

• Scope of services. If your in-house project managers know enough to put together a scope of services, you may opt to go this route. Otherwise, you might be better off hiring a third party to assist you in developing a comprehensive range of services your company will provide to avoid scope creep down the road. This third party could be a verifier, engineer or contractor.

Second, you need proposals — once you decide on who will do the work. You can go two routes:

1. Engineer. How do you know if you need an engineer on the project? If planning future expansions, you may want to consider having an engineer assess existing systems to determine the expandability of the system.

2. Contractor. Can you do this as a design/build or just a contractor replacement? There are contracting firms specializing in these replacements. They have an engineering component to them that allows them to perform the same assessment an engineer may do. Some of these same contractors also can act as the general contractor or the project manager for said project. 

Depending on your facility, you may break these out into three separate contracts and companies or go with a one-stop-shop.

These questions get you started down the path of replacing your source equipment. 

Questions for the Engineer

If you chose to go the engineering route, here are a few things to consider when going down this path:

• Has the engineer performed many of these replacements?

• Has the firm completed any medical-gas-related projects of this type and size?

• Has the engineer performed any of these types of assessments?

• Is the firm known for submitting for “add services” frequently (nickel and diming customers)?

• Is it known for thinking outside the box for projects like this?

• Is it well-known in the industry for projects like this?

• Is it usually the lowest bidder on other projects in your facility?

• Is the engineer known for asking questions?

• Does the designer/engineer do a hands-on assessment? Is he present multiple times during the replacement process to ensure everything runs smoothly and that any surprises are handled immediately and without additional fees (unless unforeseen events occur)?

• Does the designer follow up with accurate as-builts (actually followed up with contractor’s field modifications and recorded them on drawings for submitting final documents)?

Design/Build Contractor Questions

If you chose to go the design/build contractor route, here are a few things to consider when going down this path:

• Has the contractor performed many of these replacements?

• Has the firm completed many medical-gas-related projects of this type and size?

• Has the contractor performed many of these types of assessments?

• Is the firm known for submitting for “add services” or “change orders” frequently?

• Is it known for thinking outside the box for projects like this?

• Is it well-known in the industry for projects like this?

• Is the contracting firm usually the lowest bidder on other projects in your facility?

• Is the contractor known for asking questions?

• Does the contractor do a hands-on assessment? Is he present multiple times during the replacement process to ensure everything runs smoothly and that any surprises are handled immediately and without additional fees (unless unforeseen events occur)?

• Does the contractor provide accurate as-builts?

A well-thought-out scope of services — one developed early on with your project manager’s input and possibly a third party — will typically lead to a tighter proposal. 

To Bid or Not to Bid

Alright, you get this far and decide to go with a design/build contractor. Now, do you put it out there for three contractors to submit proposals to do the job or select one you know has completed great work for your facility in the past? This same contractor can provide you with updated budgetary numbers based around the scope of services you outlined.

The scope of services has only identified the replacement of the existing medical vacuum source equipment skid with a new one that has a similar capacity. 

The contracting firm performed its assessment for what it will take to swap out the existing medical vacuum skid with a new one. It has submitted a few ideas of what it will take to accomplish this with little to no downtime for the facility.

For this project, the contractor noted the need to use a portable vacuum skid located in a specific location and piped to accommodate the replacement process. And he indicated where in the medical gas system this portable connection is to be placed.

The contractor will install a bypass in several phases. Phase 1 indicates the temporary medical vacuum and where to connect it. Also, it specifies a connection to install new valving. In Phase 2, the contractor installs a bypass on the other main. 

Phase 3 has the contractor designating the interconnection between the two main lines. As part of this phase, he proposes to remove the temporary bypass pump and route the vacuum through the valving system just installed.

As part of the final phase, the contractor shows the future connection valved and capped, along with a new auxiliary connection (see Figure 5).

With all parties on board with the direction of the replacement, the contractor can put together a detailed cost of what it takes to complete this project. From here, the project will either continue forward or go for additional funding if the original budget was light.