Author: Chad Forster, PE, SE, President | Principal
Hospitals occupy a category of their own within structural engineering. Construction happens inside buildings where surgeries take place, babies are delivered, and patients recover, often on the same floor where renovations are underway. The structure has to support all of that, as well as has to keep doing so during a renovation, after a code-defined event, and across decades of change inside the program it serves.
PES Structural Engineers has done this kind of work for years, including recent renovations at Grady Memorial Hospital in downtown Atlanta. At PES, we understand how a hospital operates as a structure and how our engineering decisions can support hospital operations.
This article walks through what makes structural engineering in hospitals different, the code considerations that shape it, and a few specific moments from the Grady projects that illustrate how those ideas show up in practice.
Why Hospital Structural Engineering Is High-Stakes Work
When engineers are asked which project they enjoyed most, hospitals often come up as a frequent response. The reason is not due to the technical challenge, although there is plenty of that; however, the primary reason is that the work supports something that matters tangibly. Helping design and construct a building that the community relies on for healthcare provides a sense of purpose that carries throughout the design process.
Structural Engineering Inside an Operating Hospital
On a renovation, the hospital does not stop. Surgeries continue, patients keep moving through the building, and crews may be working in one operating room while the rest of the floor is still in active use. Additionally, the ducts, electricity, and other utilities running through the space being renovated are still serving open portions of the hospital. New structural steel, for example, must be coordinated with existing conditions that need to remain operational during construction, even when those existing conditions are not part of the affected area.
The other reality of renovation work is the existing building itself. Drawings for a 50-year-old hospital are a starting point. Many of these buildings have been added onto and modified across multiple decades. Grady’s main tower was built in the 1950s and went through a major renovation in the 1990s, while other hospitals have been renovated many times over. The engineer is coordinating not just with original construction, but with every layer that came after, including mechanical changes that may not be fully documented over the years. In these cases, field verification is not optional. Getting out to the site and looking at the actual conditions is a necessary part of the job.
PES Renovations at Grady Memorial
PES has worked at Grady Memorial Hospital across multiple renovation projects spanning several years — flood repairs, imaging equipment evaluations, new operating rooms, a burn center, and most notably, the insertion of two new elevators into existing stair cores. Each project carried a distinct scope. Together, they capture what it means to keep a hospital in operation during renovation.
The first was a flood repair, involving basic consulting, evaluating whether a given bay could carry a CT machine, and coordinating new plumbing slabs through an existing concrete slab. Structurally straightforward by comparison, but a useful early lesson in what it means to work inside a building that cannot stop operations.
The second project was the most structurally demanding of the three. The main tower lacked adequate vertical circulation, and the program called for two new elevators to be added inside two existing stairwells. At 17 stories and more than 50 years old, the existing shaft is not perfectly plumb. Connecting the elevator support steel into that geometry required constant coordination among the elevator provider, the contractor, and the PES team — coming up with solutions on the fly as conditions came to light during construction. Existing drawings of an older hospital are a starting point. What you find in the field is the rest of the work.
The most recent project was a new Burn Center, including an operating room with significant overhead equipment. Patient lifts had to be tied into the structure, and hydrotherapy tubs required the floor to be evaluated for additional load. The central complication was the operating room equipment support. The supporting steel had to be coordinated with utilities in the new space, including ductwork, plumbing, and power that served other areas of the hospital. PES designed our steel system so that all these utilities could remain in operation. Close collaboration with the contractors in the field was required to come up with a structurally sufficient solution that was constructable while leaving the rest of the hospital in operation.
Field Collaboration on Hospital Renovation Projects
Healthcare design happens while the spaces being renovated are still occupied. Field conditions get verified during construction, not before, and surprises are sometimes a part of the job. Our approach in those moments is to be as collaborative as possible, understand what the construction team is dealing with, understand what the hospital needs to keep operational, and adjust our design to fit those parameters.
The most successful problem-solving on these projects happens in the field rather than at a desk. On Grady, the most productive moments came when the structural engineer, the architect, the mechanical engineer, and the contractor were all on site together, looking at the same condition and working through what would actually work. Decisions that could have taken weeks of back-and-forth got resolved in a single afternoon.
What Owners and Architects Should Know about Hospital Renovation
If you are planning a hospital renovation or a new healthcare facility in Georgia, a few things are worth knowing before the brief goes out.
On a renovation, the first question is whether the existing structural drawings are available and what the building was originally designed for. That information shapes scope, fee, and risk before any new design begins. The second is whether the proposed program might trigger an IEBC code update. Adding a small element to the roof can quietly turn into a much larger structural exercise if wind loads or other demands change beyond the threshold the code allows.
Bringing the structural engineer in early is the single best way to avoid the more expensive surprises. Once a program has been sold and an architectural concept is in place, structural findings that require change become redesigns rather than refinements. Talking through programming with the engineer in the room is much cheaper than discovering the issue in design development.
Healthcare Structural Engineering: Final Thoughts
Healthcare structural engineering rewards judgment built up across many projects. Code, equipment loads, vibration, future flexibility, and the operational needs of an active facility all have to be worked into a single coordinated solution, often with the building still running while the work is underway. The technical demands are real. The reward is being able to drive past a hospital, knowing that what is happening inside is supported by a structure that was thought through carefully.
PES Structural Engineers has been part of that work for years across healthcare and other essential facility types. Our involvement at Grady is one piece of that. The lessons from these projects continue to shape how we approach every healthcare project that comes through the door.
Planning a healthcare renovation or new facility in Georgia?
PES can support code review, evaluation of existing buildings, vibration considerations, imaging equipment coordination, and the field collaboration that hospital work demands. Contact our team to discuss your project.
FAQs
What makes structural engineering for hospitals different?
Hospitals fall into a higher risk category than typical commercial buildings, which raises load and anchorage requirements. They also bring vibration considerations around operating rooms and labs, imaging equipment loads from MRIs and CT scanners, and lead shielding requirements that have to be coordinated with the structure. The combination is what sets healthcare apart, not any single factor.
What is the IEBC, and why does it matter for hospital renovations?
The International Existing Building Code governs how renovations to existing structures are evaluated. Certain scope changes can trigger a requirement to bring the entire building up to current code, which is rarely practical in an older hospital. Identifying those triggers during programming and adjusting the design to avoid them when possible is one of the more valuable things a structural engineer brings to a healthcare renovation.
When should the structural engineer be brought in?
Programming is the right time. By the later phases of design, many of the decisions that constrain the structural solution are already in place. Early engagement allows the engineer to evaluate the existing building, flag potential code triggers, and weigh in on material selection before those choices get locked.