In order to respond to national and local trends in pediatric care, Children’s Hospital needs to expand on our main campus and across the Puget Sound region.

Nationally, the need for pediatric specialty care is expected to grow more than 3.5% a year. A recent study by the Child Health Corporation of America, a national association of free-standing pediatric hospitals, shows that inpatient days for pediatric diseases overall are estimated to grow 3.1% annually through 2010. Causes include:

• Increasing severity of pediatric illnesses
• Increases in prematurity and low birth weight
• Increased prevalence of chronic conditions such as diabetes and developmental disorders
• Growing prevalence of obesity complicating hospital care
• More patients surviving childhood diseases, such as cancer, and utilizing health care services longer

Areas of pediatric care such as infectious diseases, premature birth related care and endocrinology are growing at even faster rates. At children’s hospitals across the country, diabetes admissions increased nearly 17% between 2000 and 2003. These types of complicated diseases require more frequent and longer hospital stays. At Children’s, more than 2/3 of our patients have chronic illnesses and we have been seeing an increase in length of stay over the past several years due to increasing severity of illness.

Children’s patients come from Washington, Alaska, Montana and Idaho and in some of these areas we’re experiencing a level of growth that exceeds national projections. Based on the 2000 census, almost 25% of King County residents, and almost 30% in Kitsap and Snohomish counties, were 18 or younger.

To care for our patients, we must modernize and grow the main hospital campus. Our new ambulatory care building is already at capacity and outpatient visits have grown 11% over the last four years with an increase of 5,000 visits from 2005 to 2006.

Currently, 100 of our 250 beds are in double rooms. To provide the best quality care, we seek to treat patients in single-patient rooms for infection control, privacy and comfort for families and the patient.

We realize that those living around our campus have legitimate concerns over growth related impacts. Children’s is committed to working with the community so we can grow our facilities to meet patient needs, while addressing community concerns.

The hospital will need 250-350 new beds over the next 15 to 20 years or more. This means a total of approximately 500 to 600 beds. While we can’t foresee the exact number of beds we will need in the future, we want to plan prudently for growth to meet the most need. In order to avoid over-building on campus, we will build in phases.

In our growth projections we are assuming that we will need approximately 4,000 square feet per patient bed. This includes patient rooms and other accessory spaces such as operating rooms, playrooms, family areas, etc. If we assume 600 beds at 4,000 square feet per bed, it equals 2.4 million square feet – adding well over 1 million square feet to our existing campus. These are preliminary projections, and may change as we move further along in the process.

In response to DPD’s Environmental Impact Statement (EIS) scoping report, Children's developed three additional alternatives for development on the hospital campus and removed the campus-only alternative, submitted in the July 2007 Concept Plan, from further consideration. Alternatives 3-5 were developed to directly respond to DPD’s suggested design changes and the three alternatives propose a lower height than the original Concept Plan submitted in July 2007.

Read a letter submitted to the City of Seattle outlining the alternatives and view graphics of the proposed development.

The three alternatives include:

Alternative 3: Proposes 600 beds with a maximum allowable building height of up to 160’ above grade in one area of the campus and up to 105’ above grade at the Hartmann site.

Alternative 4: This alternative includes extending the campus to include the Laurelon Terrace property and would only be feasible in the event that the property becomes available for use in the late phases of the proposed master plan. It would not be built without ownership of the property. Proposes 600 beds with a maximum allowable building height of 160’ above grade on portions of the campus and 105’ above grade at the Hartmann site.

Alternative 5: Proposes 600 beds with a maximum allowable building height of up to 160’ above grade in one area of the campus and up to 105’ above grade at the Hartmann site. This option spreads development to include a portion of the campus north of Penny Drive.

Previous explanations of building heights on Children’s campus have caused some confusion, and understandably so. It’s a complicated topic because Children’s is built on a hill, and building heights can be shown in terms of number of feet above grade (ground level) or number of feet in elevation (above sea level).

In other words, the tallest point on the roof of a building at the lowest part of Children’s campus could be 90 feet above ground level, but 163 feet above sea level (the elevation of Children’s campus ranges from 73 feet to 158 feet above sea level).

On the highest part of Children’s campus, that same 90-foot building would still be 90 feet above ground level, but 248 feet above sea level (because the ground itself is higher: 90 + 158 = 248). The height above sea level is expressed in terms of elevation and noted with the prefix “El.”

The City of Seattle’s Land Use Code defines building height as the measurement between the tallest point on a roof and the grade (ground). In the Concept Plan submitted to the City of Seattle in July 2007, building heights are expressed both in terms of height above grade and in terms of elevation.

“MIO” is the acronym for “Major Institution Overlay.” The City of Seattle’s Land Use Code requires that Major Institution Master Plans specify the maximum allowable building height for specific areas (“districts”) of the institution’s campus. These height limits are referred to as the MIO.

A Concept Plan presents a conceptual idea of how development on campus could be structured, and specifies different height limits for different areas on campus. At this stage, a Concept Plan does not present actual building designs.

The original Concept Plan submitted to the City of Seattle in July 2007 proposed a maximum allowable building height or MIO of 240 feet above grade, resulting in a proposed building height of El. 306’. In response to the Department of Planning and Development’s Environmental Impact Statement Scoping Report, Children’s submitted three new alternatives in October 2007 (alternatives 3-5) which all proposed an MIO of 160 feet above grade, resulting in a proposed building height of El. 266’.

Under our current MIMP (approved in 1994), the highest MIO is 90 feet. As of now, the tallest building on Children’s campus is actually 80 feet above grade, and El. 202’ (G-Wing, completed in 1953).

Here is a grid showing proposed change in MIO and building height (in elevation) from the July 2007 Concept Plan.

Concept Plan, July 2007
Existing MIO and corresponding building height	Proposed MIO and corresponding building height
MIO: 240’ Building height: El 306’above sea level	MIO: 90’ Building height: El 202’ above sea level

The new alternatives submitted to the City of Seattle on October 29, 2007 proposed raising the MIO building height limits to 160’. This would be the highest allowable building height (MIO district).

Here is a grid showing the proposed change in MIO and building height from the October 2007 alternatives 3-5.

• Existing buildings on the Children’s campus have stories that range from 11 feet to 20+ feet high. Based on the slope of the site and the height of existing buildings, the approximate difference between the tallest existing building and the tallest proposed design is:
• Concept Plan: approximately 6 stories (plus 15’ for mechanical equipment).
• Alternatives 3-5: approximately 3 stories (plus 15’ for mechanical equipment).
• To determine the difference in height between the proposed design and the existing tallest point:
• Concept Plan: El. 306’ – El. 202’ = 104’(including 15’ mechanical equipment) increase in elevation above sea level
• Concept Plan: MIO 240’ above grade – MIO 90’ above grade = 150’ increase in elevation above grade
• Alternatives 3-5: El. 266’ – El. 202’ = 64’ (plus 15’ mechanical equipment) increase in elevation above sea level.
• Alternatives 3-5: MIO 160’ above grade – MIO 90’ above grade = 70’ increase in elevation above grade.
• The Concept Plan proposes the height of the tallest building as approximately 240 feet tall, including 15 feet for mechanical equipment. This translates into a building of 16 stories above grade. Alternatives 3-5 propose the height of the tallest building as approximately 160 feet tall, including 15 feet for mechanical equipment. This building would be 12 stories above grade.
• Because the hospital is built on a hill, building heights look different when viewed from different sides of the hospital. This diagram shows the slope on the hospital site and both the existing and proposed tallest buildings from the Concept Plan and alternatives 3-5 to demonstrate the difference in elevation and building height above grade.

The Concept Plan proposed three different MIO building heights on campus: 50’, 90’ and 240’ above grade. Alternatives 3-5 propose three different MIO building heights on campus: 50’, 105’ and 160’ above grade. View images from the Concept Plan PowerPoint presentation that show where the MIO districts are located.

Remaining on the current hospital campus is essential, both financially and in terms of quality of health care. The cost to move entirely to a new location is prohibitive. If property was available, the estimated cost of land and rebuilding what we currently have is between $1 billion and $1.5 billion. This is just the cost to replace current facilities. Additional growth to meet future needs would cost at least another $1 billion.

Satellite hospitals are expensive because of inefficiencies in clinical care. It is extremely expensive to duplicate high intensity services like intensive care units. The wide swings in daily census related to the nature of pediatric illness, also make smaller hospitals financially challenging.

Satellite hospitals also pose challenges in providing quality clinical care. Illness in children is different than with adults and tends to be unpredictable. Given the uncertainty and speed at which children can get very sick, it is critical to provide a full range of service. Given the severe shortages of pediatric specialists and expert clinicians it is very difficult to provide this level of staffing at multiple locations.

Co-locating with other hospitals is also difficult both in terms of providing the necessary staffing and ensuring that beds are available. When we are full, especially in the winter, the pediatric units of other hospitals are generally full as well.

As stated in the City of Seattle’s Municipal Code, an institution prepares a Preliminary Draft Master Plan (PDMP) and the lead agency for the environmental process (Department of Planning and Development) prepares a Preliminary Draft Environmental Impact Statement (PDEIS) so that various agencies such as the Seattle Department of Transportation, DPD, the Citizens Advisory Committee (CAC) and the institution can comment on the preliminary drafts. Those comments are incorporated and later a Draft Master Plan and Draft Environmental Impact Statements are published and a public hearing is held.

The PDMP and PDEIS were presented to the CAC at the Committee’s January 2008 meeting.

If you wish to be notified when the DEIS is available, contact Scott Ringgold, City of Seattle, Department of Planning and Development (scott.ringgold@seattle.gov).

Increasing the number of patients will increase the number of staff and total trips to the campus. We anticipate that the number of staff will roughly increase in proportion to patients as we grow. Children’s will work with our transportation consultants to understand how staff, patients, and visitors currently travel to our campus in order to develop projections for future growth.

We will work very hard to influence the mode of transportation used to get here, to minimize the trips made by personal vehicles and increase trips made by transit, shuttles, ridesharing, bicycling, etc. Children’s has a great track record of effective transportation management. In recent years, Children’s has continuously reduced the percentage of staff that drives alone to work; currently only 34% of day shift staff drive alone to work. Children’s is also working on launching a Flexbike program making bikes accessible to employees in an effort to reduce automobile trips.

We are actively seeking partnership opportunities with local transit agencies to enhance transit options including additional shuttle service. In September 2007, Metro launched additional runs on bus routes 25 and 75 as a result of a partnership with Children’s. It will be important to understand what transit options are desired among potential users, including staff, patients, and the community.

The Environmental Impact Statement will include a traffic study that will include Sand Point, Montlake, and the surrounding street networks. This study will use available historical data to establish past traffic volumes, although availability of data will determine how far back we can look. Nevertheless, we will work to establish an accurate baseline, current and future traffic analyses. The transportation analysis and study will be included in the draft Environmental Impact Statement which is expected to be complete in Spring 2008.

Parking is one of the major challenges that we will face. We will need to add parking capacity; rough estimates are that a hospital of 500 to 600 beds might need about 4,280 parking spaces. Children’s currently has about 2,167 parking spaces, including 1,462 spaces on campus, 80 at the Hartmann building and 625 off campus. Therefore, up to 2,113 additional parking spaces may be needed.

Ideally, we would like to minimize as much new parking as possible, as it has financial as well as traffic impacts. We will look at building underground parking, but need to consider that surface parking costs around $5,000 per space compared to underground parking at around $50,000 per space.

We hope to locate some of the future parking at off-site lots to disperse incoming trips and minimize local traffic impacts. We will also continue to convert more vehicle trips to alternative modes such as transit to minimize both the parking need and traffic generated.

Currently, about 10% of our patients arrive at the hospital by ambulance; in 2006 there were 3,300 ambulance trips to the campus. Ambulance traffic is likely to increase proportionally to the number of beds on campus. We currently have an agreement with the neighborhood to minimize siren noise near the campus and we will continue to do so. As we begin the Environmental Impact Statement traffic study process, we will learn more about the correlation between the number of beds on campus and ambulance trips.

We have no plans to change the emergency landing program to increase helicopter landings. Landings are closely monitored and the number of landings has remained fairly consistent over the years (4-6 per month). Patients who arrive at the hospital via helicopter are in life threatening situations.

Additional entrances are being considered and will be studied as part of the Environmental Impact Statement. While the main entrance will remain on Sand Point Way, secondary entrances could potentially be located on NE 45th Street or NE 50th Street. In Alternative 4, there is also a proposed entrance at 40th Avenue NE. Additional entrances have pros and cons for hospital operations as well as the community. While they may put more vehicles on surrounding streets, this would have the effect of diffusing traffic along Sand Point Way NE.

Additional hospital entrances may require intersection improvements such as signals, sidewalks and crosswalks, which would benefit traffic flow and pedestrian safety throughout the area.

The City of Seattle’s land use code for Major Institution Master Plans requires a plan for open space. Children’s recognizes that the landscape buffers are important to neighbors because they minimize both light and noise from the hospital campus. We’ve also heard from community members that they would like to see improved connections between the campus and the community, including improved access to campus gardens or linking the hospital to existing open space such as the Burke-Gilman Trail. Further open space plans will be discussed at Citizen Advisory Committee meetings.