Transforming Emergency Care While Keeping Doors Open at Providence St. Vincent

The project expanded and modernized the emergency department within the Phil & Penny Knight Pavilion, increasing treatment capacity and improving patient flow, staff workspaces and diagnostic capabilities.

Key upgrades included larger patient rooms, new nurse stations and work areas, updated entry and security zones, and the addition of fast-track and results-pending spaces designed to improve patient flow through the department.

The team also constructed a new diagnostic imaging department directly adjacent to the emergency department, bringing CT scanners, radiology equipment and ultrasound capabilities closer to caregivers to accelerate diagnosis and treatment.

Delivering these improvements required construction within a fully operational emergency department, where patient care could never pause.

To make this possible, Lewis developed a highly detailed four-phase construction plan designed to maintain emergency services throughout the 26-month project.

Each phase clearly defined construction zones, temporary barriers, access routes and carefully timed shutdown windows so crews could complete work while protecting patients, staff and visitors. The plan ensured the emergency department always maintained the minimum number of available exam rooms required for operations.

Short-interval scheduling helped the team manage work in small, carefully coordinated increments. Weekly look-ahead plans outlined upcoming work activities and allowed the team to adjust sequencing based on real-time operational needs.

Equally important was constant communication. Lewis and JRJ coordinated closely with emergency department leadership, hospital facilities staff and clinical teams to align construction activities with patient volumes and staff workflows.

From the earliest stages of design, Lewis worked closely with Providence St. Vincent's emergency department leadership, including nurse manager Alexia Afzali and her team, to understand how construction could affect daily operations. Afzali met regularly with Lewis general foreman (now superintendent), Cindy Benton and hospital project manager Amy Brooks to coordinate upcoming work and share feedback from caregivers on the floor. These conversations helped the team anticipate potential disruptions — from power shutdowns to unexpected noise — and adjust plans before they could impact patients or staff.

"Through this whole process, good communication has been instrumental," Afzali said. "It's essential to have open lines and a dedicated point of contact that remains from start to finish."

For the Lewis field team, working inside an occupied emergency department also required a mindset of empathy.

"Working this close to patients is hard for all parties involved," said Lewis superintendent Cindy Benton. "It helps to consider that the patient next door could be your daughter or your mother. This mindset helps with the added challenges of working in an occupied space."

This level of coordination and compassion enabled the project team to safely co-locate with caregivers and patients without disrupting emergency services.

Turning over space as it was completed
Rather than waiting until the entire project was finished, the team used a progressive occupancy strategy that allowed Providence to begin using completed areas immediately.

As each phase reached substantial completion, newly finished spaces were turned over to hospital staff while construction continued in other parts of the department.

This phased turnover approach allowed the hospital to realize operational improvements sooner while maintaining flexibility as construction progressed.

Strengthening emergency care for the community
The completed expansion increases treatment capacity from 58 to 84 spaces, allowing Providence St. Vincent to serve significantly more patients each year while improving care delivery and reducing wait times.

The expansion also strengthens the hospital's behavioral health capabilities. A relocated and expanded secure behavioral health unit provides safer, more appropriate care environments for patients experiencing mental health crises, while 12 flexible treatment rooms can adapt quickly to meet a wide range of patient ages and clinical needs.

By combining detailed planning, flexible scheduling and close collaboration with hospital staff, the Lewis team successfully delivered a major renovation inside an active emergency department without interrupting services.

As Providence St. Vincent Nurse Manager Christina Venneri shared: "Through their support and leadership, we were able to make improvements to our department while still serving our community — a true testament to flexibility and resilience."