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Part of a superintendent’s job is reminding subcontractors of potential jobsite hazards, but those usually don’t involve hospital patients.

“Look both ways to make sure there’s not a stretcher coming toward you,” said Sarah Redlinger, a superintendent for Hoffman Construction. It’s a common warning at her present jobsite.

Hoffman Construction is beginning the final phase of a complex, $40 million remodel at Legacy Emanuel Medical Center in North Portland. The project, which began slightly more than a year ago, involves a complicated revamp of former pediatric facilities in which construction and medical activities are being juggled.

From the first hammer strike, the project moved like a string of dominoes.

“Juggling act is a good word for it,” Redlinger said. “It’s basically a massive puzzle piece that, I wouldn’t say constantly moves, but it’s definitely shifting.”

After the new Randall Children’s Hospital facility opened its doors in February 2012, Hoffman went to work renovating the space formerly occupied by that department. It was spread out between the third floor of the north tower, and the second and third floors of the hospital’s west wing.

First, the third floor was gutted and rebuilt as the new Trauma Recovery & Acute Care Unit. When that work finished, and all patients were transferred, space in other parts of the hospital became available for construction. For instance, the former unit for trauma recovery and care was converted into a temporary emergency room as crews began renovating the former emergency room.

Patients relocate. Demolition crews go to work. Rinse and repeat, so to speak.

Hoffman recently finished renovating a new neuro-trauma Intensive Care Unit on the third floor of the west wing building, and on Sunday the last patients were transferred to that space. Legacy also opened a 12-bed cardiovascular Intensive Care Unit on the second floor, which used to be home to a neonatal Intensive Care Unit. That freed up the final piece of the puzzle: Hoffman is now renovating part of the new emergency room.

Lori Morgan, chief administrative officer for Legacy Emanuel, said the project has been a long time coming.

“We were practicing 21st century medicine in 20th century facilities,” she said. “It has been difficult because the technology has increased the requirements just for space – for the footprints – and so many of the things we needed to do would be very tight. You had to decide if you wanted your family in the room or your physician in the room. They weren’t both happening.”

Part of the renovation included the creation of a family waiting area on the third floor of the medical center’s central building. Similar to a hospital lounge, the area has a kitchen, private consulting rooms and a business center with computers and printers so that visitors can stay connected.

The renovation is part of the $250 million budget allocated for the Randall Children’s Hospital project. Morgan said the original cost of the remodel was $25 million, but that grew by $15 million when the new ICU department was added. Morgan said it would have been more costly to add it later.

Legacy also is planning to build new operating room facilities down the road, but Morgan said that project is still in early planning. She said it would likely involve new construction and renovations of existing space.

As Redlinger knows, that can be a delicate process when medical services are going on at the same time. Infection control is a big concern.

Redlinger said crews need to be careful that air from the jobsite doesn’t filter into the hospital, so they are constantly drawing air from the hospital into the jobsite, and then exhausting it outside. Delivering large truckloads of materials also can be a challenge.

“We’ve tried to stay away from the ambulances, but that puts us in the smack-dab middle of the public,” she said. “It’s a toss-up as to what’s going to be easier for the hospital.”

Redlinger said project success ultimately is a product of the subcontractors’ ability to work efficiently. Morgan said hospital staffers are playing a key role indirectly.

“Obviously it’s been a bit of a shuffle and stressful for our (staffers), who are working in constantly changing environments,” Morgan said. “But they have done a great job of providing an excellent quality of care despite the fact that we’re changing the rules all the time.”

The team is hoping that the project wraps up before summer ends, according to Morgan.