In a 24-hour veterinary hospital, construction is not just a facilities challenge. It’s an operational one. Emergency cases do not slow down during renovation. Surgical schedules cannot simply be paused. Access to imaging, sterile environments, and critical systems must always be maintained. For veterinary teams, even short disruptions can affect patient flow, delay procedures, and introduce risk. As demand for specialty and emergency veterinary care continues to grow, more hospitals are choosing to expand existing facilities rather than relocate. However, doing so requires a fundamentally different approach to planning and executing construction—one that prioritizes continuous clinical operations from day one. At Charleston Veterinary Referral Center (CVRC) in Charleston, S.C., this reality shaped every aspect of a recent 32,700-square-foot expansion and renovation project. The 24-hour hospital treats approximately 26,000 patients annually, making uninterrupted access to surgery, diagnostics, and treatment spaces essential throughout construction. Completed in 16 months, the project nearly doubled the facility’s size while allowing it to remain fully operational. Achieving that outcome required close coordination between construction teams and veterinary staff, with decisions driven as much by clinical workflows as by construction sequencing. Start with clinical operations, not construction logistics In active healthcare environments, construction planning cannot happen in isolation. Understanding how the hospital functions day to day is the starting point for every decision that follows. At CVRC, that meant mapping patient intake patterns, surgical demand, imaging usage, and staff workflows before finalizing sequencing plans. These insights informed how and when different areas of the hospital could be taken offline, renovated, and brought back into service. That level of planning was especially critical for the hospital’s surgical suites. All six operating rooms—both new and renovated—were located within the existing portion of the facility, meaning they could not be taken offline until operations transitioned into the new addition. Early workflow planning identified this as a significant constraint. In response, the project team adjusted the sequencing to prioritize completing two surgical suites so they would be ready for the transition. This allowed the hospital to always maintain access to at least two fully functional operating rooms, enabling procedures to continue without interruption. This level of alignment helps prevent common issues that arise when construction is planned without operational input, such as restricted access to critical spaces, delays in procedures, or disruptions to staff workflows. Operating rooms at Charleston Veterinary Referral Center (CVRC) were phased carefully during construction to remain functional, allowing surgical procedures to continue without interruption throughout the project. Photo courtesy Kris Decker with Firewater Photography The surgical prep area supports pre- and post-operative care, with integrated monitoring, medical gas access and workspace designed to keep procedures moving efficiently. Photo courtesy Kris Decker with Firewater Photography Managing infection control and airflow during renovations One of the most significant challenges in any hospital renovation is maintaining safe, controlled environments while construction is underway. At CVRC, much of the work occurred adjacent to active surgical suites and treatment areas. Construction activities can introduce dust, debris, and airborne contaminants, compromising sterile conditions if not carefully managed. To mitigate this risk, construction zones were isolated with temporary barriers and negative air pressure systems designed to prevent contaminants from migrating into clinical spaces. Crews followed strict protocols when working near treatment areas, including gowning and sanitation procedures. These measures support clinical outcomes by helping preserve sterile environments and reduce the risk of infection during procedures. For veterinary teams planning similar projects, early coordination around infection control and airflow is critical. Once construction begins, these systems are much more difficult to adjust without introducing additional risk. Dedicated spaces for each specialty department, supporting the growing medical team at CVRC and allowing more patients to receive treatment. Photo courtesy Kris Decker with Firewater Photography Phasing construction to maintain surgical capacity How construction is phased can determine whether critical services remain available or are forced offline. The CVRC project was executed through smaller, tightly coordinated sequences aligned with the hospital’s operations. Surgical suites and treatment areas were renovated incrementally, allowing portions of the hospital to remain active while others were under construction. This micro-phasing approach enabled CVRC to maintain surgical capacity throughout the project, reducing the need to delay procedures or refer cases elsewhere. Maintaining access to surgical space is not simply a scheduling consideration. Interruptions can affect case flow, increase pressure on staff, and impact patient outcomes, particularly in high-acuity environments. It also helped limit operational and revenue impacts that can occur when surgical suites and diagnostic services are taken offline. As a result of this coordination, the project team provided CVRC with a clear schedule outlining when specific spaces would be unavailable. With that visibility, the surgery and neurosurgery teams adjusted their schedules, beginning procedures approximately three hours earlier than usual during certain construction phases. This shift helped offset temporary reductions in available surgical space and allowed the hospital to maintain overall capacity. The emergency treatment floor is designed to support continuous, high-acuity care, with open visibility and direct access to critical systems for rapid response. Photo courtesy Kris Decker with Firewater Photography Avoiding diagnostic disruptions While surgical capacity is critical, access to diagnostics is just as essential for delivering timely care. Imaging services, in particular, play an important role in both diagnosis and surgical planning. Disruptions to these capabilities can delay treatment decisions or require cases to be referred elsewhere. At CVRC, advanced imaging is a routine part of care delivery, with an average of 12 to 16 CT scans performed weekly across oncology, surgery, internal medicine, and other specialties. Losing that capability would have directly impacted patient care. To maintain continuity, the hospital deployed a temporary mobile CT scanner on site while a new imaging suite was constructed. At the same time, the project team accelerated the buildout of the permanent CT room, reducing the anticipated construction timeline from approximately three months to about one month. This approach allowed CVRC to continue providing advanced diagnostic services while minimizing disruption within the facility. For veterinary practices, decisions around temporary infrastructure often come down to balancing costs against operational impact. In high-volume or specialty environments, maintaining access to diagnostics can be critical to sustaining care delivery. The expanded pharmacy is centrally located for seamless collaboration. Photo courtesy Kris Decker with Firewater Photography Coordinating specialized infrastructure installation Behind every clinical space is a network of systems that support patient care, including electrical, mechanical, and medical gas infrastructure. CVRC’s expansion included installation of a new medical gas system, a 5,500-liter bulk oxygen storage tank, and an exterior medical gas farm. Integrating these systems required tying into existing infrastructure while the hospital remained operational. Even brief interruptions to power, airflow, or medical gas supply can pose risks in active treatment environments. To mitigate this, project teams coordinated closely with engineers, subcontractors, and hospital staff to plan and sequence these tie-ins. Medical gas integration, in particular, required detailed coordination. Unlike other systems, there is rarely an ideal time to interrupt oxygen supply in a 24-hour hospital. While planned shutdowns were scheduled during early morning or late evening hours to avoid impacting procedures, emergency cases remained unpredictable. To address this, teams worked closely with CVRC’s facilities staff to establish backup oxygen delivery systems in advance of planned outages. Tie-ins were also overlapped, where possible, to reduce the total number of shutdowns required. In addition, teams confirmed equipment placement, outlet locations, and room layouts with hospital staff before walls were closed, allowing early adjustments and reducing the risk of rework. Planning for future clinical needs Expansion projects are not only about addressing current demand. They are also an opportunity to prepare for future growth and evolving clinical capabilities. At CVRC, planning decisions considered how the facility could support additional services and changing care models over time. Early coordination between clinical teams and project partners helped align infrastructure and layout decisions with long-term needs. This included designing and building space for future departments, including dental and radiation oncology. The dental suite was constructed with the infrastructure needed to support the service once it is added. The linear accelerator vault and control room were also completed in advance to support a future radiation oncology program. Planning for these capabilities in advance allows the hospital to bring new services online more efficiently, without requiring major renovations or disrupting existing operations. Renovations without compromising care As veterinary hospitals expand to meet growing demand, maintaining continuous operations during construction is becoming less of an exception and more of an expectation. Projects, such as the CVRC expansion, demonstrate that success is not defined by how quickly space is delivered, but by how well care is protected along the way. Hospitals that align construction decisions with clinical realities from the outset will be better positioned to grow without disrupting the services their patients depend on. Eddie DeSimone is a senior project manager at Frampton Construction. He is responsible for managing construction projects from start-up through close-out with a focus on schedule, budget, quality, safety, and client satisfaction. Holly Williams has been the hospital director at Charleston Veterinary Referral Center (CVRC) for the past two years, bringing more than 20 years of leadership experience in healthcare. Tyler Ulietti is the hospital operations coordinator at CVRC, overseeing medical equipment, IT infrastructure, and facility operations. He was a liaison between hospital leadership and Frampton Construction.
