Trends in Healthcare Lighting & Upgrade Opportunities

Transcription

1 Trends in Healthcare Lighting & Upgrade Opportunities Karen Lee, LC, LEED AP 28 July Jonathan Hillyer

2 Agenda 1. Healthcare Segment Overview 2. Trends and Priorities for Healthcare Facilities 3. The Business Case for Good Quality Design 4. Healthcare Design Trends 5. Lighting for Healthcare Facilities 6. Lighting Upgrade Opportunities for Healthcare Facilities 7. Q&A 2

3 Healthcare Segment Overview

4 Healthcare Market Segment Business Types Inpatient Facilities General hospitals Small primary care hospitals Psychiatric hospitals Rehabilitation facilities Outpatient Ambulatory Care Facilities Primary care outpatient Freestanding diagnostic and treatment Freestanding urgent care Cancer treatment Outpatient surgical Office surgical Gastrointestinal endoscopy Dental 2010 Halkin Architectural Photography, LLC Residential Care Facilities Laboratories 4

5 Healthcare Facility Definitions (US DOE CBECS) Inpatient Facility Buildings used as diagnostic and treatment facilities for inpatient care. hospital inpatient rehabilitation Buildings used to offer multiple accommodations for short-term or long-term residents, including skilled nursing and other residential care buildings are classified as lodging buildings. Outpatient Facility Buildings used as diagnostic and treatment facilities for outpatient care. medical office clinic or other outpatient health care outpatient rehabilitation veterinarian Medical offices are included here if they use any type of diagnostic medical equipment (if they do not, they are categorized as an office building). Laboratories are categorized as other buildings DuPont. All rights reserved. Source: U.S. Energy Information Administration, Commercial Buildings Energy Consumption Survey (CBECS) 5

6 U.S. Hospitals (AHA Hospital Statistics, 2015 Edition) U.S. Registered Hospitals 5,686 Total 914,513 Beds $859,419,233,000 in Expenses Hospital Units of Institutions (Prisons, Colleges, etc.) 12 Nonfederal Long Term Care Hospitals 81 Nonfederal Psychiatric Hospitals 406 Federal Government Hospitals 213 Community Hospitals 60% Urban / 40% Rural Nongovernment Not-for-Profit 2,904 Investor-Owned (For-Profit) 1,060 State and Local Government 1,010 Source: American Hospital Association (AHA) Fast Facts on U.S. Hospitals (2015); data from 2013 AHA Annual Survey 6

7 Trends and Priorities for Healthcare Facilities Todd Mason/Halkin Photography

8 Challenges for Today s Healthcare Facilities Trends threaten already low profit margins Very Competitive Market Patients Most communities have many options - Other inpatient and outpatient facilities - Retail outlets (e.g., walk-in, etc.) Emphasis on community relations - Wellness; preventative care - Farmers markets Staff Physicians, nurses, other caregivers - Working environment - Amenities (e.g., shops, wellness, etc.) Financial Well-Being Shifting reimbursement models From volume-based to value-based - Patient outcome - Patient experience (HCAHPS) From inpatient to outpatient procedures No payment for Never Ever events Decreasing payment-to-cost ratio Aging population Less private payer, more Medicaid/Medicare 10% 8% 6% Total Margin Transparency via Hospital Compare web site 4% 2% 0% Operating Margin

9 Healthcare "Never Events" (2011 Revision) Care management events Patient death or serious injury associated with medication error (e.g., wrong drug, dose, patient, time, rate, preparation, or route of administration) unsafe administration of blood products labor or delivery in a low-risk pregnancy while being cared for in a health care setting a fall while being cared for in a health care setting Maternal or neonate death or serious injury associated with labor or delivery in a low-risk pregnancy while being cared for in a health care setting Artificial insemination with wrong sperm/egg Any stage 3, stage 4, or unstageable pressure ulcers acquired after admission/presentation to a health care facility Patient death or serious disability/injury resulting from irretrievable loss of an irreplaceable biological specimen failure to follow up or communicate laboratory, pathology, or radiology test results Radiologic events Death or serious injury of a patient or staff associated with introduction of a metallic object into the MRI area Product or device events Patient death or serious injury associated with use of contaminated drugs, devices, or biologics provided by the health care setting use or function of a device in patient care, in which the device is used for functions other than as intended intravascular air embolism that occurs while being cared for in a health care setting Surgical events Surgery or other invasive procedure performed on the wrong body part on the wrong patient Wrong surgical or other invasive procedure performed on a patient Unintended retention of a foreign object in a patient after surgery or other procedure Intraoperative or immediately post-operative/ post-procedure death in an ASA Class I patient Patient protection events Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than an authorized person Patient death or serious disability associated with patient elopement (disappearance) Patient suicide, attempted suicide, or self-harm resulting in serious disability, while being cared for in a health care facility Environmental events Patient or staff death or serious disability/injury associated with an electric shock in the course of a patient care process in a health care setting a burn incurred from any source in the course of a patient care process in a health care setting the use of restraints or bedrails while being cared for in a health care setting Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains no gas, the wrong gas, or is contaminated by toxic substances Criminal events Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider Abduction of a patient/resident of any age Sexual abuse/assault on a patient within or on the grounds of a health care setting Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a health care setting Source: National Quality Forum (NQF) 9

10 10 Most Concerning Issues for Hospital CEOs 1. Financial challenges Medicaid reimbursement Bad debt Decreasing inpatient volume Medicare reimbursement Competition from other providers (of any type) 2. Healthcare reform implementation Reduce operating costs Shift to value-based purchasing Alignment of provider and payer incentives Align with physicians more closely Develop information systems integrated with primary care physicians 3. Governmental mandates CMS audits, implementation of ICD-10, CMS regulations, state regulations, increased govt. scrutiny, etc. 4. Patient safety and quality 5. Care for the uninsured/underinsured 6. Patient satisfaction 7. Physician-hospital relations 8. Population health management 9. Technology 10. Personnel shortages Source: Becker s Hospital Review, Jan. 2015; American College of Healthcare Executives (ACHE) 2014 Survey (n=338) 10

11 Changing Reimbursement Model: Value-Based Purchasing (VBP) Issues now greatly co-dependent Financial challenges Medicaid reimbursement Bad debt Decreasing inpatient volume Medicare reimbursement Competition from other providers (of any type) Healthcare reform implementation Reduce operating costs Shift to value-based purchasing Alignment of provider and payer incentives Align with physicians more closely Develop information systems integrated with primary care physicians Governmental mandates CMS audits, implementation of ICD-10, CMS regulations, state regulations, increased govt. scrutiny, etc. Patient safety and quality Care for the uninsured/underinsured Patient satisfaction Physician-hospital relations Population health management Technology Personnel shortages FY 2017 View 2% Medicare Reimbursement Withheld Flu Immunization Mortality Rates Outcomes 25% Medicare Spending per Beneficiary Process 5% Clinical Care 30% Efficiency 25% Patient Experience of Care 25% Safety 20% HCAHPS Survey Hospital Acquired Infections Source: 11

12 Hospital Costs and Payments by Payer Types 150% 140% 130% 120% 110% 100% 90% 80% 70% Private Payer Medicaid Medicare Payment-to-Cost Ratios Medicaid & Medicare reimbursements do not cover hospital costs Private payers critical to hospital operation Impact worsened by decreasing inpatient revenue Hospital Payment-to-cost Ratios by Payer Type, Non-patient, 2.7% Non-patient, 2.8% Non-patient, 2.2% Uncompensated Uncompensated Uncompensated Care, 5.1% Care, 6.0% Care, 5.9% Private Payer, 41.8% Private Payer, 38.7% Private Payer, 33.3% Other Government, 6.1% Medicaid, 9.6% Other Government, 1.4% Medicaid, 12.8% Other Government, 1.8% Medicaid, 16.5% Medicare, 34.6% Medicare, 38.3% Medicare, 40.2% Hospital Cost by Payer Type Balance shifting to costs for Medicaid & Medicare patients 20% of community hospitals operating with negative margin Distribution of Hospital Cost by Payer Type, 1980, 2000 and 2013 Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2013, for community hospitals 12

13 Percent of Hospital Costs by Type of Expense (2013) Only ~2% of operating expenses is energy, but $1 saved $50 revenue Other Products (e.g., Food, Medical Instruments), 14.4% Prescription Drugs, 6.3% Although only 2.3%, most hospitals spend several million $ on energy Professional Fees, 9.1% Wages and Benefits, 59.2% Other Services, 20.0% (3) Utilities, 2.3% Professional Liability Insurance, 1.2% All Other: Labor Intensive, 3.7% All Other: Non-Labor Intensive, 3.7% (2) Source: American Hospital Association (AHA) analysis of Centers for Medicare and Medicaid Services data, using base year 2010 weights. (1) Does not include capital. (2) Includes postage and telephone expenses. (3) Percentages were rounded, so they do not add to 20 percent. 13

14 The Business Case for Good Quality Design 2012 Jonathan Hillyer

15 Creating an Improved Environment of Care Evidence-Based Design Reduce anxiety & stress Reduce staff turnover Improve wayfinding Sustainability LEED for Healthcare Daylighting & views Energy savings Patient Outcome Washington Hospital Center Washington, DC Reliability Error reduction Systems compatibility Safety & security Operational Costs Improve HCAHPS Reduce maintenance Infection control Reduce liability 2010 DuPont. All rights reserved. 15

16 HCAHPS Survey and Medicare Reimbursement Hospital Consumer Assessment of Healthcare Providers and Systems Some of the 29 survey questions: Never Sometimes Usually Always During this hospital stay, how often did nurses or doctors Treat you with courtesy and respect Listen carefully to you During this hospital stay, how often Were your room and bathroom kept clean Was the area around your room quiet at night During this hospital stay, Did you need medicine for pain How often was your pain well controlled How often did the hospital staff do everything they could to help you with your pain CMS Timeline for HCAHPS Impact 2006 survey implemented 2007 hospitals penalized 2% for not submitting data st public reporting of results % Medicare payments withheld to create value-based incentive fund FY % Medicare payments at risk FY % Medicare reimbursement dollars at risk Rate this hospital Would you recommend this hospital to your friends and family? Source: Centers for Medicare & Medicaid Services (CMS) 16

17 Medicare.gov Web Site and Hospital Compare Hospital statistics database Searchable by location Survey of patients experience (HCAHPS) Publishes scores by question Explains each survey topic and potential impact on quality of care Compares to state and national average HCAHPS scores linked to Hospital Value- Based Purchasing (VBP) program Effort to improve healthcare quality Also publishes information and statistics re: General information Timely and effective care Readmissions, complications and deaths Use of medical imaging Number of Medicare patients Payment and value of care 17

18 2017 HCAHPS Composites 25% Weight Patient Experience of Care Category (Composite) Summary of Questions Lighting Opportunities 1 Communication Nurse Courtesy and respect Listening skills Clear explanation 2 Communication Doctor Courtesy and respect Listening skills Clear explanation 3 Responsiveness of Staff Help getting to bathroom Assistance in bathroom Response to patient call 4 Pain Management Timely medication Pain control Staff assistance 5 Communication of Medications Clear explanation Side effects described 6 Discharge Information Clear discharge explanation Written information 7 Environment Cleanliness and Quietness Noise level at night Cleanliness of room and bathroom 8 Overall Rating Overall experience Would you recommend this hospital? Human-scale design Create circle of intimacy Human-scale design Create circle of intimacy Visual alerts Pathway lighting Patient control of environment Calming design Quality & quantity of illumination Well-located lighting Day/night illumination Wayfinding Safety, security 18

19 Ability of Lighting to Improve Patient Experience Good quality lighting design can: Create human scale intimacy and areas of privacy Enhance colors and surroundings Prevent furnishings & surfaces from looking dingy Highlight sparkling clean Encourage soft speaking and overall quiet with lower light levels Minimize disturbance due to noise Create soothing, relaxing environments Lower stress reduces need for pain medication Welcome and put people at ease Improve wayfinding Enhance safety and security Create positive brand position Source: The Center for Health Affairs 19

20 Priorities of the Healthcare Administration Facilities Management 20

21 Top Priorities for Facility Management Directors 21

22 Convince Stakeholders to Prioritize Lighting Audience-dependent message Patient outcomes Administrators circadian rhythms Accelerate healing Nurses HAI Physicians consistent visual perception Surgeons comfort in OR (heat) Millenials carcinogens, asthma Patient safety Slips & falls Orientation Visibility Aging population Budget, infrastructure, capital expenses Reduce lighting load to allow additional equipment to be added with other systems Generator capacity 22

23 Energy Use in Healthcare 2 nd Highest Energy Use Intensity (EUI) Energy Use Intensity by Principal Building Activity Food Service Healthcare - Inpatient Food Sales Other Public Order and Safety Lodging Healthcare - Outpatient Public Assembly Office Retail Education Service Warehouse and Storage Religious Worship Vacant Hospital Characteristics 24/7 operation Thousands of employees, patients, visitors Sophisticated HVAC systems to control temperature and air flow Energy intensive activities: - Laundry, medical and lab equipment use, sterilization, computer and server use, food service, refrigeration Large hospitals (>200,000 s.f.): - <1% of all commercial buildings - 2% of commercial floor space - Consumed 4.3% of the total delivered energy used by the commercial sector Source: US DOE EIA, 2003 CBECS Data EUI in 1000 Btu per square foot 23

24 Energy Use in Healthcare Consumption by End Use All Fuel Types (2.3% of operating expenses) Inpatient Facilities kbtu/sf Outpatient Facilities 94.6 kbtu/sf Office Equipment 1% Refrigeration 1% Cooking 2% Lighting 16% Other 7% Computers 2% Space Heating 37% Computers 3% Other 14% Office Equipment 2% Refrigeration 3% Space Heating 41% Water Heating 19% Lighting 24% Ventilation 8% Cooling 7% Water Heating 2% Ventilation 3% Cooling 8% Source: US DOE EIA, 2003 CBECS Data 24

25 Energy Use in Healthcare Electricity Consumption by End Use Inpatient Facilities 52 billion kwh Outpatient Facilities 20 billion kwh Computers 4% Other 12% Space Heating 2% Cooling 13% Other 21% Space Heating 6% Cooling 16% Office Equipment 2% Computers 5% Ventilation 5% Refrigeration 2% Ventilation 21% Refrigeration 5% Lighting 42% Water Heating 2% Lighting 42% Source: US DOE EIA, 2003 CBECS Data 25

26 Total Floorspace, million s.f. Healthcare Facilities Age by Floorspace (CBECS 2012) Hospitals build for life High renovation potential Before to to to to to to to 2012 Source: US DOE EIA, CBECS 2012 Survey Inpatient Outpatient 26

27 Lit Floorspace in million square feet Window and Interior Lighting Features of Large Hospitals (>200,000 s.f.) 2,000 1,800 1,600 1,400 1,200 1, Hospital Architecture High degree of fenestration Low penetration of daylighting harvesting and occupant detection Opportunity for energy savings and increased occupant comfort 14% of buildings 46% of buildings 0 Total Lit Floorspace Tinted Window Glass Reflective Window Glass External Overhangs or Awnings Skylights or Atriums Daylighting Sensors Occupancy Sensors Source: US DOE EIA, Large Hospital Report, CBECS 2007 Survey 27

28 Healthcare Design Trends Tom Powel Imaging

29 Evidence-Based Healthcare Design The process of basing decisions about the built environment on credible research to achieve the best possible outcomes. Non-Visual Benefits: Natural Light, Views of Nature, Positive Distraction, Circadian Entrainment Better View or Better Light?...patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays and took fewer pain killers than patients in similar rooms with windows facing a brick building wall. (Ulrich, 1984) Patient Satisfaction There is strong evidence that design changes that make the environment more comfortable, aesthetically pleasing, and informative relieve patient stress and increase satisfaction with the quality of care. (Leather, et al., 2003) Sunlight & Pain Effect of sunlight on pain medication usage of patients recovering from spinal surgery. 46% greater sunlight 22% less pain medication 21% reduction in medication cost NICU Lighting Infants exposed to day/night lighting cycles experienced deeper sleep and a greater rate of weight gain. Distraction Theory Patients diverted by a pleasant distraction have less attention to direct to their pain. Source: Cama Incorporated: The Experience of Light for Health and Wellbeing Karen Lee 29

30 Color Critical Observations in Healthcare 30

31 Healthcare Design Trends Daylight views Increased fenestration Landscaped exteriors Natural materials Neutral & warm colors create calming environments Project details: Architect: Stantec / Anshen+Allen Project: Mills Peninsula Medical Center Location: Burlingame, Calif. Source: Health Facilities Management designview 31

32 Healthcare Design Trends Dynamic color Color for wayfinding Whimsy to relax children & families Project details: Architects: Lighting : Project: Location: Stanley Beaman Sears Perkins + Will Anjan Sarkar, CD+M Nemours Children s Hospital (video) (video) Orlando, FL Images 2012 Jonathan Hillyer 32

33 Creating a Healing Environment: Light as Art Todd Mason/Halkin Photography Chris Foster University of Tennessee Medical Center St. Joseph s Regional Medical Center Paterson, NJ Lighting Designer: Rachel Calemmo University of Tennessee Medical Center Knoxville, TN Interior Designer: Heather King Anyone Who Has A Heart Manchester, UK Lighting Designers: Andrew Small, Steve Almond 33

34 Lighting for Healthcare Facilities

35 Quality Lighting For your patients For your visitors For your staff For your bottom line Todd Mason/Halkin Photography 35

36 Recommended Practices for Lighting Healthcare Facilities ANSI/IES RP-29: Lighting for Hospitals and Health Care Facilities Last revision published in 2006 (RP-29-06) Being overhauled by IES Health Facilities Lighting Committee Will better reflect current state of healthcare delivery Terminology and organization will mirror Facilities Guidelines Institute (FGI) Guidelines for Design and Construction of Hospitals and Outpatient Facilities (2014 revision) Sidebar commentary on current areas of related research Currently in committee review Will be released for public comment in compliance with ANSI process IES The Lighting Handbook, 10 th Edition Published in 2011 supersedes RP Chapter 27 Lighting for Health Care Illuminance tables by space and application Brief design narrative by space Incorporates new design recommendations: Day/night light levels to promote more restful sleep and noise reduction Night lighting using low CCT or amber-colored light 36

37 Healthcare Facilities Upgrade Opportunities by Area Patient experience begins upon arrival at the hospital Patient rooms 2 Nursing stations 3 Surgical areas 4 Examination and treatment 5 Laboratory and pharmacy 6 Helipad 7 Signage and wayfinding 8 Healing gardens 9 Parking facility Public accommodation Food service Retail shops Meeting spaces 10 37

38 Patient Rooms Design Elements Distinct zones: patient, care-giver, family Unobstructed path to toilet area Lighting Opportunities Controls Multiple task-appropriate light levels Exam, TV, reading, sleeping Patient control over environment can reduce need for pain medication Task lighting Limit disturbance of sleeping patient Day/night light levels Noise reduction Night lighting for safe wayfinding Low CCT or amber color 2012 Jonathan Hillyer 38

39 Nursing Stations and Corridors Design Elements Focal point of care unit Private communication May have decentralized nurse stations Lighting Opportunities Controls Day/night light levels to promote quiet Task lighting Charting Medication dispensing Handwashing Wayfinding Clear identification of information areas Patient door locations Alarms Accent lighting Artwork 39

40 Surgical Areas Design Elements 3 layers of light Ambient, surgical overhead, task Comfort of surgical team Low heat, low glare Lighting Opportunities Controls Effective scene setting and remote access for improved infection control procedures Energy-efficient lighting systems Reduce emitted heat for staff comfort Reduce conducted heat for better outcomes Excellent color quality for accurate observation Long-life sources for reduced downtime 40

41 Examination and Treatment Design Elements Layers of light Ambient, exam, instruments Supports compassionate discussion Lighting Opportunities Controls Ability to change scene for stage of visit Excellent color quality for accurate observation Task lighting Examination Test preparation, injection, etc. Note-taking Equipment selection may be restricted by medical equipment 41

42 Laboratory and Pharmacy Design Elements Glare-free, shadowless lighting High visual acuity tasks High vertical illumination Lighting Opportunities Controls Occupancy sensors Motion sensors on bench task lighting may qualify for LPD exemption Task lighting Allows for lower ambient light level May be tied to occupancy sensors for increased energy savings Diffuse vertical illumination Reduce medication errors 42

43 Helipad Design Elements Heliport identification beacon Touchdown and lift-off area (TLOF) Final approach and takeoff area (FATO) Taxiways and taxi routes Windsock Obstruction lighting Floodlights Lighting Opportunities Long life sources for increased reliability FAA-approved designs Well-controlled luminaire optics 43

44 Signage and Wayfinding Design Elements Information may be conveyed in a variety of ways Text Color Artistic features Art 2010 Halkin Architectural Photography, LLC Lighting Opportunities Controls Dynamic features Energy-saving schedules Motion sensors Match corporate colors or interior design palette Accent lighting Todd Mason/Halkin Photography 44

45 Healing Gardens Design Elements Human-scale lighting Long views of nature Calm respite Lighting Opportunities Controls Dim for curfew hours Limit light trespass and sky glow Well-controlled luminaire optics Safe navigation Encourage peaceful thought York Hospital in York, ME 45

46 Parking Facilities Design Elements Transition zone Parking decks and lots Cashier Elevator lobbies Wayfinding Lighting Opportunities Controls Day/night levels Occupancy sensing Scheduling Often the patient s first & last impression Safety Security Stress-free navigation 46

47 Public Accommodation Design Elements Food service Retail shops Meeting spaces Lounges Chapels Lighting Opportunities Controls Daylight harvesting Time scheduling Welcoming, inviting design Reduce stress Offer distraction for visitors and staff Lighting design appropriate for function Merchandising in retail shops Hospitality in food service Education in meeting spaces 2012 Jonathan Hillyer 47

48 Lighting Upgrade Opportunities for Healthcare Facilities 2010 DuPont. All rights reserved.

49 Specialty Applications Lighting and processes in special environments Illumination Surgical procedures Overhead, headlights Endoscopy Microscopy Special environments Wellness Cold storage Clean room Helipad lighting Therapeutic & Diagnostic Procedures Therapeutic applications Bilirubin Dermatological treatment Laboratory diagnostics UV applications Purification / Germicidal (UV-C) Fluorescent dyes (UV-A) UV curing & inspection Dental whitening and curing Heating (air & infrared) SAFELINE Shatter-Resistant Lamps HBO Mercury Short Arc XBO Xenon Short Arc Specialty Halogen Types HALOTHERM, HLX, XIR LINEARlight FLEX LED LINEARlight FLEX Protect LED PURITEC Germicidal ITOS LED Modules DULUX S BLUE Fluorescent 49

50 Easy Lighting Upgrade Strategies Sustainable Lamp Replacements Simple exchange No extra effort System Component Replacements Lamp and ballast upgrades Luminaire Retrofit Kits Convert existing fixtures to LED technology Conserve installed housing No New Wires Controls Add local controls and sensors for energy savings strategies Use of existing wiring minimizes labor 50

51 Upgrade Strategy #1: Sustainable Lamp Replacements SUPERSAVER Reduced Wattage Up to 22% energy savings OCTRON T8 Fluorescent XV, XP, XP XL, linear and CURVALUME PENTRON T5 Fluorescent Standard and HO METALARC Metal Halide DULUX EL Self-Ballasted CFL DULUX D/E, T/E/IN, & L Pin-Based CFL XL extended Life Up to 100% longer life OCTRON XP XL ECOLOGIC 3 T8 Fluorescent Standard and SUPERSAVER PENTRON HO XL ECOLOGIC T5 Fluorescent DULUX T/E/IN XL ECOLOGIC Pin-Based CFL Standard and SUPERSAVER LUMALUX PLUS XL ECOLOGIC High Pressure Sodium Solid State Lighting Mercury-free, long life, energy savings ULTRA LED A-line, PAR, MR, wet rated PAR; premium ULTRA SE and PRO HD SubstiTUBE IPS T8 LED 51

52 Upgrade Strategy #2: System Component Replacements Magnetic Electronic Ballasts Improve efficiency and reduce visual strobing vs. magnetic ballasts T12 T8 fluorescent HID magnetic electronic QUICKTRONIC Electronic Ballasts Fluorescent High Efficiency Systems QUICKTRONIC High Efficiency Electronic Ballasts Instant start for greatest energy savings PROStart programmed rapid start for use with occupancy sensors Select ballast factor to optimize performance T8 Fluorescent LED Systems ULTRA HE High Efficiency LED T8 Retrofit Kits Extended Warranty Coverage QUICK 60+ System Warranty QUICK 7XL+ System Warranty 52

53 Upgrade Strategy #3: Luminaire Retrofit Kits Convert existing fixtures to LED technology UL Classified retrofit kits Re-use installed housing Significant energy & maintenance savings ULTRA RT5/6 Downlight Kit For 5 or 6 housings Gimbal option for 6 housings 700, 900, 1200 lumens 120V, dimmable to 10% ULTRA RT6 HO LED Downlight Kit High output option for 6 housings V (UNV) 1500 lumens ULTRA RT8 Downlight Kit For 8 housings V (UNV) 2000 lumens ModuSYS Troffer Conversion Kit For 2x2 troffers; 7-year warranty V (UNV), 0-10V dimming interface Up to 4450 lumens; 3000, 3500, 4000K 53

54 Upgrade Strategy #4: No New Wires Controls Use of existing wiring minimizes labor Add local controls and sensors for energy savings strategies ENCELIUM Wall Switch Occupancy Sensors Add dimming capabilities without rewiring QUICKTRONIC POWERSENSE Controllable Fluorescent Ballasts T8, T5, T5HO systems Power line dimming OSRAM Slide Dimmers Implement daylight harvesting strategies with RetroFriendly products QUICKTRONIC POWERSENSE Controllable Fluorescent Ballasts T8, T5, T5HO systems Simultaneous power line and 0-10V control ELOGIC Sensor and Control for Daylight Harvesting Clips to T5/T8 lamp or mounts to any flat surface Wires feed into 0-10V control port of ballast 54

55 References Design IES The Lighting Handbook, 10 th Edition ANSI/IES RP Lighting for Hospitals and Health Care Facilities Currently being revised by IES committee LEED for Healthcare Green Guide for Healthcare (GGHC) Facilities Guidelines Institute (FGI) The Center for Health Design Energy ASHRAE Advanced Energy Design Guides (AEDG) 30% Energy Savings for Small Hospitals and Healthcare Facilities 50% Energy Savings for Large Hospitals 55

56 Many Thanks. Questions? For additional information, please contact: Karen Lee, LC, LEED AP