This four-story concrete hospital addition was built in St. Louis, MO by Ceco Concrete Construction, LLC – a nationwide design-assist structural concrete contractor. Ceco worked successfully between two fully-operational hospital buildings, working to reduce impact on patients, staff, and visitors throughout construction. First level framing was performed over active steam and electrical lines that could not be shut-down during construction. The site had very limited storage space and material deliveries were restricted to reduce impact on hospital operations.