As the site for the patient care moves from inpatient settings, hospitals face major decisions about the future of their facilities. Those build in the 1970's and early 1980's do not necessarily accommodate today's technology and patient care equipment, not convert readily to outpatient space. Thus administrators face the challenge of deciding what and how much to remodel in a facility, and what should be new construction. Duke University Medical Center, which includes 1124 licensed inpatient beds, on campus clinics, and off-site primary care practices, has faced such a challenge. In the past five years, administrators, clinicians, and facility designers have systematically reviewed current facility status, and planned renovations and new construction. All inpatient units were renovated in less than two years. During this time, clinical services were maintained and occupancy issues were managed. Space utilization, design and new technology resulted in units better suited to the needs of patients, families and staff.