Hospitals can lower heating costs by finding where heat is being used unnecessarily, then tuning schedules, controls, airflow and maintenance for each space’s clinical purpose. Start with meter and building-automation data; investigate avoidable simultaneous heating and cooling or excessive reheat; and verify that any change preserves required healthcare ventilation and patient and staff comfort. A single temperature or ventilation setting is not appropriate for every hospital room.
Why a hospital’s heating bill is an HVAC operations problem
Heating costs are not determined by the heating plant alone. In a hospital, a space may be heated, cooled, humidified and supplied with outside air at different times or for different reasons. Heating and reheat can therefore be part of a larger HVAC energy picture that also includes preheat, humidification, service water heating, cooling, fans and pumps. The U.S. Department of Energy (DOE) tracks these as distinct hospital energy end uses, a useful reminder to investigate the whole system rather than assume that the boiler or furnace is the only opportunity (DOE, “Researching Energy Use in Hospitals”).
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Reheat deserves particular attention: a system may cool or condition air centrally and then add heat to meet a zone’s needs. That operation may be necessary for some clinical spaces, but local data can show whether heating and cooling overlap unnecessarily, whether reheat runs when areas are unoccupied, or whether schedules and setpoints are working against one another. The category list identifies what to investigate; it does not prove that a specific hospital has a fault. Establish that from the facility’s own trend, meter and equipment data.
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Start with a site-specific review
Build an end-use and schedule picture
Gather the information the facility already uses to operate the building: utility and submeter data where available, building-automation trends, equipment schedules, temperature and humidity readings, and records of comfort complaints or service calls. Organize the review around the end uses that DOE identifies for hospital monitoring: preheat, heating and reheat, humidification, service water heating, cooling, fans and pumps. Compare when these systems operate with the occupancy and function of the spaces they serve.
Look for patterns that merit investigation, not automatic proof of waste. Examples include heating equipment operating outside its intended schedule, heating and cooling calls occurring at the same time, reheat that persists when a zone is not occupied, or a temperature reset that does not respond as intended. Confirm the cause with controls and equipment checks before changing operation. A high-level utility bill alone cannot identify which system or operating condition is responsible.
Map the building by use, not just by floor
Make a zone inventory that distinguishes clinical areas from offices, storage and other non-medical spaces, and records each area’s occupancy pattern, clinical function and applicable ventilation needs. A hospital is not one thermal zone: patients and care professionals may have different thermal preferences, and the DOE healthcare report describes thermal zoning as one possible way to address differing needs. Zoning can create a better basis for control decisions, but it does not guarantee either savings or comfort.
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For each zone, document which requirements govern its temperature, humidity, airflow and air exchange before considering an adjustment. Identify who has authority to approve changes and which clinical or facility stakeholders need to participate. Where requirements are unclear, facility engineers should check the current applicable standards and locally adopted codes with qualified staff or the relevant authority. The DOE report is a 2020 reference and does not establish what a particular jurisdiction currently requires.
Optimize controls and airflow without weakening clinical safeguards
Review schedules, resets and zone settings
Once the zone map and operating data are in hand, review the controls that determine when heating starts, how temperatures are reset, and how equipment responds to occupancy and outdoor conditions. A temperature reset can reduce unnecessary conditioning when conditions allow, but its settings and sequence must reflect the equipment, served spaces and applicable requirements. Cleveland Clinic’s Twinsburg case included rooftop-unit temperature resets among four operational measures; it also described air-exchange optimization, non-patient-area temperature settings and filter maintenance (DOE Better Buildings, “Cleveland Clinic – Twinsburg Family Health Center Spends a Little and Saves Big,” 2017).
Review the sequence of operation with the building-automation or commissioning team rather than changing a single setpoint in isolation. A reset that saves energy in one zone could create discomfort or interfere with another system’s operation if zones are not considered together. Record the original settings and schedule, the approved change, the affected spaces and the method for checking the result. That creates a usable basis for reversing or refining a change if observed conditions do not match the intended outcome.
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Assess airflow space by space
The DOE’s 2011 HVAC fact sheet recommends assessing airflow requirements across different hospital areas and discusses reducing 100 percent outside air in non-medical spaces such as offices and storage. That is historical guidance for investigation, not permission to reduce required ventilation in clinical areas or any other space with a defined requirement. Before changing outside-air fractions or air-exchange rates, verify current standards, adopted codes and facility-specific needs with qualified engineering and clinical staff (DOE, “Hospitals Save Energy and Money by Optimizing HVAC Performance,” 2011).
Airflow decisions and heating decisions are linked: the volume and condition of incoming air affect the energy required to condition it, while airflow also serves the space’s operational purpose. Do not treat a lower air-exchange rate as inherently better. Identify the space, its required ventilation, the operating condition being changed and how compliance and comfort will be checked. If those conditions cannot be established, do not make the change on the basis of energy savings alone.
Maintain filters and commission the system
Filter condition and system commissioning affect how reliably HVAC equipment performs. The Twinsburg case describes filter optimization and commissioning or optimization work, but does not establish a universal filter type or replacement interval. Use the equipment and facility requirements to set maintenance practices; do not infer a hospital-wide product specification or schedule from a case study.
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Commissioning or a focused operational review can help confirm that controls, sensors, schedules and equipment sequences behave as intended. Pair the work with maintenance records and field checks so a control adjustment is not mistaken for a repair, or a maintenance issue overlooked as a setpoint problem. The relevant outcome is performance in the actual zones being served, not merely a change entered into the automation system.
Protect comfort while interpreting temperature guidance
Thermal comfort is affected by more than air temperature. The DOE healthcare report describes ASHRAE Standard 55 as considering environmental factors—temperature, thermal radiation, humidity and air speed—and personal factors such as activity level and clothing. In a hospital, different patients and care professionals may experience the same environment differently, and clinical conditions may add needs that a general comfort model does not resolve.
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For operational changes, pair energy monitoring with comfort and service feedback. Check temperatures and humidity in the zones affected, review complaints and staff observations, and ask whether the change has affected clinical operations. A lower energy reading is not a successful result if the space no longer meets its needs. Conversely, one complaint should prompt investigation of that zone and its operation, not necessarily a building-wide temperature change.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What hospital case studies show—and what they do not
DOE case materials document savings associated with specific projects and measures. These are useful examples of what site-level optimization has achieved, not predictions for another hospital. The projects differ in facility, scope and reported metric, so their numbers should not be added together or treated as directly comparable.
| Facility and source | Reported measure or result | How to interpret it |
|---|---|---|
| Lewis County General Hospital and Residential Health Care Facility; DOE fact sheet, 2011 | 15 percent reduction in HVAC energy use; $7,500 annual savings; payback just over two years. | Historical case results tied to that facility and project; not a forecast for another hospital. DOE fact sheet. |
| Cleveland Clinic Hillcrest Hospital; DOE Better Buildings case material, approximately 2016 | 11,529,000 kBtu in annual savings from optimizing operating-room air-exchange rates. | The reported opportunity concerned operating rooms at this facility; the figure does not authorize reducing air exchange elsewhere. DOE Better Buildings project page. |
| Cleveland Clinic Hillcrest Hospital; DOE Better Buildings case material, approximately 2016 | More than 2,111,000 kBtu in annual savings from non-patient-care area temperature settings; an additional 3 million kBtu in annual savings from unoccupied-space temperature setbacks. | Separate reported measures at the same facility. They are not universal savings estimates and should not be combined with figures from other facilities. DOE Better Buildings project page. |
| Cleveland Clinic Twinsburg Family Health and Surgery Center; DOE Better Buildings article, 2017 | 36 percent energy-use-intensity savings and $246,000 in annual savings. | A facility-specific result associated with the case’s operational measures; it is not a guaranteed outcome for another site. DOE Better Buildings article. |
The Hillcrest examples demonstrate why project details matter: the reported measures involved operating-room air exchange, non-patient-care temperature settings and unoccupied-space setbacks—not one across-the-board temperature reduction. The Twinsburg report likewise describes a combination of operational changes rather than evidence that a single reset or maintenance task produced the entire result. Use each case as a prompt for a local hypothesis, then measure whether the relevant condition exists at your facility.
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Turn the review into a controlled improvement cycle
- Establish a baseline. Collect a period of energy, automation and comfort data that reflects the affected systems and spaces. Separate the relevant end uses where available; note the schedules and conditions during the baseline.
- Identify a specific opportunity. Link a suspected issue—such as unnecessary operation, excessive reheat or an unsuitable schedule—to a named system and set of zones. Do not assume the cause from a utility bill alone.
- Verify requirements and approvals. Confirm the clinical function, ventilation and comfort requirements, applicable current standards and local code adoption. Involve qualified facility engineering and appropriate clinical stakeholders before changing settings that affect care spaces.
- Make a limited, documented change. Adjust only the approved control, schedule, maintenance practice or zone operation. Keep a record of what changed, where, when and why so the effect can be attributed and the prior condition restored if needed.
- Check both energy and service outcomes. Compare post-change energy use under relevant operating conditions and inspect affected spaces for comfort, humidity, airflow and operational concerns. Review complaints and staff feedback alongside system data.
- Keep, refine or reverse the change. Retain an adjustment only when it supports the space’s requirements and the observed results. If comfort or clinical needs are compromised, investigate the cause and restore or revise the operation with the responsible staff.
Choose measures by evidence, risk and fit
There is no universal equipment upgrade or single setting that suits every hospital. Prioritize measures using the space’s function, applicable ventilation and comfort requirements, capital and disruption needs, maintenance burden, and the energy impact that local monitoring can substantiate. A low-disruption schedule or control review may be a sensible first investigation, but even an operational change requires validation in the zones it affects. More involved airflow or equipment work warrants a clear account of required conditions and how performance will be verified.
DOE’s healthcare materials offer examples and a sector-level context for energy work, but operational decisions belong to the specific facility and jurisdiction. The useful outcome is a documented improvement that reduces avoidable energy use while maintaining the conditions patients, clinical teams and staff need—not a nominal savings target detached from care and building performance.
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