The Royal Prince Alfred is one of the largest and most prestigious hospitals in Australia. It is the principal teaching hospital for the University of Sydney and has a staff of 3500. Our works included demolition and rebuilding of a two-storey, 2000m2 Accident and Emergency Unit, construction of a 2500m2 extension, refurbishment of the Albert Pavilion and refurbishment of part of the Radiology Unit. It also included the construction and upgrading of the new Ambulance/ Pedestrian Entry and Front Courtyard for the new Accident and Emergency Unit. Difficult challenges we had to overcome included restoring the Hospital’s confidence in construction companies following liquidation of the builder initially appointed for the contract. The project was completed in four stages, all of which were tied to handover dates and met without disturbing the function of the hospital. The Baulderstone team liaised with hospital departments, especially the Engineering department, to identify existing services and to prevent those existing services being switched off accidentally. We also coordinated hospital-nominated contractors to install equipment such as the Computer Topography Scan.