A fire in a large hospital can be not only mean a loss of infrastructure, but can be devastating in terms of the human loss, claiming the lives of many patients and staff. Smoke can be a major contributor to loss of life a building fire, and as such smoke control plays an important part in maintaining occupant safety in a fire. This is nowhere more important than in a hospital, where patients may be dependent upon staff to evacuate, or undergoing medical procedures that cannot be quickly terminated upon receipt of a fire alarm. Smoke control in hospitals is vital to life safety during a fire event, and if not implemented correctly, or properly maintained, can have adverse consequences upon life safety. The refurbishment, expansion or upgrade of hospital buildings must take into account the existing smoke control methodology in the building. Through two Case Studies this report looks at how the continual refurbishment of a hospital can degrade the performance of a smoke control system installed in the building. Modelling has been undertaken using BRANZFIRE to provide a comparison of the effectiveness of the smoke control measures between the smoke control measures as installed in Hospital A at construction and the smoke control measures as they currently exist in Hospital A. An analysis of the existing smoke control in a large non-sprinklered hospital has been undertaken, based on site reviews and smoke control testing and reports undertaken by a fire engineering consultant. A brief review of the design process for a hospital smoke control system is undertaken on a sprinklered hospital currently under construction.