Hord Coplan Macht’s (HCM’s) team of expert led healthcare designers have partnered with healthcare organizations and care providers to determine how their facilities will be adapting to the multitude of new challenges created as a result of the pandemic.
Over the next few weeks, HCM will share with you our thoughts and discussions with our valued partners who are responsible for the management of their facilities. We will focus on how the current situation, potential future and continued change will impact healthcare facility design and the creation of new environments of care. We will share the insights of our diverse team of specialists including architects, planners, interior designers, clinical practitioners and operational strategists.
In this installment we explore future state sustainability and the anticipated changes in flexible acuity and surge spaces.
How will health systems handle surge capacity in the future? Is change anticipated, or will systems revert to the pre-pandemic model?
Health systems are going to be in a constant state of preparedness and a fear for the worst. Hospitals will likely try to stockpile essentials to be ready for the future, which means greater storage needs. In terms of the patient capacity issues, providers are going to be constantly looking for new ways to establish specialized units that will be able to flex in use. Similar to addressing the post-Ebola concerns and deficiencies, it makes sense that the reaction timeline will be about ultimate economy of scale and adaptability.
In addition to more storage, new projects will need to accommodate features such as surge capacity through flexible acuity rooms, more isolation rooms, planning non-inpatient units for inpatient surge capacity (i.e. holding inpatients in PACU, etc. and other units), and “stockpiling” old rooms rather than renovating.
Health systems will also need a Continuity of Operations Plan – with a risk matrix, and SWOT analysis to consider potential changes to resource, facility and flexibility. This could mean changes to policy or on-call protocols, which will impact space needs (call rooms, IT and communication devices, access to facility and parking, safety and security needs etc.).
Will the flexible acuity room/universal room become a common element to handle the lack of ICU beds?
As we have seen for several years, patient acuity is growing and, in response to this growth, the “universal room” is becoming more like an ICU – ready to handle anything. For smaller hospitals, renovations will focus on how to optimize the systems installed for normal operations and peak concerns. Specifically, the U.S. has 34.7 ICU beds per 100,000 people—although major COVID-19 outbreak hubs, such as New York, Boston, and Seattle, recently came close to reaching their limits. However, the universal room is not as important as the ability to have more isolation rooms to support treatment of infectious diseases. Having the right staff, with the right training and ample resources, as well as flexible spaces, can allow for acute patient care to be provided in a myriad of spaces outside of the ICU when needed.
What changes in continuity of operations planning for alternate facilities are anticipated moving forward?
Developing a plan for how to staff alternate care sites (such as hotels and convention centers) is key. The existence of beds built by the Army Corps of Engineers is of little use without provider plans of how to provide care in a remote location. Of note is the need for a plan on how to implement planned supplemental care, such as labs, pharmacy, and imaging, etc. to the alternate care site patients. Alternate care sites, such as hotels, are more easily converted for lower acuity patients or patients in the later stages of recovery from a pandemic event, leaving hospital beds to be dedicated to the most ill/most contagious patients.
Will there be a need to change the supply chain process or vendor management to support changes in demand? Will this require more or less local space?
Vendor contracting language could be modified, similar to what is found in generator refueling or med-gas refills contracts – so that in the event of an emergency, critical supplies will be delivered within 24 / 48 / 72 hours / etc. Additionally, the overall supply chain could be rethought, so that it remains based in the U.S., and we are therefore less reliant on international market stability and access. This could help keep health systems from needing to stockpile supplies, but could also increase the cost of manufacturing, and therefore, overall supply costs.
In general, improved communication among care teams and collaborative proactive approaches to dealing with a pandemic or other health crisis are just as important as supply chain management and stocking.
Will changes in dress code policy or human resource demands impact space, or FF&E in future design? Will there be a need for more lockers, changing spaces, or need for uniform vending space?
Scrubs will likely become the default attire for clinical teams and all hospital staff to provide a way to literally leave work at work. Health systems may want to transform staff entrances as spaces to transition from interior to exterior for everyone’s overall safety. In patient units, increased PPE requirements will expand flexibility to create adaptable units. As a measure for staff safety and staff-specific protocols, it is possible that all employees of the hospital would need to enter and then change daily to make sure that patients and families are safe both inside and outside of hospitals.