HCM Principal and healthcare design expert Jim Albert recently authored an article for Healthcare Design on ten key elements he predicts will quickly change in response to COVID-19. Jim acknowledges that there are many more questions than answers as to what the future will look like, but after working with healthcare clients across the country over past few months, he has identified key changes he sees coming down the pipeline. Read the article below or on the Healthcare Design website, here.
Originally Published on HealthcareDesignMagazine.com on May 7, 2020
Reimagining Healthcare Design After COVID-19
By James Albert | May 7, 2020
Each day we watch in awe as doctors, nurses, and caregivers bravely take on the greatest public health challenge of our lifetime, putting their own health at risk to save countless lives. As parts of the country are reopening, we recognize that returning to “normal” will feel different.
While we may not know what healthcare in the U.S. will look like in a few years, those of us in healthcare design can help our clients find possible solutions to these changes and prepare for future unknowns. Working with some of our clients from around the country, we’ve identified 10 areas where we see change coming:
1. Improving infection prevention. The hospital’s infection control/prevention team is going to become a louder voice in many design meetings going forward. There will be increased pressure to make design features more easily cleaned and use finishes that withstand harsher chemicals. More health systems will use UV light or sterilizing mists in high- and medium-risk areas. Low-risk areas like exam rooms will need more thorough cleaning protocols and room turnover processes. All this needs to be done without sacrificing the warmth and hospitality of today’s designs.
2. Increasing isolation room capacity. The biggest conversion most facilities have undertaken during the pandemic is increasing the number of isolation rooms. Going forward, hospitals will need groups of rooms and entire units and wings that can be negatively pressurized and cut off from the rest of the hospital in a pandemic. These units will need easy ways to get patients in from the ED, as well as trash out, without going through the entire hospital. While anterooms are not required in the Facility Guidelines Institute’s guidance, design teams will still need to address how staff can remove PPE without contaminating the hallway outside isolated patient care areas.
3. Limiting shared staff spaces. Many of the assumptions we’ve used in designing staff spaces may need to be reconsidered, including the size and separation of workstations within a staff workspace, number of people in an office, and number of people sharing each workstation. Large, shared break rooms and locker rooms may be eliminated in favor of smaller, more discrete spaces. Additionally, administrative departments may be moved off-site or work-from-home arrangements may be devised to reduce the staff on campus. The numbers of students and vendors onsite at a given time may be limited, too.
4. Triaging patients before they enter the ED. The prevalence of tents outside of EDs during this crisis, and their susceptibility to weather events, points to a need to help our clients re-envision the triage and intake process. We need ways to triage people before they walk in the front door, including tele-triage, apps, and multiple entries and waiting solutions, based upon medical needs. Overflow facilities that are external to the hospital need to be sturdy, durable, and quickly erected, with utility connections planned for and already in place.
5. Re-imagining waiting rooms and public spaces. Nobody liked the waiting room previously, but now it seems inconceivable that people will be willing to sit next to possibly infectious strangers while they wait for an appointment or a loved one’s procedure. Trends like self-check-in and self-rooming will accelerate to minimize interactions with other people. Patients and families will be encouraged to wait outside or in their car. All public spaces including waiting rooms, lobbies, and dining facilities will have to be carefully planned and designed to create greater physical separation between people, with appropriate queuing.
6. Planning for inpatient surge capacity. We’ve been designing for flexibility in hospitals for years, and now we must consider how a hospital could accommodate double or triple the number of patients. Questions to ask include, “How could two beds fit in every room?” “Which rooms can flex up to intermediate care or ICU capacity?” “How can surgical prep and PACU be converted into overflow ICUs?” and “If they are needed, how are emergency surgeries still performed?” We need to explore these questions through every building system (HVAC, E-power, med gas, etc.) to make sure that services to these units can meet the vastly increased patient and equipment load.
7. Finding surge capacity in outpatient centers. The continued growth in ambulatory care will resume as soon as our current crisis passes. Because many of these facilities are often owned by healthcare systems and already have emergency power or limited medical gasses, they have the potential to provide faster surge capacity, with fewer disruptions, than the field hospitals being erected in hotels and convention centers. Many hospitals already include these buildings within their surge plans, even though they weren’t specifically designed to accommodate this use. As we develop outpatient clinics, freestanding EDs, and ambulatory surgery centers, we need to consider the infrastructure that’s necessary for these facilities to support sicker patients during the next pandemic.
8. Greater supply chain control. Hospitals and health systems will seek greater control of their own supply chain and will likely stockpile key supplies, equipment, and medication to avoid future supply shortages. They may develop acquisition agreements with third party supply and equipment vendors for stockpiles they cannot afford to maintain on their own and will expect greater support from their group purchasing organizations. Some stockpiles may be at individual hospitals, while larger systems may maintain supplies regionally or nationally. We will need to design facilities to house these inventories as well as systems to maintain, refresh, and replenish them.
9. Telemedicine’s impact on facility sizes. Telemedicine has boomed throughout this crisis, allowing clinicians to perform routine check-ups and triage with patients without putting either doctor or patient at risk. While the future reimbursement for telemedicine is unclear, the impact on our designs will be tremendous. The technology is relatively cheap, physicians can see more patients in the same amount of time, and there are virtually no space requirements. It’s likely that many service lines will need smaller outpatient centers in the future as telemedicine reduces the need for exam rooms, waiting rooms, and support spaces. Clinicians may even be encouraged to do a portion of their clinic days from home, rather than from their on-site office.
10. Isolation operating rooms and cath labs. The Centers for Disease Control and Prevention guidelines on how to operate on an infectious patient require that the operating room remain positively pressurized, that it stays sealed throughout the surgery, and that no activity takes place within the room for an extended time after intubation and extubation. While important, these processes greatly extend the length of surgical cases and limit staff mobility in and out of the room before, during, and after cases. To function more effectively and efficiently, many more hospitals will want ORs and cath labs with the proper airflow and design to protect the patient from surgical infection while protecting the staff in the room and the surrounding facility from the patient. This will require the addition of pressurized anterooms from the OR to both the hallway and the surgical core or control room, careful balancing of HVAC systems, and modeling of airflow within the lab or operating room itself to ensure that potentially contaminated air is drawn away from the staff to minimize risk of infection.
Unlike most healthcare design trends that develop over several years, these 10 changes have already become necessary in just a few short weeks as hospitals and health systems were forced to figure out how to make emergency changes with limited supplies and resources. In the coming years, these organizations will need to adjust their operations for future pandemics, codes will need to be rewritten to safely meet these new situations, and government grants will be necessary to encourage hospitals to make these changes permanent.
The healthcare design industry has a responsibility now to help reimagine the future of healthcare design and construction to best accommodate these new operational realities.
James Albert, AIA, is a principal at Hord Coplan Macht (Baltimore). He can be reached at email@example.com.