Around the world, national healthcare emergency plans have struggled to cope with the force of Covid-19, with healthcare facilities and critical care systems buckling under extraordinary pressure. Faced with a massive inrush of long-term intensive care patients, overstretched hospitals have often had to rely on medical evacuations organized by regional health agencies and even the army. In a growing number of countries, this is leading to a complete rethink concerning the way hospitals are designed.
Flexibility is now the most valuable ingredient of healthcare buildings. Even before COVID, there was a growing realization that buildings of every kind needed to be more flexible, as technological change far outpaces the development cycle. The pandemic has added powerfully to the case for flexibility – intruding operations in every part of the built environment and promising to disrupt markets for many years to come.
In this article, we have specified the top ten areas where we see change coming.
1. Improving Infection Prevention
The hospital’s infection control/prevention unit is going to become a much louder voice in many design meetings going forward. There will be increased demand to make design features more easily cleaned and use surfaces that withstand harsh chemicals. More health systems will use UV light or disinfecting mists in high- and medium-risk areas. Low-risk areas like exam rooms will need more thorough cleaning rules and room turnover processes. All this needs to be done without losing the warmth and hospitality of today’s healthcare designs.
2. Increasing isolation room capacity
The biggest transformation most facilities have undertaken during the pandemic is expanding the number of isolation rooms. Going forward, hospitals will need collections 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 premises. While antechambers are not required in the Facility Guidelines Institute’s guidance, design teams will still need to address how staff can remove PPE without corrupting the hallway outside isolated patient care areas.
3. Limiting shared staff spaces.
Many of the assumptions that we have used earlier in designing staff spaces may need to be reconsidered, including the size and division of workstations within a staff workspace, the number of people in an office, and the number of people sharing each workstation. Large, shared break rooms and locker rooms may be excluded in favor of smaller, more discrete spaces. Additionally, administrative departments may be relocated off-site, or work-from-home arrangements may be devised to lessen the staff on campus. The numbers of students and merchants onsite at a given time may be limited, too.
4. Patients must be triaged by paramedics before they enter the ED.
The predominance 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 alternatives 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 resolute, 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 earlier, but now it seems unimaginable 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 reduce interactions with other people. Patients and families will be prompted to wait outside or in their car. All public spaces including waiting rooms, lobbies, and dining facilities will have to be carefully planned, structured, and designed to create a greater physical separation between people, with appropriate queuing.
6. Planning for inpatient surge capacity.
The design of the healthcare organization must be such that it can easily accommodate double or triple the number of patients. The hospital planning team must rethink how they can convert surgical prep and PACU into overflow ICUs. They need to explore through every building system (HVAC, E-power, med gas, etc.) to make sure that the design should be such that the services to these units can meet the vastly increased patient and equipment load.
7. Finding surge capacity in outpatient centers.
The continued growth in mobile or 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 flood capacity, with fewer disruptions, than the field hospitals being erected in hotels and convention centers. As we develop outpatient clinics, freestanding EDs, and ambulatory surgery centers, we need to consider the infrastructure that is necessary for these facilities to support sicker patients during the next pandemic.
8. Inventories for greater supply chain control.
Hospitals and health systems are looking for greater control of their 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.
Many service lines will likely need smaller outpatient centers in the future as telemedicine reduces the need for exam rooms, waiting rooms, and support spaces. Telemedicine has flourished 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 these designs will be enormous. The technology is relatively cheap, physicians can see more patients in the same amount of time, and there are virtually no space requirements.
10. Isolation operating rooms and cath labs.
Setting up key spaces that allow for social distancing in design will be predominant. Healthcare entrances will need to consider queuing in line with social distancing and biometric temperature screening requirements.
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 need 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 the operating room itself to ensure that potentially contaminated air is drawn away from the staff to minimize the risk of infection.
Healthcare planners, architects, and designers must take a leading role in creating safer healthcare spaces in a post-COVID-19 world. Executing these types of innovative strategies along with the recommendations of distancing and avoiding contact will let patients receive care in safer spaces.
Unlike most healthcare design trends that develop over several years, these changes have already become essential in just a few short weeks, as hospitals and health systems are forced to figure out how to take emergency changes with limited supplies and resources. In the coming years, healthcare 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 promote hospitals to make these changes permanent.
The healthcare design industry has a responsibility now to help reimagine the future of healthcare design to best lodge these new operational realities.