“Space: the final frontier” – this statement spoken at the beginning of every Star Trek episode [well, except for two] was the lead into the recounting of a perilous situation and the ensuing response. Each week told the story of one part of an ongoing mission. It feels a bit like those of us in the healthcare design community are also embarking on an extended mission every bit as arduous as the one the crew of that fictional starship are on.
Our adversary is the SARS-CoV-2 virus [aka COVID-19] that has disrupted our lives since March 2020. The virus has also changed the way we design and operate our healthcare facilities. Much has been written about how COVID has or will affect the design of our healthcare facilities. Many of the changes are “fixes” to facility issues that we should have been incorporating before combatting the virus made them a necessity.
Facility Design Items That Can be Immediately Implemented
Consider adding these items to all renovation and new construction projects. Many will be able to be accomplished without additional space.
- Set up “front door” screening areas at main, ED walk-in, and outpatient entrances to accommodate a screening area for temperature checks, safety assessments, PPE distribution and to accommodate social distancing recommendations
- Provide a variety of accommodations for pre-registration, self-registration [in person or digitally] and where assistance is necessary, adequate space for queuing
- Establish single direction patient flow to streamline patient flow and facilitate social distancing recommendations:
- Designated entries and exits instead of combined entry/exit vestibules
- Dedicated “up” and “down” elevators and stairs
- Waiting areas designed for less occupants but not smaller due to increased area/occupant and compartmentalized design to facilitate social distancing. [Assuming a 24” wide chair, and 6’-0” between chairs, = 28.25 NSF per occupant]. Reduce number of chairs appropriately
- Eliminate main waiting areas and provide waiting space only in areas such as ED and surgery as well as in ICU and OB patient units. Be sure to include an adequate number of hand-washing stations.
- Relocate administrative functions to an off-site location or to a work-from-home arrangement
- Install hands-free plumbing fixtures and touch-free electrical switching for lighting
Items That Can Maximize Facility Resilience and Flexibility
Increase facility capacity in the event of a surge in patients by considering the inclusion of these items in projects currently in the planning phases. Unlike the prior list, most of these modifications will require additional space.
- Plan for inpatient surge capacity by flexing up the number of patients per room, conversion of prep/recovery spaces for ICU use, and even use of waiting space and dining rooms by anticipating HVAC, emergency power, and medical gas service requirements
- Keep in mind resilient design principles such as visibility, easily convertible spaces and consider use of modular/prefabricated construction
- Plan for control of patient room lighting, temperature, shades, television, and communication from the corridor to minimize care-giver trips into the patient room
- Consider providing dedicated air-handling units by area or floor
- Include HVAC systems that can switch to negative pressure, increase ventilation rates, and to increase the percentage of outside air to provide maximum flexibility
- Organize buildings by common function rather than distinct programs will allow nursing units to be flexible enough to switch function to respond to demand
- Consider designing patient rooms as “acuity-adaptable” to maximize flexibility
- If planning an expansion of patient care units, consider designing one floor [or portion thereof] as a permanent COVID-19 unit
- Increased on-site storage of key supplies, equipment, and medications
- Include provisions to triage patients at the ED and other entries before they enter the building
- Increase the number of isolation rooms, including groups of rooms and/or entire units. With the return of anterooms, there will need to be a process and location to remove PPE without contaminating adjacent space outside the isolated areas
- Consider wider corridors [possibly 10-12’] in select areas – such as EDs and Surgery – to accommodate use of portable anterooms
The American Society for Health Care Engineering [ASHE] has provided a comprehensive of these issues as well as many more dealing with short term and long-term considerations in planning and adapting healthcare facilities to fight and recover from the effects of this and future infectious diseases. This information can be accessed at: https://www.ashe.org/covid-19-recovery?utm_source=HFM%20Insider%20%28weekly%20e%2Dnewsletter%29&utm_medium=email&utm_campaign=HFM%20Insider%3A%205%2F19%2F20
Additional information on the effects of COVID on healthcare facility design can be found by reading the latest guidance issued by CMS in a publication titled OPENING UP AMERICA AGAIN – Centers for Medicare & Medicaid Services (CMS) Recommendations Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I, and by the American Institute [AIA] in a white paper titled COVID-19 Frontline Perspective – Design Considerations to reduce risk and support patients and providers in facilities for COVID-19 care.