How to Rethink Wayfinding to Increase Infection Control and Decrease Patient Stress

Three Ways to Guide Hospital Visitors Seeking Coronavirus Care

April 13, 2020

Principal

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post was co-authored by Eric LeVine, Janet Dugan and Alexandra Alfaro.

 

As hospitals across the world flex to meet a surge of coronavirus cases, they are rapidly adapting their facilities to accommodate testing, infection control and inpatient care. However, navigating to, around, and in a hospital — particularly under these quickly-evolving circumstances — can be stressful and challenging.

Studies show high levels of the stress hormone, cortisol, can decrease memory and critical thinking skills. Even during normal circumstances, 30 percent of hospital visitors find it difficult to get to the right place because they get lost. Today, some people with coronavirus symptoms, many severely ill or under duress, enter the hospital without alerting staff before they are triaged, potentially exposing others unnecessarily to the illness and requiring staff to then isolate them, triage them and disinfect any spaces that may be contaminated.

1. Deploy a comprehensive wayfinding system for COVID-19.

Given this urgency, it’s critical to employ a consistent wayfinding system for COVID-19 (PDF) to help direct patients to the right place. The good news is hospitals can quickly improve the patient experience now with a comprehensive set of environmental graphics that address a visitor’s spectrum of interactions — from pre-arrival to discharge — with unified elements such as simple shapes, unique colors and a list of COVID-19 symptoms. Here are a few items to consider when creating signage for the crisis.

Graphic design and content recommendations

Keep signage simple to decrease anxiety. Graphic design treatments such as using the color pink, which is unique from typical hospital signage colors, can help important messages pop. Recognizable shapes like circles or squares are both noticeable and simple. Much like retail stores, such as Ikea with its clear, visible and instantly recognizable signage, hospital wayfinding that relies on repetition, standardization and familiar shapes can help people quickly orient themselves and lead them through a space in an intuitive way.

Reduce text to only the essentials so directions are easy to digest. Outline primary symptoms of the coronavirus to help visitors differentiate between other illnesses like the flu. For example: “Follow the pink circles if you have COVID-19 symptoms such as a dry cough, fever and shortness of breath.” Signs for non-COVID medical conditions could include language such as: “Follow the green square for non-viral treatment or care.”

Consistent visuals and content should be carried through all steps of a hospital visitor’s journey, from pre-visit information online to outdoor signage at arrival, to indoor navigation once visitors are through the hospital entrance. It is key for hospitals to utilize a wayfinding system that is easy for patients and healthcare staff to understand and follows a unified theme.

Website notices

To better welcome and inform visitors before they get to the hospital, it’s crucial to incorporate coronavirus-related wayfinding graphics into pre-visit messages. These should use the same colors and shapes as on hospital signage for COVID-19, so there is a consistent look and feel when a visitor arrives on site.

Pre-visit information can include online notices featured on the top of a hospital’s homepage, on social media, or a dedicated landing page that can be regularly updated. For example, using a URL like “www.HospitalName.com/coronavirus” will rank higher in search results when patients query “Hospital Name Coronavirus.”

In addition, be sure to address: Where should people go to get tested? Are directions to the campus straightforward and concise? Provide these details succinctly up front to clarify any confusion. Given the highly-contagious nature of the coronavirus, this can help ensure visitors who may present with COVID-19 understand any special protocols ahead of arriving at the hospital to help keep the public and caregivers safe.

2. Prioritize signage.

It’s important to consider the placement of signage to help guide visitors before and when they step foot into the hospital. Signage allows patients to self-triage prior to entering the hospital. It streamlines the process for emergency departments, reduces patient stress upon arrival and increases the ability to identify infectious patients, making arrival safer for all. It also provides guidance for patients that may not have seen pre-visit information online or forgot the instructions.

Moreover, wayfinding should accommodate various modes of arrival. Consider the hospital setting and what type of transportation people use to get there. For example, suburban hospitals tend to have more visitors arriving via car versus urban hospitals, where many people travel by foot, public transportation and rideshare. Accommodate each mode accordingly. People in personal vehicles with coronavirus symptoms can be directed to designated parking lots to wait, queue and even be tested from their car before entering the hospital. Meanwhile, visitors arriving by foot can be guided to special coronavirus sheltered triage areas outside of the emergency department.

Signage locations can include highways, vehicular entrances to the hospital campus, outside hospital doors and more.

Adjacent highway signage

For drivers, temporary highway notices about COVID-19, mounted near existing hospital signage, can help visitors capably navigate with confidence.

Site threshold informational signage

Signs placed before entering the hospital campus can separate visitors with coronavirus symptoms from non-COVID-19 medical conditions.

Onsite directional signage

Signs mounted to existing infrastructure outside of the hospital, such as light poles, can provide parking or walking directions for visitors. These signs could also include a list of COVID-19 symptoms.

Onsite A-frame signage

Additional graphics, movable by staff, can provide further instructions to visitors, like which entrance to use or any safety precautions to take, before stepping into the hospital.

Interior wayfinding signage

Temporary wall signage allow staff to direct the flow of patients and identify critical supply locations as needed. Floor decals spaced six or more feet apart can also ensure proper social distancing and direct patients to exam or isolation rooms. Slim interior stanchions can also be helpful, but should be properly secured so they remain in place.

3. Address accessibility.

Just as hospitals are designed to accommodate accessibility, wayfinding systems should too. Special graphic design treatments like dark outlines and clearly-recognizable shapes can help visitors with color blindness navigate a facility. Meanwhile, using iconography — visual symbols and images — can improve comprehension for non-English speakers.

By employing a wayfinding system that is simple, bold, and inclusive — produced with minimal logistics and a low implementation cost — hospitals can create a calming, safer and streamlined experience for visitors, patients and healthcare staff during the coronavirus pandemic, and also be prepared for future events that require specialized navigation.

Click here to download the PDF: COVID-19 Response – Patient Self-Sorting Signage System

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Sean Airhart/NBBJ.

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I Lived Through China’s Coronavirus Crisis. Here’s What Western Hospitals Should Know.

Three Strategies to Transform Hospitals from a Healthcare Planner Working in Shanghai

April 6, 2020

Senior Medical Planner, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

 

On a global scale, we are witnessing three critical shortages during the coronavirus pandemic: beds, staff and personal protective equipment (PPE). Yet as cases rise in countries around the world — from Spain to the U.S. — China is on its way to recovery. As a medical planner who lives in Shanghai, here are three ideas to consider for healthcare systems in other parts of the world based on what we’ve learned here.

Add more patient beds rapidly via temporary hospitals for milder cases.

With countries like the U.S. just now establishing temporary hospitals to fight the coronavirus, China deployed this method on a rapid scale. Officials asked permanent hospitals to focus on the 20% most critical patients and temporary hospitals to care for the remaining 80% of patients with milder illness. In addition, healthcare experts established a series of building design and medical best practices. To meet the surge of patients, the Chinese government built temporary hospitals across the country, including two major facilities in Wuhan: Huoshenshan Hospital and Leishenshan Hospital with 2,500 beds. They also sent 40,000 top doctors and nurses to operate them and support the city.

Medical team leaders shared their experience about infection control in Wuhan and developed guidelines [Mandarin at the top, English below] that address site selection, architectural requirements, detailed workflows and even how to recycle some PPE like protection goggles in a worst-case scenario. The temporary hospitals — some which are now closed as coronavirus cases have declined in the country — are based off of mobile military medical systems and organized around three types of distinct areas: clean, semi-clean and contaminated spaces. They also feature separate circulation for medical staff and patients. In addition, China officials also converted hotels, dorms, stadiums and exhibition centers into temporary hospitals as well, as other countries are now doing to meet this critical need.

Use multi-bed units on hospital floors to save resources.

While isolating coronavirus patients in separate rooms may be ideal depending on a healthcare system’s unique needs and real estate portfolio, many hospitals are increasingly short on crucial resources, like space. Grouping individuals diagnosed with the coronavirus together in multi-bed units on a hospital floor — or in other buildings entirely — can maximize space, with the ability to fit more beds into an area. A multi-bed unit can also help medical staff efficiently monitor patients’ conditions at one time and potentially reduce nursing staff, giving healthcare workers better sightlines to patients. This strategy may also save equipment, as healthcare staff don’t have to change their PPE as often if they are working only with coronavirus patients in a designated area — unlike isolation rooms distributed on different levels of a hospital that require medical staff to put on and take off their PPE when entering and exiting single patient rooms.

Separate suspected and diagnosed coronavirus patients for efficient treatment.

While temporary sheltered screening areas outside of hospitals, such as triage tents, are the new norm across healthcare facilities, many hospitals in Asia also benefit from designated “fever clinics” that were recently repurposed for coronavirus testing. This is a permanent space that allows medical staff to screen people with fever-causing illnesses like the flu — and divert them without entering the emergency department. These types of facilities could be considered and implemented in other countries for future pandemics and more typical cases like the flu, not only as part of new hospital projects, but also as additions to existing ones. In Shanghai, positive cases are then funneled to the Shanghai Public Health Clinic Center, a specialty infectious disease hospital outside the city.

While the outcome of the coronavirus is uncertain, it is different than other viruses we’ve faced in the past, such as SARS and MERS. As countries around the world respond to the coronavirus pandemic — with peaks in many countries including the U.S. predicted for April — we hope these takeaways help our peers across the world conquer this great challenge.

 

How are you and your healthcare organization dealing with the Coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Sean Airhart/NBBJ.

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How to Design for Improved Outbreak Response Capacity

The Pros and Cons of Distributed and Cohort Isolation Models

April 2, 2020

Healthcare Strategist, NBBJ

@dbellef

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post was co-authored by Donald Bellefeuille and Erin Kelley.

 

Cohort isolation, in which infectious disease patients are treated together in an isolated unit, wing, floor or facility, has been a response model during the COVID-19 crisis and any pandemic. Yet many hospitals are designed to treat infectious disease patients in distributed isolation rooms embedded within other patient care units. As hospitals consider their current and longer term facility plans, it’s important to assess the pros and cons of cohort vs. distributed isolation approaches.

Benefits of Cohort Isolation

One benefit of cohort models is that staff on the unit are specially trained to work with Universal Precautions as well as additional isolation precautions, reducing the risk of caregiver infection. Cohort isolation unit staff can also function more efficiently, caring for only one type of patient, and potentially conserve personal protective equipment (PPE) if they’re treating patients with the same disease. In addition, cohort units consolidate airborne infectious inpatients into one area of the hospital, reducing the risk of spreading infection to other patients and staff, and can respond more rapidly during an epidemic, as all specialized staff and equipment are colocated.

A cohort isolation unit can in certain instances be set up on a temporary basis or scaled up or down depending on need. This requires specialized HVAC systems which can change the pressurization of the space from standard to negative. Many emergency departments, for example, have the capability of shutting airtight doors and creating negative airflow to create temporary airborne isolation units within the ED when required. A number of major hospitals also have the capability of creating airborne isolation suites within other units by changing the airflow. These suites can function as standard patient rooms when not needed for airborne isolation purposes.

While the mechanical requirements of creating negative air pressure within cohort units for airborne isolation increase costs, there may be economies of scale that accrue as infection prevention elements are consolidated in one cohort isolation location. For example, a consolidated airborne isolation unit may only require one airlock lobby or anteroom for staff to don and doff PPE and one infectious waste disposal system, whereas a distributed model might need multiple ones.

Benefits of Distributed Isolation

There are several reasons why hospitals may rely solely on distributed isolation rooms rather than have a consolidated cohort isolation unit, beyond the cost considerations. Perhaps the most important clinical benefit of distributed isolation is that infectious patients may have other underlying conditions that require specialized treatment. With distributed isolation rooms, these patients can be treated by specialized staff within the patient care unit, while in cohort units staff are trained primarily in infectious diseases and would require additional support to treat underlying conditions.

Another potential benefit of distributed models is that the caseload of isolation patients may be easier for nursing staff to sustain. The need to wear PPE continuously and maintain Universal Precautions in cohort units can be physically and psychologically demanding and contribute to staff burnout.

Like many cohort units, distributed isolation rooms are also used as standard patient units when not required for airborne infectious diseases. Care should be taken to conceal and minimize the visibility of antechambers and any other isolation infrastructure that may be present to alleviate patient concerns over potential infection.

Access is an important consideration for both cohort isolation units as well as distributed isolation rooms, as infectious patients need to be able to get to the unit or room while minimizing contact with the general hospital population. This requires a cohort isolation unit to be served by separate dedicated elevator, and requires dedicated entrances for both cohort and distributed rooms.

Hospitals will continue to evaluate their outbreak response capabilities during and after the current COVID-19 crisis, and many will more deeply consider the long-term need for expanded isolation capacity in distributed rooms or cohort units. The right approach will require a thorough consideration of the pros and cons of both models and the unique needs of individual healthcare systems.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Benjamin Benschneider/NBBJ.

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