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 Bryan Langlands and Sarah Markovitz.
As America’s hospitals grapple with the coronavirus (COVID-19) pandemic, they are rapidly considering ways to retrofit existing facilities to cope with an influx of cases. And new analysis out of Harvard University suggests that most parts of the US are under-resourced in the number of hospital beds — particularly ICUs — needed if the coronavirus continues to spread and escalate as projected.
Here are near-term solutions to create appropriate space and add additional treatment areas to prepare for the challenge.
Allow patients to bypass emergency rooms.
A number of healthcare organizations are looking to divert patients from entering the emergency department altogether while still providing treatment. For those patients arriving to the emergency department requiring diagnosis and simple treatment, hospitals are coming up with ways to do all of this proximate to — but not directly within — the emergency department. Temporary tent structures, mobile units, or partitioning of waiting areas for treatment are all potential solutions for hospitals.
Once in the emergency department, due to the highly transferable nature of the coronavirus, hospitals should find ways to spatially separate those patients presenting with virus symptoms from those coming in for other emergency conditions. One New York City hospital did this by repurposing its pediatric emergency area to focus exclusively on coronavirus cases.
Relatedly, some children’s hospitals are expanding the age range of patients that they will care for to free up additional adult care beds at general hospitals. These spaces are also well-suited to be repurposed for coronavirus care since they’re already designed with designated arrival and treatment zones to accommodate children with contagious conditions.
Repurpose other hospital room types into ICUs.
As some U.S. hospitals start to limit non-emergency and elective surgical procedures, enclosed patient care spaces within post-anesthesia care units (PACUs) and recovery rooms can be converted into ICU environments to accommodate additional patients with severe cases. If an open PACU environment exists, then the entire space would need to be dedicated exclusively to a COVID-19 patient care ward.
For hospitals faced with quickly and effectively transitioning these spaces, there are four primary spatial and clinical considerations:
Ensure rooms are properly equipped. Any room being treated as an ICU will need piped medical gases (commonly found in PACUs), oxygen, medical air and vacuum supply, both power and emergency power backup, and data. The infrastructure requirements for an ICU are similar to what is provided at PACU positions.
Avoid mixed modeling. Where possible, hospitals should ensure, via signage, physical barriers, and/or operational protocols, that repurposed wards are distinctly dedicated to coronavirus treatment in order to eliminate the possibility of exposure to other patients.
Clear hallways and provide PPE areas. For wards being converted to coronavirus response zones, hospitals will need to ensure clear and segregated hallways and corridors, limiting who is able to pass through. Each enclosed room where the patient is on isolation should be equipped with a cart outside, stocked with appropriate personal protective equipment (PPE) for staff to change into and out of before entering and exiting.
Create necessary barriers and protective measures. Hospital leadership will need to work closely with construction partners and mechanical engineers to balance, when possible, the unit’s airflow system. With the right infrastructure, the mechanical systems can help create infection control barriers and ensure negative air pressurization of the area and treatment rooms. If the existing mechanical system cannot provide the negative air pressurization and 100% exhaust to the exterior, strategies could be implemented similar to the type of configuration utilized when doing construction and renovation in an existing, operational healthcare environment.
For any repurposed rooms in close proximity to operating surgical suites, additional protective measures will be needed. These spaces typically operate as positive air flow rooms, requiring construction barriers and an additional antechamber or buffer zone. Additional security measures and access control can be introduced which restrict access to prevent non-surgical staff from entering.
Each hospital will have to consider these measures in relation to their own unique floorplans, layouts and infrastructure. And of course ensuring an adequate supply of appropriate hospital beds is just one part of the solution, alongside staffing needs and flexibility, and appropriate supply of equipment and protective gear. Integrated teams should also consult closely with any authority having jurisdiction (AHJ) in exploring these ideas.
How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at firstname.lastname@example.org.
Banner image photography by Benjamin Benschneider.Follow nbbX