Many Rural Hospitals Are Not Prepared For COVID-19 Surge. Here’s How They Can Be.

Five Design and Planning Strategies Will Be Critical to Adapting to the Pandemic

April 30, 2020

Partner, 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.

This post initially appeared on Forbes. It was co-authored by Teri Oelrich and Bryan Langlands.

 

So far the coronavirus pandemic has been concentrated mainly in New York, Detroit and other major cities. But there is a problem brewing that has received little attention: over two-thirds of rural counties have now reported COVID-19 cases. The pandemic presents a formidable challenge for rural hospitals, which have faced 120 hospital closures over the past decade and frequently struggle to recruit staff and balance the books.

The effects of the pandemic on rural hospitals don’t make the headlines the same way major cities do, partially because the problem is spread out across places many have never heard of. For example, Idaho’s Blaine County has one of the highest infection rates in the U.S. With only 25 hospital beds, Blaine starkly illustrates how the virus can rapidly overrun the healthcare infrastructure of rural communities.

There are critical steps rural hospitals can take now to adapt to the pandemic. Here are five design and planning strategies that will be critical to success.

Develop regional care strategies

Rural communities are usually served by small hospitals that frequently lack the capacity and resources necessary to deal with a spike in COVID-19 cases. One method of mitigating this shortcoming is to develop a regional care strategy with other rural facilities in the region, in which patient care is coordinated to enhance capacity and minimize infection risk.

Areas with multiple hospitals within a roughly 150-mile radius should begin designating one facility as a COVID-19 hospital and care for non-COVID-19 patients at other facilities. The non-COVID hospitals could then potentially perform elective treatment and alleviate some of the financial burden caused by the crisis. Tools like this COVID-19 Inpatient Bed Demand Calculator can help in determining local and regional capacity needs and where coordination may be most beneficial.

Alternative care sites, such as converted dorms, motels or hotels, can also be used to care for non-COVID-19 patients or to monitor less severe COVID-19 cases. Missoula, Montana, for instance, is planning to purchase a motel to use as a safe shelter for those isolating and self-quarantining during the pandemic. Similar buildings can also be repurposed to house caregivers who treat coronavirus patients, or to house out of town doctors, nurses and staff temporarily assisting beleaguered hospitals.

Rural hospitals can also partner with larger urban hospital systems to support care needs. Telemedicine can help provide input from specialists that don’t typically live in rural areas. It could also help rural hospitals receive temporary ventilators, PPE distribution and clinical staff.

Apply for federal aid

While the CARES Act includes a number of provisions to assist rural hospitals— including small business loans, $100 billion in new funding, and Medicare payment improvements— providers can also apply for FEMA Public Assistance (PA) funding. Certain emergency protective measures taken by hospitals in response to COVID-19 are eligible for reimbursement at 75% federal cost-share under the PA program, which is using a new streamlined application process. Applying for federal funding is no small task and requires significant investment in time and follow up documentation. Often hospitals engage consultants who have been successful with previous federal applications to assist them with this process. There is good news though: the cost of consultants to handle applications is covered by FEMA.

Prioritize clear signage and wayfinding

It is critical that COVID-19 patients are able to seek care without inadvertently infecting the general hospital population. This is especially true for rural hospitals, where care for more vulnerable long-term care patients is frequently integrated within the facility. Navigating in and around a hospital can be confusing and stressful, which makes signage and wayfinding vitally important for getting COVID-19 patients where they need to go while minimizing the risk of infecting others.

It is important to have a comprehensive wayfinding system for COVID-19 patients that is succinct, unique and recognizable. For example, using an unusual color like pink to direct patients to the right place helps the signage stand out, as does simple language like, “Follow the pink circle if you have COVID-19 symptoms such as dry cough, fever, and shortness of breath.” This unified wayfinding theme should be employed at every step of the patient’s journey, from the hospital website to signage as patients approach and enter the hospital. COVID-19 patients arriving in personal vehicles could, for example, be directed by signage to a separate parking lot to wait to be tested before entering the hospital.

Screen patients in triage tents

One method of minimizing contact between potentially infectious and non-infectious patients is to set up a triage tent for COVID-19 screening. This is a temporary outdoor structure, frequently set up in a parking lot, which is separate from the emergency department and enables patients to be triaged before they enter the facility. A triage tent must accommodate space for at least four activities—a place for visitors to queue, a check-in area, a waiting area, and private screening rooms. Because the interior of the tent has no walls, screens can be used to create separation and privacy, in addition to flexibility.

Tents need to maintain CDC protocols, such as social distancing of at least six feet, while being able to test the highest number of people at one time. For example, a triage tent of 25 feet by 45 feet can hold no more than 15 people seated. Ensuring the space is as simple as possible to clean and sanitize is also critically important. Frequently vinyl-wrapped tents are used along with furniture and fixtures from the hospital. Some hospitals have even rented tents, complete with lighting, smoke detectors and HVAC, from fire departments.

Make common areas safer

Ensuring safety is an ongoing challenge for hospitals. It is of particular concern in common areas like building entrances, waiting rooms and lounges, where patients and visitors congregate and transmission risks may be more acute. There are several design strategies that can help mitigate these risks while still reassuring and comforting patients and visitors.

Material and furniture selection— including the use of antimicrobial surfaces like copper and easy to clean furniture pieces with seamless detailing and solid surfaces— can help minimize the risk of coronavirus surface transmission. Similarly, touchless surfaces like automatic doors and hand sanitizer dispensers can reduce infection risk. Seating arrangements can also be moved or otherwise modified to create sufficient space between patients to support social distancing. It is also advised to divide patients into infectious and non-infectious groups, supported by adequate signage and physical separation.

As the pandemic expands into rural communities, their hospitals are tasked with the difficult job of safeguarding the health of communities that are typically older, less affluent and less healthy than urban populations. While constrained by capacity and resource challenges, rural hospitals also have a history of adaptability and flexibility that may enable them to deal more nimbly with the rapidly evolving pandemic landscape. Design and planning strategies such as those outlined above can play a major role in supporting them in this critical work they are doing for the communities they live in and support.

 

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 Luke Hayes.

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