By Catherine Gow and Jennifer Kenson
From the June 2020 Issue
How will hospitals design future healthcare spaces after the pandemic? As COVID-19 is impacting every facet of our healthcare systems, frontline workers will have a voice in how we prepare for the future. As such, listening and learning from them will be fascinating and challenging endeavor for all stakeholder in the industry.
The hospital administrator’s point of view will be different. We must consider how they will build flexibility into each of their facilities in order to manage the influx of patients. As we move forward, we will learn if COVID-19 will reoccur every year like the flu, with hospitals already anticipating busy flu seasons. What will this new demand mean for increasing flexibility during this new “season?”
Francis Cauffman Architects’ (FCA) design teams are working closely with healthcare systems such as Weill Cornell Medicine and Mount Sinai Health System to help with creative ideas on how to adapt their facilities during and after this global pandemic. There are many strategies that could be utilized to make safer healthcare spaces, which should parallel the CDC’s original recommendations of distancing, washing hands, and avoiding contact. We developed five topics of focus: distancing/separation; patient, staff, and supply flow; materials/surfaces; smart technology; and surge design.
Setting up key spaces that allow for social distancing in design will be paramount. Healthcare entrances will need to consider queuing in line with social distancing and biometric temperature screening requirements. We can mitigate waiting outside though implementation of modular, elongated entry vestibules that allow for patients to queue without exposure to weather (see Figure 1 below).
The waiting room is where people come together; however, the number of people awaiting treatment will now need to be minimized. One solution is integration of technology, which could provide real-time exam room availability for more expedient services. For practices with limited access to this technology, furniture can be part of the solution with arrangements featuring less seating, smaller groups, or separations with screens (see Figure 2 below).
Ambulatory processes, like check-ins, will need to be addressed prior to arrival, requiring patients to sign in via computer or smartphone. For those who are not able to check-in beforehand, plexiglass screens will be needed to provide separation. Transferring more of the paperwork into a digital format will decrease paperwork passed around, making one less touch point between staff and patients. Tele-health services will also continue as physicians and patients have gotten more accustomed during the pandemic.
Emergency departments have been on the front lines, doing the critical job of distinguishing the COVID patients from non-COVID patients. This has created the challenge of keeping each group separated and safe. The key to controlling this lies within how patients enter the facility and are then screened. Creating a third “fever entrance,” which will handle patients that are showing signs of COVID-19, is one concept. The traditional walk-in vestibule will have remote biometric temperature screening. If patients have a fever of 100.4 degrees or higher, they would be sent to enter the “fever entrance.”
2. Patient, Staff, And Supply Flow
Circulation of patients, staff, and supplies must be considered for distancing and separation, for proper flow. Even though clinical teams do interact with patients, providing off-stage staff circulation could decrease exposure. Corridors could be widened so that a two-way flow could occur with the appropriate amount of distance.
We also predict that there will be a need for a higher level of cleaning between patients. Pre-COVID-19, the sanitization of exam rooms was limited primarily to the exam room table. The strategic use of exam rooms for example, using 50% at one time could allow for the remaining half to be cleaned thoroughly. In another scenario, every other exam room in a corridor could be using one pod or group of exam rooms, while another group is being deep cleaned.
New cleaning protocols will need to be evident to the public, so they have confidence in their safety while visiting. As the Infection Control and Environmental Services teams increase their knowledge of this virus, new protocols will be developed. Understanding materials and what they can and cannot do will be important to not overdesign and overspend. Many products and finishes have proven anti-microbial properties, but we will need to assess if they are effective on new viruses. The combination of these products with improved cleaning will better equip facilities to protect patients and healthcare workers.
The two main areas of product development have focused on copper and silver. The design industry has made inroads developing and understanding the cradle-to-cradle impact of products on environment and human health. We must maintain that rigor in order to continue creating environments that do not negatively impact health.
Reducing physical contact of surfaces is another way to limit exposure to germs. Use of hands-free devices on doors, plumbing fixtures, and other high-touch items can reduce exposure and minimize the items that need to be wiped down in between each patient.
Finally, implementing new technologies can be another part of the toolkit. Two techniques have come into focus recently: UV Light technology and Hydrogen Peroxide Fogging (iHP) should be considered to decrease pathogens within healthcare settings.
4. Smart Technology
Smart technology continues to impact our daily lives, and we will certainly see more technology integrated into healthcare. Physicians are using virtual appointments at a higher rate to accommodate patients during this crisis, and we anticipate this continuing. Telemedicine has also aided in the monitoring of ICU patient rooms, providing distancing and connectivity to help treat patients.
5. Surge Design
Any new medical/surgical patient units should consider using “acuity adaptable rooms” to provide future flexibility during patient surges, and existing units can be adapted to surge as needed. Acuity adaptable rooms are cutting-edge hospital rooms that can allow care to flex to a higher level as needed in the same room. These units that can flex up to ICU-level care can be used faster to accommodate infectious disease patients. Medical gases, outlets, patient monitoring, ventilators, and mechanical and HEPA filtration requirements would all meet ICU-level care.
PPE donning and doffing should be considered at the entrance of each unit. Space should be defined for portable anterooms to be set up. Hallways will need to look at that 8-foot dimension with a critical eye and allow for space for the anteroom, as well as space to remove all unnecessary equipment and store them just outside the room. This space should be considered outside of the clear 8-foot traffic zone and be a minimum of 4 feet wide to allow for maximizing the space.
Healthcare architects and designers must take a leading role in creating safer healthcare spaces in a post-COVID-19 world. Implementing these types of innovative strategies along with the CDC’s recommendations of distancing, washing hands, and avoiding contact will allow patients to receive care in safer spaces.
Gow is the Principal, healthcare planning practice at Francis Cauffman Architects. Her more than 20 years of experience in healthcare planning has included master plans, system consolidation planning, and department planning for complex areas such as emergency departments, surgery and imaging suites, cardiac care, cancer centers and critical care units.
Kenson, Principal,interior design at FCA, has been creating successful interior environments for over 20 years. Her experience extends not only to planning and interior architecture, but also interior materials and finishes.
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