Getting Hospitals Back on Track: Safely Bringing Healthcare Back Online

How to Prepare Our Hospitals to Balance COVID and Non-COVID Care

May 21, 2020

Healthcare 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 Ryan Hullinger and Sarah Markovitz.

 

Since the middle of March, nearly all elective surgeries and medical procedures in America were postponed to create capacity for the first wave of Covid-19 patients. While the curve has started to flatten and many facilities are reactivating their procedural platforms, there is still hesitation in patients seeking in-person care for fear of inadvertently exposing themselves to the virus. As a result, many patients with both chronic and acute conditions are putting off necessary health maintenance and avoiding trips to the hospital.

For the healthcare industry, this is devastating both in terms of its impact on patient care and its bottom lines. Hospitals — especially non-profit hospitals — historically operate on extremely narrow financial margins. With so many departments sidelined, the average American hospital has seen an estimated average drop in operating revenue of 40 – 45%, resulting in significant furloughs. These actions take a huge emotional toll on staff, many of whom were bracing for battle only a month ago and are now suddenly without a job.

America can’t afford to continue putting its wider healthcare system on pause in the likely event of another patient surge in the summer or fall. So what solutions could help keep appointments and procedures on track? And how can we ensure that they are performed in a safe manner?

All entrances, lobbies and screening processes should look calm and well-organized to assure patients that the facility is in control of the situation and safety is the number one staff priority.

There are many design changes that can make this happen and many of them begin before patients set foot on hospital grounds. Hospitals should use their websites to present clear communications with patients so they are aware of the safety precautions and instructions for their arrival.

Inside the hospitals, there needs to be legible signage that communicates cleaning and disinfecting processes for the facility. For example, many hospitals have existing digital signage outside of rooms that previously communicated room occupancy. This can be repurposed to communicate cleaning frequency and efficacy. This can be as simple as something like “This room was cleaned three minutes ago and is ready for use.”

Thoughtfully planned wayfinding will be equally important. These need to demarcate separate pathways for those with and without Covid-19 symptoms entering the site, covering the patient journey from the parking to the entrance to the treatment areas. Wayfinding solutions could use unique colors and shapes – such as the color pink or a triangle shape – to help messages stand out.

Planning hospital flow for optimal safety

Accommodating coronavirus and non-coronavirus patients in the same hospital requires thoughtfully planned and clearly delineated processing and treatment zones. The Centers for Medicare & Medicaid Services recommends establishing distinct zones for each group. In the coronavirus care areas, symptomatic patients will be identified, screened and receive appropriate medical guidance and contract tracing efforts. Where possible, these areas should be physically separate from other hospital services — this could be a different building, a dedicated room/floor with its own entrance, or pop-up tents adjacent to the hospital.

For patients with Covid-19 who come for treatment of other issues and conditions, a bespoke multidisciplinary clinic can be set up to address their needs. For patients who have yet to be screened, administrators can work together to plan uni-directional flows throughout hospitals so those coming in and going out don’t cross paths with one another.

This will also require consideration for features like elevators to ensure they don’t become contamination zones — potentially by having designated staff operate them, reducing the number of persons allowed in at any given time, and identifying separate elevators for coronavirus and non-coronavirus patients.

Rethinking the waiting room

Balancing care for coronavirus and non-coronavirus patients in parallel may require rethinking the traditional waiting room entirely. Hospitals are designing new patient experience systems to alleviate patients’ anxiety by limiting the amount of time in the hospital outside of direct appointments and treatment.

After being screened for Covid-19 at a triage tent, patients can wait outside the hospital until they receive a text that their doctor is ready to see them, at which point they are taken straight into a treatment room to promptly be seen by their provider. By using mobile communication tools, these hospitals are decentralizing and streamlining the waiting room experience.

For the majority of Americans who access hospitals with their own vehicle, cars could become the new waiting room. For those living in more urban settings, hospitals can consider converting larger and more spacious rooms like cafeterias and conference rooms into waiting areas. This would allow for greater distance between patients waiting to be seen. Reconfiguring furniture for appropriate spacing, leaving signs on chairs and tables after they’ve been cleaned, and using markers to establish appropriate distancing for any lines are all immediately actionable solutions.

All of these considerations will change as PPE supplies, Covid-19 screening, antibody testing, and tracing programs continue to evolve. By closely aligning thoughtful and innovative hospital programming and operations with solutions that project a sense of safety and care, we can start to reconfigure our hospitals and healthcare facilities to operate within this new reality.

 

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.

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How to Design a Nightingale Hospital to Be Operational in One Month

Five Lessons in Rapid Hospital Construction

May 11, 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.

 

To deal with a potential surge of inpatients due to COVID-19, many healthcare organisations around the world are constructing “Nightingale Hospitals,” named after the founder of modern nursing Florence Nightingale, in which patients are typically housed in open wards instead of private rooms.

Designing, building and commissioning these hospitals quickly is a major undertaking. But lessons learned from recent projects [download an infographic about the construction of one here] provide insight into how to deploy them elsewhere in the future. Here are five ideas to consider when developing a temporary field hospital:

Choose a simple structure: Because making quick decisions is imperative, opting for a prefabricated shell ensures a hospital can be quickly erected and demountable. For example, a spaceframe roof can be assembled at ground level with a hydraulics lift to put the roof into position. In some cases the shell can be erected in as little as five days.

Care for the caregivers: Provision of staff respite spaces is incredibly important during this stressful time. These facilities may include a staff lounge with views of the outdoors, a space for pause and reflection, as well as staff changing facilities and a dedicated staff entrance into the hospital. Space should also be furnished for changing into and out of PPE, with strategically placed PPE top-up facilities throughout the building.

Ensure patient privacy: Preserving dignity is important to patients, particularly at such a traumatic time and in such a large open space. Folding screens and fixed “wing walls” can create a sense of privacy that helps put patients at ease and enables them to recover faster.

Create a clear segregation of flows: Arranging the wards as 30-bedded units with a centrally placed nurse base and medication facility at the centre of each provides good views to patients. Placing clean and dirty utilities at opposite ends of each ward provides ease of access and segregation of flows.

Standardise for quick construction and easy navigation: Standardising bedheads for acute care, including oxygen provision but not invasive ventilation, is a good way to save time during construction and use.

When creating a Nightingale Hospital, all established ideas about designing healthcare environments need to be rethought. Solutions must be developed, first from principles and patient services to fire strategy and the coordination between the design teams, site teams and the client.

 

To learn more about how to construct a nightingale hospital, click here to download an infographic overview of a recent one in Jersey. 

 

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

 

 

 

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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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