The new Pittsburgh Academy of Architecture of Health (AAH) is a Knowledge Community committee of the American Institute of Architects, advocating “for innovations in design that help improve healthcare and shares the latest research in webinars, conferences and publications and works with allied organizations.”
On April 27th, the AAH / AIA Committee conducted a Webinar presenting the topic of how the Coronavirus Pandemic has affected the Healthcare Community and the Construction Industry.
One of guest panelist was Mr. Doug Spies – Senior Director of Architecture and Engineering, UPMC, who brought insight of how a local, major healthcare provider made accommodations to their facilities in response to the COVID-19 crises. The other guest was Mr. Randy Keiser – National Healthcare Director, Turner Construction Company, providing construction experiences to quickly design and construct needed healthcare facilities to meet the expected increase of infected patients.
Encapsulated Insights
Now, a few months into the crisis, the ability of “Thinking out of the Box” was, and continues to be, essential to react quickly to a possible pandemic surge. Teams had to combine the facts we know, such as the need to intake, detect, isolate, and treat infected patients, with the unknown facts of how to rapidly accommodate a patient population infected by a new disease. Conversion of areas not intended for these types of patients, in vast numbers, was the challenge. All the while, not precisely knowing the full extent of the ramifications of the spreading disease. How to keep the patients, staff and public safe was the mission. The way we minimize expose to healthcare providers and others is of key importance. To solve the problem, healthcare systems and the construction industries needed to seek many “work-arounds” to built permanent and temporary healthcare grade facilities. Someone made the comment, “Who would ever think that you would be seeing patients in a parking garage?”
The response to the current crisis force both healthcare providers and the design and construction industry to plan for the unexpected. UPMC had enough space and opened shuttered buildings for increased capacity. However, there was not enough staff to take care for the increase of infectious populations anticipated. Many volunteers showed up, but many staff also became sick. Things taken for granted became big issues. It was never anticipated at all Oxygen Outlets in a facility would be used at the same time. Additional trucks needed to deliver a continuous supply for all infected patients.
Time is of the Essence
For quick construction, Turner Construction relied on Fast-tracking the process utilizing a collaborative Design-Build-at-the-same-time process, where Healthcare providers, Architects, and Construction Managers worked together around the clock to provide medically safe environments in make-shift or permanent structures. In one facility with 1,000 patient beds was constructed in 16 days. A challenge was to incorporate social distancing concepts and PPE procedures into the construction field. This was done by staggering the timing of construction crews, in engaging smaller crews, and doubling the number of shifts. Surprisingly, Turner saw greater productivity and a smaller rate of safety infractions.
How will “Lessons Learned” from the Coronavirus effect the future design of hospital?
A result of 911, the emphasis was on security, and limiting access to the hospital into smaller, single point entry to gain better control over who enters the hospital. With the COVID-19 crisis, social distancing becomes important, and how to spread people out may be the new thought process to be undertaken as we analyze patient and staff flows. Maybe the days of crowded Elevators are over. Would you be comfortable in an elevator with eight people? Psychologically, four people might by be better. But that would require the formation of lines in the Elevator Lobby, or in a Corridor. Increasing the number of Elevators is expensive and adding them to an existing facility may be prohibitive.
Emergency Departments may need to rethink how patients and visitors are received. The public thought process may need to change. Perhaps only trauma and infectious patients are admitted in the future. Broken bones and other ailments go to an amped up 24-hour Urgi-Care.
The number and type of rooms requiring increased Air Changes or Reversible Pressure will definitely be considered as a method to provide the appropriate environments for Patient Rooms and Treatment Rooms. Ante Rooms were eliminated years ago as a requirement for Isolation Rooms. In the current crisis, infection control saw the re-introduction of Ante Rooms for Isolation Room, Operation Rooms, and other functions. “For COVID-19, each patient is thought as a TB Patient.”
The ability to accommodate a surge capacity will also need to be considered for future pandemics, natural and man-made catastrophes. Building additional Patient Beds for an rare emergency basis is financial infeasible. But can single-Patient Rooms be equipped to accommodate another patient with the connection of a mobile headwall – if an emergency warrant doubling up on rooms? Universal Rooms can also provide the type of Patient Bed that can accommodate patients of different or changing acuities. However, if a Med-Surg Bed can be turned into an ICU bed, the staff needs to be trained, certified, and be paid to be part of the ICU Staff.
Clinical patients will always need to see their doctors. We have now seen a greater use of Telemedicine, which can prescreen a patient before the patient arrives at a hospital our doctor’s office. Soon, I-Watches or Fit Watches could send vital information from the Patient to the Doctor during the telemedicine visit. Perhaps lowering the need for some doctor’s offices and exam rooms.
Over the decades of being an architect designing healthcare architecture, I have seen some of these concepts considered, coming to the foreground and dissipating in preference. It will be interesting to seem how future FGI Guidelines and ASHRE/ASHE standards will evolve in the light of the Coronavirus.
About the Author: Leonard Dirk van Heest AIA, NCARB is a Senior Project Healthcare Architect at MacLachlan, Cornelius & Filoni Architects bringing 35+ years of project management, design and planning experience in multiple aspects of architecture. He is member of the American Society of Healthcare Engineers.