COVID's Imprint Redefining Hospital "Footprint"

No person or industry will be left untouched by Covid-19. In the design and construction industry, the impact is arguably most pronounced in healthcare, where codes, procedures and patient expectations will be evolving as the pandemic progresses and well into the future. According to Stephanie Pielich, JJCA's healthcare practice leader, the following planning needs that have been made evident during the pandemic will result in the incorporation of even greater flexibility in future master plans and designs to ensure hospitals can be "fleet of foot" in adapting their facilities to meet the unexpected.

Rapid Capacity Scaling
Perhaps no images better capture the healthcare impact of the pandemic than ERs bursting at the seams, overflowing ICUs, and scenes of an overwhelming influx of seriously ill and highly contagious patients. The ability to scale an individual hospital and system to meet a rapidly growing patient need is critical in a situation like a pandemic or even a major natural disaster. An established relationship with an architectural and engineering team will significantly reduce the time necessary to hit the ground running on quick solutions to address the most current need.

Adaptability of Specialty Rooms
A situation like Covid-19 requires looking at the ability to adapt at the master plan level from a whole system perspective, i.e., the use of universal or adaptable rooms in the facility, using nearby ambulatory spaces, or identifying temporary/mobile provisions. Existing facilities within the hospital’s control need to be evaluated to determine spaces that could be used to relocate ambulatory functions or provide for the emerging needs. Implementation considerations include identifying local construction sources, and use of local hospital staff and/or mobile facilities and staff. Ideally, this type of crisis planning is developed ahead of time with a hospital's A&E team so that when an urgent situation arises, the facility is well-prepared.

Incremental Staging
Understanding whether solutions are deemed to be permanent or temporary will impact the approach to implementation and when done properly, will allow a hospital to meet incremental needs with incremental expenditures. If the solution is permanent, we want to identify potential limitations to future development. If it is temporary, we want to map out a plan for returning the facility to "normal" and understand the likely timeline.

PPE Placement
While location and use of PPE is typically a part of a general discussion during the planning and design process, COVID-19 has demonstrated that this level of planning may not be adequate, particularly as it relates to the flow of PPE doffing and donning. The storage, supply and location of PPE needs to be designed to facilitate a highly efficient doff and don process for both normal and high capacity scenarios. As a part of this, hospitals will need to define the full gamut of potential PPE needs.

Telemedicine Expansion
As a result of Covid-19, requirements and reimbursements for telemedicine have been relaxed. Medicare now allows the same billing rate for telemedicine as for in-person office visits. Greater use of technology is now allowed for telemedicine, expanding the scope of what can be achieved in these appointments. As a result, many patients who had been hesitant to use telemedicine are using this approach with positive experiences and outcomes. Physician interaction can be enhanced by the use of telemedicine in several scenarios:

• In psychiatric consultations, environmental contributors in the home can be observed and evaluated.
• Physicians can have a more relaxed connection with the patient to improve overall health and limit unnecessary trips to the office or hospital.

For rural hospitals, harnessing the resources of larger partner facilities for services not available in the immediate community, such as telemedicine, is critical.

Spaces being used for telemedicine need to be designed to effectively address acoustics, lighting, technology and branding/background in order to present the best environment for clear communication with the patient.

Code Revisions and Public Health
Following are several items that will likely begin to work their way into code revisions or public health policies as a result of recent experiences with Covid-19:

• Outline specific requirements to address surges in capacity
• Address which spaces are allowed to flex during an emergency and what is needed to achieve that flexibility
• Increase attention and awareness of health practices, such as washing hands, to become more a part of the norm throughout society, whether going to a restaurant or visiting the hospital

Conclusion
While it might be said that nothing could have quite prepared us for what has occurred during Covid-19, we can take what we are learning during this healthcare crisis to develop plans that ensure our hospitals are more nimble in the future. At JJCA, we are listening carefully to our clients to support them in being responsive to the most current and compelling healthcare needs. We are dedicated to leading our clients through the process to identify design solutions that ensure the best possible patient outcomes.