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Hospitals all prepare for disasters, but the type, severity, duration and related circumstances are difficult to predict. Even having the most thorough emergency preparedness plans, the magnitude and unpredictability of some crises can easily impair a facility’s ability to safely triage and treat a sudden influx of patients.

 

As the COVID-19 pandemic began to unfold, many facilities across the country anticipated unprecedented increases in patients. So, hospitals, cities, states and federal entities called on healthcare construction partners to quickly add and convert spaces to increase their capacity for everything from triage and testing, to isolation rooms and ICUs.

Thanks to these efforts, the US’s healthcare disaster preparedness and patient surge capacity have already significantly improved. But this pandemic will undoubtedly shape healthcare design and construction long after COVID-19 is just a memory.

Implications for Long-term Surge Planning and Pandemic Preparedness

With the pandemic’s continued unpredictability and its impact on healthcare facilities, thought leaders across the industry are anticipating several long-term implications for hospital disaster preparedness and surge capacity planning for the built environment.

First and foremost, it is quite possible that recommendations and requirements published by entities ranging from the Facility Guidelines Institute to The Joint Commission, will become more detailed and robust. Lessons learned from this experience are likely to be reflected in industry standards and best practices moving forward.

This could pave the way for hospitals to explore options for easily converting emergency department and inpatient rooms from private to semi-private during an emergency. Similarly, hospitals are likely to consider creative ways to design and build spaces such as parking structures, lobbies, conference rooms, and classrooms that could easily transform into additional triage and treatment areas at a moment’s notice.

Furthermore, stories of ICUs overwhelmed with COVID-19 patients underscored the need to ensure adequate numbers of critical care beds. Even before the coronavirus, hospitals were exploring options to increase the number of beds suitable for treating the sickest patients. One solution for doing so, for example, is an acuity adaptable room. These rooms can “flex up” from a standard medical-surgical room all the way to an ICU room, singlehandedly meeting the entire range of a patient’s needs during their stay. Options to design and build for higher acuity and acuity flexibility in ways like this are also likely to grow.

The Domino Effect

While the emergency department and patient rooms are obvious places needing adequate surge capacity, COVID-19 has also highlighted the domino effect of crises on other areas in hospitals. This means facilities must also assess ways to dramatically increase capacity in areas like pharmacy, lab, and imaging. Even temporary surge solutions for storing and/or sterilizing large volumes of supplies, such as personal protective equipment, may become more prevalent.

The coronavirus pandemic will also draw more attention to other infrastructure needs such as power and oxygen supply and access, which are necessary to support significant increases in treatment involving respiratory support, like mechanical ventilation. Similarly, HVAC capability is also likely to be assessed, especially given the pandemic’s sudden impact on demand for negative pressure and isolation rooms. Being able to easily monitor and optimize air quality will continue to be critical for patient and healthcare professional safety.

While allowing for increased space and supplies is important for preparedness, all of it must be planned in the context of surge staffing plans and workflows. COVID-19 has reiterated how a crisis increases demand and exacerbates staffing shortages. Consequently, facility preparedness plans must also allow for the most streamlined, efficient workflows for caregivers through proximity and easy access.

Without a doubt, telehealth will also play an increasingly more important role across the entire healthcare industry. While it’s use has been growing in outpatient settings for several years, increased utilization due to COVID-19 has been dramatic. Furthermore, hospitals are demonstrating its value more broadly in the acute care setting as well. Whether it is being used by intensivists to care for more patients in the ICU, or as a tool for remote monitoring and virtual follow-up visits after a patient is discharged from the hospital, additional infrastructure to support increased telehealth in hospitals is a trend that is likely to continue.

Enhancing Speed to Market, Schedule Certainty and Jobsite Safety

Two other strategies expected to grow in popularity as a result of COVID-19 are mobile and modular solutions. Mobile solutions can be particularly good options for disaster preparedness. They do not require dedicated, valuable space onsite, and hospitals can quickly deploy them to wherever the need exists, whenever crisis strikes. Mobile solutions can work especially well for storage of things like extra supplies and equipment that need to be accessed rapidly during a disaster.

Similarly, offsite prefabrication and modular solutions also proved to be valuable for the healthcare industry’s response to the pandemic for several reasons. Two of the primary benefits of prefabricated and modular solutions are schedule certainty and speed to market. In the past, these have been important for hospitals needing accelerated construction schedules to gain competitive advantage and market share. But as we’ve seen with COVID-19, speed becomes even more important during a crisis, not because of a business case, but because lives are at stake. The healthcare construction industry has demonstrated just how viable and essential these highly efficient construction methods are. When combined with the long list of other benefits they bring, their popularity is expected to grow even more in the months and years ahead.

Predictability during construction is just as important as speed, especially during a crisis. Advanced work packaging is another solution likely to become more common since it increases predictability. It combines planning, early design involvement, prefabrication, and modular components, and takes them to the next level. By breaking project scopes into smaller executable “packages,” schedule and cost certainty increase so the traditional project controls management style can shift toward production management. “Work packaging is advantageous since schedule certainty increases by moving construction planning to the very beginning of the overall project schedule,” said Senior Project Manager Joseph Schultz. “Studies have shown that this can significantly reduce unplanned events, trade partner congestion, simultaneous material movements, and simultaneous worker movements.” With the need to deliver results quickly during a crisis, plus social distancing guidelines expected to remain for the foreseeable future, solutions like this will allow construction to continue, quickly, and safely.

Emerging Stronger

COVID-19’s long-term impacts are still unfolding, but one thing is certain. Healthcare, and consequently, healthcare design and construction, will be forever changed in ways and at speeds that likely wouldn’t have been possible otherwise. Both industries are positioned for a truly transformative and dynamic road ahead. And all of it will undoubtedly result in enhanced environments for delivering patient care and preparedness to respond to the next unknown that the future may hold.