How the Pandemic is Changing Healthcare Design
In 2020, when a pandemic broke out over the world, our healthcare facilities were the center of attention like never before. But several countries had already made ambitious plans to construct new hospitals and renovate old ones before the pandemic had started.
Now that the pandemic has been going on for nine months, there have been lessons learnt from the immediate difficulties with healthcare design, in addition to ongoing talks of the long-term changes which are probably going to have an impact on how, where, and when we receive our treatment.
The impact of pandemic on healthcare design
While technology, aging populations, and net zero objectives continue to revolutionize how hospitals are created, utilized, and maintained, the pandemic will have an impact on those new buildings.
According to the architectural tenet "form follows function," the processes and flows that save lives shape hospitals. Although healthcare services are increasingly focusing on prevention-based models and telemedicine to reduce the amount of time patients spend in hospitals, healthcare facilities are transitioning from a largely inpatient focus toward more varied space typologies.
Here are a few of the main conclusions changing.
Short-term design changes
Our current healthcare facilities were not necessarily built or set up to handle the increased patient traffic, as the pandemic has demonstrated. As a result, it was challenging to prevent the spread of illness within the medical workforce.
1. Emergency intensive care units: Reimagining shipping containers
As the COVID-19 epidemic spread, hospitals all over the world initially struggled with a lack of Intensive-Care Unit (ICU) space to treat an increasing number of patients who required respiratory care and ventilators.
One innovation centered on converting shipping containers into plug-in intensive care units (ICU) pods, outfitted with all the required healthcare facilities to treat patients who require intensive care. The pod's design prioritized biocontainment, patient and medical staff safety, and deployment speed.
Pop-up care locations pose clinical problems and delivery problems, yet many of these initiatives have brought together architects, engineers, physicians, and others to develop solutions.
2. Design changes motivated by clinicians
During a crisis, on-site physicians' "here-and-now" temporary fixes brought unexpected design problems to light. For instance, on-site modifications to solid-panel hospital doors in the form of cutting-out sections to create vision panels were made in response to the necessity to visualize high-acuity patients housed in typical hospital rooms.
To enable providers to make changes without having to put on and take off PPE and enter the patient room, healthcare design like medicine drips, IV tubing, and lines that are typically positioned at the bedside in intensive care rooms were moved out into the corridor. These on-site, clinician-led design modifications could potentially be viewed as long-term requirements and have an impact on our minimum standard design recommendations.
3. Managing connection and infection
For service providers, patients, and families, the clinical procedures to stop the virus' transmission have created new ethical and medical conundrums. We must be aware that reducing contact with infectious patients who are either possibly or definitely contagious has major health hazards, and that a balance needs to be struck between this and isolation and a lack of social engagement. It should always be possible for loved ones to participate in birthing and dying processes in some way. Healthcare design concepts for visitation in long-term care facilities and hospitals have centered on temporary visitation pods and digital/virtual networks that could enable interactions between socially isolated people. Although open areas near to one another are not always secure during the present COVID-19 outbreak, we aim to return to this paradigm in the future. However, architectural modifications are required to make healthcare facilities adaptable in the event of an infection or emergency. It should be noted that the above-described visitor pods could link to already-existing lobby or entry spaces.
Long-term design strategies
While it is expected that life will resume being lived in close physical proximity after the pandemic, including community dining, socializing, and in-person workstations, it is also possible that healthcare facilities will adjust to accommodate flexibility in the event of more infections.
1. Patience care delivery
The survey's examination of patient care delivery concentrated on three fundamental areas: patient treatment, space usage, and cleaning procedures.
During surges, many locations reporters said they reduced staff and patient interaction. Although this wasn't a surprise, it's fascinating to notice how each healthcare facility handled these difficulties in a different way, particularly in terms of patient care. In order to enable equipment control from hallways, a number of temporary anterooms were built, and wall sleeves were erected between the corridor and patient rooms.
Most interviewees also mentioned using temporary surge units. Behavioral units, operating rooms, and other medical/surgical units were among the several types of spaces, along with repurposed perioperative recovery sections. In these temporary treatment areas, medical gasses and temporary exhaust ventilation have been added to facilitate patient care.
2. Screening of patients and visitors
The healthcare facility team described how their ingenuity and resources assisted in problem-solving during the first wave's peak and how this experience will influence the design and planning of future projects. The solutions varied from techniques to improve ventilation into ICU rooms to screening at entry points.
When the pandemic first started, screening everyone who entered the facilities was crucial, and due to the lack of information about COVID-19, monitoring for fevers was the quickest and most straightforward diagnostic procedure. By using technology to measure temperature, any potential infections were swiftly identified.
To adopt remote thermal scanning and temperature guns, which are still utilized in hospital settings and have also been implemented across outpatient settings, facilities swiftly installed the power and data required at entryways.
3. Weariness among healthcare workers
COVID-19 still impacts healthcare workers as a result of staffing shortages that affect the entire world in addition to the healthcare design. According to the American Nursing Association and the American Hospital Association, the healthcare sector as a whole was experiencing a physician and nurse shortage prior to the epidemic. People are quitting the healthcare industry for a variety of reasons, including staff burnout, anxiety, mental health issues, and public mistrust and lack of respect.
Staff members also had experienced worry about protecting their families at home. There are often no designated areas for personnel to put on and take off PPE clothing in inpatient wards. Although there were dedicated spaces for this to happen, the employees still didn't feel comfortable wearing clothes that they had worn at the hospital to go home. To prevent infection in their homes and families, many people were changing in their automobiles or garages.
4. Adapting hospital facilities
The major adjustment hospitals had to make was converting units into COVID-19 units. Together with the healthcare facilities teams, engineers, contractors, architects, and patient rooms were updated. Doors, electrical needs, and air exchange rates all changed for converted units. Solid door modifications were necessary for the safety of both staff and patients because this highly contagious disease necessitated being able to see into the room from the hallway.
In a traditional medical or surgical unit, charting is done in one spot. Still, since ICU patients require direct monitoring, staff members were forced to use computers while sitting in the hallways. To preserve this proximity, sites outside of rooms were introduced with power and data.
5. Indoor air quality
At first, it was believed that HEPA filtration equipment would be needed in addition to outside air in patient rooms for interior air. Many claimed that HEPA filtering devices were retrofitted into curtain wall systems. These rooms were converted to full exhaust with additional air exchanges in patient rooms after further information about the virus's transmission was discovered.
The majority of filtration systems needed to be improved since they couldn't handle the necessary number of air exchanges and increased direct emissions. Since most healthcare design structures are not built with windows that can be opened, it has been difficult to provide the necessary ventilation and direct exhaust. Operable windows and increased air levels are being considered for new projects that are currently being planned.
Designing for Resilient Health
The necessity of strengthening and maintaining healthcare design and systems through a comprehensive strategy to disaster preparedness and response has been made obvious by COVID-19. When exposed to external threats, resilient building systems are able to take in, adapt, anticipate, and change while maintaining control over their domain of responsibility in order to carry out their principal goals and duties.
The pandemic has forced us to think about immediate design modifications as well as long-term healthcare design considerations for coping with the subsequent disaster or pandemic in our altered reality. The delivery of community models to enable patient/provider engagement and collaboration around health and wellness has been the emphasis of recent developments, but COVID-19 has changed this focus to keep individuals in narrower operational bubbles, necessitating fewer distributed amenities. It will be crucial to offer solutions that can be changed.
Beyond the scope of a pandemic, when the aim is to stop the spread of infection, we also need to think about resilience. Rapid patient and staff evacuation may be necessary in other emergency situations, such as a natural disaster. In order to develop hospital readiness in a range of conditions and give a tried-and-true framework for response and recovery—before, during, and after an emergency—general preparedness is required. Even in the midst of a severe epidemic, healthcare design solutions must take into account enduring baseline population health demands.
Future of Healthcare Design
The resilience of short-term and long-term healthcare design is significantly influenced by architects and engineers. In order to further improve our built environment resiliency and emergency readiness, we must keep working with healthcare facilities at the building and policy levels to address design difficulties as well as public health challenges. To combat this pandemic and the next, healthcare designers must stay on the cutting edge of developments in this dynamic environment. The best ways we can support healthcare organizations are through creating flexible, adaptive environments.
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