Hospital Design will Change in the Aftermath of COVID-19

Hospital senior executives now realize that hospital design will likely change as a result of the Covid-19 outbreak. These changes will follow the pattern experienced by airports and commercial office buildings after 9-11. Some of these changes will require retroactive modifications to existing hospitals and others will require changes to designs that are currently being planned or under construction.

Obviously it is cheaper to change a design before the facility breaks ground or before the building has been completed. Therefore, the sooner hospital leadership identifies the likely changes in hospital design that will occur because of Covid-19, the cheaper it will be to comply with the new normal. To begin this process, successful hospitals will:

1. Assign someone to be responsible for determining how the experience during the Covid-19 crisis might impact hospital design.
2. Conduct comprehensive "lessons learned" debriefing of key constituencies who participated in combating Covid-19:
   1. The "surge" committee that managed the response to Covid-19.
   2. Care givers (e.g., doctors, nurses, and technicians).
   3. Line managers and administrators.
3. Closely follow governmental regulatory groups that will be enacting new regulations following the Covid-19 outbreak to:
   1. Influence relevant new regulations.
   2. Anticipate regulations that will affect hospital design.
4. Closely follow the observations and recommendations coming from other sources, such as:
   1. Professional associations (e.g., AMA, AIA, NACA).
   2. Trade associations (e.g., AGC, ABC, ASHE, AHA).
   3. Other.

Design changes must avoid causing unintended consequences. A major challenge facing management is to ensure that patients, visitors, and healthcare workers all benefit from the changes under consideration. Or, at a minimum, ensure that a design change under consideration for one constituency, does no harm to one of the other constituencies.

Some of the possible design changes that will be identified, include:

1. Redesigned certain patient beds to convert quickly to accommodate isolation patients:
   1. Medical/surgical beds.
   2. Recovery beds.
   3. SNF and memory care rooms.
2. Built and then "shell" patient rooms so that the hospital can bring them online quickly if additional surge capacity is needed.
3. Modify HVAC systems to add features such as:
   1. Negative pressure in certain rooms.
   2. Higher values for air turnover.
   3. Provide ability to temporarily close off HVAC flow by room to accommodate new generation fog and sanitizing robots.
4. Modify hospital ingress to provide:
   1. Fewer entry ports with larger capacity per port.
   2. Sufficient floor space to allow for deployment of visitor testing, if required.
   3. Sufficient floor space to allow for social separation.
5. Fewer hospital ingress ports will result in longer distances to in-house destinations, and therefore may result in:
   1. Taller hospital structures.
   2. Moving walkways or other similar systems in the hospital's interior.
6. Hospital exit doors may have to be redesigned to allow only one way traffic.This is because code requirements will dictate that there be sufficient exits for emergency escape purposes (e.g., fire, terror threats) while simultaneously infection control will require the number of entrances be limited.
7. Change ceilings in procedure and patient rooms to antimicrobial ceiling tiles.
8. Redesign all elements of the hospital that require hand contact, such as:
   1. Door knobs can convert to motions sensing, voice control, foot operated, or lever operated systems.
   2. Sink spickets can convert to motion sensing systems.
   3. Computer touch screens for non-staff (e.g., visitors or patients at reception areas, intake, food courts, or cashiers desk) can convert to verbal command systems.
9. Redesign waiting rooms to accommodate social separation.
10. Redesign Patient rooms to allow for social interaction with visitors without physical contact.
    1. Enhanced electronic communication tools.
    2. Visitor hallways on the exterior of patient rooms:
       1. With glass windows on the exterior of the room facing into the "visitor" hallway.
       2. And the care services having access to the room from the interior or core of the building.
11. Provide for antirooms adjacent to patient rooms to allow patient care workers to don and doff PPE.Equipe antirooms to accommodate fog and sanitizing robots.
12. Expand sterilization coverage by introducing sterilization to parts of the hospital that heretofore have not existed. For example:
    1. Increased use of ultraviolet lighting.
    2. Increased use of fog and sanitizing robots.
    3. Sterilization stations in places frequented by doctors and staff during the normal performance of their duties.
    4. Small sterilization units to accommodate PPE sterilization.
    5. Enhanced hand cleaning stations for bathrooms.
    6. Glove and disinfectant dispensaries located throughout the hospital.
13. Expand storage capacity to store emergency supplies, such as:
    1. Personal Protective Equipment (PPE).
    2. Patient care delivery equipment such as respirators and ventilators.
14. Provide the platform and equipment needed to scale up at-home work force capability for management and technical staff, through the expanded use of hospital communication tools and software and at-home electronics.
15. Finally, if the hospital contracts with a nearby university or hotel for access to overflow capacity (e.g., for patient beds. or hospital staff housing), then the contract should also include elements that will enhance activation of this capacity.

The preceding list of potential hospital design changes is only a preliminary list and does not have the benefit of the lessons-learned that will be identified after the Covid-19 epidemic is over. Nevertheless, consideration of this list is a good way to begin thinking about how hospital design will change in the future. Please do not hesitate to email ResX with any other design changes you identify that are not included in this list. We will keep a running history of these suggestions and publish them in the future for your consideration.

The professionals at ResX, PC focus on helping senior executives at organizations engaged in large construction projects. We can help you identify the questions you need to ask your line managers and the actions that must be pursued in order to achieve the best outcome when dealing with the turmoil caused by Covid-19.

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