Hospitals and health systems are looking ahead toward a post-pandemic surge strategy to resume operations. Community health will eventually shift from “stay home, stay safe” to a re-focus on preventive medicine and wellness. Many New York healthcare system campuses are losing $350-400 million per month during the COVID-19 pandemic (as reported by the WSJ). E4H Environments for Health Architecture is collaborating with clients to resume normal operations as soon as possible by developing strategies around their existing facilities, utilizing construction sites and many quick-fix renovations and modifications.
During a webinar on April 9, Dr. Mark Jarrett, senior vice president of Northwell Health (New Hyde Park, New York), outlined the system’s strategy for the separation of COVID-19 patients and re-purposing spaces to accommodate the patient surge. During the surge, all noncritical procedures and treatments were postponed to reduce the risk for post-procedure patients. This strategy, while critical during this period of rapid spread, is not sustainable for hospital operations as the COVID-19 population begins to plateau. Remote locations are critical when demand is high, but long-term these locations are difficult to support with infrastructure and staffing. Northwell Health leadership partnered with E4H to review their system-wide resources and create a space that would be a mid-term solution to decant COVID-19 patients from other facilities over the next six months.
In 2014, during the planning and design of the $90-million Cohen Children’s Medical Center on the New Hyde Park campus, the design team had included a shell space for a future pediatric surgery center. As the multi-year implementation plan progressed, construction had begun in 2019 on a $90-million pediatric surgery center project in the shell space of CCMC, which includes eight pediatric operating rooms. A 26-bed PACU for the surgery center was designed in the adjacent Cohen Children’s main building; CCMC IP and Cohen’s Children main building are separate buildings but connected with two sky-bridge connectors. The design team had just finished decanting over 10,000 square feet of space in the Cohen’s Children main building, relocating practices and administrative functions to other locations offsite. The demolition of the future PACU space had just been completed in February of 2020.
Mark Mazza, director capital projects reached out to the design team, providing a 48-hour window to plan how 60+ COVID-19 beds could fit into this project space and how to move the project along for an aggressive fast-track schedule. Northwell worked closely with the team to ensure successful communication and quick decision making with the project team, including general contractor Gilbane.
The pediatric ORs created challenges in that the framed walls limited the number of beds the surge unit could contain, as well as concerns of contamination to already constructed areas. The adjacent future PACU in the Cohen’s Children main building could be easily isolated from the adjacent parts of the hospital, as well as the OR spaces presently under construction. Existing electrical, medical gas, plumbing and HVAC infrastructure still remaining could be utilized for the final design – which also helped to minimize utility shut-downs. The existing utility risers that remained in place created floor plan layout challenges, but moving any of the services would have impacted the floors above so the layout reflected the critical needs of the care teams along with the parameters of the space. Within two days the design team delivered a conceptual floor plan, door schedule, bed layout and headwall elevations. With a strict budget and a two-week window to complete the design, it was an all-hands-on deck effort to deliver an efficient solution that could be used for the next six-plus months.
With the conceptual plan, the contractor went onsite and chalked out the proposed layout, finding space for an additional five beds. As the plan was being finalized in the field, engineering focused on the final requirements for medial gasses, HVAC, plumbing and electrical.
To speed construction, the collaborative team sought quick solutions that could be easily implemented. Engineered vinyl plank flooring that complied with NYC code and could be easily installed was quickly procured. PVC liner wall panels were screwed directly to the metal studs eliminating the need for drywall – but creating a smooth, cleanable surface. Headwall outlets were surface mounted to quickly implement the required electrical and medical gasses. The contractor reviewed material resources from project sites across its portfolio, re-directing materials from other projects that had gone on hold.
As the surge recedes, Northwell Health plans to decant all COVID-19 patients from its other facilities to this one unit, allowing other system hospitals to resume noncritical procedures and care. This isolated unit opened April 25, allowing for better infection control and providing the critical confidence needed to resume operations at hospitals across the system.