America’s hospitals are managing care for increasingly sick patients—and not just because of rising cases of COVID-19.
Since outpatient services began moving out of downtown hospital towers decades ago and into medical office buildings, standalone surgery centers and even strip malls, hospitals have been tasked with treating the highest-acuity patients, those who need specialized, concentrated and round-the-clock care.
This shift in patient population, with less-acute patients being moved from hospitals to outpatient settings, has affected hospitals in several ways, changing the services they offer and the physical space in which they provide them. With roughly 1 in 31 hospital patients acquiring a healthcare-associated infection on any given day, according to the most recent data available from the Centers for Disease Control, design and facilities management decisions that limit the spread of infections and the exposure of staff are essential.
Stopping the spread of infection relies on measures both simple, like hand-washing, and complex, such as creating multiple backup systems for power, water and air handling. Throughout the design and operation of hospital systems, these steps must be considered, implemented and communicated to the broader community. This last step is critical to assuaging a long-held belief—that hospitals are only for sick people—which can prevent some individuals from seeking the care they so desperately need.
Knowing hospital facilities will continue to evolve to serve more critically ill and treatment-intensive patients—and that addressing fears of the broader population will remain a top concern—hospitals can adapt their physical space to meet the changing patient population and help support better outcomes.
One building, one specialty—with limited access
To account for a higher case load of serious illness and acute patient needs, hospitals can embrace a one-stop services model, centering single buildings in the treatment of a particular disease or area of medicine.
This approach gained attention throughout COVID-19 as convention centers, decommissioned hospitals and other temporary facilities and dedicated buildings were converted to treat the most critically ill patients. The same steps that made these sites suitable to treat and slow the spread of the pandemic offer useful guidance for the design and renovations of hospital space—especially when conversion doesn’t have to happen at a rapid pace.
One effective strategy is to compartmentalize high-acuity services and limit the size of certain public spaces like cafes, and administrative rooms that house finance and human resources offices, which can easily become overcrowded or cause patients, non-patients and caregivers to comingle.
Other public spaces like lobbies play an important role in emergency situations, converting to triage centers to accept incoming patients and quickly assign them to treatment centers based on need. These areas are of less concern given the natural design barriers that limit their size and capacity, and in some instances proved invaluable in managing the influx of patients due to COVID-19. One hospital utilized its lobby as a large emergency room and triage area, with medical gas, vacuums and power hidden in lobby columns that could be called on at the peak of cases, though keeping triage offsite and limited to drive-through was the No. 1 contagion control healthcare facilities used throughout the pandemic response.
In our recent projects, we have been keeping these public areas to a maximum of 20,000 departmental gross square feet, which limits the ability of patients, caregivers and others to cross paths and potentially spread infections.
Relatively small spaces such as these—or a specific bed count within a larger area—can be efficiently shut down and isolated to control the spread of infection. Most hospitals are not designed to pivot their infrastructure at a systemwide scale, so limiting the footprint of high-acuity care can allow for rapid building changes, like reversing the flow of HVAC systems to create a negative-pressure suite, preventing cross-contamination.
Center the patient in healthcare design
A separate facility may not be necessary or practical for many hospital systems depending on their patient volume and the immediacy of the infection threat. But consolidating care functions into a single room or dedicated area can offer both better patient care and reduced risk of contagion.
In addition, hospitals can modify existing spaces to serve linked patient services. An intensive care unit adjacent to a stepdown unit, or a birthing suite that encompasses labor, delivery and recovery, for example, eliminates the need to move patients through shared space in the hospital, thus reducing the potential for cross-contamination.
Within the patient room, hospitals can make design changes to ensure both patient and caregiver safety. In the case of COVID-19, those changes meant sealing rooms, ensuring a certain number of air changes per hour and moving contaminated air through appropriate filters and outside the hospital. Other adaptations can prohibit the spread of direct contact diseases, such as instituting don/doff zones for caregivers and disposing of used personal protective equipment via dedicated service elevators.
The extra precautions that caregivers undoubtedly take on to prevent the spread of infection—from donning personal protective gear to navigating exchange/pass-through doors meant to control the flow of air—can and do take a toll on caregiver stress levels and ability to best serve patients. Limiting the frequency of medical/technical tasks and maintenance time with patients can help offset this fatigue and ensure the protocols in place are followed exactly.
These methods require advanced planning, but the benefits of reducing caregiver stress and exposure to infectious disease by reducing, combining or eliminating menial tasks are essential and effective in keeping the overall health system safe.
Demonstrate health + safety precautions for the broader community
While decontamination procedures will evolve as new tools and information are made available, hospitals can lean on third-party certification programs to provide an additional layer of guidance and assurance that everything is being done to protect the people within their space. Architects and design professionals can also aid future decontamination efforts by building in adaptable design features, including HVAC and power that impact the entire healthcare system, but particularly specialized equipment used to treat the most infectious diseases.
Patients and caregivers have the most to gain from these protocols, but the broader community needs to be made aware of them as well. Hospitals and healthcare facilities can often feel like insular environments, yet they remain major authorities for the communities they serve. This role is especially important in modeling comfort and confidence in established protocols, which invariably are carried out to the broader population.
As hospitals continue to take on the patients with the greatest needs and most severe illnesses, adapting their physical space to meet higher-acuity care will be paramount, ensuring better patient outcomes, less stressed caregivers and educated communities who won’t hesitate to seek out necessary medical treatment.
