November 20, 2020

The second installment of the COVID-19 Healthcare briefing series delves into the insights provided by DPR Construction's industry partners and clients as they navigate changes to the healthcare industry.

Many facilities altered safety, capacity, and isolation protocols in response to COVID-19. DPR Construction’s conversations with customers and partners identified universal challenges to responding to the pandemic. Industry leaders consistently agreed that new solutions must be future-proof as we prepare for pandemics and ongoing care to co-exist and recapture patient confidence.

Acuity Adaptability was a hot topic prior to COVID-19, and continues to be discussed in many ways

  • A universal room model could be designed and built to the highest level of acuity and allow for flexibility over time. With this model, rooms could be reassigned from an intensive care unit to general acute care, or vice versa, without staff going into the room and making physical changes down the line.
  • With regulatory agency approval, outpatient and ambulatory facilities could provide greater flexibility in the future. Lower acuity facilities can flex into negative pressure spaces for higher acuity demands (i.e. up license for surges).
  • In the future, MEP systems can be designed or retrofitted to support increased capacity within existing rooms, including power and med-gas.
  • With changes to current codes, ORs and ERs could be designed to flex between positive and negative air systems. Alternatively, by modifying space within hospital walls, ante rooms could be added to ORs.
  • Modularization can be utilized to quickly create additional triage space and beds. This is particularly relevant for rural and remote areas where there are additional challenges with scaling labor and material procurement.

An important distinction with many of the temporary and makeshift conversions deployed to flex to alternate acuity levels during the early stages of this pandemic is that they do not meet all of the required codes and are identified as “negative pressure rooms,” not “isolation rooms.” As further refinements and adjustments to the concept emerge, the acuity-adaptable room may find a place as a standard in future healthcare facilities.

A desk with newly-installed plexiglass inside a healthcare facility.
New measures were implemented quickly, but some will be here to stay. Photo courtesy of DPR Construction

Infrastructure Flexibility strategies to accommodate rapid change were identified.

Having correctly scaled systems in place within a facility are vital to allow for adaptability and agility. Looking closely behind the walls of healthcare facilities will be an important focus for both future renovations and new construction.

  • Robust mechanical systems support surge preparedness while providing flexibility to also manage seasonal census and non-surge times. Potential areas of focus include:
    • Negative air pressurization
    • Outside air
    • Increased air exchanges
    • HEPA air filtration
    • UV solutions
    • Medical gas infrastructure
  • Additionally, IT and communication systems must be in place that can flex to monitor, treat and communicate outside the room of the highly contagious patients.

Patient and Staff Flow changes were among the fastest adjustments healthcare facilities made during the pandemic and will continue to be fundamental for future safety protocols.

A safe and secure flow pattern is a key to regaining patient confidence in healthcare environments.

  • ERs should not be the first stop. Screening, testing, and triage were identified as front-line services that could be separated and occur outside the hospital walls or in a designated, isolated location within the existing facility to create a safer workflow. Modular facilities are a fast, economical way to accommodate this change.
  • Future entry sequencing, wayfinding tools and waiting rooms will be shaped by technology. Waiting rooms could be smaller, less populated and self-regulated by patients and families. Features that can be improved upon, made socially distant, and therefore safer, by technology include:
    • Kiosks
    • Self-check ins
    • Health checks
    • Wayfinding
    • Off stage, just-in-time paging
    • Micro waiting areas
  • Sanitation stations and sinks for handwashing will be expected throughout the facility, including at entrances and exits.
  • Separate areas for sick and healthy patients may be prioritized to regain confidence of the public. This will be an important part of bettering the patient experience through signage, wayfinding and public health education. The importance of increasing consumer confidence in safety while not losing touch with the headway that has been made in the patient experience will be an area for all to consider.
  • Elevators remain challenging. Limiting the number of people and where they stand on elevators needs to be worked out. How we queue up for the next elevator is also an issue.
A worker in a facemask uses a machine to cut drywall.
New PPE isn't limited to crews cutting drywall. Hospital staff is also adjusting to new safety protocols. Photo courtesy of DPR Construction

PPE requirements have broad effects to spatial changes that need to be made within facilities, including:

  • Donning and doffing areas
  • Ante rooms
  • Storage for required inventory (especially in light of PPE shortages when the just-in-time delivery chain was under strain.)

How did customers initially respond to the pandemic?

Sean Ashcroft, one of DPR’s national healthcare leaders, shared that “early in the pandemic, most of the facility modification requests from DPR’s healthcare customers were temporary walls for additional triage and isolation space, tents for screening, modified entrances, and converting existing space within facilities for additional patient rooms. It was amazing how our industry and partners jumped into action with us and were ready to help.”

Now that the industry has learned more about facility needs during a pandemic, projects that are in planning or early in construction stages have an advantage. Teams are able to quickly respond by tweaking infrastructure, evaluating new workflows and patient flows, incorporating technology, and even changing to adaptable or universal rooms. Existing facilities have many innovative options to retrofit.

A pie chart detailing the different types of early stage project types healthcare facilities used in the pandemic.
Photo courtesy of DPR Construction

How do we address change when uncertainty remains?

A known result and action for DPR's healthcare customers is being future ready for pandemics and other disruptions.

“Emergency preparedness, surge planning, and implementation of new regulatory requirements will impact all healthcare facilities,” said Hamilton Espinosa, one of DPR’s national healthcare leaders.“Collaborative design and construction solutions are more important than ever, and this will require collective action by our industry.

“We have all learned a lot over the past many months. Sharing intelligence and the industry’s willingness to collaborate has been humbling and our shared knowledge will lead the industry to the best path forward. As this industry group consistently repeated, with flexible solutions around safety, capacity and isolation – we can stay ahead, be ready, and find solutions to provide a patient centered environment of care for everyone at any time.”