Officials at Rady Children’s Hospital in San Diego began work on a $1.2 billion campus renovation when the pandemic hit, forcing them to shift gears. As hospitals across the country struggle to cope with rising cases, it becomes clear that the new design of the facility will need to evolve.
“When the pandemic hit, it really changed the lens of how we set up,” said Dr Nicholas Holmes, chief executive officer of Rady, the only children’s hospital in San Diego County and the largest in California. health care plan. “And what we’ve learned over the last few years, first and foremost, is to be as flexible in the design process as possible.”
The initial waves of the pandemic hit hospitals, leaving intensive care units with insufficient beds, corridors and waiting rooms forcing the healthy and sick to move and ventilation becoming the conduit. for airborne pathogens. With that hindsight, many hospitals are remodeling with a flexible design philosophy, with the idea that spaces must be adaptable for different purposes at different times. When the next pandemic comes, they will be better able to meet at this point.
Traditional hospital design calls for areas to isolate the most vulnerable and infectious patients, with features not found in conventional inpatient rooms. These include variable airflow systems to keep microorganisms from going beyond the walls of the room; wall behind the bed to install electricity, gas and equipment; and generally, a larger floor plan to accommodate specialized equipment such as exhaust fans.
In times of crisis, hospitals demand more of these specialized spaces, with different isolation procedures for different diseases.
At Rady Children’s Hospital, where a new seven-story tower will house the intensive care unit as well as the emergency department, the designers considered lessons learned from the pandemic and scrapped the floor plan pictured. original rectangle of the tower. Instead, they created an X-shaped room, with a 60-bed floor plan that can be converted into 20 fully isolated rooms for infectious disease patients, if the need arises.
“Instead of looking at it on a single room basis, when you think about maximum flexibility, you think about banks of rooms,” says Dr. Holmes. “Seeing it through that prism allows you to not have to transfer patients with moderate illness into critically ill intensive care units.”
Much of the shift in hospital design revolves around capacity spikes, which is how healthcare workers adapt inside their buildings as patient numbers increase dramatically. In March and April 2020, the sudden increase in infectious patients meant that some hospitals had to scramble to find beds, pitch tents in parking lots and rationing equipment.
“During the pandemic, they hopped or jumped; Douglas King, vice president of healthcare for Project Management Advisors, a real estate consulting firm. “Hospitals are now identifying wards, which typically have 24 to 32 beds, and they can stack some of those wards together to become pandemic wards.”
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To prepare for that change, designers are thinking about how traditional rooms can be quickly transformed into secluded areas by upgrading or overhauling their heating, ventilation and air conditioning systems. they. Fabrics and finishes are also being revisited, aiming for durable materials that can withstand industrial-grade scrubbing.
Ultimately, the roads leading to these hospital wards need to be rethought, says King, “so patient and staff transport allows these spaces to be isolated and operate independently of the rest of the hospital.” the rest of the hospital.”
A new ICU at Doylestown Hospital in Doylestown, Pa., opening in 2021, features separate rooms for flexibility between intensive care and palliative care. Rooms are grouped into groups of 8 rooms to reduce traffic in the corridors.
It will be the second new wing with a flexible design at Doylestown. After realizing that a new wing for heart and vascular care opened in January 2020 could be used for critically ill Covid-19 patients during the pandemic, hospital managers turned to design flexible.
“The pandemic has demonstrated the need for flexible spaces,” said Jim Brexler, chief executive officer of Doylestown Health. “The impact of having enough critical care space is essential, and you don’t want to build all that out and not be able to use it for other purposes.
“This is the future of hospitals,” he added.
CannonDesign, a New York-based architecture firm, has been involved in two hospital expansion projects.
At Barnes-Jewish Hospital in St. Louis, workers broke ground on a 16-story inpatient tower in 2021, which includes acute care rooms that can be turned into ICU rooms. To achieve that flexibility, the designers included additional outlets for medical gas and electricity, and a larger space around the bed to accommodate additional equipment. The upper half of the door will be made of glass so that practitioners can observe potentially infectious patients without entering the room.
And at WellSpan Health in York, Pa., an eight-story health care and surgery tower is being built as part of a $398 million hospital expansion that will feature oversized wards can act as space for critical care.
“The general feeling I get is that this is not a one-time situation that we have to go through with Covid,” said Jocelyn Stroupe, co-director of health furniture at CannonDesign. “It’s just one of many infectious disease conditions we’ll encounter in the coming decades.”
Preparations for these illnesses can be seen on other construction sites across the country.
Ballantyne Medical Center, a 168,000-square-foot hospital in Charlotte, NC that is scheduled to open next year, will feature dual partition walls for additional capacity in patient rooms and allow ventilation The rooms are converted to negative pressure to prevent harmful particles in the air. from flowing into other dimensions. An outpatient center under construction as part of a $151 million renovation at Grady Memorial Hospital in Atlanta will feature flexible rooms with mobile devices that can be quickly transported from space from one universe to another.
And in Los Angeles, CHA Hollywood Presbyterian Medical Center plans to open a new patient tower in 2023 with larger waiting rooms allowing for remote control, more rooms with negative pressure ventilation and Triple capacity for blood oxygen monitoring system. Thirty-three private rooms are also being added, all of which can be reconfigured to increase capacity.
John Swift, head of healthcare at engineering and design consulting firm Buro Happold, said: “Three years after the pandemic, it has become an almost universal concern.
“We see these trends not only in the healthcare sector, but in all the facilities we work in, from lab buildings to campus organizational buildings,” he said. university.
The move to a flexible design will mean that in the short term, at least, some hospitals are better equipped than others to deal with the next pandemic. And it will also exacerbate the gap between haves and don’ts in health care, said Armstead Jones, real estate strategic real estate advisor at Real Estate Bees.
“You have hospitals that are barely sustainable in rural areas, and they don’t have architectural flexibility. So what does it look like to them? ” he say.
But in the long run, designers hope the lessons from the coronavirus will resonate. They say pandemic amendments are likely to eventually be written into law, like wheelchair access and structural requirements for earthquakes.
“This is no different from the code updates we do every time there is an earthquake in California,” said Carlos L. Amato, a healthcare architect at Cannon Design. “The lessons learned after the pandemic will eventually make it the building code.”