Context and Challenges

Facing overburdened capacity at many of the nation’s healthcare facilities is not a new experience, healthcare leaders are driven to expand facilities to accommodate population increases—while lacking the funds to do so even before COVID-19 existed. The resulting balance between space, and the costs of building and maintaining it, can often feel like a tightrope.

Frequent changes to reimbursement rules are just one part of the equation. ER visits fluctuate, trending down as the number of patients with insurance increases, then upward again as coverage decisions are reversed and insured patient populations fall. Demand on the ER system and the associated billing changes in a pandemic also dramatically impact facilities.

Additionally, urgent care clinics are seeing higher usage as population demographics change. On-demand care appeals to a growing number of patients who would rather see a doctor when it’s more convenient for them (e.g. weekends), than make an appointment and take off work.

At the same time, leaders are concerned with COVID-19 and the already ongoing changes in rulings from the Centers for Medicare & Medicaid Services (CMS), making their prospective payments unreliable, which puts a further strain on healthcare systems.

Both space constraints and funding challenges are closely interrelated, as many systems and providers simply don’t have the budget to expand their facilities to meet growing demand. This is especially true in California, where the cost of building new facilities is much higher than the national average. Budget is also a new struggle as hospitals where forced to cancel elective procedures during the pandemic, many of which help significantly fund a number of hospitals.

To address these challenges, leaders can look to examples where creative planning, good change management, and rethinking space and resources helped to balance costs and improve efficiencies.

Planning, Change and Collaboration

Creative, Savvy Planning. Creative, savvy healthcare planning offers a path forward. Thinking outside the proverbial box yields flexible solutions that enable leaders to do more with less.

Multipurpose spaces, such as ER swing spaces, offer an excellent example to consider. A triage room could be used as a two-bed patient room in a situation like a flu epidemic, where unmanageable numbers of people would otherwise sit in the waiting room. Opening a triage room can get patients into a bed for observation, fluids, and either admission or release to help unburden the waiting room.

Exam rooms that can also be used as consult rooms are another example of expanded use through flexible design. However, while exam rooms can be dual purpose, there is less opportunity to co-use inpatient rooms because turnover is very high. One way to combat this is to create a wing that is flexible in influx situations like the pandemic. If you could flex a medical surgical unit to a slightly smaller number of negative pressure isolation rooms in less than 24 hours would that be worth the initial HVAC upgrade costs?

One solution is to co-host ancillary services. For example, a behaviorist and a nutritionist, each of whom are only on site one or two days a week, can share an office.

Selection. Despite the need to streamline operations and improve efficiency, significant changes that affect staff can understandably result in resistance. How leaders respond depends largely on organizational culture.

Some cultures have a very strong leadership decision-making component, while others have a more grassroots, inclusive decision-making component. Both have advantages and disadvantages.

When an organization is inclusive, group collaboration approaches offer more advantages. Changes come from front-line staff providing care and services, and as a result are more incremental, making it easier for staff to adapt. Inclusive managers are considerate of the front-line staff, and, therefore, receive more feedback. Although the amount of feedback can be considerable relative to a dominant management culture, the outcome is more input allowing for more informed decisions.

Therefore, wisely assembling a group of decision makers to come up with an effective strategy for developing solutions and implementing changes requires careful selection. These candidates are willing to look at a variety of options. They also value each individual as a professional, not just a commodity, to reach the ultimate goal of great patient outcomes.

Furthermore, group members must be open to change and excited to explore new ideas. It is important to have a balance of participants who have several years’ experience and really understand the way the facility works, with participants whose careers are ahead of them and who will be around to see the plan come to fruition.

Whatever the group’s makeup, putting an array of people with different perspectives in a room together to navigate operations and create strategies that can be replicated is an effective solution. However, with a diverse group that provides thoughtful input, it is infinitely more important to get approval on a final solution.

Using a lean tool – choosing by advantages, for example – can be a way to regulate emotions, come to a group decision, and help garner that final approval. Another way to aid consensus is for the team to focus the decision tree on a certification system like Planetree International, which is designed for patient centered care.

Collaboration. Collaborative planning results in a solution that has the intrinsic endorsement of the cross-functional team who were key to its creation. However, even effective group-generated solutions must be progressively implemented, in incremental steps, to ensure widespread acceptance and implementation.

When care providers and staff who are affected by new solutions and policies are consulted ahead of time, they are more likely to recall their buy-in when the time comes for the new approach to be broadly implemented and therefore advocate for it.

One way to achieve buy-in is by harnessing the benefits of virtual reality (VR) technology. Staff can virtually experience their daily routine in the new space. The ability to visualize and experience the space completely transcends the effect of viewing plans and drawings and can advance the conversation for employees who may be understandably resistant to change. In this way, VR training can be a powerful means of planting the seeds of change before the project is built.

Solutions and Strategies

Process changes. Process changes such as virtual check-ins, combining services, and telemedicine, among others, can be a huge differentiator in the efficient use of space balance.

Streamlining the patient intake process is one way facilities can save space. If patients can check in virtually, perhaps even before they arrive at the facility, this frees up resources to treat patients.

In rural hospitals, where staff is often overstretched and under-resourced, combining and collocating departments to share nursing services can reduce the number of full-time workers on the payroll during the less active overnight hours, while still satisfying laws regarding the number of patients per caregiver.

Telemedicine is another emerging, though quickly growing under the pandemic, change that can make a significant difference for rural hospitals. When patients are referred to a specialist, but the nearest practitioner is miles away, holding a video consult with the specialist at their primary care physician’s office may be sufficient for a diagnosis. This appeals to both patient and provider because it not only saves the patient significant time and cost; it also improves provider efficiency.

Centralized versus decentralized nurse stations. When the debate focuses on centralized versus decentralized nurse stations, the conversation ultimately is about whether staff are willing to invest in enhanced circulation.

A transparent discussion about what people see on a daily basis and how they can improve flow will result in a solution that works for everyone, even if that is a hybrid between centralized and decentralized stations.

Storage. Another kind of flow improvement can come from choosing a time-saving storage solution. In one hospital, for example, IV supplies needed to administer patient medications were kept in a clean supply room. Nurses and providers had to constantly enter the room to pick up needles, IV bags, poles, and so on.

In the past, they carried the materials to a medication room, which lacked adequate work surface space to place supplies and access medications. For this provider, moving the IV supplies to the medication room was a simple, clear solution that saved time and reduced frustration for everyone.

Pharmacy plus lab. Pharmacy and lab groups are often among the most willing to talk about possible solutions for process and layout changes.

In one example lab, two people worked overnight, and eight people during the day. The team sought a solution that was comfortable for both, where the two-person overnight crew would feel safe and not have to travel long distances, while the eight-person day crew wouldn’t feel unnecessarily constrained.

The employees talked about flow and optimizing functionality together. They arrived at a bench layout that worked for both groups, moving things that were accessed less frequently—like printers—above or below the main counter to free up space.

At the same time, the solution consolidated other functions to make smaller spaces easier to use. The group located the overnight functions more centrally, promoting better visibility and security for the overnight crew without compromising the workflow of the eight people during the day.

Standard care model versus modern on-stage/off-stage exam clinic. In another example, an outpatient clinic was switching from a standard care model to a more collaborative on-stage/off-stage exam clinic approach.

A building shell was completed on a traditional clinic layout; however, the new on-stage/off-stage approach required more square footage to accommodate the new clinic module.

The solution involved reducing the pediatrics area, as well as sharing spaces that were not used full time. These included geriatric rooms, internal medicine, etc.

A total of eight exam rooms were ultimately removed from the total project, and the reduction allowed the system to avoid removing a complete service line.

In addition, staff were given shared workspace in the central staff support area, with two to three employees rotating through one shared space rather than individual offices. The staff area’s central location provided mobility to quickly see patients in the unit.

The Bottom Line

Balancing cost. While efficiency and ease of use are key components, the impetus for these solutions is balancing costs.

Redesigning an area to optimize performance often means allocating less square footage and fewer employees to reduce operating costs.

For example, employee salaries are the most significant part of the operational budget. If it’s possible for part-time employees or those with shifting tasks to share spaces and resources, the reduction in overhead can help finance future expansions as the community grows.

When expansion does become necessary, creative and savvy planning can substantially impact the operation and construction bottom line. Still, it’s important to be mindful of scope.

For example, when studying the feasibility and impact of a new ultrasound machine, decision-makers must consider all real costs—not just the machine itself, but also construction and installation costs. Starting with awareness of those kinds of additional costs saves time in the overall analysis.

Speed to market is another cost-savings driver: the faster a facility can open, the less it will be subject to the disruptive influences of escalation and market fluctuation, and the more quickly it can start generating revenue. With construction prices continually increasing, quick, decisive action to plan and implement new strategies is especially key.

Involving the key decision makers and getting that final buy in is paramount to successful project execution. The best way to optimize the budget is by engaging stakeholders early on to determine where it’s possible to save on space, cost, FTEs, and resolving these issues in design.

Overall, committing to and executing a project requires smart and thoughtful planning that optimizes the project’s success while navigating the space and cost tightrope.

Kelly Schreihofer, AIA, is an associate medical planner with Architectural Nexus.

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NEW YORK—A year after merging operations, CityMD of New York and Summit Medical Group (SMG) of Berkeley Heights, N.J., are marking the anniversary by touting their joint efforts at working to alleviate overrun healthcare facilities in the New York Metro Area, which suffered greatly during the spring spike in cases of the coronavirus.

The joint operation announced last month that their urgent care centers were able to take up the slack when the region’s emergency rooms were deluged with the wave of cases earlier this year.  In addition to handling non-COVID-related patients, the healthcare operation was able to assist with COVID-19 diagnostic testing to such an extent that it tripled testing capacity in and around New York.  Furthermore, Summit facilities have undertaken to care for the sickest patients from New Jersey hospitals when many other facilities had to pivot specifically to covid care.

“We knew our combined organization possessed incredible strengths and capabilities, but the COVID-19 crisis showed the true colors of Summit CityMD’s teams and providers, as well as the values that underpin both organizations,” Jeffrey Le Benger, CEO of Summit CityMD, said in a recent statement.  “What we’ve experienced ultimately advanced us down the path because of how we were able to come together in this crisis.”

In the first months of the coronavirus pandemic earlier this year, CityMD and SMG both experienced a slowdown in routine care, but recently they have been seeing an uptick in elective procedures and even essential surgeries that had to take a backseat when the pandemic hit.

Other benefits of the merger within its first year included an increased presence of primary care in New York, urgent care expansion, as well as “co-located” physicians working in both New York and New Jersey.

At present, Summit CityMD employs over 8,000 people at several hundred different locations on both sides of the Hudson River.  Summit CityMD says that its future plans for expansion entail rebranding as a singular entity but maintaining both individual brands.  The joint venture will also be expanding into more locations as well as investing in what they call “an enhanced digital experience” for patients.

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Before the COVID-19 pandemic unfolded, occupied hospital renovations were already a complicated task. From maintaining sterile areas and negative pressure spaces to avoiding disruption to patient services—managing these projects has always been a complex task that requires expert oversight. And these challenges have only been amplified by the current pandemic.

Below are several healthcare construction best practices to consider when navigating COVID-19’s challenges, what trends we can expect to arise as a result, and how these learnings can be applied to our post-pandemic world.

Building for COVID-19 While COVID-19 Was Building

The key to maintaining long-term relationships with premier healthcare institutions is trust and flexibility. COVID-19 necessitated quick action, requiring the reallocation of construction staff from other ongoing projects on campus to address the immediate and rapidly evolving needs the hospitals had for addressing the pandemic. Management needed to quickly assess best fit roles for staff to pivot into. Staff, in turn, had to rapidly switch their focus from one project to the next. Additionally, they had to be flexible in their roles and be prepared to do whatever it takes to keep the project moving: project managers became supers. Moreover, subcontractors needed to modify their plans on all projects, COVID-19 specific and other, to incorporate COVID-19 measures.

Social Distancing Complicates Construction Operations

Hospital renovation teams were already tasked with separating construction activities from the ongoing activities of the hospitals. Typically operating with limited space — COVID-19 has only made this more difficult due to social distancing mandates.

Take for instance the fact that very often teams share bathrooms with hospital staff and visitors. When feasible, it’s important to rotate staff and minimize the number of construction personnel on-site at any given time. This requires maintaining robust PPE protocols – proper gloves, masks, and eyewear at all times — in addition to a significant increase in the frequency of sanitizing common areas including offices, shanties, bathrooms, etc.

The Role of Technology

To perform in this environment, you have to be technically sound. New technology for temperature scanning and screening of workers is essential for all projects, not just healthcare construction. What’s more, the need for laser scanning and reality capture of existing conditions is necessary — now more than ever — as we limit the amount of time needed to survey in and around occupied buildings.

Design Changes

We are already beginning to see changes in the way facilities are designed. Design changes related to addressing the admittance of virus patients will now begin at the front door. There will likely be separate entrances for elective patients, adults, pediatrics, etc., with robust prescreening. The logic being that separation and isolation as soon as patients walk through the front door can mitigate any potential infection spread. Moving into the depths of the hospital, waiting areas will all become negatively pressurized. Rooms will be larger to accommodate surge beds.

The HVAC controls system will include greater flexibility in isolating a bed unit, an entire floor, and/or units on multiple floors. HEPA filtration and UV systems will be standard and commissioned as such to ensure that healthcare facility systems are operating properly to limit the spread of the virus and other airborne pathogens. Access to these floors will be restricted and may include separate elevators for further isolation. More treatment will be taking place just outside the patient rooms, allowing for less frequent caregiver visits to infected patients, without any sacrifice to patient care.

Looking Ahead

Prefabricated and modular construction continues to innovate year after year, and as we look to reduce the amounts of hours and workers on site, this type of construction allows the majority of work to take place off-site within a controlled and clean environment. We are also seeing modular solutions being implemented to offer COVID-19 screening at building entry points and hospital emergency rooms. Going forward, we anticipate that these screening measures will be designed into the lobbies and entry points to help tackle the challenges of future pandemics and increase security for healthcare facilities.

Worker welfare and wellness are also a top priority for the future of healthcare construction. We must ensure workers are safe and healthy above and beyond current best practices. Additional protocols are required for cleaning, on-site medics can assess the health of workers displaying symptoms and provide treatment, and designated areas for hand washing will be much more abundant in and around the construction sites of the future. Better and more available cleaning equipment like “foggers” will help projects be cleaned more efficiently as well as recover from a positive case faster, and the live, electronic tracking of PPE supplies will be mandatory. 

Without exception, the needs that our industry had resulting from the virus were immediate.  Being responsive, nimble, and flexible were mandatory skills that will transcend the pandemic. COVID-19 also highlighted the importance of being willing to work in a team environment, as every aspect of project delivery was expedited through clear and continuous communication.  Only the construction organizations that can adapt to COVID-19’s hurdles and uncertainty will survive. Because if this summer’s prolonged challenges have shown us anything, it’s that this virus isn’t going away anytime soon. 

Rich Steimel serves as principal in charge, Lendlease Healthcare. For nearly 30 years, Lendlease has worked with some of the nation’s leading healthcare organizations—including New York City’sMount Sinai Medical Center, New York University Langone Medical Center, Northwell Health andNew York-Presbyterian Hospital—on expanding, renovating and modernizing occupied facilities, as well as building new ones.

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With an industry shift toward measuring and rewarding better patient outcomes, we have been seeing a renewed focus on the point of care experience. We also know that factors such as long wait times or accessibility challenges can negatively impact a patient’s experience as well as the quality of care provided. When patients feel safe, comfortable and empowered, better outcomes are more attainable.

These patient considerations are intensified today as the COVID-19 pandemic continues to reshape and challenge the patient care experience within acute and ambulatory healthcare settings. Layer COVID-19 on top of the common phenomenon of “white coat syndrome” and a visit to the doctor’s office can become a difficult experience for a patient. This amplifies the need to ensure the patient experience is safe and non-stressful.

By evolving exam room design, workflow data and equipment to meet today’s challenges, healthcare organizations can facilitate a better experience for both patients and caregivers. The following are elements of the patient care experience where COVID-19 is acting as a catalyst for accelerated evolution at the point of care.

Exposure to Contagions

Due to its high transmission rates, COVID-19 has heightened the awareness of environmental exposures for both patients and healthcare organizations. As a result, policies and practices have been instituted to help minimize exposure.

Self- and direct-rooming approaches have been gaining attention as a way to minimize exposure to contagions. Patients check in for their appointment and proceed directly to an exam room or diagnostic sub-waiting location either on their own, like at a hotel, or escorted by a staff member. The most efficient way to know which exam rooms are immediately available is with real-time locating system (RTLS) technology. Patients receive locator badges at check-in and staff use RTLS software to identify which rooms are clean and ready for a new patient. The concept is popular with patients—95 percent of participating patients preferred checking in and proceeding directly to an exam room (self-rooming or direct-rooming) as compared to conventional rooming from a waiting area.

RTLS technology can also automate a contact tracing process for easier exposure identification. When RTLS badges are worn, organizations can easily identify individuals that have been exposed to a known contagious person at the granularity of numbers of seconds that individual was exposed as opposed to manual tracing by administrative staff. This data offers powerful evidence to support exposure control and can help keep patients safe.

Long Wait Times

While traditionally not viewed as part of the patient-caregiver interaction, the waiting room could potentially have a negative impact on patient experience–especially if the wait is perceived to be too long. As patients move throughout a facility to various locations for diagnostic testing or other ancillary services, waiting in the lobby or the exam room can disrupt a patient’s visit and potentially foster the transmission of a contagion.

A better way is to take a more patient-centric approach to care delivery with the Collaborative Care Model—allowing patients to remain in one location during their visit. This approach helps to decrease the patient’s overall length of stay while optimizing the patient’s visit by allowing multiple caregivers to collaborate on their care plan. RTLS technology enhances this model by providing greater visibility to identify the exact location of patients and outlining the steps that need to take place during the visit.

The dynamic room assignment model is another way to limit wait times and better utilize rooms. It eliminates the “physician-owned” exam room by assigning patients and caregivers to the first-available room. This fluid allocation of resources provides the flexibility to deal with unexpected patient emergencies, walk-in patients, or, in certain cases, the extra capacity can be used to add additional physicians or allow for specialist visits to be added to the schedule.

Healthcare Everywhere

A fully accessible facility design that can be navigated easily by everyone – both patients and caregivers – is critical to providing safe, quality care and improving patient outcomes.

An important piece of the point of care ecosystem is the mobile workstation. Workstations have been a central fixture in most exam rooms for many years, designed to streamline workflows and support interactions occurring within that space. While clinical encounters have traditionally occurred in an exam room setting where caregivers meet with patients in person, that practice is being challenged. Advanced technology and the shift to create a more accessible patient-centered experience are driving the need to expand the point of care outside the traditional model.

This shift has been further accelerated by the COVID-19 pandemic. Some organizations have been forced to establish triage sites to meet demand from growing patient populations, while many others are being forced to take a renewed look at patient-caregiver interactions and how care can be delivered safely and effectively to achieve improved outcomes. Mobile workstations offer an optimal platform for introducing telehealth, providing an ideal location for the monitor and necessary storage.

All of these factors are placing workstations front and center in the evolution and expansion of the point of care, helping ensure the time shared between the caregiver and patient remains the most important, meaningful and unobstructed aspect of the healthcare journey. By creating a fully connected ecosystem where processes, equipment and caregivers are integrated, healthcare organizations help ensure a seamless patient experience.

Most healthcare organizations understand that the interaction between the patient and caregiver at the point of care is a foundational element of effective healthcare. However, many organizations fail to fully recognize how the entire point of care ecosystem, which goes beyond the direct interaction between patient and caregiver, has an effect on improving the overall experience, including clinical outcomes.

It’s safe to say COVID-19 will continue to reshape the healthcare experience in our country—and patients will continue to expect a better care experience. The patient experience should continue to be the driving focus behind everything from practice design for comfort, efficiencies and workflow to technology to ensure the delivery of patient care is improved. A better patient care experience starts with a better designed care environment.

Kurt Forsthoefel serves as director, medical marketing, for Midmark.

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ALBANY, Ga.—In an effort to increase treatment capacity amid the ongoing pandemic posed by the coronavirus, Phoebe Putney Memorial North hospital is adding a 24-unit modular unit specifically for patients afflicted with COVID-19.

The Georgia Emergency Management and Homeland Security Agency (GEMA) recently announced a partnership with modular manufacturer BMarko Structures of Duluth, Georgia, and CertainTeed—a firm with Georgia offices in Athens, Social Circle, Peachtree City, Norcross and Winder—on the addition to the hospital facility in Albany. The new 24-unit extension will be constructed in the parking lot of the Phoebe Putney Memorial North facility.

The modular units are basically large shipping containers that are being repurposed for patient treatment. The units can be lowered directly into place in front of Phoebe Putney Memorial North, and from there outfitted with medical equipment. The units—which are meant to be hermetically sealed for long voyages across oceans, with their contents kept intact and safe even during travel over choppy seas—can be utilized in this new paradigm to keep covid patients isolated and thus away from medical staff working on non-covid patients inside the main medical facility.

The shipping containers have been retrofitted such that they are outfitted with washable ceilings and other surfaces that can be treated to avoid the further spread of pathogens. Furthermore, the units are outfitted with HVAC, plumbing and insulation for various weather patterns that can range from the chilly to Georgia’s notorious summer heat and humidity. This way, patients suffering from the coronavirus can also be treated in an intensive care setting that is comfortable as well as keeping the virus from spreading as much as possible.

Georgia Gov. Brian Kemp announced the gradual relaxation of certain social distancing requirements throughout the state late in April. This meant that certain businesses, including nail salons, massage parlors, gyms, bowling alleys and certain restaurants and movie theaters, were allowed to reopen. However, given sporadic outbreaks of the coronavirus in various other areas of the world that have tentatively reopened—including a recent hotspot in Seoul, South Korea, due to eager young people flooding back into recently reopened nightclubs, which have since been re-shuttered—it is uncertain how long or how extensive Kemp’s dictum will be. Furthermore, Kemp’s policies are at odds with those of Atlanta’s mayor, Keisha Lance Bottoms, who advises continued caution in Georgia’s capital and largest city.

A second similar modular structure is being planned for another hospital in Macon, Georgia, in the weeks to come. The Peach State has so far recorded over 34,000 confirmed cases of the novel coronavirus and nearly 1,500 deaths, according to the Georgia Department of Public Health. Efforts such as those at the Phoebe Putney Memorial North facility are meant to help the state ease its path in treating future cases of covid-19 throughout the state.

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According to the government policy watchdog website, TheHill.com, more and more governors across the United States are instructing state health officials to increase bed capacity to meet the expected surge in COVID-19 patients. As a result, many healthcare leaders are effectively working two jobs right now. Not only are leaders fulfilling their usual day-to-day responsibilities, but leaders are also focusing on how they’re going to modify their existing operations and facilities to care for COVID-19 patients.

Hospitals are looking for effective, efficient strategies and solutions that can be implemented quickly to keep patients safe and protect the caregivers and medical professionals on the front lines battling this disease. It’s important that our medical professionals are safe throughout this pandemic. With appropriate PPE clothing, doctors should be kept fairly safe. Additionally, distance tape should be used to help to keep people at least 2 meters apart at all times. Marking it out with this tape will help to remind people and make it clear where they should and shouldn’t be. As well as this, all people working in hospitals all over the world should have access to hand sanitizer at all times so they can kill any bacteria on their hands. Luckily, hospitals in the UK have strong supplies of hand sanitizer thanks to companies like phs Direct. For those who don’t know, phs Direct are the UK’s leading supplier of commercial wholesale hand sanitiser, helping to keep offices, workspaces and businesses as a whole up to vigorous hygiene standards. This is helping many people stay safe from COVID19. In contrast, hospitals in the US are only just starting to catch up with those in the UK. US officials are finally beginning to realize the problem that coronavirus is causing worldwide.

Here are several key issues to consider and strategies for leaders to address the unique aspects of the novel coronavirus.

Understand air handling issues regarding isolation spaces. As with any airborne infectious disease, COVID-19 patients need to be isolated to protect the health of other individuals in the facility. Since most hospitals only have a few isolation rooms, the influx of COVID-19 can be problematic. The air handling requirements to create additional isolation spaces fall into three categories, each with their own issues that are important to be aware of:

• First, 100% exhaust air is required. As with any airborne infectious isolation room (AIIR), the air in a COVID-19 patient room should not be recirculated. To conserve energy, most hospitals are designed to intake 25% of outdoor air and recirculate the remaining 75%. To achieve 100% intake of outdoor air poses a significant issue, as most hospital facilities do not have an infrastructure designed with this capability. It is important to conduct a thorough analysis of the hospital’s existing heating, cooling, fan output and controls. The total system impacts need to be understood and considered before attempting to increase isolation spaces. This is a difficult issue but one that is absolutely necessary in the case of COVID-19.
• Second, it is important to create a negative pressure in an isolation room to protect the other patients and staff in the hospital. Since the supply air to the room is typically designed to the code minimum, creating a negative pressure must be controlled through the exhaust system. Creating a negative space in the patient room on a temporary basis can be simple if the facility is willing to take out the window and put in what is basically a fan, blowing air out of the building. This will meet the code requirements for a temporary response. Creating a negative space is tricky because of the pressure relationship to certain rooms. If you make a change to one room, leaders could disturb other air change relationships.
• Finally, try to increase the amount of outdoor air to as close as 100% as possible. However, this poses issues. It is critical that leaders consider the ambient air temperature of outdoor air. If the air handlers are not sized appropriately to manage large intakes of cold air, they could freeze. Similarly, if the air is humid, and the air handlers do not have enough capacity, this may impact the ambient temperature within the isolation rooms as well.

Monitor. Monitor. Monitor. COVID-19 patients are in acute respiratory distress and require significant amounts of oxygen and medical gas supply for ventilators. As facilities start doubling up patients on ventilators, medical gas usage can increase significantly. It is important that leaders assign an individual to monitor the following on an ongoing basis:

• Bulk oxygen levels. When does the system need to be filled? Has this been scheduled?
• Med gas supply. Are there any supply chain issues? Are the current providers operating as usual, or has their delivery schedule been affected?
• Fuel oil levels. Are there enough fuel reserves to last a few days in case of inclement weather or if the facility has a power outage?
• Air filters. With the potential change in air flows, it’s essential to make sure all of the air filters have been replaced to limit the load on the air handler.
• Is there a sufficient supply of salt for the water softeners?
• Water treatment. Is the water treatment vendor able to maintain service?

Implement a formal checklist. The patient surge due to COVID-19 has changed how hospitals operate on a daily basis. Items that were once addressed on a weekly or monthly basis, now need to be checked daily. Keeping track of what leaders are responsible for can easily fall through the cracks, especially in light of quarantines and staff changes. Since there are still only 24 hours in a day, leadership does not always have time to focus on everything. A thorough checklist can be beneficial in times like this. Not only does it serve as a reminder for those in charge, but it also makes it easy to delegate individual tasks to others.

Limit the spread of coronavirus in surgical areas. As facilities are scrambling to create isolation units for COVID-19 patients, leaders are also preparing for other likely scenarios, such as how they perform surgery on an infectious patient. By code, operating rooms are required to be positive airflow. There are no exceptions to this rule. How does a hospital limit the spread of coronavirus if they have to put a patient in a room that is required to be positive, which is contrary to the current infection control measures? The following is a list of considerations:

• Do the procedure when no other surgeries are occurring in other operating rooms that are served by the same air handling unit (AHU).
• Use an operating room at the end of the OR suite corridor to contain the virus as much as possible.
• Put the AHU into 100% outdoor air mode if possible. If the unit does not stay on due to low limit temperature safeties, allow only as much return air as required to keep the AHU running. Operating room air handlers must have HEPA air filters. The CDC recommends not recirculating air unless it is HEPA filtered.
• If possible, put one of the temporary construction enclosures around the operating room door to the corridor and put a portable HEPA filter unit inside this enclosure.
• After the surgery is over, flush the air in the area served by the OR AHU for 60 minutes.

Recognize limits of HEPA filters. The CDC allows recirculated air as long as it goes through a HEPA filter, but it is important to remember that not all air handling units are large enough to push through a HEPA filter. There is some research that indicates that the coronavirus is small enough to pass through a HEPA filter. To err on the side of caution, consider blocking off access to areas where HEPA filters exhaust such as parking garages or spaces between buildings.

Communicate internally and externally. These are extraordinary times and call for extraordinary measures. The patient load at hospitals is changing daily, reaching unimaginable surge levels. While it is busy and lives are at stake, it is important that hospital leaders commit to a quick daily “huddle” with key departments to review status of key areas. Similarly, it is important to keep an open dialogue with all of the authorities having jurisdiction including the local Department of Health and the Joint Commission. To meet the surge requirements, many temporary renovations are being done, including some that may not be allowed by code. By keeping in continuous conversation with officials, explaining what measures have been taken, can help keep everyone on the same page. If hospitals have social media pages, then keeping the local community informed via those would also be a good idea. There are some recommendations on Violet PR that could be useful to many businesses, as well as hospitals.

In the modern era, the world has never experienced a time such as this. The global healthcare industry has been thrust to the frontlines of a viral pandemic battling an evasive and fast-moving enemy (COVID-19). The first quarter of 2020 may well be the greatest peacetime effort in innovative thinking the US, and the world has ever seen. The global coronavirus pandemic has affected everyone from teachers learning how to use e-learning full-time to everyone in the service industry learning how to work in isolation.

The industry is more equipped today than at any time in human history to handle such a battle with its enhanced technology, Lean operations, sophisticated air handling systems, and evidence-based medicine that facilitate life-saving care. The collective goal is to respond quickly – with Effective and Efficient COVID-19 Strategies… Right Now – so that we might stay ahead of this virus, reduce the spread, and allow modern medicine to save lives. Unfortunately, lots of people have contracted COVID-19 already, particularly in busy cities. For example, there are thousands of cases in NYC, which is why lots of people are choosing to contact places like this NYC COVID-19 Attorney. Seeking legal compensation is completely optional though. Just make sure you get the compensation you deserve.

Samuel Jackson, PE, LEED AP, is Director of Engineering with BSA LifeStructures. He can be reached at sjackson@bsalifestructures.com.

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CALGARY, Canada—Design-build firm Stantec has been tapped by Alberta Health Services (AHS) and the Government of Alberta to design the first temporary treatment center for COVID-19 within the Canadian province. The firm is working in conjunction with Companies Sprung Structures and CANA Construction, both of Alberta, on a temporary treatment center to be located at the Peter Lougheed Centre, a healthcare complex in Calgary.

The structure for the temporary COVID-19 treatment center, valued at over a quarter-million dollars, was donated by Sprung Structures. As designed by Stantec, the interior of the treatment center at the Peter Lougheed Centre encompasses 8,000 square feet of treatment space for up to 70 additional patients more than the healthcare facility had been able to treat prior.

Stantec, which also has offices in Alberta, was tapped with engineering and design services for the temporary coronavirus treatment center. Stantec’s duties entailed interior design support, architectural planning, as well as being in charge of structural, mechanical and electrical engineering of the project. Stantec is also in charge of equipment sourcing and furniture for the interior. Their design ensures the maximal safety of both healthcare workers and patients when dealing with a pathogen that is incredibly transmissible.

Todd Hartley, senior principal of Stantec, said that his firm has enjoyed a longstanding relationship with the Government of Alberta as well as AHS, so working together on the temporary COVID-19 facility was a natural fit for all concerned.

“As part of a private sector team, which included Sprung Structures and CANA Construction, who collectively brought this concept to AHS, we came together working at [a] rapid pace to execute the design, procurement, and construction in an unprecedented manner,” Hartley said in a recent statement. “We all want to do our part in supporting the COVID-19 response and recovery, and I know our teams feel privileged to support Albertans when they need us the most.”

The initial plan called for the facility to be turned over to AHS at the end of April and to begin accepting new patients by the middle of May, representing an incredibly fast turnaround time on a project required to address the ongoing virus pandemic that has touched all parts of the world, including Canada, which has seen 63,000 cases nationwide and over 4,000 deaths.

The greater Calgary area, known as the “Calgary Zone,” has 63 percent of Alberta’s confirmed coronavirus cases.

Stantec’s executives are utilizing the company’s “Pandemic Response Plan” so that the firm can better monitor and mitigate the spread of the disease by putting safety of employees and patients front and center.

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PHILADELPHIA—With the coronavirus pandemic having shut down much of the U.S. economy the past few months, and new cases of COVID-19 continuing to be reported, one healthcare construction project in the City of Brotherly Love has been ramped up to be able to treat patients as quickly as possible.

The Penn Medicine hospital tower, located in Philadelphia’s University City section, had already been under construction since May 2017. According to Engineering News Record, the project, which is called “The Pavilion,” was due to be completed in 2021, but in the wake of Philadelphia’s coronavirus outbreak, officials as well as workers at general contractor IMC Construction have revved up the pace of the work. According to ENR, crews have been working around the clock since mid-March to get the facility opened by early may, which would be a full 15 months ahead of the original completion date.

Pennsylvania Gov. Tom Wolf ordered all nonessential businesses throughout the Keystone State to close on March 19. This included construction companies, although work on the Pavilion has since continued.

Contractor IMC Construction, located in Malvern, Pennsylvania, is working on the healthcare facility in conjunction with architect Perkins + Will, which has its home base in Chicago. The project will include office space as well as areas devoted specifically to childcare. According to IMC data, Phase 1 entails 10 floors and 250,000 square feet of space, with Phase 2 providing an additional 290,000 square feet.

In a statement provided to HCO News, Robert Cottone, president and CEO at IMC Construction, said that the 540,000-square-foot Pavilion project is especially needed at a time when Philadelphia, and the rest of the country, faces such an unprecedented pandemic as the coronavirus outbreak.

“We take great responsibility and pride in expediting the completion of a healthcare facility that will contribute to the fight against Covid-19,” Cottone said. “However, this project will not be successful unless everyone involved follows established IMC work protocols to remain safe and healthy.”

According to ENR, when completed, the Pavilion will offer 120 hospital beds at a site that is directly adjacent to the Hospital of the University of Pennsylvania.

Said Cottone: “Our partnership with University of Pennsylvania Health Systems has allowed us to create a stringent monitoring and exposure prevention plan that will help us achieve our goals.”

Over 12,000 cases of covid-19 have been diagnosed in Philadelphia, according to the city, resulting in nearly 500 deaths. Pennsylvania’s Department of Health reports that, statewide, there have been over 42,000 diagnoses resulting in 1,600 deaths.

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HAMILTON, N.J.-Like all other economic sectors, the construction industry is feeling the pinch as the ongoing covid-19 pandemic forces businesses to close and the economy experiences a major downturn. This could potentially lead to a downward trend in the sale of construction material and machines. Consequently, a number of industry related machinery and material prices might see a downfall, like the lowering of brick making machine price. However, this followed on the heels of an overall growth spurt for building in the first few months of 2020 compared to the same period a year prior, reported Business Wire, and the upswing was present even in February-as worldwide coronavirus infections were increasing. According to Business Wire, several new healthcare construction projects were due to begin in February, which counted towards their figures for March. (April figures will not be released until May.)

According to Business Wire, “institutional building” construction, a broad category that encompasses healthcare projects, posted large gains in February. This means that there were more construction contracts signed, more need for dozer hire mackay, more tradesmen employed for the projects and more materials supplied – it was an all-round good month for the industry. In fact, the numbers got a boost thanks to several large new healthcare facilities that broke ground in February. Also of note is that educational construction was also up in March, presumably prior to the state-by-state shutdown that has seen schools closed for weeks subsequently.

Business Wire reports that the single largest healthcare facility to break ground in March was the Duncan Neuroscience Research Facility, with a sticker price of $616 million, to be located on the campus of Washington University in in St. Louis. Work has begun, with a projected completion date of 2023, but no updates on the construction have been reported since the beginning of March, just before the groundbreaking.

Richard Branch, chief economist for Dodge Data & Analytics, was cited in Business Wire’s report as saying that projects that were due to begin in April and May will almost certainly face a more uncertain fate given stay-at-home orders and “construction moratoriums,” some of which were not even due to begin until the end of April. It’s too soon to forecast the figures for April, he said, especially considering that some states have halted construction work entirely, while others have yet to do so.

Over the 12-month period that ended in March, nonresidential building groundbreakings were only slightly lower than for the 12-month period ending March of 2019, the report said. However, commercial starts were nonetheless up 2 percent.

Dodge Data & Analytics provides analytic services to the construction industry, and has worked to assist the building industry for a century. The company is located in Hamilton Township, New Jersey, not far from the state capital of Trenton.

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BRUNSWICK, Me.—Temporary wall manufacturer STARC Systems has announced that it is redirecting the entirety of its operations into the construction of critical care isolation rooms for the nation’s healthcare facilities at a time when the coronavirus pandemic has seen hospitals struggling to provide adequate patient care. STARC, which is headquartered a half-hour from Portland, said the purpose of this shift was to create more overflow space for healthcare facilities crucially in need of space to treat covid-19 patients and keep them segregated from those who do not have the virus—as well as reduce the chances that healthcare workers themselves will contract the disease while providing treatment to those already infected.

Prior to the pandemic, STARC’s “temporary wall” units were utilized primarily as a way to reduce the chances of dust, debris and pathogens moving from construction worksites to patients during renovation projects at hospitals including Massachusetts General Hospital, Cleveland Clinic and Seattle Children’s. However, the new paradigm for the separation device is, rather than keeping germs “in,” to prevent them from escaping the enclosed facility, which the firm accomplishes with what it calls “negative pressure isolation anterooms and airborne infection isolation rooms (AIIR).” Entire wings of a facility can thus be isolated with the temporary walls to effectively craft new standalone rooms.

In the final week of March, STARC Systems, based in Brunswick, announced that its work was considered “essential” at a time when Maine Gov. Janet Mills ordered many businesses—mostly in hospitality, entertainment and service—to cease most operations. Maine’s border with Canada was also closed in the middle of last month to non-essential international traffic.

To meet the demand for negative pressure isolation rooms, STARC is working in concert with vendors to speed up the procurement of raw materials and also increasing the number of shifts for workers to produce the temporary walls. STARC’s existing customers are being asked to donate any of their previously purchased, but unused, wall panels to local healthcare facilities to increase the ability to fashion more isolation rooms.

Furthermore, STARC’s production facilities were redesigned so that workers can maintain adequate “social distancing” during their shifts. STARC is also granting its employees extra sick days as they continue working during the pandemic.

“With the unprecedented health risks our country is facing, we knew we had to quickly repurpose and increase our resources to help reduce the spread of coronavirus,” Chris Vickers, president and CEO of STARC Systems, said in a statement. “Time is our biggest concern. Healthcare facilities need isolation rooms now, not two months from now. Significantly investing in our production facility will ensure we meet more demand and avoid any delays.”

STARC said that its isolation rooms exceed the ICRA Class IV and ASTM E-84 healthcare requirements for infection control, and that their surfaces can be quite easily and quickly disinfected.

Brian Hamilton, director of healthcare and life sciences at client Consigli Construction, said that his firm has relied for years on STARC’s solutions to providing a safe environment for healthcare workers and patients during renovation projects. “Now, STARC has become critical in our response to provide hospitals with immediate patient isolation rooms to reduce the spread of coronavirus,” Hamilton said in a statement.

STARC Systems’ previous work has included projects at Brigham & Women’s Hospital, Virginia Commonwealth University Medical Center, Ohio State University Wexner Medical Center and the Cleveland Clinic.

“As an ‘essential’ infrastructure company, we feel a great deal of responsibility to do all we can while maintaining the health and safety of our employees,” said Vickers, STARC’s president and CEO.

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