MAPLEWOOD, Minn.—Crowding and capacity constraints continue to stress hospitals nationwide as the number of patients seeking care increases, and the ability to discharge them to more appropriate levels of care decreases.

Emergency Department (ED) and inpatient medicine teams at M Health Fairview St. John’s Hospital in Maplewood have tirelessly confronted this challenge, facing a 5 percent rise in inpatient visits and a staggering 12 percent increase in ED visits since 2022. With limited capacity and space, and a commitment to improve patient care while visits are only expected to grow, teams at St. John’s devised a strategy for improving patient flow by expanding the emergency department, reorganizing existing services and — now — opening a new, purpose-built “short-stay and observation unit” to support newly developed workflows.

What sets this groundbreaking facility apart is the innovative construction method employed. Conventional construction posed further disruption to an already strained ED operating above capacity, so the teams at St. John’s embarked on a quest for innovative solutions. The breakthrough came in the form of a pre-fabrication technique in collaboration with construction firm The Boldt Company, and interdisciplinary design firm, HGA. The 16-bed unit was built to over 90 percent completion offsite in Appleton, Wisc., then seamlessly transported and installed on the St. John’s campus – the first of its kind in the state of Minnesota.

The short-stay and observation unit embodies M Health Fairview’s commitment to providing exceptional healthcare services by rethinking how teams work together to serve patients, no matter the circumstances.

“In the face of escalating patient visits, our ED and inpatient medicine teams have been proactive and innovative in their response,” said Will Nicholson, MD, vice president of medical affairs for M Health Fairview St. John’s, Woodwinds, and Bethesda hospitals. “This approach is a game-changer. It allows us to rapidly develop the needed space without impeding current operations.”

Construction of the unit began offsite in September. Crews delivered the prefabricated unit to St. John’s in late November, and teams then completed final construction and furnishing.

“We’re facing a very real need for patient bed space in our country right now.” said David Thomack, chief operating officer with Boldt. “Every day that is spent in planning, design or construction is another day that hospitals and patients must do without those beds. Using a modular approach, we’re delivering that space in half the time traditional construction would take, without sacrificing durability, quality or affordability, allowing healthcare providers to see patients months sooner.”

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MINNEAPOLIS—A critical care solution to the shortage of hospital beds due to the coronavirus pandemic is being introduced by leaders in the healthcare construction market. The STAAT Mod (Strategic, Temporary, Acuity-Adaptable Treatment) is a prefabricated modular solution designed by HGA, a national multidisciplinary design firm and is being constructed by The Boldt Company for immediate distribution nationwide. It can be deployed in diverse environments from convention centers to free-standing hospital expansions. A focus of these units is the safety of healthcare workers treating patients with COVID-19.

HGA and The Boldt Company have partnered with Tweet/Garot, Faith Technologies and IMEG to provide the STAAT Mod solution, available now, that can be configured for the following applications:

• A two-room isolation unit designed for use in an interior shelter, such as in a convention center. This unit can be rapidly deployed from the point of order.
• An eight-bed unit of critical care isolation rooms consisting of four two-bed modules designed to connect to a hospital or existing structure.
• A 12-bed unit of negative-pressure open-bays consisting of four three-bed open bays modules connected to the central support spine. An infinite number of additional self-sustaining tiers can be added.

Multiple independent modules can connect to each other or to a hospital with segregated spaces for patient care and healthcare workers. The units allow additional capacity to be added or re-deployed to sites where the need is greater.

The STAAT Mod provides one of the only temporary care units that can be deployed quickly and provide hospital-level care to patients suffering from coronavirus.

STAAT Mod product features include:

• Design developed and tested through Virtual Reality (VR) simulation exercises by experts, including critical care nurses trained in COVID-19 protocols, a hospital environment specialist in infection control, and Lean process engineers for rapid construction and delivery
• Hospital-level clinical care for infection control, patient isolation, access to life-saving technology and isolation rooms if needed for extended periods of time
• Safety provisions for healthcare workers through standardized design, centrally located supplies, and segregated staff workspaces
• Pre-fabrication for speed, quality, and safety for contractors
• Costs significantly less than conventional construction

The CDC recommends Airborne Infection Isolation Rooms (AIIRs) for patients with infectious disease as coronavirus is spread via respiratory droplets or from droplet contact on surfaces. To create environments that extend hospital-level care, the STAAT ModTM meets CDC guidelines to provide immediate critical care to coronavirus patients.

HGA is a leader in design for the healthcare market, with a portfolio including some of the nation’s most significant and complex hospital projects. The design of the STAAT Mod is based on clinical protocol in dealing with infectious diseases.

“The STAAT Mod answers the escalating demand for more treatment space,” said HGA’s National Healthcare Practice Leader Kurt Spiering. “This engineered, modular design of hospital-level care environments puts the safety of the patient and healthcare worker first while still accomplishing speed and capacity of other solutions.”

The Boldt Company has been serving the healthcare market for decades, building hospitals and clinics nationwide. Construction teams have prefabricated elements of customized construction and are now employing that knowledge to create self-contained modules.

“Building in a controlled environment allows us to set and achieve aggressive production schedules that improve quality for the end user and maintain safety for our team members,” said Dave Kievet, Chief Operating Officer of The Boldt Company. “By standardizing the process we can increase speed to market and help save lives,” Kievet said.

Experts are available from HGA. Their research-driven solutions are based on designing the flexible environment needed for high quality, temporary healthcare. Construction experts are also available from The Boldt Company. Boldt is pre-fabricating the structures in a secure, safe environment designed to build and rapidly deploy ward modules, support structures, and infrastructure.

Learn more about the STAAT Mod Solution, including renderings and product details at: https://hga.com/staat-mod.

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Gojo Industries, the inventors of Purell hand sanitizer, headquartered in Akron, Ohio, released the findings from a research study the company conducted at John Peter Smith Hospital in Fort Worth, Texas, at the APUC 2013 Conference in Ft. Lauderdale, Fla., in June. The company used the Gojo Smartlink Activity Monitoring System to test how the electronic compliance activity monitory system would affect hand hygiene compliance rates.

The research was conducted from June 2012 to September 2012 and showed a 92 percent increase in hand hygiene compliance rates (from 16.5 percent at baseline to 31.7 percent) when an electronic monitoring system was used. During the post-study period, the rate decreased to 25.8 percent, which was still above the baseline.

The Gojo monitoring system was installed to monitor all patient room entries and exits and all hand hygiene uses from the Gojo touch-free soap or Purell hand sanitizer dispensers. Compliance was measured as a number of uses compared to a number of opportunities and included everyone in the hospital, not just health care workers. During the study, a comprehensive hand hygiene program for health care workers, patients and visitors was implemented. Plus, a hand hygiene improvement goal, leadership support and staff feedback opportunities were also established.

The Associated Press reported that SSM St. Mary’s Health Center in Richmond Heights, Mo., has been testing a system developed by Biovigil Inc., based in Ann Arbor, Mich. Like the Gojo system, the Biovigil system also tracks the successes and failures of each hand-cleaning opportunity. It uses a flashing light on a badge that turns green when hands are clean and red if they’re not. The two Biovigil units at St. Mary’s have had few failures. One unit had 97 percent hand hygiene success and the other had 99 percent success.

HyGreen Inc. developed two Hand Hygiene Reminder Systems, which are installed at seven hospitals. One uses a similar method as the Biovigil system, which detects alcohol on the hands, but also includes an active reminding system. Unclean hands create a warning buzz, and if the buzz sounds three times by a single worker, that worker is marked for noncompliance. The other method allows a worker to interact with a patient after the touch of a sanitizer dispenser. If the worker goes to the patient bedside without clean hands, the buzz warnings begin. According to the Associated Press article, “hospital infections have dropped 66 percent at units of Miami Children’s Hospital where the badge system has been implemented.”

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Despite the evidence that hand washing is effective in reducing the risk of hospital-acquired infections, studies have shown that doctors, nurses and other health workers fail to follow proper hand hygiene more than 50 percent of the time. This is a sobering statistic. When it comes to a deadly strain of bacteria like CRE, even 95 percent compliance is not good enough.

So, the question remains: How can health care facilities get their workers to follow proper hand hygiene procedures more consistently?

Poor compliance is not a knowledge problem; it’s a behavior problem.
Many hospitals already have hand-sanitizing stations on the threshold of every room. They also post signs everywhere reminding people to wash their hands and even ask patients themselves to prompt their caregivers. Yet these measures alone don’t seem to be doing the trick. Health workers know hand washing is important — they’re not deliberately trying to put patients at risk. The reality is that hospital environments can be chaotic and busy. People get tired. They get distracted. They forget. This is why education-based efforts at increasing compliance often fall short, as they are aimed at informing caregivers of the importance of hand washing rather than at modifying behavior.

Taking the human error factor out of the equation.
Human beings are not machines. When it comes to repeating a task consistently, 100 percent of the time, humans are subject to error. Reducing the human error factor is critical to changing behavior and increasing hand washing compliance. Unfortunately, many of the approaches used by health care facilities to address the issue are also equally susceptible to human limitations. “Hall monitors” are a great example. Some hospitals hire observers to monitor health care workers as they enter and leave patients’ rooms, in order to track who is and who is not washing hands.

The problems with this technique are pretty clear. It is simply not feasible (from a practical or financial standpoint) for facilities to deploy human monitors to track hand washing in every situation. They can really only catch a small fraction of overall compliance infractions. Plus, hall monitors are subject to the same foibles as the health workers they are supposed to be watching. (They get tired, they get distracted and they miss things.) Campaigns designed to get patients involved in compliance efforts also suffer from human-related issues.

According to research reported in the December 2012 issue of Infection Control and Hospital Epidemiology, a survey of 200 hospital patients showed that while nearly 100 percent agreed that health workers should wash their hands, only 54 percent said they would feel comfortable asking a doctor to do so and only 64 percent would feel comfortable asking a nurse. And here’s the kicker — a mere 14 percent of patients reported ever actually asking a nurse or doctor to wash their hands. Taking the human error factor out of the equation demands a more “machine-based” approach.

How technology can help.
There are a number of ways that technology can be used to change the behavior of health workers and improve hand washing compliance. Innovations ranging from RFID tags and sensors to data capture devices that track people’s activities in physical spaces can potentially be deployed to consistently (and cost effectively) monitor compliance, to analyze behavior patterns so that facilities can better understand why breakdowns occur and even automate hand washing reminders through alarms and alerts. For example, technologies adopted widely in the retail industry to better understand consumer behavior are showing promise in health care. By combining intelligent devices that capture data about shoppers with advanced analytics, retailers are gaining valuable insights that help them optimize in-store promotions, deploy staff where they are most needed, minimize register wait times and improve customer service overall.

These same technologies in a hospital setting can be applied to measure entrances into a patient’s room, analyze behavior at hand washing stations and count compliance infractions, providing answers to questions such as: How often is hand washing skipped? Who is non-compliant? Under what circumstances? Is compliance better or worse in some areas of the facility as opposed to others? Why?

Linking this knowledge to action, in real-time, is the ultimate goal. Technology is critical for this purpose as well — compliance procedures need to be automatic, consistent and disconnected from human stumbling blocks (such as embarrassment or shyness) for them to work. Imagine, for example, that a sensor on a caregiver’s uniform “beeps” when a data capture device sees that the hand washing station has been bypassed. The caregiver, who was likely just distracted or in a rush, is prompted to comply without being embarrassed by a hall monitor, their supervisor or a patient. Facility managers can encourage better habits without giving staff the impression that they are breathing down their necks. And patients are relieved of the burden of confronting a cranky doctor when they are not sure he washed his hands — the onus shouldn’t be on them to make sure hospital policies are followed. More and more automated options are available as the capabilities of wireless devices and analytics have grown increasingly sophisticated. In the era of the superbug, health facilities would be wise to give these emerging technologies a look. It will save lives.

Ralph Crabtree is Chief Technology Officer and Founder of Brickstream, a leader in behavior intelligence solutions for environments where people shop, gather, work and play. He is an expert on image-understanding technologies, focusing on people tracking, video surveillance and documents recognition applications.
 

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