Crystal Ball Reflections

Crystal Ball Reflections

How the Coronavirus Could Change Healthcare Design


The Patient Room

As we navigate through this unique period of history, we are being indelibly marked by this virus that will change our world. Reflecting on how healthcare design will forever be changed, I wonder if hospital inpatient units, both new and renovated, will take on new characteristics.

For years we, as healthcare architects, have had the debate between inboard or outboard patient rooms, and between same handed or opposite handed approaches. Perhaps this pandemic will stimulate an agreed upon solution that can support any future like events. I am wondering if this is the time that we settle on a mid-board approach to inpatient rooms that nests toilet rooms in a zone between a pair of rooms.

I am intrigued by this concept because it appears to provide several opportunities that can be exploited to benefit a response to a surge of critically ill patients stressing our healthcare infrastructure. Consider these qualities that a mid-board approach possesses:

  • Maximizing usable square footage as there is neither an access corridor beside the toilet room (inboard) or a family alcove (outboard) which are not the most flexible of spaces
  • A rectangle footprint supports great flexibility of equipment placement and augmentation
  • Potential exists for a prefab approach to the patient hygiene zone
  • The positive distraction views to the exterior can be larger and accentuated giving a feeling of spaciousness
  • A wider space for a nurse alcove at the corridor end of the toilet zone
  • With a common wall shared between patient room and corridor an opportunity is created is provided that can support more storage for PPE (Personal Protective Equipment) and a better, less intrusive way to remove soiled material from the patient room
  • Larger doorway openings can be accommodated with code compliant approach clearances for movement of beds and equipment
  • Wider nurse alcove between rooms could support two nurses for a 1:1 nurse/patient ratio if the rooms need to be utilized as ICU rooms
  • The patient would feel more connected visually to the corridor and the nurse through windows which has proven to support a lower fall risk

Infrastructure Thoughts

This also poses the question as to how much infrastructure is needed to build preparedness for utilization of high acuity patients into a normal acute care bedroom. One economically palatable approach would be to organize the headwalls with the medical gases, power (normal and emergency), and data to support the ICU type patient but not modify the more costly HVAC system to increase ventilation rates. A window system could be designed such that portable ancillary exhaust could be quickly installed to augment negative pressure needs.

Finishes will continue to evolve as antimicrobial. I believe that high touch surfaces will be a focus and the use of copper plating on door handles, grab bars, bedrails etc., will become more common place. We will also continue to move toward hands free plumbing fixtures. It is also a strong probability that the fluid quantity limits of alcohol-based hand sanitizers will be relaxed due to lack of evidence regarding their classification as fire hazards. These will be placed in the rooms closer to the patient and in view of both patient and family members, thus encouraging all persons within the room to increase their utilization.

The question of expanding corridor width beyond the code-required 8’ is an interesting one. Would increasing the width to support placement of portable equipment and supplies be reason enough to make this modification?  Increasing by two feet the width of corridors has the probability of increasing construction costs by 4-6%. When institutions analyze a risk/reward scenario for that investment, I do not believe we will see that change unless mandated by codes.

One thing is for certain…

As we emerge from the current crisis, we will all learn new things. It is interesting to ponder where those will lead us. I firmly believe that as architects, we will learn how to design better facilities to handle surge events and how to support and challenge our clients to be better prepared. As human beings we will hope we never have to implement that preparedness.

John Schrott AIA | ACHA | EDAC

President | IKM Architecture

Healthcare Group Leader

Pittsburgh | Cleveland