Optimising hospital space layout for maximum patient capacity

During a pandemic, an effective hospital-based response would include adapting efficiently and rapidly to increased demand, using limited resources effectively, and carrying out a well-coordinated implementation of priority action.

As with any crisis, information plays a critical role. Regularly updated predictive modelling — as well as acuity level, census, and organisational models — can give insight into infection trends, patient numbers, and present and future needs in terms of space and resources.

To meet these developing needs, one top consideration is allowing hospitals in afflicted areas to operate at what is known as surge capacity. The term references a health service’s maximum ability to expand beyond its normal capacity to meet a surge in patients and an increased demand for clinical care. That absolute maximum capacity is calculated and can be optimised based on the total number of beds, the availability of human resources, the adaptability of facility space for critical care or isolation, and the availability of other resources.

Designing, supervising, or re-purposing new or alternative care sites

Even when operating at full surge capacity, many hospitals are still being overwhelmed and do not have the capacity to care for the influx of patients. To resolve this problem, temporary field hospitals functioning as surge hospitals are being built in countries such as the United States, Italy, Spain, France, China, Thailand, and many others. These field hospitals are customarily built by military personnel in a very short time (sometimes less than two weeks). Empty buildings, arenas, convention centres, stadiums, and other similar buildings can also be adapted into makeshift medical centres that can accommodate large numbers of patients.

Field hospitals can also take the form of mobile units, built out of materials such as those used in temporary military tent hospitals. These units operate as alternative care sites for patients who need hospitalisation and support therapy such as oxygen. Other temporary units that could be used during this pandemic include testing centres, triage centres outside of hospitals (to sort patients on level of need for immediate medical treatment), quarantine accommodations, and morgues.

Setting up these alternative care sites, along with maximising resources such as qualified healthcare personnel and personal protective equipment, can go a long way to aiding response and recovery efforts. Introducing new technologies and innovative solutions can also boost these efforts; for example, some countries including China are using artificial intelligence applications (such as robots) to make up for shortages in human resources. Other Asian countries are also using smartphones to track quarantine patients and monitor the progress and condition of COVID-19 patients convalescing at home.

Differentiating spaces for different care needs

In responding to this crisis, another critical consideration is patient acuity level which corresponds to how severe a patient’s illness is and what type of care is needed. Communities afflicted by COVID-19 are implementing multiple strategies in order to separate patients by acuity level. For example, hotels and schools are being repurposed to accommodate low-acuity patients, which frees up space in hospitals for high-acuity patients. Some hospitals are also turning their hospitals into all ICU beds and transferring existing patients to other facilities in order to isolate and care for high acuity and critically ill patients. However, because of the required engineering modifications, this particular process takes more effort and significantly longer time.

Hospitals designed and constructed to incorporate an acuity-changeable model allow for organisational flexibility and would only require minor modifications to cater to different patient acuity levels and adapt to immediate and future needs.

Creating clean, well-maintained, and comfortable patient environments

Strict infection control measures are key to the design and engineering of any hospital or medical care site and have been at the forefront of this pandemic. Strict respiratory and droplet precautions must be followed at hospitals. Airborne precautions for aerosol generating procedures must be performed in adequately ventilated rooms with airflows of at least 160L per patient or in negative pressure rooms with a minimum of twelve air changes per hour and controlled direction of air flow in mechanical ventilation.

Pertinent to the current situation, another important consideration in designing hospitals is logistics, specifically with regards to identifying physical space to allow for the storage and stockpiling of additional supplies. Other factors to consider are accessibility, security, ambient temperature, light exposure, and humidity.

Equipping a healthcare sector for immediate and future needs

In this crisis, Dar is using its vast healthcare engineering, architectural experience, and in-house capabilities to offer support to clients in public and private healthcare. Dar is also currently discussing options with clients on how to best carry out their related initiatives, one of which is highly specialised and a first of its kind in the region.

The current situation has forced governmental and private entities to reassess their healthcare strategy and budgets in a manner that will better prepare and guarantee capacity for any future pandemics or outbreaks. This strategy will not only facilitate an increase in bed capacity, it will also set the stage for significant investment in research labs, manufacturing plants for equipment and pharmaceuticals, educational medical facilities, and others.

Isabel is based out of the Dar Dubai office. Prior to joining Dar, she was the Regional Healthcare Director for Arcadis in the Middle East Region, where she was responsible for the overall business unit and served as advisor to governmental and private organisations. During her tenure in the United States, Isabel served as the Regional Director for the two largest U.S. for-profit healthcare organisations with operational responsibility for 26 hospitals, over 150 ambulatory/outpatient centres, and corporate compliance. Her experience and expertise include: hospital administration and operations, public health, disaster preparedness, infection control, quality control, strategic planning, medical planning, risk management, and numerous other fields.