Across the country, we are seeing numerous changes at healthcare facilities as they reopen for elective and non-critical care while still addressing potential surge capacity issues related to COVID-19. One of the biggest difficulties is getting into and through these facilities while practicing social distancing and minimizing risk to patients and staff.
Healthcare facilities are employing a variety of strategies and tactics, including technology, to overcome these challenges. For example, the use of online/mobile patient portals for registration, payment, and arrival instructions has increased to minimize interactions and the time spent inside. Telemedicine, which reduces the number of patients on-site and face-to-face interactions, also has grown in popularity during the pandemic and is here to stay if Centers for Medicare & Medicaid Services continues reimbursement.
Once on-site, different strategies are being employed depending on the facility’s size and capabilities. Some organizations are creating designated entrances for COVID-19 (known/suspected), non-COVID-19 (tested negative within 24 hours), and “unknown” patient types as well as for staff and materials management. Another strategy is to direct patients to the entrance closest to the area where they will be seen to minimize travel throughout the hospital.
The utilization of more entrances needs to be balanced with the ability to monitor and screen patients at each location. At a minimum, facilities are making sure patients wear masks or don a new mask upon arrival.
Temperature checks and/or screening questions are common, and some facilities are creating negative-pressure triage and screening rooms. These rooms are typically similar to an exam room and ideally are located adjacent to the vestibule at the main entrance or the entrance to individual departments. In retrofit situations, they can be housed directly off the waiting room by repurposing an exam or procedure room and putting a door into the waiting room, corridor, or elevator, allowing the clinician to enter from the clinical side while the patient enters from the public side.
Inside a facility, two of the biggest challenges are vertical circulation and waiting areas. For stairs, facilities can designate them as up or down to minimize cross traffic, while for elevators, it’s important to limit capacity and monitor queuing lines to maintain six-foot distance between patients. Corridors, stairs, elevators, and even entire wings or zones of the building can also be designated as COVID-19, non-COVID-19, unknown; staff; and/or materials management to match facility entrance points.
A variety of tactics can be applied to make the waiting rooms safer, such as modifying HVAC systems, increasing the spacing between seats, and installing glass or divider panels at the reception desks and between seating areas. The ideal strategy, however, is to bypass waiting rooms completely, by having the patient escorted directly to the clinical care space on arrival or, in some cases, asking patients to notify the clinicians when they arrive and wait in their car until they are ready to be taken directly into the clinical care room.
Self-rooming, whereby patients go directly to the clinical care room without escort after check-in, is also gaining traction. Just prior to the pandemic we designed a clinic with self-rooming because the organization wanted the clinic experience to be as autonomous and anonymous as possible in response to the city’s sexually transmitted infection crises.
The design solution required enhanced wayfinding, such as graphic icons indicating the testing rooms and specimen drop off locations, and the implementation of new technologies for scheduling appointments, facilitating check in, delivering motion-activated video instructions in the collection rooms, and sending results via text. These strategies that allow patients to go through the entire testing process without having to see or speak to anyone can be applied in a post-COVID-19 world to limit physical interactions between patients and staff to support infection control.
Healthcare facilities will need to embrace new ideas and concepts that support flexibility as they continue to face the challenges of providing services as safely as possible in balance with the potential recurrence of COVID-19 inpatient surges. We expect these changes to have lasting implications to the design and delivery of healthcare services.
John Fowler, AIA, EDAC, LEED AP, is a healthcare planner and associate principal/associate partner at Margulies Perruzzi (Boston). He can be reached at jfowler@mparchitectsboston.com
