The Covid-19 pandemic changed the way health systems approach hospital design, prompting several health system executives to detail some of the ways hospital design has evolved to incorporate ideas that "seemed extraordinary in the past," Joyce Frieden writes for MedPage Today.

Adjusting to 'fluctuations in volume and need'

In a panel discussion hosted by U.S. News Live, several health system executives detailed some of the ways hospital design has evolved to incorporate ideas that "seemed extraordinary in the past" in response to frequently changing "volumes and needs." Many are "changing the way they use their space" while "finding more ways to provide high-level care outside the hospital," Frieden writes.

"The pandemic forced us to change faster than what was imagined before," said Chris Bowe, SVP and COO of Atrium Health-Greater Charlotte Region. "Instead of 'What could we do?' it became 'What do we have to do?' And many of the spaces that we opened during the height of Delta and Omicron [have since] returned back to their origin."

While Atrium is still operating bed and care spaces under the public health emergency rules, "what seemed extraordinary in the past now has become prepared responses to fluctuations in volumes and needs," Bowe said.

"Some examples of this include expansion of our ICUs and emergency department spaces and teams, meeting surging populations, [dealing with] longer lengths of stay and shifting acuity ... And we expanded our use of virtual critical care and virtual hospitalist services," he added.

"This is still an ongoing, although diminishing, crisis and so it's left a lot of challenges in terms of how to run the organization and frankly, the focus on our staff wellness," said David Reich, president of Mount Sinai Hospital and Mount Sinai Queens. "That being said, there were some incredible lessons learned and we're much stronger as an organization. Our command center now has a permanent hospitalist and intensive care physician stationed there. So our level-loading between organizations is a much more highly developed process than it was before."

In Los Angeles, "throughout the pandemic, we looked towards New York with an anxious eye because what was happening there was coming to us a month to 6 weeks later," said Jeffrey Smith, COO of the Cedars-Sinai health system.

According to Smith, the health system has adapted "to listen to our providers, especially in uncertain times." Cedars-Sinai has implemented "a daily or multiple-times-a-day huddle" to regularly obtain important information from front line workers.

"Building trust with our physicians and our staff was really key. We also implemented a command center and accelerated that, and we matured very quickly. As a result, we learned how to use our space in a much more flexible way," Smith added.

Solutions for capacity constraints

Initially, Cedars-Sinai officials thought tents could be a viable solution to increase capacity, "but for us, when we thought about how we provide utilities, whether that be water or electricity, or medical gases, doing things outside of the hospital became very challenging for us," Smith said. Ultimately, the hospital decided to focus on increasing the capacity "within the four walls of the hospital."

According to Bowe, "[Atrium] had tents across the region, and really took down the last tent about 14 days ago."

"But we've also invested in different design processes in our emergency departments space, so in the last 2 years, we have taken teams offline to invest frontline teammates and physicians and providers into design teams, so that we can create spaces that flow better," Bowe added.

Notably, Atrium's new design focuses on "giving patients sight lines to care teams in their environment, and more daylight and better windows so that they can have the outside as part of their healing process," Bowe noted.

"And by the way, that design has now become our standard" for any new construction, he added. "And on our inpatient units, it even includes 'same-handedness,' so every room that Atrium Health builds from now on, we'll have same-handedness as you walk into the room so that you understand where the equipment is, where the patient is, and you don't have to think as you're entering into the space." 

Expanding beyond the hospital

Before the Covid-19 pandemic began, Cedars-Sinai was "in the process of designing a brand new replacement hospital for one of our community hospitals," Smith said. "And the pandemic really caused us to go back and re-examine those plans that we had, and ask some different questions."

Cedars-Sinai—like Atrium—used simulations to answer questions like "Where will we put tents, if indeed they're needed again, and how does that affect the flow of patients through the area? How many respiratory isolation or positive pressure rooms do we [have]? How do we segment the flow of our patients through our emergency room if we have potentially infectious patients? How do we separate those patients from the flow?'" Smith shared.

Many hospitals are considering creating longer-term spaces to use for patients, which could include "taking hospital spaces that we might need for future pandemics that could potentially be converted to respite-type care, so that we could even discharge people who have housing, food instability, or other challenges to apartments nearby, or to hospital buildings ... and then they would be available in future pandemic for re-initiation as hospital beds because they have the basic requirements," said Reich.

"I think that it's going to require us to deal with the lower-acuity patients and come up with a viable means of caring for them outside of the hospital, even though the level of care may be very much approaching the hospital," he added. (Frieden, MedPage Today, 10/24)