Changes made during pandemic influence hospital design

As we emerge from the worst of the coronavirus pandemic, one sentiment persists: We’re entering a “new normal” that will lead to changes in our daily lives, including the design and development of hospitals and medical facilities.

In the wake of the pandemic, developers are rethinking the future of building design, especially for patient care and communal spaces. While those responsible for the design and layout of hospitals were likely some of the most prepared for the onslaught of a highly infectious disease, it doesn’t mean the pandemic didn’t affect operations at area hospitals.

Early in the pandemic, like hospitals across the nation, Eastern Idaho Regional Medical Center in Idaho Falls had to turn away visitors and reduce access to various parts of the building. It’s something that’s already led to new policies, according to Brett Hanson, the director of facilities management.

Hanson said the early days of the pandemic forced EIRMC to create controlled access to the facility through ID badge readers, restricting visitor access to certain areas, and even restricting access to some staff members. It’s a move he said that will likely stay in place, and it’s one that took some getting used to at first.

“Idaho Falls is typically an open community, which goes against what you typically see in health care,” Hanson said. “It’s a good security move though.”

The early days of the pandemic also forced staff at EIRMC to adjust the way they cared for emergency patients by creating isolated treatment areas for anyone with respiratory illnesses, or those showing symptoms of the coronavirus. Hanson said he sees those practices, along with changes to waiting areas, being worked into future remodels or new construction.

“We’d probably look at our triage process and our waiting room process differently, and have a space for those we suspect are infectious or have respiratory symptoms,” Hanson said. “For the treatment areas, we’ve considered looking at treatment areas in silos — making sure that if there’s a block of treatment rooms, it has an associated nurse station, housekeeping closet, linen supply room, all in the same area so those staff members are not crossing over into other areas.”

EIRMC is part of HCA Healthcare, a publicly traded health care facility operator based in Nashville, Tennessee. According to Hanson, one of the benefits of being part of HCA is that all its facilities receive specialized input on these matters.

“We get a lot of direction and vision from a corporate engineering team, and discussions have already started around what is the future of what hospitals look like,” Hanson said. “They’re working hand-in-hand with the American Hospital Association and the American Society for Health Care Engineering who both work to make sure the guidelines in place are well suited for patient care.”

Hanson said that he and coworkers from HCA facilities across the country meet often via teleconference to discuss what HCA medical facilities might look like in the future, and he pointed out that some elements are likely to be guided by legislation or in the form of regulations from governmental bodies such as the Occupational Safety and Health Administration.

While EIRMC doesn’t have any immediate plans for building new facilities, Hanson said he thinks future developments will certainly be built with highly infectious and respiratory diseases in mind.

“What that looks like, I don’t know yet, but I do imagine there will be some sort of requirements around how many negative pressure treatment areas you have,” Hanson said.

Negative pressure rooms are isolated hospital rooms that keep patients with infectious illnesses separated from other patients, as well as visitors and health care staff. The air pressure in the room is lower than the air pressure outside the room so when the door is opened, the air inside — which could potentially be contaminated — doesn’t leave the room and endanger the health of others.

These negative pressure rooms, along with air filtration systems, have long been a part of hospital design, and they’re something Peter Mundt, the community relations director with Gritman Medical Center in Moscow, sees as being critical in future plans as well.

While the COVID-19 pandemic increased the need for more physical distancing in lobbies, waiting rooms and other communal areas of facilities, Mundt said he thinks the need for physical distancing is ultimately temporary.

“We anticipate that as the pandemic is brought under control through increased vaccinations and good public health practices, the need for these temporary measures will subside,” Mundt said. “But respiratory illnesses in general aren’t going away and we always need to be prepared to respond to the next emergent situation.”

He said as a health care system, Gritman is constantly learning to adapt and improve, but currently doesn’t have any plans to make major changes to facility design specifically related to COVID-19.

“Hospitals have been in the business of fighting and preventing infectious diseases, including airborne and respiratory illnesses, for a very long time,” he said. “We have many protocols, safety equipment and special areas of the hospital that help us keep our patients and staff safe.”

Here to stay

One element of health care that has become immensely popular during the pandemic is telehealth, but while the idea was new to many patients prior to the pandemic, it’s not new to hospitals. In fact, according to Coleen Niemann, the director of marketing for Eastern Idaho Regional Medical Center, there are two key types of telehealth that hospitals have been using for years.

“The first is patient to provider. You started to see this really amplify during the pandemic,” Niemann said. “The second type of telehealth is hospital to hospital. This is lesser known by the public, but still extremely vital when we talk about Idaho and its rural nature.”

Because EIRMC is the largest hospital in southeast Idaho, and services several states, it has used hospital-to-hospital telehealth for years, Niemann said. An example she provided was a scenario where a patient checks into an emergency room at a smaller hospital in western Wyoming with symptoms of a stroke. The patient may need to be airlifted to EIRMC for treatment, but prior to that, ER doctors in Wyoming can use hospital-to-hospital telehealth to consult with specialists at EIRMC to determine whether the patient needs to be transported.

While it’s difficult to predict the future of health care, or what elements of pandemic care will be incorporated into future hospital development or renovations, both Niemann and Hanson with EIRMC see both forms of telehealth sticking around, largely for the convenience it provides.

“It’s created a convenience, and such an opportunity, that I don’t see it going away,” Hanson said.