Valuable lessons for future hospital design

COVID-19 Healthcare Series: Part 3

Following the initial urgency of March 2020, as DHBs (district health boards) and the Ministry of Health (MoH) prepared for a possible onslaught of COVID-19 patients, New Zealand has since managed this global pandemic better than most countries. So effective has the national response been, at the time of writing all social distancing restrictions have been lifted!

However, COVID-19 may yet re surface and is unlikely to be the last pandemic we face in our lifetime. The next one may have different modes of transmission and infection rates and at this stage, there is still limited official guidance from within the medical profession on how hospitals should be designed and adapted to better cope with pandemics.

With a number of hospitals in New Zealand, Australia and Singapore currently in key stages of design, the Beca Health taskforce team put our heads together to brainstorm how we could engineer the ideal building. The key take-out is that for new and existing hospitals, planned pandemic responses need to consider their flexibility to expand capacity as case numbers grow and shrink as the caseload reduces, and building services systems will need flexibility to match the plan.

So, what do we recommend?

As we previously noted in ‘Part 2 - Helping our healthcare clients prepare for a global pandemic’, various learned societies in the building services space have provided valuable advice on how hospitals and other healthcare facilities can respond effectively to the COVID-19 pandemic, which is spread by contact, droplets or aerosols.

We have taken this advice, combined with our own lessons from working with DHBs over the past few months and have developed practical recommendations for adapting healthcare facilities to be ready for future pandemics. 

• Have a pandemic response plan – the first step is to have a carefully considered pandemic response plan in place to begin with. This plan should be clinician-led and consider co-adjacencies and staffing needs with various stages of “surge” capacity increase and subsequent pandemic recovery.
• Keep flexibility in mind – flexibility is paramount when designing a healthcare facility for responsiveness to a pandemic. Things to keep in mind include multi-modal HVAC systems that can match adaptable models of clinical care and the ability to convert regular hospital wards or part wards into pandemic zones - with increased ventilation rates, nil recirculation and an inward air flow. Unless spaces are specifically designed for this flexibility, they can be very difficult to convert later.
• Keep increased demand in mind – demand for services during a pandemic (especially medical oxygen) can be 5x more than is required during ‘normal’ times. This impacts storage and delivery requirements and the equipment capacity to deliver on these demands.
• Consider staff accommodation – during a pandemic or another severe health crisis, healthcare staff are likely to be working around the clock, covering multiple shifts and generally under considerable pressure. Providing staff amenity where the pandemic response team can rest between shifts is vital in terms of caring for their wellbeing.
• Consider patients underlying complications - patients may come into the hospital with pre-existing conditions, exacerbated by a viral pandemic. Keeping this in mind when designing your facility will aid in delivering more effective patient treatment.

Taranaki Base Hospital – a case study in pandemic preparedness

One example of the lessons we’ve applied in this space is the Tarankai Base Hospital – Project Maunga Stage 2 project, which is currently at a key stage of design. During our lockdown, the Ministry of Health asked Taranaki DHB (TDBH) to consider how it would cope with future pandemics in their new building design. Working with the project team including clinical leads at Taranaki DHB, we reported back on lessons learnt and recommended best practice going forward. This included how TDHB planned to operate the new facility to respond to pandemics  and advising on what changes would need to be made to the current design to accommodate this. Areas and departments that would be most impacted by a planned pandemic response were specifically focused on, including:

• Main public entrances
• Emergency Departments
• Acute Assessment Units
• Intensive Care Unit (ICU’s) – incorporating ICU/HDU & CCU
• Renal Dialysis Units

Our contribution to this report included advice on building services (HVAC, medical gases, plumbing systems and electrical systems) fire engineering, as well as the space planning implications of providing these systems with the capability to flexibly meet clinical pandemic needs.

The result would be a healthcare facility that can mobilise at short notice to support an increased number of patients, if and when another pandemic strikes and expand the response in multiple stages of “surge”. We recommend that all current hospital projects pause to assess clinically how their spaces and building services may need to be adapted during a pandemic to accommodate high need patients. This is a task we are here to assist you with.

Footnote: International benchmark standards and guidelines

As it currently stands, international benchmarks and planning guidelines for healthcare facilities are generally silent on the specifics of designing for a global pandemic. There is a vast body of knowledge about design for contagious diseases, however existing guidelines are focused on the provision of features for “normal” patient volumes of individual cases and not for the surge demand arising from a pandemic.

One of the few guidance documents that considers pandemics is by the World Health Organisation (WHO) entitled “Infection prevention and control of epidemic and pandemic-prone acute respiratory diseases in health care” which they released following the 2003 outbreak of the SARS virus. The latest update was published in 2014. Specific advice in this document is limited to triage and waiting areas, recommending high air charge rates and spatial separation between waiting patients.

Special acknowledgements: Ian Grant and the team at Taranaki District Health Board.

This is part 3 of our COVID-19 healthcare series. Stay tuned for more insights we’ve gained on helping our healthcare clients prepare for one of the biggest challenges they’ve ever faced!

The full series can be viewed here:

• Part 1 - Supporting healthcare facilities
• Part 2 - Helping our healthcare clients prepare for a global pandemic
• Part 3 - Valuable lessons for future hospital design