COVID Insights, Perspectives March 19, 2020

A Nurse’s Insight: Responding to COVID-19 and the Protection of Healthcare Workers

By Marvina Williams RN, BSN, Senior Medical Planner

Before coming to Perkins&Will, I was the Nursing Director of Emergency Services at a large trauma center for more than 20 years. Now, as a medical planner at our firm, I’ve focused on operational planning in healthcare architecture for the last 15 years. In our current pandemic, I think back to working at the hospital during 9/11 and the preparation that was both invaluable and necessary to respond to the disaster. We had been through many disaster drills in the past and had our command center set up. That was a time for action, and now it is, too.

Amidst the current outbreak of COVID-19, keeping patients, their families, and the healthcare workers at the front lines safe is a national priority, yet it is one that comes with unique challenges. When addressing this pandemic, hospital design and capacities are critical for success in both response and safety measures for all parties involved. Our teams design with the priorities of emergency room spaces, rapid isolation and contaminant containment in mind, creating spaces that can be easily sectioned off to treat infected patients while keeping those outside safe.

Here are some of our recent projects that incorporate these resilient design elements:

Rush Emergency Department and negative pressure rooms are designed to prevent the spread of airborne diseases.

Rush University Medical Center, Chicago, Illinois

We designed Rush to be one of the country’s premier bio-terrorism preparedness facilities, designed to meet even unrealized healthcare needs of the 21^st century, like the one we’re facing now.

The Rush Emergency Department was designed for easy access to private treatment rooms and divided into three zones that can be isolated from one another to prevent the spread of airborne diseases, like COVID-19. These areas also integrate negative pressure technologies to prevent germs inside the room from being pushed out into the corridor and infecting others. The ambulance Sally Port that leads to these areas is also prepared for surges and infectious diseases, designed with easily accessible decontamination showers and extra spaces for tents and triage assessment spaces specifically for patients that have infectious diseases, such as COVID-19. Our teams worked with doctors, patients and the community to design a hospital that doesn’t just serve everyday needs, but can take on emergencies and surge capacities when needed, keeping people safer and healthier, by design.

The columns in the lobby of Rush are equipped with electricity and medical gasses to supply during a surge.

A Large Academic Medical Center

Rapid patient isolation was also at the forefront of our design for a large academic medical center that we worked on following another outbreak, Ebola. We ensured that negative pressure isolation rooms were in place immediately adjacent to the emergency department lobby, and that these rooms were connected, so that one could serve as an ante room to protect the healthcare staff, allowing them to change into their personal protective equipment (PPE) as well as undress at the end of their shift.

This facility also has an area adjacent to the Emergency Department with negative pressure beds that are routinely designated for observation, but in times of surge, can be used for influenza patients or infectious disease. Flexibility and adaptability is key for the success of any healthcare facility, and disaster preparedness was addressed through a large ambulance bay that is strategically located so that it can easily do mass decontamination or set up for mass triage in cases of surge. The canopy of the ambulance deck is equipped with drop-down showers and curtains, and tempered water connections drain into separate waste streams—storm versus decontamination. Electricity is also located in columns and ceiling for connection to ambulance generators.

Here, we also made sure to address the important issue of inpatient rooms and beds, designing a bed tower containing acuity adaptable rooms that can handle any acuity of patients, including critical care, and “future-proofing” the hospital by meeting challenges of surge and emergency.

The Large Academic Medical Center's Ambulance Bay is strategically located so that it can easily do mass decontamination or set up for mass triage in cases of surge.

CHRISTUS Spohn, Corpus Christie, Texas

At CHRISTUS, we designed the facility to be prepared for surges by including an ambulance canopy that can convert into a mass decontamination area. Furthermore, the entire Emergency Department is isolated from the remainder of the hospital’s air distribution system, and there is an adjacent potential isolation unit. A large multipurpose room is prepared for emergency adaptation that contains radio hook-ups, antennae, and multi-media equipment for communication.

Intermountain Healthcare: Alta View, Sandy, Utah

As medical facilities become more dynamic and flexible, life-saving information needs to be accessible, too, no matter where a patient is. An emerging area of design intelligence is telemedicine, where specialized centers allow doctors of all specialties to communicate with each other in real time, offering advice and instruction in the case that a patient may require the expertise of a doctor miles away. At Intermountain Healthcare: Alta View in Sandy, Utah, our design teams incorporated telemedicine monitors in each trauma room and each intensive care bed, enabling videoconferencing with specialists at their main telehealth center. The added information and aid this technology gives to healthcare providers and doctors can be a key factor in stopping the spread of COVID-19.

The Telehealth Center at Nicklaus Children's Hospital in Miami, Florida, enables specialists to teleconference with other healthcare providers around the world.

Emergency departments and healthcare facilities around the world are at the front lines of crises and pandemics like COVID-19. Our healthcare design teams work with clients, patients, and doctors to create customized and future-ready solutions for spaces that ease the workloads of healthcare workers while also keeping them, their patients, and their families healthy and safe. By combining operational design approaches with healthy, flexible spaces, we continue to transform our healthcare system, helping doctors everywhere offer life-changing care with confidence.

A Nurse’s Insight: Responding to COVID-19 and the Protection of Healthcare Workers

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