By Dr Jane Repin Carthey

COVID-19 has shaken up the world of healthcare design

COVID-19 has shaken up the world over the last 18 months or so. Travel, socialising, employment and business have taken a massive hit, and the health sector has possibly undergone the biggest evolution. Health services, including hospitals (ED, ICU and IPU) and front line service providers such as GPs, have had to consider how they do business. Their concerns have included reducing the spread of infection, keeping non-infectious staff and patients safe, and providing adequate, suitable capacity to respond to increased demand for treatment and hospital beds. We are now moving into the next phase of the pandemic, where safely vaccinating people, as quickly as possible, is the primary concern.

The hospitals and other buildings that support healthcare delivery are rarely the priority in this type of situation. The organisational models for care delivery plus the associated workforce are the first consideration in such circumstances. However, these models and their staffing requirements must have suitable physical facilities to deliver the necessary health services. This short piece summarises a review of international and national responses to the demands of the pandemic on healthcare facilities. It is not intended to be comprehensive and will be expanded in future blog posts.

This list was developed for the Optimising Health Environments Seminar 2021 as an overview of the types of literature available relevant to the future design of healthcare facilities to cope with pandemics.

Literature – an overview

Although the output of peer-reviewed literature dealing with the Covid-19 is increasing, most of it is to date is related to clinical and organisational issues rather than facility responses. Some academics are writing about facility issues, with output expected to increase in quality and quantity over the next year. Trade and similar publications contain articles regarding possible facility responses. Architects’ professional associations publish guides and articles in some countries. Globally, the Union of International Architects Public Health Group (UIAPHG) has dedicated a website page to a list of these resources. Some of the larger consulting firms have published guides to designing healthcare facilities to cope with Covid-19, and most of these also suggest how to futureproof facilities against the next pandemic.

Academic resources

Source	Citation
American Society for Microbiology (USA)	Dietz, L., Horve, P. F., Coil, D. A., Fretz, M., Eisen, J. A., & Van Den Wymelenberg, K. (2020). 2019 Novel Coronavirus (COVID-19) Pandemic: Built Environment Considerations To Reduce Transmission. mSystems, 5(2), e00245-00220. https://doi.org/10.1128/mSystems.00245-20
Emergency Medicine Journal, (USA)	Noble, J., Degesys, N. F., Kwan, E., Grom, E., Brown, C., Fahimi, J., & Raven, M. (2020). Emergency department preparation for COVID-19: accelerated care units. Emergency Medicine Journal, 37(7), 402-406. https://doi:10.1136/emermed-2020-209788
Health Environments Research and Design Journal (HERD) – US/international	Hercules, W. J., Anderson, D. C., & Sansom, M. (2020, 2020/07/01). Architecture—A Critical Ingredient of Pandemic Medicine: An Open Letter to Policy Makers. HERD: Health Environments Research & Design Journal, 13(3), 247-252. https://doi.org/10.1177/1937586720928432
Journal of Patient Safety and Risk Management, (USA)	Gurses, A. P., Tschudy, M. M., McGrath-Morrow, S., Husain, A., Solomon, B. S., Gerohristodoulos, K. A., & Kim, J. M. (2020, 2020/04/01). Overcoming COVID-19: What can human factors and ergonomics offer? Journal of Patient Safety and Risk Management, 25(2), 49-54. https://doi.org/10.1177/2516043520917764
Kai Tiaki: Nursing New Zealand	Sutton-Smith, L. (2020). Planning for a COVID-19 crisis. Kai Tiaki : Nursing New Zealand, 26(4), 26-27.
La Radiologia Medica (Italy)	Ierardi, A. M., Wood, B. J., Arrichiello, A., Bottino, N., Bracchi, L., Forzenigo, L., Andrisani, M. C., Vespro, V., Bonelli, C., Amalou, A., Turkbey, E. B., Turkbey, B. I., Granata, G., Pinto, A., Grasselli, G., Stocchetti, N., & Carrafiello, G. (2020). Preparation of a radiology department in an Italian hospital dedicated to COVID-19 patients. La Radiologia Medica, 1-8. https://doi.org/10.1007/s11547-020-01248-1
Scandinavian journal of trauma, resuscitation and emergency medicine, (Scandinavia)	Nadarajan, G. D., Omar, E., Abella, B. S., Hoe, P. S., Do Shin, S., Ma, M. H.-M., & Ong, M. E. H. (2020). A conceptual framework for Emergency department design in a pandemic. Scandinavian journal of trauma, resuscitation and emergency medicine, 28(1), 118-118. https://doi.org/10.1186/s13049-020-00809-7

Trade Publications

Source	Citation
Healthcare Design Magazine	(USA) Albert, J. (2020). Reimagining Healthcare Design After COVID-19 [Perspective / opinion]. Healthcare design. Retrieved August 9, 2020, from https://www.healthcaredesignmagazine.com/trends/perspectives/reimaging-healthcare-design-after-covid-19/ Fowler, J. (2020). Strategies for Reopening During The COVID-19 Pandemic [Opinion]. Healthcare design. Retrieved August 9, 2020, from https://www.healthcaredesignmagazine.com/trends/perspectives/strategies-for-reopening-during-the-covid-19-pandemic/ McCarthy, A. (2020). Implications of COVID-19 on Healthcare Design. Healthcare design. Retrieved August 14, 2020, from https://www.healthcaredesignmagazine.com/trends/perspectives/implications-of-covid-19-on-healthcare-design
Modern Healthcare (USA)	Kacik, A. (2020). Pandemic prompts flexible healthcare design. Modern Healthcare, 50(20), 2 https://www.modernhealthcare.com/construction-design/pandemic-prompts-flexible-healthcare-design

Professional associations

Association	Citation
Australian Institute of Architects	Post-pandemic cities: The great reset. https://www.zinio.com/au/reader/readsvg/507967/66Roundtable: A pulse check during the COVID-19 recessionhttps://www.zinio.com/au/reader/readsvg/507966/12The architecture of crisishttps://www.zinio.com/au/reader/readsvg/470338/12Moving forward in a time of crisis https://www.zinio.com/au/reader/readsvg/470337/6
Union of International Architects Public Health Group	UIAPHG (2021) Covid-19 Resource Bulletin, updated April 14, 2021, https://www.uia-phg.org/covid-2
Australasian College of Health Service Management (ACHSM)	Library Bulletin: Covid-19 Special Issue 18 https://mailchi.mp/19952e0eb221/updated-covid-19-resources-february-2021
Canadian Architect	Broz, M. (2020). HOSPITAL DESIGN [Article]. Canadian Architect, 65, 19-19. https://gateway.library.qut.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=vth&AN=145181559&authtype=sso&custid=qut&site=ehost-live&scope=siteLam, E. (2020). BUILDING CAPACITY [Article]. Canadian Architect, 65(3), 4-4. https://gateway.library.qut.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=vth&AN=143053881&authtype=sso&custid=qut&site=ehost-live&scope=site
Canadian Medical Association Journal	Patey, C., Asghari, S., Norman, P., & Hurley, O. (2020). Redesign of a rural emergency department to prepare for the COVID-19 pandemic. Canadian Medical Association. Journal, 192(19), E518-E520. https://doi.org/10.1503/cmaj.200509

https://www.uia-phg.org/covid-2

Consulting firm publications

Consulting firm	Citation
Arup (International)	Peavey, E., Kim, M., Roark, J., Holton, S., Schroer, J., Scrantom, B., & Evans, J. (2021). The Pandemic-Resilient Hospital: How Design Can Help Facilities Stay Operational and Safe. https://www.arup.com/perspectives/publications/research/section/pandemic-resilient-hospital
Cannon Design	Stone, K. (2020). Planning Next: The eReport for planning and designing health’s future beyond COVID-19. https://www.cannondesign.com/ereport/
Ramboll (Scandinavia)	Ramboll. (2021). Pandemic Resilience. Retrieved February 15 from http://www.pandemic-resilience.com/
Stantec (Canada/International)	Eastwood, T. (2020). Pandemic preparedness: How hospitals can adapt buildings to address worst-case scenarios. Stantec. Retrieved April 13 from https://www.stantec.com/en/ideas/content/blog/2020/pandemic-preparedness-how-hospitals-can-adapt-buildings-to-address-worst-case-scenarios

Other

Nuffield Trust (UK)	Edwards, N. (2020). Here to stay? How the NHS will have to learn to live with coronavirus. Nuffield Trust. https://www.nuffieldtrust.org.uk/resource/here-to-stay-how-the-nhs-will-have-to-learn-to-live-with-coronavirus
The New Yorker	Chayka, K. (2020). How the coronavirus will reshape architecture. The New Yorker. Retrieved September 18, 2020, from https://www.newyorker.com/culture/dept-of-design/how-the-coronavirus-will-reshape-architecture?itm_content=footer-recirc
Sara Marberry LLC	Web blog: (USA) Mayberry, S. (2021, April 18). Let’s Talk About the Impact of the Pandemic on Healthcare Facility Design. SaraMarberry LLC. https://www.saramarberry.com/impact-of-pandemic-on-healthcare-design/

Some key findings

Following is a summary of some of the key findings and issues to be considered from the literature to date. These findings are sorted under several headings – although some may be relevant to more than one of these themes. The work of Arup/HKS is acknowledged with many illustrations drawn from their excellent document – referenced above.

Policy considerations

• The importance of design and buildings to the management of COVID-19;
• Forward planning of the health service to cope with after-effects of the pandemic including the need to do non-urgent surgery, screening tests, etc;
• Staff capacity and training needs;
• Preparing buildings to cope with the next pandemic;
• Moving care closer to communities – with more outpatient functions/facilities and more services available in the home;
• Review of capital budgets.

Infection control

• PPE – donning and doffing procedures;
• Isolation rooms – need for more with negative pressure;
• Providing 100% single rooms (or ability to effectively cohort);
• Reduce crowding with more space to allow physical distancing;
• Air conditioning – indoor air quality is extremely important to prevent infection spread;
• Research needed into materials less likely to harbour germs or to spread infections e.g., copper.

Arup HKS

Flexibility and adaptability

• Circulation space to be adequate to allow for physical distancing;
• More floor area per patient may be needed;
• Waiting room redesign – bigger or smarter? Or none at all?
• Pre-fab / modular solutions to reduce construction time;
• Pop-up facilities to assess and stream patients pre-admission;
• Flexible use of clinical spaces to allow expansion of e.g., ICU or ED into adjoining areas;
• Re-think use of administration space – with many people working at home – will this continue into the future?

Arup/HKS

Technology

• Virtual e.g., use of telehealth;
• AI – remote monitoring of patients;
• Space for accommodating and using these technologies – may increase, decrease or change.

Arup/HKS

Patient experience / avoiding staff burnout

• Mental health issues – ICU-related, staff working in PPE all day, stress and anxiety;
• Access to nature, views, sunshine and fresh air;
• Relaxation/stress reduction in areas away from the workplace;
• Food provision for patients, staff and visitors (with so many food outlets closed);
• Salutogenesis / biophilia is more important than ever.

Management of resources in possible weakened economies

• Climate change – strategies to address may become more important;
• Control energy use.
• An overview of literature regarding covid-19 design responses for hospitals and other health facilities

Arup/HKS

Conclusion

There will be another pandemic! We need to be better prepared.

The New Yorker (Emma Roulette)