Healthcare facilities should rethink technology usage, entrance/exit layouts, and waiting room strategies as they start bringing back elective and non-critical care.
By John Fowler
Across the country, we are seeing numerous changes at healthcare facilities as they reopen for elective and non-critical care while still addressing potential surge capacity issues related to COVID-19. One of the biggest difficulties is getting into and through these facilities while practicing social distancing and minimizing risk to patients and staff.
Healthcare facilities are employing a variety of strategies and tactics to overcome these challenges, including technology that has gained traction recently out of necessity. Telemedicine which reduces the number of patients and the face to face interactions physically on site, is here to stay if CMS continues reimbursement. The number of telemedicine applicable visits varies by clinic, but estimates range from 25-40%. Another example is the increased use of online/mobile patient portals for registration, payment, and arrival instructions to minimize interactions and the time spent inside.
Once on-site, different strategies are being employed depending on the facility’s size and capabilities. Some organizations are creating designated entrances for COVID-19(known/suspected), NON-COVID-19 (tested negative within 24 hours), and UNKOWN patient types as well as for staff and materials management. Another strategy is to direct patients to the entrance closest to the area they will be seen to minimize travel throughout the hospital.
The utilization of more entrances needs to be balanced with the ability to monitor and screen patients at each location. At a minimum, facilities are making sure patients wear masks or don a new mask on arrival. Temperature checks and/or screening questions are common, and some facilities are creating negative-pressure triage and screening rooms These rooms are typically similar to an exam room and ideally they are located prior to entering the waiting room either adjacent to the vestibule at the main entrance or the entrance to individual departments. In retrofit situations they are sometimes directly off of the waiting room by repurposing an exam or procedure room and putting a door into the waiting room, corridor or elevator allowing the clinician to enter from the clinical side while the patient enters from the public side.
Inside, two of the biggest challenges are vertical circulation and waiting areas. For stairs, facilities can designate them as up or down to minimize cross traffic, while for elevators, it’s important to limit capacity and monitor queuing lines to maintain six-foot distance between patients. Corridors, stairs, elevators, and even entire wings or zones of the building can also be designated as COVID, NON-COVID, UNKNOWN, staff and/or materials management to match facility entrance points.
A variety of tactics can be applied to make the waiting rooms safer, such as increasing the spacing between seats, installations of glass or divider panels at the reception desks and in between seating areas or modifying HVAC systems. The ideal strategy, however, is to bypass waiting rooms completely. One option is having the patient escorted directly to the clinical care space on arrival. The common practice of asking patients to arrive 30 minutes prior to appointments may be headed for extinction. In some instance’s patients are being asked to notify the clinicians when they arrive and wait in their car until they are ready to be taken directly into the clinical care room.
One of our clients is considering options to limit the need for waiting and improving patient privacy in its radiology department by having patients wait in their dressing room, skipping the awkward gowned waiting area. Self-rooming, whereby patients go directly to the clinical care room without escort after check-in, is also gaining traction. Just prior to the pandemic we designed a clinic with self-rooming because the organization wanted it to be as autonomous and anonymous as possible in response to the city’s sexually transmitted infection crises. It required enhanced wayfinding such as super graphic icons indicating the testing rooms and specimen drop off location , and the implementation of new technologies for scheduling appointments, facilitating check in, motion-activated video instructions in the collection rooms, and sending results via text. The same changes in operations and design that allows patients to go through the entire process without having to see or speak to anyone to remove apprehension about testing can be applied to limit the physical interactions between patients and staff for infection control.
Healthcare facilities will need to embrace new ideas and concepts that support flexibility as they continue to face the challenges of providing services as safely as possible in balance with the potential recurrence of COVID-19 inpatient surges. We expect these changes to have lasting implications to the design and delivery of healthcare services.
John Fowler, AIA, EDAC, LEED AP, is a healthcare planner and associate principal/associate partner at Margulies Perruzzi (Boston). He can be reached at [email protected]
See the original article at Healthcare Design Magazine here: https://www.healthcaredesignmagazine.com/trends/perspectives/strategies-for-reopening-during-the-covid-19-pandemic/
