'Hospitals Reinventing Themselves Post-Pandemic'

 Hospital design has evolved since the COVID-19 pandemic began, with hospitals not only changing the way they use their space but also finding more ways to provide high-level care outside the hospital, several health system executives said during a panel discussion sponsored by U.S. News Live.

"The pandemic forced us to change faster than what was imagined before," said Chris Bowe, MHA, senior vice president and COO of Atrium Health-Greater Charlotte (North Carolina) Region. "Instead of 'What could we do?' it became 'What do we have to do?' And many of the spaces that we opened during the height of Delta and Omicron [have since] returned back to their origin."

Responding to Fluctuations

Although the health system still has bed and care spaces that continue to operate under the public health emergency rules, "what seemed extraordinary in the past now has become prepared responses to fluctuations in volumes and needs," he said at the webinar, which was also sponsored by Medxcel, a health facilities maintenance firm. "Some examples of this include expansion of our ICUs and emergency department spaces and teams, meeting surging populations, [dealing with] longer lengths of stay and shifting acuity ... And we expanded our use of virtual critical care and virtual hospitalist services."

"This is still an ongoing, although diminishing, crisis and so it's left a lot of challenges in terms of how to run the organization and frankly, the focus on our staff wellness," said David Reich, MD, president of Mount Sinai Hospital and Mount Sinai Queens in New York City. "That being said, there were some incredible lessons learned and we're much stronger as an organization. Our command center now has a permanent hospitalist and intensive care physician stationed there. So our level-loading between organizations is a much more highly developed process than it was before."

Meanwhile, in Los Angeles, "throughout the pandemic, we looked towards New York with an anxious eye because what was happening there was coming to us a month to 6 weeks later," said Jeffrey Smith, MD, JD, COO of the Cedars-Sinai health system. "We've learned many of the same skills -- to listen to our providers, especially in uncertain times, and implementing a daily or multiple-times-a-day huddle, getting information from the front line and being transparent with what we knew and most importantly, what we didn't know at the time. Building trust with our physicians and our staff was really key. We also implemented a command center and accelerated that, and we matured very quickly. As as a result, we learned how to use our space in a much more flexible way."

Expanding Capacity Within...

Cedars-Sinai officials initially thought that tents might be part of their solution to increase capacity, "but for us, when we thought about how we provide utilities, whether that be water or electricity, or medical gases, doing things outside of the hospital became very challenging for us," Smith continued, adding that they instead decided to focus on "'How do we increase our capacity within the four walls of the hospital?'"

At Atrium Health in North Carolina, "we've had tents across the region, and really took down the last tent about 14 days ago," said Bowe. "But we've also invested in different design processes in our emergency departments space, so in the last 2 years, we have taken teams offline to invest frontline teammates and physicians and providers into design teams, so that we can create spaces that flow better."

For example, "we have taken security patient transporters, nurses, physicians, radiology, pharmacy -- anyone that would interact in that [emergency department] space -- and we put them in a sim environment for them to create the space that they should work in," he said. "Those hundreds of hours of design have turned into our newest de novo hospital that we opened in February of this year. And it's really...an amazing space to see because the team has created less waste in their own processes, so that there's fewer steps for the teammates. There is better visualization of patients throughout the entire shift. There's less time away and less steps, and there's more daylight."

"And by the way, that design has now become our standard" for any new construction, Bowe added. "And on our inpatient units, it even includes 'same-handedness,' so every room that Atrium Health builds from now on, we'll have same-handedness as you walk into the room so that you understand where the equipment is, where the patient is, and you don't have to think as you're entering into the space." In terms of the patient experience, the new design has focused on "giving patients sight lines to care teams in their environment, and more daylight and better windows so that they can have the outside as part of their healing process."

...And Outside the Hospital

At Cedars-Sinai, "just before the pandemic, we were in the process of designing a brand new replacement hospital for one of our community hospitals and in addition to that, we were planning a major expansion of our emergency department at our academic medical center," Smith said. "And the pandemic really caused us to go back and re-examine those plans that we had, and ask some different questions like 'Where were will we put tents, if indeed they're needed again, and how does that affect the flow of patients through the area? How many respiratory isolation or positive pressure rooms do we? How do we segment the flow of our patients through our emergency room if we have potentially infectious patients? How do we separate those patients from the flow?'"

Cedars-Sinai, like Atrium, also used simulations, "and one of my favorite stories is when I was completely overruled by the nurses, which happens often, by the way," he continued. "We were planning our new hospital and planning where the bathrooms should go. And this new hospital is in Marina Del Rey; it overlooks...the Pacific Ocean on one side and the mountains on the other. And I thought, 'What a great opportunity for unobstructed views.' And then the nurses came in and showed me where the IV poles for all the equipment were going to go and said, 'Nope, the bathrooms need to go on the other side.' So truly listening to those people who are going to be using the room and providing care there is critical."

Hospitals are also looking to use some space for patients over the longer term. This may include "taking hospital spaces that we might need for future pandemics that could potentially be converted to respite-type care, so that we could even discharge people who have housing, food instability, or other challenges to apartments nearby, or to hospital buildings ... and then they would be available in future pandemic for re-initiation as hospital beds because they have the basic requirements," said Reich. "I think that it's going to require us to deal with the lower-acuity patients and come up with a viable means of caring for them outside of the hospital, even though the level of care may be very much approaching the hospital."

https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/101393