HOSPITAL DESIGN
A strategy for regular operations Using these factors; the FleXX framework, the FleXX Hospital Principles, and the Pandemic Considerations, we developed a strategy for maintaining regular operations during a pandemic. Ideally, the facility is designed using the aforementioned principles and strategies – the vertical circulation and service cores clustered together at strategic points, the facility programme occupying the areas between with regular grids, and standardised slab-to-slab heights. Half of the single inpatient rooms will be designed and serviced to accommodate
two patients when needed. During regular operation there would be standard facility entrances for public, blue light, and services. When the first cases begin to appear, one end of a ward can be segregated, with flows diverted to a separate entrance/exit to allow patients to be cared for in isolation from the rest of the facility. A triage tent will be set up outside the facility to ensure that no infected person enters along the incorrect flows.
As cases increase, a greater separation occurs, and a one-way system through the infected zone can be introduced. A
portion of the ground floor can be taken over for emergency treatment of the infected, while the external threshold could provide roadside testing or triage for patients arriving. The isolated zone can expand vertically as case numbers increase, and those wards that were designed to accommodate two beds can begin to augment, while leaving as much of the facility as possible operating as normal.
Pandemic patient care If needed, at the peak, over one third of the facility could be dedicated to
How the principles were applied at a Kentucky hospital
Located on a 129-acre greenfield site in Lexington, Kentucky, the Baptist Hamburg campus was developed as a state-of-the-art healthcare and mixed use development serving the surrounding neighbourhoods. The site masterplan and architectural scale were designed to minimise the traditional institutional environment, and embody the principles of successful walkable public street design.
Improving patient and staff experience, while leveraging efficiency and flexible spaces, was a critical guiding principle. HKS’s design and research team performed a ‘design diagnostic’ at two existing clinic buildings and two surgical platforms (inpatient and outpatient) to understand the current state workflow, pinch points, and desired future state. The project was in early design when the COVID-19 pandemic hit the US. The design team worked ‘virtually’ alongside users and hospital leadership to identify measures that best prepare for future outbreaks. The design incorporates several strategies to address enhanced entry functions, compartmentalisation, surge planning, ‘safe’ and ‘hot zone’ delineation, and HVAC system flexibility. The main driver was to provide the flexibility to maintain operations amid a pandemic, and offer safe and high-level care for all patients.
Screening area
The plans include a screening area that allows staff to screen patients before entering the building. From this area, screening staff control separate vestibule doors into the waiting rooms, and can direct patients to the respiratory or non-respiratory sides. A handwashing sink within the entry vestibule promotes good hand hygiene, and within the waiting room, a moveable glass partition provides patient separation while maintaining full visibility for staff. The HVAC system is
50 Health Estate Journal March 2021
designed to activate a pandemic mode when necessary, allowing exam rooms and larger zones to be switched to negative pressure and full exhaust whenever needed.
Karen S Hill, DNP, RN, NEA-BC, FACHE, FAAN, COO and Chief Nursing Officer, Baptist Health Lexington, said: “A guiding principle of our design is flexibility. We worked with HKS Architects to envision multiple uses for our Emergency Department and Clinical
Decision Unit, including as a respiratory infection receiving unit, as a triage unit for our larger facility, and to hold and stabilise patients in an overflow situation. Paramount in the design were additional handwashing sinks, negative pressure capability, re-configurable waiting space, and additional restrooms and toilet facilities. We feel the new unit will be adaptable to unknown emerging healthcare issues in the future.”
An exterior view of the entrance of the proposed Emergency Department at Baptist Hamburg. Below: Hamburg Intent Document Emergency: The design strategies implemented for the Baptist Hamburg Emergency Department that will allow it to be able to respond safely, quickly, and efficiently, to a future pandemic scenario.
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