DESIGNING FOR RESILIENCE
Flexible hospital design key for future pandemics
Hiroshi Yasuhara, President of the Healthcare Engineering Association of Japan (HEAJ), discusses a study undertaken with the participation of 257 of the country’s hospitals into some of the key infrastructural and other adaptations they made to address a surge in patient numbers during the COVID-19 pandemic.
The study we undertook aimed to identify important infrastructural adaptations that were undertaken by the hospitals in question in response to increasing number of COVID-19 patient admissions during the surge phase of the pandemic. We studied 257 hospitals that responded to a questionnaire about the infrastructural adaptations they made during the pandemic – in areas ranging from facilities management, management of medical equipment, and human resources management, to management of beds for emergency COVID-19 patients. We also questioned them about the hospital features and clinical activities for both non-COVID and COVID-19 patients between 2019 and 2020.
Statistical analysis We statistically analysed the important explanatory variables for increasing the number of COVID-19 patient admissions, using a multivariate logistic model, followed by a stepwise procedure. The possible explanatory variables were selected beforehand by univariate analysis. The accommodation capacity was defined as the number of admissions of COVID-19 patients adjusted by the number of nurses. Three infrastructural adaptations emerged as important
explanatory variables for increasing the accommodation capacity for COVID-19 patients: mandatory securing of beds for COVID-19 patients (odds ratio [OR] 10.24, 95% confidence interval [CI] 4.79-21.85, P<0.000), additional purchase of ventilators (OR 2.46, 95%CI 1.28-4.73, P=0.007), and installation of negative pressure rooms (OR 3.84, 95%CI 1.68-8.78, P=0.001). As regards infection clusters, a large increase in the accommodation capacity was selected as a single explanatory variable (OR 9.45, 95%CI 3.16-28.24, P=0.00006).
Conclusions based on the survey The survey results showed that effective management of the facilities, patient beds, and medical equipment, were all key to the ability to secure sufficient accommodation for COVID-19 patients during the pandemic’s surge phase. The results also indicated that a large rise in COVID-19 patient admissions might have led to infection clusters regardless of the precautions taken. From the results we concluded that the ability to promptly secure accommodation capacity for COVID-19 patients is commensurate with the degree of infection risk. A flexible design incorporated into infection control could be an effective solution in preparedness for a future pandemic. Healthcare professionals have learned many invaluable lessons from the COVID-19 pandemic – among them
the importance of a range of anti-pandemic measures to prevent coronavirus transmission, such as standard precautions, isolation and surveillance of infected patients, control of human behaviour, and vaccination. When considering infrastructural adaptations,
improving ventilation in hospital buildings is one of the most important ways to mitigate the spread of aerosol infection. However, the rapid architectural renovations
Hospital beds Features No. of admissions of
ordinary patients in 2019 No. of admissions of
ordinary patients in 2020 No. of COVID-19 patient
admissions in 2019 No. of COVID-19 patient
admissions in 2020 No. of physicians No. of nurses
No. of infectious disease specialists No. of infection control nurses No. of infection control doctors No. of ICU beds
No. of isolation rooms No. of negative pressure rooms
No. of additionally purchased ventilators No. of additionally purchased ECMOs No. of additionally purchased
dialysis machines No. of additionally purchased
portable negative pressure systems May 2025 Health Estate Journal 25 100 to
399 beds (n=193)
54092.8 54602.5 6.0 110.2 25.8
159.7 0.2 0.7 1.1 1.5 1.3 1.0 1.0
0.04 0.3
1.3
Above: The pandemic presented unprecedented clinical challenges.
Below. Table 1: Features according to hospital size. (Data are presented as mean values.)
400 to
799 beds (n=52)
800 beds or more (n=12)
148910.0 283572.7 134712.5 248030.3 4.8 191.5
150.8 524.9 0.8 1.6 3.1 9.1 3.1 2.9 4.0 0.6 1.0
2.9 5.6 230.8 351.2
1045.9 5.8 2.3 7.5
20.0 13.5 12.0 12.2 3.3 3.1
3.3
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