TELEMEDICINE
Redesigning hospitals for the telehealth revolution
Michaela Sheahan, senior researcher at Hassell, explains how, with a significant switch to ‘virtual’ consultations during the COVID-19 pandemic, the international architecture, design, and urban planning practice collaborated with the Centre for Online Health, Centre for Health Services Research at The University of Queensland, to understand where and how digital consultations were undertaken in Australia in 2020. The firm surveyed and interviewed healthcare workers in Australian hospitals to better understand how telehealth spaces worked (or didn't) for them and their colleagues, with some interesting findings.
In 2020, while hospitals and healthcare providers grappled with infection control issues and community anxiety about COVID-19, the long-anticipated widespread uptake of telehealth consultations finally happened – seemingly overnight, and with chronic disease and an ageing population increase putting pressure on hospital space and staff, there is much to be gained from this significant, potentially permanent, shift in service delivery. What if we could sustain lower numbers of patients fronting up to hospitals in the first place, and then give that space to those who really need it? It sounds simple, but of course health systems are complex, risk-averse, and too important to fail. The pandemic is a once- in-a-generation real-time experiment to see where change can be made safely and effectively.
A generation of change
As the first wave of the pandemic began, and healthcare systems all over the world switched to telehealth wherever and however they could, one practitioner in London declared: ‘We’ve had ten years of change in one week.’1
Between February
and March 2020, registrations to use the UK’s NHS app more than doubled. Around the same time, virtual appointments with GPs tripled – from 25 to 71 per cent of all consultations. Visits to the NHS non-emergency online advice site increased by 257 per cent compared with 2019.2
A similar pattern was observed in other countries. In the US, demand for telehealth grew by over 60 percent.3 Australian government-funded virtual consultations grew exponentially too, jumping from one million appointments in March 2020, to over six million the very next month.4
While GPs delivered many of these consultations, hospital telehealth services also expanded, along with allied health, mental health, and nurse practitioner
consultations. Research shows that despite fears of compromising confidentiality, safety, and patient-doctor relationships, telehealth models can and do deliver lower mortality and hospitalisation rates across a range of patient groups, including the elderly, and people with chronic illnesses such as heart disease, diabetes, and stroke rehabilitation.5
A recent survey of
telehealth patients also shows that patients are a lot less reluctant to use, and are more satisfied with, telehealth services than might have been expected.6
A question of space
It’s safe to say we can anticipate at least some change over the long term in how services are delivered, and that has significant implications for hospital spaces
The Australian study was undertaken in conjunction with The Centre for Children’s Health Research, Brisbane.
and the design teams that plan them. However, information about telehealth space design in hospitals is hard to come by. Most telehealth research projects investigate the safety or efficacy of initiatives, rather than the spatial implications of changes to models of care. Compounding a lack of design research, many health facility guidelines refer to telehealth in only general terms, (e.g. ‘consider telehealth requirements’, ‘telehealth technology should be available for teaching and clinical assessment’, etc.),7
without recommendations on size, layout, lighting, or other design considerations. The assumption is that staff can just access a computer or phone in whatever space is available and make the best of it. However, when the COVID-19 crisis came, what spaces were actually available, and did they work?
Consultations from cupboards and other limitations
International design practice, Hassell, collaborated with the Centre for Online Health, Centre for Health Services Research at The University of Queensland, to understand where and how digital consultations were undertaken in Australia in 2020. We surveyed and interviewed healthcare workers in Australian hospitals to better understand how telehealth spaces worked (or didn't) for them and their colleagues. Were the clinicians using spaces that were appropriate for patients? Will hospitals need to re-think their spaces to accommodate this new model of care? Most importantly, how can we take advantage of this significant change in healthcare delivery to design hospitals that best support clinicians and patients? The research findings suggest that current hospital infrastructure in Australia (and likely everywhere else, too) was ill- equipped to accommodate the significant increase in telehealth services during the pandemic. Telehealth delivered at scale
October 2021 Health Estate Journal 27
©Christopher Frederick Jones
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