TELEMEDICINE
requires a more considered response than the (understandably) hastily conceived solutions of 2020 – borrowed offices, vacant meeting rooms, the driver’s seat of a car, or, in one case, a storage cupboard.
Need for ‘visual and acoustic privacy’ In our survey, healthcare staff expressed a need for visual and acoustic privacy, and the ability to switch from in-person to virtual consultations easily. Their preference was to conduct telehealth in existing consult rooms, which made perfect sense in 2020, but is not necessarily a space-efficient long-term solution. If telehealth growth is sustained, as is widely predicted, hospitals will soon be busy planning new and refurbished spaces to accommodate emerging models of care that focus on digital delivery.
From hybrid hospitals to to fully online futures
There are very few built precedents or best practice guides to steer hospitals through this change. Some hospitals are already exploring activity-based work spaces to combine telehealth and in- person consultations, while others have made significant investments in digital- only hubs to connect with patients at home, spurred on by their pandemic experiences.
The Mercy Virtual Hospital in the US, which opened in 2015, was the first example of a fully online health service facility, connecting patients and clinicians across the entire state of Missouri.8 At Sydney’s Royal Prince Alfred Hospital, the RPA Virtual space opened (fortuitously) in February 2020 to allow clinicians located in a central 24-hour hub to treat palliative care and cystic fibrosis patients in their homes. The hub quickly flicked the switch to COVID-19 care, allowing patients that were isolating at home to remain connected to the hospital in case of deterioration.9
A ‘virtual hospital’
Hospitals in the UK also successfully adopted this virtual ward approach when COVID-19 infections were rising dramatically. In Watford, the West Hertfordshire Hospitals NHS Trust set up a virtual hospital that has since managed thousands of patients at home, and saved over 300 bed days in one three-week period. It has been so successful that the Trust wants to continue the system after COVID-19, initially for respiratory patients, but potentially across other groups, too.10 Looking beyond the pandemic, each hospital will need a tailored solution to suit its unique patient characteristics, funding, staff profiles, and models of care. Will clinicians be on site all day, or will visiting staff rotate throughout the week? Are there excess consult rooms that
28 Health Estate Journal October 2021
separation, but are the least space- efficient compared to other design solutions. Patients can check in personally, and readily enquire at reception about any issues they may be worried about (car parking, usually, booking a next appointment, or, ‘How long do I have to wait?’). Each room can (theoretically) feature the same layout and equipment available for use. While clinicians delivering telehealth in these spaces will be taking up space that could otherwise be used for in-person consultations, this approach may be appropriate for those services where telehealth consultations remain very limited.
A consultation room at the St Vincent’s Private Hospital, New East Wing, Sydney.
can be converted to smaller telehealth booths, or do the clinicians (particularly in allied health) need space for equipment or exercise demonstrations? Is multidisciplinary team care common, or is space for one-to-one consultations more useful? Can we do away with public waiting space altogether?
A design response
The floor plans in Figures 1-5 explore what the future might hold for a hospital outpatient setting in three different scenarios: 'Business as usual', in which 10 per cent of consultations are delivered virtually; ‘Mixing it up’, with up to 50 per cent of services delivered virtually; and ‘Complete transformation’, where a facility delivers all of its services virtually.
Business as usual – 10 per cent telehealth Old habits die hard. As the pandemic passes, many facilities are likely to revert to delivering most services in-person again. Patients and clinicians will be eager to re-establish personal connections, and the limitations of existing technology, building infrastructure, funding, and staff capabilities, will also put the brakes on. For our survey respondents, pre- pandemic in-person delivery was around 90 per cent of all their consultations. The floor plan in Figure 1 shows a common planning approach to outpatient departments, with a central waiting area surrounded by consultation rooms. During the pandemic, clinicians in hospitals all around the world accommodated telehealth services in spaces just like these: meeting rooms, treatment areas, administration offices, and ancillary spaces. Our research indicated that for services already offering regular telehealth, this presented few problems. However, for others, appropriate space was hard to find – because it was inappropriately noisy, visually exposed, too small, too large, or just not available for use.
Individual enclosed consultation rooms provide excellent privacy and acoustic
Mixing it up – 50 per cent telehealth ‘Business-as-usual’ spaces have worked as well as could be expected given the unprecedented nature of the COVID-19 crisis, but layout changes are both necessary and inevitable for healthcare workers to deliver optimal care for their patients in the future. As clinicians and administrators examine the successes of telehealth during 2020, it’s likely that many will look to deliver mixed-mode healthcare on an ongoing basis. The barriers to telehealth implementation will be addressed gradually, to limit disruption, eventually allowing clinicians to make permanent changes in their models of care. While there are endless possible approaches, Figures 2 and 3 show two. Each has its advantages, and the benefits will vary according to patient cohorts, models of care, and available space. One research participant outlined
Reception Entry
Waiting
Staff support and meeting rooms
n Consult rooms n Waiting area
n Staff circulation n Patient circulation
Figure 1: This floorplan shows a common planning approach to Outpatient Departments, with a central waiting area surrounded by consultation rooms.
©Simon Wood
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