ARCHITECTURE & DESIGN
level of risk. Green denotes a mild disease or a severe disease that does not spread rapidly from person to person; yellow denotes a severe disease that spreads rapidly but is not affecting Singapore, or is typically only producing mild symptoms; orange denotes a severe disease that spreads rapidly but is being contained effectively, and red denotes a severe disease that is spreading widely. What’s interesting from a UK healthcare estates perspective is the ways in which this system has been used to inform hospital design in Singapore and other countries in the region. It has nurtured design strategies that facilitate a rapid response to prevention and infection control when a potential epidemic is identified, while allowing existing hospitals to continue delivering routine care and treatment pathways. The design strategies have been effective because they have been integrated with speed and clarity of information, widespread testing, and contact tracing, so it would be naïve to suggest that resilience-based hospital design can provide a standalone solution on its own. However, building crisis strategy into the design of hospital assets is part of an effective rapid response to the threat of a developing pandemic, so it’s useful to understand the lessons Singapore’s DORSCON-influenced design approach can offer the UK.
Designed with significant surge capacity
One of the key elements that has supported improved resilience in Singapore is that healthcare facilities are designed with significant surge capacity, and for complex surge scenarios. This includes provision for a mass-casualty incident, pandemic, or mass exposure to hazardous materials incident, requiring a hospital decontamination station. To enable surge scenarios to be implemented, hospitals are designed to segment patient flows before incoming patients enter A&E, providing virtual self-assessment tools, and deploying external spaces, such as car parks, for triage and testing. Access routes into the hospital are segregated for those with symptoms and those without, to enable high levels of infection control. These separate entry routes can then be used to further segment patients according to risk (contact, positive, negative, and quarantine), to enable high- risk patients to be treated in isolation while the rest of the department continues to operate as normal.
A zoned, compartmentalised design strategy with adaptable patient flows (see Fig 1) provides the potential to isolate and lock down specific areas of both the hospital and key departments, such as radiology, ICU, and IPU. This enables the hospital to be switched from normal
operations to crisis response to allow infectious patients to be treated without additional risk for those who are in need of treatment, but are unaffected by the pandemic/accident. The addition of adequately pressurised buffer zones to separate compartments prevents transfer of contaminated airflow to enable effective infection control.
Overflow provision
This design approach also includes overflow provision for isolation and resuscitation by designing critical care cubicles with negative pressure and resuscitation capacity. Trauma areas are also designed to support double occupancy for use in a surge scenario. Of course, managing the facility in this way not only relies on a layout and circulation routes designed for compartmentation, but also involves specifying the building services to allow independent functioning of isolated areas. This involves a highly resilient building services engineering strategy to provide up to 100% redundancy in air-handling units, power, and medical gases, ensuring that the critical treatment facility can remain operational even if catastrophic failure of any of the building services occurs. It’s also important to note that the design strategy employed in Singapore also considers the impact of pandemic
Buildings of the future
Our futurebuildings will be energy positive and smart grid ready. They will be Hyper-efficient in utilisation a waste and thoughtfully designed for people
and
infrastructure provides hitect
An all-electric arc
ure paired with an all-digital b .
to healthy uilding actib occupant experiences.
www.se.com/uk d o uilding
maximum efficiency benefit, insights ons an verall improvements to
September 2020 Health Estate Journal 59
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92
