The immediate need for surge hospitals turned the traditional design process upside down, while also revealing the collective strengths of a team on a mission.
Thankfully, we haven’t had the anticipated surges in our geographic regions. Yet as the economy begins to reopen, the danger of a sudden increase in infections remains. And the lessons learned remain timely as we move forward.
Members of the Karpinski team worked with a number of healthcare organizations as they evaluated their existing facilities and developed surge facilities. Here are some of their thoughts about the process and about the future.
Fast decision-making was key
Given model projections, the surge hospital teams needed to work fast and make decisions quickly. They delivered.
“It’s amazing what can actually get done by a group of professionals in a very short period of time….People can break down barriers if they need to. It’s refreshing,” said Principal Frank Eisenhower, PE, LEED AP, NITC, ASSE 6005 Certified.
During the first surge hospital meeting he attended, Eisenhower said, the team designed the entire oxygen system for 1,100 patient beds while onsite, and the contractors procured all the materials (pipe, fittings, outlets, alarms, etc.) before they left the meeting.
Principal Rocco Gallo, LEED AP, witnessed a shift in the project decision-making structure: “People [within the healthcare organization] were given authority to make decisions, and I think that was the key. They didn’t have to run decisions through the typical decision-making process. They had the autonomy to get the job done.”
The availability of construction materials drove design decisions
The surge hospital teams made design decisions based on what construction materials were immediately available in the quantity they needed. The contractors played a key role in the process.
“I could sit here and sketch things all day, but if we couldn’t get a thousand of it, it didn’t matter. I started with the contractor and asked what was available, then designed around that,” said Gallo.
“A direct line of communication with the contractor was vital,” said Karpinski President Jim Cicero, PE, LEED AP. “We were able to understand exactly what materials they were going to get, then modify our sketches based on what they’d be getting.”
People did amazing work
“The common goal was obvious and what people focused on,” said Mechanical Associate Matt Morgan, PE, LEED AP BD+C. “There was a united effort among firms that are often otherwise competitors.”
“Our clients thanked us a lot. I just kept saying ‘thank you’ to them, because what they were going through had to be much more demanding than us.”
For Construction Coordinator Bob Rhodes, QCxP, the contractors were most important in getting the job done “because they were the ones doing the work. They had to get the equipment and the materials and put it all together in the field. At the time, we were not sure how coronavirus spread. They worked around the clock, side by side, risking their own wellbeing, to be able to help the wellbeing of others.”
Cicero described how one team designed a 500,000 SF facility within a week, with the contractors building it within two weeks. He applauded everyone involved “for being able to change gears from that mental state we’re all used to being in, of protecting ourselves from risk, to one of just getting it done.”
We need to do our part to help healthcare organizations prepare for the next time
One way to be better prepared is by building adaptability into facilities.
Gallo noted that on one of his projects, the new question became, “Can the building be modular? Can it change easily from one function to another?”
As designers, he said, they’re asking, “How do you design the building in a way that you’re not pouring a lot of money in up front, but can easily change it to something else?”
Similarly, Cicero recounted a conversation he had with architectural colleagues, as they began brainstorming how to design B Occupancy buildings (such as academic buildings or outpatient facilities) with the capacity to be transformed into temporary hospitals. For example, would you include connection points for an emergency generator or oxygen system? Would you install additional valves in the plumbing system, so more sinks and toilet rooms can be added if needed? What’s realistically achievable?
Hospitals’ medical gas systems need a fresh look
With COVID-19, patients have needed respiratory support (such as oxygen or ventilators). In conversation with staff at one healthcare organization, Director of Plumbing Tim Foresta, CPD, NITC, ASSE 6005 Certified, learned that most of the COVID-19 patients in step-down were not only given oxygen therapy, but were using oxygen at a higher rate than is typical.
Within hospitals, medical gas is available in every patient room. However, the expectation is that it won’t be used in every room at the same time. Standard medical gas systems aren’t sized with the capacity for 100% of the rooms to be using it simultaneously.
That raises questions about a hospital’s medical gas supply: Does the hospital have enough medical gas to support a substantial increase in demand? And if not, can they get an emergency supply? How much can they get?
For Foresta, it also got him thinking about how hospitals can prepare for the future to withstand such an event. He suggested that hospitals undertake an initiative to create dedicated spaces that can support simultaneous, 100% use of oxygen and medical air for a greater-than-normal number of patients on ventilators. When selecting a location for these spaces, hospitals need to consider proximity to the oxygen bulk plant and medical air compressors, as well as the respective pipeline’s mains. These spaces also should not be, for example, up high in a bed tower too distant from the oxygen and medical air sources. Too often the critical care areas, which are well-suited for this service, are located where the normally-adequate pipeline lacks the capacity to deliver under this kind of duress. In this situation, reworking the existing infrastructure pipeline would be very expensive. Instead, a more cost-effective is to create a make-shift surge area closer to the source.
And if the hospital’s existing bulk medical gas system isn’t sized to accommodate the increased demand, then they’ll need mobilized emergency equipment. Foresta recommends reviewing options for bringing in mobile capacity and having the pipeline already in place for faster connection.