cshe- the future of hospital design & constructionr
TRANSCRIPT
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1CSHE Redwood Chapter‐ October 29, 2020
The Effect of the Pandemic on Future
Hospital Design and ConstructionChris Tokas,
Deputy Division ChiefFacilities Development Division, OSHPD
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2CSHE Redwood Chapter‐ October 29, 2020
Operational Changes in Healthcare Delivery Forced by COVID 19• The goal: be able to isolate and treat infectious patients while continuing to provide other vital services that keep people healthy and bring in the revenue
• Triage and check in patients remotely• Quarantine the infected in separate facilities and reduce physical contact with caregivers to prevent the spread of disease
• Resurgences of the coronavirus, and potential outbreaks of other infectious diseases
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3CSHE Redwood Chapter‐ October 29, 2020
Making Patient Intake Safer (zero‐contact intake process)• Separate infectious patients
• Patient Triage • Quarantine zones
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4CSHE Redwood Chapter‐ October 29, 2020
Making Patient Intake Safer (zero‐contact intake process)• The End of Traditional Single Entrance
• Implemented restrictions on patient/visitor traffic flow to control cross‐contamination.
• Separate patients and clinicians from visitor traffic
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5CSHE Redwood Chapter‐ October 29, 2020
Making Patient Intake Safer (zero‐contact intake process)• Digital Check‐in patients as they approach the hospital (GIS) Red, Yellow, Green designation based on symptoms
• Higher‐risk patients are escorted directly to care rooms
• Rethinking the medical record preadmittance component
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6CSHE Redwood Chapter‐ October 29, 2020
EDs – Observations from the COVID 19 Experiment• Dedicated isolation and decontamination rooms that can be used for patients who present with infectious disease, behavioral‐health or chemical‐contamination issues
• Separate incoming and discharged patients• Multiple entrances for different levels of patient severity• Reduces potential for cross contamination either in hallways, adjunct patient holding/waiting, or within radiology rooms
• Interdepartmental imaging and X‐ray facilities so patients don’t have to be transported to the main hospital for tests
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7CSHE Redwood Chapter‐ October 29, 2020
EDs – Observations from the COVID 19 Experiment
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8CSHE Redwood Chapter‐ October 29, 2020
Actions to Increase Space/Beds for Surge Capacity • Normal operations, regular patient treatment, elective procedures paused through pandemic
• Increase No. of beds within the hospital proper• Use of shelled spaces • Increase patient room capacity
• Activation of decommissioned spaces in SPC‐1 Buildings.• Alternate Care Sites (FMS)• Portable Buildings Mobilized as Needed
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9CSHE Redwood Chapter‐ October 29, 2020
Aggregating COVID‐19 Into One Site or Hospital Wing
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10CSHE Redwood Chapter‐ October 29, 2020
Conversion of (E) Patient Units for Higher Acuity Patient Care• More intensive care units / negative pressure isolation
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11CSHE Redwood Chapter‐ October 29, 2020
Conversion of (E) Patient Units for Higher Acuity Patient Care• Negative pressure isolation anterooms
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12CSHE Redwood Chapter‐ October 29, 2020
Building Management Systems Automation for Changing Patient Units for Higher Acuity Use
• Increase the number of airborne infection isolation rooms• Some patient rooms adjustable to:
• Negative pressure• All air exhausted through HEPA
• Some ORs with a negative ante‐room• Operating rooms capable of switching from positive to negative
• Built‐in options to converting patient rooms to negative pressure (similar to PIN 4)
• Rethinking circulation in triage/ED units
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13CSHE Redwood Chapter‐ October 29, 2020
HVAC System/Ventilation
• UV‐C treatment at coils and/or filters• R.H. from 40% to 60% in some spaces• Enhanced filtration with MERV 13 or 14 as a starting point.
• 13 is more applicable to many spaces while 14 may induce excess pressure drop
• Measures to increase outdoor air rates (dilution)• In‐room HEPA recirculating systems• Evaluate the application of minimum 6 total ACH where there starts to be a point of diminishing return in the reduction of Quanta within a room
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14CSHE Redwood Chapter‐ October 29, 2020
HVAC System/Ventilation
• Increased locations for low return/exhaust grilles• Dedicated exhaust path for each toilet stall (partitions up to the ceiling). Possible increase to 15 ACH
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15CSHE Redwood Chapter‐ October 29, 2020
MEDICAL GAS SYSTEM
• Availability of Ventilators• Increase medical gases, suction and electrical power capability, which can be deployed quickly to handle space needs in a massive patient surge
• Revisit Diversity Factors ‐ Oxygen, Medical Air• Piping Sizing Impact• Medical gases and emergency power in non‐patient areas that could be used for surge
• Systems Capacity
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16CSHE Redwood Chapter‐ October 29, 2020
RFID Asset Tracking Software for Equipment, Patients and Staff• A Radio Frequency Identification (RFID) system, allows staff to know the exact location and condition of critical resources needed.
• Track assets not only by room or bay, but even by shelf‐level locators. • Expanding on this technology and tracking staff and patients can be a crucial aspect of defending the spread of infectious diseases in hospitals.
• The ability to know who and what the staff came in contact withcan reduce the risk prior to the infectious diseases getting out of control.
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17CSHE Redwood Chapter‐ October 29, 2020
Automatic Infection Control Systems
• Handwashing Monitoring Systems• Touchless operational components:
• Water fountains• Water bottle fillers• Revolving doors• Elevators• Doors not requiring hand contact (accessibility bars, etc.)
• Disinfectant mats at entries
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18CSHE Redwood Chapter‐ October 29, 2020
Keeping Doctors and Patients at a Distance
• Doing virtual rounds with one doctor in the room and others connected via videoconference outside
• Potential use of video cameras for caregivers
• In ICUs, IVs and monitors positioned outside the room so nurses can check patients’ status without unnecessary exposure for both
Jon Gerberg/The Washington Post)
Barcroft Media via Getty Images
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19CSHE Redwood Chapter‐ October 29, 2020
Keeping Doctors and Patients at a Distance
• Computerized Robots • Telehealth visits to patient rooms enable doctors to have more‐frequent visits with patients because they don’t need to take time to don and doff protective equipment
• “Mechanized helpers” to provide more service in hospital wards
• Robots to perform tasks that take nurses away from direct patient care, such as fetching and delivering medications and supplies to patient rooms and handling lab samples
Flavio Lo Scalzo/Reuters
Orissa Post
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20CSHE Redwood Chapter‐ October 29, 2020
Move to a Broader Telehealth Model
• Technology will be the catalyst, but it must be applied strategically• Augmented reality• Artificial intelligence‐enabled technology, • Precision medicine; and,• Virtual care support
• The combination of increased data gathering and artificial intelligence to make the society more resilient to disease spread
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21CSHE Redwood Chapter‐ October 29, 2020
More accommodations for telehealth (82%)
Requirements for more surge capacity (70%)
More intensive care units / negative pressure isolation (66%)
Increased adoption of prefabricated / modular elements for flexibility (43%)
Other (28%)
How Will The Covid‐19 Pandemic Impact The Design And Construction Of Healthcare Facilities In The Future?
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22CSHE Redwood Chapter‐ October 29, 2020
OSHPD Emergency Design Task Force• Team Members
• OSHPD FDD• Executive Staff
• Paul Coleman• Chris Tokas• Gordon Oakley
• Building Standards Unit• Richard Tannahill• David Mason• Bill Gow
• SCU/CDPH ‐ Carl Scheuerman• Northern Supervisor ‐ Diana Scaturro• Southern Supervisor ‐ Diana Navarro• FLSO – Nanci Timmins
• CDPH• Industry Representatives• Design Professionals• Contractors/Builders• IOR• Field Staff (RCO)• Others
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TASK FORCE
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23CSHE Redwood Chapter‐ October 29, 2020
Construction Protocol Changes
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24CSHE Redwood Chapter‐ October 29, 2020
Current Changes To Construction Process Activities During Covid‐19• Labor/Productivity Impacts:
• Verification• Temperature Checks• Wrist band• Distancing during construction• Disinfection• Sanitize Tools & Equipment• PPE Costs• Material Impacts• etc.
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25CSHE Redwood Chapter‐ October 29, 2020
COVID‐19’s effects on supply, demand, and industry dynamics
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26CSHE Redwood Chapter‐ October 29, 2020
Short and Long‐Term Trends
• Increased digitization (Short term)• Shifting to remote ways of working.
• Designers and engineers are relying even more heavily on digital collaboration tools such as building‐information modeling (BIM)
• Leading engineers and contractors are using 4D and 5D simulation to re‐plan projects and reoptimize schedules
• Digital‐twin solutions are being developed to be used end to end, from project concept to commissioning
• Contractors are looking to monitoring their employees’ well‐being through apps, ordering construction materials, managing scarce resources more accurately, and maintaining cash flow
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27CSHE Redwood Chapter‐ October 29, 2020
Short and Long‐Term Trends
• Rebalanced supply chains toward resilience (versus efficiency) – (Short term)
• Contractors are building inventory, securing critical materials and long‐lead items, and identifying alternative suppliers
• Augmented consolidation (Long term)• Players are looking to consolidate to establish economies of scale and support investment in IT, talent, R&D, and technology
• Companies and investors will increasingly look to consolidation for much‐needed resilience in their balance sheets
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28CSHE Redwood Chapter‐ October 29, 2020
Short and Long‐Term Trends
• Vertical integration (Long term)• Industry players have started to vertically integrate to increase efficiency and as a route to standardization and control of design and execution
• In a post‐crisis world, vertical integration (which may include a return to greater reliance on direct labor) is a potential route to greater resilience
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29CSHE Redwood Chapter‐ October 29, 2020
Short and Long‐Term Trends
• Further investments in technology or digitization and innovation of building systems (Long term)
• Shortage of skilled labor • Physical‐distancing measures • Restrictions on cross‐border movement of labor
• Digital tools have proven to increase productivity, such as 4D simulation, digital workflow management, real‐time progress tracking, and advanced schedule optimization
• Increased in R&D spending to develop new standardized building systems to speed up and automate elements of design and construction
• Are we going to see more players investing in automation of on‐site and back‐office processes
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30CSHE Redwood Chapter‐ October 29, 2020
Short and Long‐Term Trends
• Increase in off‐site construction (Long term)• Quality and speed benefits• Contractors gradually push fabrication off‐site
• Manufacturers expand their range of prefabricated subassemblies• Building in controlled environments is more effective and efficient in a world that requires close management of the movement and interaction of workforces
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31CSHE Redwood Chapter‐ October 29, 2020 31
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HBSB Technology Committee - September 10, 2020 32
Questions