Significant drivers affecting emergency and hospital design

Brinda Sengupta, Associate, HKS, Inc.

Angela Lee, Managing Director, HKS Asia Pacific

Health Systems across the globe are challenged with the issues associated with pandemic events, including such as SARS, and the recent COVID-19. HKS has been at the forefront of emergency preparedness. The Macau Island Hospital and Changi General Hospital are being designed with several key elements that support the objectives for meeting emergency and disaster preparedness initiatives.

The current outbreak of COVID-19 has given all countries a jolt and made them think about their healthcare facilities in a new light. Most countries are struggling with a lack of isolation wards and adequate decontamination facilities. It is the need of the hour for health professionals, operators, government departments to implement disaster preparedness within existing and new hospitals. While healthcare policy, governance, and operations will play a big role in planning and management, healthcare design professionals have a significant task of leading a radical shift in the design of hospitals.

Here we outline a few design strategies for hospital design to address disaster preparedness.

1. Allow compartmentalisation for isolation: For Macau Island Hospital, the emergency department (ED) was designed in a way so as to allow for a portion of the ED to be isolated for a mass casualty or contagious outbreak, while at the same time allowing for the main ED to remain operational. The emergency department was designed to operate under normal circumstances with six key zones including a fever clinic, multiple floors with 23-hour emergency observation, level 1 trauma / resuscitation rooms, level 2 and 3 emergency room beds, level 4 and 5 fast track/triage area and dedicated computerised tomography (CT) and radiology imaging services.

2. Remodel existing emergency departments to be pandemic ready: The remodelling the of emergency department at Changi Hospital is still on going with the participation of EP team at an early stage. The workflow of the pandemic is introduced and incorporated into medical planning with several key planning points to ensure the hospital the ability to respond to a pandemic event effectively within a short timeframe.

3. Plan for exterior expansion of ED: To ensure higher footfalls can be accommodated during an outbreak, it is imperative to create a larger department for pandemic readiness. In Macau Island Hospital, several design features are integral to allow for the expansion of exterior emergency drop-off area into a temporary triage area and separate decontamination area that allows for the treatment of potentially contagious or contaminated patients. Structural davit connections or permanent ceiling mounted tracks can be provided to accommodate temporary fabric partitions or curtains. Strategically located hose bibs with shower heads for decontamination of patients Trench drains with dedicated plumbing diverted for decontamination

4. Ensure dedicated vertical circulation during an outbreak: In order to provide enough accommodations for isolation of large patient populations during quarantine events, it was necessary to provide dedicated vertical circulation access to multiple levels of the facility. This access was coordinated to allow for the segregation of these isolated floors while also maintaining vertical circulation capabilities for the remainder of the hospital tower to allow for normal operations to continue during quarantine and pandemic events. The AGV Supply and Soiled Service Elevators will be temporarily quarantined for isolation of infectious patient movement from the ED to the isolated emergency observation floors on levels 8 and 9.

5. Design of Isolation Room Suites: Isolation Patient Room Suites: In Queen Mary Hospital, Hong Kong, these suites are areas where isolation patient rooms have been consolidated along a dedicated corridor with two entrances: one from the ward they are associated with and a secondary entrance from outside the ward. This will allow utilisation of these room both as part of the department or as a free-standing infectious patient suite.

6. Devise a sound mechanical engineering strategy: The physical design of isolation facilities needs to be complimented by a sound mechanical strategy. This requires mechanical systems which have to be designed to allow for the compartmentalisation and isolation of several zones during seasonal flu season or potentially pandemic events.

While providing flexibility to convert patient care areas to negative pressure zones during mass quarantine or pandemic events is crucial, the solution must also be designed to conserve energy during normal use. Areas programmed for quarantine isolation zoning are typically areas that are not fully exhausted during normal operation. Operating these areas with full exhaust during normal operation would increase the energy required to condition the necessary extra outside air. Using strategically placed dampers and direct digital controls energy can be conserved and the isolated areas can still be converted to negative pressure with minimal effort or disruption.

At the Macau Island Hospital, during normal operation the return air damper is open, the exhaust damper is closed, and the air handling unit is only bringing in the minimum amount of outside air required for the space. However, when the area is under isolation a command can be sent from the controls system to close the return air damper, open the exhaust air damper and also open the economiser damper in the air handling unit. When the damper positions are confirmed by the controls the exhaust fan starts, the area becomes active pressure and is isolated from spreading contamination to adjacent patient care areas.

During times of disaster, hospitals play an integral role within the health-care system by providing essential medical care to their communities. Without appropriate emergency planning, health systems can easily become overwhelmed in attempting to provide care during a critical event. It is time that hospital design and engineering professionals work together with healthcare operators, government officials and the community at large to be prepared for future disasters. Learning from International best practices and case studies would help create a shared knowledge platform on disaster preparedness which will help control outbreaks in the near future.

--Issue 48--

Author Bio

Brinda Sengupta

With 13 years of international design experience as an Architect and Urban Planner, Brinda Senguta has led teams across Asia, turning her clients’ visions into reality. Brinda believes the key to a successful project is great teamwork coupled with the pursuit of creativity and excellence at every step of the design process.

Angela Lee

As regional managing director of HKS Asia Pacific, Angela Lee has had 26 years of architecture and medical planning experience for over 1.1 million square meters of healthcare projects worldwide. She has been honoured and recognised by international institutes and publications such as AIA, Modern Healthcare, Health Facilities Management and Medical Construction and Design.

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