Until mid-March, the emergency room entrance at Baystate Medical Center in Springfield, Massachusetts, looked much like the entrance to other ERs: an illuminated red “EMERGENCY” sign mounted on a brick facade, above an open space where cars and ambulances could unload patients.
By the end of the month, part of that once-open space had been enclosed by temporary walls. Two swinging doors led to a new entrance, with a registration desk protected by a pane of glass. Beyond that, a series of cubicles waited, spaced 6 feet apart. Hand sanitizers dotted the walls. One room was reserved for testing. Health care workers were trained to travel the new hallway in one direction, to reduce crowding. A portable HVAC unit circulated air in and out.
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The new temporary facility is for assessing potential Covid-19 patients. With the renovations, the Springfield ER in just a few weeks more than tripled its triage capacity, to 33 from 10, with an eye toward the special needs of infectious diseases.
Pop-up field hospitals and Navy hospital ships have received a lot of attention during the Covid-19 crisis. US hospitals generally do not have surplus beds and protective equipment, because of the cost. So bed-filled convention centers in New York City and Detroit have become unsettling symbols of American shortcomings in preparing for the virus. But inside and around hospitals bracing for more sick patients, the changes have been subtler—if just as serious.
Health care workers need more space for examining patients, hand-washing, and putting on and taking off personal protective equipment. They need to quickly separate Covid-19 patients from those suffering from other maladies—heart attacks, respiratory issues, and broken bones. They must enforce new, strict visitor policies, which sometimes bar relatives from the rooms of dying patients. They’d like to check on infectious disease patients without entering rooms, which would require another change of still-limited protective gear.
“It’s becoming clear that they’re going to be treating patients with Covid for a long period of time,” says Kate Mullaney, a health care marketing strategist at the architecture firm HGA, which works with hospitals. She says the firm is aiming for “a midterm strategy for hospitals, to get them back to business.”
In Springfield, the triage center is only the most visible of Baystate Medical Center’s pandemic-related design tweaks, says Kirsten Waltz, the hospital system’s director of facilities planning and design. In one week, an in-house engineering team replaced solid doors on patient rooms with glass ones, so health care workers can see patients without risking exposure to the virus. It erected glass sneeze guards at nurse stations and reception desks. It limited entries to the hospital, so the visitors still permitted into the facilities are forced to sign in and wear masks when they arrive. In the future, Waltz says, the hospital will consider building more sinks and constructing storage rooms so workers have easier access to protective gear.
The situation in Springfield does not look as immediately dire as it did when the hospital began constructing its triage area, in mid-March. Massachusetts closed nonessential businesses on March 24, and does not expect its peak in cases until next week. But Baystate’s workers still feel like they are racing the clock. “We’re at the plateau right now,” says Waltz, referring to the number of Covid-19 cases in the area, which reached 540 on Monday. “I think it’s essential for us to learn in case we have another spike.”
Equipping hospitals to battle an infectious disease is not just about installing more beds or adding ventilators. Infected patients need to be isolated; air needs to be sucked out of patient rooms up to 10 times an hour, to avoid cross-contamination. Safe storage spots are needed for oxygen tanks, both full and empty. And each room needs to be near an equipped nurses’ station, where workers can fill out paperwork, talk to each other, and wash their hands.
Of course, it’s easier to envision the ideal space for infectious disease patients than to build and fund one in the midst of a pandemic. A stopgap solution may be prefabricated modules like those built by the architecture firm HGA and the construction company Boldt. The units are designed to be placed next to hospitals, as additions, or as standalone field hospitals. They come equipped with specialized stations for workers to safely put on and remove protective equipment; controls for patient’s IV pumps reach into corridors, so workers can monitor them without entering patients’ rooms.
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Last month, HGA heard mostly from health care systems interested in field hospitals or tents, amid concerns they would not have enough beds for the sick. “Now, we’re looking more into the quality of the care environment,” says Kurt Spiering, an architect and a principal at the firm who specializes in health care design. The company expects to ship its first prefab module to a client on Monday.
As the crisis drags on, health care designers are thinking about more far-reaching changes to hospitals, too. In the past, “universal rooms” with built-in flexibility to handle patients at all stages of care have been seen as inconvenient for hospital staff, with specialists forced to run all over the facility to see their patients. These spaces also tend to be more expensive to construct. But the model might get a second look in health care facilities newly worried about adapting to sudden onslaughts of infectious disease, says Frank Zilm, the director of the Institute of Health and Wellness Design at the University of Kansas.
The pandemic may also spark interest in planning for future patient surges, whether they’re related to global pandemics or more local disasters, like earthquakes and mass shootings. Hui Cai, the associate director of the institute, predicts US hospitals may imitate facilities overseas and identify potential places for overflow patients, such as nearby parking lots, public buildings, or convention centers, before they even start building.
In Springfield, the dramatic surge in Covid-19 patients that health care workers feared hasn’t yet arrived, so the new triage center isn’t being used to evaluate or test sick people. Instead, the Baystate Health system is using the space to train workers to use new kinds of protective equipment, and to fit them to N95 masks. “It has been a benefit, but it hasn’t been used for patients,” says Waltz, the design director. She’s hoping it stays that way.