A Unit-Level Case: Radiology Emergency Viewpoints
For over two and a half years, the world has been fighting COVID-19, with the total death toll passing 6.5 million, and there has been a new variant every several months, making the effects of the pandemic remain active. Hence, there is an urgent need for sustainable health emergency preparedness to deal with the next pandemic with the knowledge and experience of healthcare experts and design experts. It will be crucial to design future healthcare buildings and departments, to be pandemic resilient, sustainable and adaptable for different scales of usage.
Whether large or small, healthcare systems can implement resilience strategies to support and maintain operations during a pandemic. In addition to unit-level details, some basic principles must be considered, such as versatility, surge readiness, supporting well-being, hygiene, isolation, patient visibility and safe circulation of patient movement, to name a few. Many healthcare facilities had to quickly implement and streamline technology, enabling providers to communicate with patients remotely, i.e., telehealth or telemedicine, and a resilient layout should also consider the impact of this trend. Therefore, ‘resiliency’ is a keyword with the ability for healthcare facilities to adapt their design and functionality to respond to changing situations.
Building more flexible hospitals has accelerated as a new trend in American healthcare. Patient rooms in emergency departments use glass doors to increase visibility and decrease the contacts and negative-pressure ventilation to fully isolate infectious patients, for example. The challenge, however, is to be able to cater to all possible scenarios because the next pandemic may very well be different from what we have recently experienced.
In terms of optimization, the widely used quantitative objective in the facility layout literature is minimizing material handling costs between departments units in the facility. However, quantitative factors, such as material handling cost and adjacency scores, and qualitative factors, such as flexibility of the layouts for future changes, health and safety concerns (especially with healthcare emergencies requiring interpersonal distancing) must be considered together.
These additional objectives will require dynamic facility layout and multi-objective mathematical modeling, which bring extra complications to modeling layout problems and solving them. One good fit might be utilizing a zone-based dynamic facility layout where the dimensions of the departments are decision variables, and the departments are assigned to flexible zones with a pre-structured positioning. A zone-based block layout inherently includes possible aisle structures that can easily be adapted to the current material handling system. The zone-based design is crucial in the dynamic facility layout because the changes in a block layout from one period to the next (such as before, during and after pandemics) may require structural modifications in the layout, which in turn may be very costly or even impossible to implement practically. Most importantly, since a hospital is an interconnected system, any departmental improvement will also affect the other departments’ operational efficiency.
The Penn State health experience
The Penn State Milton S. Hershey Medical Center is a large, academic tertiary-care hospital in Central Pennsylvania and the home of the Penn State College of Medicine. From a facilities standpoint, prior to the COVID-19 pandemic, there had been no scenario planning nor any preparations made in consideration of risks related to an outbreak of infectious disease; the facility was prepared to contain and safely care for isolated individuals with infectious diseases (e.g., the occasional case of measles) but was woefully unprepared for a pandemic virus.
During the peak of the COVID pandemic in 2020, there was considerable added cost, staff and patient pathogen-exposure risk and operational confusion brought about by the need to rapidly repurpose and reconfigure spaces within the hospital. The Radiology reading room serving the Emergency Department was hastily relocated to the basement of the hospital, and protocols were developed for remote-only consultation between radiologists and emergency physicians.