October 2020 — Health Care & Senior Housing Quarterly — Page 13 Design H ealth care facilities across the country are making dramatic changes to their waiting areas in response to the coronavirus pandemic, which has accelerated the grow- ing belief that the very concept of a “waiting room” is long overdue for a critical reevaluation. Currently, from hospitals to retail clinics, patients entering a health care environment are being treated with the assumption that they could be COVID-19-positive and adjustments to intake processes have been made accordingly. The Centers for Disease Control and Pre- vention recommend the implemen- tation of “source control for every- one entering the facility, regardless of symptoms.” These changes start with the medical staff’s level of per- sonal protective equipment, such as N95 masks, face shields and gowns, for all personnel interacting with visitors and patients. Many health facili- ties also are attempt- ing, as much as possible, to maintain 6 feet of separation between visitors, and between pro- vider and patient. Such “social distancing”modi- fications have extended to waiting rooms themselves, either by remov- ing or reconfiguring seating areas. For nonemergency intake facilities, the increased use of appointments is help- ing to reduce crowding as well. Patients must also do their part by wearing masks before entering the facility and arriving unaccompanied. Old carpets are replaced with other resilient floorings, deep cleanings occur regularly, hand sani- tizer is everywhere and Plexiglas shields are being installed. Waiting rooms in the time of COVID- 19 are definitely areas in transition. WhyWait? Even before the pandemic, the medical commu- nity widely recognized the idea of a “waiting room” was in dire need of a rethink. Waiting is never enjoy- able, especially if you are waiting in an area with other potentially sick and contagious patients. From an economic standpoint, a patient waiting is not contributing to a hospital’s bottom line and it is sel- dom a “value-added” experience for patients, who are often missing out on their own work and other obliga- tions as they wait. Most importantly, improved intake improves health outcomes. After all, getting the patient where he needs to be as quickly as possible, especially in emergency situations, is vital. Intake trends already were headed in the right direction, including incorporating biophilic design in waiting areas and prioritizing quick and efficient intake and rooming. But they still have a way to go. Overall, the average wait time to see a doctor in a taken before the pandemic was approximately 18 minutes, 13 seconds; as expected, longer waits negatively impacted patient satisfaction. For hospital emergency departments, normal wait times exceeded 90 minutes. Pioneering facilities are beginning to completely rethink the process; several have created the position of “intake physician” as a point person to immediately assess incoming patients and assign them to the appropriate path of care. COVID- 19 may push health care facilities toward “just-in-time” delivery of care and a greater integration of technology. A Future Relic Revamped intake procedures go hand in hand with revamped spac- es, and clearly the temporary modi- fications to the areas themselves must be made permanent in many respects. Private waiting spaces – they might even be described as “pods” – are one possible step forward, because while patients must be socially distant from each other, the close companionship of a friend or family member who can advo- cate and convey patient needs, is often vital to health outcomes; it can truly save lives if the patient is incapacitated to some degree and is unable to fully describe their need themselves. More broadly, patient intake needs to be staged in various zones of processing. Some facilities have even erected pre-entry tents amid the COVID-19 outbreak to screen for high temperatures before admitting The demise of the waiting room as it exists today Akshay Sangolli, AIA, ACHA, EDAC, LEED AP BD+C Senior medical planner, managing principal – Denver, EYP Architecture & Engineering Mark Vaughan, AIA, FACHA National director of medical planning, senior principal, EYP Architecture & Engineering Please see Sangolli, Page 19 Construction H ealth care construction is one of the most necessary and challenging sectors of commercial construction. As technology advances, regulations change and the needs of patients and employees shift, a constant evolution in design and construction is necessary to meet the objectives of these projects. The urgency of the onset of COVID-19 has shed light on a need for improved efficiency in the renovation and construction of health care facilities. “An immedi- ate concern is for hospitals to keep elective, or necessary but not life- threatening, surgery cases going while dealing with overflowing emergency departments and inten- sive care unit beds,” said Richard Simone in Healthcare Construction + Operations News. Implementing facility renova- tions to create segregated areas and reconfigure existing spaces will be key to maintaining revenue-gener- ating operations. Revisiting modular construction solutions, building new HVAC systems and considering micro-hospital developments for specialized services will lead these developments. “What drives our clients to modular is the flexibility, time and financing we can bring with it,” said John Lefkus, president and a prin- cipal owner of RAD Technology, a modular builder that specializes in radiation, steriliza- tion and oncology facilities. Urgent care facilities and ambulatory surgi- cal centers sepa- rate from large hospital facilities will continue to grow, as they often offer procedures at a lower price and reduce the risk of exposure to infection. In addition, the desire for treatment options to be available closer to patients and for facilities themselves to become smaller and more specialized is increasing the demand for additional free-stand- ing centers. The future of new con- struction will include an expansion of medical facilities providing ser- vices outside of acute care, such as childbirth, dialysis, medical imaging and rehabilitation. Increased regulations and policies around isolation and surge capacity at hospitals to mitigate COVID-19 have impacted the build environ- ment and will continue to do so. In order to deliver a quality construc- tion project on time and on budget under this new environment, stake- holders must select a team that is up to date on the latest techniques in the health care planning, design, and construction processes as well as Life Safety Code compliance, and understand the special consid- erations in Infection Control and Risk Assessment. Moving forward, specialized healthcare certifica- tions such as ASHE and ICRA will be expected of all members of the project team. Onboarding general contractors earlier in the design and precon- struction phase provides another opportunity to maximize efficiency. As issues in supply chains, speed- to-market and labor shortages continue to increase as a result of COVID-19, the insight and experi- ence of professional general con- tractors will be an asset early on. Their ability to advise on material selection and procurement to fit the goals, budget and project timeframe combined with longstanding rela- tionships with subcontractors can mitigate the impact of the afore- mentioned issues. To expedite the construction process so that the provider can start servicing patients, the owner, design professionals and contrac- tors are, “Working together to see how these buildings can be con- structed as fast as possible,” said Robert Brewer, a partner of Grassi's architecture and engineering prac- tice in a recent Construction Dive article. Involving GCs from the get-go can help owners identify any potential obstacles from the start and inte- grate solutions into the project bud- get and timeline. Inspections can be scheduled in an efficient sequence, clear purchasing, and delivery dates can be set, and performance stan- dards can be set so that work gets done correctly the first time. “We have a keen understanding of who can do what and have cre- ated a dynamic and flow within our team,” says Bill Bryant, senior proj- ect manager at Global Construction. Seasoned professionals also will be able to react on the fly, overcoming obstacles and adapting resource allocations to ensure maximum job- site productivity. Finally, selecting a team that val- ues staff and patient safety and understands the expectations of conducting work in an operational facility will still be paramount. Designers and architects who have a holistic view of the project and understand how their decisions impact the construction process will be better suited for these proj- ects. General contractors who have developed systems and practices that ensure uninterrupted patient care and patient, staff and visi- tor safety will lead the way for the future of medical facility construc- tion. s Flexible design solutions for health care renovations Erik Good Senior project manager, Global Construction LLC