COVID-19 Unit Design: Prior Planning, Teamwork is Key
On Sunday, March 15, 2020, our first patient tested positive and we made the call to activate our COVID-19 cohort unit.
Our success was due to great teamwork. I am certain this teamwork will equip us for whatever future challenges come our way.
A task force had been meeting for several weeks to ready our hospital for this event. As the virus spread across the nation, we saw firsthand the challenges other organizations were facing. Equipment and space were limited, even leading some hospitals to stage patient rooms in areas like parking garages. Internally, we faced the reality of many unknowns. How many rooms would we need? What level of care would be required? What supplies were needed? Where would we house these patients? What PPE was needed to keep our staff safe?
A command center was established as a resource for the many questions we knew would come. The only thing we knew with certainty was the pathway to success required a team effort.
Thinking back to that Sunday afternoon, I am extremely thankful for the planning done years prior in the design of the North Mississippi Medical Center-Tupelo West Bed Tower. I recall Bruce Ridgway (my former leader and mentor) urging us to think beyond the needs we knew and consider what might occur in the future. What capabilities would this building need to provide in the decades to come? Two design concepts came from this planning: (1) the idea that future inpatients would need a higher level of care and (2) one day we might experience a pandemic and would need to group affected patients into an isolated area or cohort unit.
The West and Central Bed Towers were designed similar to a Critical Care Unit with a workstation and window that allow staff to monitor the patient from outside the room. It also meant more medical gases and electrical capacity than is typical in a standard patient room.
The possibility of a future pandemic also led to another key design feature. Instead of the traditional patient room HVAC design, we opted for a design that provided increased air filtration capacity, allowing groups of negative pressure rooms if needed. This filtration efficiency is like that of an N-95 mask. In normal times, a few rooms per floor could be used as negative pressure rooms; however, with this pandemic pre-planning two entire floors were ultimately converted to negative pressure rooms.
The design of these bed towers was just the beginning for successful implementation of our cohort units. The first necessary modification was to shift the negative pressure room capabilities to a unit level. Facility Operations was able to accomplish this quickly. The next task was to develop “zones” within the cohort unit that represented various levels of potential exposure. These were identified as green, yellow and red zones to provide visual indication of the PPE required in each area. Work areas were modified to provide positive pressure while patient care areas were under negative pressure.
Providing the necessary room set up was a challenge because COVID-19 patients require additional medical equipment. Our Biomed Department worked with departments across our organization to identify existing equipment that could be utilized. Fortunately, these units had been wired for the potential of added monitors. Clinical staff recommended placing equipment in the hallway instead of inside patient rooms to limit exposure for routine checks and monitoring. These pivot points in the unit layout and design would not have occurred without teamwork and close coordination from everyone involved.
We have shared our experience at NMMC-Tupelo throughout our health care system to ensure patient- and family-centered care and staff safety are always the priority. Different facilities present different challenges, but the concepts of good planning, creative thinking, maximizing resources and listening to direct care providers is consistent. Our success was due to great teamwork. I am certain this teamwork will equip us for whatever future challenges come our way.