Accelerating patient-ready spaces in response to COVID-19
The surge of patients during the COVID-19 pandemic has health systems across the country assessing their past, current and future resources to see how they can rapidly increase patient capacity.
CannonDesign, alongside construction partner Hensel Phelps, have been working with the University of Texas Medical Branch (UTMB) on its League City medical campus, where a new patient tower expansion is slated to welcome first patients in May 2020. As the novel coronavirus pandemic started its spread across the country, UTMB realized the new South Tower space would need to be patient ready much sooner, and worked with its many partners to fast track the project’s opening.
We spoke with Jaclyn Whelan, manager, hospital operations and health system special projects at UTMB Galveston and Tarek Thomas, program director for UTMB’s capital projects, about how they accelerated work to ensure the floors were patient-ready, what’s been most important for preparing for a patient surge, and prioritizing current construction projects.
Question: How did the conversation about fast tracking the opening of the new part of the South Tower start?
Whelan: We were about a month and a half away from opening the new hospital tower when the coronavirus conversations began. Initially, my mindset was about operations — if we needed to put patients outside the building to triage then we would, even without air conditioning or other necessities. But we went back and forth with the team, and ended up figuring out a plan to get the tower prepared to see patients.
Thomas: Two weeks ago Dr. Gulshan Sharma, UTMB Vice President and Chief Medical & Clinical Innovation Officer, said we needed to start thinking about getting spaces ready for coronavirus. We went over the new tower space and outlined all the risks, and the items we do not have right now. Because it’s a pandemic situation, there’s more of a give and take relationship of what’s necessary. Right now we just need the beds, and we’re able to have those beds open and ready.
We brought all the groups to the table and identified and prioritized items that were needed to operate the unit. Our new punch list included everything that impacted patient safety – med gas certification, emergency power – things that we can’t budge on, that’s what our focus was. Anything that is more aesthetic went to the bottom of the list. It’s all about patient safety when opening the space ahead of schedule.
What did you use as guidance for creating plans and spaces for COVID and non-COVID patients?
Whelan: The Centers for Disease Control and Prevention are coming out with recommendations daily. At first they recommended all COVID patients needed to be in negative pressure rooms. We don’t have enough negative pressure rooms; the world doesn’t have enough negative pressure rooms to follow that guideline. After more time passed, and it was determined that COVID was passed more through droplets rather than airborne, CDC changed their recommendation that after negative pressure rooms are filled, COVID patients could be put in neutral rooms. Currently, we are continuing to swab patients on our campus who administer COVID symptoms and use our testing capabilities locally.
Q: As of now, what is the screening and surge plan you have in place?
Whelan: Right now, our ICU on campus has 17 beds. Our surge plan is to double up patients in rooms if need be – these ICU rooms used to be LDRP rooms and are very large, close to 420 SF each. A secondary approach would also be to triple up the old C Section suites to treat 6 additional patients, if need be. We have a surge committee working on the plans and operations regarding equipment, monitors, staffing, etc. The UTMB Pathology department is also supporting our equipment concerns with insufficient ventilators for a pandemic by building a prototype for a makeshift ventilator. Our system is continuing to prepare for a possible surge with providing as many beds, equipment (pumps, ventilators, high flow nasal cannula, flowmeters etc.), monitors, and trained staff in order to take care of these patients.
From an operations standpoint, our biggest priority is supplies and equipment. We made a policy change that anyone entering a UTMB healthcare facility (ambulatory, emergency department or inpatient), including non clinical personnel, are required to wear a mask. The N95 masks are reserved only for nursing staff who are taking care of a positive COVID patient or a PUI (Patient Under Investigation) for COVID. Receiving supplies is an issue globally and UTMB is experiencing this first hand.
In order to continue to protect our patients and staff, UTMB League City closed off various entrances and funnel traffic through three main entrances with screeners around the clock. All employees, patients, and contractors are screened by taking their temperature and answering the required health questions before entering the building.
If anyone does not pass our screening protocols, they are directed to the tents outside the Emergency Department for triage if necessary, asked to follow up with their manager for next steps, and not allowed to enter the facility. We have also changed our system policy to not allow any visitors on the campus, with the rare exceptions for end of life patients, labor and delivery and pediatrics. This policy change further allows us to manage who is on the campus and reduces the interactions and possible exposure.
Q: How are you prioritizing current capital projects across UTMB?
Thomas: We have prioritized any projects that are set to handle COVID-19 patients like hospital screening clinics. We are putting some capital projects on a temporary hold so we can use those resources to get a testing site up over the weekend, or add plexiglass as a safety feature where we need it.
Of course we’re limiting the amount of contractors in hospitals, but we don’t mind if contractors are in academic or research facilities in progress because no one is in there right now, and this seems like the time to get projects done. In the hospitals, we want to limit contractors interacting with staff and patients. If you look at the list of projects put on hold, they’re all inside hospitals, like our emergency department renovation project.
We are screening everyone coming on construction sites with thermometers. If they’re above 99 degrees, they don’t come on site. It’s the same protocol every day, we give them a dot for the day that says they can be on site, and it’s a different one every day.
Q: What’s been the biggest lesson learned from managing and planning for pandemic preparation on campus?
Thomas: The key is everyone from the beginning took it seriously. Even though we weren’t sure how it would impact us or Texas in general, all contractors immediately jumped in to support wherever was needed. When we said we needed to activate in a week or two, it was all hands on deck and we immediately went into crisis mode. We had a meeting at 9am to discuss objectives for the day and at 3pm we had another follow-up call to make sure they were being met. We had every single stakeholder on the phone. People would think up scenarios no one thought of before and we just started working and moving forward.
The key was communication. Every evening I would write a report to give an update to the UTMB president via Steve Leblanc, VP of business operations & facilities, on what the status was and our hurdles. Just a real quick summary that we’re on track to have beds open, and the risks that we were working on. So everyone from the subcontractor to president knew where we were at and the risks. There were no silos – everyone knew what everyone was doing.
I feel like everybody gets energized to do something important that is not easily accomplished, and then their name is associated with managing a big crisis response like this one; it gets everybody motivated. That’s what we capitalized on.