When the epidemic began to spread, 500 to 1,000 confirmed cases were expected in metropolitan areas such as Madison with a population of 250,000 to 500,000 people at one time. This was expected to result in a total admission of 250, with an increase expected in late April and early May.
Hospitals in this part of the UW Health system had a total of 671 beds, but availability fluctuated daily, including some days when no beds were available. Already in need of more Intermediate Care Unit (IMC) and Intensive Care Unit (ICU) beds to cope with capacity issues, the COVID-19 surge further impacted the system to investigate how to expand available beds.
To begin addressing the situation, UW Health stakeholders decided to retrofit existing inpatient rooms at several of its hospitals to increase capacity and enhance some inpatient projects to increase overall bed capacity.
In addition, the University of Wisconsin was already developing a comprehensive care model and is implementing one of these modules at University Hospital. This gave UW Health Planning, Construction and Design, UW’s partner in the project, information to build on to guide the design of a new comprehensive inpatient care unit at East Madison Hospital.
As construction progresses in the unit, here are some thoughts on project planning and development as well as future projections.
Design tools for augmenting inpatient care
Using an evidence-based design (EBD) approach, the project was already defined with goals and objectives of ongoing work with adaptable inpatient rooms for comprehensive/acuity care within the UW care system.
Specifically, the new project design was to ensure improvements in a variety of organizational metrics, including clinical outcomes, safety indicators, patient satisfaction, and financial performance. The new question became: Can a patient-centered, safe and inclusive inpatient unit/adaptable inpatient unit be implemented – which also enhances staff efficiencies and satisfaction?
Using the Lean strategy, EUA team members analyzed patient and caregiver movement through the unit and identified ways to improve the user experience, including addressing complications added by pandemic protocols such as visitor restrictions and the required use of personal protective equipment.
EUA team members conducted field visits to some of the existing hospitals to observe shift changes among the nurse staff and stayed throughout their shifts to understand how they used the unit, offices and supply rooms, as well as the distance traveled by staff during these shifts.
The field visits were complemented by online meetings, in which a wide range of user groups participated. Similarly, due to the high level of demand for UW Health staff, online questionnaires and surveys were also used to include them in the design process. Interestingly, important information was obtained from this method, as employees were more forthcoming in addressing their concerns.
Forms were also used during meeting times to allow stakeholders to judge spatial relationships, particularly given the medical equipment and controls to be placed in the disease-acute adaptable rooms.
Design features of a comprehensive inpatient care unit
Creating flexibility to serve a high-risk patient environment means that many changes must be made from typical medical/surgical patient rooms. As a result, these design improvements were identified for the final design of the new comprehensive inpatient care unit at the University of Wisconsin:
- All patient rooms can convert to negative pressure, and the rooms have been made more robust with additional medical gases, electrical outlets, and low-voltage capabilities.
- Monitor windows and individual chart stations added. Patient monitoring windows allow staff a direct view into the room, while also placing monitors and controls outside the patient room. In the face of an epidemic, this allows staff to continue to monitor patients without having to wear full personal protective equipment (PPE) when they enter a patient’s room.
- Each room has a decentralized graphing area, which will add up to 28 additional computer stations/seats. In the future, these additions will also support the additional personnel necessary when the unit needs to operate in a high-risk environment, regardless of the medical incident.
- A larger collaboration area has been added in the center of the unit to support better communication between employees. The unit can be accessed from all parts of the central Al Taawun area.
- To reduce walking distances and give staff more flexibility for clinical support, twice as many dirty rooms, clean storage rooms, and medical equipment storage spaces have been added.
- A focus room has been created, which gives employees daily and long-term flexibility. Currently, it can be used for dictation or for a conference between the nursing manager and the nurses. In the future, it can be moved to an office space if necessary. The electronic ICU infrastructure has been added to allow communication with specialists from remote locations as well.
- Dialysis capabilities have been added to the rooms. Throughout the pandemic, moving patients with COVID-19 through the hospital to dialysis treatment has been problematic. This is also true for non-COVID-19 patients. Dialysis access would allow patients to stay within a single room for all care.
- Bathrooms are designed to improve safety and functionality such as redesigning walk-in showers and adding accessible features. Additional space for staff support and shower chair access has also been added.
While improvements in the project were aimed at clinical outcomes, UW Health and the EUA also focused on family, staff, and patient experience. The wayfinding to the nurses’ station has been enhanced with lighting, while materials within the space have also been changed to provide improved acoustics. A spacious staff rest room with large windows was added, as well as family space for patients.
Measuring the success of inpatient capacity
The unit’s adaptability to severity will help prepare UW Health’s infrastructure for the next pandemic or medical event. For example, rooms in a renovated area can be quickly converted to a higher acuity level for patients, which will help staff work in spaces they are already familiar with and, as a result, improve user experiences.
And while it would be ideal to make universal inpatient care units a system-wide change, stakeholders understand that may not be feasible. The fact is that the space needed to convert an existing room into an acute-adaptive room would require converting two space-renovation inpatient rooms into one new acute-adaptive room, resulting in a reduction in the total bed count.
The success of the project will be determined by comparison with the metrics that UW Health already tracks. Baseline levels of patient falls, hospital-acquired infections, etc. will be determined and compared to the same levels from the inpatient units on the fourth and fifth floors at East Madison Hospital.
These performance measures are built into the project design and are tracked throughout the construction period and in Post Occupancy Evaluation (POE).
When the project is completed and the POE is complete, a clearer picture will be revealed of whether significantly increasing the size of adaptable rooms is medically necessary and/or financially sound, and whether staff and patients would benefit from the renovations made throughout the UW system. the hospital.
Michael McKay is Director of Health Planning Design and Construction at the University of Washington (Madison, WI). It can be accessed at mailto: [email protected]. John Ford is chief design engineer at EUA (Madison). It can be accessed at mailto: [email protected]. Ed Anderson is a healthcare market leader with EUA (Madison). It can be accessed at [email protected].