The coronavirus is ascendant again in many states, and based on what the science is telling us, this is now a condition of life that we all must get used to. Unless and until there is a medical breakthrough to stop the spread, we need to prepare for the fact that coronavirus is here to stay. The severity of the virus and its high rate of transmission is leading to sweeping structural and design changes in healthcare facilities. Once we acknowledge this as the new normal, we can begin to strategize and visualize what the future of healthcare will look like in medical centers and hospitals across the nation.
The advantage that we have now at UVA Health is the learning acquired over the past six months. The innovation that allowed us to continue to provide excellent care during the first stages of the pandemic can start us on the path to the long-term changes required to address the prevalence of the coronavirus. New cultural and behavioral patterns have already emerged in response to the fear of transmission. Just six short months ago, many Americans were putting on a mask for the very first time. Today, we have the muscle memory to reflexively reach for a mask anytime we head for the car or enter a building. When walking in the park, or even walking down a grocery aisle, most of us now instinctively move far away from others to avoid close contact. New policies, procedures, and workplace norms will be adopted to codify these behaviors. In hospitals, these practices will help minimize exposure for physicians, nurses, administrators, staff, and patients.
Changing the Layout of Public Spaces
As I’ve written about previously, in April we evaluated our preparedness for having a scalable response for a COVID-19 surge, and came up short. In response, we quickly mobilized multidisciplinary UVA teams to innovate ways to shore up supplies like face masks, face shields and nasopharyngeal swabs for COVID-19 testing. We also immediately took measures to improve safety by marking off seating and standing areas with yellow tape to ensure social distancing. We began installing plexiglass and other barriers to prevent contact, and patients and visitors quickly learned to adapt to new rules on face masks, keeping their distance from others, and visitation restrictions.
Designing Patient Rooms for Better Communication
The realities of this pandemic made patient room redesign mandatory. For example, we recently completed construction on a new bed tower that was originally meant to house medical and surgical patients. This space is now used for COVID-19 patients, which necessitated logistical changes to accommodate different priorities. Originally, small monitors were installed in each room, and we immediately understood that they would have to be replaced with larger monitors for better communications. Both inside and outside the patient rooms, monitors are a critical tool for patients to communicate with the nursing staff and with their own families since visitors are prohibited. Larger monitors made it easier for staff to see what was going on and communicate effectively with patients while lowering the risk of spreading the infection.
Limiting Traffic for COVID-19 Patient Rooms
While large medical equipment like ventilators and other monitoring equipment had to remain inside patient rooms, we redesigned the space so that the alarms for those devices were relocated outside of the rooms. Since nurses can tend to the alarms without entering patient rooms, this decreased the exposure rate for staff. In addition, COVID-19 nurses took on additional responsibilities for their patients, which further reduced the number of people coming and going from patient rooms. In some cases, the nurses were doing the work of phlebotomists, medical technicians, nurse’s aides, and even food and cleaning service workers. Our UVA Health nurses are an extraordinarily dedicated and professional group. They took on these added duties without hesitation and adapted to the new workflow to decrease the potential rate of infection across the hospital.
Retrofitting a Tower for Negative Air Flow
To ease the PPE burden for nurses and other COVID – 19 healthcare workers, we’ve retrofitted the tower to create negative pressure rooms, where the air pressure inside the room is lower than the air pressure outside the room. When the patient’s door is opened, potentially contaminated air from inside the room will not flow outside into non-contaminated areas. In our new UVA Health tower, our engineering team retrofitted patient rooms as negative pressure rooms to control the spread of pathogens. We converted a conference room to accommodate the HVAC equipment to make this work. Negative air flow also forces droplets out of the air more quickly. This mitigates staff members’ risk of contracting COVID-19 and provides the nursing staff some level relief from wearing PPE all the time. Outside of patient rooms and inside the nursing station, nurses can safely take off the googles and plastic shields and other PPE. For long and difficult shifts, it is a luxury to remove all the cumbersome PPE except for the face mask.
Expanding the Role of Nurses for COVID-19 Patients
Our nursing staff had to greatly expand their role to care for COVID-19 patients. Under normal circumstances, a nurse may care for five to six patients. For COVID-19 patients, the number of patients drops to one or two. The reason for this is that COVID-19 patients require a great deal more from the nursing staff. First, nurses must spend an exorbitant amount of time donning and doffing the PPE, while another staff member checks off a list to be sure they have the proper goggles, shields, masks and gowns in order to safely enter the patient’s room. Then in addition to providing traditional nursing care, COVID-19 nurses must do much of the work that is ordinarily performed by other staff members. Furthermore, because patients are sick, frightened, and isolated from their support network of family and friends, nurses also must be a sounding board, providing psychological, social, and emotional support. Having only one nurse manage the whole spectrum of patient needs can be stressful and takes a toll over time. However, the resulting one on one patient relationship experience is proving to be a positive one. The model appears to work for both lowering the spread of infections and for providing the best possible care for acute patients.
The coronavirus pandemic has required us to create and enact safety procedures and protocols to protect the health of our community. Although it was not always easy or simple to make these accommodations, our innovative, adaptable, and resilient healthcare community rose to the challenge. We now know that this virus is likely to be with us at some level for at least the next couple of years, and we can begin to see how healthcare delivery will change as a result. I am proud to be part of a community dedicated to finding innovative new ways to adapt to this new rhythm of life. We are all at cause to provide the best possible healthcare during these difficult times, and to ensure the wellbeing of our staff, patients, and the community we serve.
Originally posted on September 16, 2020, on LinkedIn