May 14, 2020

America’s hospitals and healthcare workers are stretched thin battling the COVID-19 pandemic. Looking at the recent reports from the University of Washington’s Institute for Health Metrics and Evaluation, which use the latest data on every state’s intensive care unit (ICU) and hospital bed capacity as well as its social distancing policies, more than half of U.S. states could face bed shortages if the curve doesn’t flatten. Working long hours and late nights, our frontline heroes are not only running low on stamina and supplies—they’re also running low on space.

We recently worked with our colleagues to assist AdventHealth, a longtime Gresham Smith client, in preparing their system for medical surge capacity, which is defined by the CDC as a facility’s ability to provide adequate medical care during events that exceed the limits of their normal medical infrastructure. Our team is hopeful that social distancing and shelter in place decisions will mean AdventHealth won’t need to use their surge plan, but even while hoping for the best we’re also preparing for the worst.

Keep reading to learn how we’re using creative thinking to create a flexible, adaptable surge plan that will give healthcare providers the space and resources they need to care for the communities we call home.



Looking at the Numbers

To begin the surge planning process, our team re-oriented ourselves with the AdventHealth Altamonte Springs and Waterman campuses, facilities that we’ve had the pleasure of working on before. The Altamonte Springs hospital has six floors and under normal circumstances utilizes 346 beds. Waterman is a six-story building that can typically accommodate 300 beds. Additionally, Waterman’s new patient tower includes one floor of shell space that was constructed while planning for future growth back in 2017.

Using a template provided by AdventHealth, we began analyzing the number of existing rooms and the number of ancillary spaces that could be converted to hold beds at each facility, keeping in mind the spaces we would not touch: staff lounges, offices or cafeterias. We entered the data in the spreadsheet as we went, utilizing software to analyze the number of beds possible for different surge levels.



Taking a Tiered Approach

The uncertainty of the pandemic creates many question marks when it comes to critical care. To create flexibility, the team developed three different tiers of care within the surge plan.

The first tier of the surge plan works under the assumption that most patient rooms can be doubled up—instead of a single bed in the middle, two beds can be placed against the walls and still utilize the in-room medical gasses. The first tier also maintains only one bed in each patient room in the intensive care unit and only one patient bed in negative air isolation rooms.

The second tier takes advantage of clinical treatment areas that already have medical infrastructure in place, such as medical gasses and electrical supply. Our team did bed calculations for operating rooms, prep and recovery areas, exam rooms, clinical treatment areas, cath labs and imaging departments and created a floorplan for each scenario.

The third tier plans for utilizing lobbies, conference rooms, waiting areas and the chapel, understanding that these areas have no infrastructure in place—it’s only space. In this scenario it’s a full blown surge unit, however caring for patients indoors is better than caring for patients under an outdoor tent or in a parking garage.



Investigating the Infrastructure

At AdventHealth’s Waterman campus, we worked with a local engineering firm to understand how the hospital could alter the HVAC system to maximize space in their nine operating rooms and an old cardio procedure area. By switching several of the rooms from positive to negative pressure, the hospital could create isolation rooms and a full pandemic ward.

Additionally, our team investigated ways to take advantage of the shell space, recommending HVAC modifications and methods for piping medical gas to the area. We provided a footprint for patient beds, clean rooms, toilet rooms and support spaces, as well as recommendations and pricing for portable headwalls and partitions.

Every hospital has its own floorplan, however starting with the numbers and staying organized, creating flexibility through a tiered approach, and making sure the correct infrastructure is in place to handle new configurations are key to successful surge planning. While we ultimately hope that AdventHealth will not have to rely on their medical surge plan, we hope that our healthcare heroes are prepared to provide critical care if and when that day comes.