Navigating a Pandemic: Planning Ideas for Pathways, People and Reduced Touch

A visit to the doctor will not be the same after COVID-19.  As our healthcare practitioners prepare to re-open medical office buildings after COVID-19 closures, they will be working in a very different medical landscape. Healthcare organizations are committed to delivering the best possible care for their patients, and are extremely conscious of new protocols for both patient and staff safety. LS3P is exploring with our clients ways in which clinics can adapt the physical environment to help maintain physical distancing and follow CMS recommendations for reopening facilities to provide non-emergent, non-COVID-19 healthcare.

An adaptive response
To get facilities operational as we continue to navigate this public health crisis requires a multifaceted approach. Designers and care teams need to collaborate to develop ways in which existing clinic layouts can support the separation, physical distancing, and infection prevention strategies that have become the “new normal” while continuing to provide a supportive patient and family experience with efficient workflow.

Design Strategies can include:

Bypassing Check-in / Vitals / Check-out stations
Patients can be routed through a drive-up pre-screening area.  Clinic staff would screen all patients for symptoms of COVID-19, including temperature checks; patients that pass screening would be directed to a dedicated vehicle “waiting room.”  When notified to proceed to treatment areas, patients would go directly to their designated exam room.  Vital signs can be taken and check-out can all be completed by clinic staff in the exam room, minimizing the number of interactions and physical locations.

PPE Stations
Face coverings, gloves, hand sanitizer, trash bins, and other PPE can be made available at multiple locations both inside and outside the facility. Additional donning and doffing stations with showers can be added temporarily to ease staff stress when coming to work and heading home to their families.

Designing One-Way Patient Flow
One-way patient flow can help achieve required physical distancing throughout the facility.  This may require additional signage and temporary walls. Designers and care teams will need to plan circulation pathways that support staff workflow and identify areas where temporary separations may be needed while maintaining code egress compliance.  One-way vertical circulation may also be necessary to reduce cross-contamination of patient flow throughout the facility.

Staff Work Areas
To allow adequate physical distancing for providers, teams may need to increase staff areas for virtual registration, scheduling, supply storage, PPE donning/doffing, and staff lounge areas.

Patient Navigators
As people traverse these new one-way traffic patterns, Patient Navigators can be stationed strategically to guide patients to and from exam rooms, procedural areas, and other services. These Patient Navigators will help control overcrowding in circulation spaces, maintain steady directional flow, and ensure PPE and cleanliness protocols are observed. Patient Navigators will also support a positive patient experience by providing personalized service and addressing patient concerns and questions.

Increasing Telemedicine
The current lockdown has taught us that an estimated 30% of clinical visits for some practices can be effectively transitioned to telemedicine visits, within CMS guidelines. Exam rooms can be easily converted to telemedicine space for providers to conduct both video and audio visits. These telemedicine rooms could be grouped strategically to further segregate providers and patients. In rural areas, these telemedicine exam rooms may be a place for patients without internet to connect with specialists at facilities outside their area.

Implementing a Physical Distancing Seating Plan
As operations ramp up, patients may need to spend part of their overall wait time within the facility in addition to the vehicle waiting room. Generously spaced seating arrangements can help facilitate physical distancing guidelines both in patient areas and staff areas. In shared work areas, transparent dividers may be installed to protect staff members who need face-to-face interaction to perform their clinical duties.

Reducing Touch
Enhancing infection prevention measures will be vital to avoid transmission originating from hands, equipment, air, etc. To minimize contact with door handles, buttons, and switches, facilities may need to implement automated features in high-touch areas for optimized passive infection prevention. Door openings could include hand-wave technology for an estimated $2,900 per opening; application of anti-microbial coatings and stringent cleaning protocols could reduce transmission opportunities via door handles. No-touch elevator keypads and voice-operated controls could reduce the need to touch elevator call buttons, though stringent cleaning protocols or dedicated elevator operator staff may provide a more cost-effective option.  To avoid upgrades in existing facilities, Patient Navigators could be placed inside elevator cabs to serve as operators, providing enhanced customer service and convenience.

Easily cleanable solid-surface materials and anti-microbial coatings may provide additional protections against infections. Frequently used items such as tables and other furnishings, door handles, computer keyboards, and textile products such as cubicle curtains will require frequent cleaning and should be durable and easy to maintain.

Delivery staging
Delivery staff can be screened at the drive-up pre-screen area before proceeding to the delivery entrance.  A breakdown area can be provided at the delivery entrance, where materials can be safely removed from their shipping packaging and sanitized before being brought into the building.

The road ahead

We anticipate a ripple effect through healthcare systems with some long-lasting changes in the way we plan and design spaces for health care.  This initial period of ‘adaptive response’ will give designers and care teams the opportunity to ‘test drive’ some of these design strategies and evaluate what solutions may transition into best practices in the future.

LS3P has created several case studies of existing facilities implementing planning ideas for pathways, people and reduced touch.  For more information please contact Willy Schlein, LS3P’s Healthcare Practice Leader.