The Leaflet Article
A Call to Action
On March 17th, the first full day of HGA's firmwide "Work from Home"; directive, Kurt Spiering (healthcare sector leader at HGA) received a phone call from Ben Bruns, executive vice president for northern operations of The Boldt Company. He was asking if we would combine our talents and experience with modular and prefabricated construction to respond with facility solutions to the emerging healthcare crisis. What followed has been several weeks of intense problem solving to meet our goal of Hospital Quality Care with Speed to Market. Drawing upon a collaborative and committed team of over 80 people working remotely and virtually we were able to rapidly prototype and model a solution, fabricate and ship the first order to a client in the Mid-Atlantic on April 20th.
The solution that HGA and The Boldt Company devised is STAAT ModTM [Strategic, Temporary, Acuity-Adaptable Treatment - Modular On Demand]. The key attribute of the product is a quality-based, quick-ship solution for healthcare ICU surge capacity that met the CDC guidelines for airborne infection control for patients undergoing aerosol generating procedures This is a higher acuity level solution focused on patient and staff safety, where the need is to “heal” versus ”house“patients. Using virtual reality, the design was tested by lean process engineers and critical care nurses trained in COVID-19 to ensure work flows were efficient and safe for patient treatment. A hospital environmental specialist also reviewed the design for infection control.
SPEED TO MARKET
One fabrication line can produce 2 modules per day, with 16 Airborne Infection Isolation Rooms (AIIR’s) fully installed including site prep in 3 weeks, ready for owner occupancy and activation. It should be noted the units are fully finished in the fabrication shop prior to being shipped, with module connections and minor corridor finishing completed in the field. Equipment planning was provided by IMEG, and the team is able to procure FF&E through vendors, or the client can, it is negotiated in the Purchase Order. Boldt has also created a national network of fabrication partners to expand production capacity and shorten shipping times
Many healthcare organizations have been able to meet the crisis demand by repurposing existing space or tapping into government solutions to provide overflow for lower acuity patients. The purpose of our solution was focused to meet critical care levels not provided in tents or convention centers, and demand that wasn’t easily or economically provided for through renovation or adaptive reuse, especially when you factor in the cost of returning spaces to their original condition after they are no longer needed.
The STAAT Mod system is intended to be flexible to meet multiple applications: connected to a hospital infrastructure to provide utility connections, self-sufficient in locations where utilities aren’t available (we can provide at the site), but even serve as part of a system of care such as ICU rooms located within a convention center. It gives healthcare systems and government agencies a solution that provides the level of clinical quality needed for the most acute cases.
INVESTMENT IN THE FUTURE:
The demand and the peak vary by region, timing of social distancing protocols, and based on urban and rural geography. Wherever clients are in that curve, it is clear the current situation is financially untenable. Further, much is being reported now about the dangers for patients who need care but are unsure if it is safe to go to the hospital. While telehealth services and home visits can supplement some hospital visits, other in-person appointments cannot be replaced.
The modules have a ten-year useful life, originally designed to dimensions that could ship without delays caused by oversized loads so they could be on site to meet crisis demand. The original concept met the intent of all building codes, did not compromise the clinical quality for patients or caregivers, but still relied on several jurisdictional waivers that could disappear after crisis conditions passed. The design has since evolved to meet all code requirements, so they can support a longer-term strategy solution for clients losing millions of dollars a day, tens of millions a month, while non-emergent procedures are halted. Our solution proposes that hospitals can begin to separate patient populations without sacrifice to the levels of quality, safety, efficiency, or the dignity of patients.
While these are temporary hospitals, this is not disposable construction. They are designed to be portable (move to where the need is greater) and stand-alone so they can be used in other situations and reconfigured to meet other needs beyond this pandemic: clinical exam rooms, medical school simulation classrooms, housing and shelters, administrative space, swing space for future renovations…the opportunities are many.
CRITICAL TO QUALITY FEATURES
The design provides ample space to provide care with access to equipment. The isolation room also provides enough clearance around the bed to safely transfer a patient and reduce staff injuries. A key element to patient recovery is the recliner in the room. Getting the patient vertical improves clinical outcomes and shortens length of stay, which has the added benefit of optimizing room utilization. The features of the Airborne Infection Isolation Room (AIIR) are driven by Evidence-based Design research that have been proven to increase staff and patient safety and improve clinical outcomes in the areas of:
- Infection Control
- Work Efficacy
Further quality is derived from building in a controlled environment that allows us to set and achieve aggressive production schedules to improve quality for the end user. By standardizing our process using Boldt’s Lean production approach, we can build faster, reach customers’ goals, and better control costs.
Given the potential for material shortages and the need to respond in a matter of weeks, innovation took place in the development of the mechanical system, building structure and certain restrictions on dimensions due to the need to ship these units commercially across the country.
The key attribute of the HVAC system is that it provides negatively pressurized patient rooms with high air changes rates of HEPA filtered air, providing an Airborne Infectious Isolation room environment to promote patient recovery and staff safely. The HVAC system accomplishes this by exhausting approximately 80 cfm per room, pulling air into the patient room (or the ward), in order to protect staff in adjacent work areas outside the room. The HVAC system incorporates an airflow design featuring HEPA filtration of the recirculated air, MERV 14 filtration of the supply air, and air distribution designed so that supply air passes past staff toward the patient, where it is exhausted through a low wall grille, capturing as many particles as possible.
Medical gas systems consisting of medical air, medical vacuum, and oxygen are provided, with outlets incorporated into the patient room headwall and the systems fully piped for distribution. Each tier can be connected to a site’s medical gas infrastructure, or a separate C-Can, containing a medical air compressor, medical vacuum pump, and a manifolded oxygen tank system can be provided.
Each unit is equipped with proper handwashing facilities, and with the plumbing fixtures needed to provide for patient and staff care. Domestic cold water is piped between units, and electric hot water heaters are provided in specific locations. The plumbing fixtures all drain via a gravity sanitary waste system, which can be connected to the site utilities or a holding tank, for periodic removal.
The power distribution system for the STAAT Mod consists of a normal (utility) source and an essential systems (generator) source and is based upon a 480V distribution. The power is separated into normal, life safety, critical, and equipment branch sources compliant with NFPA 70 requirements. The primary distribution is in a standalone primary power module and the generator is provided on a separate skid with additional fuel storage. The primary distribution scheme if scalable to a three-tier configuration by adjusting breaker settings, increasing primary cabling, addressing the size of the generator and adding additional distribution equipment to sustain each tier. Each tier has distribution equipment to sustain the power, lighting, systems and mechanical requirements for that tier. Receptacles are designed to meet FGI guidelines and the lighting design meets the intent of IES illumination requirements. Each unit identifies circuits serving the unit to assist in the modular construction.
Each tier has a dedicated IT room furnished with two racks. Each module is technology ready with boxes, raceways and a pathway to designated location above room door. Cabling and terminations will be completed at the device and in the IT closet. The nurse call system will create a complete patient communications system. Monitoring of engineering systems will be provided to the IT room for integration into owner furnished equipment.
It’s hard to overstate the level of passion the team had for this project. We began not knowing if we would ever ship a single module, we just knew we had to try, we felt compelled to use our resources to help. As Kurt Spiering said, “What started as sketches on my dining room table, with tireless effort of many talented individuals, has turned into a collaborative of 5 firms and 80 people focused on providing patients and caregivers a safe environment during the next and longer phase of the battle against this disease.”
“There was a high degree of passion and enthusiasm surrounding this whole effort because we were doing something meaningful,” said Dave Kievet, Boldt’s chief operating officer. “We were helping. We were solving a problem the healthcare industry was facing.”
About the Author
Kate Mullaney, CPSM is an Associate Vice President and the national healthcare market strategist at HGA Architects and Engineers.
A dedicated landing page with video animation, descriptions, and downloads of brochure materials and renderings, and contact information can be found at: https://hga.com/staat-mod