According to an excellent piece which recently appeared in the Wall Street Journal, the coronavirus pandemic has upset the way in which hospitals have arranged their businesses. In hard hit areas, ICU’s have filled up and other departments in the hospital have been forced to adapt to care for patients sickened by the illness. Emergency departments have become jammed up with sick patients when there has been no place to put them. Non-Covid patients are staying away from emergency departments for fear of catching the disease. Elective procedures have been cancelled or postponed. All of this has seriously disrupted the normal business model and is forcing hospitals to rethink the way they treat patients and provide services.
There is some very innovative thinking going on right now. Hospitals plan to use technology to a greater extent in the future to monitor patients and to reduce the risk of transmission of highly contagious diseases. One example is to give mobile devices to patients who have been diagnosed with a disease and are isolating at home so they can enter their vital signs and symptoms. Providers at the hospital can monitor these patients and determine when or if to bring them in for treatment. This procedure can also be used for any patient who needs monitoring but does not need to be in the hospital to receive active treatment. Patients recently diagnosed with heart disease is one of the examples mentioned in the article.
Hospitals are also likely to use separate entrances for different categories of patients to avoid the problems associated with mixing infected and uninfected patients. Patients entering the hospital for elective surgery or for childbirth will be directed to enter the hospital through a dedicated entrance away from the entrance used for potentially infected patients.
Similarly, traffic patterns and corridors are being designed to avoid to the greatest extent possible exposing uninfected patients to those who have been diagnosed with an infection.
Robots will be used to deliver supplies to patient rooms and to perform certain routine tasks. This will reduce exposure for health care workers.
Telemedicine will be used more aggressively. It will be used to assess patients before they arrive at the hospital to determine if they need immediate treatment and, if they do to what hospital entrance they should be directed. It will be used to reduce the number of doctors in patient rooms during rounds. One doctor will enter the room and interact with the patient while the other doctors or care providers who, in earlier times would have gathered around the patient bed, will be watching and participating by video link.
The ability to ramp up capacity in an emergency has proved to be important. Hospitals are looking at a number of different ways to achieve this. Among some of the innovative solutions is the use of mobile pods that can be fitted up with hospital beds and equipment and delivered to the hospital in times of need. These can even be set up for use as an ICU. Some hospitals that used adjoining space for additional capacity during the recent surge are returning those spaces to their original purposes but leaving behind equipment and infrastructure to allow for a quick return to hospital use in the event of another surge.
Most of what I have been discussing involves making use of existing infrastructure or adding temporary space. New hospital planning and construction will likely be different going forward so as to create infrastructure that can be quickly repurposed in the event of a surge. Rush University Medical Center is Chicago is already ahead of this curve. It designed the main lobby of its recently opened tower so that it can be converted into patient treatment areas in the event of a surge. It has medical gases, suction and electrical built into the support pillars to allow this to happen.
As with so many things in the age of Covid, hospitals will not return to the old normal. There will be a new “normal,” the nature of which we are just beginning to see.