As the coronavirus has demanded responses from health systems across the globe, we have seen a number of temporary hospitals housed in converted conference or sports centres take shape, including in Italy, Spain, Brazil, UK and the US. Closer to home, a temporary hospital was built in Canberra, with sites in major capital cities around the country considered in case a need for additional capacity emerged.
Recent developments have demonstrated how quickly a temporary solution can be made operational in an emergency situation. The NHS Nightingale in London was completed in only nine days, using the vast space that already existed within the Excel Centre, and an exhibition centre in Milan was converted into Italy’s largest intensive care facility for Coronavirus patients in just ten days.
Of course, the current situation with COVID-19 is exceptional. It is severely testing the resilience of healthcare systems around the globe, and major action is needed to ensure lives are saved. However, we are already in the midst of a crisis, and the rapid deployment of these facilities has depended on direct support from Governments and the military, along with access to almost unlimited resources.
In Australia, a third of all intensive care capacity is in the private hospital sector, and we’ve seen public sector healthcare capacity also boosted by additional bed spaces requisitioned from the private sector. At the end of March, the Government entered into an agreement that would ensure over 30,000 private sector hospital beds and over 100,000 staff would be made available to strengthen the Australian COVID-19 response, and preserve the sector’s capacity to resume hospital services after the epidemic.
However, while the large scale, temporary hospitals are getting most of the headlines at the moment, a huge amount of work is also going on behind the scenes at hospitals across the country to improve resilience on a local level. These have been ordered to free up significant capacity by discharging as many non-critical patients as possible, and by temporarily ceasing all planned and elective procedures.
Hospitals that were already under significant pressure with bed numbers; staffing pressures; and myriad competing demands, have responded in a Herculean manner to the challenges posed by the COVID-19 outbreak. But in a number of cities and regions, healthcare leaders have been concerned that it might still not be enough, depending on which of the forecast paths were used to predict the number of cases and admissions, or have been facing other challenges in converting existing facilities into areas suitable for treating COVID-19 patients.
As a result, some hospitals have turned to temporary solutions using prefabricated modular units, or mobile clinical facilities that can be deployed rapidly to extend a hospital’s capacity or be deployed away from the main hospital site. There is a big difference between something that’s designed for permanent use and that meets all the standard specifications, and facilities deployed very quickly for emergency use – such as the temporary hospitals housed within conference centres.
Additional capacity should form part of hospital’s contingency planning, and regardless of the outcome of the COVID-19 crisis, it’s clear that healthcare providers, and governments, need to rethink their resilience for future pandemics and other crises, and be more prepared.
Flexible healthcare infrastructure can be part of this resilience upshift. A number of healthcare providers worldwide are already using flexible infrastructure in a planned way, often to provide additional capacity to cope with expected shifts in demand; or to provide replacement capacity for planned refurbishments or to help choreograph a series of complicated changes to a hospital site.
As mobile and modular wards, operating theatres and endoscopy procedure rooms already meet the relevant standards, they can be rapidly repurposed to provide additional bed spaces. They also meet infection control standards, through a number of well-thought-through design features.
Many healthcare providers and hospital leaders already see mobile or temporary modular units as a valuable extension of their permanent estates and facilities, and as key to surge planning within their facilities, helping to optimise their use of resources. The use of flexible infrastructure allows hospitals to better choreograph their changes in order to provide uninterrupted care for patients in a situation that is changing daily.
Mobile and modular infrastructure can also easily be removed or relocated, or very quickly be repurposed to support hospitals in clearing the inevitable backlogs in surgery, diagnostics and other procedures that have been postponed during the crisis.
During the ongoing crisis, a number of operators who provide temporary infrastructure have reported being inundated with requests for wards and isolation units, very few of which are sitting in a yard somewhere waiting to be deployed. It makes sense for healthcare planners to think about future events such as the current crisis, and work with operators to develop more resilience and flexibility within the broader healthcare system. The expertise and the willingness is there; the strategic forward planning needs to bring it together.
Preparation is key. There is a real threat of a potential second wave of the Covid-19 outbreak, and waiting until then, or until a new pandemic occurs, could result in losing valuable time and delays in the implementation of suitable solutions.