Most health service organisations will find themselves in need of a temporary infrastructure solution at some point, either because of a planned event, such as refurbishment of the existing facility; or an unexpected event, the Covid-19 outbreak being a recent example. But while modular facilities often provide the answer to a temporary issue that requires a quick resolution, that doesn’t mean the solution has to be short-term.

Why use a modular facility?

A common reason for commissioning a temporary solution is insufficient capacity or a spike in demand, due to seasonal pressures or another temporary reason, which can present a risk of compromised care standards and patient dissatisfaction.

The need to maintain high standards of patient care, compliance and safety throughout a refurbishment or service reconfiguration project, or after an unforeseen event, is another common reason for requiring an external healthcare facility. A temporary facility can offer a way to reduce the time that patient services are suspended following an incident or emergency.

However, it’s not all about being able to respond to an urgent need or crisis; temporary healthcare facilities are also an essential component of strategic plans.

Although the very nature of emergencies means that they are unpredictable, planning for different scenarios is essential and the use of temporary infrastructure should be considered. Temporary buildings can also enable health service organisations to deliver community-based care outside of the acute hospital setting, either on an ongoing basis or as part of a specific programme.

A modular building can also be used to pilot new surgical delivery methods, new models of care delivery or new technology and equipment, without risk to existing routines. This in turn can mean gaining a competitive edge over other hospitals. Finally, major sporting events or other large-scale events may require a temporary healthcare village or treatment centre on-site.

Adding capacity

Whenever waiting times increase due to a temporary fall in activity, a modular facility can add much needed capacity. The suspension of all non-urgent surgery following the Covid-19 outbreak was a recent event causing a fall in activity, but any event causing one or more theatres or procedure rooms to be taken out of action, such as a shortage of clinical staff, can create a need for additional capacity.

Even once the service resumes to normal levels, it can be difficult to get on top of waiting lists. In the example of the current pandemic, there was a need to retain capacity in hospitals for a potential influx of Covid-19 patients, meaning that theatres were limited to operating at 50% or 75% of previous capacity for an extended time. A temporary modular healthcare facility could add sufficient capacity to bring this up to 100% or even above, allowing hospitals to continue caring for patients in a safe environment.

Modular wards are being used during the pandemic to not only supply additional hospital bedspaces, but also to provide additional reassurance for patients. Although they can be connected to the existing hospital, external wards can be configured to provide a separate entrance and exit, and all the usual facilities found on a ward as well as HEPA-filtered air and an integral climate control system.

Temporary and semi-permanent stand-alone operating theatres can be set up and connected to the main hospital very quickly. Equipped with air conditioning systems that allow variable humidification, modular theatres can also incorporate IPS, UPS, integrated water system and medical gas bank, vacuum and scavenging systems, and an environment control system ensuring temperature, humidity and sanitation are always optimal.

Completely stand-alone, so called ‘cold’ sites, are also being set up using modular buildings during the pandemic. A combination of either a standard or laminar flow operating room with enhanced ventilation, and a hospital ward, can create a visiting hospital. This can provide a complete clinical environment, including an anaesthetic room, scrub and recovery areas, clean and dirty utility areas, a reception/nurse station, waiting room, ward and WC.

Delivering new models of care

A modular outpatient clinic can offer the opportunity to care for and process outpatients in the heart of their own communities, or to increase outpatient access within the boundaries of the existing hospital site. To deliver fully integrated community-based healthcare, flexibility is required.

In terms of healthcare service delivery, one concept that is being implemented widely in areas where emergency departments are under particular pressure, is to improve patient flow by separating urgent cases from patients with less serious injuries or ailments, either on a temporary or a more permanent basis.

To effectively reconfigure a service, buildings will need to be adapted. Setting up a temporary facility can allow hospitals to test out scenarios before investing significant amounts of money in a new or remodelled permanent building.

Ensuring uninterrupted care

Temporary healthcare facilities can also enable hospitals to rapidly respond to a crisis or emergency. One of the most recent examples is the priority assessment spaces or isolation pods, created with the intention of preventing any patients with suspected Covid-19 who arrive at the hospital from mixing with vulnerable patients.

Another is the need for additional staff changing and rest areas, such as those provided by modular building supplier Oscar Building in the early phase of the pandemic. In many cases, a portable, modular building has been the answer to the most immediate need, as they can be delivered quickly, can be placed virtually anywhere, for example on an unused car parking space, and can contain the virus.

It’s currently unclear how long these will be needed on site and what will happen once the outbreak is over, but that doesn’t really matter, since units like these can be moved, repurposed or handed back when they are no longer needed.

Sometimes the emergency itself brings a need for healthcare facilities, or for temporary accommodation to house emergency workers or medical staff. During the unpredictable and ferocious bushfires that raged in Australia last summer, Humanihut – a provider of rigid redeployable infrastructure – was called upon to provide accommodation for local emergency services personnel fighting these fires in extremely challenging conditions.

The modular set-up with integrated utilities allowed for easy deployment, even at a remote site with no existing infrastructure. Being accommodated in huts rather than tents meant that fire crews were able to achieve adequate rest between shifts, and even had the luxury of hot showers and air conditioning. More huts can be joined together to provide larger facilities such as mess halls or hospitals.

Temporary buildings designed for permanent use

A less dramatic but more common reason for using modular is the need to minimise disruption to healthcare services during a reconfiguration of departments or a refurbishment programme. Where a major project is taking place, there may be a need for a bespoke semi-permanent building.

This was the case for Skåne University Hospital (SUS) in Malmö, which is currently undergoing a major construction programme that is estimated to take seven to ten years to complete. The hospital is Sweden’s third largest and it represents one of two national centres for cardio-thoracic surgery. An average of 128 operations are performed there each day.

During the build, an urgent need arose for increased capacity for performing high-risk orthopaedic procedures, and the hospital’s management wanted an interim solution that would be quick to implement, while being robust enough to fill the gap until the new building was complete.

Young Medical, a global supplier of modular healthcare buildings, provided the hospital with a 324 m2 operating theatre complex to strict requirements and a tight timescale. Initial prefabrication was carried out at Young Medical’s production facility in the Netherlands with the final construction being completed at a ‘pop-up building site’ in the Malmö area.

The interim facility was to be integrated with the existing operating theatre department on the third floor of the hospital to ensure a seamless extension. This involved a precision engineered steel construction, which was fixed at the exact same height as the existing facility.

The operating rooms were equipped with the most advanced surgical lights and pendants, as well as a video routing system and a building management system. An ultra-clean air system was also installed to reduce the risk of infection during surgery, and the entire operating theatre was tested for <10 CFU/m3 in line with local regulations.

The entire project was completed within just 10 months from start to finish, and while commissioned as an interim facility, the complex is designed to serve the hospital for a period of up to ten years.

More than just a temporary solution

The use of modular construction techniques and volumetric buildings in the healthcare sector is not new; offsite manufacturers have supplied healthcare buildings for many years. However, modular is often seen as just a ‘box’ or ‘shell’; a short-term solution that is necessary but very basic and that may look unsightly.

Over the past decade, the modular concept has moved on and a range of different solutions can be achieved; from a basic container concept to bespoke, sophisticated buildings housing fully equipped operating theatres that can be integrated with the existing hospital’s own infrastructure if required.

Modular solutions don’t have to be temporary; it is possible to have a permanent extension to an existing hospital built entirely using a modular concept, and designed to fit seamlessly with the rest of the building.

Mobilising flexible infrastructure of any kind can support hospitals in; maintaining control of the patient pathway, preventing operational downtime, reducing build and refurbishment project time scales and facilitating uninterrupted patient care. A modular solution can also deliver cost savings and provides a more sustainable option compared with a traditionally built healthcare building.

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