The unprecedented challenge of the COVID-19 pandemic is putting tremendous strain on healthcare infrastructure in the US, with staff and patients at elevated risk. 

A recent study found that in a moderate outbreak scenario, hospitals in 40 per cent of American markets would not have room for all COVID-19 patients, even if they emptied all beds of other patients. While authorities are responding with strategies to address the national bed shortage, such as New York’s plan to create 8000 new hospital beds in two weeks, there will be an ongoing need to increase inpatient surge capacity nationwide.

Rapid response 

A rapid-response inpatient unit can be set up in a range of converted spaces, including military bases, schools, dormitories, office spaces, and arenas. Additionally, temporary structures such as tents, modified shipping containers and even purpose-built semi-trailers/RVs can be utilised. 

One such approach, the US military’s Deployable Rapid Assembly Shelter, provides a turnkey system combining portable enclosure and high-output HVAC provisions. These and other mobile approaches are particularly compelling for virus response because they enable a healthcare structure to be delivered precisely to the point of greatest need, and can be moved from one hotspot to another in direct response to viral transmission patterns.

Yet in many ways, the building enclosure around a temporary ICU is the easier part to construct and deploy. The more challenging step is the construction of the life-support medical engineering systems that support patients within that enclosure.

The potential of prefabrication 

One solution may be an unconventional approach to ICU unit design and construction that maximises the potential of prefabricated patient room components. These components act as a highly adaptable chassis for an ICU’s most complex engineering subsystems, including the life-support headwalls that deliver data, power and medical gases via a highly adaptable ‘plug-and-play/motherboard’ framework. Rather than building these components conventionally at the job site, the modules can be prefabricated in a dedicated off-site assembly plant and then delivered and installed with significantly improved schedule, precision, cleanliness and efficiency.

Prefabricated building components can be installed up to 50-per-cent faster than similar conventional construction methods; the speed afforded by this modular approach has clear applications for rapid crisis response. Our research in this field benefitted greatly through a partnership with the Ministry of Health in Christchurch, New Zealand, after the devastating earthquake in 2011 created a need to design a state-of-the art replacement hospital. The research was pushed further still in response to the Ebola crisis in 2015.

With these global events acting as a catalyst for innovation, headwall components can now be developed for prefabricated delivery, as well as for demountability throughout the life-cycle, enabling continuous reconfiguration and redeployment. In a conventional healthcare setting, this flexibility allows caregivers to calibrate their work environment more precisely to need, and in a crisis situation – like COVID-19 – it could enable rapid ICU fit-out for a variety of temporary enclosures. 

These systems achieve their increased flexibility by incorporating features such as quick-connect fittings, flex piping, scalable technology management, adaptive levelling and panellisation (rather than relying on conventional wet-joint sheetrock). Overall, the design gives influence to a great deal of manufacturing logic from the demountable furniture systems built into corporate workplace projects.

The capacity issues that face the healthcare sector in the current crisis are daunting and cannot be addressed by conventional approaches and thinking alone. Modular construction offers one potential path forward, which may help hospitals respond more rapidly and effectively to the challenges ahead.

About the author

Ryan Hullinger AIA is a healthcare partner at NBBJ. 

This article was originally published on NBBJ's nbbX ideas platform on global design and architecture.