The COVID-19 pandemic has exposed our healthcare system in the U.S. like nothing before. The impact for hospital facilities in particular has been deeply felt in many ways Even though some areas of the country didn’t have the large number of critical patients that was first anticipated, it was still a wake-up call that hospitals need to be better prepared for future patient surges.

The emergency department (ED) and the med/surg patient care unit are two areas of the hospital that often encounter sudden spikes in patient visits and stays. Design Collaborative has worked closely with two hospitals to address the local concern for the potential influx of emergent and acute medical cases. Both projects were planned, designed, and built before the COVID-19 pandemic, but the ideas, solutions, and takeaways from these projects now have greater relevance and application.

All hospitals and the communities they serve have varying needs, but these examples demonstrate how a collaborative process can generate unique and affordable solutions for accommodating higher patient volumes.

Case study: Mercy Health—St. Rita Medical Center

A primary goal for the expansion and renovation of the Mercy Health—St. Rita’s Medical Center ED (SRMC; Lima, Ohio), completed in 2013, was to incorporate flexible treatment spaces for multiple patients. One of the major industries in Lima is the production and refinement of coatings and chemicals and local leaders were concerned that an accidental spill or malfunction at one of these industrial sites could potentially harm a large number of workers and overwhelm the hospital’s ED.

The overall project program was based on reconfiguring and enlarging the existing ED to improve patient flow and accommodate up to 60,000 patient visits per year with a total of 44 treatment spaces. The firm’s healthcare design team worked closely with the  SRMC administration and ED staff to develop a multiphase solution.

One of the concerns addressed on the project was the potential surge of patients, especially in the ED, with a mass casualty unit (MCU) identified as a solution. This MCU at SRMC comprises five larger treatment spaces (approximately 250 square feet each) in a designated area near the ambulance entrance, a decontamination shower room, and trauma rooms. Each MCU treatment space is arranged for a single patient during normal patient visit volumes and can flex to accommodate up to three patients in the event of a surge of patients to the ED.

The rooms are equipped with two vertical headwall units that provide the necessary power, data, medical gases, and monitoring capabilities for each patient. The headwall units are positioned on either side of the primary single-patient bed, which allows close access from all bed locations, with additional privacy curtains on either side to provide visual separation from the other beds.

While the primary driver of the MCU was to handle a surge of patients from a local industrial accident, these specialized treatment spaces can be used for other events as well. For example, multiple patients in the same family, such as a parent and child, spouses, or siblings, can be treated in the same space, keeping the family together. During events such as pandemics, the MCU also has the potential to treat multiple non-infected patients, freeing up private treatment spaces for triage and holding of potentially infected patients.

Case study: Rush Memorial Hospital

A similar strategy was used for the renovation of the medical/surgical patient care unit at Rush Memorial Hospital, a critical-access hospital in Rushville, Ind. The hospital received a donation from a former patient who requested it be used for improving the hospital’s existing 1960s-era patient rooms. The hospital administration had plans to build a new addition, including a new medical/surgical patient care unit with all private rooms, but hadn’t set a timeline for that project. In the meantime, Design Collaborative’s healthcare team was engaged to renovate the interiors of the existing patient rooms to provide patients with an improved experience until the future addition was built.

During the planning process, it became evident that the size of the existing multipatient rooms could be used to their advantage. The original project strategy focused on converting six of the eight patient rooms from three-patient rooms to private rooms. However, doing this would have reduced the number of available beds below the number needed for the hospital to handle the yearly increase in flu-related cases. The planning team instead decided to provide a private room setting that incorporates a second bed location, allowing the private patient rooms to function as semiprivate rooms when the census or other circumstances dictate.

The added flexibility of the patient rooms allows the hospital to have a total capacity of 14 beds on the unit when demand or needs require it, while six more rooms on the unit will be renovated in a future project.

To make this approach work and not have patients feel like they’re in a semiprivate room during low-census periods, the rooms are equipped with a primary headwall with a secondary headwall on the opposite side of the room. This approach was necessary because the existing rooms were originally sized and built to have beds on opposite walls. The secondary headwall has all the same functions as the primary headwall. However, when not in use, the secondary headwall serves as additional storage for clean linen and medical supplies with the electrical, data, and medical gas services designed to be hidden within the casework.

Because there’s no footwall in these rooms, alternative locations were found for the items typically located there. The TV was mounted to the ceiling near the foot of the bed and away from the traffic pattern in the rooms. Other items such as the patient whiteboard were mounted on the corridor side walls near each bed location. Careful attention was also given to the location of privacy curtains and other furnishings and equipment. For example, the primary bed was located near the entrance to the patient toilet room, but privacy curtains were placed to provide each patient access to the toilet while maintaining visual privacy for both patients. The placement of the two beds was also carefully planned to ensure the required minimum clearances around each bed were maintained.

The transformation of the unit was so significant that RMH leaders decided to postpone plans for building a new med/surg unit for now. With the ability to accommodate a surge of patients without further renovations or a building addition, the hospital has been able to focus on other capital project needs.

Strategic planning

These projects are just two examples of how flexible space can be achieved without significant additional cost and space. With some careful planning and asking the right questions early in the process, hospital leaders and their design teams can explore effective ways for accommodating anticipated surge, as well as unanticipated changes in patient volumes.

It’s not always possible to predict the future needs of each hospital, but it’s possible to apply strategic thinking in how more flexibility can be achieved. There will undoubtedly be many changes coming for hospital planning and design from the current COVID-19 pandemic. Flexible and adaptable space will likely be one of the top considerations, and hospital and design professionals alike can use these and other developing strategies for meeting this need.

Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP, is director of healthcare design at Design Collaborative (Fort Wayne, Ind.). He can be reached at