The healthcare design industry is on the front lines of the COVID-19 outbreak, responding to myriad needs tied to the built environment to ensure patients can be tested and treated effectively.

Healthcare Design turned to its esteemed Editorial Advisory Board members and other industry leaders for an inside look at how they’re responding to the crisis. In this ongoing web series, we’ll share what we hear, as we hear it—the challenges you’re all up against and the solutions being put into place.

In these “Notes from the Field,” you’ll find an industry diving in to combat the COVID-19 pandemic and quickly disseminating ideas to help others manage similar scenarios.

The executive director of planning and facilities at a hospital, whose infrastructure and campus we know quite well, called me for urgent advice to help her prepare for a COVID-19 hospital leadership meeting the next morning. She needed to know how it would be possible to make six med/surg private patient rooms, located on the top floor of one of their patient towers, into six, negatively pressurized, semi-private rooms.

Her direction was that the rooms do not need to meet FGI guidelines and do not need to be qualified airborne infection isolation rooms as defined by FGI.

Although the hospital also will be implementing the operation of one of its 100 percent exhaust air, negative pressure med/surg units that was recently designed for pandemic conditions such as this, leaders are also assessing the feasibility to provide additional patient care spaces for patients who have been showing symptoms, have been tested, and are awaiting test results for COVID-19.

The hospital wants to create space that, in their own estimation and evaluation, will reduce the risk of the patients potentially infected with COVID-19 from impacting other patients and staff within the hospital.

We were not asked to provide a design but information based on our knowledge of this med/surg unit, a renovation project that we designed, and perspective on potential implications, needs, and feasibility.

The executive director explained that the hospital is currently responsible for managing its own compliance (or non-compliance) with federal and local regulations under emergency protocols and are using leaders’ own judgement in order to provide a safer environment for patients and staff.

With that context in place, within just a few hours we provided a quick sketch of a floor plan test fit, ran some exhaust air volume calculations, and commented on a proposed way to accomplish exhausting air from these rooms. Considerations were as follows:

  • Create a segregated patient care unit by “compartmentalizing” seven contiguous beds that could have temporary walls and access doors placed off the main unit entry and at the opposite end of the rooms within the existing patient care unit.
  • Potentially section off the adjacent nurses’ station in half with demising temporary walls to allow half of it to serve the new compartment.
  • Two options for exhaust air were: (1) place individual HEPA exhaust units in each room and retrofit the windows to duct exhaust out; or (2) place a new exhaust fan on the roof directly above, feed three rooms with new ductwork and grilles and intercept existing ductwork for three rooms because the existing configuration allowed these to be easily blanked off from the existing main.

The client explained that it likely could only consider the first exhaust air configuration option because the provider can’t afford the time it takes to get a new fan. There is much more that could be analyzed in this example; however, this is how rapidly clients need information and to act. Note that the hospital leadership, clinicians, environmental health, and safety and infection control officers must ultimately be the ones deciding and directing which measures they determine are best practice in these emergency conditions.

After the executive director reviewed the information we sent, she had enough information to build on and manage expectations regarding operating a unit like this. These are ways that we can provide our assistance as trusted advisors for our healthcare clients. It is a critical role we can always play—and especially at a time like this.

SmithGroup’s John Viapiano and Jonathan Hulke also contributed to this article.

Stacey Yeragotelis, LEED AP, is principal at SmithGroup (Boston). She can be reached at