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 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.

Gary Vance, president of Vance Consulting (Indianapolis)

All healthcare and health/wellness organizations across the United States have been planning on how to respond and what to do related to the COVID-19 virus. Much of this planning has been organizational and procedural in nature. In addition, this planning has been logistical for items like how to obtain the required supplies and where are the locations where we will treat effected patients. These organizations are excellent with this type of planning and preparedness.

Now that we have identified more confirmed cases of the virus, the reality of where they are treated in the facility is emerging. First thing on Monday morning, I received an e-mail asking if I could join my client in a web meeting at 10 a.m. that same morning. The situation for the hospital was that a behavioral health patient currently located in a closed behavioral health nursing unit had tested positive with the coronavirus.

Our task was determining the most appropriate location for this patient within the hospital system. In this case, the system has three facilities within a 10-mile radius.

The challenge from the executive team was that we had four hours to plan and develop a solution. The solution had to be implemented within a 24-hour period. The patient had to be admitted into the room, area, or space within 28 hours from the time our meeting began.

The meeting included eight total health professionals who included: vice president of nursing, director of behavioral health, chief physician officer, director of patient safety, vice president of facilities, project manager, architect/planner (me), and general contractor project manager. This group quickly assessed the number of existing “as-is” rooms available and how we could quickly modify a similar room for the patient. The primary discussions included the following topics:

  • What is the impact of the location on other patients (either behavioral health patient or other patients)?
  • What are the current as-is locations that are appropriate? How many of these locations are there?
  • If a specific location is selected, how will it impact the second behavioral health patient if this occurs?
  • How ligature safe and specific are the existing locations?
  • How can we make an alternative location ligature safe in the designated time?
  • Could the work be done in 20 hours, giving ourselves a four-hour buffer?
  • Where will the next confirmed virus patient be located, regardless what type of patient (behavioral, obstetrics, cardiac, etc.)?

Our solution was to plan an eight-room unit at the end of an underutilized nursing unit. The first patient room was completed in 22 hours, and the patient was moved there immediately. There are seven more rooms being prepared and modified as required—one room at a time and within an 18-hour time frame now. To have all of the required products for the room, specific products have been borrowed from other patient rooms.

The nursing unit we’re converting for isolation patient rooms is an underutilized medical/surgical nursing unit. What makes this work for the initial behavioral health patient is that the staffing ratio is 1:1 because of the crisis. The high staffing ratio is the primary reason this solution works, because only the available and quick-install safety features and products could be included. Interestingly, we are now planning for four more true and fully fitted isolation rooms, which will have both type of HVAC conditions: positive and negative pressure.

If you have insight you’d like to share in this format, email Editor-in-Chief Jennifer Kovacs Silvis at