FEATURE ARTICLE, JUNE 2005

KEY CONSTRUCTION TRENDS IN HEALTHCARE
As America’s population ages, challenges in healthcare construction take on a new significance.
John J. DeFazio

In 24 years in healthcare construction, I’ve learned that one thing is certain: the healthcare industry is constantly changing, which makes for an interesting, yet extremely challenging work environment. Factors currently impacting the industry include advancing technology, aging healthcare facilities, an aging population, a growing number of patients and increasing competition among healthcare providers, all leading to a boom in healthcare construction.

High-Tech Digital Hospitals Check In

Just as the information age has reached into other major industries with airport check-in kiosks, ATM machines and online banking, the hottest new healthcare construction trend is the digitization of hospitals.

In an effort to remain competitive and become more flexible and efficient, hospitals are going digital. The digital hospital is designed so that medical equipment and information systems are completely integrated into one centralized system, along with everyday building operations systems. Picture Archiving and Communication System (PACS) technology enables hospitals to convert to a new digitized system of storing, retrieving and displaying patients’ medical images. Digitized medical records and pharmacy services help to complete the picture. This means no more paper charts for patients; hard-to-read doctor notes and prescription orders; or developing film results from diagnostic tests. All of this information is available digitally to the physicians and other healthcare staff throughout any number of access points in the hospital, including operating rooms, emergency departments, patient rooms and nursing stations.

This digital hospital strategy is cutting edge and not restricted to new-build or specialty facilities. There is currently only a few fully digital hospitals in the country, however, many hospitals are increasingly incorporating parts of the overall digital hospital strategy, and the fully digital hospital will be increasingly found in the next few years.

Infection Control Concerns at Hospitals During Construction Work

About 75 percent of all construction projects in healthcare involve an expansion or renovation to an existing hospital. An estimated 2 million infections are acquired in U.S. hospitals each year, resulting in the death of approximately 90,000 patients, according to the U.S. Centers for Disease Control. In response, professional, accreditation and regulatory agencies have provided guidance for demolition, construction and renovation projects in hospitals that builds infection prevention and safety into the planning process. An important first step in a hospital construction or renovation project is to conduct an infection control risk assessment (ICRA), which was mandated a few years ago. This assessment provides the foundation for long-range planning, as well as for each phase of the project from concept to completion. As the project progresses, the construction area should be continuously monitored according to the ICRA plan to ensure a safe, well-maintained, infection-free environment.

One of the main concerns in maintaining a safe environment during construction is controlling dust and molds, some of which are carried within the physical building, while others are carried in the soils. For example, when building an addition, it is important to prevent molds in the soil from becoming airborne in the hospital. This is accomplished through the implementation of dust control methods on the site, as well as filtration of air entering the building. An important precaution to take in renovations is keeping the construction area negatively pressurized, which means air, along with dust and dirt, is continuously directed back into the construction area. In addition, pay particular attention to the HVAC system and filter the air that is going into patient rooms and other areas of the hospital. In some cases, if dealing with particularly high-risk areas of the hospital, even the filtered air is not permitted to enter certain spaces until all major construction activities are complete. Another method of infection control isolates the construction area from the rest of the hospital by creating physical barriers, such as temporary partitions and passageways with zippered, air-locked entryways. These practices may seem obvious, but when a strict time schedule and budget pressures are considerations, extensive planning and preparation are necessary in order to provide a successful outcome.

Expanding Emergency Departments

In recent years, the emergency department has become the hospital’s front door. Due to growing patient demand, along with increasingly limited access to physician’s offices, many patients find themselves utilizing the emergency department for immediate healthcare needs. In order to accommodate this reality, the emergency department is being expanded and reconfigured to serve more patients more effectively and efficiently.

Patients are classified into three basic categories. Those experiencing trauma of any kind, such as cardiac arrest, are taken immediately to rooms specially equipped for these serious situations. Others who may be generally ill and who may require observation for potential admission to the hospital are placed in comfortable rooms where they can be examined by attending physicians in an atmosphere that maintains their privacy.

Finally, those with minor injuries such as cuts, sprains and simple fractures are treated on a fast-track basis so they can be processed as quickly as possible. This configuration may include a separate, walk-in entrance so as to separate those with major injuries from those with less critical needs.

Relocating Doctor’s Offices

10 years ago, stand-alone, professional office spaces were the typical outpatient facilities used by most physicians. However, this trend could be reversing as medical offices move closer to hospitals, if not directly onto hospital campuses. The reason for this reverse lies in the convenience of being closer to the diagnostic testing and other services offered at the hospital.

John J. DeFazio is a senior vice president and project executive in the Pennsylvania office of Parsippany, New Jersey-based Skanska USA Building Inc.


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