Prior to March 2020, UW Health, the health system of the University of Wisconsin-Madison with seven hospitals and 156 clinics and other points of care, faced the challenge of high occupancy and limited bed capacity. Its Madison region was already full, with occupancy averaging 95 percent. Most days it surpassed 100 percent.
When the pandemic began to take hold, metropolitan areas like Madison with populations of 250,000 to 500,000 people were expected to have 500 to 1,000 confirmed cases presenting at once. That was anticipated to result in 250 total admissions, with surge expected to hit in late April and early May.
The hospitals in this part of UW Health’s system had a total of 671 beds, but availability fluctuated daily, including some days when no beds were available. Already in need of more intermediate care (IMC) and intensive care unit (ICU) beds to meet capacity issues, the COVID-19 surge further influenced the system to investigate how it might expand its available beds.
To begin addressing the situation, UW Health stakeholders decided to modify existing inpatient rooms at several of its hospitals to increase capacity and advance some inpatient projects to increase overall bed capacity.
In addition, UW was already developing a universal care model and was implementing one of those units at its University Hospital. This gave UW Health Planning Design and Construction and design firm EUA, UW’s partner on the project, information to build upon to guide the design of a new universal care inpatient unit at East Madison Hospital.
As construction on the unit progresses, here are some insights on the project’s planning and development as well as future expectations.
Design tools to increase inpatient care
Using an evidence-based design (EBD) approach, the project was already defined with goals and objectives from the ongoing work with universal care/acuity-adaptable inpatient rooms within UW’s system of care.
Specifically, design of the new project had to ensure improvements in a variety of organizational metrics, including clinical outcomes, safety indicators, patient satisfaction, and financial performance. The new question became: Can a patient-centric, safe, universal care/acuity-adaptable inpatient unit—that also enhances staff efficiencies and satisfaction—be implemented?
Employing a Lean strategy, EUA team members analyzed patient and caregiver movement through the unit and identified ways to improve the user experience, including addressing complications added by pandemic protocols such as visitor restrictions and the required use of personal protective equipment.
EUA team members made site visits to some of the existing hospitals to observe shift changes among nurses’ staff and stayed throughout their shifts to understand how they utilized the unit, offices, and supply rooms, as well the distance employees walked during those shifts.
The on-site visits were supplemented with meetings online, engaging a wide swath of user groups. Similarly, due to the high level of demand on UW Health employees, questionnaires and online surveys were also used to include them in the design process. Interestingly, important information was gleaned from that method, as staff members were more forthright with their concerns.
Mock-ups were also utilized during meeting times to allow stakeholders to judge spatial relationships, especially considering the medical equipment and controls that would be housed in the acuity-adaptable rooms.
Design features of a universal care inpatient unit
Creating flexibility in serving a high-acuity patient environment meant several changes had to be made from the typical medical/surgical patient rooms. As a result, these design improvements were identified for the final design of UW’s new universal care inpatient unit:
- All inpatient rooms can switch to negative pressure, and the rooms were made more robust with additional medical gases, electrical outlets, and low-voltage capabilities.
- Observation windows and individual charting stations were added. Patient observation windows allow staff a direct view into the room, with monitors and controls placed outside the patient room, as well. In the face of the pandemic, this allows staff to continue monitoring patients without having to wear full personal protective equipment (PPE) when they enter a patient room.
- Each room has a decentralized charting area, which will add up to 28 additional computer stations/seats. In the future, those additions will also support the additional staff necessary when the unit needs to operate in a higher-acuity environment, regardless of the medical incident.
- A larger collaboration area was added in the center of the unit to support better communication among staff. The unit is accessible from all parts of the central collaboration area.
- To reduce walking distances and give staff more flexibility for clinical support, twice as many soiled rooms, clean storage rooms, and medical equipment storage spaces were added.
- A focus room was created, which gives staff day-to-day and long-term flexibility. Currently, it could be used for dictation or for a conference among a nurse manager and nurses. In the future, it can be transitioned into office space if necessary. Electronic ICU infrastructure was added to allow communication with specialists from remote locations, as well.
- Dialysis capabilities were added to the rooms. Throughout the pandemic, transporting patients with COVID-19 through the hospital to dialysis treatment has been problematic. This is true for patients without COVID-19, as well. Having dialysis access will allow patients to stay within one room for all care.
- Bathrooms were designed to improve safety and functionality such as redesigning the shower enclosure and adding accessible features. Additional space was added for staff support and shower chair access, too.
While improvements for the project were aimed at clinical outcomes, UW Health and EUA also focused on the family, staff, and patient experience. Wayfinding to the nurses’ station was improved with lighting, while materials were also changed within the space to provide improved acoustics. An ample staff break room with large windows was added, as was family space for patients.
Measuring inpatient capacity success
The acuity-adaptable unit will help ready UW Health’s infrastructure for the next pandemic or medical event. For example, rooms in the renovated area can be converted quickly to a higher acuity level for patients, which will help staff to operate within spaces they’re already familiar with and, as a result, improve user experiences.
And while it would be ideal to make universal care inpatient units a system-wide change, stakeholders understand it may not be feasible. The reality is that the space necessary to convert an existing room into an acuity-adaptable one requires the conversion of two inpatient rooms to renovate the space into one new acuity-adaptable room, resulting in less overall bed count.
Success of the project will be determined by comparison to metrics that UW Health already tracks. Baseline levels of patient falls, hospital acquired infections, etc., will be established and compared with the same levels from inpatient units on the fourth and fifth floors at East Madison Hospital.
These performance measures are embedded within the project’s design and are being tracked throughout construction and into post-occupancy evaluation (POE).
When the project is finished and the POE is completed, a clearer picture will be revealed as to whether dramatically increasing the volume of acuity-adaptable rooms is medically necessary and/or financially sound, and if staff and patients will benefit from renovations made throughout UW’s hospital system.
Michael McKay is director of UW Health Planning Design and Construction (Madison, Wis.). He can be reached at mailto:[email protected]. John Ford is a senior design architect with EUA (Madison). He can be reached at mailto:[email protected]. Ed Anderson is a healthcare market leader with EUA (Madison). He can be reached at [email protected].