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Hospital infrastructure: New challenges and opportunities

Day-1-Panel-2-1

Six top healthcare leaders across India came together to converse and contemplate on vital topic Hospital infrastructure: New challenges and opportunities; at the first edition of the Healthcare Transformation Summit. The panel discussion saw experts stressing on how many hospitals right from public health facilities to super-specialty hospitals are going in for new approaches in hospital building design and architecture healthcare systems.

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The panelists for the session were Nitin Pandey, Head HTSI, Solutions CoE, Philips India, Joy Chakraborty, COO, P D Hinduja Hospital, P Hari Krishna, Executive Director, Medicover Hospitals, Devanand KT, CEO , Aster Prime Hospital, Sam Mehta, Executive Vice Chairman, Dr Mehta’s Hospital, Rajkumar Mani, Director-Strategy and Covid-19 management, Yashoda super-specialty hospitals.

Initiating the discussion, Pandey explained about the HTSI vertical where the design solutions are offered in hospital fraternity by Philips India said, ” We are in the hospital design market for more than a half-decade now our market includes countries like Latin America, North America, Europe, Asia. As for India, we are quite in the nascent stage till now we have delivered 2.7 billion square feet of hospital space design for different hospital clients across the country.”

Giving a comprehensive presentation on the topic pandemic responsive design, Pandey said, “In this pandemic situation the infrastructure challenge was segregating the COVID-19 patients and non-COVID-19 patients, isolation of IPD areas are given separate blocks or floors. Right now what the hospital does is that they create makeshift screening areas where the entries for ER areas, main lobby are separate. Challenges are seen in ICUs, lifts, air circulation, and isolation areas. Hospital is not designed for complete traffic management for the pandemic the makeshift arrangements are not so effective it might end up in cross-contamination. So Philips has worked with certain hospitals’ emergency departments where one portion is isolated for mass casualties. Certain hospitals liked the idea of screening, isolation facility on different floors, exterior expansion with the covered shed where OPD can be managed near the entry. In one of the hospitals we had put an enclosed cabinet with showerheads for patients who are disinfected as they enter the hospitals.“

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Also read: HAI–An imminent threat amid Covid-19

Speaking about how COVID-19 has taught hospital infrastructure is crucial, Joy Chakraborty,COO,P D Hinduja Hospital, said, “This pandemic has taught us in a big way that functioning, architecture, hospital design will be the key factor for hospitals. Initially, we had to create a safe room and a triage room was put in place so the hospital doesn’t get contaminated. We had a separate building and converting it into the COVID-19 isolation ward was not an easy task; we had to create proper zones like red, yellow, and green, installing the HEPA filter, air circulation, and transportation of patients. It needed meticulous planning and execution. In Mumbai, certain hospitals had no separate building and had to convert the whole building to a COVID-19 zone. “

Further adding to it Devanand KT, CEO, Aster Prime Hospital, said, “During the first lockdown period when there was not much patient occupancy in the hospital we started with hands-on training for the hospital staff on infection control measures, the way to stay safe and safe garbage disposal. Root maps for accessing the wards or floors were given to each staff in the hospital. We had separated the diagnostic labs and radiology departments and we had adopted different timings for the COVID-19 and non-COVID-19 patients. The major challenge encountered was counseling the family of the patients with digital devices like tab and videos to update about the patients. To move a critical patient from the Emergency Room (ER) triage and move them to a respective ward was a challenge. Hope innovative hospital design can be useful in this segment. As for oxygen tanks, many of the small scale hospitals have it in less capacity it can be enhanced if the hospital infrastructure designs are advanced. We should also bring in more mechanized infection control measures. The modules like plug and play ICUs can be used.”

Sam Mehta, Executive Vice Chairman,Dr Mehta’s Hospital, said, “As for public health set up the management of COVID-19 for each state it has been a different response many have done it differently some better than others. The private sector has been mostly the same, we are an 87-year-old health system, our main hospital building was built in 1955 and we have been modifying the layout. The important observation made during COVID-19 in terms of infrastructure was not just about the patient or visitor flow it was other about how the clinician, nurses’ safety, garbage disposal, and flow of equipment. Hospitals had to manage their strengths and weaknesses. Our strength was the two buildings in our new hospital with interconnectivity so one was converted into COVID-19 zone and the other into non-COVID-19. You can’t make a hospital futureproof; different scenarios demand different responses. It is a new virus and the pandemic has tested many of us and made us think differently. As part of our NABH accreditation and as part of our contingency preparation in early January we piloted a project where we had connected every ICU and pediatric ICU monitors were connected with a technology sense where the doctors can check the vitals of the patients. Safety of doctors, nurses were huge for private healthcare but for public healthcare, it would have been enormous. This technology helped patients in real-time.

Informing that the COVID-19 experience is transformative and it makes us reflect what we have been doing in the last two months, Rajkumar Mani, Director-Strategy and Covid-19 management, Yashoda super-specialty hospitals, said, ” I don’t think we did everything very well as we have the benefit of hindsight. We started converting hospitals into COVID-19 and non-COVID-19, patients were not admitted in many of the hospitals that caused a lot of difficulty for patients. Many times asymptomatic patients affected with heart attack, stroke, or in labor visited the hospital and later turned out to be a positive patient. Hospitals were more worried about losing business. It was more important to triage properly, in our hospital we had a seven-point questionnaire and properly accessed. Initially, we had difficulty in ascertaining the COVID and non-COVID-19 patients but now with the antigen testing that has become easier. We cannot make all the hospitals COVID-19 and the hospitals need to be more prudent to accommodate both patients with proper safety measures. Outside hospital centers like hotels, railways coaches turned to containment zones they cannot replace hospitals it is not safe. Hospitals need to improve hygiene conditions and adhere to all infection control practices in ICU, IPD, OPD, wards, labs should be strictly adhered to. This pandemic is an alarm signal of our unpreparedness so we need to have a default level of good infection control.

Talking about the initiatives taken in the hospital, P Hari Krishna, Executive Director, Medicover Hospitals, ” We run 15 hospitals in 3 states Telangana, Andhra Pradesh and Maharashtra with 3000 beds. In Telangana, Andhra Pradesh COVID-19 peaked a little later so we were able to see the other models. Out of 15 hospitals, we converted one into a COVID facility in Hyderabad. As of today we are treating 1000 COVID-19 patients and have already treated over 4000 suspected COVID patients in the past three months. We created an executive board particularly to tackle the pandemic. A lot of learning was done before initiating COVID management. We had created different zones, triage areas, separate entry points, and created an internal video conferencing app. Over 1000 consultations we do on a daily basis. Even the nursing hostels and using vehicles were separated. We were able to manage as we had the infrastructure support. Ensured a separate supply chain team was kept for the COVID-19 and seamless supply of PPEs and the entire medication. Across the room, we had only 25 doctors and staff who were treated for the virus-infected we started aggressive treatment they are all recovered. Protocols are kept in place during the pandemic. We got learning from our European counterparts on safety protocols.

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