By Milly Baker, AIA, ACHA, LEED AP, Senior Medical Planner at Margulies Perruzzi
Many hospital administrators feel pressure to increase the size of their healthcare spaces despite a shortage of capital available to support facility investment. Even with efforts to tighten up space and increase efficiency to cut costs, hospitals need larger and larger buildings. The outcome is more space per patient and provider and, therefore, increased costs.
Why is everything getting larger? A combination of many program developments has added area to hospitals. These changes include technology, general improvements in diagnostic and treatment methods that require bigger clinical teams and larger equipment sizes, more robust mechanical, electrical, and plumbing (MEP) systems, the introduction of robotics, an increase in team collaboration space, and revised requirements for accessibility. Each of these changing requirements adds increments of additional square footage.
Technology
Technology, the equipment that continues to improve patient care, requires greater infrastructure capacity. Years ago, there were 20 square foot data closets, but now, data rooms as large as 180 square feet are needed to accommodate all the digital equipment racks. Cutting-edge features throughout hospitals drive this growth, including the interconnectedness of different clinical and monitoring systems, intelligent boards in patient rooms, smart boards in conference rooms, digital communication at the patient room entrance, signage and tracking systems, and direct clinical access to patient records. Because of the continued increase in technology use, it is critical to build specific data room requirements into the program from the start.
Robotics
For many institutions, robotics are being introduced to augment surgery, save on staffing costs, and increase safety. While robotics in operating rooms, pharmacies, and labs is nothing new, re-engineering supply management through robotics is becoming more common. Robotic devices provide improved services, but they take up space both when in use and stored. Planners for new buildings should consider adding space to supply rooms and depots with dedicated corridors and elevators for this equipment. Isolating robotics equipment movement from staff and public circulation may also double circulation requirements.
MEP Infrastructure
Particularly since the start of the pandemic, hospitals require better air flow and humidification. While new technology and equipment increase typical floor-to-floor dimensions, the MEP infrastructure should grow to serve the larger space requirements. Concerns for preventing contagions from spreading have also increased the demand for protective isolation wherever patients are treated. These robust systems need flexibility and capacity for future changes as well.
Equipment
Equipment size has increased, challenging staff to accommodate the need for more space within current program standards. An example that requires more space is the reliance on ECMO (Extracorporeal Membrane Oxygenation), a form of life support for patients with life-threatening illnesses, often used to combat COVID. An ECMO setup for an inpatient requires large elevators, wider doors, and greater patient room clearance than current standards. Introducing ECMO into current, smaller patient rooms has proven difficult.
Hospital room size creep is frequent in treatment areas, including Operating Rooms, Nuclear Medicine Rooms, Radiation Treatment Rooms, and MRI Rooms. These spaces are vital to each hospital’s mission but require more space than traditional planning methods. It is now not unusual for surgeons and patient staff to request 800 – 1,000 square feet for specialty and hybrid operating rooms.
Collaboration Space
As recruiting clinical staff has become increasingly challenging in recent years, many organizations have started paying more attention to the functionality of their workspaces. Many hospitals have inadequate meeting areas and workspaces to accommodate all the staff meetings. The historic administrative model, including a nurse station and one physician’s office, is no longer sufficient for an inpatient unit. Staff now include clinical nurses, physicians, residents, case managers, social workers, educators, and nurse management. Workstations are needed for this range of support staff to do their jobs efficiently.
The ability for staff to collaborate in appropriately sized areas supports teamwork and protects patient confidentiality but is missing from minimal space standards in the Facility Guidelines Institute (FGI) guidelines. Both patient-facing workstations and private areas are needed to support team workflow. Many institutions have also started to request rest space for staff, particularly in high-stress areas, such as emergency departments and intensive care units. Breakrooms and other areas should be carefully designed to support staff respite.
Accessibility
As Americans get larger, FGI guidelines are requiring a whole new category of room sizes for “patients of size” and a newly required expansion of the American Disabilities Act (ADA) Standards turning radius. These new requirements to build larger inpatient rooms, exam rooms, and bathrooms, have been put in place to improve patient care and staff safety. However, they come with added space and cost requirements.
Program needs are driving hospitals to increase space. The challenge to planners, architects, and builders is how to manage client expectations, specifically during the programming phase when space requirements are established. The old space requirement formulas for area per bed or area per operating room need to be carefully re-examined and revised. It is critical to take account of these conditions when developing conceptual fit plans and pinpointing scope feasibility to ensure that clients understand this new paradigm. The old rules no longer apply.