Hospitals and healthcare systems have spent much of the last three years balancing being in a state of emergency readiness while waiting for the next COVID-19 wave and safely delivering routine health services. Many of the challenges that existed before — a shrinking workforce, an aging infrastructure, and narrow operating margins — have worsened during the pandemic. At the onset of the global pandemic, faced with rising COVID admissions, many hospitals canceled elective procedures and redeployed patient care space in new ways to meet the rising demand for beds and new infection control measures. At the same time, U.S. adults delayed or avoided medical care due to their coronavirus-related concerns causing non-COVID admissions to plummet. Starting the third year of the global pandemic, staffing shortages due to burnout were at an all-time high as hospitals still struggled with COVID-19 admissions while treating higher-acuity patients. Hospitals and health systems continue to face increasing costs for labor, drugs, personal protective equipment (PPE), and other medical supplies needed to care for higher-acuity patients.
According to the American Hospital Association (AHA), America’s hospitals are experiencing unprecedented financial losses — 2022 was the most financially difficult year for hospitals and health systems since the start of the pandemic, leaving over half of hospitals operating at a financial loss at the end of 2022, and with negative operating margins continuing into 2023. As a result, healthcare organizations are rethinking their capital investments while existing facilities are being retooled, expanded, and underutilized simultaneously. In this post, you can read about some of the current issues in healthcare facility planning — fluctuating utilization and forecasting challenges, shortage of nurses, new safety protocols, rapid growth in telemedicine, advances in telecommunications technology, and integration of imaging into most medical specialties.
Fluctuating Utilization and Forecasting Challenges
According to the Centers for Disease Control and Prevention (CDC), 41 percent of U.S. adults delayed or avoided medical care in 2020 because of the pandemic. Heading into 2023, hospitals are not only still treating COVID-19 patients but continue to treat those who have postponed care and are now much sicker, requiring longer lengths of stay than before the pandemic. The continuing shift of surgical and endovascular procedures to the outpatient setting has also accelerated during the pandemic. Even emergency department (ED) visits, which have increased steadily since World War II, experienced their first significant drop in 2020; the CDC reported a 42 percent drop in ED visits in the spring of 2020 compared to the year before. Although ED volumes started to pick up by the end of 2020, they are still below pre-pandemic levels as nonurgent patients seek care in alternate settings. At this point, forecasting future bed need, emergency visits, and ancillary department workloads is challenging at best, and there seems to be no agreement on what will be the new normal.
Shortage of Nurses
The United States was projected to experience a shortage of registered nurses (RNs) even before the pandemic. A large portion of the nursing workforce is retiring just as aging baby boomers are requiring more health services, and the global pandemic has put further stress on an already dire situation. With many nurses leaving the profession due to burnout, the Bureau of Labor Statistics projects that 1.2 million new RNs will be needed by 2030 to address the current shortage. The AHA reports that the average vacancy rate for RNs across the U.S. in 2022 was 17 percent. Many hospitals are forced to hire traveler nurses whose rates are rising exponentially, dramatically increasing labor costs for hospitals. Consequently, facility planners need to design patient care spaces that facilitate efficient staffing patterns, reduce walking distances, provide a safe working environment, and promote collaboration and teamwork.
New Safety Protocols
There has been a focus on patient safety and reducing medical errors for several decades. Patient rooms are being standardized to reduce staff errors, redesigned to reduce patient falls, and equipped with patient lifts to accommodate individuals of size and the frail elderly. Other trends related to patient safety include planning medication safety zones and reducing noise to improve staff concentration and promote patient sleep. While hospitals have focused on controlling nosocomial (hospital-acquired) infections with ample hand hygiene stations and easily-cleaned surfaces, the coronavirus has brought new attention to airborne transmission. Fortunately, new technologies — such as ultraviolet light, electrostatic applications, and mobile air purification systems — provide more options than ever before to keep hospitals safe.
On the patient care unit, hospitals are triaging (or even prohibiting) visitors, converting staff break rooms to PPE don/doff zones, and leveraging point-of-care testing. Where possible, hospitals are increasing the number of airborne infection isolation (AII) patient rooms and compartmentalizing spaces that can be efficiently shut down and isolated to control the spread of infection. Throughout the hospital, split flow models are being implemented to cohort patients based on their acuity and level of suspected infection. In addition, visitor traffic is being carefully controlled, and dedicated staff entrances are being created with expanded changing/locker rooms, showers, and respite space.
Hospitals continue to demonstrate how they are redefining the “H” in providing care outside of the hospitals’ four walls, whether it’s in the home; through telehealth and remote monitoring; in schools; community centers; sports arenas; or anywhere that care is needed. — Rick Pollack, President and CEO of the American Hospital Association
Rapid Growth in Telemedicine
Telemedicine usage surged at the peak of the COVID-19 pandemic as patients and providers looked for ways to safely access and deliver healthcare services. This rapid shift, borne out of necessity, was enabled by increased patient and provider willingness to use telemedicine along with regulatory changes enabling greater access and reimbursement. During this spike, it is estimated that one-third of office and outpatient visits occurred via telemedicine. Since that time, telemedicine utilization has stabilized and varies by specialty. Sweeping changes in federal and state regulations and health plan reimbursement policies included loosening privacy regulations, allowing phone visits to qualify as telemedicine, allowing clinicians to practice across state lines, and waiving the need for a pre-existing relationship. Medicare also expanded the list of services and providers who could deliver telemedicine, and commercial insurers expanded telemedicine coverage as well. Concurrently, an effort was made to expand the telecommunication infrastructure and ensure patients have internet access. Telemedicine offered a bridge to obtaining care during the pandemic’s peak but now offers a chance to reinvent the healthcare delivery model to improve healthcare access, outcomes, and affordability. In fact, the AHA forecasts that 27% of evaluation and management visits will occur virtually by 2032.
Advances in Information/Telecommunications Technology
The healthcare industry is increasingly relying on data, whether in the form of electronic health records, financial and management data, imaging studies, sensor and device readings, voice communications, or telemedicine. Continued advances in information technology are creating new staff positions and job descriptions and altering historical perceptions regarding necessary functional relationships. As common databases generate data more quickly and effectively, many traditional health and financial data management functions are being consolidated — such as medical records, quality assurance, risk management, infection control, finance, data processing, and telecommunications. At the same time, new interdisciplinary fields are evolving — such as health informatics — that will require healthcare professionals with the skills and knowledge necessary to develop, implement, and manage information technology software and applications in a medical environment.
Integration of Imaging into Most Medical Subspecialties
Traditionally, imaging services were used only for diagnostic purposes. Today, they are increasingly used for imaging-guided interventions and treatment planning optimization. As a result, imaging services are integrated into most medical subspecialties — not just pieces of hardware organized in a centralized department. For example, real-time imaging, using a mobile ultrasound or endoscopy unit or a C-arm (its name derived from its shape), has been a standard part of the surgical operating room for many years. Today, the hybrid operating room has permanently-installed equipment such as intraoperative computed tomography (CT), magnetic resonance imaging (MRI), and fixed C-arms. Hybrid operating rooms enable diagnostic imaging before, during, and after a surgical procedure, and are typically used in conjunction with cardiovascular, thoracic, neurosurgery, spinal, and orthopedic procedures. Unfortunately, the rapid development of new imaging technologies, equipment, instruments, and different treatment options, while undoubtedly beneficial to the patient, can also lead to ambiguity regarding specific specialty claims on certain techniques and devices. As a result, practitioners sometimes compete with each other, thus creating turf wars.
See the new SpaceMed Guide (fourth edition for more information on current trends in the the dynamic healthcare industry and their impact on facility planning.
This article is an update of a previous post.