TEXT Michel Broz, Partner, Jodoin Lamarre Pratte architectes
Planning new hospital facilities is a long-term process, sometimes spanning more than a decade. This process has to take into account a plethora of parameters: demographic and socio-medical projections, evolution of technology, and risks such as a global pandemic. Investing in preventative measures to mitigate such risks is costly, and can be difficult to justify politically, since their likelihood is not easily assessed. However, when we now consider the costs of the COVID-19 crisis—whether in the loss of lives, construction of improvised infrastructure, or mental stress endured by society at large—investing in the necessary resources to be well prepared seems like an obvious choice.
In Quebec, certain hospitals have been visionary in integrating infection-disaster preparedness systems, policies, and programming elements within their new facilities.
The 350,000-square-metre CHUM project in Montreal was programmed more than ten years ago. (The first phase, by CannonDesign and NEUF, opened in 2018; phase two, by Jodoin Lamarre Pratte and MSDL, is set to open in spring 2021.) Even so, the possibility of having to accommodate a sudden influx of highly infectious patients was considered, such as in the planning of an isolation unit for respiratory illnesses, and another 36-bed unit that allows for contact isolation. Generally, the horizontal and vertical circulation movement of staff, materials, and ambulatory patients is separated from public and medical zones. Furniture and equipment alcoves were strategically located to optimize movement while maintaining necessary corridor widths. Recently, some extra isolation measures were added—including Ebola isolation rooms—even before COVID-19 emerged.
Another success story is the recent major expansion of the Jewish General Hospital in Montreal, programmed and designed by Jodoin Lamarre Pratte. The hospital and design teams decided to improve infection control beyond the basic requirements of the time. In the new critical care pavilion, all rooms for intensive care patients are 100 percent isolated. For the medical and surgical units, each floor includes three isolation beds and four acute care beds. The 32-bed nursing units in these areas can be divided into three sub-units, each with their own common services and nursing stations, such that staff can be maintained within each cohort when needed. The coronary and cardiovascular care unit, neonatal unit, O.R. suite and birthing suite are all equipped with their own isolation rooms. Some treatment pods can also be isolated by designating one-way corridors.
Additionally, the Emergency Department was the first in Quebec to be planned so that all 53 observation beds are isolated from one another, with some rooms in negative pressure, and others in positive pressure. Each observation bed has double access through separate corridors—one for the patient and visitors, and one for the medical staff—further limiting the risk of infection spread.
Finally, a 24-bed, 100 percent isolation unit was planned on the top floor of the 11-storey building, ensuring that infected patients may be properly isolated from staff and other patients.
Today, the hospital has become one of the primary care sites for COVID-19-related cases in Quebec, with patients and staff benefitting from a safe environment of care.
New hospitals—and there will be many in Quebec in the next 10 to 15 years—are presently integrating lessons learned from the COVID-19 crisis. They are considering the possible cohorting of patients in isolated pods within nursing units, an increased number of isolation rooms for various specialties, a better segregation of clean and soiled material trajectories, and an increased separation between public and medical staff circulation. The province’s university teaching hospitals, which integrate tertiary and quaternary care, are especially sensitive to these issues, since their patients are in a much more acute state of illness. Community and regional hospitals are applying these new approaches to a lesser degree. The Ministry of Health is expected to make new recommendations for projects that are currently in the programming and planning phases.
One must note that architects may plan for certain spaces and specific physical barriers, but the staff’s strict adherence to daily operational protocols is equally important for successful infection control in an acute care hospital environment.
This article is part of our Pandemic Effect series. Our complete list of experts in this series includes:
- Michel Broz (Jodoin Lamarre Pratte) on hospital design
- Darryl Condon and Melissa Higgs (HCMA) on community centres
- Robert Davies (Montgomery Sisam) on long-term care homes
- Jason-Emery Groen (HDR) on team structure
- Susan Gushe and Kathy Wardle (Perkins and Will) on the climate crisis
- Bruce Kuwabara, Mitchell Hall, Kael Opie and Geoff Turnbull (KPMB Architects) on academic facilities
- Matthew Lella (Diamond Schmitt) on theatre design
- Caroline Robbie (Quadrangle) on office design
- Graeme Stewart and Ya’el Santopinto (ERA) on housing retrofits
- Vincent Van Den Brink (Breakhouse) on retail and hospitality
- Betsy Williamson (Williamson Williamson) on social and gender equity