Phoenix Convention Center - 2019 PDC Summit

ASHE’s 2019 PDC International Summit and Exhibition in Phoenix, Arizona took place at the end of March. The multi-day health facility planning, design, and construction conference brings together leaders in the healthcare networks, architecture and engineering, construction companies, and vendors specializing in products for the healthcare market. The sessions covered major trends in the healthcare space that will influence healthcare facility design now and well into the future. Here are my five key takeaways from the conference.

1. CYBERSECURITY

Cybersecurity was a major topic of discussion. No longer an IT issue, cybersecurity is an enterprise-wide risk management issue. John Riggi, a former FBI Agent, now serves as the Senior Advisor for Cybersecurity and Risk at American Hospital Association, discussed the various risks health facilities face when it comes to its data.  

Operational systems, corporate and personal financial information, protected health information (PHI), and personal identification information (PII) are all at risk. Healthcare networks are data-rich environments and are therefore a target-rich environment.  Emerging and embedded risk threat sources are crypo-hijacking, internal threat, ransomware, business e-mail compromise, supply chain attacks, and computer intrusions.    

It’s important for facilities to know its potential risks and develop a response plan because if a cybersecurity issue does arise, patient safety could be at risk. As designers, this topic should be one of the design criteria we discuss with our clients.

 2. USP REGULATION CHANGES

If all facilities report data accurately, medical errors would be the 3rd largest cause of death in the U.S., mostly due to compounding errors. Approximately 8 million healthcare workers are potentially exposed to hazardous drugs per year. Right now, USP (United States Pharmacopeia) Chapter 1 through 999 are considered official monographs and are enforceable by the FDA and the State Boards of Pharmacy. However, Chapter 1000+ are only considered guidelines and are not enforceable.  

On December 1, 2019 the USP Chapter <800>, which regulates hazardous drugs, goes into effect. This mandate was put in place to help protect the safety of healthcare workers. The approaching regulation has healthcare facilities scrambling to be complaint be year’s end. In addition, the USP revised Chapters <795> and <797> to better align with Chapter <800>. Chapter <795> regulates non-sterile compounding while Chapter <797> regulates sterile compounding. All states license pharmacists to compound; however, not all states use uniform compounding standards. Both Chapters 795 and 796 will go into effect in December as well.

It’s important for architects to understand the new standards in order to properly aid healthcare facilities to meet the new guidelines in its pharmacies, clean rooms, and infusion centers. Protocols for restricted areas and unclassified rooms depend on the category of drugs and time limitations that the drug is compounded and used. Primary and secondary engineering controls are required for air quality in clean rooms, the key element in clean compounding products. Areas should be physically and mechanically segregated from the clean room suite, with differing positive and negative air pressures and proper air purity standards (ISO Classifications). Operational practices such as hygiene and garbing are also key components in the workflow and should be kept in ante rooms with a buffer between itself and the designated clean room.  Finishes and cleanability play a key role in maintaining the sterile environment.

3. CHANGING POPULATON: NEURODIAGNOSTIC / BEHAVIORAL HEALTH / BARRIATRIC / GERIATRIC HEALTHCARE DELIVERY 

Another topic discussed in numerous sessions were the changes in demographics and what challenges the changing population impose on healthcare facilities. The sessions covered holistic approaches to patient separation, safety and security, strategies in finish and furniture design, and additional building components.

Neurodiagnostic: One session, "Improving Behavioral Healthcare Delivery", presented a case study on the NeuroDiagnostic Institute and Advanced Treatment Center in Indiana, showing how implemented design could enhance the behavioral health environment. The session discussed the need to visually and physically separate patients, provide anti-ligature and temper-proof components, plus material selection and durability of the physical environment.

Behavioral Health: Another session titled "Reducing Ligature Risk & Suicides in Hospitals" discussed reducing risk and the regulatory agency compliance requirements. Regulatory agencies, such as CMS (Centers for Medicare & Medicaid Services) can cite a facility and immediately close it down if ligature risks are present. There are design and building component methods that can be utilized to reduce risks and better the environment for patients receiving behavioral healthcare.

Bariatric Population and Universal Design: One session discussed the aging and obesity trends in the U.S.  The increased aging population and obesity epidemic is putting pressure on healthcare spending. Workplace injuries are increasing for both patients and healthcare providers. Environmental barriers need to be recognized and overcome through more efficient design. Equipment and building modifications need to be made to better suit the population. Respect, dignity, and care need to be a focus for this population and considered in the design of the spaces.

Even in the "AIA/AAH Forum: Codes and Standards Behavioral Health Design" session they discussed issues related to design and planning for behavioral health. The session provided case studies and illustrated the need to create code compliant spaces in the emergency, patient unit, and other areas in the hospital. Sections of the 2018 FGI were reviewed delineating the minimal requirements for general and pediatric Psychiatric Patient Care Units, Alzheimer’s and Dementia units, and Forensic Psychiatric Units. 

Additionally, the panel discussed conflicting, problematic provisions in the code set-up and the different priorities within the code. Patient and staff safety were also addressed. Better understanding the patient needs has led the Joint Commission Task Force to make new recommendations, further emphasizing patient safety design.

Geriatric Health: Kathryn Gallagher, MS, BSN, RN, NE-BC, from the University of Pennsylvania Health System states that the geriatric population requires 50% more laboratory and imaging services than the younger population, presenting multiple co-morbidities. They take multiple medications, exhibit complex physiological changes, and require social services for discharge planning. Emergency Departments are experiencing a steady increase in people with these needs and must develop new models that better suite these patients.

Implementation of geriatric design accommodations will assist healthcare facilities in better allocating resources and improving admission and readmission rates. “Further, geriatric-friendly design decreases iatrogenic complications and the resulting increased length of stay and decreased reimbursement. The design should consider modifications that promote safety, comfort, mobility, memory cues, and visual and auditory perception,” said Gallagher.

4. CHANGES IN THE LIFE SAFETY CODES AND FGI (Facility Guidelines Institute)  

In "Compliance with Accreditation: Leading the Way to Zero", Mark Pelletier, RN, MS, describes the purpose and mission of The Joint Commission and its focus to improve patient outcomes, by identifying the potential paths to help healthcare facilities for achieve zero harm. Preventing patient harm events such as fires, falls, pressure ulcers, and wrong-site surgeries are not only operational issues, the design of the built environment can also assist in the prevention of patient harm.  The 1961 Harper Hospital Fire greatly affected building codes and design to avoid the loss of life of people who were not capable of self-preservation, thus changing hospital construction.  It’s time to take a proactive design approach in solving emerging healthcare challenges, such as aging buildings and equipment, multiple campuses, and consumer safety concerns.

At the session "A Quick Look at the 2021 – The Next Edition of NFPA 101 and 99", Mike Crowley, Jensen Hughes, and David Dagenais discussed how the NFPA Life Safety Code development process works. Though public input, the NFPA Chapter recommends proposals and technical committee review and requests comments by the public and chapter membership. Here are a few of the possible major changes in NFPA 101: 

• Chapter 7 Means of Egress will link door security in the occupancy chapters. 
• Chapter 8 Fire Protection will allow smoke detection for early warning.
• Chapter 10 Interior Finishes, Contents, and Furnishing will begin to address exterior furnishings and furniture, as these items have contributed to exterior flame spread. 
• Other revisions include construction type changes in Chapter 19 to allow nursing homes that passed the FSES in 2000 to remain. 
• Chapter 21 Existing Ambulatory Care corrects an omission in the past code requiring automatic sprinkler protection for all existing high-rise buildings.

The presentation "Facilities Guidelines Institute Beyond Fundamentals" by Bryan Langlands and Doug Erickson discussed opportunities to stay current with trends and research that goes beyond the current code, providing resources for the healthcare industry that are relevant, innovative, clarifying, and educational.  These topics, including additional studies, white papers, and industry collaboration go beyond the minimal current FGI Guidelines and focus on emerging trends.  

5. NEIGHBORHOOD HOSPITALS 

The increase in smaller neighborhood hospitals isn’t a new trend, but it’s still a big topic of discussion as regulations and planning continue to evolve.  Jason Carney and Julissa Tellez presented “Neighborhood Hospitals 2.0” which explained how market sources are shaping delivery models and facility needs. Consumers are looking for convenience and neighborhood hospitals allow consumers to choose from a few facilities. Healthcare providers are also experiencing increased competition while seeing a demand shift in services.

Outpatient hospital revenue now exceeds inpatient hospital revenue, a newer phenomenon over the past few years. Hospital revenue generated from out-patient services points to a trend where, in 2015, the percentage of hospital revenue from out-patient services exceeded in-patient services.

To take advantage of this dynamic change, health-system networks seek to provide a “Direct-to-Consumer Access Channel” in which Microhospitals in a localized area can serve patients unable to access a primary care physician. These facilities often attract patients for emergency and diagnostic services.  Competition and consolidation also play an importation role in developing these new business models.

Neighborhood hospitals require a very different design plan, logistics, and planning than larger facilities. Microhospitals need to have scaled down support services, lean workflows, and flexible and adaptable programs in case expansion is needed in the future.

In summary, between new technology, changing trends, and new code requirements, healthcare facilities are currently going through a design overhaul. Staying informed on changing trends and regulations is important for architects to be able to share the latest information with clients.

To discuss these trends, reach out to Senior Healthcare Architect, Leonard van Heest.