High Performance Covid-19 Inpatient Bed Solutions

Solace© Rapid Assembly

‘faster, cheaper, smarter, safer, more adaptable & importantly healthier, which cause health’

Overview

There is an acute need for innovative, rapid response technical solutions to provide added COVID-19 inpatient bed capacity options in the healthcare system, that also recognise the need for high quality environments that support the performance of workers, doctors and nurses in particular, who are performing in highly stressed, emotional and challenging situations. 

Solutions that are faster, cheaper, smarter, safer, offer more adaptable to individual hospital needs and importantly – are healthier – which cause health, need to be considered.

The Situation

Medical staff are enriching the oxygen for Covid-19 infected patients which allows their lungs to function at a higher level – than would be possible without the oxygen enrichment – increasing the chances of a better outcome. 

The Solution

Rapid assembly covid-19 patient bed environments likewise need to be ‘enriched’ if we are to achieve better outcomes for patients, and importantly help medical staff at a time when they are working incessantly; allowing them to work to their best under some of the worst medical conditions imaginable. 

The Solace Rapid Assembly – Covid-19 Inpatient bed solutions delivery team at the outset established as their guiding principles in the creation of the rapid assembly – high performance Covid-19 inpatient bed solution of creating a solution that is “faster, cheaper, smarter, safer, more adaptable and importantly healthier, which cause health” for medical staff and patients alike.

The Solace team is a collaboration between Canadian based Nucap Industries and Farrow Partners. Nucap is a global leader in the manufacturing and automotive sector that has revolutionized that industry. Their state-of-the-art technologies and innovative advanced designs solutions have been achieved by re-defined manufacturing process flows married with innovative product designs and standards. Farrow Partners is a globally recognized architectural firm in the health and knowledge sectors that consistently uses strategic planning and design methods to achieve environments that ‘cause health.’

The manufacturing and engineering communities have pivoted quickly to the challenge by using innovative methods to rapidly design and manufacture ventilating machines or handheld COVID-19 virus detection device, which produce results in half an hour; remarkable innovation against a relentless foe. The Solace team knew it could combine advanced technologies and manufacturing product flow system thinking with design on how to create high performance environments – which cause health – for these critical COVID-19 healthcare environments.

The Solace team observed that the rapid assembly COVID-19 hospital building solutions constructed to date globally – the UK ‘Nightingale hospitals’ constructed out of exhibition hall centre partition wall cubicles; the New York tented enclosed battle frontline field hospitals in Central Park; or Italian shipping contain adapted inpatient room solutions – while good initial reactions to the problem at hand, naturally left room for reflection, lessons learned and improvements towards the goal of achieving solutions which are “faster, cheaper, smarter, safer, more adaptable and importantly healthier – which cause health”- versus working against those that were doing the caring and healing. 

Solace – the project’s inspiration – from the Latin verb ‘solari’, is to comfort, calm and soothe one’s grief. How could the physical space achieve the same outcome for those caring or healing alike under very difficult conditions?

The innovation embedded in the Solace inpatient bed solution falls into two categories: first, high performance healing environment innovation and second, materials, method, fabrication and construction innovation.

1.  High Performance Healing Environment Innovation:

A very efficient ICU or Alternative Care Unit (ACU) design composed of twelve-beds wrapped in close proximity and sightlines of a central medical team care work area. The twelve-bed ward is approximately fifty by one hundred feet (15 by 30 metres) in overall dimensions, and when two units are paired together with a central access corridor, it is approximately fifty feet square for twenty-four bed inpatient unit.

The inpatient room size is equivalent to a highly functional ICU hospital room, twelve by fourteen feet in dimensions, allowing staff to access the patient beds from all sides while also providing a separate dedicated equipment zone in addition to the staff working zone, along one of the long sides of the room. Each patient rooms party wall to the next patient room has a small window, which allows staff visual surveillance of patients in adjacent rooms if they suddenly become distressed.

The staff work areas surfaces and standing areas are larger enough to avoid cramped condition of many medical personal while remaining very effective from a travel distance standpoint. Adjacent this is the staff support area including: medicine room, dictation room, team meeting room and large clean supply and soiled rooms, both with access to the corridor exterior to the twelve-patient bed unit.

The staff support area is lined on the exterior side of the unit by an access corridor, which connects the units, the public zone and logistics side of the building.

The ‘U’ shaped inpatient bed form is wrapped on the exterior of the unit by an enclosed, environmentally controlled eight foot (2.4 metre) logistics corridor that houses all mechanical, electrical and medical gases, the equivalent to a  ‘vertical interstitial space’, allowing building plant staff to access and modify systems in the space without any interaction with the patient areas within the unit. This corridor is connected back to the logistics access zone and medical gas farm side of the inpatient unit, completely separated from the public or inpatient/staff side of the unit. Fresh air is fed from the public corridor side through HEPA filtration and exhausted in the logistics interstitial corridor, creating the negative pressure requirements to contain the airborne spread of the virus.

As the twelve bed units are shaped as multiples of a square, they can be combined into any combination of total hospital beds from 12, 24, 36, 48, 60, 72, 84, 96 or more beds, in a compact efficient form adjacent to an existing hospital parking lot or a greenfield site.

Enriched environments that cause health Evidence based design research studies over the past thirty years from around the world has confirmed time and again what we knew intuitively, that the quality of the built environment can significantly hinder – or enhance – human performance, comfort and medical outcomes and ultimately our health.

One of the core dimensions of this is the concept of ‘activated optimal health’, which is driven by space, and the elements of our physical space. We know that space is not neutral. Space is effectively a ‘prescription’, which can improve our health, or limit our ability to heal and grow.

Emerging research in neuroscience on architecture reveals importantly that mind health is impacted – or enhanced – by certainly design decision on how were shape physical space; where we work and heal. 

Through design, we can connect the dots between psychological cognitive and pre-cognitive reactions that have physiological responses; the responses that fundamentally effect human performance – specifically under stressed conditions. 

We can intentionally create ‘enriched environments’ that enhance human performance, through specific spatial characteristics, both cultural and causal, and thus support optimal health, where we are work under extreme pressure – and where we heal.

Space can be tuned for constructive human behavioural performance. These elements (or characteristics) of enriched environments, create embodied simulation within our mind/bodies’ biological and chemical systems. Like architectural ‘super vitamins’ that can enhance and activate 

Can we incorporate the concept of enriched environments into a temporary rapid assembly Covid-19 hospital buildings so we can achieve solutions which are “faster, cheaper, smarter, safer, more adaptable and importantly healthier – which cause health” than the examples we have seen to date?

The Solace teams approach to creating enriched working and healing environment for medical staff and patients alike is based on using daylight and views to the sky and changing light of day/night cycles, season and weather conditions as an accelerant for health and wellness outcomes.

The rectangular form of the twelve-patient ward has three side made up of inpatient beds, with the fourth side consisting of staff support areas. These surround a central rectangular medical staff care zone. Above this central area we have lifted the ceiling to create a four-sided clerestory window lined lantern volume. 

The “raised lantern” architectural element allows daylight and natural light to bathe the working areas for staff. For patients that need to face forward to the care areas for obvious reasons, a window in the back of the inpatient room is of little value or impact. The lantern solution provides direct views for the patient lying in their beds facing forward under ventilated conditions, out the windows above the care station, to observe and absorb the changing light of day/night cycles, season and weather conditions.

Better Outcomes for Staff and Patients Alike: We know well from abundant evidence based design research on the health outcome benefits of views of nature for all patients (let alone staff) and equally research on the health benefits of light and day/night cycles- circadian rhythm evidence –  as it relates to health outcomes of prematurely born babies in neonatal intensive care units which are in proximity to daylight and nature light. 

We can surmise the health benefits on ventilated ICU patients would be similar. For example, the ability to sense the changing light conditions of a passing cloud, a sudden rainstorm, the warm colour of afternoon light, gentle moonlight or the early morning first raise of the rising suns. These changing conditions give a sense of life, time and hope and forward motion. They support the concepts of enriched environments: variety and vitality; sense of occurrence; optimism; nature; solidness, silence, stillness and intimacy: authenticity; and legacy.

2. Materials, Method, Fabrication and Construction Innovation

Similar in performance and environmental properties to a concrete block  The base component of the Solace Inpatient bed solution is a state-of-the-art building block, the first of its kind in the world, using proven technologies. The Grip Timber Cross Laminate Block (GTCLB) is a construction block similar in performance properties and strength to a concrete block, however it is lighter, non-brittle to shattering and made of offcut discarded small pieces of wood bound together mechanically by thin strips of a proven technology called Grip Metal. Grip Metal is a patented mechanical bonding system that evolved out of the process of binding car brake pad metal saddles to the fibrous material that engages the disc brake surface. 

Similar in performance and environmental properties to cross-laminate timber  (CLT) floor and wall systems, yet binds the small wood elements together quickly through a stamping press process by applying pressure versus the CLT assembly process using glue and a long chemical curing process. It also shares similar positive char characteristics as CLT from a life safety perspective. The GTCLB block is also of a size that is easy to handle by a person, versus using a crane in the CLT construction process. The stamping press block assembly process allows the possibility to fabricate one thousand blocks per hour, creating a very cost-effective block to produce.

Similar simplicity and accuracy building block system to that of stacking Lego blocks, as we did as children. The bottom and top of each block has two strips of Grip Metal, one side pressed into the wood assembly, with the exposed face cover with a thin sponge-like sheet, which cover the grip hooks while not assembled, however compresses when stacked against another block, creating a Velcro-like mechanical connection between the two faces of Grip Metal hooks. The connection creates a bond that resists massive horizontal and vertical forces similar to a concrete block and masonry assembly. Once GTCLB blocks are stacked, the corner of the room assembly are tied together with a vertical tie rod from the top to bottom of the wall enabling the wall to resist virtually any impact or uplift force.

Due to the blocks being manufactured to an accuracy of five thousands of a inch, and the Velcro-like bond, anyone with low skill levels can assemble the blocks extremely quickly with and accurate fit, similar to a Lego block assembly, with no need for a wet mortar binding system that requires drying and curing time. A single unskilled person can assemble the structure of one inpatient bedroom in thirty-five minutes, thereby importantly creating very low labour costs to construct the structures. 

Equally importantly, when the building is no longer in use, the corner tie roads can be removed and the blocks disassembled as simply as it is to disassemble Leg blocks, for reuse in other hospital sites or building needs.

Previously glued together, the Nucap innovation for brake pads was to create a Velcro-like surface on the metal surface equivalent to hundreds of small hook-like connections between the surfaces. The barb-like metal hooks are applied to thin sheets of aluminum or steel, enabling virtually any two or more sheet materials (wood, polymer, composites and other metals) to be bound together without being glued, welded or bolted. When stuck together, the two pieces can become up to three times as strong as they were in their individual state. Nucap has produced or licenced one billion brake pads with zero failures; an impressive achievement for a car part that is exposed to extreme changes in pressure, temperature, moisture and salt conditions.

As a result of the blocks structural strength characteristic, the rapid assembly walls can support any wall mounted medical device loads. The blocks also have internal cavities, like a concrete block, allowing any mechanical or electrical services or conduits to be run within the walls. As the blocks are in ten-inch (254 mm) modules, rooms can be sized to any shape and size, versus the cramped clinical functional limitations of the shipping container inpatient wards solutions which don’t allow for staff access to all sides of the inpatient bed due to their limited room dimensions. The walls and ceiling are clad in quick assembly fibre reinforced panels fastened directly to the structural walls.

Grip Metal flooring system: the sister flooring system to the building block system is based on the theory of ‘spreading the load’ over wide areas, by binds together thin layers of eighteen inch wide by fifty-four inch long of precision Grip Metal steel and aluminum Velcro-like panels with layers of a composite infection resistant & waterproof surface material creating a floor with the strength and load supporting properties of concrete. The system can be applied directly on sand, soil, old concrete, asphalt (hospital parking lot adjacent the building) or virtually any surfaces to create a waterproof, level, loadbearing surface to support the structure above without the need for footings or foundations. The floor system also includes a low tech/high performance radiant heating/cooling system placed directing under the assembly, providing pleasant radiant heating and cooling needs for the occupants.

Solace rapid assembly – high performance Covid-19 inpatient bed solutions are “faster, cheaper, smarter, safer, more adaptable and importantly healthier – which cause health.” The system can equally be used for other inpatient unit requirements, clinical or medical uses, long-term care needs and other building uses.

More on Solace© Rapid Assembly – High Performance Covid-19 Inpatient Bed Solutions at:

www.nucap.com

www.gripmetal.com

www.farrowpartners.ca

For more information contact:

Tye Farrow  Senior Partner, Farrow Partners Architects

tye@farrowpartners.ca

Mark Lavelle Global OE Sales Director, NUCAP Global 

mark.lavelle@nucap.com

About the author:

Tye Farrow

Senior Partner, Farrow Partners Architects

FRAIC, B.Arch., M.Arch.U.D., OAA, MAIBC, AIA Assoc, LEED AP

Tye Farrow has gained international recognition for designing places that enhance our capacity to thrive—culturally, economically, mentally and physically. He has initiated a global “Cause Health” movement aimed at raising expectations for design as the basis for total health, which extends beyond environmental sustainability and physical health to encompass our mind health; connects the dots between neuroscience and architecture.  

Tye’s projects across North America, Asia, Africa and the Middle East demonstrate leadership in this visionary quest. He has been invited to present his ideas at leading institutions including the Mayo Clinic and the Cleveland Clinic, as well as venues from Helsinki Finland to Auckland New Zealand. His portfolio includes multiple international awards for designing some of the most technically advanced facilities in the world.

The Stockholm-based World Congress on Design and Health identified him as a global leader who is making “a significant contribution to health and humanity through the medium of architecture and design.” Hospitality Design Magazine has deemed Farrow globally one of “nineteen earth champions and wellness visionaries who are changing what it means to do good.”

Tye Farrow holds a Bachelor of Architecture degree from the University of Toronto and a Master of Architecture in Urban Design from Harvard University. 

Besides running Farrow Partners, in his spare time Tye is in the process of obtaining a Master of Neuroscience applied to Architecture and Design degree from the University IUAV of Venice (Istituto Universitario di Architettura di Venezia), one of fifteen people from around the globe accepted into the program. He anticipates obtaining the degree in September 2020.