How do I build 1,500 hospital beds in 2 weeks?

March 26, 2020 12:52 PM

Our 1,000 bed academic medical center needs to put up 1,000 to 1,500 beds in the next two weeks. How have others done this? Are you aware of any case studies that might point us to best practices and pitfalls?

I'm a planner at a major academic medical center that's trying to get in front of the pandemic. We're looking to create up to 1,500 beds before COVID-19 demand peaks two weeks from now.

We have a strong brain trust and lots of physical space to work with (empty dorms, a basketball arena, etc). The team is working full-steam ahead, but focused effort can sometimes cause people to walk into traps. There are innumerable details to worry about (staffing models, traffic management, HVAC, utilities, sterilization, patient transport, etc).

I'm trying to put together case studies of what other institutions have done that might point us to best practices and pitfalls. My google-fu is failing me. I'd love help from the hive mind.

I'm hoping there are non-english examples to draw from at this point, and plenty of interesting local news stories about what may be going on at a more local level.

Sorry to ask for help with my homework here, but anything you're aware of would be massively appreciated.

posted by woof to Health & Fitness (15 answers total)

Have you looked through the US Army Corps of Engineers Alternate Care Sites templates? https://www.usace.army.mil/Coronavirus/Alternate-Care-Sites/

I haven't reviewed it in detail yet, but it looks like there could be some useful standardized info in there.
posted by cnidaria at 1:11 PM on March 26, 2020 [6 favorites]

They're building a 4000 bed one in London. See https://metro.co.uk/2020/03/25/ inside-new-4000-bed -coronavirus-hospital -built-excel-centre-12455409/
posted by TheRaven at 1:24 PM on March 26, 2020 [1 favorite]

MSF medical guidelines "Médecins Sans Frontières (MSF) produces medical guides to help practitioners in the field. The contents of these guides are based on scientific data and MSF’s field experience. The scientific data used are that of the World Health Organization (WHO) or renowned international medical institutions as well as medical and scientific journals."
posted by katra at 1:36 PM on March 26, 2020 [6 favorites]

Three Army field hospitals ordered to New York, Washington states (Army Times, Mar. 25, 2020) "Army Secretary Ryan McCarthy has issued deployment orders to three Army hospital centers, the service said Tuesday afternoon."

Workers build field hospital as coronavirus spreads (The Columbian, Mar. 19, 2020) "In Oregon, Gov. Kate Brown has ordered the government to establish a 250-bed temporary hospital at the Oregon State Fairgrounds in Salem.", Caption from a photo: The Oregon Army National Guard help set up beds to assist with the Oregon Health Authority at the Oregon Medical Station at the Oregon State Fairgrounds in Salem. (WaPo)

Coronavirus: Field hospital coming to Jacksonville (Florida Times-Union, Mar. 23, 2020) "Florida emergency management director Jared Moskowitz said at a news conference Monday that a field hospital is on its way to Jacksonville, one of a few being set up across the state.", Broward County sets up field hospital to handle coronavirus patient overflow in Fort Lauderdale (7 News Miami, Mar. 19, 2020) "“We have four 250-person mobile field hospitals. One of them is actually being set up right here in Broward County right now,” said Moskowitz at a news conference"

‘Field hospital’ to be built in Coachella Valley to help with coronavirus crisis (Press-Enterprise, Mar. 23, 2020) "“Riverside County health officials are in discussions with Indio, state and federal representatives as they prepare for the placement of a federal medical station at the Riverside County Fairgrounds in Indio,” [county spokeswoman Brooke] Federico wrote in an email."

Baltimore Convention Center, Hilton hotel to be used as field hospitals amid coronavirus pandemic (WBAL-TV 11) "Peggy Daidakis, executive director of the Baltimore Convention Center sent a statement to 11 News, saying: "The center has been designated as an 'alternative care' facility by Gov. Hogan."
posted by katra at 2:05 PM on March 26, 2020 [1 favorite]

American College of Emergency Physicians: "We are updating our COVID-19 Clinical Alert repository daily to assist you with patient care."

FEMA: Community Emergency Response Team Basic Training Participant Manual (includes Section 6 - CERT Basic Training Participant Manual - Unit 3: Disaster Medical Operations Part I and Section 7 - CERT Basic Training Participant Manual - Unit 4: Disaster Medical Operations Part II)

via Americares: Responding to Emergencies (list of resources)
posted by katra at 2:36 PM on March 26, 2020 [1 favorite]

Iteratively. Build 1 as a template, and keep building it until it works out to do it 1000 times. Build it in the worst space you have first.
posted by The_Vegetables at 2:40 PM on March 26, 2020 [4 favorites]

I'm hoping there are non-english examples to draw from at this point, and plenty of interesting local news stories about what may be going on at a more local level.

Perhaps look at the Handbook of COVID-19 Prevention and Treatment for a non-US, non-UK perspective on how real-world doctors and nurses managed facilities and treatment.
posted by They sucked his brains out! at 3:07 PM on March 26, 2020 [2 favorites]

Response by poster: Thank you all so much. This is immensely helpful info.
posted by woof at 4:12 PM on March 26, 2020

Response by poster: Iteratively. Build 1 as a template, and keep building it until it works out to do it 1000 times. Build it in the worst space you have first.


This wasn't the answer I asked for, but it was the one I needed...
posted by woof at 4:19 PM on March 26, 2020 [7 favorites]

Topic Collection: Alternate Care Sites (including shelter medical care) (TRACIE / HHS)

There are a lot of resources, including in the Plans, Tools, and Templates section:

Alaska Division of Public Health. (2006). Alternate Care Site Plan. This document provides guidance and planning tools and templates to support the identification, set-up, and operation of an alternate care site to support pandemic influenza response. Included are a site selection checklist; lists of equipment and medication needs; and descriptions of staffing needs.

California Department of Public Health. (2008). Government-Authorized Alternate Care Site Operational Tools Manual. This resource includes templates and checklists to support the operation of an alternate care site.

Florida Department of Health, Bureau of Preparedness and Response. (2013). Alternate Care Site Standard Operating Procedure. Broken into six sections (e.g., concept of operations, authorities and references, and attachments), this state-specific standard operating procedure can be tailored by other states involved in designating and planning for Alternate Care Sites. Specific logistics and staffing recommendations are made with comprehensive supply lists.

Illinois Medical Emergency Response Team. Alternate Care Site Planning Temporary Medical Treatment Station Planning.This site provides tools, planning considerations, and supply and equipment information for temporary medical treatment stations. Though not specific to temporary hospitals, this guidance may provide some useful information regarding sample pharmaceutical caches, medical supplies and equipment, site selection, and the like.

Kansas Department of Health and Environment, Bureau of Public Health Preparedness. Alternate Medical Care Site Emergency Operations Plan. (Accessed 2/15/2019.) This template was developed for local agencies to use for developing an alternate medical care site plan. This template provides an opportunity for partners to identify and address issues associated with alternative medical care sites in the community by providing possible approaches for site operations.

Mercy Hospital Joplin. (2018). Temporary Hospital Buildout and Design: Floorplans. These floorplans can help healthcare facility planners and builders erect temporary, hard-sided facilities to replace buildings damaged by disasters.
posted by katra at 4:35 PM on March 26, 2020

Project manager here -- and the build 1 template is solid advice. But once you have a workable template, you need to build in parallel and likely in shifts.

Here's a quick primer on how you might do that:

Can you break the work into an assembly line?

Assembly step 1: Carpentry team frames room
Assembly step 2: Power and air team runs power & oxygen
Assembly step 3: Wall team comes in and staples up plastic for walls
Assembly step 4: Fixture team brings in bed & monitors
Assembly step 5: QA team walks through for any outstanding issues and marks room as open

Keep your most skilled labor focused on the highest value work. Make the other work easily exchangeable. If the wall team starts running behind, for example, re-allocate some of the fixture team can pick up that task.

Maximize your completion rate by making sure you have a team set to pick up the next step as soon as possible. Meaning don't keep everyone at the carpentry phase until you have 1000 rooms built out. You'd be better off with 500 finished rooms and another 100 rooms at step 3 than you would be with 1000 rooms that are only framed.

Figured out your "minimum viable product". That means what is the least room you can build and still get a functioning room. This is your standard.
posted by countrymod at 5:11 PM on March 26, 2020 [6 favorites]

Try seeing if there are any MSF logisticians looking for work in your area (many people who are normally on mission overseas are stuck at home, and looking to contribute). Maybe contact your local association, or post a shareable post on Facebook. This is absolutely, spot on, their thing. This kind of emergency is in our DNA :)
posted by hasna at 6:21 AM on March 27, 2020 [2 favorites]

Iteratively. Build 1 as a template, and keep building it until it works out to do it 1000 times. Build it in the worst space you have first.


This wasn't the answer I asked for, but it was the one I needed...

I meant build the template many times by the way, before you build the other rooms. You should have all your experts (construction, regulations, requirements) in the room building the template with you, until it works from a construction speed, cost, and requirements perspective.
posted by The_Vegetables at 7:35 AM on March 27, 2020

Architect in Italy turns shipping containers into hospitals for treating Covid-19
posted by oceano at 10:03 AM on March 27, 2020

The Guardian has an article today with more details on how they're building a field hospital in a large exhibition hall (article also discusses things like temporary morgues):

transformation of the ExCel convention centre at the Docklands area in east London into an emergency field hospital, NHS Nightingale, ultimately capable of holding 4,000 patients. [...] The ventilation system is equipped to handle large numbers of people, the floors are riddled with mechanical service boxes and there is a readily available supply of modular partitions and teams of technicians used to mounting exhibitions overnight.

“The strategy was all about using as much of the existing infrastructure as possible,” [...] “It was clear on day one how difficult procurement was going to be, as a lot of factories were shutting down. We used the exhibition partitions with a bit of extra stiffening to create the bedheads, then ran the power, water, drainage and medical gas in a long service run behind, mirroring the bed bays on either side.” Visibility between the bays was key, given that the doctors will each be charged with many more patients than usual.

More detailed article in Architect's Journal including that they had to beef up the electrical system and some considerations around running medical gas to all the beds.

They've have summarized their process in a one-page how-to manual for building a field hospital in a convention center (PDF).
posted by LobsterMitten at 8:51 AM on April 8, 2020 [1 favorite]