While the construction of large scale, temporary field hospitals is getting most of the headlines at the moment, a huge amount of work is also going on behind the scenes at NHS trusts and hospitals across the country to improve resilience, and in some cases Vanguard’s fleet of mobile healthcare facilities have played a key role.
The NHSE has ordered all hospitals to free up capacity by discharging non-critical patients and ceasing all planned and elective procedures by 15 April at the latest, to prepare for the expected spike in Covid-19 related admissions. To date, over 30,000 bed spaces, equivalent to over 50 new hospitals, have been freed up or created across existing NHS hospitals for coronavirus infected patients. This represents a phenomenal achievement and shows just how responsive the NHS can be in a major situation.
Many hospitals have needed to repurpose internal space and redeploy resources in various ways in order to free up areas within the hospital for Covid-19 patients. However, converting existing space into a ward or a facility suitable for this purpose is not necessarily that straightforward or quick to do. Above all, it has required careful planning, taking the entire hospital’s estate and resources into account.
Responding to the challenge
Guidance issued by the Government in March for managers and estates teams that want to convert an existing facility into a temporary Covid-19 ward to house intubated patients, recognised the speed at which hospitals need to adapt, and was suitably pragmatic. It states that in identifying suitable locations, existing traffic flows should be considered, and any through routes for non-Covid-19 traffic avoided. Logistical flows, clean and dirty waste management must also be taken into consideration.
Another key requirement is for adequate ventilation and extraction, since the high number of ventilators in use could enrich the air with oxygen, thereby increasing the combustion risk. A range of other planning considerations must also be considered, such as fire safety given the change in layout and use, particularly if construction work is required to convert the space. As well as connections for medical gas and oxygen, bed spaces also need additional connections and space around them for equipment that is used intermittently in the bed area.
The recent guidance also states that, wherever possible, a designated self-contained area or wing of the healthcare facility should be used for the treatment and care of patients with Covid-19. This area should ideally have a separate entrance and exit and a separate reception, and must not be used as a thoroughfare by other patients, visitors or staff, including patients being transferred, staff going for meal breaks, and staff and visitors entering and exiting the building. It must also be separated from non-segregated areas by closed doors.
Using flexible healthcare solutions
As Vanguard’s mobile theatres and wards are self-contained units, they are particularly suited for treating infected patients that require isolation, or for providing critical surgery or treatment away from Covid-19 areas of the hospital. In addition, they already meet the relevant standards so can be rapidly repurposed to provide additional bed spaces.
However, what has emerged in recent weeks is that hospital managers with a Vanguard mobile theatre, treatment facility, CSSD unit or ward already on site, are seeing this unit as a vital extension of their own clinical estate and as key to Covid-19 capacity planning within the hospital.
The additional external capacity of the unit has allowed some hospitals to better choreograph their changes across the estate as a whole in order to provide uninterrupted care for patients in a situation that is changing daily.
In recent weeks, Vanguard’s fleet of mobile wards, operating theatres and endoscopy suites have been repurposed in a number of different ways as part of hospitals’ Covid-19 planning, as part of their overall plan to increase resilience. The resulting solution and the eventual use of the mobile facility has depended on each hospital’s individual requirements, the position of the unit within each site, and its proximity to certain departments.
Emergency surgery and essential treatment
Since speed is of the essence, hospitals are being encouraged to identify the areas that can be converted effectively with a minimum of modifications, such as existing wards, theatres and catheterisation labs, including preparation and scrub areas. Because of the requirement for piped medical gases and additional oxygen, many hospitals are finding that the optimal site for adding Covid-19 capacity is within an existing operating theatre department.
The NHS has been encouraged strongly by its Strategic Incident Director, Professor Keith Willett, to ensure that when they look back after this crisis, that they have not done as much harm to non-Covid patients requiring urgent care, as they have done to the positive in supporting Covid-19 patients.
As a result, a number of hospitals with a Vanguard mobile theatre or ward on site are using the mobile facility to decant existing internal surgical or clinical space. Examples of procedures that are now being undertaken in Vanguard’s mobile units include emergency surgery, urgent care such as cancer treatment, and the treatment of trauma patients.
One hospital is using their operation theatre for urgent plastics work and dermatology, while another is using theirs for emergency obstetrics. Key to this has been the flexibility of these facilities in that they can be repurposed very quickly, depending on the desired use.
Another advantage is the mobile nature of the units, since they can relatively easily be relocated where they are needed the most. In Scotland, one Health Board is considering relocating their mobile theatre to another hospital site within the same Board where the need is greater.
COVID-19 and patient isolation
A mobile or modular ward could be converted into a Level 1 respiratory support ward, while mobile operating theatres have to potential to be repurposed as HDU or ITU wards or be used for procedures and treatments that benefit from the additional isolation.
Some units are also used to isolate patients who are showing suspected Covid-19 symptoms but are awaiting further assessment. One major regional hospital has repurposed their mobile facility temporarily as a surgical observation suite to help alleviate pressures in other areas of the hospital, while others are using mobile theatres and wards for critical day surgery, in order to keep patients away from Covid-19 zones within the main hospital.
Because Vanguard’s mobile healthcare facilities already meet most of the relevant standards, they can be repurposed to accommodate a change of use as the situation changes, whether that is adding ITU bed spaces or additional treatment capacity, without facing many of the usual problems associated with converting an existing facility or constructing a new building or department.
Some hospitals have identified the need for additional space for other purposes, for example, to support staff by providing much needed rest areas, or providing changing facilities that need to be located separately either from infected or non-infected patients. Vanguard has also been able to donate a number of spare ventilators to the NHS.
In many cases, Vanguard’s experienced clinical support staff have been redeployed, either within the unit or in other areas of the hospital, including Covid-19 zones, to provide support to the hospital where it is needed the most. Should a converted theatre be required for increasing surgical capacity, it can then very rapidly be repurposed back into a fully staffed operating theatre.
It is inevitable that once the immediate crisis is over, patients will face long waiting lists for procedures that have been postponed or cancelled during the crisis. Therefore, a number of hospitals are already considering how to deal with the expected surge in demand for surgery, diagnostics and various forms of treatment.
It makes sense to plan ahead for the use of flexible healthcare facilities that can be deployed quickly to provide additional capacity and improve resilience within hospitals, and which can be removed or relocated when no longer required to continue to provide support where it’s needed the most.