Providing additional bed capacity in hospitals poses many challenges, with the pandemic affecting different communities and healthcare systems worldwide in a variety of ways. Hospital campuses are typically constrained sites, and any solution must mitigate the risk of further virus transmission.
Arup has developed flexible, modular design guidelines called CareBox, engineered for rapid deployment and optimisation of transportation. The guidelines have been developed in accordance with the following principles:
- Adaptable design
- Fast production
- Transportable
- Easy to deploy
- Cost-effective
The series of design guidelines describe methods and approaches that can be applied to the design and construction of new ward space, without providing information on full ward design or healthcare planning layouts.
They can be adapted in line with local conditions, site constraints, regulations and guidance specific to each country’s healthcare system.
Capacity expansion
CareBox has been designed to be adaptable, to suit a variety of spaces and contexts, so that it can address the widest range of challenges faced by different national healthcare systems. These include:
- CareBox Plug-In: Modular design guideline to provide healthcare space attached to existing hospitals.
- CareBox Multi-Storey: Modular design guideline to provide healthcare space in confined spaces, e.g. multi-storey car parks, which may or may not be beside hospitals.
- CareBox In-Door: Design guideline to install temporary medical care facilities in non-confined spaces in existing buildings, e.g. beds and equipment inside existing convention centres or sport halls.
- CareBox Low Resource: Design guideline to install temporary medical care facilities in low resource contexts by adapting available spaces, e.g. temporary buildings and tents or existing community and healthcare buildings.
Plug-In
Modules can be joined together to provide the configuration and capacity required for a particular site. They can be standalone or joined together on to an existing hospital.
It combines the concept of a ready-to-use field hospital with the advantage of connection to an existing healthcare centre in terms of medical staff, logistics and access to medical gases and other services.
Depending on the hospital needs, the concept is flexible to incorporate a varying number of ventilation-assisted beds, ICU beds, or a combination of both. Expansion or adaptation is also possible. Wards can also be used for those patients who are close to recovery.
The wards are designed following the Modern Methods of Construction (MMC) and Design for Manufacture and Assembly (DfMA) concepts. Both are standard approaches in the construction industry.
The guidelines provide information about ward modules, ICU modules and support modules, with further details of how to incorporate the requirements for medical gases, electricity, HVAC, water and sewage, and fire safety.
Multi-Storey
The Multi-Storey guidelines provide advice about reusing available spaces to create additional wards, such as vacant commercial spaces or multi-storey car parks in cities and towns. This option would work in situations where there is limited external space for traditional field hospital solutions.
There are two options within the CareBox Multi-Storey solution – expand the capacity of an existing facility or create a new facility. If the available space is near the hospital, a semi-standalone facility to expand capacity would be suitable – providing its own power, medical gases and ventilation, but making use of existing hospital staff and logistical operations.
In cases where the available space is too far from the hospital, the facility will require logistics and amenity spaces to be incorporated as well, with consideration given to patient admissions, staff welfare, laundry and cleaning, as well as patient care.
In both cases, the existing space must first be surveyed to ensure it can accommodate the standard building blocks of the temporary ward, and that there is sufficient capacity in utilities and space to locate plant. Digital surveying techniques, such as laser scanning, can be used to speed up the process.
A template ward design is proposed in the guideline document; however, the specific constraints of the existing building will require some element of rearranging, adding or omitting space, as required. The modular approach and layout philosophy should be followed.
As these are existing buildings, services distribution cannot pass above or below clinical spaces due to height restrictions. Dedicated service corridors are needed, which drives the philosophy of the layout. The guidelines also contain further details of incorporating the requirements for medical gases, electricity, HVAC, fire safety and plant and utilities.
In-Door
This solution involves bringing temporary health services to existing buildings, such as convention centres, sports halls or outdoor areas sheltered by tents or other temporary structures, converting them into efficient-to-operate healthcare venues.
Building clinical spaces in available buildings requires a change in mindset to ensure that the essential service provision and model of care are appropriate for the patient. Close collaboration with clinicians, healthcare teams, designers and the supply chain will facilitate positive outcomes and development of bed capacity.
The guidelines provide examples for various modules, including bed areas, wards, ICU and medical and operational support areas. Further details are included about the requirements for accessibility, fire safety and partitions.
Low Resource
The aim of the Low Resource guidelines is to help organisations achieve the best possible clinical care environment within the spaces available to them by optimising the use of existing sites, infrastructure and resources. In low resource contexts, access to mechanical equipment and other construction supplies may be limited.
CareBox Low Resource was designed to be read in conjunction with the WHO Guidance: 'Severe Acute Respiratory Infections Treatment Centre: Practical manual to set up and manage a SARI treatment centre and a SARI screening facility in health care facilities'.
The scope of the Low Resource document is to provide supplementary guidance on how to achieve the design criteria stated in the WHO document, while working within the given contextual constraints, whether that be within an existing hospital complex or as a standalone facility.
The guidelines cover site assessment, including risks to natural hazards, such as tsunamis, landslides and earthquakes. Examples to incorporate the requirements for water and sewage, environmental control, electrical supply and medical gases are included. All of these requirements need to be adapted in line with local conditions and regulations.
Information on fire strategy is also provided. While not included within the WHO guidance, it is nonetheless important in facilities where many patients are likely to be immobile and where oxygen is being supplied for medical use. This is particularly important in dense urban areas, such as informal settlements where fire risk is already high.
Healthcare resilience
When restrictions are lifted and pressure on healthcare systems lessens, there are other potential uses for these temporary medical facilities, e.g. future testing facilities or storage areas for medical equipment. The modular nature of the designs enables future dismantling, so the materials can be recovered and reused in different cities or countries, as needed.
This may be particularly useful in developing countries or those with limited existing healthcare infrastructure. Once implemented, it could continue to be valuable to these communities, either providing ongoing medical facilities or being redeployed to other locations where the need is greatest.
CareBox design guidelines: https://www.arup.com/news-and-events/introducing-carebox-modular-healthcare-for-covid-19.
Low resource CareBox design guidelines: https://www.arup.com/-/media/arup/files/publications/c/CareBox_Low-Resource.