Turning temporary structures into permanent spaces

With the ever-growing number of COVID-19 patients in need of hospitalization, hospitals need to increase their number of beds. Normally this would be quite a lengthy process including conceptual design; plan development; mechanical, electrical and plumbing schematics; site and civil plan development; authority having jurisdiction (AHJ) plan review; inspections, etc. Fortunately, the Centers for Medicare & Medicaid Services (CMS) recognized the need for extra beds early in 2020 and allowed temporary emergency facilities under the 1135 waiver.

Early on in the pandemic, our health care organization recognized the need to construct additional facilities for COVID observation beds. Since time was of the essence, we procured prefabricated modular buildings. These were moveable via tractor-trailer and easily connected together with medical gas, nurse call, life safety, lighting, electrical, plumbing, HVAC, emergency power, and the rest of the health care infrastructure a typical hospital requires to provide patient care and be in compliance. These quick connections and modular construction provided us with a time-effective solution.

We erected two temporary facilities (hopefully, the term temporary will also apply to this pandemic). However, the state of Georgia may allow these facilities to permanently remain as long as our organization provides all necessary documentation and meets all codes and standards for construction. If you are interested in keeping your own “temporary facilities,” we strongly encourage you to involve your local CMS office, state fire marshal’s office and local building departments during planning and construction. Once the state of emergency is lifted, we will have 90 days to submit all required documentation as we would for a new construction or renovation project.

The first temporary project progressed extremely fast from concept to patient care. It is a 16-bed unit connected to our existing hospital by an enclosed, covered, fully conditioned corridor that extends into two extra-long, double-wide modular buildings. As far as life safety goes, it is fully sprinklered, split into two smoke compartments, provided with fire-rated hazardous rooms, emergency power, emergency lighting, and a fully addressable fire alarm system tied into the existing hospital fire alarm system.

In the planning phase, around April 2020, we discussed our plans with our local CMS office, state fire marshal’s office and local building departments. All were on board and said we were the first to reach out to them. Many other health care providers were going through the process at that time without AHJ oversight or involvement. 

The second facility was much larger, a 72-bed COVID observation unit split into seven smoke compartments and connected just like the 16-bed unit above. The only difference in this one is its size: everything else as far as construction, systems and communications with our AHJs remained the same.

These temporary emergency facilities are now full and several of our hospitals are on diversion. We are currently looking into procuring more of these facilities, and we will communicate our needs and plans to our local, city, state and federal AHJs. I hope this helps those of you looking to develop a plan to accommodate the ever-growing need for more beds. Two final tips: (1) definitely don’t forget about staffing while you are adding square feet to your already existing facilities and (2) maintain the temporary facilities as if they were permanent.

Patrick C. Rhinehart, CSP, CHFM, is EOC/life safety system manager at Northside Hospital.