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Acuity-adaptable rooms, microhospitals are healthcare tech trends on NFPA’s radar


June 1, 2018

ECRI Institute has released its annual top 10 list of technology-related issues that hospital and health system leaders should pay close attention to over the next 12–18 months. The NFPA believes building and life safety professionals should keep an eye on two trends from the list.

One of them, microhospitals, is something the NFPA has been monitoring for a while now. The other, acuity-adaptable rooms, got on the association’s radar when it appeared on the list.

“One of the great benefits of the NFPA is we have a three-year code revision cycle,” says Jonathan Hart, principal engineer for the NFPA. “So, we’re constantly trying to keep our eye on what are the newest technologies and trends and how we can create codes and standards that are going to allow for effective healthcare delivery but also provide a level of safety for patients and staff.”

From that standpoint, acuity-adaptable rooms should be the more challenging of these two tech trends.

‘An interesting issue that hospitals are exploring’
For those unfamiliar with acuity-adaptable rooms, some U.S. hospitals have experimented with a care delivery model in which a hospital keeps a patient in the same room throughout the entirety of the stay, regardless of acuity level. Those hospitals’ goal, according to ECRI, “is to improve workflows, enhance care continuity, improve patient safety, decrease length of stay, and reduce costs.”

Moving patients from room to room can exacerbate patient safety issues, such as increased chance for hospital-acquired infections or patient falls. Medication error is also a major worry, says Rob Maliff, director of strategic growth and business development at ECRI Institute, pointing to research suggesting that verbal handoffs when a patient is moved “can be troubling.”

Maliff says the concept of acuity-adaptable rooms is “not brand, spanking new” and not for every patient or hospital. “It’s been around for a couple of years with a few hospitals implementing the model,” he adds. “This isn’t something where we’re going to see whole hospital conversions to acuity-adaptable rooms. It’s probably more suitable for hospitals treating complex patients.” He mentioned open-heart surgeries, organ transplants, and cancer treatments as examples.

Acuity-adaptable rooms may challenge hospitals from a staffing perspective because the expertly trained nurses and hospitalists will have to come to patients, rather than the other way around. However, Maliff says the limited amount of feedback ECRI has received boasts of improved patient outcomes, a decreased length of stay, and in some cases reduced costs.

“There are some positive findings with these, but with ECRI being an evidence-based practice center, we’d love to have literature evidence [proving] their effectiveness,” Maliff says. “But it’s an interesting issue that hospitals are exploring right now ... and a lot of the architects we work with are also very interested in this idea as this plays out in healthcare design.”

The NFPA is interested, too, after admittedly not having heard of the concept until this list came out.

“I thought, ‘Wow, that’s interesting,’ ” says Hart. “If that’s really a trend that is going to be picked up in a wide number of facilities, there’s certainly some life safety things we have to look at.”

At first glance, the most immediately impacted code application will likely be NFPA 99, says Hart, as acuity-adaptable rooms will need to be designed and constructed so they meet medical gas and vacuum system requirements and electrical system requirements of the highest applicable acuity level. In other words, they must meet the highest level of risk of patients that occupy them.

“In most cases, the areas that have the higher acuity levels, we’re going to require more protection and more stringent design standards for those spaces,” says Hart. “That can include the number of piped medical gas and vacuum outlets [and inlets] that we have there. It can include the number of electrical receptacles in that space because the more acute the patient, typically the more equipment needed. ... And so that is going to change how the entire system is designed, or it can impact the entire system anyways, so it’s something that is going to have to be thought of.”

Members of the NFPA’s technical committees are researching acuity-adaptable rooms and the association encourages the public to submit input on potential codes and standards. But right now, Hart says, “My instinct would say that it will be more just awareness and making sure there’s an understanding that the current codes and standards that are out there are followed because it’s new, it’s something that could be overlooked as a move to that approach is made.”

He adds: “There’s always a chance you could look at it and say that this needs to be addressed in some way in a code or a standard. But as of right now, I think the documents really include the requirements to provide an adequate level of safety. It’s just something [to be aware of].”

Smaller hospitals, but no safety shortcuts
Compared to acuity-adaptable rooms, Hart says there has recently been more attention paid to microhospitals from “a big-picture standpoint,” and he’s seen “a lot more articles and information out there about” them. That said, he reports that the NFPA hasn’t “had a ton of feedback.”

According to ECRI, microhospitals “are neither urgent care centers nor full-service hospitals.” They are typically designed to be between 15,000 and 25,000 square feet of space and are capable of services such as surgery, pharmacy, imaging, and diagnostic services. They “sometimes provide labor and delivery, emergency, and limited inpatient services.” Most microhospitals do not have ICUs but “generally do provide emergency care and inpatient beds,” per ECRI.

Maliff says ECRI is “really seeing a lot of interest in microhospitals” from C-suite executives.

“Microhospitals are a way for hospital systems to gain exposure, capture a patient population that can be fed into the hospital system, and they’re a way for them to do so without committing a lot of money [like they would if they were funding] a 300-bed facility,” he says. “Microhospitals are an entryway into a marketplace that can also fill a clinical need in a rapidly growing area, [and] ideally they are scalable facilities, so they can grow in size and the types of services offered.”

Since these are essentially just smaller hospitals, Maliff says they are subject to the same life safety standards and CMS operating conditions to which standard-sized hospitals must adhere.

“There aren’t any shortcuts in a microhospital design from a safety perspective,” Maliff says.

Hart, speaking on behalf of the NFPA, confirmed that from a Life Safety Code® perspective.

“What we base our life safety codes and standards on are the type of occupant you’re going to have inside your building,” says Hart. “So, with hospitals, we’re expecting that you have four or more people in there on an inpatient basis who are incapable of self-preservation. ... That’s what defines a hospital, so it doesn’t matter if it’s a 1,000,000-square-foot hospital in the middle of a city or one of these microhospitals with between 15,000 and 25,000 in square footage.”

While microhospitals will likely be new structures, allowing concepts such as smoke compartments to be worked into the design, Hart believes it could get tricky in particularly small spaces.

“It could be interesting to see just how it is done on such a small footprint in some [microhospitals],” says Hart. “It’s just going to require a different look at things from the architectural design standpoint, and then when you’re maintaining it.”

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