“We cannot transfer our patients to the hospital next door. “ The reminder is not meant to be bitter, it is simply a statement in the mouth of Bruno Jarrige, head of the Covid-19 crisis unit at the CHU de Guadeloupe. Here as elsewhere, caregivers have had to adapt, in an emergency, to the epidemic. “Until now, we have relied on human agility, to manage crises like chikungunya or cyclones, explains this manager. But the construction of a new CHU in Pointe-à-Pitre, whose commissioning is scheduled for 2023, will allow the hospital itself to be agile. “
Rapidly transform services into intensive care
For more than a year, hospitals have had to move beds, oxygen and devices to create intensive care units, but also to rethink their reception areas so that Covid patients do not contaminate others and find ways to disinfect tons of sheets. contaminated. An experience acquired in haste and sometimes painfully but rich in lessons for future structures. Especially if such epidemics are called to recur.
The hospital of tomorrow will have to be more flexible, and faster. The lack of new intensive care beds after more than a year of crisis clearly reveals the lack of anticipation. In the future, respirators should be able to be installed in reception areas and standard rooms.
“Generalist premises could be pre-equipped with medical fluids and gases and have more electrical outlets, to be quickly transformed into temporary intensive care units,” said Thierry Le Guyader, founder of LEA Architects, a firm specializing in health. In Israel, for fear of a war, the authorities had arranged the underground parking lots of certain structures so that they could accommodate the seriously ill, with oxygen and outlets, and this was used during the Covid. “
Automated trolleys, filtered air and automatic doors
Faced with the risk of highly contagious epidemics, some healthcare centers are also wondering about the possibility of isolating services. “It is possible to easily create airlocks in existing buildings”, confirms Maud Grandperret, director of Sanae Architecture. Other simple improvements can be made without rebuilding the hospital. “We realized that some doors were not automatic and therefore had to be touched to open them, increasing the risk of contamination”says Audrey Simon, in charge of the “Hospital 2025” project at the Saint-Luc university clinics in Brussels.
More technical, the future Belgian structure will use automatic vehicles, a kind of remote-controlled trolleys, to ensure logistics deliveries between buildings, and avoid the arrival of non-essential personnel in any contaminated areas.
→ READ. In the intensive care unit of the Bobigny hospital: hold on, but at what cost?
For the University Hospital of Guadeloupe, the Architecture Studio agency is considering the circulation of air in the rooms. “Normally, a critical chamber is at a slight overpressure so that the outside air does not enter and contaminate the patient, describes Laurent-Marc Fischer, architect associated with the agency. There, we would like to have the possibility of reversing the pressure, so that, on the contrary, the potentially contaminated air inside the chamber does not “flow” to the outside and limit the risks of contagion. “
Distribution of disinfection points
On the other hand, the architect remains cautious about “biocidal” materials, for example stair railings or paints which would kill viruses and bacteria. “There is a lot of marketing but very few standards, he judges. Not to mention the questions about the lifespan of these materials. In a hospital, we disinfect very often and we need resistance. “ In the future Pointe-à-Pitre University Hospital, doctors and architects preferred to pay particular attention to the distribution of hand washing and disinfection points.
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The risks of contamination have also forced us to hastily double access to emergencies, with Covid patients on one side and conventional patients on the other. In the future Saint-Luc clinics in Brussels, emergencies, “classic” reception for consultations, and scheduled outpatient surgery will be organized into three separate entrances around the hospital pole, to avoid crossings. And can therefore be easily reflected in the event of a serious epidemic.
Rethinking patient flows
The management of the various flows is at the heart of hospital planning. “Some places are frequented only by caregivers and patients, others are used to welcome the public and still others for logistics, such as laundry or catering, reminds Bruno Jarrige. We do not have the same needs and do not have the same constraints for each of these places, so not the same layouts. “ As Maud Grandperret sums it up, “Hospitals are not museums, we work less on the envelope than on the flow of people, inside and around the hospital”.
Outside, the largest projects involve modifications of roads and accesses which sometimes affect all the neighboring agglomerations. Because a hospital is also conceived in a territory, and the accesses are not the same according to its implantation in town or in open country.
Within the care complex, the referral systems for patients and visitors must take into account any difficulties they may encounter, such as visual or physical disabilities or problems with comprehension. “It’s actually quite difficult to do something very simple! “ recalls with a smile the architect specializing in healthcare buildings.
Take into account the well-being of caregivers
“Beyond the usual signage, with signs and markings on the ground, we must put an end to uniformity and symmetry, wishes for his part Laurent-Marc Fischer. It is important that buildings and units are differentiated, in size, shape, style, color. If they all look alike, it is very difficult to find your bearings. “ For caregivers, whose well-being has long been relegated to medical efficiency, these spatial disruptions also allow them to better “cut” between work and moments of pause.
The Guadeloupe project includes, for example, a large outdoor terrace for the staff canteen, in order to enjoy a real moment of respite in the sun. In Brussels, the future Saint-Luc clinics plan to transform a parking lot into a garden for caregivers and visitors. The project also intends to increase the number of skylights in emergency rooms, so that the 24-hour guards look slightly less like a hellish tunnel.
Everywhere, modularity is becoming the watchword of the hospital of the future. “We have to offer diversity, Maud Grandperret argues. There is no magic recipe for all hospitals because it depends on the existing building, the land, but also the territory, the environmentment, of the population that uses the hospital. “
The issue of resuscitation beds
On the 3,000 French hospitals, 45% are public. The rest is divided between private clinics and private non-profit structures.
Thirty-two regional and / or university hospitals are spread over the entire metropolitan and overseas territories, with the exception of Corsica and Mayotte.
In 2019, France had 5,433 intensive care beds. With the outbreak, the capacity has increased to around 8,000. The figure has been almost stable since 2013, as the population ages.
The emergency room visits have been increasing for twenty years, by 3% per year on average. In 2018, 21.8 million emergency room admissions were recorded.
The average length of stay in a public hospital was 5 and a half days in 2018.
73,000 full-time hospital beds (with overnight stay) were canceled between 2003 and 2018.
Source: Panorama 2020 of health establishments in the Drees