‘Can We Really Do This?’ How UVA Health Transformed Its New Tower to Fight COVID
At dawn one bright April morning, dozens of construction workers, clad in bright yellow vests and stiff white masks, lined up to applaud those entering and leaving UVA Health at shift change, men and women on the front lines of the COVID-19 pandemic.
It was a touching moment, made more poignant by what stood, gleaming in the morning light, behind the workers – a new, six-story inpatient hospital tower.
The tower, which has been six years in the making, was scheduled to open in June and house, among other things, three floors with a cardiac intensive care unit, a musculoskeletal and orthopedic floor, and a special unit for solid organ transplants.
Now, thanks to quick thinking and immense effort by the design team and construction crews and a huge team of staff across UVA Health, those floors are devoted to COVID-19 patients, with 56 of the 84 patient rooms specially retrofitted as “negative airflow” rooms. Those rooms, which suck air in rather than pushing it out, are ideal for treating patients with airborne infectious diseases like COVID-19 because they keep the virus from spreading into public spaces, and allow staff to conserve valuable personal protective equipment.
Previously, UVA Health had five negative pressure ICU rooms available and ready to treat COVID-19 patients. The story of how they went from five to 56 – in just a few weeks, and as the entire University moved online amid a global pandemic – is remarkable, even in these remarkable times.
‘Can We Really Do This?’
In February and early March, as the pandemic spread to the United States and University leaders looked to transition academic courses online, administrators at UVA Health went through question after question.
How many COVID-19 patients would UVA see?
How would the hospital be able to safely accommodate all of them?
What could they do to protect the more than 7,000 doctors, nurses and other hospital staff who would be putting their lives on the line every day?
And, how could they do it all with existing negative pressure rooms, which included five ICU negative pressure rooms, as well as a few dozen more non-ICU negative pressure rooms scattered among different units? Normally, those rooms would be sufficient for a hospital of UVA’s size. The challenges facing UVA Health, though, were anything but normal, and scattering COVID-19 patients in rooms in various units would increase the chances of exposure for everyone involved.
“It became very clear that we needed more negative pressure units for COVID-positive patients, or patients being investigated for possible COVID,” said Chief of Service Lines Jody Reyes, a nurse and former naval officer who oversees patient services.
That’s when the “a-ha” moment hit – the new tower, with all of its new patient rooms, also had a new HVAC system that was completely separate from the HVAC systems powering other areas of the hospital, which would make it easier to maintain separate airflow for patient rooms. If those rooms became negative airflow rooms, all COVID patients could be isolated in one area of the hospital.
“Those rooms were already equipped to be ICU rooms; could we make them negative airflow rooms?” Reyes said, recalling those early conversations. “It was this ‘a-ha’ moment and everyone, right away, went from asking ‘Can we really do this?’ to ‘How do we do this?’”
How, indeed? That was a question for UVA Health’s Facilities Management and Operations leaders, among them Administrator for Facilities and Safety Tom Harkins, whose team oversees the hospital’s infrastructure and facilities planning; Director of Health System Physical Plant Derek Wilson, responsible for the operation and maintenance of UVA Health facilities; associate director William Schnorr; director of facilities planning Kevin Fox; and senior construction manager Chris Hoy.
Their teams had been planning and working on the tower, which includes surgical floors and a first-floor Emergency Department that opened last year, for more than six years. Now, they needed to quickly change course, reverse airflow in most patient rooms and get the building ready to serve a potential influx of highly infectious patients.
It’s a task that should have taken months. They had weeks, at most. But, Hoy said, everyone jumped right in, eager to help.
“We knew what was going on nationally; my daughter lives in Seattle, one of the first places in the U.S. to be hit hard,” Hoy said. “There was an opportunity at UVA, and we knew we had the expertise and the history to do it. As a team, we had been building trust for six years; and we were able to put that trust to work when the pandemic hit.”
From Smoke Evacuation System to Infectious Disease Control
The team had a few factors working in its favor, including a smoke evacuation system already built into the tower, intended to move smoke out of the building after a fire.
“In negative airflow rooms, you need to vent air directly out of the building,” Harkins said. “We were able to take the smoke evacuation system, cannibalize it and dedicate that ductwork to move air exhaust out of the building.”
To start, they focused on turning the 15 third-floor patient rooms directly connected to that ductwork into negative airflow rooms – not quite negative pressure chambers, but very effective in containing potentially infected air.
Those 15 rooms opened on April 2, and nurses wheeled the first COVID-19 patient into the new tower at 11:30 that day – a proud moment for staff who had been working around the clock.
As the pandemic escalated, however, the team realized that more negative airflow rooms might be needed. That’s when they started to think about adding another fan to the tower’s roof.
The existing exhaust fan was only large enough to support the first 15 rooms on the third floor. Adding another fan would allow the team to route air from patient rooms on the fourth and fifth floors directly to the fans on the roof, where it could be safely discharged.
Certain that was the right course, the team put together a plan, presented it to UVA Health leadership and received rapid approval for another fan. It was installed late at night on April 10.
Now, air from 56 patient rooms on the third and fifth floors, which were opened in phases following the installation of the new fan, moves up to a mechanical space on the roof where a few facilities staff, all wearing personal protective equipment, work to safely filter and discharge it. Their work, and the new system, helps protect both patients and health care workers while conserving PPE that would have otherwise been necessary in public spaces throughout the building.
“Access to these negative airflow rooms helps us in every way,” said Dr. Paul Helgerson, section head of Hospital Medicine, who oversees service lines including the ICU. “It was a lot of work, but it was amazing – no one batted an eye. Everyone understood what we were trying to accomplish, and what was at stake.”
“Every decision we made has been based on the needs of the clinical staff, and treating our patients,” Wilson said. “That’s our mantra.”
“It was certainly a big lift, but everyone worked so hard, 110%, for weeks, to get ready for this,” Harkins said.
Looking back on those whirlwind weeks now makes the whole team proud.
“Honestly, it was rewarding,” Hoy said. “It was obvious that we had the means to make a difference for our patients and for our colleagues, and we pulled together to do what we needed to do.”
Moving In, in Record Time
Think about how long it might take you to move from one house to another – planning the layout of each room and acquiring furniture, packing and unpacking boxes, putting each kitchen tool or bedroom lamp in the room where it belongs, setting up cable, water, electricity, internet.
Then, imagine that all of the rooms in your new house suddenly had to function differently.
That is basically the task that UVA Health was facing. They had been planning the move to the new tower for months, of course, but they had been planning for cardiac, orthopedic and organ transplant units. Now, they needed to plan for infectious disease ICUs.
“All of the teams who had been planning for the move into the new tower had to be redirected to focus on the new plan,” Reyes said.
As Harkins and his team finished retrofitting the tower, Reyes and her colleagues got to work, aiming to move all necessary equipment – and people – into the space as soon as possible.
“The entire hospital pivoted when we got our first COVID patients,” she said, especially as few elective surgeries and ambulatory visits were being performed. “We all focused on what was needed to prepare for a patient surge, while keeping our team members safe as they provided care for our COVID patients.”
Rebecca Lewis, an administrator and clinical liaison for facilities planning, had already begun thinking about what it would take to operationalize the new tower – hospital beds, ventilators, various monitors, all of the computing systems needed to support daily activities, fire safety equipment, pharmacy and lab equipment, testing equipment, and so much more.
Some shipments of beds, monitors and equipment for the new tower was already on the way, and Lewis and her team scoured the hospital for others, at the time unused because of the halt on elective procedures.
Representatives from more than 39 teams across UVA Health worked daily to bring it all together, and every detail mattered, right down to finding the most convenient, accessible locations for hand sanitizer and soap dispensers.
“We had so many people putting in many hours a day, making sure that everything was appropriately set up, tested and certified,” Lewis said.
“Teams from Housekeeping, information technology, supply chain, nurses, physicians – everyone played a role,” Reyes said. “On move-in day, I remember watching nurses and others carry patient care supplies by hand, just doing whatever needed to be done.”
Meanwhile, nurses from across UVA Health were steadily volunteering to work in the new units, according to Rick Carpenter, patient care manager for the Medical Intensive Care Unit. Carpenter, who also helped develop UVA Health’s contingency plans during the Ebola crisis, led a team putting together staffing plans for the new tower.
“We put together plans for how many additional nurses and support staff we would need from other units, while honoring people’s ability to work in this environment and any medical conditions or concerns they might have,” he said.
COVID-19 units, Carpenter noted, require myriad support staff in addition to care providers. Some staff help keep track of personal protective equipment and monitor its safe usage, others serve as couriers, to keep doctors and nurses who have been in patient rooms from having to leave and go to the pharmacy or blood bank, for example.
Carpenter put out a call to nurses and staff from other units at UVA Health. The response, he said, was overwhelming, and his team worked quickly to train nurses and staff from other areas who might not be familiar with ICU procedures.
“This was a new challenge and adventure for all of us, and people wanted to be involved,” he said. “The best part has been seeing new people come in from around the hospital, joining my team of 140-plus ICU staff who have worked together for years. The camaraderie, and the ability to quickly work as a team, has amazed me, and has been the best part of my days.”
Ready for What the Future Brings
Once the pandemic subsides, the tower’s floors will be converted back to their originally intended use. For now, though, they remain one of UVA Health’s best defenses against COVID-19.
As we enter May, all 84 patient rooms in the new tower are operational, and 56 of them are negative airflow chambers. So far, approximately 20 to 30 COVID-19 patients have occupied those rooms at any given time, treated by all of the ICU staff and other physicians, nurses and staff who have volunteered to help.
The two fans whir on the roof, day and night, sucking air away from public areas in the hospital and giving staff peace of mind at a time when peace is scarce. Personal protective equipment can be conserved for patient rooms, instead of public areas, which will help UVA Health to maintain a steady supply of masks, gowns and gloves in the weeks and months ahead.
“The opening of our bed tower is just one example of how team members from across UVA Health have come together to serve patients in need during this pandemic. The level of innovation and creativity required to create these additional negative airflow rooms is truly remarkable,” said Dr. K. Craig Kent, executive vice president for health affairs. “Along with helping us provide excellent care for patients with COVID-19, opening this new tower sooner is also enabling us to provide the safest care for our non-COVID patients.”
So far, there have been encouraging signs. Though new COVID-19 patients keep coming in, others are recovering and leaving the hospital, going home to relieved loved ones. Remdesivir, an antiviral drug tested against COVID-19 at UVA Health and other sites around the country, has been cleared by the FDA after initial studies showed that it speeded patients’ recovery time and improved survival rates.
UVA’s in-house testing rates continue to grow, almost two months after a UVA team developed its own test with the same whirlwind determination that marked the completion of the new tower. Today, UVA can test more than 650 patients per day, with hopes to grow that number rapidly in the weeks to come.
And the team that worked so hard on the tower, sprinting for nearly two months, has been able to take a quick, collective breath before facing what is left of this pandemic.
“I don’t think there was a single team within this organization that did not somehow work on this,” Reyes said. “We rallied, we had an end goal in mind, and we got there, with lots of hard work.”
As Lewis put it, “We made it. We were as ready as we could be.”