The 368-bed hospital building, which celebrates its one-year anniversary on Nov. 17, features technology and design features that have made handling COVID-19 cases easier.

By Ruthann Richter 

The new Stanford Hospital had been open a matter of months when the pandemic struck. People began pouring in, worried they might be infected with the virus that causes COVID-19. 

Springing into action, hospital staff turned an adjacent parking garage into a drive-up testing and screening site in just 12 hours. Gowned and gloved nurses took nasal swabs of people in their cars and checked their vital signs through the windows. Patients also were evaluated by an emergency physician from their cars via internet video, enabled by a new wireless system installed in the garage.

“Multiple departments within the hospital came together overnight,” said Patrice Callagy, RN, executive director of emergency services at Stanford Health Care.

For Stanford Health Care President and CEO David Entwistle, the response to the pandemic was a demonstration of exactly what the new hospital building, at 500 Pasteur Drive in Palo Alto, was made to handle. “This state-of-the-art building was designed to enable our exceptional staff to do their very best under worst-case scenarios: mass casualty, natural disaster or even a global pandemic,” Entwistle said. “We didn’t expect to be challenged so soon, but, because of this new facility, we were ready.”

The 368-bed hospital building, which celebrates its one-year anniversary Nov. 17, has proved to be an adaptable and effective facility for handling the pandemic. The increased space, new technologies and private patient rooms, as well as other design features, all have helped keep patients, staff and clinicians safe during the nation’s worst infectious disease outbreak since 1918.

“We are so fortunate, from a timing standpoint, that we had the new hospital and the entire staff trained three months before this happened,” said architect George Tingwald, MD, director of medical planning at Stanford Health Care. “I won’t say it was a miracle, but if COVID-19 had happened a year before, we would have been in a world of hurt.”

Bigger, better emergency department

Doctors and staff in the new Marc and Laura Andreessen Adult Emergency Department are often the first points of contact for patients arriving at the hospital, and they were able to adapt particularly well during the crisis because of the department’s increased space and new features. The department has a total of 66 rooms, most of them private, so caregivers can handle a large influx of patients while minimizing exposure to the virus. The unit is as big as a football field — three times the size of the previous emergency department — so patients can be seated at a safe distance from one another in the lobby and segregated if they showed signs of infection.

Children needing urgent attention receive treatment at a separate pediatric ED at 300 Pasteur Drive. Previously, children and adults were seen in the same location.

“As we put together protocols for COVID, the space really enabled us to create a very effective environment that was safe for our patients, our staff and our faculty,” said Helen Wilmot, vice president of facilities services and planning at Stanford Health Care. “It would have been super-challenging to do that in the existing space.”

The hospital’s many years of planning have paid off during the pandemic, Tingwald said. For instance, the designers had long envisioned the parking garage as an overflow facility in the event of a major disaster. So the infrastructure was in place to create the emergency department’s drive-up telemedicine-care system in a matter of hours.

Patients also benefited from Stanford Medicine’s early development of a sophisticated COVID-19 test, which at the time supplied results in 24 hours. (The turnaround is now about 4 ½ hours.) The adult emergency department has processed as many as 100 tests a day, Callagy said.

“The pandemic challenged all of us to innovate, adapt and learn,” said Lloyd Minor, MD, dean of the Stanford School of Medicine. “The new Stanford Hospital served as an incubator for discovery, while providing an unmatched setting for high-quality patient care.” 

Resourceful staff, helpful design features

Inside the emergency department, staff members identified some creative ways to use the space to minimize infection risk. For instance, they took X-rays through a set of glass doors, as gowned and gloved nurses in the rooms placed the imaging film behind the patient’s back, then left the room as a radiology technician shot the pictures from behind the transparent door.

 “We were saving personal protective equipment and decreasing the risk of exposure and contamination, as the machine didn’t have to be wiped down between patients,” Callagy said.

Throughout the new hospital, various design features have helped reduce chances of viral transmission. From the outset, the building’s planners considered it “absolutely essential” that all rooms be private to minimize the possibility of infection, Tingwald said.

Patient Dylan Thomas, 23, who has been in and out of the hospital for much of his life, said he relishes the quiet, the space, the views and, above all, the safety, of having a room to himself.

“In all of my stays, I never had to worry I would get COVID because of the private rooms,” said Thomas, who lives in Los Altos Hills. “With the private rooms, I’m isolated from other patients. The nurses do a very good job of washing their hands. So I’ve always felt as safe as I could be.” 

Thomas, who suffers from a connective tissue disease called Ehlers-Danlos syndrome, among other health problems, said the extra space and private treatment rooms in the emergency department also are salutary.

“I’m pretty immunocompromised, so the ED is a nervous place for me,” he said. “But with more of the space, it’s easier for them to put you in a room, rather than in a hallway.”

Dedicated unit for COVID-19 patients

Because of its ample capacity, the hospital was able to convert one of its four intensive care units into a dedicated, 20-bed COVID-19 unit, staffed by clinicians experienced in handling personal protective equipment and using ventilators to manage lung problems, said critical care specialist Norm Rizk, MD, the Berthold and Belle N. Guggenhime Professor. The ICU rooms also are equipped with a sophisticated technology that allows air pressure to be adjusted to meet patient needs. Thus, staff were able to convert rooms with COVID-19 patients to negative air pressure, preventing air from leaving and minimizing risk of contamination, Rizk said.

At the same time, the hospital quickly refurbished a patient unit in the hospital complex at 300 Pasteur Drive to handle general ICU patients. “That move reassured those who were admitted to the hospital for other types of illnesses that they weren’t in a ward with intermittent COVID patients,” Rizk said.

Overall, he said, “I think the extra capacity was a big plus. The fear was that there would be a big surge and we wouldn’t have rooms available,” as was the case in other areas of the country. The hospital remains fully prepared, though that surge has not yet materialized.

One of the big challenges of the pandemic has been managing visitors. From March through May, family members were not allowed inside the hospital to minimize exposure risk. To help ease the burden, the hospital supplied iPads to each patient room, enabling family members to conduct Zoom visits online. Some family members also got creative, taking advantage of the expansive picture windows in patient rooms to stand outside with signs declaring their support for loved ones.

 “The pandemic has given us an unwelcome but powerful opportunity to prove what we’re capable of,” Entwistle said. “It helps to validate our decision to build a state-of-the-art medical facility that can meet and exceed patient needs in the face of a health disaster.”