Hey.

Howdy.

How are y'all doing?

Okay, so today we have Doctor Hui Cai, professor from the School of Architecture and Executive Director of the SimTigrade Design Center at Georgia Tech.

And also Marzia Chowdhury, PhD candidate from University of Kansas.

Doctor Chi's research focuses on performance driven and evidence based design for health care.

Her research activities include conducting pulse occupancy evaluations on healthcare facilities and also other building types using rigorous tools and quantifiable metrics.

And Marzia is a PhD candidate who conducts research on health care, facility design and planning.

And her current research has been funded by air Art.

Arthur Tuttle, and it focuses on how the physical environment in emergency departments during Covid 19 performed for caregivers and patients.

So please help me welcome Doctor Wilkie and Marsha Chowdhury.

So hi everyone.

First of all, thank you for inviting us, to the Texas A&M architecture for health lecture series.

This is a wonderful lecture series.

It's not only a great benefit to, Texas A&M students and really a great resource for our, healthcare design community, as well.

So I'm Joyce.

Hi.

As, Doctor Jafari has mentioned, I'm a professor at Georgia Tech and also lead centigrade design center.

So centigrade is actually a made up word.

Is combining simulation and integrate, and, we conduct, interdisciplinary research.

Linking design with, health outcomes.

And our work actually spans across different scale, including products, services, built environment, of course, and urban planning.

So it's an honor to be, part of this lecture series and together with me, is, my PhD student, Marzia Chowdhury.

So before I, returned to Georgia Tech, I was at, you know, University of Kansas Institute of Health and Wellness, designed for ten years.

And I continue to work with our faculty and, Marzia as one of our students as well.

So we're very happy to have this opportunity to share our work.

So our talk today is really about, looking at how to use design, right, of, emergency department to maximize the flexibility.

And we will divide our talk today into two parts.

The first part is, really looking at how, design can maximize the, flexibility of emergency department during, pandemic or other, surge events.

We'll use Rush University Medical Center as a main case study.

To walk you through, the design as well as the effectiveness of the design.

So this is actually part of Marcia's, dissertation.

So she will be sharing more details with you.

And the second part of the talk will actually shift our focus to, the other end of the spectrum, the small, rural hospital.

So, will focusing on, evaluating or sharing ideas about how to develop flexible EDI design, that can support, small rural eds.

With better efficiency.

So with our, talk today, we would like to achieve those, four learning objectives.

I'm not going to read all of them, but hopefully we'll, also leave some time.

For some discussion.

In the end, to discuss some future trends of EDI.

So now I'll hand over to Marcia to, share about her her work on the EDI, design.

Yeah.

Marcia, take it away.

Thank you, Professor tight.

Hi, everyone, this is Marcia.

In our presentation, I'm going to present our case study on pandemic resilient, emergency department from Rice University Medical Center.

This EDI actually incorporated flexible design features before the pandemic actually happened.

So we are going to learn what are those design features that allow them to maximize their flexibility.

And how did that go to understand how will the response work?

We first need to take a look at the different types of storage events.

Not every search is the same.

They can be different in size, in how long they last and in how much impact they have.

For example, mass casualty event or natural disaster is what we call as a container based surge event.

These events happen sudden the and last for a short period of time.

They usually happen in one area and caused a quick large increase of patients coming to the emergency department.

On the other hand, infectious disease outbreaks like an epidemic or a pandemic are called population based events.

They often last last for a long time and can happen in several waves, and they don't stay in one place, and they can spread across to countries or even the world.

And this is what I actually see in the Covid 19 pandemic.

Now let's take a look at a little deeper into infectious disease outbreaks, how they unfold over time across the region.

The image on the left actually shows the timeline of infectious disease throughout the history.

It reminds us that outbreaks are not one time events.

They happen in the past and there is a chance of happening in the future.

The map on the right shows why these outbreaks begin.

But we all know an outbreak rarely stays in one region.

So when these types of outbreak, epidemic or pandemic happen, emergency department face major challenges.

One of the main reason for areas facing this challenge is because they are not originally designed to handle a pandemic or epidemic scenarios.

So they face several challenges.

And when an outbreak occurs, the first and most critical challenge is protecting staff and the patients safe.

At the same time, a sudden influx of the patients, especially high risk and high activity patients, are coming to the Ed to make a space for them.

The emergency department and the hospital need to make a space for them by reducing the treatment capacity for regular patients that lead to disruption in regular emergency care and eventually added a burden on the needy.

So when the pandemic happened, rash was not very different than other emergency departments in terms of facing the heat of the pandemic, but it was exceptional in their design, which was designed by Perkinson SunRail and the hospital tower was opened in 2012, and it was the first Chicago area hospital specifically designed to provide treatment for bioterrorism attacks.

Because of the unique design, it was prepared for the pandemic and the reason for us to select it as a case study.

So this is a floor plan of the emergency department, and this academic aid provides a level two trauma care in the 60 treatment rooms.

And they they are divided into three pods A, B and C. Pod A is primary providing care a key to patients primarily a safe four and five.

Sometimes they see a side three.

But before you say 1 to 3.

And in this seven rooms they are treating the highest acuity patients over the years and part C for years like 2 to 3.

So this is how they usually look like.

But these EDS goes beyond the regular layout what we usually see.

It has implemented the idea of the flexible design in their layout.

The layout incorporated the flexible spaces in the ambulance bay and the lobby, which is outside of the Ed and inside of the Ed.

They also incorporated the flexibility concept that allowed them to increase the treatment capacity and also provide a cure for the negative for the infectious patients.

We're going to go into the details about those features when we are going to talk about the pandemic responses, but with those flexible design features, how do we know this place have been designed, actually works?

Actually, pandemic gives us a unique opportunity to evaluate the performance on those flexible design features.

We collected the data through interviews to understand the success and the lesson learned of those design features, and we also evaluated the patient's length of stay by analyzing the operation data to understand the effectiveness of the flexible design features.

To understand the performance, we need to also understand the reason behind the activation of the flexible spaces.

Primarily two factors.

Actually, determines the activation of those spaces.

Looking at that patient volume because of primary factors.

And if we look at the graph of the patient volume volume, we can see the multiple surges of the patient volume across the different surges.

We can also see that with the time from the beginning to the end of the pandemic, clinicians gained actually a better understanding of how the virus actually spread and how to treat how to treat the patients effectively together.

Primarily these two factors, the knowledge of on the model of bias transmission and the volume of Covid 19 patients that actually determine when and where to activate the spaces.

If you look at those diagram, we can see when the surges were happening at the time.

The lobby spaces are activated for different group of patients.

We're going to take a look at those spaces and the design features.

So I want to start with first the ambulance bay which was activated during the pandemic.

I'm sorry.

This, diagram, it shifted a little bit.

This space is an ambulance bay, lobby spaces.

And this is the image of that ambulance bay area.

So usually what we see in traditional emergency room that have ambulance bay, it is primarily used for drop off the patients.

But rush has the design features incorporated.

Decontamination showers in this area to decontaminate patients in the event of my tourism event or the chemical spillage accident.

And it also has, enclosed space and full Hepa filters.

So they took that opportunity during the pandemic so that it can be turned into negative pressure spaces and use it for the triaging and seeing lower acuity.

Suspected patients, to understand the, performance of those spaces.

We actually conducted a thematic analysis of the interviews.

Interviews were coded based on the design features and the relevant outcomes, which is related to infection control and the source responses.

The number actually represent the number of interview codes that actually mentioned those relationship.

And the color means, for the positive outcome and orange for the lesson learned of the spaces and for the ambulance bay.

We have seen that this space helped them to minimize their risk of infections, primarily for the Hepa filter, which acted as a negative pressure capability.

And the lesson learned for these spaces when it is using for, prolonged surges.

There are other importance of accessing the clinical services from the interview code.

We learned how the design features played a major role in helping the department to stay adaptive during the surge.

This surge plan also shows that the open design made it possible to create a multiple flexible operational zoning that actually helped them to create, operated, flexible operational zoning and based on the patient need.

We also learned that the adjacent spaces when going to be used for prolonged surges, it needs some critical access to the basic infrastructure and the services.

We have to remember that this space was not originally designed for patient treatment purposes.

So when they repurposed these spaces, they faced some challenges.

For example, bringing the portable toilets in here, which led to some issues with the clogging back odors or sometimes even the flooding.

And we also had seen that during the winter time when they were using these spaces, they had to brought the portable heaters, which created a problems with overheating and uncomfortable conditions for the staff and the patients.

Now moving to the next flexible spaces, which is the lobby spaces, and this is the entrance into the emergency department.

And this is serving as a main lobby for the hospital building.

It can also be converted in the treatment area, because the necessary medical gases and the electric outlets are built into this columns.

You might not even see, those service lines.

Lines, when you go there, because they are locked and then, but can be quickly opened to access those services when it is needed.

During the pandemic, they were not used for the direct patient care, but they were used for charging the equipments, which actually helping them to plan these spaces for operational purposes.

These are the image of the pandemic time, which shows that how mobile equipment was brought together and quickly transferred the spaces and the low acute care area because they wanted to reserve the main emergency department for seeing heart activity.

Patients.

Here is the lesson learned about these spaces.

And they highlighted the importance of access to the clinical supplies into the extended areas.

From the interview, one of the staff members shared that the supply access could be a challenge in the extended areas for the prolonged search for years.

These.

In here you can see the main supply area within the main emergency department and in the surge spaces.

They are ready for that away, but the close we worked with the supply team, so they didn't face any kind of a major issue in terms of accessing the support services.

Now going to from outside to the inside of the emergency department or to concept of flexibility was incorporated within those pods.

These there are three pods and they do have separate here handling unit which can help them to turn into a negative pressure isolation zone.

So they took that opportunity during the pandemic by closing one of the door and turn them into a negative pressure.

They choose to pick the distant pod to turn it into a negative pressure isolation unit, because it will help them to better containment of the negative pressure, on the front of the year.

There are lots of movement and this scared that like that might not be very effective in terms of containing the negative pressure.

One of the benefits of the Covid isolation unit is that it helped them to increase the capacity for infectious patients, and also help them to minimize the risk of the infection spread.

This is reflected from the one of the interview code, where it shows the.

At that beginning of the pandemic, they didn't have to worry about that because we have seen maybe probably remember from the news in the media that many hospitals across the country weighed about how to minimize the risk of infection within the emergency department.

The last part is about the flexibility, how in the patient from the layout actually help them to create a flexible route for the patient, for splitting the patients by the infection risk and the acute level.

This is the layout for an event.

If there are any infectious patients coming, and this is the usual route they take for transporting the patient from an area to the isolation room.

But the layout helped them during the pandemic.

And this is the layout which actually showing how the patient routes were splitted during the outbreak.

At the outbreak, you probably remember there was not enough knowledge of how the virus is actually spread it.

So that's why they try to maintain a strict speed flow between the Covid and non-COVID patients.

And these red road are used for taking Mirror County patients upon arrival in, through the ambulance bay to the isolation room.

And the pink room is for lower acuity.

Covid patients in the darker blue line is for, non-COVID media acuity patients, and the lighter blue is for lower acuity, non-COVID patients.

And those are the route they use for transporting the patients from the arrival area to their designated routes.

We can see the similar splitting flow from arrival area, and they were actually distributed in the two parts.

And this was was used when the lobby space was primarily used for lower acuity non-COVID patients.

Since the summer and the delta wave, they didn't have that much storage use of the Covid 19 patient volume.

They still use the emergency departments inside.

And this urgent care area use for mid acute Covid 19 patients and stealing here they are trying to maintain the speed flow by their risk and their equity level.

But if you look at that, there was really minimal or overlapping in their route and similar things.

We can see giving the winter wave and the Omicron wave.

So during the winter, what happened that, there was a severe cold in the Chicago area.

So that's why they didn't use this ambulance space, but they decided to use the main lobby for treating more acute Covid and non-COVID patients, but into a different zone.

Still, we can see when the lobby spaces were used, they're still trying to maintain the speed flow.

And from there we can see the layout actually help them to stay flexible in splitting flow, even as the conditions kept changing.

But the one of the lesson learned about using the outside route is that when they were transporting the Covid patient outside the main, and they were facing some challenges with the weather conditions and potential hazard tripping hazard for the patients who might use the clinic here.

But those are the minor one.

But there are like major lesson learned about the flexible spaces, which actually summarize the findings from the qualitative first, which is that when adjacent flexible spaces are used, they allow them to expand and contract the treatment capacity during the surges.

The volume responsive spatial design also help them to demised the space utilization across the different fluctuating patient volume and also adaptive layout, supporting the seamless adjustment to evolving operation flow.

So when thinking about designing the flexible spaces for the future, there are three factors we need to think about.

One is that spaces of opportunities within the emergency department and the consideration of the staffing model in those surgery spaces, and what would be the operational design in that spaces.

When those taken three components were considered, they can actually perform operation sustainability, sustainability.

Since we're talking about operational sustainability, the major question is like when the spaces were used, how did that actually perform during those time for use?

So we actually take this operational data, and from there we learned about the length of stay.

The length of stay were grouped by different time periods, when the different spaces were activated.

The top diagram, sorry, the graph actually shows the patient volume for Covid 19 patients during the time period.

And the this diagram shows the activity spaces during the time period that the second diagram shows the patient volume Covid 19 and non-COVID-19.

Non-COVID-19 is blue and white is for pink.

And this bottom icon, sorry.

The graph actually shows the length of stay for the two groups of the patients dotted for the lower active patients primary in years and four and five.

And the solid line is for the active patients who is for primarily ESR 2 to 3, pink for Covid and blue for non-COVID.

I want to have your attention primarily these two pillars summer and delta.

When they were using the mean and the winter with they when they were using the lobby spaces for Covid and non-COVID during the winter with the feast of surges of the Covid 19 patients and they activated the lobby spaces.

But if you look at the bottom, graph, we can see that there was no major changes or spikes in the length of stay for lower acute.

And the media, active patient groups, both for Covid and non-COVID, what it actually tells us, it tells us that when the flexible spaces were used, it shows a consistent, consistent operational performance.

So spectacles space actually help them to maintain that operational performance.

So what does that lesson learn actually tell us, why is it important to learn for us from the pandemic, even though we know that events like this may happen only once in a century?

The reality is that these are always facing changes, changes due to the technological advances or changes due to the different kind of surges that can be happen daily to see the surges.

The lessons that we learned from the pandemic help us to understand what are the spaces of the opportunity and the design features that we can use in our Ed, so that the departments can be more flexible and resilient for whatever the challenges and the changes come next.

So with that notion, I'm actually finishing my presentation and want to welcome the tie to take over the next part of this presentation.

Thank you.

So, for this part of the, talk, I would like to share some case studies that shows the flexible emergency department design, that support small rural hospital is kind of shifting our lens to the other side.

So, first of all, I don't know if everyone in the room knows, what is a critical access hospital?

It's, one type of designation, approved by CMS, for a specific type of small rural hospitals.

And in order to be qualify as CHC, they have to fulfill a certain criteria, right?

First of all, they have to have no more than 25 inpatient beds and their length of stay has to be less than 96 hours long.

And more importantly, they have to maintain 24 seven emergency care.

And, distance wise, they have to be, 35 miles away from another hospital and some of the hospitals, after many of them, do have to swim that agreement, which allow them to use the inpatient bed actually used to provide for skilled nursing services, and that can support the financial, bottom line of many of the hospitals.

So there are actually a lot of them, there are, by July 2025, there are 1377 critical access hospital in the United States.

If you think about it, we have about 5100 community hospital in the United States.

And that's almost 27% of the total number of community hospitals.

So there are a lot of them, but many of them share similar challenges, right?

Due to their location, because they are located in, geographically isolated area that make, access to care very difficult.

And there's, pretty clear, disparity between urban and rural area make the, affordability of care become more challenging and more importantly, because of the location.

There is a bigger challenge to, recruit, where, health care workforce also has a smaller, labor pool.

So with all these challenges, what we have, witnessed and observed is a continuous, increase of number of those small rural hospital closures, since 2005.

So this number is actually pretty scary.

195, hospital closed and some of them converted, but some of them completely closed, right?

110.

And you can see from this map, Kansas, Texas, Georgia, we are all affected by, this, this, challenge here.

So next slide please.

Yeah.

So, how to we, keep these small rural hospital alive, right?

One of the mission as architects, as designers, is how can we design those hospital spaces, including emergency departments?

Right.

To maximize the efficient space and staff you right to keep them, alive?

So one great, point that, FDI guideline actually, made and helped, pointed a direction that our, architects and planners can start thinking about, is, what they have stated here, critical access hospital reimbursement is actually based on patient care provided and not tied to the specific room occupied.

That's a huge point that they're making here, is that it gives us a lot of freedom.

And, room to consider how to, creatively design the space to allow the space to be used for multiple, patient care functions.

So in the next couple slides, I would like to, use some case studies to show you.

How does that work?

Right.

How do we design to be able to, be successfully, realized that, multi-use.

So I'm using case study from HSG architecture.

It's a firm that's dedicated to, health care design.

And they have done a lot of work in rural hospitals, more than, 20 hospitals.

So the first example that I'm showing here is a Logan County Hospital, located in Logan, Kansas, with less than 3000 population, small time.

So in order to, manage, the, operation of both inpatient unit and ed, what they did there is quite creative.

They consolidated the nursing center, by having one counter looking towards the pink site, which is the Ed side, and the other side of the counter, the nurse station looking, towards the, inpatient unit, the yellow, colored side.

So.

And there, you know, really a shared nurse station that allowed nurses to move across those two, departments very effectively and really allow the cross staffing to save one staff.

And, and they also created some shared, staffs for space, as you can see here, the teamwork area or the staff breakroom, which is off on the yellow, inpatient, unit side and the toilet.

Right.

The shared staff support area.

So next slide, I want to show you another example, Scott County Hospital.

So again, what you can see from the overall, hospital layout is that, they strategically positioned the inpatient unit, the green one, in between the, er and the surgical department, which is the white, area.

So this, position or, location adjacency allow the, space to be inpatient room, actually to be, shared between E.R.

and the surgical suite.

So next slide, you will see, a little bit better, the enlarged view, as you can see here again, the in terms of the nurse station, Marcia, if you don't mind me, click one more time.

Yeah.

So, it has, each one actually has a dedicated nurse station, but they are connected through internal, back of house hallway.

So that again, allow the nurses to, move easily, between those two departments without necessarily crossing the hallway with, patients.

And then they also have this, shared, patient area.

The patient rooms can be used as ed exam room, treatment room, or observation beds.

Right.

Depending on the, the demand.

And then it can also be used as prepper recovery beds or skilled nursing beds.

Really multi use of, of the same, patient room.

The third a case study that I'd like to share is, a more recent project, our Buckel Memorial Hospital.

So again, you can see something similar, but also a little bit different.

Right.

Similarly, the position, the inpatient unit between, which is the teal color one, between the purple, that's the ed, and the, the, surgical department, which is on the left side.

Okay.

So again, upon closer look, you can see some, interesting strategy that evolved from the previous two projects.

One is that you can see the two again, each department, the inpatient unit and the Ed each has its dedicated nurse station and, they are connected through this shared charting and teamwork area.

So this approach further eliminated the need for the internal circulation space that reduced, the square footage, and also, reduce the grossing factor for both emergency department and, the inpatient unit as we all know, right sizing, building the right space just when you need it is really important, right, for maintaining the, financial bottom line for the small rural hospitals and second thing that's, interesting is, as you can see here, this has, more clear consolidated staff support area behind the nurse's station.

So teamwork area staff, breakroom and toilet, they are all consolidated and co-located, which not only create a better privacy, for staff, but also create a better teamwork.

For a small staffing team, for those more rural hospitals.

And certainly, in addition to having patient room being used for multiple purposes, just like the previous example, they dedicated three rooms as kind of more highly used, multi-use, beds.

They're facing directly from the nurse's station.

So therefore they can be heavily used by Ed or by surgical, unit for Prabhakara.

That was better.

Nurse, surveillance, visual surveillance.

More importantly, they are equipped with negative pressure.

So therefore those rooms can be isolated when needed.

Right.

To be separate from, the swim bed or inpatient beds in that, two wings from the yellow, area.

Yeah.

The inpatient area.

All right.

So as you can see here, there are a lot of different, design strategies that, help to improve, the efficiency of, our space use and more importantly, in this particular context, is really to support better, staff efficiency here.

So another, possibility, or model that, shows some, design opportunity is, new alternative model coal, rural emergency hospital.

So RH is actually recently being approved as a new designation to, replace or allow some of the existing, ACH to convert into, the rural emergency hospital designation, is different from CRH in mainly in the regard, that they don't have any inpatient beds.

Right.

So they only provide emergency departure services and observation care or some outpatient care.

That's, at least, within the 24 hour limit.

So what does that mean to our design?

Right.

So I'm sharing this, example, actually, from our previous students, just like you guys.

Right.

Creative students, from University of Kansas.

When we were exploring this, our prototype.

So what they did was, so an interesting is, without, instead of thinking about our as a stand alone element, they thought about a model of, healthy village.

Right?

So co-locate, our with nursing home assisted living and community, health services and community center to create this, interconnected, support network and more importantly, through this project, they also explored the idea of universal care room.

Right.

So this universal care room is designed to the, the highest level acuity to provide flexibility and allow multiple use, all the way from intensive care to meet surge, to swing bed for skilled nursing or use as prep or recovery or, as, you know, treatment beds or, observation beds or even exam room for, visiting physicians.

Right.

Specialists, who coming in town?

So as you, recall.

Right.

Most, RH they're they don't have inpatient beds, but this design allow them to, accommodate to future growth as well as, you know, demand of the community might change, when they actually have enough demand for, inpatient volume.

They can actually quickly adapt those rooms to meet those inpatient beds.

Purpose.

So, overall, as you have seen from both parts of our, talk today, flexibility design is a key, for the success of Ed, regardless of your volume or the size of your ed.

Right.

So you can fit, the high volume scenario to help increase the capacity to meet the surge capacity, and and can help reduce the cross-contamination.

Or it can meet the low volume, scenario.

Right.

Try to increase the efficiency of space use, or, reduce unnecessary construction and improve, staff, efficiency and reduce the staffing needs.

So I would like to, wrap up our, presentation with, five elements, for flexibility design.

And this is actually based on, wonderful, literature review paper, from, doctor, Jim Heady, and, their team together.

So I want to kind of share those different strategies and hopefully, will inform your future design solutions.

Right.

The first one is tolerance.

Tolerance is basically the ability to, have the space enough to, accommodate additional needs.

Example of that could be a wider hallway that allow you to put more beds when needed.

But the difference is that it doesn't necessarily consider the built in medical gas outlets, etcetera.

Right.

But it does provide the space less tolerance and scalability is the ability to expand and contract the capacity.

And that, a good example of that will be having the ambulance garage that mark the edges, show you right to be able to have the tent, put that, up in a relatively quick, time frame, to quickly expand or contract your, capacity.

And then the third is convertibility, and that is, allow, Eddie to alter the men function, with some level of construction.

So a good example would be installing temporary partitions, right, to separate a unit into, area for, people with, let's say, infectious disease versus not, and then the fourth, strategy is, versatile, versatility.

And that's, about, having, the design to allow you to alter its main function without, doing any additional construction.

And a good example of that will be, for example, having your non-clinical space like the lobby, right, to be able to provide, clinical care, services.

Another example would be if you have the built in, let's say negative pressure, right, zoned, Hvac system that allow you to quickly, conduct, the, the separation of the different zone to have the call for isolation and the last, strategy is modify ability, and that is the ability to alter the min function, without, requiring the total reconstruction.

Right.

Or main construction.

So that, could be, an example of, having, you know, let's say your Ed exam room have double, had wall already built in.

So, when you need that additional capacity, you can quickly activate.

So as you can see, all those five elements, or five strategies, they do have, different level flexibility, but also they are associated with different levels.

First construction cost.

Right.

And they might affect your operational flow.

So for us as designers and researchers, we have to work closely with each emergency department to determine the best strategies that fit their workflow, fit their operational model.

So with that, I think we will wrap up our, presentation and, love for you to connect with us.

And, we'll come.

Any questions from the room?

I think you're muted.

We can't can't hear you.

Okay, I'm going to use the mic on my we have technical issues.

So let's see.

Can you hear me now okay.

So thank you so much for the city's mercy.

And we, I hear you talked about, the environment in Ed and how the design elements can impact managing Covid cases, which is really impressive.

And we thank you so much for bringing up the issue of staff support areas.

My students in the studio this semester, we're working on, basically design for mental and behavioral health among adults.

And adolescents.

The students are basically designing urgent care, 23 hour crisis observation units and crisis stabilization units, which are more inpatient.

And we had lengthy discussions regarding the importance of having this staff support areas consolidated and connected to one another for increasing efficiency in workflows.

So thank you so much for elaborating on that.

Although, the case is where a little bit different, but in terms of staff support and efficiency, you can definitely incorporate those same concepts in your work.

So again, greatly appreciated.

We can take a couple of questions, from the audience.

So I'm just gonna mute myself.

Questions.

For if any, any.

Since they were not during the the question.

So what was our thinking?

I had one question that I wanted to ask regarding, that Roche hospital, that you covered Marzia, with a negative pressure isolation units.

What were some challenges with making that, with accommodating those rooms in flexible rooms?

Like, were there any ante rooms?

Where did donning and doffing take place in case, there was a Covid patient using those rooms at a time of pandemic?

Thank you, Jeffrey, for your question.

During the interview, we didn't hear about your unmute.

Marcia, can you hear me?

Yeah, I can hear you, but, I don't understand.

Jeffrey, can you hear me?

Okay.

Perfect.

Thank you.

When we did the interview and did decide to visit in Arash, we didn't hear about any kind of challenges in terms of, putting the patients in any room.

Since the unit was under the negative pressure, they were very flexible enough to put the patient the suspected and the, like, highly suspected Covid patients.

So in terms of the patient placement, they didn't facing the challenges and the donning and doffing, the part was done before, before entering the, treatment room since the whole unit was under negative pressure.

So they did have the challenges about that part.

I would highlight only one thing, which is a very minor thing, is about those rooms are pretty much standardized.

And they did have some support spaces within the room.

So at the beginning, pretty early, we didn't know how the virus was actually transmitted.

Whether it is, for my transmutation or the airborne transmission.

So with an unknown, risk, they actually took out some of the equipment from outside, from the inside of the room to the hallway, just for extra measures.

But it wasn't a very minor, not a big issues for them.

So in terms of containing, or minimizing the risks, they were actually pretty confident about the success of their design features.

Well, thank you so much.

And I know that we're, basically, kind of beyond running beyond the end of our class.

So students, if you have another class, you can leave, feel okay to leave?

I just want to thank you.

And, of course, we can stay here and talk among ourselves.

I saw that you had a question.

So we can stay online a little bit longer.

But, students, let's thank Doctor Kai and Razia for joining us again.

Greatly appreciate it.

It was a pleasure.

Thank you.

Thank you.

Our pleasure.

Yeah.

And hope to see, visit you guys sometime soon.

In person.

Yeah.

Good luck with it.

Forward to that.

Thank you so much.

Thank you.