Gertler & Wente is currently engaged in the construction of a 20 bed pediatric vent unit and 20 bed adult vent unit within a Skilled Nursing Facility (SNF) in Brooklyn, NY. Due to the Covid-19 crisis the New York State Department of Health has asked that these units be brought on-line ahead of schedule due to their “essential nature” and their ability to assist if off-loading non-infected patients from the mainstream hospital system. The design goals of any Skilled Nursing Facility (SNF) is to create an environment that supports patient healing by promoting the highest possible functioning level to recover fully or assist those in the need of long-term care. Some typical examples of skilled nursing services include wound care, intravenous (IV) therapy, injections, catheter care, & physical therapy recovery after specific surgeries, injuries or aging related ailments. However, a Ventilator Dependent Unit, as a type of SNF, is specifically focused on restoring/maintaining airway function & maximizing independence. The desired outcome for these patients is medical stability with adequate growth & healing of the lungs and eventual withdrawal of assisted ventilation.
For a patient to be considered mechanical ventilation (MV) dependent they must be on a ventilator 6 hours per day for up to 3 weeks. Therefore MV patients require rehabilitation services to address impairments and to provide the ability to wean patients off of MV. A Vent Dependent Unit has both the physical infrastructure and the staff to wean patients off of ventilators. These units typically have piped in oxygen from a central source that can supplement air delivery by mechanical ventilation, piped in vacuum systems that assist in suctioning of secretions from patient airways and emergency power systems in case of power outages. Nurses and respiratory technicians that manage and staff these units are familiar with ventilator alarms, heart/respirator rates, oxygen saturation level requirements, emergency MV supplies, and all the training procedures related to MV patients to avoid patient injury & infection during the sizing, placement and removal of breathing tubes. In addition, additional resources and physical spaces to promote education, physical activity, physical therapy, occupational therapy and speech therapy for children and adults are often part of ventilator unit programs. Providing dialysis services in-house for MV patients to reduce the discomfort and transport time to an outside dialysis facility is helpful. This SNF will have the dialysis center open to outpatient services as well in an effort to serve the overall local community.
Eventually, many of these patients can be weaned off of a ventilator if they have had no escalation in ventilator support for 2 days, have stable chest x-rays, normal blood PH levels, stable blood pressure, stable heart rate, tolerance of adequate nutrition, no active infections and the understanding by family and the medical staff of the desirability of weaning.
Article written by Marc F. Goldstein, AIA Partner
SNF In-House Dialysis Center