Planning and Designing a Hospital

Parnab Roy MHM(1st year) SMU

Hospital must meet two basic fundamental needs Must meet the needs of the patient it is going to serve adequately. It must be in a size and proportions which the owners or promoters will be able to build and operate.

Basic objectives which are to be met by the hospital Sound architectural plan Economic viability Effective community orientation Quality patient care

Principles of hospital planning Protection from unwanted and unnecessary disturbances in order to help speedy recovery Separation of dissimilar activities Control the nurses station should be positioned strategically to enable proper monitoring of visitors entering and leaving the ward, infants and children should be protected from theft and infection etc. Circulation- all the departments of a hospital must be properly integrated. (separate all departments, yet keep them all together; separate types of traffic, yet save steps for everybody; that is all there is to hospital planning Emerson Goble)

Selection of site Needs of the community Ease of accessibility Range of services offered Availability of specialists Availability of technology Study of existing hospital(if any)

Requirements of staff and services

Type of hospital Primary Secondary Tertiary

Private Partnership Public charitable trust Cooperative society

Bed planningBed: Population=A S 365 100 PO

A= number of inpatient admissions/1000 population/year S= average length of stay PO= percentage occupancy

Planning of finances Funds required for constructing, furnishing and equipping the hospital. Operating funds- salaries, loans and interest, other maintenance expenses. Arranging financial assistance-patient fees, bed charges, and other modes of revenue generation process.

Equipment planningBuilt in equipment These include counters and cabinets in laboratory, Pharmacy and other parts of the hospital,elevators,incinerators,coolers, fixed sterilizing equipment etc.These are usually included in the construction contract and the planning of these equipments is the architect's responsibility.

Depreciable equipment

This includes equipment that has a life of five years or more and is not purchased through construction contracts. These are large pieces of furniture which have a relatively fixed location and are capable of being moved e.g., diagnostic and therapeutic equipment, laboratory instruments, office furniture etc.

Non depreciable equipment

These are small items with a low unit cost and life span of less than five years. These are generally under the control of the store room and are bought through other than construction contracts. They include kitchen utencils,surgical instruments,linen,waste baskets etc.

Operation programmeAdmission Human resource

Administration
General engineering Laundry Clinical services

Stores
Purchasing Maintenance Waste disposal plant

Pharmacy
Nursing services House keeping Records

Fire and safety

Disaster plan information Dietary services

Public relations
Employee facilities

Clinical engineering
Sanitation

Planning of departments In patient department Patient room- These may be private/semi private rooms or multibed general wards. They should be designed to be safe and aesthetically pleasing so as to assist in quick recovery of patient. They must contain space for equipments, staffs and various need of the patient. Nurses control station- should be located and designed in such a way that the nurses can observe the patient room. The work area- related to handling materials necessary for patient care, maintaining communication and records etc.

Economical High quality patient care Comfort to the patient Efficient operation of the unit Meeting the needs of the visitors

Facilities and space required Examination and treatment room with wash basin etc. Cupboard for clean linen. Basket for soiled linen with sink, waste receptacles. Equipment storage room for walkers,IV stands etc Space for storing stretchers and wheel chairs Lockers for staff personal belongings Staff toilet Small laboratory

Out patient department Preferably on the ground level with a separate entrance and adequate parking facilities. It should be close to admitting area , MRD,emergency,radioogy /,lab services and pharmacy. Attention should be paid to circulation, which results in the smooth flow of various traffic lines Traversing the department. Properly signed

Emergency department Should be located on the ground floor with easy access for patients and ambulances Separate entrance for the department Well marked with proper lighting and signs.shoud be easily visible and accessible from the street. Should be close to the admitting department, medical records and cashiers booth, radiology department, lab services, blood bank,elivators and wards

Intensive care unit Should preferably be located on the ground floor with convenient access from the operation theatre suit and emergency department and easy accessibility for wards. It consists patient area, staff area, support area. Four basic requirements Direct observation of the patient by nursing and medical staff Surveillance of physiological monitoring Provision and efficient use of routine and emergency diagnostic procedures and interventions. Recording and maintenance of patient information.

Monitoring equipment Cardiovascular therapy Respiratory therapy Dialysis equipment Radiological equipment Laboratory equipment others

Obstetrical unit The obstetrical unit should ideally be located close to the labour and delivery room as also to the nursery to avoid the exposing the bodies to infection. A room for patient education and group discussions is essential with cheerful decoration is desirable

Newborn unit An area of 30sq.ft/ infant with a space of at least three feet around is recommended All partition should be made of clear glass to permit observation. Furnishing in the full term nursery include a bed side cabinet,incubator,utility table, wash basin, waste receptacles, outlets for oxygen and suction, facilities for examination etc.

Pediatric unit Equal space should be provided for beds. If patients are allowed to stay with the parents, provision must be made for toilets, sleeping and storage of personal belongings Separate provision for examination and treatment of infants. Each pediatric unit have isolation room with other necessities like washing facilities and sterile gowns and masks. Single room for critically ill and uncontrollable patients Recreation or play room Storage space for toys,linen,recreational materials Walls between patient room and the corridor should have glass panels for viewing Lighting decoration and equipment must create a cheerful atmosphere.

Psychiatric unit Consultation area containing staff offices for individual and family care sessions. Conference therapy area for group therapy session. Inpatient area for hospitalizing patients Activities area for occupational recreational therapy. The number of beds should be between 20-24 I order to permit proper observation and treatment and private rooms are preferred. One room for the management of violent patients are desirable. There should be no object which can be used to hurt one self.

 Should be easily accessible to the OPD, casualty and the inpatient wards. Preferably be sited on the ground floor. Adequate reception and registration area Convenient patient flow with minimization of criss cross traffic. Adequate waiting area Separate entrance for accident and emergency cases in busy hospital Provision of room for technical functioning Flexibility, expandability and upgradability need to be kept in mind while siting the department.

Radiology and laboratory services-

Pharmacy Out patient should have ready access to the hospital pharmacy to collect prescription. Staff of wards and department can access it without having to travel a long distance thorough other crowded areas. Collection of indents and dispensing of prescription for inpatients can be carried out in a central dispensing area which is accessible to hospital staff when they come to consult the pharmacist or to obtain stocks for ward use. Suppliers have an access to it from out side Space required for Dispensing counter Cash counter Drugs storage including dressings Cool and cold storage Administrative office Circulation space Space for compounding and bulk preparation

Hospital store

It should be located centrally to the hospital Approachable by supply vehicles and should have separate service entrance Risk of fire and explosion in a medical supplies storehouse, storage of acids, inflammable materials and oxygen and other gas cylinders will require special attention CSSD mostly serves the operation theatre, emergency, casualty department, wards, maternity suit and should be so cited as to be central to all this Should be located taking into consideration the prevailing wind direction so that smoke and kitchen odours are not constantly wafted to patient care area Should be sited at ground level and connected to store with lift

CSSD

Hospital dietary service

Hospital work shop/BME department

A large quantum of various types of mechanical and electrical equipment is installed in a hospital and requires repair and preventive maintenance.

Laundry

Used linen from wards, operation theatres and delivery suites maybe infected, and therefore needs careful handling at an area remote from all other clinical and supportive services areas Space for washing, storing, drying shades and ironing rooms have to be catered for at an appropriate area with plentiful supply of water
Should be located immediate to the admission and registration area. Enough space for keeping/storing of patient files Adequate safety .

MRD

Space requirements of some basic departmentsArea Nursing unit Nursery Delivery suite Operation theatre Physical medicine Radiology Laboratory Pharmacy Sq .ft / bed 250-280 12-18 15-20 30-50 12-18 25-35 25-35 4-6

CSSD Dietary
Medical record

8-25 25-35
8-15

Area
House keeping Laundry

Sq .ft / bed
4-5 12-18

Mechanical installation
Maintenance work shop Stores Public areas Staff facilities Administration Total Circulation Total net area

50-75
4-6 25-35 8-10 10-15 40-50 567-751 115-751 682-891

Project costing The most common method of estimating hospital construction costs has been the per bed method,i.e.,if the total cost of a 100 beded hospital has been Rs.400 lakhs,the cost/ bed is Rs.4,oo,ooo. Break up of project cost Acquisition of site

Site survey, investigation Landscaping Construction contact-building with fixed equipment Supervision and inspection Equipping the hospital-diagnostic and therapeutic equipment Movable equipment, furniture etc. Architect's fee Consultants fee Site engineers fee

Phasing The necessity to bring facilities into use as quickly as possible for operational reasons. The necessity to split a major project into a smaller units as a contractual consideration The necessity of having certain departments ready before others Limitation on availability of capital funds

 Formation of commissioning team

Hospital consultant Hospital administrator Chief of clinical services Senior nurses Supplies officer Others

Commissioning-

Activities Bring the hospital building, plant and equipment to a state of the operational readiness Development operational system Testing of equipments Coordinate training of staff Ensure good communication

Hospital project stagingStage A Functional content: Outline brief: Project team Assessment of functional content Submission of owners( Govt,private organization etc.)for approval Site appraisal, gross floor areas Building space. Draft master plan Estimation of cost and phasing Appraisal of work by owners Operational policies Departmental and inter related activities Departmental and hospital policies Development control plan Budget cost Continuous informal discussion with owners

Stage B Operational policies: Developmental plan:

Stage C Schedules of accommodation, sketches, Final cost estimate:

Schedules of accommodation Sketch drawing Equipment schedules component estimates Cost revenue and staffing estimates Final cost approval Working drawings Engineering details Bills of quantities Calling tenders Assessments of tenders Award of contract Construction Engineering commissioning Staff assembly and training Equipment and supplies assembly Testing of installation

Stage D Detail design working drawings, tender action:

Stage E Contract and construction:

Stage F Commissioning:

Conclusion Technology requirement must be met Clinical needs must be considered Safety is a major factor Standards and Guidelines are essential Importance of the role of Hospital Staff in construction and design.

THANK YOU