Hospital planning and designing

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Planning and Designing a Hospital

• Parnab Roy
• MHM(1st year)
• SMU

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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.

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Basic objectives which are to be met by the
hospital-

• Sound architectural plan
• Economic viability
• Effective community orientation
• Quality patient care

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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)

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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

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Type of hospital-

• Primary
• Secondary
• Tertiary

• Private
• Partnership
• Public charitable trust
• Cooperative society

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Bed planning-

• Bed PopulationA S 100
• 365 PO
• A number of inpatient admissions/1000
  population/year
• S average length of stay
• PO percentage occupancy

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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.

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Equipment planning-
Built 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.
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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.
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Operation programme-
Admission Human resource
Administration Stores
General engineering Purchasing
Laundry Maintenance
Clinical services Waste disposal plant
Pharmacy Fire and safety
Nursing services Disaster plan
House keeping information
Records Dietary services
Public relations Clinical engineering
Employee facilities Sanitation
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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.

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

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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

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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
  

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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

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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.

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

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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

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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.

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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.

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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.

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Radiology and laboratory services-

• 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.

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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
• 
  

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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 CSSD mostly serves the operation theatre, emergency, casualty department, wards, maternity suit and should be so cited as to be central to all this
Hospital dietary service 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
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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
MRD Should be located immediate to the admission and registration area. Enough space for keeping/storing of patient files Adequate safety .
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Space requirements of some basic departments-
Area Sq .ft / bed
Nursing unit 250-280
Nursery 12-18
Delivery suite 15-20
Operation theatre 30-50
Physical medicine 12-18
Radiology 25-35
Laboratory 25-35
Pharmacy 4-6
CSSD 8-25
Dietary 25-35
Medical record 8-15
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Area Sq .ft / bed
House keeping 4-5
Laundry 12-18
Mechanical installation 50-75
Maintenance work shop 4-6
Stores 25-35
Public areas 8-10
Staff facilities 10-15
Administration 40-50
Total 567-751
Circulation 115-751
Total net area 682-891
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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

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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

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Commissioning-

• Formation of commissioning team
• Hospital consultant
• Hospital administrator
• Chief of clinical services
• Senior nurses
• Supplies officer
• Others
• 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

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Hospital project staging-
Stage 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
Stage B Operational policies Developmental plan Operational policies Departmental and inter related activities Departmental and hospital policies Development control plan Budget cost Continuous informal discussion with owners
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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
Stage D Detail design working drawings, tender action Working drawings Engineering details Bills of quantities Calling tenders
Stage E Contract and construction Assessments of tenders Award of contract Construction Engineering commissioning
Stage F Commissioning Staff assembly and training Equipment and supplies assembly Testing of installation
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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.

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