Hospital Literature Study

Hospital: • Hospitals/Healthcare centres are the first contact point between members of the Public and health workers. • Medical institutions provide treatment for and care of patients with a wide range of chronic acute conditions. • Construction must satisfy the needs of a number of functions: accommodation, research, teaching, medical activity, storage and administration. • Most important to remember wihle designing is that you are designing for physically unfit people. There are several that should be considered in the design of a primary healthcare building. These include –  Location of the building: should be convenient in relation to the people it serves.  Circulation: Entrance and circulation within the building must consider wheelchair users, parents with small children and people with disabilities, etc.  Effective zoning is required: public zone, clinical zone and staff zone.  Privacy and confidentiality are important, especially at the reception desk and clinical rooms during consultations and treatments.  Security and supervision in the premises will be necessary, including staff protection against personal assault and safeguarded against theft and vandalism.  For running costs, efficient staffing, energy efficiency, long-life and low-maintenance approache should be adopted.  Flexibility and growth should be catered for: flexibility in use of some, and potential for future extension of the building.

PLANNING CONCEPTION Location: • Site should offer sufficient space for self contained residential areas and hospital departments. • Should be a quiet location with no possibility of future intrusive developmnet. • Adequate area should be there for future expansion. • Should be away from dust, noise and pollution.

Orientation: • Treatment and operating rooms are preferred between north-west and north-east. • For nursing ward facades, south and south-east is favourable due to: Pleasant morning sun Minimal heat build up Little requirement for sun shading Mild in the evenings • East and west facing rooms have comparatively deeper sun penetrations, though less winter sun. • The orientation of wards in hospitals with short average stay is not so important. • Some departments might require rooms on the north side so that patients are not subjectes to direct sunlight.

Forms of building: • Spine form with branching sections. • Radial arrangement, i.e. circulation will be radially outward from the centre of the core. • Any form that goes with the proper connectivity of all the units.

Effective arrangements: • Top floor: Helipad, ac plant room, nursing school, laboratories. • 2nd/3rd floor: Wards can be provided. • 1st floor: Central sterilisation unit, surgical area, intensive care, maternity, children’s hospital. • Ground floor: Entrance, radiology, medical services, ambulance, entrance for bed-ridden patients, emergency ward, information centre, administration, cafeteria. • Basement: Stores, physiotherapy, kitchen, heating and ventilation plant room, radio therapy, linear accelerator. • Sub-basement: Under ground garage, electricity supply.

FUNCTIONAL AREAS: • Intensive Care, Special Care, Normal Care. Functional Area 1 – Care Surgery Recovery area Rehabilitaion Physiotherapy X-ray diagnosis NMR diagnosis Radiotherapy Clinico-chemical laboratory Clinico-physical laboratory Clinico-neurophysical laboratory Central reception and treatment Delivery Dialysis Specialist anaesthesia department Specialist eye department Specialist surgical department Specialist gynaecology department Specialist obstetricts department Specialist ENT department Specialist internal medicine department Specialist surgical department Specialist paediatric department Specialist neurology department Specialist psychiatry department Specialist X-ray area department Specialist urology department

Functional Area 2 – Examination/Treatment Functional Area 3 – Research Functional Area 4 – Pathology Functional Area 5 – Teaching/Training Library Files

Functional Area 6 – Scientific information Emergency services Blood bank

Functional Area 7 – Special interdisciplinary facilities Central administration Patient reception

Functional Area 8 – Administration/Management Staff changing room Canteen Shop

Functional Area 9 – Housekeeping Food provision Central store Central sterilisation Pharmacy Laundry Bed cleaning Waste disposal Transport service

Functional Area 10 – Supply/Disposal Foyer/Entrance Cleaning service Maintenance

Functional Area 11 – Other functions

FUNCTIONAL AREAS FOR VARIOUS DEPARTMENTS -

Types of hospitals No. of beds Smallest

Function General

(up to 50 beds) Small (up to 150 beds)

University ( includes- medical academics, lecture rooms, general hospital)

Standard (up to 600 beds) Specialists Large

( includes- special clinics of different treatments)

HOSPITAL RELATIONSHIPS ADMINISTRATION

EMERGENCY

INPATIENTS

SERVICES

DIAGNOSTIC AND TREATMENT

RESEARCH AND TEACHING

OUT PATIENTS

General Medical Practice Premises

CORRIDORS, DOORS, STAIRS, LIFTS Corridors: Must be designed for the max. Expected circulation flow. • Acess corridors must be atleast 1.50 m wide. • Corridors for access by patients and equipment shall have a min. width of 2.25 m. • Suspended ceiling in corridors may be installed upto 2.40 m. • Windows for lighting and ventilation should not be more than 25 m apart. • Effective width of the corridors must not be constricted by projections, columns or other building elements. • Smoke doors must be installed in ward corridors in accordance with local regulations.

Doors: Doors must be designed keeping the hygiene requirements in mind. • Surface coating must withstand the long term action of cleaning agents and disinfectants. • Designed to prevent the transmission of sound, odours and draughts. • The clear height of doors depends on their type and function (1) Normal doors: 2.10 - 2.20 m (2) Vehicle entrances, oversized doors: 2.50 m (3) Transport entrances: 2.70 - 2.80 m (4) Min. height on approach roads: 3.50 m

Stairs: Must be designed in such a way that if necessary they can accommodate all of the vertical circulation. • Should consist four flights and three landings between finished floor levels. • Finishing material should not be slippery. • Handrails must be provided on both sides at a height of 1000 mm. • The minimum headroom in a passage under the landing of a staircase and under the staircase shall be 2.2 m. • Winding staircase should be avoided for main access. • Doors must not constrict the useful width of the landings and, in accordance with hospital regulations, doors to the staircases must open in the direction of escape. • Effective width: 1.5 - 2.5 m. • Riser: 170 mm. • Tread: 280 mm. • Riser/tread ratio of 150:300 is preferable.

Lifts: Transports people, medicines, laundry, meals, hospital beds/stretchers, etc. • At least two lifts for transporting beds/stretchers must be provided. • One multipurpose lift should be provided per 100 beds, with a minimum of two for smaller hospitals. • A min. of two smaller lifts for portable equipment, staff and visitors. Clear dimensions of lift car: 0.90 x 1.20 m Clear dimensions of shaft: 1.25 x 1.50 m • Internal surfaces must be smooth, washable and easy to disinfect, the floor must be non-slip. • Lift shafts must be fire resistant.

MEDICAL AND ANCILLARY SERVICES OUT PATIENT DEPARTMENT(O.P.D): The O.P.D provides consultation, investigation and diagnostics for patients who require little or no recovery services afterwards. Outpatient : Any person given general or emergency diagnostic, therapeutic or preventive health care and who at that time is not registered as an in-patient in the hospital. Location: Should be located on the ground level preferably. • Should be close to vital adjunct services such as registration and medical records, admitting, emergency and social service. • Should be easily accessible to the laboratories, radiology, pharmacy and physical departments. • Should have a separate entrance and adequate parking facilities.

Organization: The staff is made up of four major organizational components – Medical staff (It is central to the organization)  Nursing staff (Consists of registered nurses, nursing and hospital aides)  Ancillary staff (Includes radiology, laboratory and ECG technicians)  Clerical staff (Carries out registration, patient’s billing, receiving cash, secretarial, records, etc)

FUNCTIONS OF OPD: • Early diagnosis, curative, preventive and rehabilitative care on ambulatory services. • Effective treatment on ambulatory basis. • Screening for admission to hospital. • Follow up care and care after discharge. • Promotion of health by health education. • Rendering of preventive health care. SIZE OF O.P.D (GENERAL REQUIREMENT): Recommendations a/c to BIS(Bureau of Indian Standards) • For entrance zone - 2 sq. m./bed. • Ambulatory zone - 10 sq. m./bed. • Diagnostic zone - 6 sq. m./bed. • Total hospital area - 60 sq. m./bed.

Sub-waiting area - should be 1 /3rd of total patients visiting clinic per day. Consultation room - Space for doctor’s chair, patient’s stool, follower seat, wash basin, examination couch and equipment for examination. Area - 15-17 sq. m. and each clinic should handle 100 cases per day. Special examination room - Required for certain departments.

IMPORTANCE OF OPD: • First point of contact. • Facilitates teaching. • About twice the in-patients attend O.P.D everyday. • A good O.P.D service can reduce the work load on in-patient services. • It is a place for implementing preventive and promotive health activities.

FACILITIES AND SPACE REQUIREMENTS Public Areas and Administration: • Wheelchair and stretcher storage alcove. • Reception and information desk. • Registration counter and cubicle for staff. • Lobby and waiting lounge. • Public toilet facilities. • Public telephone(s)/room with assisted STD/ISD call facilities, etc. • Water coolers or drinking fountains. • Space/office(s) for supplies, equipment, etc. • Multipurpose room(s) for conferences, meetings, health education programmes, etc. • Employees facilities including lockable drawers and cabinets and for personal belongings. • General storage for supplies, equipment, etc. • Coffee shop/snack bar in the vicinity. • Meditation room/retiring room. • Doorman’s station.

Clinical Facilities: • General purpose examination rooms – min. floor area 7.43 sq. m, excluding vestibules, toilets, closets, etc. Wash basin and a counter top for writing. • Special purpose examination rooms – for specialty clinics such as eye(dark room required), ear, nose, throat – facilities as required for special procedures and equipment. Wash basin, counter/work top, etc. • Treatment room for minor procedures and cast work. • Nurse’s station with work counter, communication system, space for charting, supplies, refrigerator, locked storage for drugs, etc. • Clean storage for storing clean and sterile supplies, cabinets and shelves. • Containers for storing clean and sterile supplies, cabinets and shelves. • Containers for collection, storage and disposal of soiled materials. • Sterilizing facilities. • Wheelchair storage space out of the direct line of traffic.

Registration Medical Records

Reception/Enquiry

Waiting

Waiting

Admitting Office

Consultation/Examination Minor Treatment and Procedures

Hospital Inpatient

X-ray

Lab

Dispensing Pharmacy

Other Investigations and Therapeutic Facilities

Injection Dressing

Outpatient Entrance

EMERGENCY SERVICES: Purpose: To treat patients who seek emergency services for situational medical conditions other than acute medical services. Location: Should be located on the ground floor with easy access for patients and ambulances. • Should have a separate entrance to the department, which is away from the main hospital and the outpatient entrances. • The department should be close to the admitting department, medical records and cashier’s booth. • Should be close to radiology unit, laboratory services, including the blood bank. • Should be close to elevators so that one can proceed to surgery without loss of time. Design: The entrance to the emergency should be sheltered to protect ambulance patients from the weather while unloading. • Adequate reserved parking space for ambulances and cars of patients and medical staff. • Entrance should be large enough to admit one or more ambulances negotiating with stretchers. • Ramps should be provided for wheelchair and pedestrian access. • Design should facilitate good public relations and quick access to the patients by staff and supplies.

Organization: An efficient, prompt, well-equipped ambulance service with competent personnel in charge. • A well equipped emergency operating room with supplies always ready for use. • A small recovery room. • Efficient personnel including at least a component physician, nurse, and attendant on round-the-clock duty or on call. • Supervision of treatment of fractures and other injuries by qualified and competent surgeons in their respective fields. • Adequate diagnostic and therapeutic facilities under competent medical staff. • A well documented medical record for every patient that includes immediate record of all injuries, physical findings, treatment, etc.

FACILITIES AND SPACE REQUIREMENTS – Facilities in the emergency department can be considered broadly under two categories: Administrative and public areas  Clinical facilities

Administrative and Public Areas: • Reception-control: For observation and control of access to the treatment area, public waiting area, and pedestrian and ambulance entrance area. Should be equipped with a communication system including intercommunication. • Waiting patients and their relatives should be better shielded from what is going on in the treatment area. • Space for stretchers and wheelchairs adjacent to the entrance but out of the stream of traffic. • Stretchers should be provided with wheel locks. • Waiting area should be separated from the working or treatment area and should be provided with toilet facilities, water coolers, or drinking fountains, public telephones, STD and ISD call facilities and vending machines if possible. • Space/room for security staff, police, ambulance driver and attendant. • Office for the night adminnistrator/night supervisor – can be off site but not too far away. • Coffee snack bar in close vicinity. Clinical Facilities: Four major functional areas can be identified. These are • Trauma care area where the severely surgical cases are handled. • Medical examining area. • Splintage and casting area for orthopaedic cases. • Observation beds for patients who need to be kept under observation for neurological and other medical reasons.

Facilities Required: • Trauma rooms for emergency trauma procedure or where the severely injured surgical cases are handled. Resuscitation and life support equipment and drugs, medical gas outlets, examination table, examination lights, X-ray film illuminators, cabinets and supply shelves. For orthopaedic and cast work, it is necessary to have closed storage space for splints and other orthopaedic supplies, a plaster sink, traction hooks, etc. • Examination/treatment rooms with examination tables, examination lights, work counters, cabinets, wash basins, X-ray film illuminators, medication storage facilities and medical gas outlets. • Scrub stations conveniently located to each trauma and orthopaedic room. • Additional adjustable space for triage, treatment, observation, etc. in the event of disaster handling. • Staff work area and charting space with counters, cabinets, medication storage facilities, dictating facilities, etc. • Storage space for equipment such as portable X-ray and “crash carts” (cardio-pulmonary resuscitation emergency carts) which should be easily accessible. • Separate soiled and clean utility rooms. • public toilets and janitor’s closet. • Rooms for duty/on-call doctors, separate for men and women, with sleeping accommodation, shower and toilet facilities. • Locked cabinets, etc. for staff’s personal effects.

OTHER CONSIDERATIONS – Triage Area: The emergency department has an active role to play in situations when several emergency cases arrive in the hospital simultaneously, for example, victims of bus or train accident, major fire or other disaster. • The emergency staff are trained to recognize the nature and relative severity of a patient’s condition. In what is called the “triage area”, patients are rapidly sorted sent to appropriate treatment areas. • For example, hyper acute(life threatening) cases are sent to the emergency room, serious casualties are sent to surgery area, ambulatory care(non-life threatening) cases to outpatient department, waiting room or observation area, the emotionally disturbed cases to the chapel or meditation room, and the dead on arrival to the morgue. • A triage sorting system establishes priorities for treatment of critical patients. Priorities are based on the degree to which the patient’s life is threatened. Typically, patients are classified as follows: Emergency: Patient requires immediate medical attention; life, limb or sight is threatened.  Urgent: Patient requires medical attention within a reasonable time and will be in danger if not attended. Non-emergency: Disorder is minor, not acute and can wait.

CLINICAL LABORATORIES: Purpose: Primary function is to perform tests in the six main fields of bacteriology, biochemistry, histology, serology, haemotology and cytology to assist medical staff in making or confirming diagnoses and in the treatment and prevention of disease.

Location: Should be conveniently located on the ground floor to serve the outpatient, emergency, and admitting departments. It should also be close to or easily accessible to surgery, intensive care, radiology and obstetrics.

FACILITIES AND SPACE REQUIREMENTS • Work counter with space for equipments. • Workstations should be equipped with vaccum, gas, electrical services, sinks and water. • Specimen collection area for blood, urine and faeces. • Work counter, space for patient’s seating and a wash basin. • Toilets with a washbasin for urine and faeces collection area. • Storage facilities for reagents, standards, supplies and stained specimen microscopic slides. • Admin. areas, offices for pathologists, secretarial and clerical work area, space for records.

• Staff facilities. • Sterilizing area. • Glass washing area – dirty area that should be separated and closed. • Storage for surgical specimens.

Blood Bank: The functions of the blood bank encompass donor selection, collection of blood, grouping and cross matching, testing for transmittable diseases, blood component separation, storage of blood components, issue of components and data management. According to the Government of India Drugs and Cosmetic Rules, existing blood banks and those that intend to apply for a license to operate a blood bank are required to fulfil the conditions set out in the amendments. The salient features of the conditions are – • Seven rooms within a space of 100 sq. m. • Registration and medical examination room and blood collection room with suitable furniture and facilities. • Two laboratories, one for blood group serology and another for screening the blood for Hbs Ag, HIV antibodies and syphilis. These should be air conditioned. • Two refrigerators for maintaining temperature between 4 to 6 degree C with recording thermometer and alarm device, one for the blood collection room and another for laboratory. • Sterilisation and washing room. • Store and records room.

RADIOLOGICAL SERVICES : The main function of the radiological services is to assist clinicians in the diagnosis and treatment of diseases through the use of radiography, fluoroscopy, radioisotopes and high voltage acceleration.