HEALTH BUILDING NOTE 22 Accident and emergency ... 22 v2 ed2005.pdfFor queries on the status of this document contact [email protected] or telephone 029 2031 5512 Status Note amended

For queries on the status of this document contact [email protected] or telephone 029 2031 5512

Status Note amended March 2013

HEALTH BUILDING NOTE 22

Accident and emergency facilities for

children and adults

2005

STATUS IN WALES

APPLIES

This document should be read in conjunction with the Welsh Government’s Circular WHC (2005) 036 - Confidential registration within A & E departments It replaced HBN 22 - Accident and emergency facilities

for children and adults

Ist edition 2003

http://howis.wales.nhs.uk/doclib/WHC_2005_036.pdf�

HBN 22Accident and

emergency facilities for adults and

children

For information only:NHS Acute Trusts and

NHS Foundation Trusts

HB

N 22 – A

cciden

t and

emerg

ency facilities fo

r adu

lts and

child

ren

9 780113 227020

ISBN 0-11-322702-7

www.tso.co.uk

http://www.tso.co.uk

HBN 22Accident and

emergency facilitiesfor adults and

children

London: The Stationery Office

HBN 22 ACCIDENT AND EMERGENCY FACILITIES FOR ADULTS AND CHILDREN

Published by TSO (The Stationery Office) and available from:

Onlinewww.tso.co.uk/bookshop

Mail, Telephone, Fax & E-mailTSOPO Box 29, Norwich NR3 1GNTelephone orders/General enquiries 0870 600 5522Fax orders 0870 600 5533E-mail [email protected]

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© Crown copyright 2005

Published with the permission of NHS Estates, an Executive Agency of the Department of Health, on behalf of the Controller of Her Majesty’s StationeryOffice.

This document/publication is not covered by the HMSOClick-Use Licences for core or added-value material. Ifyou wish to re-use this material, please send yourapplication to:

Copyright applicationsNHS EstatesWindsor HouseCornwall RoadHarrogateHG1 2PW

ISBN 0-11-322702-7

First published 2003; second edition 2005

Printed in the United Kingdom for The Stationery Office

Front cover photograph:Resuscitation room, Southampton University Hospitals NHS Trust(NHS Photo Library. Photographer: Tim Hetherington)

The paper used in the printing of this document(Revive Silk) is 75% made from 100% de-inked post-consumer waste, the remaining 25% being mill brokeand virgin fibres. Recycled papers used in itsproduction are a combination of Totally Chlorine Free(TCF) and Elemental Chlorine Free (ECF). It isrecyclable and biodegradable and is an NAPM andEugropa approved recycled grade.

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Since the previous edition of this guidance (HBN 22,2003), the following changes have been made:

1) All references have been updated. Where necessary(for example in the case of superseded BritishStandards), relevant changes have been made toensure that the guidance reflects the new standards.References that are no longer relevant have beendeleted.

2) The text has been updated with respect to theDisability Discrimination Act 1995 (BuildingRegulations 2000: Approved document M: ‘Accessto and use of buildings’ and BS 8300: 2001 ‘Designof buildings and their approaches to meet the needsof disabled people. Code of practice’).

3) Clarification on ambulance parking issues(paragraphs 2.7–2.9).

4) Clarification on siting A&E facilities in close proximityto diagnostic imaging facilities.

5) The chapter on engineering services has beenupdated.

6) The previous edition recommended the use of hair-wash basins in assessment and treatment rooms, asthey are considered useful when treating people withsome head or eye injuries. As these are not easilyavailable to the same specification as a clinical hand-wash basin, the recommendation has reverted to“clinical hand-wash basin” in this edition of theguidance.

7) The schedules of accommodation have beenupdated to include a range of options for 40,000,50,000, 70,000 and 90,000 attendances.

OTHER USEFUL DOCUMENTS

Since the previous edition of this guidance (HBN 22,2003) several research projects have been carried outwhich aimed to find solutions to help improve accidentand emergency facilities. Planning teams may find thatthe research findings in the following are useful whenread in conjunction with this HBN:

‘Modernising A&E environments’ (NHS Estates, 2004);

‘The impact of the built environment on care within A&Edepartments’ NHS Estates, 2004);

‘A&E design evaluation’ (NHS Estates, 2004);

‘Supporting patient care in Accident & Emergency –Redesigning housekeeping and support facilities’ (NHSEstates, 2003).

In addition, a useful reference is the report from theNational Audit Office, ‘Improving Emergency Care’ (The Stationery Office, London, 2004).

Significant changes since the previousedition of this guidance


This guidance covers facilities for emergency carelocated within an A&E department in an acute generalhospital, which functions 24 hours per day, seven daysper week, is consultant-led, and treats and cares forpeople of all ages.

This guidance is based on the “See and Treat” bestpractice model, which involves assessing and treatingpatients with relatively minor problems as soon as theyarrive in the department.

The standards set out in this guidance essentially applyto new-build facilities. However, the principles areequally valid, and should be applied, when existingaccommodation is being upgraded or newaccommodation is being constructed within an existingbuilding that may previously have been used for otherpurposes.

It excludes minor injury units, Walk-in-Centres (WiCs),and primary healthcare facilities that are not integral to abespoke accident and emergency (A&E) departmentsituated within an acute general hospital.

It describes the optimum design and functionalrequirements of an A&E department where 50,000patients attend per year, but the schedules ofaccommodation include information for different rangesof attendances. Planning teams should consider theprovision of a separate children’s area for alldepartments with an attendance of over 70,000 peryear (see also HBN 23 – ‘Hospital accommodation forchildren and young people’).

The document gives guidance on general and specificdesign considerations in patient and support areas. Italso covers general functional design requirements andengineering services in detail.

Example room layouts are provided in the appendices,along with a comprehensive list of useful references anda glossary of abbreviations.

Executive summary

* http://www.nhsestates.gov.uk

http://www.nhsestates.gov.uk

NHS Estates would like to thank the following for theircontributions to this guidance:

Al Aynsley-Green, National Clinical Director ofChildren’s Services

Ruth Brown, A&E Consultant, St Mary’s Hospital,London

Matthew Cooke, A&E advisor to the Department ofHealth and Senior Lecturer in Emergency Care,University of Warwick

Robert Crouch, Consultant Nurse/Senior Lecturer,Emergency Department, Southampton UniversityHospitals NHS Trust

Ffion Davies, Paediatric A&E Consultant, The RoyalLondon Hospital

Ben Gowland, IDEA Programme, ModernisationAgency

Pat Hamilton, Service Centre Chair, Children andWomen’s Services, St George’s Healthcare NHS Trust

John Heyworth, President, British Association ofAccident and Emergency Medicine

Intercollegiate Advisory Committee on Accident& Emergency Services for Children

Steve Isaac, Architectural advisor, AHA Associates

Roddy McFaul, Consultant Paediatrician, MedicalAdvisor, Child Health Services

Katrina McNamara, Nursing advisor, Child HealthServices

Kate Silvester, IDEA programme

Fiona Smith, RCN Paediatric Nurse Advisor

Rosie Tope, Health planning advisor, HERCAssociates

Gary Ward, Clinical Director, A&E, Coventry

Staff from the following trusts:

Blackpool Victoria Hospital NHS Trust

Bradford Hospitals NHS Trust

King’s Healthcare NHS Trust, London

The Newcastle upon Tyne Hospitals NHS Trust

North Cheshire Hospitals NHS Trust

North Cumbria Acute Hospitals NHS Trust

Queen Elizabeth Hospital NHS Trust, London

York Health Services NHS Trust

Acknowledgements

Executive summaryAcknowledgements

1. Background page 3

InfluencesThe service modelPatients with simple injuries or illnesses

Patients requiring further assessmentPatients requiring resuscitationBabies, children and young people

Impact on the built environmentThe patient’s journeyScope of this guidanceIntended readership

2. The built environment – general functional anddesign considerations page 8

Considerations at the initial planning stageSiting the A&E departmentRelationships with other hospital specialtiesPrivacy and dignity of patientsDisabled peopleInfection controlIsolation of patients with infectious diseasesDecontaminationMajor incidentsSecurityEnvironmental considerations and designDesign considerationsArt in hospitalsNatural and artificial lightingDiagnostic imaging

Ultrasound imagingTransfer of equipment to installation site

Near-patient testingPharmacySocial careTherapiesCaring for people who are distressed or disturbed Dental careDeath of a patient in emergency careActivity DataBase

3. The built environment – specific functional anddesign requirements page 15

EntrancesReception areaWaiting facilities for patients, their families and friends

The waiting baby, child or young personAssessment roomsTreatment rooms

Multi-functional treatment roomsHead and neck treatment roomGynaecology/genitourinary treatment room

Resuscitation roomClinical Decision Unit/Observation UnitDecontamination facilitiesCommunications baseInterview room for distressed or disturbed patientsSitting rooms for family and friendsVisiting/viewing roomNear-patient testing areaDigital imaging suite Dirty utility roomEquipment service roomStorage and supplies roomsStorage of drugs

4. Support facilities – general and specific functionaland design requirements page 25

Staff accommodationRest and recreation facilities

PantryOvernight accommodation for staffChanging rooms and associated facilitiesOffice accommodation

Single-person officesMulti-person officesAdditional office spaceSignposting of offices

Education and training facilitiesSeminar roomThe library

Support spacesAmbulance cleaning bayAmbulance equipment storeMajor incident equipment storeEquipment and supplies storeSterile supplies store

1

Contents

Ready use medical gas cylinder storeHousekeeper’s roomDisposal holdBattery/Uninterrupted Power Supply roomSwitchcupboard

5. Other general functional and design requirementspage 29

CommunicationsRadioTelephonesFaxPatient-to-staff and staff-to-staff call systemsStaff-to-patient communications

Controlled drug cupboardsFire alarmsInternal environmental engineering considerations

VentilationNoise and sound attenuation

FinishesColoursFloorsWallsDoors and framesWindowsCorridorsMaintenance and cleaning

6. Engineering services page 33

General engineering considerationsIntroductionModel specificationsEnergy conservation and sustainabilityDesign for safetyVentilation (substances hazardous to health)Fire safetyFire detection and alarm systemsNoiseSpace requirements for services and plantEngineering commissioning

Specific mechanical engineering servicesIntroductionMaximum demandsHeating systemHot and cold water systemsVentilation (General)Piped medical gasesPneumatic tube systemsFire protection systemsInternal drainage systems

Specific electrical engineering servicesIntroductionSwitchcupboardEmergency electrical suppliesSmall power distribution systemsLighting systemsControlled drugs (DDA) cupboardsBedhead servicesFire detectionIM&T and telephone systemsSecurity systemsCall systemsPublic area entertainment facilitiesLightning protection

7. Cost information page 42

Appendices page 50

Appendix 1 – Example room layoutsAppendix 2 – ReferencesAppendix 3 – Glossary of abbreviations

About NHS Estates guidance and publicationspage 62


2

INFLUENCES

1.1 The 1999 A&E Modernisation Programme ensuredthat A&E departments were providing maximum benefitto patients and staff and best value for money in fivemain areas:

a. increasing the circulation space in clinical treatmentareas, most particularly in resuscitation rooms;

b. installing technology for telemedicine and other ITdevelopments;

c. increasing the level of security;

d. improving facilities for babies, children and youngpeople;

e. identifying ways in which to increase the privacy anddignity of all patients.

THE SERVICE MODEL

1.2 The service model covers both the built environmentand the way in which non-clinical support services aredelivered. Waiting times in A&E can only be met byoptimising patient flow through the department, withminimal restrictions to the delivery of care.

1.3 The “See and Treat” system has been designed toreduce waits and improve the patient’s experience inA&E departments. It is based on the principle that onarrival in A&E, patients are seen, treated and referred forfurther assessment or discharged. More seriously illpatients, or those who require in-depth assessment ortreatment, should be streamed to, and dealt with in, aseparate area. Under this system the prioritisation ofpatients in terms of “safe” waiting times is unnecessary.For further details refer to ‘See and Treat’, NHSModernisation Agency, 2002 (http://www.modern.nhs.uk/emergency).

1.4 Patients are streamed into the following categories:

• simple injuries or illnesses;

• further assessment of those with more serious orcomplex conditions;

• resuscitation.

Patients with simple injuries or illnesses

1.5 Designers should recognise that these patients,most of whom arrive by their own means, form a largeproportion of those who attend A&E departments,although they are unlikely to require subsequentadmission to hospital. Clinicians are able to assess,diagnose, reassure, and treat, if appropriate, many ofthe patients in this stream. Most patients will bedischarged at this stage. (See ‘See and Treat’, NHSModernisation Agency, 2002.)

1.6 Other patients will need further intervention or tests.Direct access or telemedicine links will be needed tospecialist staff, for example radiologists, cardiologistsetc.

1.7 Immediate referral of some patients to specialistteams, for example to paediatricians, surgeons orphysicians, may be necessary. For other patients whohave been transferred to the treatment room it may bemore appropriate for the A&E staff to order tests andawait the results before a decision to refer is made.

Patients requiring further assessment

1.8 These patients may arrive by ambulance or mayself-refer. A number will arrive on stretchers, but otherswill be walking or in wheelchairs. Many will have beenassessed by paramedics in the ambulance.

Patients requiring resuscitation

1.9 Many patients arriving by ambulance will be taken tothe resuscitation room. Others will be transferred fromtreatment rooms if their condition deteriorates. Babies,children and young people needing resuscitation willrequire an appropriately equipped area.

Babies, children and young people

1.10 Typically, 25–30% of patients attending A&Edepartments are children. Children undergo the samestreaming process, so that early discharge to self-careand treatment by primary care practitioners is availablewhen appropriate.

1.11 The design of facilities should seek to minimisestress in children whilst ensuring that they do notbecome an isolated stream.

3

1 Background

http://www.modern.nhs.uk/emergency

1.12 Babies, children and young people with simpleinjuries or illnesses, or those requiring rapid assessment,will follow a similar journey to adults but will beexamined and treated in designated child-friendlyassessment and treatment rooms. “There should beprovision for them to be examined, parents interviewedand counselled away from the immediate hustle andbustle of acutely ill adults” (Professor Al Aynsley-Green,National Clinical Director for Children).

1.13 Some babies and young children, who may be critically ill, will arrive by means other than anambulance. It is essential that they are able to gainimmediate access to the treatment areas, including theresuscitation room if necessary.

1.14 Facilities may be provided for staff specialising incaring for children, including for example nursery nurses,play specialists and others who are able to superviseyoung people.1

1.15 Planning teams should consider the provision of aseparate children’s area for all departments with anattendance of over 70,000 per year.

IMPACT ON THE BUILT ENVIRONMENT

1.16 The service model has major implications for thedesign of A&E departments, including:

• the introduction of individual assessment roomswhere patients with simple injuries or illnesses areseen. In this room they are attended to, treated andreferred or discharged by one clinician;

• the introduction of individual treatment rooms wheremore seriously ill patients or those requiring in-depthassessment or treatment are attended to, unless theyrequire resuscitation, when they will be taken to theresuscitation suite;

• the introduction of the Clinical Decision Unit (CDU) orobservation unit, where patients who need furtherassessment with access to diagnostics are

accommodated for a number of hours before beingdischarged or transferred to other in-patientaccommodation. The concept allows patients to beaccommodated in an area that would constitute“admissions”. (No guidance on the accommodationrequired in a CDU is currently available. Facilitiesshould be developed in relation to local servicedelivery requirements.)

THE PATIENT’S JOURNEY

1.17 In designing new facilities it is essential tounderstand the journey the patient makes through thedepartment. This will vary depending on the means ofarrival, the clinical condition, and whether the patient isan adult or a child.

1.18 When patients arrive on foot or by public or privatetransport (see Figure 1):

• a patient will arrive at the main entrance to the A&Edepartment;

• from there they will go to the reception area wherethey will be greeted and either directed to anassessment room, or asked to wait a short timebefore being called to the next available assessmentroom. A small number of patients will need to betransferred immediately to the treatment orresuscitation room;

• registration, assessment, examination, and minortreatment if appropriate, will take place in theassessment room. Tests will not take place here. The majority of patients are fit to be discharged atthis stage;

• other patients will be taken to a treatment room fortests, more extensive clinical examination andtreatment;

• some patients may be moved to the clinical decisionunit/observation unit (for a number of hoursdepending on local decision). In some instances they may be admitted directly to an acute ward (seeHBN 4 – ‘In-patient accommodation: options forchoice’).

1.19 When patients arrive by ambulance (see Figure 2):

• patients arriving by ambulance who require astretcher will normally be taken to the treatment roomor if necessary to the resuscitation room.

SCOPE OF THIS GUIDANCE

1.20 This document is a revised version of HBN 22 –‘Accident and emergency facilities for children andyoung people’ (NHS Estates, 2003).


4

1 There are two existing initiatives that are driving these

requirements, the first being the UNICEF global ‘Baby

Friendly Initiative’ and the second being the ‘Child Friendly

Hospital Initiative’. Both emphasise that planning teams

should demonstrate that the needs of breast-feeding

mothers, babies and children are accommodated in much

the same way as the needs of people with a disability are

addressed.

Guidance on a “child-friendly” environment for babies,

children and young people is given in detail in ‘Friendly

healthcare environments for children and young people’

(NHS Estates, 2004) and HBN 23 – ‘Hospital

accommodation for children and young people’ (2004). This

guidance complements the National Service Framework for

Children, Young People and Maternity Services (DH, 2004).

1 BACKGROUND

5

Figure 1 Relationship of rooms and areas to the main entrance where patients arrive on foot or by public or private transport. NBthis is an example only

Receptionmeet & greet

Resuscitation

Clinicaldecision unit

or observationunit

Digital imagingsuite

Assessmentunit in children’s

department

Assessment roomsincluding registration

Waitingarea Pharmacy

WCsBaby changeInfant feeding

Socialcare

Sub-waitWC

Interview

ENTERWELCOMINGENTRANCE

Communicationsbase

Main entrance

Head/neck

Gynae

Childwait

Sub-waitWC

Treatment rooms


6

Figure 2 Relationship of rooms and areas for patients arriving by ambulance. NB this is an example only

Resuscitation

Assessment unitin the children’s dept

Critical careOperating theatres

Acute wards

Treatment rooms

Mortuary

Clinicaldecision unit

or observation unit

Digital imaging suite

Ambulancebay

Ambulancestore

Viewingroom

Sittingroom

WC

Sub-waitWC

Sub-waitWC

AMBULANCEENTRANCE

The ambulance entrance

DESIRABLE EXIT

GARDEN VIEW

THESE FACILITIES SHOULD BELOCATED CLOSE TO THEDEPARTMENT – THIS MAY INVOLVEVERTICAL CIRCULATION

1.21 the guidance covers facilities for emergency carelocated within an A&E department in an acute generalhospital, which functions 24 hours per day, seven daysper week, is consultant-led, and treats and cares forpeople of all ages. It reflects current good practice andanticipates future needs.

1.22 The standards set out in this guidance essentiallyapply to new-build facilities. However, the principles are equally valid, and should be applied, when existingaccommodation is being upgraded or newaccommodation is being constructed within an existingbuilding that may previously have been used for otherpurposes.

1.23 It excludes minor injury units, Walk-in-Centres(WiCs), and primary healthcare facilities that are notintegral to a bespoke accident and emergency (A&E)department situated within an acute general hospital.

1.24 It describes the optimum design and functionalrequirements of an A&E department where 50,000patients attend per year. For schedules ofaccommodation, including different ranges ofattendances, see Chapter 7.

1 BACKGROUND

Welcome flooring, Hillingdon Hospital

7

CONSIDERATIONS AT THE INITIAL PLANNINGSTAGE

2.1 The following criteria are essential in a new-build ornewly refurbished A&E department:

• the building should be fit for the purpose intended;

• the building will facilitate the outcome of clinically safeand effective care;

• it should be aesthetically and environmentallypleasing;

• the building should be acceptable to the patients andtheir carers, as well as to the staff who work in it;

• it should be capable of adapting to change.

(Tope et al, 2001)

These criteria are an appropriate framework for eachplanning team to adopt from the outset of theirdiscussions.

2.2 There is no single model for the organisation anddelivery of A&E services with acute general hospitalsthat is appropriate for implementation across England.Each locality will have its own specific requirements andneeds.

2.3 When preparing an outline business case, localplanning teams should:

• consider the broader healthcare system, includinggeographical location, proximity and function of otherhealthcare facilities such as a walk-in centre or minorinjury unit within the locality;

• consider the relationship with other hospitaldepartments;

• undertake a risk assessment of the likelihood andprobable nature of major incidents (for exampleproximity to motorways, airports, railway stations,industrial estates, sports and leisure centres, holidaylocations), and any seasonal peaks and troughs indemand for care;

• project the number of patients who will attend thedepartment every year, together with someanticipation of case mix.

SITING THE A&E DEPARTMENT

2.4 Ease of access to the department is a primeconsideration. An integrated public transport system isrequired, and appropriate provision must be made forthe safe transfer of people from bus stops, taxi ranks,drop zones and car parks to the building.

2.5 Directions to A&E departments must be clearlysignposted on major road routes and directional signsshould continue onto the hospital site right up to theentrance of the department itself. All public signs on the hospital site should always be signed as either“Accident and Emergency” departments or, whereappropriate, “A&E” departments. Other variants are not acceptable. The importance of clear wayfindingcannot be over-emphasised. NHS Estates’ guidance,‘Wayfinding: effective wayfinding and signage systems –guidance for healthcare facilities’ (2005) should beconsulted at the earliest stage of any project so that aco-ordinated internal and external wayfinding strategycan be prepared.

2.6 Wherever possible, the A&E facilities must besituated on the ground floor.

2.7 The forecourt should be large enough toaccommodate sufficient ambulances to meet local need.Ambulance parking bays should be provided close tothe entrance so that bays beneath the entrance canopycan be vacated as soon as possible.

2.8 Although a number of patients arrive by ambulance,the majority will arrive using other means of transport.Easy and unobstructed access to the A&E departmentis essential at all times for all patients, although there isa need to balance open access against securityconsiderations (see ‘Effective management of security inA&E’, DH, 1997).

2.9 The most important considerations regardingaccessibility are:

a. the entrance should be easy to find, adequatelysized, and offer level and unobstructed entry;

b. the main entrance should be well lit, and signed insuch a way that patients and their escorts can findtheir way immediately, avoiding confusion with theambulance entrance. Ideally, patients accessing themain entrance should not have to pass directly wherethe ambulances offload;


8

2 The built environment – generalfunctional and design considerations

c. each entrance should have a canopy so that patients are offered protection from adverse weatherconditions as they transfer from ambulances, taxis orprivate transport.

2.10 The access needs of babies and young childrenare very similar to those of disabled people, in that thecarers require sufficient space in each parking bay toenable them to lift children in and out of cars. Lack ofdesignated “child spaces” located close to thedepartment is a cause of criticism amongst the generalpublic (Tope et al, 2001). Free car parking spaces,reserved for disabled people and for carers with babiesand young children, should be allocated next to the A&Edepartment.

2.11 Patients may in some cases be brought ortransferred by helicopter ambulance. Considerationshould be given to the provision of landing facilities andtransfer arrangements at the planning stage of anyproject.

RELATIONSHIP WITH OTHER HOSPITALSPECIALTIES

2.12 For A&E departments to function safely andeffectively, immediate access to key supportingspecialities is essential (see Figure 3). It is desirable that

diagnostic imaging and A&E departments are in closeproximity. The following services should be available onthe hospital site as a minimum (BAEM 1998):

• critical care;

• operating theatre and anaesthetics;

• acute medicine;

• acute surgery;

• orthopaedic trauma;

• child health;

• 24-hour access to imaging (including CT scanning);

• on-site laboratory services.

PRIVACY AND DIGNITY OF PATIENTS

2.13 The privacy and dignity of each patient should bemaintained at all times whilst allowing for adequateobservation of patients by staff. From a clinicalperspective the need for staff to have a clear,unobstructed view of a patient in certain circumstancesis without question. This should be balanced with aperson’s right to privacy.

2 THE BUILT ENVIRONMENT – GENERAL FUNCTIONAL AND DESIGN CONSIDERATIONS

9

OPERATINGTHEATRE

anaesthetics

CRITICAL CAREAREA

ACUTESERVICES

CHILDREN’SAND YOUNG

PEOPLE’SSERVICES

A&E DEPARTMENT

Main imaging

Main pathology

Main pharmacy

Sterile supplies

Figure 3 Relationships with on-site services

DISABLED PEOPLE

2.14 It is essential to ensure that suitable access andfacilities are provided for people who have problems ofmobility or orientation. These include people who use awheelchair, those who have difficulty in walking, andthose with a visual or hearing impairment. Authoritiesshould comply with the provisions of the DisabilityDiscrimination Act 1995 and the Building Regulations,Approved Document M: ‘Access to and use ofbuildings’ (ODPM, 2003).

2.15 Local representatives of people with disabilitiesshould be consulted regarding the planning of spacesused by patients and escorts. Project teams should alsorefer to HBN 40 – ‘Common activity spaces’ and HFN14 – ‘Disability access’.

INFECTION CONTROL

2.16 Reducing the incidence of healthcare-associatedinfection (HCAI) is a major challenge for all thoseworking in healthcare. Within the A&E department it is essential to protect patients who are immuno-compromised and at high risk of acquiring an infection.Other patients may present with a communicable orinfectious disease.

2.17 Infection control teams should be consulted at theoutset of any new build or renovation project. They willadvise on issues such as storage and equipmentcleaning areas, appropriate types of ventilation system,furnishings and appropriate finishes.

2.18 For further information refer to HFN 30 – ‘Infectioncontrol in the built environment’. This document shouldbe the first point of reference for planning teams withregard to infection control.

ISOLATION OF PATIENTS WITH INFECTIOUSDISEASES

2.19 Consideration should be given to the provision ofisolation facilities for patients with suspected infectiousdiseases. For further information see HBN 4 Supplement 1 – ‘Isolation facilities in acute settings’.

DECONTAMINATION

2.20 Every A&E department should have procedures forthe reception or transfer of patients contaminated withradioactive materials or chemicals as well as for socialdecontamination. This is an area that is currently beingdeveloped to reflect new thinking and will be added tothe document at a later stage. Advice must be soughtfrom the Radiation Protection Adviser (RPA), theEmergency Planning Officer (EPO), and the MedicalToxicology Unit. Storage for all the necessary equipmentand protective clothing must also be calculated.

2.21 Reducing the risk of cross-contamination to otherareas is essential. The ventilation and drainage systemsmust be independent and capable of being isolated.Further information on (radiation) decontamination canbe obtained from ‘Planning for major incidents: the NHSguidance’ (DH, 1998).

MAJOR INCIDENTS

2.22 All hospitals receiving emergency cases shouldhave contingency arrangements for the reception ofmultiple casualties following a major incident. It isnormal practice for the A&E department to be the mainfocus for the organisation and implementation of theseplans.

2.23 Planners should identify any design implicationsthat need to be addressed in receiving large numbers ofpeople in the event of a major incident. There are siximportant planning and design issues associated withthe occurrence of a major incident:

a. identification of a control centre with multipletelephone lines and ambulance aerial point forinformation gathering and communications co-ordination;

b. identification of possible usage of adjacentdepartments and possible reconfiguration of the A&Edepartment and associated parking areas at an earlyplanning stage in the event of an influx of patients;

c. provision of adequate storage space for theequipment and supplies that may be required,together with a facility for recharging portableelectrical equipment;

d. clearance of car parks where necessary to provideample space for ambulance access and turn-round;

e. press liaison room;

f. identification of offices and meeting rooms for use inmajor incidents;

g. identification of a single entry point.

2.24 See also ‘Planning for major incidents: the NHSguidance’ (DH, 1998).

SECURITY

2.25 Reference should be made to ‘Effectivemanagement of security in A&E’ (DH, 1997).

2.26 Security arrangements centre on two main issues:

a. the prevention of crime and abuse by those who usethe A&E facilities;

b. the protection of the building fabric and theequipment it contains.


10

2.27 In addition to the recommendations contained in‘Effective Management of Security in A&E’ (DH, 1997)there are a number of other ways in which security canbe increased. The planning team should take account oflocal knowledge coupled with advice from the policecrime prevention officer. Any requirement to securedoors should be discussed with the fire officer, as thedemands of security and fire safety may conflict.Maintaining a secure environment should include thefollowing measures:

• management should ensure that adequate securitystaffing levels are maintained to deal effectively andquickly with any issues that arise;

• all staff should wear identity badges with photograph;

• all staff dealing with the public should attend“customer care” training;

• staff should be issued with a personal attack alarm(see paragraphs 6.143–6.146);

• a CCTV camera should be positioned behind thereception desk covering a wide-angle view of thewaiting area, the images to be displayed on monitorsin the central security office;

• panic buttons should be placed in readily accessible,covert locations, and should not be audible onactivation. This alarm will alert security officers of anincident to be attended;

• if possible, the alarms should be activated before the incident threatens violence to staff or others, toenable the security team to defuse the situation whenthey arrive.

2.28 Only after all other options have been testedshould a permanent security presence be located in theA&E department.

ENVIRONMENTAL CONSIDERATIONS ANDDESIGN

2.29 The impact of any new procurement on theenvironment is of significant importance and is anintegral part of NHS responsibility for the health andwell-being of the community. Care should be taken tocontain the environmental impact of activities to apractical minimum consistent with maintainingresponsibilities for providing high-quality patient care.Commitment to the requirements of the EnvironmentalProtection Act 1990 and all other relevant statutorylegislation is essential. See ‘Environmental strategy forthe NHS’ (NHS Estates, 2005) for environmentalconsiderations when designing and building healthcarefacilities. See also ‘Sustainable development in the NHS’(NHS Estates, 2001).

2.30 All capital development schemes are required toscore business case submissions against the NHSEnvironmental Assessment Tool (NEAT). (For furtherinformation see http://www.nhsestates.gov.uk/sustainable_development/content_set.asp?content_ID=neat.)

DESIGN CONSIDERATIONS

2.31 Designers should create an environment inemergency care that will help patients feel at ease, beconducive to efficient working, and contribute to staffmorale. For information on understanding the fivesenses in relation to design, see ‘Friendly healthcareenvironments for children and young people’ (NHSEstates, 2004).

2.32 Indoor planting and external landscaping are ofspecial value. Imaginative use of floor and wall finishes,colour and lighting will help to produce a warm andfriendly atmosphere in emergency care (see also‘Lighting and colour for hospital design’, Dalke et al,NHS Estates, 2004).

2.33 The design process should include the choice ofwell-designed furniture and fittings, and co-ordination offlooring and wall finishes and colour. All areas should bedecorated in calming colours. When choosing andpositioning furniture and fittings, the size and reach ofpatients should be considered. Fittings and furniturewith sharp corners should be avoided.

ART IN HOSPITALS

2.34 Works of art and craft can contribute significantlyto the internal environment. These need not be limitedto simply pictures on a wall. Every opportunity should betaken to include works by artists and craftspeople inappropriate spaces in the department. These mayinclude paintings, murals, prints, photographs,sculptures, decorative tiles, ceramics, textile hangingsand furniture; the reception desk can also be used in acreative way.

2.35 Works of art and craft often lend special identity toindividual spaces and help give a sense of locality.

2.36 Advice should be sought from experts on:

• obtaining grants. In some cases, moneys for artwithin a capital scheme can be matched by grantsfrom charities or regional arts boards;

• ensuring quality in all art and craft works;

• appropriately locating art and craft works;

• selecting artists and crafts people.

2.37 Advice should also be sought from the infectioncontrol team on the appropriate use of art in hospitals.


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http://www.nhsestates.gov.uk/sustainable_development/content_set.asp?content_ID= neat

2.38 See also ‘The art of good health: using visual artsin healthcare’ (NHS Estates, 2002) and ‘The art of goodhealth: a practical handbook’ (NHS Estates, 2002).

NATURAL AND ARTIFICIAL LIGHTING

2.39 Sunlight enhances colour and shape and helps tomake a room bright and cheerful. The harmful effects ofsolar glare can be dealt with by architectural detailing ofwindow shape and depth of reveals, as well as byinstalling external and internal blinds and curtains. Ifsolar glazing is utilised, care should be taken to ensurethat changes in patients’ skin tone and colour can beeasily identified.

2.40 Natural lighting is important to the well-being ofpatients and staff. Wherever possible, spaces to beoccupied by patients, escorts and staff should havenatural daylight with an outside view.

2.41 Artificial lighting, as well as providing levels ofillumination to suit activities, can make an importantcontribution to interior design. Designers should developa lighting scheme that will help to promote a high-qualityimage for clinical activities in emergency care and anon-clinical, soft environment in as many spaces aspossible.

2.42 Artificial lighting provided in spaces occupied bypatients should enable changes to skin tone and colourto be clearly defined and easily identified.

2.43 Luminaires should not be mounted on ceilingsimmediately above positions where patients lie on atrolley. This applies to all patient spaces, includingcorridors through which patients may be moved on atrolley (see also paragraphs 6.109–6.122 and ‘Lightingand colour for hospital design’, Dalke et al, NHSEstates, 2004).

DIAGNOSTIC IMAGING

2.44 Facilities for diagnostic imaging are continuallychanging, therefore design flexibility (within the confinesof statutory regulations) is the concept to aim for. (Seealso paragraphs 3.105–3.110.)

2.45 A significant proportion of patients attending A&Edepartments need some form of diagnostic imaging.Some may require immediate access to diagnosticservices and constant clinical assessment andintervention by a doctor or nurse. A dedicatedcomputed radiography (CR) facility should be providedin close proximity to the A&E department.

2.46 The spatial relationship between the A&Edepartment and the general diagnostic imaging facilitieswill depend on whether additional dedicated traumaimaging facilities are provided within the A&Edepartment. This may be considered necessary in

certain contexts to provide good patient care andaccess to diagnostic imaging in emergency situations(HBN 6 – ‘Facilities for diagnostic imaging andinterventional radiology’).

2.47 In the future, as cost and size of equipmentreduce, it is likely that CR imaging will be provided via a medical supply unit in most treatment rooms, therebynegating the need for a separate imaging suite or mobileX-ray facility. However, this development will need to beconsidered in the context of radiation protection (lead-lined walls).

Ultrasound imaging

2.48 Ultrasound is commonly used for diagnosis ofpatients with abdominal pain, vascular, obstetric andgynaecological problems. Many patients with thesetypes of problem attend A&E departments, thereforeaccess to ultrasound imaging is invaluable. There shouldbe space to store a small ultrasound machine and alsoa Doppler for deep vein thrombosis (DVT) scanning.

Transfer of equipment to installation site

2.49 The method used to bring diagnostic equipmentinto a department may need to be carefully considered,particularly in the case of X-ray systems. Although mostdiagnostic imaging equipment is broken down intomodules for transportation and re-assembled on site,these modules can be large and in some cases havemasses that exceed 1–2 tonnes.

2.50 The equipment will usually be transferred inwooden crates, thus increasing the overall dimensions.It is therefore advised that architects and estatesmanagers consider at early planning stages how theequipment will be transferred to the proposed site. Care should be taken over the width and height ofdoors, loading specifications for floors and the turningcircles of the equipment.

NEAR-PATIENT TESTING

2.51 Near-patient testing has assumed a greatersignificance over the past few years, with a number ofstudies indicating that there are definite benefits forpatients as far as their total time in A&E is concerned.More than 90% of the tests carried out for A&E patientsconsist of X-ray, full blood count, urea and electrolyte,glucose, ECG and blood gases. The most frequentlyrequested blood tests can be classified into three maingroups:

a. clinical chemistry;

b. microbiology;

c. haematology.

See paragraphs 3.102–3.104.


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PHARMACY

2.52 Whenever a patient is prescribed a medicine, quickand easy access to a pharmacy should be available –regardless of whether the consultation has taken placein the hospital or the community, in-hours or out-of-hours. See paragraph 3.122 for information on thestorage of drugs.

2.53 Locating the central pharmacy close to the A&Edepartment is recommended.

SOCIAL CARE

2.54 Social workers should be considered an integralpart of the A&E team, hence they will require officeaccommodation (see paragraphs 4.17–4.26) and accessto an interview room with an en-suite toilet facility (seealso paragraphs 3.87–3.90).

THERAPIES

2.55 Therapy staff require an interview room (seeparagraphs 3.87–3.90). Space is also needed for thestorage of crutches and other mobility aids (seeparagraphs 4.36–4.39).

CARING FOR PEOPLE WHO ARE DISTRESSEDOR DISTURBED

2.56 A small proportion of people who attend an A&Edepartment in the UK each year are distressed ordisturbed, many exhibiting mental health problems. This includes people who have substance addiction orabuse problems; those who physically harm themselvesdeliberately; and those where mental illness is evident orsuspected.

2.57 Rapid assessment and streaming of these patientsis vital, mainly for their own safety, but also for the safetyand security of others. Some of these patients needconstant supervision and support. The physical layoutshould allow for the immediate segregation of thesepatients into a separate area with specific facilities.Some of these patients will be escorted by the police.(See ‘Effective management of security in A&E’, DH,1997 and ‘Management of Imminent Violence: QuickReference Guide’, Royal College of Psychiatrists CollegeResearch Unit, 1998.)

2.58 The interview room used for social care can alsobe utilised to enable such patients to pace or walkaround without undue restraint, to sit quietly and talk orbe interviewed and, in extreme cases, to be restrained ifconsidered necessary on clinical grounds.

2.59 The en-suite facilities should be located in a quietplace, away from the general distractions of thedepartment (see also paragraphs 3.87–3.90).

2.60 In rare circumstances, in order to protectthemselves or for the safety of others, a patient mayneed to be admitted to a separate room that has theminimum of fitments and furnishings. If necessary, thepatient will be left alone in this room for a suitable“cooling off” period. Local policy will determine whetherthis type of room is required in an A&E department (seealso paragraph 3.90).

DENTAL CARE

2.61 A number of A&E departments contain a dentalsurgery. ‘Modernising dentistry’ (DH, 2000) notes that more than half a million people a year requireemergency dental care, with significant numbers ofthese seeking help from A&E departments. If plans todivert such patients away from A&E departments aresuccessful, there may not be a need to include a dentalsurgery in A&E departments.

2.62 One of the treatment rooms in an A&E departmentwill be used for patients with head and neck problems.It should be furnished with the equivalent of a dentist’schair. If local policy dictates, this room could befurnished with dental equipment. The equipping of thistreatment room is discussed in greater detail inparagraphs 3.57–3.58.

DEATH OF A PATIENT IN EMERGENCY CARE

2.63 Some patients may be pronounced “dead onarrival” whilst others may die in the department.Provision should be made to deal respectfully with adead person and their family. The family may need aprivate room in which they can stay with the body for aperiod of grieving before it is moved on to the mortuary.

2.64 Following pronouncement of death and thedeparture of the bereaved, the body will be taken to the mortuary. A route should be designed that avoidspatient areas.

2.65 See also paragraphs 3.91–3.101.

ACTIVITY DATABASE

2.66 The Activity DataBase (ADB) data and softwareassists project teams with the briefing and design of thehealthcare environment.

2.67 Room data sheets provide an activity-basedapproach to building design and include data onpersonnel, planning relationships, environmentalconsiderations, design character, space requirementsand graphical layouts. Schedules of equipment/components are included for each room, which may begrouped into ergonomically arranged assemblies.

2.68 Schedules of equipment can also be obtained atdepartment and project level.


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2.69 Fully loaded drawings may be produced from thedatabase.

2.70 Reference data is supplied with ADB which may beadapted and modified to suit the users’ project-specificneeds.

2.71 For further information refer to the ADB sectionavailable from a link on NHS Estates website(http://www.nhsestates.gov.uk).


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15

ENTRANCES

3.1 There should be two separate entrances to an A&Edepartment, the “main entrance” for those arriving bytheir own means and the “ambulance entrance” forpatients arriving by ambulance on a stretcher.

3.2 Both entrances should have canopies. Theambulance canopy should be high enough to clearlights and aerials. The area should be well lit.

3.3 The entrance should be bright and easily identifiablefrom entrance roads, with good signage (see‘Wayfinding’, NHS Estates, 2005).

3.4 Both entrances should have a suitable draughtlobby, with two sets of automatic sliding doors thatensure the heat is retained within the building. It shouldnot be possible to open both sets of doors at the sametime. The main patient entrance lobby is often a busyplace. It will need to accommodate patients with avariety of conditions, including those using wheelchairs,those on foot but using walking aids, and those on footbut supported by escorts. It is essential that the lobbybe large enough to permit easy movement of this traffic,and it should have a floor covering that will trap dirtcarried by footwear or on wheels, and which can beeasily cleaned. See also ‘Welcoming entrances andreception areas’ (NHS Estates, 2004).

3.5 A wheelchair bay should be provided adjacent to themain patient entrance lobby for immediate use. There

should be a designated trolley/wheelchair storage arealocated close to the ambulance entrance lobby.

3.6 There should be a telecommunications link from thelobby to the central porters’ base. Ambulance crewsshould have access to changing and wash facilities.

3.7 Consideration should be given to the provision ofexternal shelters for use by smokers.

RECEPTION AREA

3.8 The main function of the reception area is to meetand greet patients and direct the majority of them to an assessment room or, if necessary, the waiting area. If a receptionist is concerned about a patient’scondition, they should be able to summon help fromclinical staff. It should be possible to transfer a patientimmediately to a resuscitation room, or to a treatmentroom.

3.9 Concerns are frequently expressed over the securityof staff and the privacy and confidentiality of patientswaiting at the reception desk. It has been identified thatthe most effective way of overcoming these problems isto register the patient in an assessment room. As eachroom will be equipped with a computer terminal, a“roving” receptionist moving between the assessmentrooms can obtain the patient’s personal details beforethe assessment by a clinician, unless the patient’scondition dictates otherwise.

3.10 The risk of violent behaviour in the form of physicalor verbal abuse is very high in A&E departments, withreception and waiting areas being particularly vulnerable.Boredom, anxiety or pain, and for some individuals anexcess of alcohol or drugs, can trigger acts of verbal orphysical aggression in some people. It is not necessarilythe patient who will act in an unacceptable way; it maybe the person who is accompanying them. Theaggression may be directed at members of staff, otherpatients and visitors, or even between groups whicharrived together. (See paragraphs 3.87–3.90 for detailson facilities for patients.)

3.11 It is not normal practice for security officers orpolice to be a permanent presence in the A&Edepartment, as this may serve only to worry patientsand visitors unnecessarily. CCTV should be installed in

3 The built environment – specificfunctional and design requirements

Bradford Royal Infirmary Accident and Emergency (mainpatient entrance)

strategic places linked to monitors situated in the centralsecurity office (see paragraphs 6.140–6.142).

3.12 The reception area should be located in an openspace directly inside the entrance. The position of thereception area should allow staff to see all patients andescorts entering the department and have vision to themain waiting and children’s waiting/play areas.

3.13 The design of the reception desk should be of ahigh quality and allow access for disabled people. It isappropriate to make the desk as friendly as possible,and the inclusion of children’s décor/mosaics isdesirable. ‘Friendly healthcare environments for childrenand young people’ (NHS Estates, 2004) gives greaterdetail on designing a child-friendly environment.

3.14 The reception desk should reflect suitable securityrequirements based on local security advice. This mayinvolve enclosing the desk with a security-glazedscreen. However, a well-designed reception and waitingarea with a pleasant ambience will help to reducetension and security risks. The introduction of securityglass may well be counter-productive. If security glazingis necessary, people with hearing difficulties should beconsidered. See also ‘Welcoming entrances andreception areas’ (NHS Estates, 2004).

3.15 The reception desk is the focal point of the waitingarea. Computer facilities will be required to monitoroccupation of the assessment rooms.

3.16 Space should be provided behind the receptiondesk for photocopying, faxing, printing equipment andthe disposal of confidential waste paper etc.

3.17 Security of the reception area should include theuse of personal alarm transmitters.

3.18 Office chairs with castors should be used for easeof movement.

3.19 With the advent of computerised medical records,there will be limited need for a records store within thedepartment.

WAITING FACILITIES FOR PATIENTS, THEIRFAMILIES AND FRIENDS

3.20 A waiting area may be required to accommodatesome patients during very busy periods and for familyand friends who accompany the patient to hospital. Thegeneral circulation area is the least easily defined, as ithas to provide a number of varying environments. Froma design professional’s viewpoint these are:

• a waiting area for patients prior to their assessment;


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Waiting area – the Hillingdon Hospital NHS Trust (photograph courtesy of the King’s Fund’s Enhancing the Healing EnvironmentProgramme)

• a sitting area for friends and family, as some mayelect to stay in the waiting area;

• a designated, secure play area for children;

• an area for enquiries, information, and providingliterature/notices of primary healthcare and localfacilities.

3.21 The design of the waiting area and all sub-waitingareas should include:

• circulation space for wheelchair users andpushchairs;

• space around seating for parking pushchairs andwheelchairs without impeding circulation areas;

• public and/or free phones;

• information boards;

• drinking water dispensers;

• the use of natural lighting, although thought shouldbe given to shade control;

• appropriate heating and ventilation;

• a secure environment.

The seating layout should be considered carefully toprevent confrontational situations (for example, avoidseats directly opposite each other).

3.22 The pre-assessment waiting area should be closeto WCs, a wheelchair-accessible WC, nappy changeand baby feeding area. Each sub-waiting area shouldhave access to WCs.

3.23 Comfortable seating should be provided. Thenumber of seats should be determined locally. The useof durable materials is essential. A variety of chairdesigns – some with arms and some without – shouldbe available. Occupational therapists or ergonomistsshould be consulted on the appropriate selection ofseating. Care should be taken to ensure that loosefurniture cannot be used as a potential weapon.

3.24 Any waiting area should create a comfortable,relaxing and informal environment. There should bespaces for patients in wheelchairs and for those usingwalking aids. Consideration should also be given to theneeds of pregnant and nursing mothers.

3.25 Finishes should be easy to maintain, and providevalue for money, as well as being aesthetically pleasingand easy to clean.

3.26 Public toilets should be installed close to thereception area for men and women. At least onewheelchair-accessible WC, a nappy change facilityaccessible to either sex, and a separate infant feedingfacility (where a woman, if she chooses, can breast-feedher baby in privacy) should also be provided. Carefulconsideration should be given to the selection of finishesin public facilities. In addition to ease of cleaning,opportunities should not be created for concealment ofdrugs or weapons. Lighting should be installed thatguards against drug abuse.

3.27 An inner screen should be installed to prevent adirect view into these facilities from the general waitingarea.

3.28 WCs should be located at each sub-waiting area,close to the treatment rooms.

3.29 A telephone with a freephone taxi service shouldbe provided. Ideally this would be located within thevestibule between the entrance lobby and reception,and it should meet the criteria of the DisabilityDiscrimination Act 1995 (see HFN 14 – ‘Disabilityaccess’). Provision should also be made for a vendingbay and display systems for healthcare information.

3.30 For further information on waiting facilities see also‘Welcoming entrances and receptions’, NHS Estates,2004.

The waiting baby, child or young person

3.31 The children’s waiting and play area may belocated within the existing main waiting area but placedslightly away from the main section of the seating.Consideration should be given to the use of laminated

3 THE BUILT ENVIRONMENT – SPECIFIC FUNCTIONAL AND DESIGN REQUIREMENTS

17

Sub-waiting area – Epsom and St Helier NHS Trust(photograph courtesy of the King’s Fund’s Enhancing theHealing Environment Programme)

one-way view glazing so that people can see in butchildren cannot see out.

3.32 Toilet facilities, baby change and infant feedingshould be located close to the children’s waiting area.

3.33 For best practice in designing, furnishing anddecorating child-friendly facilities see ‘Friendly healthcareenvironments for children and young people’ (NHSEstates, 2004).

ASSESSMENT ROOMS

3.34 A cluster of rooms will be needed that can fulfil thedual functions of assessment and treatment for patientswith simple injuries or illnesses. Some patients willcomplete their journey at this stage and will bedischarged.

3.35 The initial assessment of a baby, child oradolescent with primary care needs or simple injuries orillnesses will take place in one of the assessment rooms(a number of which should be suitably decorated,furnished and equipped for children). For furtherguidance on child-friendly facilities see ‘Friendlyhealthcare environments for children and young people’(NHS Estates, 2004).

3.36 While there will be rooms specifically designatedfor babies and children, every room will have thecapability of receiving patients of all ages.

3.37 The assessment rooms should be located next tothe reception area.

3.38 Following assessment, unless the patient isdischarged at this stage, the relevant information aboutthem will be forwarded to the communications base viathe computer link for the next stage of their journey.

3.39 Each of these rooms should have a set of lockabledoors on each of the front and rear walls (linked to apersonal attack alarm) and should accommodate:

• an emergency care trolley;

• a clinical hand-wash basin;

• a ceiling-mounted adjustable examination/minoroperating luminaire;

• provision for manual blood-pressure monitoring;

• a wall-mounted auroscope and ophthalmoscope;

• a lockable cupboard for the storage of drugs,needles and syringes;

• a mirror and coat hooks;

• a computer workstation for recording clinicalinformation and viewing digital images, with aadjustable-height office chair;

• if digital imaging is not part of whole-hospital policy,an X-ray viewing screen will be required;

• a dressings trolley;

• two small upright chairs;

• personal alarm transmitters for the security of staff;

• a staff call system for use of patients;

• a clinical emergency call for use by staff;

• bin holders for waste disposal (clinical includingsharps, used sterile supplies and general waste).

It is essential that sharps bins are wall- or trolley-mounted in any area where children may be present.

3.40 Assessment and treatmentrooms should provide sufficientspace to allow trolleys to be place inan “island” situation when required.As well as reducing the risk of injuriesto staff, this will help patients withdisabilities. Sufficient space shouldbe provided for this purpose.

3.41 In all assessment and treatmentareas, a patient’s aural and visualprivacy and dignity should bemaintained at all times. Unlessinvited, members of staff other thanthose actually assessing or treating apatient should not enter an occupiedroom. The use of curtains betweenbays is no longer acceptablepractice, as they offer little visualprivacy and no aural privacy.


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Nurse playing with children

Moreover, a closed, lockable door prevents people(most particularly staff) from entering uninvited. Thereshould be an emergency external override to the lockingmechanism. A visual indicator of occupancy should beconsidered.

3.42 See Appendix 1 for example room layouts.

TREATMENT ROOMS

3.43 The required number of treatment rooms should bedetermined locally.

3.44 A proportion of these treatment rooms will bemulti-functional and equipped and furnished identicallyto enable clinical staff to consult, examine and treat themajority of patients. A number of these rooms should besuitably decorated, furnished and equipped for children.One should be equipped to deal primarily with patientswho have head and neck problems (see paragraphs3.57–3.58).

3.45 One treatment room should accommodate patientswith possible gynaecological or genito-urinary problems.It can also be used for other patients requiring extensiveclinical examination (see paragraphs 3.59–3.61).

3.46 Flexibility of room use is the key to reducing thetime that patients have to wait. It is recommended thatevery treatment room should be built to the samespecification, with identical basic fitments and clinicalequipment.

3.47 There must be sufficient space in each room toenable a minimum of two clinicians to move freelyaround the trolley and be able to examine and treat the patient from either side. There should be sufficientspace to accommodate at least two relatives or friendswho are accompanying the patient. Account needs tobe taken of different cultural and ethnic expectations interms of the number of visitors.

3.48 Multi-parameter monitoring equipment should beinstalled in each treatment room and should be centrallymonitored.

3.49 Some pieces of equipment will be ceiling-mounted.The overall height of the ceiling is an importantconsideration as adequate overhead clearance isessential.

3.50 Many emergency departments use plaster of Paris.The inclusion of a bespoke “plaster room” should be alocal decision made by the planning team, who shouldincorporate this into their schedule of accommodation.Provision should also be made for those using resinplaster.

3.51 General anaesthetic facilities with a scavengingsystem will be required in the resuscitation room only.

All other patients requiring an anaesthetic should betransferred to await treatment in the operating theatresuite. Recovery facilities are no longer required in A&Edepartments.

3.52 For maximum flexibility, and to help minimise therisk of cross-infection, all rooms should have full-heightwalls and doors. Access should be via one-and-a halfdoors (half door can be opened to allow space fortrolleys and large equipment). For circumstances whereobservation of occupants is necessary from outside theroom, some rooms should have a glazed front wall withintegral blinds or a number of open-fronted treatmentrooms adjacent to the communications base may beconsidered.

3.53 The engineering requirements for each treatmentroom will be identical and will allow the majority ofclinical procedures to be undertaken. All treatmentrooms will need medical gas supplies. For further detailson engineering services see Chapter 6.

3.54 To facilitate flexibility of use and efficientmanagement, all treatment rooms should surround, andbe accessed from, an open-plan area. Direct access tothe supplies base and dirty utility room is required. Itshould be possible to observe access to the rooms fromthe communications base.


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Epsom General Hospital, Epsom and St Helier NHS Trust

Multi-functional treatment rooms

3.55 Each of these rooms should have lockable doors(linked to a personal attack alarm) and shouldaccommodate:

• an emergency care trolley;

• a ceiling-mounted medical supply unit for multi-parameter monitoring and medical gases;

• a clinical hand-wash basin;

• a ceiling-mounted adjustable examination/minoroperating luminaire;

• a wall-mounted auroscope and ophthalmoscope;

• a lockable cupboard for the storage of drugs,needles and syringes;

• a mirror and coat hooks;

• a computer workstation for recording clinicalinformation and viewing digital images with anadjustable-height office chair;

• a dressings trolley;

• two small upright chairs;

• a hands-free telephone, either wall-mounted orattached to the medical supply unit;

• personal alarm transmitters for staff security;

• a staff call system for use of patients;

• a clinical emergency call for use by staff;

• bin holders for waste disposal (clinical – includingsharps – used sterile supplies and general waste).

3.56 See Appendix 1 for example room layouts.

Head and neck treatment room

3.57 The head and neck treatment room should beequipped to deal with patients with ENT, ophthalmic anddental problems. This room, in addition to the flexibletreatment rooms, can also be used for patients withminor facial or scalp injuries requiring suturing.

3.58 The equipment required in this room is identical tothat listed in paragraph 3.55, with the exception of thetrolley. An ENT patient chair, which can also be used forpatients with dental problems, and an adjustableanatomic stool will be required. An ophthalmic slit lampmounted on a desk will also be required.

Gynaecology/genito-urinary treatment room

3.59 This room will be used for patients who aresuspected, at assessment, as having gynaecological

or genito-urinary problems that require an intimate orinternal examination. It should be located adjacent to aWC.

3.60 The equipment required in this room is identical tothat listed in paragraph 3.55, with the exception of thetrolley. A gynaecology/urology couch may be requireddepending on local preference.

3.61 For maximum flexibility this room can also be usedas a general treatment room.

RESUSCITATION ROOM

3.62 Local policy will determine the number ofresuscitation bays within each A&E department. SeeAppendix 1 for room layouts.

3.63 In an A&E department that receives 50,000patients a year, a minimum of four resuscitation bays are required. For other levels of attendance see theschedules of accommodation (Chapter 7). The numbersof patients treated in resuscitation rooms are expectedto increase as senior clinicians are starting to undertakerapid assessment in this area before transferringpatients, once stabilised, to a treatment room.

3.64 The resuscitation room should have easy,unimpeded access from the entrance whereambulances arrive and should not be isolated from theother treatment rooms.

3.65 The recent trend has been to locate theresuscitation room(s) as close as possible to theambulance entrance of the A&E department, therationale being the need to admit, assess and treatcritically ill patients without delay. Consideration shouldbe given to locating the resuscitation room at the backof the department, as the extra few seconds that ittakes to transfer a critically ill patient will not adverselyaffect the patient’s care. Critically ill patients should notbe transferred to the resuscitation room through themain waiting area. A decision on location should betaken locally, based on existing building provision.

3.66 The resuscitation room, which will have integralimaging facilities, should be located to enable directaccess to the critical care area, coronary care unit,operating theatres, and imaging suite including CTscanning. Pathology services and pharmacy can bemore remote if technology is used for communication.The relationship of the resuscitation room to therelatives’ sitting room and visiting/viewing room is alsovery important.

3.67 Clinicians must be able to access the patient fromall four sides of the trolley at all times. Many clinicalinterventions take place at the “head end” of the patient,and this means that plenty of space is required behindthe patient as well as at the end and sides of the trolley.


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3.68 Each resuscitation bay should be contained byretractable lead/PVC protective curtains or lead-linedscreens. This will allow several patients to be assessed,treated and resuscitated simultaneously in visual privacy.

3.69 Space is required in each resuscitation bay for aminimum of five staff to work at speed and under stress.

3.70 Members of the patient’s family are encouraged, if they so wish, to remain with the patient within theresuscitation room itself. Additional space should beallowed to accommodate them.

3.71 Staff will need to perform clinical procedures fromall sides of the trolley and to use a variety of equipment.Patients in the resuscitation room may require surgicalprocedures, which will make them particularlysusceptible to temperature changes; accuratetemperature control is very important for manyresuscitation patients (see also paragraph 6.37).

3.72 The trolley should be capable of being rotatedthrough 360°. Equipment will need to be parked in thebay in accordance with the procedures being performedand, when required, manoeuvred into place withoutdisturbing clinical activity. Staff will also need to take and view X-rays and digital images, view monitors, andaccess and record data on a computer. Various storagefacilities are required for a range of medical and surgicalsupplies and sundries.

3.73 Resuscitation bays should be located in oneresuscitation room so that some facilities can be shared.

3.74 At least one resuscitation bay should be equippedfor babies, children and young people.

3.75 Fixtures and fittings required for each resuscitationbay include:

• ceiling-mounted examination lamps;

• ceiling-mounted piped oxygen, nitrous oxide, medicalvacuum and medical air (4-bar) outlets;

• an adequate number of electrical socket-outlets, onthe ceiling-mounted medical supply unit, to minimiseobstacles and danger from tangled and trailing leads.A minimum of 12 twin sockets in each resuscitationbay is required. These must be connected to theessential supply;

• a “grab” board at the head of the trolley, with“shadows” of small items of equipment, instrumentsand medical and surgical sundries stored there;

• a workstation for preparation, and for monitors and acomputer and keyboard;

• an imaging viewer;

• a hands-free telephone, either wall-mounted orattached to the medical supply unit;

• bin holders for waste disposal (clinical – includingsharps – used sterile supplies and general waste);

• boards to record progress, drugs etc;

• screens for posting algorithms;

• space for ventilator/anaesthetic equipment;

• space and shelving for immediate supplies such asfluids, oxygen masks etc.

3.76 Furniture, fittings and other equipment that can beshared in a resuscitation room include:

• ceiling-mounted and mobile imaging equipment;

• drugs (including the controlled drugs) cupboards;

• shelving and racking for medical and surgicalsundries, including sterile packs;

• a refrigerator;

• clinical hand-wash facilities;

• storage and recharge of drug pumps;

• X-ray gown storage;

• linen storage and disposal;

• biers cuffs for intravenous (IV) anaesthesia;

• portable monitors and ventilators to transportpatients following resuscitation.

3.77 Modern resuscitation techniques may involvepatients remaining in the resuscitation area forsubstantial periods during which frequent and high-quality imaging is required. The Resuscitation Councilupdates its recommendations (which include informationon the built environment) every two years, and anychanges should be incorporated as appropriate (seehttp://www.resus.org.uk).

3.78 Until recently, mobile imaging machines weremostly used in resuscitation rooms. Planning teamsshould give preference to a ceiling-mounted solutionwherever practical. Differing requirements of traumapatients will determine the type of imaging equipmentinstalled. Where ceiling-mounted imaging equipment isprovided, a gantry is required so that the equipment cantraverse, and be used in, as many resuscitation bays aspossible.

3.79 The design of the imaging system and the lightingsystem should be co-ordinated to ensure that use ofeither installation is not compromised. Considerationshould be given to the ceiling height and protection from


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http://www.resus.org.uk

radiation hazard, including the use of fixed lead-linedcurtain systems (to provide visual privacy as well asradiation protection) and lead aprons for use by staff.(See HBN 6 – ‘Facilities for diagnostic imaging andinterventional radiology’ for further information.) Leadaprons should be stored vertically to maintain theirprotective quality. Suitable wall brackets or mobilestands are required for this purpose.

CLINICAL DECISION UNIT/OBSERVATION UNIT

3.80 Patients may be taken to the clinical decision unit(CDU)/observation unit straight from assessment ortreatment, where they will be accommodated for anumber of hours before being transferred to other acuteaccommodation, or discharged. The unit should belocated in a separate area within the A&E departmentand, in the absence of a local requirement, should meet the definition of a ward (see HBN 4 ‘In-patientaccommodation: options for choice’) to improve thepatient experience of their treatment and care. It shouldbe an appropriate environment where patients’ needsare met and essential care can be provided, for exampleprivacy and dignity, access to refreshments and meals (if appropriate), toilet and washing facilities, as well asbeing suitably equipped to support the observation andmonitoring of the patient’s condition.

3.81 Medical gases (normally oxygen, air and suction)should be provided.

DECONTAMINATION FACILITIES

3.82 See paragraphs 2.19–2.21.

THE COMMUNICATIONS BASE

3.83 The communications base is the centre for thecontrol of clinical activity within the A&E department.Patient flow is supervised from here. Clinicians carry out administrative tasks here. Partial enclosure of thecommunication base will prevent conversations beingoverheard but will permit a good view of patient flowfrom both the simple injuries or illness stream and rapidassessment stream.

3.84 All communication systems should have a terminalhere, including computer, short-wave radio in the eventof telecommunications failure, telephones, fax, callsystems and alarms. Telephones should be located in aprivate area so that conversations cannot be overheard.

3.85 Staff will access initial information about eachpatient from clinicians in the assessment rooms via acomputer link. Space should be provided for multiplePC monitors.

3.86 As telephone enquiries regarding the clinicalcondition of patients will be made at the

communications base, adequate provision of spaceshould be made in that area. See paragraphs 5.3–5.8.

INTERVIEW ROOM FOR DISTRESSED ORDISTURBED PATIENTS

3.87 A room should be provided where interviews anddiscussions with distressed or disturbed patients maytake place in private. It should contain easy chairs andan occasional table, arranged as informally as possible.Personal alarm transmitters should be installed. Atelephone should be provided with direct access to anoutside line. This space may also function as a smallgroup room. En-suite WC facilities made of stainlesssteel should be included.

3.88 The facilities should be located in a quiet place,away from the general distractions of the department,with an external view.

3.89 Rooms should be decorated in calming colours,with comfortable seating. Care should be taken inchoosing furniture and fittings that present the least riskof causing deliberate or accidental injury to the patientand the supervising staff. The need for rapid andthorough cleaning of these rooms is essential. Interiordesigners with expertise in furnishing such facilities areinvaluable and should be consulted at the initial planningstage.

3.90 If a special room is provided for patients who aresusceptible to self-harm, a mattress on the floor may bethe only furniture. None of the fittings in the room shouldbe able to be used as a weapon. Walls should have anon-abrasive finish decorated to achieve a calmingenvironment. Ceiling tiles should not be installed. Astainless steel en-suite toilet and wash-hand basinshould be installed. The room should have two exitswhich are lockable from the outside and can provideeasy escape for staff from inside. Consideration shouldbe given to noise reduction, alternative means of entryand egress. Concealed heating and recessed lighting ofa non-fluorescent type should be provided. The roomshould be located to provide good observation by staff.

SITTING ROOMS FOR FAMILY AND FRIENDS

3.91 Two sitting rooms with a non-clinical atmosphereshould be provided. These should be sensitivelydecorated, bright, well-lit and homely, where peopleaccompanying seriously ill and injured patients or therecently bereaved may sit and talk, make telephonecalls, prepare and consume beverages, and wash theirhands and faces. A variety of comfortable seatingshould be provided for a minimum of eight people(escorts and staff). Ideally, the sitting room should havea window with an outside view. Carpets and wallpaperfinishes are appropriate in these rooms. Whatever the hospital policy, distressed relatives may smoke;


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therefore, consideration should be given to installing asmoke extraction system.

3.92 Each sitting room should be:

• located adjacent to the visiting/viewing room andnear the resuscitation room but not within earshot ofany sounds which may be disturbing;

• accessible from the resuscitation room without havingto pass through public areas of the department;

• accessible by, and with space to accommodate, aperson in a wheelchair;

• close to a WC (en-suite an option);

• provided with tea- and coffee-making facilities;

• clearly and well signposted.

3.93 These rooms should not be identified as a“relatives’ room”. A more appropriate, less clinical andinformal phrase is recommended. Local knowledge anddiscussion between staff should help identify the mostsensitive name.

3.94 It is essential that these rooms are located in aquiet area, away from the activity and noise of thedepartment, where the bereaved may leave thedepartment without having to go through the generalwaiting or treatment areas.

3.95 Specific religious icons and artefacts should beavoided. There are a number of publications that identifythe needs of a multi-cultural society, many of whichdescribe the traditions and rituals of death and dying.Many hospitals now have their own reference manualsand associated protocols, and these should beconsulted in such circumstances. A copy of thereference manual and any associated protocols shouldbe located permanently within the A&E department(Neuberger 2004, Murray Parkes et al 1997, Collins et al1993).

3.96 A selection of literature may be appropriate, andshould include a choice of texts. General advice andinformation leaflets giving contact details of religious,secular, social and welfare organisations and voluntarybereavement support agencies should be provided.

THE VISITING/VIEWING ROOM

3.97 The decor in the visiting/viewing room should besimilar to that of the sitting room.

3.98 It should be possible to position the trolley carryingthe deceased person in a peninsular position with thehead to the wall, to permit access to both sides of thebody.

3.99 Comfortable chairs should be provided, withconsideration given to the height of the chairs in relationto the height of the trolley.

3.100 Other furniture may include a domestic chest ofdrawers and/or dressing table where linen and amenitiesrequired for limited preparation of the deceased personmay be stored. For infants and young children, a“Moses” basket or similar carrier should be available.

3.101 It should be accessible both from the clinical areaand from the sitting room, with a lockable door from theviewing room into the sitting room. Consideration shouldbe given to the installation of a window between thesitting room and the viewing room for visitors who mightnot want to enter the viewing room itself.

NEAR-PATIENT TESTING AREA

3.102 A near-patient testing area is required for bloodgas, electrolyte and glucose analysis and other testscarried out within the unit. The main requirements arefor a sink, laboratory benching and adequate benchspace on which equipment will be placed, electricalsocket-outlet provision, a blood gas machine, aspecimen fridge, and sufficient space for staff to performtests and use computer equipment. Separate clinicalhand-washing facilities are also required.

3.103 The laboratory should be quiet and well lit, withseating that is ergonomically appropriate for the task.Variable-height seating (stools/chairs equipped withback-rests) and working surfaces should be provided.

3.104 Storage space should be provided for equipmentand machinery.

DIGITAL IMAGING SUITE

3.105 At least two general imaging rooms will berequired within easy access of the A&E department, withan associated sub-waiting area. Local circumstanceswill determine the exact number required. At least oneof the general imaging rooms should be equipped withan orthopantogram. Every room should be able toaccommodate both trolley patients and mobile patients.This will avoid unnecessary delays.

3.106 Depending on local policy, a mobile imaging unitmay still be required, and adequate space for parkingthis equipment will be needed. If mobile X-rays are stillin use, an illuminated X-ray viewer will be required ineach treatment room.

3.107 All imaging rooms in the digital imaging suite must be equipped with resuscitation equipment, pipedoxygen and suction. They should be connected by anintercom to the A&E department, and an emergency callsystem should be installed.


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3.108 HBN 6 – ‘Facilities for diagnostic imaging andinterventional radiology’ describes two models for theprovision of general imaging services for emergencycare.

3.109 There are a number of statutory requirementsrelating to diagnostic imaging that each planning teamshould take into account. These include the following:

• 1999 Ionising Radiations Regulations (which focus onprotecting staff);

• 2000 Ionising Radiation (Medical Exposure)Regulations (which focus on protecting patients);

• 1993 Radioactive Substances Act (which isconcerned mainly with the safe use of radioactivesubstances).

3.110 Codes of practice issued by the Health andSafety Executive and the National RadiologicalProtection Board should also be adhered to. See alsoparagraphs 2.44–2.47.

DIRTY UTILITY ROOM

3.111 At least one dirty utility/sluice room should beprovided where the analysis of specimens can becompleted. It should be easily accessible from all areasused for treatment.

3.112 A storage fridge should be provided for urinesamples.

3.113 WCs should be located adjacent to the dirtyutility/sluice room for patients who are requested tosupply a specimen of urine or faeces. A hatch should beprovided to enable specimens to be passed from theWC to the dirty utility/sluice room. Hatches should bedesigned to ensure patients’ privacy at all times.

3.114 A macerator and a sluice should be provided.

3.115 Unused (clean) disposable bedpans, urine bottlesand vomit bowls should not be kept in the dirty utility/sluice room because of the risk of cross-infection fromdirty equipment. Such equipment should be stored in anappropriate storage room or within a closed cupboard ineach treatment room.

EQUIPMENT SERVICE ROOM

3.116 Facilities are required within this room forequipment servicing as defined in the user manualssupplied by equipment manufacturers, supplemented by any formally agreed local instructions. Such localinstructions may require the provision of additional

facilities. Visiting electronics and medical engineering(EME) technicians carrying out minor scheduled orunscheduled servicing also use this room. The spaceprovision should be sufficient to park and manoeuvreequipment and accommodate a workbench with integrallockable cupboards, preferably in a self-contained roomor space. There should be sufficient socket-outletsprotected by residual current devices (see paragraph6.107). A hand-wash basin should also be provided. It isrecommended that manufacturers’ user manuals bekept in this room.

3.117 Medical gas outlets supplying oxygen, medicalcompressed air and vacuum should be provided. Theprovision of nitrous oxide together with gas scavengingfacilities is a local decision. Some items of equipmentmay require decontamination prior to scheduledservicing being done. Local policy will identify where thisis undertaken (for example, in the SSD and/or EMEdepartment).

STORAGE AND SUPPLIES ROOMS

3.118 The planning team should determine the numberof storage rooms required. For this it will need to takeinto account local working practice.

3.119 One storage room will be required for the holdingof sterile equipment and supplies, and refrigeratedstorage.

3.120 Double-sided cupboards that can be stocked and emptied from the corridor and accessed from within every assessment and treatment room arerecommended (see room layouts in Appendix 1 fordetails). Where double-sided cupboards are used, it isimportant to ensure that acoustic properties, securityand privacy are not compromised.

3.121 The introduction of “just-in-time” storage systemsusing bar-code systems to top up supplies on a regularbasis (twice daily if necessary) will reduce the need forlarge amounts of supplies to be retained in thedepartment.

STORAGE OF DRUGS

3.122 Controlled drugs storage should be provided forthe treatment of patients attending the A&E department.In addition, secure storage space should be provided fortake-home drugs when the main pharmacy is closed.These facilities should include space for fridges and forthe preparation of IV drugs. The facilities also shouldcomply with current requirements for controlled drugsstorage (see paragraphs 5.13 and 6.123–6.125).


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STAFF ACCOMMODATION

4.1 In A&E departments staff work in stressful situationsevery day. The provision of well-designed facilities helpsmorale and contributes to the efficient functioning of thedepartment. Excellent staff facilities that are locatedwithin the department will encourage this.

4.2 Ways of preventing access to staff areas – otherthan by authorised staff – should be implemented.Security locks with close proximity card entry are thepreferred option, but planners and designers shouldconsult with police officers and security experts beforedeciding on the appropriate deterrents.

4.3 In new-build facilities all patients and staff should beable to enjoy natural light and ventilation. However, inexisting buildings due for refurbishment this may not bepossible.

4.4 There are six main categories of staff facility, all ofwhich should be designated clearly as non-patientareas:

a. rest and recreation facilities;

b. overnight accommodation for staff;

c. changing rooms and associated facilities;

d. office accommodation;

e. facilities for education and training;

f. storage.

REST AND RECREATION FACILITIES

4.5 A&E departments employ large numbers of staff, all of whom will need access to the rest and recreationfacilities. These facilities are in use every day, 24 hours aday. The principles of good housekeeping (cleanlinessand minimising the risk of cross-infection) have to beapplied over the same period.

4.6 A rest room is required where staff can relax andtake beverages and snacks. The room should havewindows with a pleasant outlook, be comfortablyfurnished, and have a telephone. The room should havedirect access to the pantry and be located with otherfacilities for staff and away from patient treatment and

traffic areas. A dining table and chairs should beprovided to enable staff to eat and drink in comfort.

4.7 The rest room should be designed so that staffwishing to read or talk are not disturbed by the noisefrom a TV or music system.

4.8 An appropriate number of male and female WCsshould be located within the rest and recreation facilitiesas well as in the staff changing rooms. For guidance seethe Workplace (Health, Safety and Welfare) Regulations1992.

Pantry

4.9 Pantry facilities are required for the safe handling offood, including the preparation of beverages and lightsnacks, for washing and storing crockery and cutlery,for storing a limited quantity of dry goods, and for therefrigerated storage of milk etc. Equipment may includea stainless steel sink and drainer, an electric waterboiler, a microwave cooker, a worktop with cupboards,an automatic dishwasher and a hand-wash basin.

4.10 The organisation should ensure that patients have access to refreshments at all times. This maynecessitate the occasional use of the pantry forpreparing beverages for patients and escorts. For thispurpose, a separate entrance should be provided sothat staff can access the pantry without passing throughthe rest room.

OVERNIGHT ACCOMMODATION FOR STAFF

4.11 For senior on-call staff a minimum of one single en-suite bed/sitting room that provides overnightaccommodation is required within the department. Theplanning team should decide on the number, size andlocation of rooms following local consultation.

CHANGING ROOMS AND ASSOCIATEDFACILITIES

4.12 Clinical staff are in daily contact with patients’ body fluids (blood, sputum, vomit, urine and faeces),encounter infection, and handle contaminatedinstruments and dressings on a daily basis. They mayneed to shower and change their clothes whilst on duty. It may not be feasible for all staff to use thedepartmental changing facilities, but it is essential that

4 Support facilities – general and specificfunctional and design requirements

all clinical staff are able to shower and change withouthaving to leave the department.

4.13 Provision should be made for separate male andfemale changing facilities. Estimates of changing spaceand locker provision should take into account thenumbers of full-time and part-time staff, includingtrainees and students.

4.14 Steps should be taken to ensure the security ofpersonal belongings left in the staff changing facilities.There must be secure lockers, and access to the areasmust be via doors with close-proximity card facilities.

4.15 The sanitary and shower facilities should beprovided in self-contained, full-height rooms to providemaximum privacy; cubicle partitions are not acceptable.

4.16 Dry changing areas equipped with mirrors, hairdryers and a shaving point are required. Male andfemale staff WCs should be provided in association withother facilities for staff. For guidance see the Workplace(Health, Safety and Welfare) Regulations 1992.

OFFICE ACCOMMODATION

4.17 Office accommodation should be located withinthe department. Entrance to the area should be througha single controlled access door with secure entryfacilities (see paragraphs 6.140–6.142).

4.18 All single and multi-occupied offices should beequipped with a computer terminal with access to theinternet on each desk.

4.19 In certain circumstances it is not appropriate to interview patients, relatives or staff in an officeenvironment. Planners should consider including, as an alternative to more offices, one small informal roomthat is comfortably furnished and can be used forinterviewing patients, relatives or staff, and one largerinterview/meeting room that could be accessed bymembers of staff when required.

4.20 Such a strategy would ensure maximum utilisationof interview/meeting rooms, and office space would notneed to be increased. All confidential meetings couldtake place in absolute privacy. Offices can then be usedexclusively for administration and clerical work.

4.21 A small safe where patients’ valuables can be heldif necessary should be located in an office that is staffed24 hours a day or at the communications base (seeparagraphs 3.83–3.86).

4.22 Most offices described in this chapter are similar in size and, providing they are appropriately located, can be used flexibly. All offices should be equipped with a computer with access to the internet.Telecommunications facilities are essential (seeparagraphs 5.1–5.12).

Single-person offices

4.23 Single-person offices will be required for seniorclinicians and managers. These should be sufficientlyprivate for confidential discussions between staff. Theyshould accommodate an office workstation, withmonitor and keyboard, seating for up to three otherpeople, and storage for books and files. The officesshould be close to each other and to the secretarialoffice, and associated with other office accommodation.

Multi-person staff offices

4.24 Multi-person offices are required for secretarialactivities and administrative work. The number of officeswill depend on local policy, and should be discussedand agreed with the A&E team during the initial planningmeetings.

Additional office space

4.25 Additional office accommodation will be requiredfor people who may not be permanent members of theA&E staff but who may still spend substantial periods oftime with patients. Health visitors and social workers, forexample, are frequently called to A&E departments. Thisaccommodation should be located in close proximity tothe department.

Signposting of offices

4.26 Office signs need consistent naming conventions.Signs for “major incident rooms” should be permanentlyin place so that staff are familiar with the areas usedduring an emergency.

EDUCATION AND TRAINING FACILITIES

4.27 Staff should be given every opportunity to use anyquiet times to undertake pre-arranged or spontaneouspersonal or group learning. Continuing professionaldevelopment (CPD) is now mandatory for all NHS staff.This implies that the number of people needing accessto and use of education and training facilities is likely toincrease significantly in the future.

4.28 Facilities should include a seminar room and library,along with access to a large multi-functional educationand training room. All staff will need access to ITfacilities.

Seminar room

4.29 A seminar room should be provided within the A&Edepartment for teaching, tutorials, meetings, caseconferences and clinical instruction. Furniture andequipment should include upright stacking chairs withwriting arms, a wall-mounted whiteboard, an imagingviewer, a video/TV monitor and a computer andkeyboard.


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4 SUPPORT FACILITIES – GENERAL AND SPECIFIC FUNCTIONAL AND DESIGN REQUIREMENTS

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4.30 A computer image projector is required. A ceiling-mounted screen should be provided, with efficientblackout curtains and facilities for projection of slidesand overhead transparencies.

4.31 The Accident and Emergency ModernisationProgramme (AEMP) suggests that project teams maywish to consider the provision of a CCTV system withfull two-way audio links between treatment areas andthe seminar room (AEMP, 2001). In these circumstancesit is essential that consent is gained from the patient.

The library

4.32 A separate room, in the form of a small library withadequate secure storage space for books, should beprovided for the purpose of private study. Computerterminals should be provided, each with access to theinternet.

SUPPORT SPACES

Ambulance cleaning bay

4.33 A bay is required where ambulance staff can cleanambulances (the interior of which can occasionallybecome excessively soiled). A hose point should beprovided. The bay should be located out of public view.

Ambulance equipment store

4.34 This lockable store should be located off theambulance cleaning bay or, alternatively, the ambulanceentrance lobby, so that the ambulance crews canrestock their vehicles once they are clean.

Major incident equipment store

4.35 A store is required for the storage of major incidentpacks and equipment. Emergency signage for externaluse is also stored here.

Equipment and supplies store

4.36 A store should be provided for the storage ofmobile and smaller items of equipment that are not inregular use or are being held as replacements. Shelvingand floor space where mobile equipment can be parkedwill be required. Some equipment will be delicate andcostly; therefore, sufficient space is needed formanoeuvring to permit easy retrieval, with doorwayswide enough to allow the largest items to pass freely.

4.37 A back-up store for bulk supplies (other than sterilesupplies) is required to supplement working stocks heldin various spaces throughout the department. Rackingand adjustable shelving, as appropriate, should beprovided. An exchange linen trolley may be parked here,or linen may be stored on shelves.

4.38 Crutches and splints in various sizes, and differenttypes of walking aid, should be stored in this room.

4.39 Supplies for use in the department should bedelivered in accordance with local procedures; for most supplies, this may involve delivery to the majorequipment and supplies store and redistribution to userareas.

Sterile supplies store

4.40 The “just-in-time” system should ensure that onlysmall quantities of sterile supplies will need to be storedin the department. A small back-up store for sterilesupplies such as dressing packs, syringes and needlesmay still be required to supplement working stocks heldin various spaces (for example every treatment room)throughout the department.

Ready use medical gas cylinder store

4.41 A dedicated, easily-accessible store is required,where gas cylinders for use with anaesthetic machinesand anaesthesia ventilators can be stored. It shouldconform to the requirements of HTM 2022 – ‘Medicalgas pipeline systems’.

4.42 The project team should ensure that the provisionof standby gases and equipment reflects the emergencyprocedures and contingency planning processesdeveloped for the area.

4.43 The store should be in a room that is easilyaccessible and enclosed in fire-resisting construction.

Housekeeper’s room

4.44 Space and facilities should be sufficient for parkingand manoeuvring cleaning machines and a cleaner’strolley, cleansing of cleaning equipment, and disposal offluids and used cleaning materials. Hand-washingfacilities are also required.

4.45 Shelving and vertical storage should not encroachon the working space or restrict access to the cleaners’sink. (Not requiring a close relationship with anyparticular area within the department, this room shouldbe located away from the principal routes used bypatients.)

Disposal hold

4.46 This locked room should be accessible from thehospital street. Collections may then be made withoutthe need for porters to enter the main circulation spaceof the department.

4.47 Bagged refuse and soiled linen are held here safelyand securely whilst awaiting collection. They areidentified by colour-coding, in line with whole-hospital


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policy. The size of the disposal hold should bedetermined by the frequency of collection.

Battery/uninterrupted power supply room

4.48 A room may be required to house theuninterrupted power supply (UPS) to the essentialelectrical supply to patient ventilators and monitoringequipment. This should be ventilated and kept locked atall times, with access only permitted for estates staff.

4.49 Monitoring of the UPS status is advised – this maybe connected to the communications base monitoringequipment where appropriate.

4.50 The use of centralised rather than distributive UPSarrangements within A&E departments should beconsidered in view of the likely security andmaintenance advantages.

4.51 Care should be taken to ensure that lightingcircuits within A&E, as well as specialist power supplies,are provided with adequate UPS to maintain lighting atall times.

Switchcupboard

4.52 See paragraphs 6.92–6.93.

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COMMUNICATIONS

5.1 Provision of effective communication systems isessential for the efficient management of emergencycare. Specialist advice should be sought, andambulance and police services consulted asappropriate, when systems are being considered andspecified. Communication systems are described below.

Radio

5.2 Radio equipment may be required for directcommunication with ambulance vehicles.

Telephones

5.3 In locations where public telephones are provided,at least one should be mounted at a height suitable for wheelchair users and the handset fitted with aninductive coupler to assist people using a hearing aid.

5.4 Telephones should be provided in accordance withthe whole-hospital policy for telephone services. Wheretelephones are provided for reception use, considerationshould be given to hands-free systems. Ringingtelephones in and adjacent to treatment spaces are a particular nuisance at times of peak activity, andconsideration should be given to the installation of asystem which will enable calls to be intercepted at anappropriate alternative location.

5.5 Staff based in different parts of, and staff movingaround, emergency care are required to communicatewith each other. Unnecessary or abortive staffmovement can be reduced, and messages can bereceived “hands-free” of communications equipment, byprovision of an intercommunication system. This systemshould utilise the standard telephone system andtelephone instruments, be simple to use, and coverlocations of high staff activity. It can also accommodatea wide range of functions, both routine and emergency,and enable staff to communicate rapidly and when theyrequire assistance, for example with calls:

• to all telephone instruments or a selected group oftelephone instruments within emergency care. Thisfacility can be used to locate a member of staff, forexample a doctor, a senior nurse or a porter, and foremergency calls for assistance in case of clinicalneed or potentially violent incidents;

• between two selected telephone instruments,including:

(i) calls for assistance. For example, a nurseworking alone could open a communicationchannel to the communication base and call forassistance without leaving the patient;

(ii) routine communications;

• to intercommunication systems in other departments,for example the diagnostic imaging department.

5.6 At least one ex-directory exchange line or direct line should be provided for communications with theemergency services. Such instruments should have adistinctive bell or buzzer.

5.7 Public telephones for patients and escorts shouldbe located adjacent to the waiting area. This shouldinclude a freephone telephone for taxis.

5.8 See also paragraphs 6.134–6.139.

Fax

5.9 Fax equipment will be required for communicationwith various outside agencies.

Patient-to-staff and staff-to-staff call systems

5.10 Patient-to-staff call systems should be provided inall spaces where patients may be left alone temporarily,such as treatment rooms and patient WCs. Staff-to-staffcall systems should be provided in all spaces wherestaff consult, examine and treat patients. The staffsystems must have a distinctive ring from the patientsystem. Terminals to the call systems should be locatedat the communications base.

5.11 The emergency call system in the resuscitationarea should have a sound that is distinctive from otheralarms.

Staff-to-patient communications

5.12 Project teams will need to consider how patients,including those with visual and auditory impairments,can be kept informed should they be required to waittemporarily prior to assessment. Options includeannouncements:

5 Other general functional and designrequirements

• by a member of staff personally;

• over a loudspeaker system;

• using a visual display unit.

CONTROLLED DRUGS CUPBOARD

5.13 Repeater indicator lights from the controlled drugs cupboard should be provided at a continuouslystaffed location, for example the reception desk orcommunications base. (See paragraphs 6.123–6.125.)

FIRE ALARMS

5.14 Fire alarms should be provided in accordance withHTM 82 – ‘Alarm and detection systems’; see alsoparagraphs 6.129–6.130.

INTERNAL ENVIRONMENTAL ENGINEERINGCONSIDERATIONS

Ventilation

5.15 Natural ventilation is preferred unless there are internal spaces or clinical reasons that call formechanical ventilation or comfort-cooling systems. If a smoking room is provided, adequate ventilation isessential.

5.16 Mechanical ventilation and comfort-coolingsystems are expensive in terms of capital and runningcosts; planning solutions should be sought that takemaximum advantage of natural ventilation. Mechanicalventilation costs can be minimised by ensuring that,wherever practicable, core areas are reserved for rooms whose function requires mechanical ventilationirrespective of whether their location is internal orperipheral, for example sanitary facilities and dirtyutility/sluice rooms. See also paragraphs 6.50–6.63.

Noise and sound attenuation

5.17 Any unwanted sound is a noise and may disturbpatients and staff. Noise-sensitive areas should belocated as remotely as possible from internal andexternal sources of unavoidable noise. See alsoparagraphs 6.22–6.23.

5.18 Speech privacy is essential in spaces wherepersonal and confidential discussions are held, such asinterview rooms and any clinical areas; discussionsshould be unintelligible in adjoining spaces.

5.19 Particular care should be taken where the adjoiningspaces are waiting areas.

5.20 Sound transmission can be reduced by use ofsound-containing partitions and doors. Use of soft floor-coverings and acoustic treatment of walls and ceilings

(where hygienically acceptable) will improve soundabsorption in a space.

5.21 Induction loops should be fitted where necessaryin reception areas.

FINISHES

5.22 The quality of finishes in all areas should be of ahigh standard. Guidance on the selection of finishes isprovided in the relevant Health Technical Memoranda(HTMs) – see Appendix 2.

5.23 Finishes should be robust enough to withstandaccidental impact, and additional protection should beprovided at likely points of contact. Trolleys and items ofmobile equipment that may cause damage should beappropriately buffered. Cleaning regimes should beconsidered when materials are selected.

5.24 The infection control team should advise on the appropriate finishes throughout the project (see alsoHFN 30 – ‘Infection control in the built environment’).

Colour

5.25 Colours of surfaces in spaces occupied by patientsshould not distort the colour rendering of light sources.It must be possible to clearly define and easily identifychanges to a patient’s skin tone and colour. Decorshould be light and pleasant.

Floors

5.26 Floors in emergency care have to withstand harshtreatment. Therefore, the floor coverings and skirtingsshould be smooth, easily cleaned, contribute to theprovision of a non-clinical environment and, at the sametime, be hard-wearing. They must not present a hazardto disabled people nor restrict the movement of wheeledequipment. Floors should not be, nor appear to be,slippery, and the patterning should not inducedisorientation.

5.27 Carpets should not be used in clinical areas.Carpets may be suitable for use in the offices, staff restroom, overnight stay accommodation if included, andvisitors’ sitting rooms, but not the reception area.Carpets are extremely difficult to keep clean; thereforethey must be meticulously monitored and maintained.

5.28 Changes of floor level are not acceptable andshould be avoided wherever possible. Surface drag,static electricity, flammability, infection hazards andimpermeability to fluids must be considered.

5.29 HTM 61 – ‘Flooring’ should be consulted for adviceon user requirements and performance selection.


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Walls

5.30 Wall finishes in A&E departments should bedurable and able to withstand wet cleaning and the accidental impact of trolleys and heavy mobileequipment. Especially vulnerable points should haveadditional protection. Smooth paint surfaces are theeasiest for cleaning, for example eggshell or vinyl silkemulsion.

5.31 Vinyl wall-coverings can be used in rest, interviewand relative rooms.

5.32 Ceramic wall tiles are preferable in kitchen, showerand toilet areas.

Doors and frames

5.33 Doors and frames are particularly liable to damagefrom mobile equipment, and materials that will withstandthis should be used. All double-swung doors shouldincorporate clear glass vision panels at the level ofchildren and adults, but privacy, safety, or otherconsiderations may require that the panels should becapable of being obscured. Where necessary, doorsshould be capable of being fastened in the openposition. Magnetic door retainers should not restrict the movement of traffic.

5.34 Doors should designed to be resistant to damagefrom trolleys etc and should ideally be automatic inoperation.

Windows

5.35 In addition to the various statutory requirementsconcerning windows, the following aspects requireconsideration: illumination and ventilation; insulationagainst noise; user comfort; energy conservation; theprevention of glare; and the provision of a visual link withthe outside world. Windows should, if possible, have apleasant outlook.

5.36 Guidance on types of window and safety aspectsis available in HTM 55 – ‘Windows’.

Corridors

5.37 Corridor design can be improved by:

• reducing their length;

• introducing changes in shape by inclusion of waitingspaces and lobbies;

• introducing daylight;

• providing views of outside areas such as landscapedcourtyards;

• varying the colour of walls;

• the use of works of art (see paragraphs 2.34–2.38).

Maintenance and cleaning

5.38 Materials and finishes should be selected tominimise maintenance and be compatible with theirintended function. Building elements that requirefrequent redecoration or are difficult to service or cleanshould be avoided. Special design consideration shouldbe given to corners, partitions, counters and otherelements that may be subjected to heavy use. Wallcoverings should be chosen with cleaning in mind.Guidance on these aspects is given in HTM 56 –‘Partitions’, HTM 58 – ‘Internal doorsets’ and HTM 61 –‘Flooring’.

5.39 The infection control team should advise on themaintenance and cleaning of the materials and finishes(see HFN 30 – ‘Infection control in the builtenvironment’).

5 OTHER GENERAL FUNCTIONAL AND DESIGN REQUIREMENTS

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GENERAL ENGINEERING CONSIDERATIONS

Introduction

6.1 This chapter provides general engineering guidancefor healthcare facilities. Specific guidance on theengineering requirements for an emergency departmentare set out in paragraphs 6.33–6.148 of this document.

6.2 Engineering services account for a significantproportion of the capital cost and a continuing chargeon revenue budgets. The project design engineer shouldensure economy in provision, whilst achieving functionalrequirements and maintaining clinical standards.

6.3 Lifetime costs should be identified as part of thecost-benefit analysis. Energy usage has a major impacton the environment. Heating, ventilation, cooling andlighting should be automatically controlled when not inuse (for example at night or weekends).

6.4 Engineering installations should provide anorganised and systematic arrangement that can bemodified to facilitate changes in service requirements.This should be achieved by distributed systems withvertical or horizontal services ducts. These should bereadily accessible so they can be remodelled andmaintained with minimal disruption to the facility.

Model specifications

6.5 The National Health Service Model EngineeringSpecifications are sufficiently flexible to reflect localneeds. The cost allowance is based on the quality ofmaterial and workmanship described in the relevantparts of the specifications. In addition, the reader isdirected towards the range of Health TechnicalMemoranda (HTMs) relevant to this facility (seeAppendix 2).

Energy conservation and sustainability

6.6 The commitment of the NHS to sustainabledevelopment is encapsulated in the document‘Sustainable development in the NHS’. Whilst thisdocument considers a wide range of sustainabilityissues, one area identified as having a major impact onthe environment is the use of energy. The minimising ofenvironmental impact by ensuring that energy is only

used necessarily and efficiently is considered in thissection with regard to:

a. natural daylighting;

b. natural ventilation;

c. night set-back;

d. building regulations;

e. heat recovery.

6.7 Efforts should be made to maximise the use ofnatural lighting. Passive solar design (PSD) should beemployed to ensure, as far as possible, that patient andstaff areas are located where they can benefit fromnatural daylight whilst other areas, for example stores,toilets and utility rooms, are located towards the core ofthe facility.

6.8 Areas where glare may be a problem, for examplerooms where VDUs are routinely used, should similarlybe located away from direct natural daylight.

6.9 Rooms should be naturally ventilated whereverappropriate. The design should incorporate measuresfor minimising solar heat gains which, if uncontrolled, willprecipitate a need for mechanical ventilation. Measuresto minimise the need for cooling should include locatingtemperature-sensitive accommodation away from south-facing fascias, shading windows with brise soleil, andusing solar-reflecting glass where this is cost-effective.

6.10 Energy-using systems including heating,ventilation, cooling and lighting should be controlled toreduce energy input to the facility, or sections of it, whenit is not in use, for example at night or weekends.

6.11 Energy recovery systems should be considered forair-conditioning and ventilation systems.

Design for safety

6.12 Health and safety legislation imposes a statutoryduty on all who design, manufacture, import, supply,install or erect “articles for use at work” through a rangeof co-ordinated health and safety regulations enactedunder the Health and Safety at Work etc Act 1974.

6 Engineering services

6.13 Key safety regulations relating to healthcarepremises and equipment are:

a. the Construction (Design and Management)Regulations 1994;

b. the Management of Health and Safety at WorkRegulations 1999;

c. the Workplace (Health, Safety and Welfare)Regulations 1992;

d. the Provision and Use of Work EquipmentRegulations 1998;

e. the Health and Safety (Safety Signs and Signals)Regulations 1996;

f. the Noise at Work Regulations 1989;

g. the Pressure Systems Safety Regulations 2000;

h. the Pressure Equipment Regulations 1999;

j. the Gas Safety (Installation and Use) Regulations1994;

k. the Control of Substances Hazardous to Health(COSHH) Regulations 2002.

6.14 The vulnerability of patients in healthcare premises,where many engineering systems impact on patientsafety, introduces additional risks and calls for anincreased awareness of the importance of engineeringsystem integrity. This is even more the case in facilitiesfor patients in emergency care, and engineering systemsshould be designed to be especially robust to ensurethat a failure in the quality or continuity of an essentialengineering service cannot compromise patient safety.

6.15 Designers should be particularly aware of the role of engineering design in the control of infection,particularly in respect of water services (see HTMs 2027and 2040) and ventilation systems (see HTM 2025).

6.16 Clearly-identified devices for the control andisolation of primary engineering services should belocated in areas where they can be protected againstunauthorised interference, ideally in plantrooms,engineering service spaces, or circulation areas.

6.17 The need to employ formal “Permit to Work” and“Permit to Use” procedures should be noted, particularlyin respect of electrical systems (see HTMs 2020 and2021) and medical gas systems (see HTM 2022).

Ventilation (substances hazardous to health)

6.18 Local exhaust ventilation will be required whereexposure by inhalation of substances hazardous to

health cannot be controlled by other means. The Healthand Safety Executive publication EH40, ‘OccupationalExposure Limits’, updated annually, sets limits that formpart of the Control of Substances Hazardous to HealthRegulations 2002 (COSHH).

Fire safety

6.19 The policy in respect of fire safety is set out in the‘Firecode’ series of documents. The trust should satisfyitself that the design meets the objectives of ‘Firecode’by either compliance with HTM 81 or a fire-engineeredsolution that achieves similar objectives.

6.20 It is important to establish during the design stagethose aspects of fire strategy that may affect theplanning of a project. At appropriate stages of thedesign process, the architect and engineer shoulddiscuss and verify their proposals with the relevantBuilding Control/Approved Inspector, and ensure thatthe project team and all other planning staff are fullyacquainted with the fire safety strategy for the design.This will include operational aspects (staff responsibilitiesetc), equipment provision, and building and engineeringlayouts. HTMs 57–60 provide detailed information forthe selection of fire-resistant building components andmaterials.

Fire detection and alarm systems

6.21 A fire detection and alarm system complying withHTM 82 should be installed throughout the facility.

Noise

6.22 Excessive noise and vibration from engineeringservices – whether generated internally or externally andtransmitted to individual areas – or noise from othersources, for example speech, which can be transmittedvia the ventilation system, can adversely affect theoperational efficiency of the department and causediscomfort to patients and staff. The limits and means ofcontrol advocated in HTM 2045, ‘Acoustics’ shouldprovide an acceptable acoustic environment.

6.23 In addition to designing for control of noise levels,there may also be a need to ensure speech privacy, sothat confidential conversations are unintelligible inadjoining rooms or spaces.

Space requirements for services and plant

6.24 A high level of availability of engineering plant andservices is critical to the ability of the facility to functionsafely and efficiently. It is therefore essential that buildingdesign should incorporate adequate space for theinstallation and maintenance of plant, ductwork,pipework and cabling.

6 ENGINEERING SERVICES

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6.25 Space for plant and services should provide:

a. easy and safe means of access;

b. secure accommodation protected from unauthorisedaccess;

c. adequate space around plant and services to permitinspection and maintenance;

d. sufficient space to permit redundant plant to beremoved without the need to dismantle other majorplant.

6.26 Recommended spatial requirements forengineering plant and services is contained in HTM2023. Further useful information regarding the provisionof space for plant is contained in BSRIA Technical NoteTN 9/92, and for building services distribution systemsin BSRIA Technical Note TN 10/92.

6.27 Space should be allowed within walls and aboveceilings to facilitate the concealment of electrical andmechanical services where possible. Securabledemountable panels should be provided to allow accessto control and isolation valves as well as any equipmentthat is necessarily concealed within the spaces. Eachpanel should be clearly, but discreetly, marked to identifythe controls or equipment to be found behind the panel.

6.28 In general, but with the exception of drainage and, when appropriate, heating pipework, engineeringservices should not be brought from the above-ceilingspace of a floor below. Service distribution to aparticular area should be contained in service spaces onthat floor.

6.29 Wherever possible, access to plant and servicesshould be from plantrooms or maintenance areas.Where this is not possible, every endeavour should bemade to effect access from general circulation areasand not from operational spaces.

6.30 In areas where wall-mounted heat emitters areinstalled, they should be contained within a 200 mmwide perimeter zone. The 200 mm zone, together withthe space for minor engineering ducts required toservice the emitter, is included in the building circulationallowance. The amount of space required for wall-mounted emitters can be limited by the use of ceilingemitters as an alternative.

6.31 Care should be taken to ensure that noise andstructure-borne vibration cannot be transmitted from theplantroom to other areas.

Engineering commissioning

6.32 The engineering services should be commissionedin accordance with the validation and verificationmethods identified in the latest HTMs. Engineering

services for which a specific HTM is not currentlyavailable should be commissioned in accordance with‘Guide to engineering commissioning’ (IHEEM, 1995).Flow measurement and proportional balancing of air andwater systems require adequate test facilities to beincorporated at the design stage. Guidance is alsocontained in a series of commissioning codes publishedby the Chartered Institute of Building ServicesEngineers.

SPECIFIC MECHANICAL ENGINEERINGSERVICES

Introduction

6.33 Mechanical services may include the following:

• heating system;

• hot and cold water systems;

• ventilation systems;

• refrigeration plant;

• environmental control and building managementsystems;

• medical gases;

• steam and condensate systems;

• sterilizing and washer-disinfector equipment.

Maximum demands

6.34 The estimated maximum demand and storagerequirements, where appropriate, for each engineeringservice will need to be assessed individually to takeaccount of the size, shape, geographical location,operational policies and intensity of use of the facility.For the purposes of initial planning only, the servicesdemands in Table 6.1 may be considered typical of anaccident and emergency department with a throughputof 50,000 patients per annum.

6.35 For the purposes of this document the installationis deemed to include each system from the point ofentry to the facility to the final connection to serviceoutlets or specific equipment.

Heating system

6.36 A building management system (BMS) shouldcontrol the heating system in zones to ensure that it isautomatically set back or turned off when the facility, or zones within the facility, is/are not in use. Heatingthroughout the facility should be controlled to aminimum “set back” temperature of 10ºC during “out of use” hours. The BMS should be equipped with amanual override to permit restoration of the plant to fulloperational status at short notice (see also HTM 2005).


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6.37 In areas other than resuscitation rooms, treatmentrooms, and plenum ventilated/air-conditionedaccommodation, general space heating requirementscan be met by either wall-mounted low-pressure hotwater radiators or ceiling-located low-pressure hot wateremitters.

6.38 The surface temperature of wall-mounted radiatorsshould not exceed 43ºC. Ceiling-mounted radiantpanels can exceed this surface temperature and willallow floor space savings. Exposed heating pipework attemperatures above 43ºC and accessible to touch,should be encased or insulated. Further information isgiven in the Health Guidance Note (HGN) – ‘“Safe” hotwater and surface temperatures’.

6.39 Radiators should be located under windows oragainst exposed walls. There should be space betweenthe top of the radiator and the window-sill to preventcurtains reducing the output. There should be adequatespace underneath, at least several inches, to allowcleaning machinery to be used. Where a radiator islocated on an external wall, back insulation should beprovided to reduce the rate of heat transmission throughthe building fabric.

6.40 All radiators should be fitted with thermostaticcontrol valves. These should be of robust constructionand selected to match the temperature and pressurecharacteristics of the system. The thermostatic headshould incorporate a tamper-proof facility for pre-settingthe maximum room temperature. It should be controlledvia a sensor located integrally or remotely. To providefrost protection, the valve should not remain closedbelow a fixed temperature.

6.41 Radiators should be used to offset only buildingfabric heat loss in mechanically ventilated rooms. Allrooms should have local heating controls; the facilityshould be controlled throughout by the BMS.

6.42 Ceiling heating panels may operate at highersurface temperatures than 43ºC as long as the surfaceis not readily accessible. Heating panels should runaround the perimeter of the building. Panels should notbe located over beds, patient trolley positions or in otherlocations where they might radiate directly down on apatient or member of staff for a prolonged period.

6.43 Ceiling panels should be selected to aestheticallymatch the adjacent ceiling and should be sealed to theadjacent ceiling by means of a gasket or similar device.

6.44 Heating loops of ceiling panels should becontrolled by automatic valves located above the ceilingand actuated from room thermostats. In large spacesseveral loops should be provided, each controlled fromits own thermostat, to serve separate zones within thespace.

Hot and cold water systems

6.45 Hot and cold water storage and distributionsystems should be designed in accordance with therequirements of HTM 2027 and HTM 2040.

6.46 Whilst cold water storage at high level will be thenorm, care should be taken to ensure that all equipmentproposed for the department is capable of operatingfrom the available static head. Where the static head isinsufficient, a pressurisation set incorporating dualpumps should be installed.


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TABLE 6.1

Service Typical max demand Notes

Heating/ventilation (kW) 90

Domestic hot water (l/s) 1.8 720 litres storage(2 hours recovery)

Cold water (l/s) 2.6 4000 litres storage(24-hour supply)

Supply ventilation (m3/s) 2.3

Extract ventilation (m3/s) 2.3 Clean and dirty

Cooling (kW) 33

Electrical (kVA) 18

Medical gases (l/min)

Oxygen 70

Medical compressed air 300

Vacuum 100

Nitrous oxide 60 Anaesthetic gas scavenging required if nitrous oxide provided


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6.47 All cold-water pipework, valves and fittings shouldbe insulated and vapour sealed to protect against frost,condensation and heat gain.

6.48 The domestic hot water supply should be takenfrom the calorifiers installation at a minimum outflowtemperature of 60ºC ± 2.5ºC and distributed to alloutlets in a manner that ensures a return temperature to the calorifiers of at least 50ºC. Exposed hot waterpipework, accessible to touch, should be encased orinsulated. Further information is given in HGN – ‘“Safe”hot water and surface temperatures’.

6.49 Where possible, automatic water-conserving tapsactuated by proximity detectors should be used.

Ventilation (General)

6.50 Air movement induced by mechanical ventilationshould be from clean to dirty areas, where these can bedefined. The design should allow for adequate flow ofair into any space having only mechanical extractventilation, via transfer grilles in doors or walls. However,such arrangements should avoid the introduction ofuntempered air and should not prejudice therequirements of ‘Firecode’ or privacy of patients.

6.51 Mechanical ventilation should ensure that bothsupply and extract systems are in balance and, asappropriate, take account of infiltration.

6.52 Fresh air should be introduced via a low-velocitysystem and should be tempered and filtered beforebeing distributed via high-level outlets. Diffusers and grilles should be located to achieve uniform airdistribution within the space, without causing discomfortto patients or staff.

6.53 A separate extract system will be required for“dirty” areas, for example toilet facilities. It shouldoperate continuously throughout working hours. A dual-motor fan unit with an automatic changeover facilityshould be provided.

6.54 External discharge arrangements for extractsystems should be protected against back pressurefrom adverse wind effects and should be located toavoid reintroduction of exhausted air into this oradjacent buildings through air intakes and windows.

Ventilation of resuscitation rooms

6.55 In establishing the nature of the ventilation regimeto be provided in the resuscitation room, it is imperativeto ascertain at the outset the spectrum of activity thatwill be undertaken within the particular facility. Indetermining the technical solution applicable to thefacility, the engineer should consult with the clinical teamand the control of infection officer to ensure that thesolution is appropriate.

6.56 It should be noted that at times there will be highlevels of activity in a relatively confined space, and it isessential that the ventilation system is able to respondto demands for the maintenance of comfortable workingconditions in such circumstances.

6.57 The system should also be capable of respondingrapidly to user demands for changing temperature, asrequired by the condition of the patient. Whilst an over-engineered solution cannot be encouraged, care shouldbe taken to ensure that any solution decided upon takes into account any need for future-proofing, sinceretrospective fitting of full air-conditioning is bothexpensive and disruptive.

Ventilation cooling systems

6.58 Refrigeration loads for ventilation systems shouldbe met either by the hospital’s central water chiller plant,or by a packaged, remotely located water chiller plantdedicated to the facility. Direct expansion systems arenot advocated unless the refrigeration load is small,since direct expansion plant can only be controlled insteps, unlike chilled water, which can be continuouslymodulated.

6.59 Heat rejection plant should consist of air-cooledcondensers. Wet cooling towers should not be used.

Ventilation controls

6.60 Ventilation systems should be controlled by aBuilding Management System (BMS) which willautomatically set back or turn off plant serving areasthat are not in continuous use. Ventilation systemsshould be controlled to ensure a minimum “set back”temperature of 15ºC during “out of use” hours tofacilitate rapid warm-up if necessary. The BMS should be equipped with a manual override to permitrestoration of the plant to full operational status at shortnotice.

6.61 Supply and extract ventilation systems shouldinclude local indicator lamps to confirm the operationalstatus of each system.

6.62 The indicators for a system serving a particularspace should be both immediately adjacent to thespace and at a central staff base.

6.63 Where manual controls are available for staff use,they should be provided with labels that clearly definetheir function.

Piped medical gases

6.64 Medical gases should be provided in accordancewith HTM 2022.

6.65 Medical gases should wherever possible belocated in overhead supply units or on bed-head beams

in order to minimise obstruction of the working areaaround the patient.

6.66 Due consideration should be given to thecontainment of noise from plant. A suitable acousticenclosure may be required to effect compliance with thenoise levels deemed acceptable in HTM 2022.

Medical oxygen

6.67 It should be anticipated that the main hospital’svacuum insulated evaporator (VIE) will have capacity tosatisfy the requirements of the facility. Should this not bethe case, consideration should be given to increasingthe capacity of the VIE. Having regard to the probablescale of oxygen consumption, it is unlikely that anoxygen bottle manifold will be appropriate.

6.68 Oxygen should be provided to all resuscitationbays, treatment rooms, and bed positions in the clinicaldecision unit/observation unit.

Nitrous oxide

6.69 Where local anaesthesia policy and riskconsiderations permit, one nitrous oxide outlet shouldbe provided to each resuscitation bay.

6.70 Where provision is made for the supply of nitrousoxide it will be necessary to provide a gas scavengingsystem.

Medical vacuum

6.71 A separate medical vacuum plant should beprovided comprising:

• at least two identical pumps;

• a vacuum reservoir with by-pass facilities;

• two duplex bacteria filters with drainage traps;

• appropriate non-return valves;

• isolating valves, gauges and switches;

• an operating and indicating system;

• an exhaust system;

• a test point.

6.72 The plant should have good all-round access formaintenance and should be sited to allow for adequateflows of air to cool the pumps.

6.73 Medical vacuum should be provided to allresuscitation rooms, treatment rooms and bed positionsin the clinical decision unit/observation unit.

Medical (400 kPa)

6.74 Medical compressed air at 400kPa should beprovided to all resuscitation rooms, treatment rooms,and bed positions in the clinical decision unit/observation unit.

6.75 Separate medical compressed air plant should beprovided comprising:

• air intake filters;

• at least two identical compressors with after-coolers;

• pressure-reducing valves;

• appropriate non-return valves;

• an air receiver with pressure relief valve;

• isolating valves;

• gauges and switches;

• an operating and indicating system;

• a test point.

6.76 The plant should have good all-round access formaintenance and should be sited to allow for adequateflows of air to:

• provide air to the intakes of the compressors;

• provide cooling of the compressed air by the after-coolers;

• cool the compressors themselves.

Pneumatic tube systems

6.77 Pneumatic air tube systems may provide a viableand rapid alternative to porters for moving specimens topathology and receiving medicines from the pharmacy.To determine the viability of using this type of system,the following factors should be assessed:

a. distance, time and cost of travel between the variouslocations;

b. proportion of pathology specimens that requireurgent results;

c. proportion of medicines that are required at shortnotice;

d. security;

e. whether the system can be used for transportation ofother materials, for example general post;

f. parallel use of an electronic data infrastructure forrequests and pathology results.


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6.78 For further guidance on pneumatic tube systemssee HTM 2009 – ‘Pneumatic air tube transportsystems’.

Fire protection systems

6.79 Fire protection systems should comply with therequirements of HTM 81 – ‘Fire precautions in newhospitals’.

6.80 Dry risers should be provided adjacent to stairwellswith branch hose connections at each landing. First aidhose reels and sprinkler systems will not generally beprovided unless there is a specific requirement to do soby the local fire authority.

6.81 Where there are major IM&T equipment roomslocated within the facility there may be a need for theprovision of a gas extinguishing system.

Internal drainage systems

6.82 The internal drainage system should:

• use the minimum of pipework;

• remain water- and air-tight at joints and connectors;

• have sufficient ventilation to retain the integrity ofwater seals;

• include clear labelling of waste pipes that maycontain radioactive waste or effluent.

6.83 The facility should be provided with a system ofsoil and waste drainage including anti-siphon andventilation pipework in accordance with BS EN 12056-1.

6.84 Where plastic pipework materials are used, suitableintumescent collars should be fitted when breaching firecompartments, and acoustic wrapping should beapplied when drainage runs above patient areas.

6.85 The gradient of branch drains should be uniform,and adequate to convey the maximum discharge to the stack without blockage. Practical considerations,such as available angles of bends, junctions and theirassembly, as well as space considerations, will normallylimit the gradient to about 1:50 (20 mm/m).

6.86 For larger pipes, for example 100 mm in diameter,the gradient may be less, but this will require high-quality workmanship if an adequate self-cleaning flow isto be maintained. It is not envisaged that pipes largerthan 100 mm diameter will be required within inter-flooror ground-floor systems serving this facility.

6.87 Bedpan washers or macerators should dischargewith a short branch to a vertical stack or horizontaldrain. The waste pipe should not be installed above orclose to heating or hot-water mains. If a bedpan washer

or macerator discharges to a 100 mm drain, frequently-used large-volume appliances should be situatedupstream of its connection to provide additional flushing.

6.88 Provision for inspection, rodding and maintenanceshould ensure “full bore” access and be located tominimise disruption or possible contamination. Manholesshould not be located within this facility.

SPECIFIC ELECTRICAL ENGINEERINGSERVICES

Introduction

6.89 Electrical services include the following:

• main intake switchgear and distribution board;

• emergency electrical supplies;

• small power distribution systems;

• lighting systems;

• IM&T cabling systems;

• telephone systems;

• security systems;

• staff call, public address and entertainment systems

• lightning protection.

6.90 Electrical installations should comply with BS 7671and HTM 2007 – ‘Electrical services supply anddistribution’.

6.91 Care should be taken to avoid mains-borneinterference and electrical radio frequency interferenceaffecting diagnostic and monitoring equipment,computers or other sensitive electronic equipment.

Switchcupboard

6.92 The departmental switchcupboard, which housesthe main isolators and distribution board, should be:

• sited within the department away from patient areas;

• accessible directly from a circulation area providingclear and safe access for maintenance staff (accessspace may be part of the circulation area). Careshould be taken to ensure that safety is notcompromised during maintenance from passingtraffic or the opening of adjacent doors;

• sited away from water services and lockable.

6.93 Wherever possible, equipment should be mountedat a height that gives safe and easy access from astanding position. All switchgear should be lockable inthe “off” position.

Emergency electrical supplies

6.94 Emergency electrical provision should comply, as a minimum, with the requirements of HTM 2011 –‘Emergency electrical services’.

6.95 The emergency generator providing electricity inthe event of a main supply failure should be capable of providing full (100%) backup to the exclusion ofrefrigeration plant serving air-conditioning and comfortcooling plant.

6.96 If an existing generator is to be used, the extent ofemergency coverage will be dependent on the sparecapacity available, subject to a minimum provision. Ifthis minimum requirement cannot be met, it will benecessary to either replace the existing generator with alarger set, or provide an additional generator dedicatedto the facility.

6.97 Equipment and systems that cannot tolerate thedelay inherent in bringing a generator supply on line,including imaging systems and computers, should befurther protected against outages by the provision ofsolid-state non-interruptible power supplies.

6.98 In the event of a main supply or local final circuitfailure, escape routes should be illuminated by self-contained, battery-powered luminaires chargedcontinuously from the main supply and capable ofproviding illumination for a period of three hours.

Small power distribution systems

6.99 Depending upon the available capacity of theemergency generator installation it may be necessary to provide separate essential and non-essential smallpower distribution systems as detailed in HTM 2011.

6.100 Thirteen-amp switched and shuttered socket-outlets in accordance with the requirements of the roomdata sheets should be provided, connected to ring orspur circuits. It is preferable for socket-outlets at bedpositions to be unswitched, thus obviating the possibilityof essential equipment accidentally being switched off.

6.101 Where there is separation between essential andnon-essential small power distribution, socket-outletsserved by the essential distribution should be clearlymarked with an engraved red capital letter “E”. Allsocket-outlets at bed-head locations should be servedfrom the essential distribution.

6.102 The special requirements of BS 7671 andGuidance Note 7, Institute of Electrical Engineers (IEE) in respect of medical locations and associated areasshould be adhered to. The electrical supply connectionsto all medical electrical equipment should comply withBS EN 60601-1-2.

6.103 Guidance on the power supply requirements formobile radiodiagnostic equipment is contained in HTM2011, whilst guidance on engineering accommodationfor this equipment may be found in HBN 6 (Volume 1).

6.104 Where equipment is permanently installed orwhere there is a possibility of equipment theft, switcheddouble-pole 13-amp spur outlets should be used inpreference to socket-outlets. The spur outlet shouldincorporate a red neon lamp indicating when the supplyto the equipment is live.

6.105 Equipment requiring a three-phase supply shouldbe permanently connected to a separate sub-circuit.The sub-circuits, incorporating a circuit breaker, shouldbe fed from the distribution board and terminate in alocal isolator.

6.106 Adequate provision should be made in circulationareas, for example corridors and lobbies, to permit theuse of domestic cleaning equipment having flexiblecords up to 9 metres long.

6.107 Isolation switches should be provided immediatelyadjacent to all engineering plant and equipment, clearlylabelled to identify the equipment that they relate to.

6.108 Heating appliances and automatic equipmentshould be provided with red neon lamps indicating when they are energised. The neon lamps should beincorporated in the control panel of the equipment, inthe control switch, or in the socket-outlet or spur unitfrom which the equipment derives its supply.

Lighting systems

6.109 To achieve energy efficiency, lighting systemsshould be designed to:

• maximise natural daylight;

• avoid unnecessarily high levels of illumination;

• incorporate efficient luminaires, control gear andlamps;

• incorporate effective controls.

6.110 See CIBSE guide F for further information.

6.111 For detail regarding illumination levels, designersshould consult BS EN 12464, BS EN 60598-2-25 andIEC 60598-2-25.

6.112 Lighting within the facility should be coordinatedwith architectural design. In particular, there should becollaboration to ensure that decorative finishes arecompatible with the colour-rendering properties of lampsand that the spectral distribution of the light source isnot adversely affected. See also ‘Lighting and colour forhospital design – A report on an NHS Estates-fundedresearch project’ (Dalke et al, 2004).


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6.113 The positioning of artificial lighting should beconsidered carefully. Clinical task lighting is essential toeach bed space and can be part of the medical supplyunit. It should be dimmable, flexible and discreet. Eachlight should be adjustable from the patient’s bedsideand also from the communications base. Staff should be able to read prescriptions and observation charts atnight. Further consideration should be given to the typeof lighting that can be used by more alert patients, sothat they can control their own environment.

6.114 Ceiling-mounted fluorescent lighting should notbe positioned directly over a bed space, as an awake orlightly sedated patient will find the glare distressing. Ifceiling-mounted fittings are used they should be locatedto prevent unwanted glare. The lighting should bedimmable without flicker.

6.115 Floor or low-level lighting should be provided tofacilitate the observation of chest drains and urinarydrainage. The light can also be used around the bedspace at night or when the patient is resting.

6.116 Lighting switches should be provided in easily accessible positions within each area, and atappropriate locations in corridors and general circulationareas. In areas with multiple luminaires, switching shouldpermit the selection of luminaires appropriate only tothat area requiring illumination.

6.117 Where local circumstances permit, the provisionof time switches or occupancy controls using infrared,acoustic or ultrasonic detectors should be considered.

6.118 Generally, luminaires should be fitted withfluorescent lamps equipped with low-loss or high-frequency control gear. Where luminaires are infrequentlyused, or where the design intent of the architect inrespect of ambience dictates, compact fluorescent, LVor tungsten lamps may be used.

6.119 Colour-corrected lighting should be provided in allpatient areas.

6.120 Where necessary, general lighting should besupplemented with dedicated task lighting.

6.121 In areas where VDUs are in use, lighting shouldbe designed to avoid any bright reflections from thescreen. Generally, the lighting in such circumstancesshould comply with the guidance given in CIBSE LG3.

6.122 Safety escape lighting should be provided onprimary escape routes in accordance with the provisionsof HTM 2011, BS EN 12464, BS EN 60598-2-25 andIEC 60598-2-25.

Controlled drugs (DDA) cupboards

6.123 Drug cupboards to contain controlled drugs in asecure manner should be provided to BS 2881.

6.124 Each controlled drugs cupboard should be fittedwith a red lamp indicating when the cupboard isunlocked. A repeater lamp should be sited outside thedoorway of the room in which the cupboard is located.If appropriate, a secondary repeater should be taken toa permanently staffed station.

6.125 The normal supply for each cupboard should bebacked up by a small UPS to cover the short periodbetween mains failure and the generator supplybecoming available.

Bedhead services

6.126 Every bed position should incorporate a bed-headunit providing the following:

• 28 No – 13 amp switched and shuttered socket-outlets;

• oxygen and medical vacuum outlets;

• medical air;

• bed-head luminaire switch;

• nurse call button/indicator lamp;

• staff/staff emergency pull switch;

• socket for patient handset;

• IM&T connection(s);

• telephone connection (optional);

• entertainment system (optional).

6.127 A handset control should also be providedincorporating:

• nurse call button;

• reassurance lamp;

• luminaire switch/dimmer control;

• entertainment system control (optional).

6.128 Discussion with staff should be undertaken atplanning stage to determine the desirability of providingentertainment functions including radio, television andtelephone.

Fire detection

6.129 Fire detectors throughout the facility shouldgenerally be of the ionisation type.

6.130 Xenon flashing light indication of a fire alarmsituation should be installed alongside sounders, withthe sounders being mutable from the communicationsbase.


40

IM&T and telephone systems

6.131 The approach to provision of IM&T and telephoneinfrastructure within the facility may be conditioned byexisting systems within the hospital. However, wherepossible, a structured wiring system as described in theHGN ‘Structured cabling for IT systems’ should beprovided. This will permit a unified approach to theprovision of cabling for:

• voice systems;

• data systems;

• imaging systems;

• alarm systems.

6.132 Whilst this ”universal” cabling system is initiallymore expensive than separate voice and data systems,the long-term cost of ownership is less.

6.133 In determining the nature of the IM&T system tobe provided it is necessary to identify:

• areas to be served;

• whether structured cabling will be used;

• what density of outlets is to be provided (not lessthan two per workstation);

• whether wiring will be on a “flood” or “as required”basis;

• special requirements of imaging and picture archivingsystems.

Telephone systems

6.134 The extent and complexity of telephoneequipment and associated infrastructure will bedependent on the size of the department.

6.135 As stated in paragraphs 6.131–6.133, it may bebeneficial to integrate voice cabling with the structuredwiring system for IM&T if provided.

6.136 Incoming calls to the facility should be routedthrough the reception. However, depending on the sizeof the establishment, a limited number of direct dialinwards (DDI) lines may be considered desirable.

6.137 Silent methods of annunciation should beconsidered as an alternative to audible telephones.

6.138 A properly planned telephone system will provideprompt intercommunication facilities between allextensions.

6.139 Coin- and/or card-operated phones may beprovided. Payphones should incorporate acoustic hoods

to facilitate privacy. If payphones are provided, at leastone should be suitable for use by disabled persons. It should be wheelchair-accessible and fitted with aninductive coupler to assist people using a hearing aid.

Security systems

6.140 Any parts of the facility that are only used duringthe day should be protected “out of hours” by anintruder alarm system complying with BS 4737,BS 7042 or BS 5979 as appropriate.

6.141 Points of ingress and egress from the facilityshould be monitored by high-definition CCTVs equippedwith pan and tilt facility and capable of producing high-quality images at low levels of light. Positioning ofcameras should be determined with care, selectingoptimum positioning for maximum field of coverage.Monitors should be sited at a location that ispermanently manned whilst the facility is in use.

6.142 Entrances to wards and sensitive areas such asdiagnostic and treatment areas should be protected byone of the variety of electronic access control systemsavailable.

Call systems

6.143 Personal attack alarms should be made availableto vulnerable staff, preferably capable of identifying thelocation of a member of staff in difficulty.

6.144 Patient/staff call points should be provided in allspaces where patients may be left alone temporarily,such as rooms for consultation/examination rooms,treatment rooms and patient WCs.

6.145 Each call unit should comprise a push-button orpull cord, reassurance lamp and reset unit. The audiblealarm signal initiated by patients should operate for one second at 10-second intervals with correspondinglamps lit continuously until cancelled. The alarm shouldbe capable of operation by a disabled person.

6.146 A visual and audible indication of operation ofeach call point should be provided at the staff base togive responding staff unambiguous identification of thecall source, with a repeater unit in the staff rest room.

Public area entertainment facilities

6.147 Cabling provision should be made for television/video and piped music/radio systems in waiting areaswhere shown on room data sheets.

Lightning protection

6.148 Protection of the building against lightning should be provided in accordance with HTM 2007 andBS 6651.


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42

INTRODUCTION

7.1 For all types of health building, it is important thatbuilding costs and revenue expenditure are kept as lowas possible and consistent with acceptable standards.In applying the guidance in this document to determinea detailed design, the need for economy should alwaysbe of prime concern, and the activities should becarefully considered so that, where appropriate, space can be shared for similar activities which areprogrammed to take place at different times. Thesolution should not be detrimental to the properfunctioning of the spaces involved nor to the needs ofthe users. Within this general context, this series ofdocuments provides a synopsis of accommodation for health buildings which the Department of Healthrecommends for the provision of a given service.

DEPARTMENTAL COST ALLOWANCE GUIDES

7.2 Departmental Cost Allowance Guides (DCAGs)related to this HBN are officially notified in ‘QuarterlyBriefing’, published by NHS Estates. A full listing of all DCAGs is published in the ‘Healthcare CapitalInvestment’ document – a hard copy of which can be obtained from NHS Estates; copies can also bedownloaded from http://www.nhsestates.gov.uk. Furtherinformation on this can be obtained from NHS Estates,telephone 0113 254 7070.

7.3 The attention of the project team is drawn toguidance given in the ‘Capital Investment Manual’(Business Case Guide) published by The StationeryOffice. This publication seeks to reflect the importantchanges that have taken place over recent years, bothwith the introduction of the NHS reforms and with thechanging patterns of healthcare delivery. This newprocess is intended to reduce unnecessary and oftenexpensive planning work that may subsequently proveto be abortive, and emphasises the necessity for asound business case in support of both the capital and the revenue expenditure involved. The CapitalInvestment Manual also states that the capital worksestimate of the intended scheme must be based,wherever applicable, on industry norms such as theDCAGs plus a percentage to cover for on-costs.

7.4 The DCAGs for this HBN reflect the total buildingand engineering requirements and accommodation thatthe accident and emergency facilities for adults andchildren will require when incorporated into an acutegeneral hospital where the common use of services willbe available. Costs are based on a typical two-storeynew-build unit, on a greenfield site with no planningconstraints.

7.5 DCAGs are exclusive of VAT, Building and PlanningFees and all Local Authority charges, and are based ona Location Factor of 1.

ON-COSTS

7.6 It is important to bear in mind that an allowance foron-costs should be added to the DCAGs for all units,this element being for external works, externalengineering services and abnormals etc. The abnormalswill largely be determined by the characteristics of thesite, such as an inner-city location or poor groundconditions, or the condition and type of the existingbuilding if refurbishment is the only option.

7.7 It is important that project teams should assess atthe earliest opportunity all the likely on-cost implicationsof individual sites and schemes.

LOCATIONAL FACTORS

7.8 Locational factor adjustments may be applied to the Works Costs (that is, the total of the DCAGs plusestablished on-costs) to take into account the localmarket conditions. For further information regardingthese, please refer to the latest Regional Locationfactors in ‘Quarterly Briefing’, published by NHS Estates.

SCHEDULES OF ACCOMMODATION

7.9 The schedules at the end of this chapter showexample notional whole department accommodation.The examples are not to be taken as idealprovision for any particular project.

7.10 The examples included are as follows:

• 40,000 attendances: 6 assessment rooms and 6 treatment rooms;

7 Cost information


7 COST INFORMATION

43



• 90,000 attendances: 12 assessment rooms and 12 treatment rooms.

DIMENSIONS AND AREAS

7.11 In determining spatial requirements, the essentialfactor is not the total area provided but the criticaldimensions, that is, those dimensions critical to theefficient functioning of the activities which are to becarried out. To assist project teams in preparing detaileddesign solutions for the rooms and spaces, studies havebeen carried out to establish dimensional requirementsin the form of critical dimensions. The results of thesestudies appear as ergonomic diagrams in HealthBuilding Note 40 Volumes 1–4.

7.12 For development planning and at the earliest stageof a design, it may be convenient for designers to havedata available which will enable them to make anapproximate assessment of the sizes involved. For this reason, the areas prepared for the purpose ofestablishing the cost allowances are listed in theschedules of accommodation found at the end of thischapter.

7.13 It is emphasised that the areas published donot represent recommended sizes, nor are they tobe regarded in any way as specific individualentitlements.

7.14 Planning of the building efficiently may alsonecessitate variation of areas, for instance, in therefurbishment or conversion of older property:

a. rooms tend to be larger than the recommended area;

b. some rooms may be too small or in the wronglocation for efficient use;

c. circulation space tends to form a larger than normalproportion of the total area.

CIRCULATION

7.15 Space for circulation – that is, all internal corridors,small vertical ducts and spaces occupied by partitionsand walls – is included.

7.16 Provision is also made for a 5% planning zone anda 3% addition for an engineering zone adjacent to theexternal walls. These areas are all included and thereforecosted in the DCAGs.

7.17 It is also important to remember that the circulationfigures included in the DCAGs for this type of

accommodation are those anticipated for new purpose-built premises with no constraints. Where constraintsare encountered, for example in refurbishment orconversion of older types of property, this circulationfigure would be likely to increase accordingly, andtherefore some adjustment may be necessary to thecirculation figure.

COMMUNICATIONS

7.18 Staircases and lifts are not included in the DCAGsrelevant to this department. Costs related to theseelements, along with a suitable space allowance, shouldbe made in the on-costs.

LAND COSTS

7.19 As is the norm for DCAGs, costs are exclusive ofall land costs and associated fees. However, the projectteam’s attention is drawn to the fact that costsassociated with these should be included in theBusiness Case submission, all as detailed in the CapitalInvestment Manual, and could therefore be an importantpart of the overall cost viability of the scheme.

ENGINEERING SERVICES

7.20 The following engineering services, as described in Chapter 6 and exemplified in the Activity Data, areincluded in the cost allowances. Primary engineeringservices are assumed to be conveniently available at theboundary of the department.

Mechanical services

a. Heating – low pressure hot water system.

b. Ventilation – mechanical supply and extract to allclinical areas and areas requiring extract due to typeof room, that is, WCs, showers etc. Ventilation plant,that is, air handling units/extract fans, are notincluded in the cost allowances.

c. Cold water service – centrally supplied to servicepoints including drinking water. Storage tanks areexcluded.

d. Hot water service – supplied from a central system;storage and generation is excluded.

e. Piped medical gases oxygen, medical compressedair and vacuum. An emergency 2 x 1 oxygenmanifold is included in the cost allowances; medicalcompressed air and vacuum plant are excluded.

f. Nitrous oxide and anaesthetic gas scavenging systemare project options and are not included in the costs.

g. Pneumatic tube transport systems are project optionsand are not included in the costs.


44

Electrical services

a. Departmental distribution boards.

b. General lighting as required by task.

c. Examination lighting (examination lamps).

d. Emergency luminaires as appropriate.

e. Socket-outlets and other power outlets for fixed andportable equipment.

f. Supplementary equipotential earth bonding.

g. UPS supplies and equipment.

h. Fire alarm system.

j. TV/radio wireways only.

k. Telephone internal cabling distribution and outlets –handsets are excluded.

m.Data wireways only included.

Equipment (Group 1)

a. Water boiler in staff room and pantry.

b. Drugs cupboards.

c. Service pendants.

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EXAMPLE SCHEDULES

Clinical decision unit facilities

No guidance on the accommodation required in a CDU is currently available.Facilities should be developed in relation to local service delivery requirements

Patient decontamination facilities

No guidance on the accommodation required in a decontamination area is currently available.Advice must be sought from the Radiation Protection Officer, Emergency Planning Officer and the Medical Toxicology Unit

Department functional size/comprising Example 1 Example 2 Example 3 Example 440,000 attendances 50,000 attendances 70,000 attendances 90,000 attendances6 assessment/ 8 assessment/ 10 assessment/ 12 assessment/6 treatment rooms 8 treatment rooms 10 treatment rooms 12 treatment rooms

Activity Space Qty Area Total Qty Area Total Qty Area Total Qty Area Total Para Ref Notes

Entrance, reception & waiting facilities

Car parking spaces for people with disabilities and parents with young children – – – – – – – – – – – – Para 2.10 –

Ambulance parking bay – – – – – – – – – – – – Para 2.7 –Main entrance draught lobby 1 11.0 11.0 1 11.0 11.0 1 11.0 11.0 1 11.0 11.0 Para 2.9, 3.1, 3.2, Main entrance

3.4 Includes entrancecanopy area

Main entrance draught lobby 1 11.0 11.0 1 11.0 11.0 1 11.0 11.0 1 11.0 11.0 Para 2.7, 2.9, 3.1, Ambulance entrance3.2, 3.4 Includes entrance

canopy areaParking bay: 3 wheelchairs 1 2.0 2.0 – – – – – – – – – Para 3.5 –Parking bay: 6 wheelchairs – – – 1 4.0 4.0 1 4.0 4.0 1 4.0 4.0 Para 3.5 –Parking bay: 2 accident trolleys & 2 wheelchairs 1 9.0 9.0 – – – – – – – – – Para 3.5 –Parking bay: 3 accident trolleys & 3 wheelchairs – – – 1 12.0 12.0 1 12.0 12.0 1 12.0 12.0 Para 3.5 –Reception: 2 staff 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 Para 3.8 See Appendix 1

Sheet 6Parking bay: shopping, prams & pushchairs 1 6.0 6.0 – – – – – – – – – – OptionalParking bay: shopping, prams & pushchairs – – – 1 12.0 12.0 1 12.0 12.0 1 12.0 12.0 – OptionalWaiting area: 15 persons including 2 wheelchair users 1 25.5 25.5 – – – – – – – – – Para 3.20 –Waiting area: 20 persons including 2 wheelchair users – – – 1 33.0 33.0 – – – – – – Para 3.20 –Waiting area: 25 persons including 2 wheelchair users – – – – – – 1 40.5 40.5 – – – Para 3.20 –Waiting area: 30 persons including 3 wheelchair users – – – – – – – – – 1 49.5 49.5 Para 3.20 –Waiting play area: 5 children 1 13.0 13.0 – – – – – – – – – Para 3.20, 3.31 –Waiting play area: 10 children – – – 1 18.0 18.0 1 18.0 18.0 1 18.0 18.0 Para 3.20, 3.31 –Public telephone: single booth, accessible 2 2.0 4.0 2 2.0 4.0 2 2.0 4.0 2 2.0 4.0 Para 3.21, 3.29, –

5.7Refreshment: drinking water dispenser 1 0.5 0.5 1 0.5 0.5 1 0.5 0.5 1 0.5 0.5 Para 3.21 –Refreshment: vending machine 1 3.0 3.0 1 3.0 3.0 1 3.0 3.0 1 3.0 3.0 Para 3.29 –WC & hand-wash: semi-ambulant 4 2.5 10.0 4 2.5 10.0 6 2.5 15.0 6 2.5 15.0 Para 3.22, 3.26, Separate Male &

3.32 FemaleWC & hand-wash: accessible, wheelchair assisted 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 Para 3.22, 3.26, –

3.32Nappy change room with hand-wash 1 4.0 4.0 1 4.0 4.0 1 4.0 4.0 1 4.0 4.0 Para 3.22, 3.26, –

3.32Infant feeding room 1 5.5 5.5 1 5.5 5.5 1 5.5 5.5 1 5.5 5.5 Para 3.22, 3.26, –

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46 Department functional size/comprising Example 1 Example 2 Example 3 Example 4

40,000 attendances 50,000 attendances 70,000 attendances 90,000 attendances6 assessment/ 8 assessment/ 10 assessment/ 12 assessment/6 treatment rooms 8 treatment rooms 10 treatment rooms 12 treatment rooms


Social care & distressed/disturbed persons facilities

Interview room: 5 person 1 11.0 11.0 1 11.0 11.0 1 11.0 11.0 1 11.0 11.0 Para 2.54, 2.58, Distressed/disturbed 3.87 person’s

WC & handwash: accessible, wheelchair 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 Para 2.54, 2.59, –independent/assisted 3.87

Special room: distressed/disturbed patient – – – – – – 1 11.0 11.0 1 11.0 11.0 Para 2.60, 3.90 OptionalDual access required

WC & handwash: accessible, wheelchair – – – – – – 1 4.5 4.5 1 4.5 4.5 Para 3.90 Optionalindependent/assisted

Assessment facilities

Assessment room: A&E 3 16.0 48.0 4 16.0 64.0 5 16.0 80.0 6 16.0 96.0 Para 3.34 See Appendix 1 Sheet 1

Assessment room: Paediatric, A&E 3 16.0 48.0 4 16.0 64.0 5 16.0 80.0 6 16.0 96.0 Para 3.35 –

Treatment facilities

Waiting area: 5 persons including 1 wheelchair user 1 9.0 9.0 – – – – – – – – – Para 3.20 –Waiting area: 10 persons including 1 wheelchair user – – – 1 16.5 16.5 1 16.5 16.5 1 16.5 16.5 Para 3.20 –WC & handwash: specimen; accessible, wheelchair 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 Para 3.113 –Treatment room: A&E, multi-functional 4 16.0 64.0 6 16.0 96.0 8 16.0 128.0 10 16.0 160.0 Para 3.43, 3.44, See Appendix 1

3.55 Sheet 2A number of theserooms should besuitably decorated, furnished & equippedfor children

Treatment room: A&E, head & neck 1 16.0 16.0 1 16.0 16.0 1 16.0 16.0 1 16.0 16.0 Para 3.44, 3.57 See Appendix 1 Sheet 4

Treatment room: A&E, gynaecology/genito-urinary 1 16.0 16.0 1 16.0 16.0 1 16.0 16.0 1 16.0 16.0 Para 3.45, 3.59 See Appendix 1 colposcopy Sheet 3

WC & hand-wash: accessible, wheelchair assisted 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 1 4.5 4.5 Para 3.59 AdjacentStaff & communication base: 2 staff 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 Para 3.83 –Supplies base 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 Para 3.54 –

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Patient resuscitation facilities

Resuscitation room: 3 places 1 89.0 89.0 – – – – – – – – – Para 3.62 See Appendix 1 Sheet 5One bay equipped forbabies, children &young people

Resuscitation room: 4 places – – – 1 116.0 116.0 – – – – – – Para 3.62 See Appendix 1 Sheet 5One bay equipped forbabies, children &young people

Resuscitation room: 5 places – – – – – – 1 143.0 143.0 1 143.0 143.0 Para 3.62 See Appendix 1 Sheet 5One bay equipped forbabies, children &young people

Distressed & bereaved persons facilities

Sitting & body viewing room with beverage bay: 2 16.0 32.0 2 16.0 32.0 2 16.0 32.0 2 16.0 32.0 Para 2.63, 3.66, Family and friends8 persons 3.91

WC & hand-wash: accessible, wheelchair-assisted 2 4.5 9.0 2 4.5 9.0 2 4.5 9.0 2 4.5 9.0 Para 3.92 En-suite optionalBody viewing/bier room 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 Para 3.66, 3.99 Dual access

Support facilities: Clinical

Near-patient testing/status laboratory 1 8.5 8.5 1 8.5 8.5 1 8.5 8.5 1 8.5 8.5 Para 2.51, 3.102 –Dirty utility: bedpan disposal & urine test 1 12.0 12.0 1 12.0 12.0 1 12.0 12.0 1 12.0 12.0 Para 3.54, 3.111 –Parking bay: ultrasound unit 1 1.0 1.0 1 1.0 1.0 1 1.0 1.0 1 1.0 1.0 Para 2.48 –

Staff support facilities: Rest & recreation

Rest & dining room: 20 staff 1 25.0 25.0 – – – – – – – – – Para 4.6 Direct access topantry

Rest & dining room: 30 staff – – – 1 40.0 40.0 – – – – – – Para 4.6 Direct access topantry

Rest & dining room: 35 staff – – – – – – 1 46.0 46.0 1 46.0 46.0 Para 4.6 Direct access topantry

Pantry: serving 20 persons 1 6.0 6.0 – – – – – – – – – Para 4.9 –Pantry: serving over 20 persons – – – 1 12.0 12.0 1 12.0 12.0 1 12.0 12.0 Para 4.9 –

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48 Department functional size/comprising Example 1 Example 2 Example 3 Example 4

40,000 attendances 50,000 attendances 70,000 attendances 90,000 attendances6 assessment/ 8 assessment/ 10 assessment/ 12 assessment/6 treatment rooms 8 treatment rooms 10 treatment rooms 12 treatment rooms


Staff support facilities: Overnight accommodation

On-call overnight stay room 1 13.0 13.0 1 13.0 13.0 2 13.0 26.0 2 13.0 26.0 Para 4.11 –Shower, WC & wash: ambulant (non patient) 1 5.0 5.0 1 5.0 5.0 2 5.0 10.0 2 5.0 10.0 Para 4.11 –

Staff support facilities: Sanitary & changing

WC & wash: ambulant 5 2.0 10.0 8 2.0 16.0 10 2.0 20.0 10 2.0 20.0 Para 4.8, 4.16 –Shower: ambulant (non-patient) 4 2.5 10.0 4 2.5 10.0 4 2.5 10.0 4 2.5 10.0 Para 4.12 –Staff changing room: 20 places 1 11.5 11.5 – – – – – – – – – Para 4.13 –Staff changing room: 30 places 1 16.0 16.0 1 16.0 16.0 1 16.0 16.0 – – – Para 4.13 –Staff changing room: 40 places – – – 1 20.0 20.0 – – – 1 20.0 20.0 Para 4.13 –Staff changing room: 50 places – – – – – – 1 25.0 25.0 1 25.0 25.0 Para 4.13 –

Staff support facilities: Offices

Office: 1 staff 3 10.5 31.5 4 10.5 42.0 4 10.5 42.0 4 10.5 42.0 Para 4.23 –Office: 2 staff 1 13.0 13.0 1 13.0 13.0 1 13.0 13.0 1 13.0 13.0 Para 4.24 –Office: 3 staff 2 18.0 36.0 – – – – – – – – – Para 4.24 –Office: 4 staff – – – 2 24.0 48.0 2 24.0 48.0 2 24.0 48.0 Para 4.24 –Interview & counselling room: 5 persons 1 9.0 9.0 1 9.0 9.0 1 9.0 9.0 1 9.0 9.0 Para 4.19 –Interview/meeting room: 6 persons 1 14.0 14.0 1 14.0 14.0 1 14.0 14.0 1 14.0 14.0 Para 4.19 –

Staff support facilities: Education & training

Seminar & training room: 15 persons 1 27.5 27.5 – – – – – – – – – Para 4.29 –Seminar & training room: 20 persons – – – 1 37.5 37.5 1 37.5 37.5 1 37.5 37.5 Para 4.29 –Library & study room: 5 persons 1 20.0 20.0 1 20.0 20.0 1 20.0 20.0 1 20.0 20.0 Para 4.32 –

Support facilities: Holding & storage

Store: equipment & supplies 1 24.0 24.0 – – – – – – – – – Para 2.55, 4.36 –Store: equipment & supplies – – – 1 30.0 30.0 1 30.0 30.0 – – – Para 2.55, 4.36 –Store: equipment & supplies – – – – – – – – – 1 36.0 36.0 Para 2.55, 4.36 –Store: sterile supplies 1 9.0 9.0 – – – – – – – – – Para 3.119, 4.40 –Store: sterile supplies – – – 1 12.0 12.0 1 12.0 12.0 – – – Para 3.119, 4.40 –Store: sterile supplies – – – – – – – – – 1 15.0 15.0 Para 3.119, 4.40 –Store: major incident equipment 1 6.0 6.0 1 6.0 6.0 1 6.0 6.0 1 6.0 6.0 Para 4.35 –Store: ready to use medical gas cylinders 1 9.0 9.0 1 9.0 9.0 1 9.0 9.0 1 9.0 9.0 Para 4.41 –Store: ambulance equipment 1 6.0 6.0 1 6.0 6.0 1 6.0 6.0 1 6.0 6.0 Para 4.34 –Service room: equipment 1 12.0 12.0 1 12.0 12.0 – – – – – – Para 3.116 –Service room: equipment – – – – – – 1 21.0 21.0 1 21.0 21.0 Para 3.116 –

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Support facilities: Miscellaneous

Ambulance cleaning bay 1 – – 1 – – 1 – – 1 – – Para 4.33 –Hold: disposal 1 6.0 6.0 – – – – – – – – – Para 4.46 –Hold: disposal – – – 1 10.0 10.0 1 10.0 10.0 1 10.0 10.0 Para 4.46 –Cleaners (Housekeeping) room 1 7.0 7.0 1 7.0 7.0 1 7.0 7.0 1 7.0 7.0 Para 4.44 –Switchgear room 1 4.0 4.0 1 4.0 4.0 1 4.0 4.0 1 4.0 4.0 Para 4.52, 6.92 –Battery & UPS room 1 9.0 9.0 1 9.0 9.0 1 9.0 9.0 1 9.0 9.0 Para 4.48 –

Net Allowance 865.5 1068.5 1229.5 1315.5

5% Planning Allowance 43.5 53.5 61.5 66.0Total 909.0 1122.5 1291.0 1381.53% Engineering Allowance 27.5 33.5 38.5 41.533% Circulation Allowance 300.0 370.5 426.0 456.0

Total Allowance 1236.5 1526.0 1755.5 1879.0

Essential complementary/shared accommodation

Activity Space Qty Area Gross Para Ref NotesArea

Dispenser bay: car park ticket 1 10.0 13.5 – –Seminar & training room: 30 persons 1 55.0 55.0 Para 4.28 –

Optional accommodation

Activity Space Qty Area Gross Para Ref NotesArea

Waiting area: 5 persons including 1 wheelchair user 1 9.0 12.0 – Supplementary waitingTreatment room: plaster 1 16.0 21.5 Para 3.50 –Store: plaster 1 3.0 4.0 – –On-call overnight stay room 1 13.0 17.5 Para 4.11 AdditionalShower, WC & wash: ambulant (non-patient) 1 5.0 7.0 Para 4.11 AdditionalParking bay: mobile 1 X-ray unit 1 2.0 2.5 Para 3.106 –


50

The following room layouts are provided as a guide onlyto the organisation of space and equipment in A&Efacilities.

Sheet 1 Assessment Room

Sheet 2 Multi-Functional Treatment Room

Sheet 3 Gynaecology/genito-urinary Treatment Room

Sheet 4 Head and Neck Treatment Room

Sheet 5 Resuscitation Room (critical dimensions)

Sheet 6 Reception Counter

Note: all measurements on the following sheets aregiven in millimetres (mm)

Appendix 1 – Example room layouts

APPENDIX 1 – EXAMPLE ROOM LAYOUTS

51

Assessment Room

Sheet 1

Accommodation for carrying out assessment and registration of patients. The patient may enter the room walking, with or without aids, or using a wheelchair, and may transfer onto the trolley. One or more escorts may be present. The patient may undress with assistance. Examination will be performed by 1–2 staff who may need to work from all sides of the trolley.

Computer facilities for recording patient data by the ‘roving’ receptionist are required. Facilities for clinical handwashing, storage of medical items, and disposal of soiled dressings must also be provided.

The computer should be on a 750 high worktop. This is satisfactory for short spells of keyboard use, or standing to write. A printer will be required for prescriptions, information sheets, appointments etc. An adjustable height office chair will be required for staff.

1. Escorts’ stacking chairs2. Hat and coat hooks3. Mirror4. Adjustable trolley5. Dressing trolley6. Storage with access from corridor7. Clinical hand-wash basin8. Computer terminal and printer on work surface and office chair9. Examination lamp

zone for washing

minimum space

1200

for sitting

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cces

s

1200

1000

zone

aro

und

tro

lley

unob

stru

cted

wor

king

1500

zone

aro

und

tro

lley 10

00

minimum spaceto use worktop zone around trolley

unobstructed working

3600

600

23

5

6

7

1

1000

8

1000

unob

stru

cted

wor

king

zone

aro

und

tro

lley 10

00

4

9


52

Multi-functional TreatmentRoom

Sheet 2

Computer facilities for recording patient data must be provided. Facilities must also be provided for the storage of medical items and disposal of soiled dressings. Clinical handwashing facilities are required. X-ray viewing will be via an illuminator or computer terminal.

The computer should be on a 750 high worktop. This is satisfactory for short spells of keyboard use, or standing to write. A printer will be required for prescriptions, information sheets, appointments etc. An adjustable-height office chair will be required for staff.

Trolley to be adjustable in height to facilitate patient transfer, especially from a wheelchair, and for the requirements of staff of different heights.

3

4

2

5

6

7

1

1. Escorts’ stacking chairs 2. Supply unit with medical gases, monitoring equipment and examination lamp 3. Mirror 4. Hat and coat hooks 5. Dressing trolley 6. Storage with access from corridor 7. Clinical hand-wash basin 8. Optional X-ray viewer 9. Computer terminal and printer on worksurface and office chair 10. Adjustable trolley

zone for washing

minimum space

1200for sitting

450

4500

unob

stru

cted

wor

king

cup

boa

rdsp

ace

to a

cces

s

1200

1000

zone

aro

und

tro

lley

unob

stru

cted

wor

king

1500

zone

aro

und

tro

lley

1000

minimum spaceto use worktop

zone around trolleyunobstructed working

1000

3600

1000

600

5

8

9

10

Accommodation for carrying out clinical examinations and emergency medical and nursing procedures. The patient may enter the room walking, with or without aids, or using a wheelchair and may be transferred to the trolley, or may be brought into the room on a trolley. One or more escorts may be present. The patient may undress with assistance.

Procedures will be performed by 1–4 staff who may need to work from all sides of the trolley. Minor surgery may take place and plasters may be fitted.


53

Gynaecology/genito-urinaryTreatment Room

Sheet 3

4500

cup

boa

rdsp

ace

to a

cces

s

1200

unob

stru

cted

wor

king

1000

zone

aro

und

tro

lley

unob

stru

cted

wor

king

1500

zone

aro

und

tro

lley

1000

zone for washing

minimum space

1200for sitting

450



10001000

600

3600

5

8

9

2

14

7

6

35

11

1. Escorts’ stacking chairs 2. Supply unit with medical gases, monitoring equipment and examination lamp 3. Mirror 4. Hat and coat hooks 5. Dressing trolley 6. Storage with access from corridor 7. Clinical hand-wash basin 8. Optional X-ray viewer 9. Computer terminal and printer on work surface and office chair10. Gynaecology/urology couch11. Curtain and track for privacy

10

Accommodation for carrying out clinical examinations and treatment for patients with gynaecological or genito-urinary problems. The patient may enter the room walking, with or without aids, or using a wheelchair and may be transferred to the trolley or may be brought into the room on a trolley. One or more escorts may be present. The patient may undress with assistance. Procedures will be performed by 1–4 staff who may need to work from all sides of the trolley. Computer facilities for recording patient data must be provided. Facilities must also be provided for the storage of medical items and disposal of soiled dressings. Clinical handwashing facilities are required. X-ray viewing will be via an illuminator or computer terminal. For maximum flexibility this room can also be used as a multi-functional treatment room.

The computer should be on a 750 high worktop. This is satisfactory for short spells of keyboard use or standing to write. A printer will be required for prescriptions, information sheets, appointments etc. An adjustable-height office chair will be required for staff.


54

Head and Neck Treatment Room

Sheet 4un

obst

ruct

ed w

orki

ng

for sitting

zone for washing1200

8

7

9

1000

spac

e to

acc

ess

1200 cu

pb

oard

45003

minimum space450

5

2

14

1500


1000


600

1000

3600

zone

aro

und

tro

lley

10

11

1. Escorts’ stacking chairs 2. Supply unit with medical gases, monitoring equipment and examination lamp 3. Mirror 4. Hat and coat hooks 5. Dressing trolley 6. Storage with access from corridor 7. Clinical hand-wash basin 8. Optional X-ray viewer 9. Computer terminal and printer on work surface and office chair10. Patient ENT chair11. Slit lamp

Accommodation for carrying out clinical examinations and treatment of patients with ENT, ophthalmic and dental problems. The room can also be used for minor facial or scalp injuries requiring suturing. The patient may enter the room walking, with or without aids, or using a wheelchair. They will be examined and treated whilst sitting on the ENT chair or in a wheelchair. One or more escorts may be present. Procedures will be performed by up to two staff who may need to work from all sides of the chair. Computer facilities for recording patient data must be provided. Facilities must also be provided for the storage of medical items and disposal of soiled dressings. Clinical handwashing facilities are required. X-ray viewing will be via an illuminator or computer terminal.

For maximum flexibilty this room can also be used as a multi-functional treatment room.

The computer should be on a 750 high worktop. This is satisfactory for short spells of keyboard use or standing to write. A printer will be required for prescriptions, information sheets, appointments etc. An adjustable height office chair will be required for staff.

6


55

zone forfixed

equipment

zone forparking andmanoeuvringequipment

zone forworking aroundpatient trolley

2

600 1000800

zone forworking aroundpatient trolley

1000

zone forparking andmanoeuvringequipment

800

Resuscitation Room(critical dimensions)

Sheet 5

Ceiling-mounted pendant for multi-parameter monitoring and medical gases.

Computer facilities for recording patient data should be provided. Facilities should also be provided for the storage of medical items and disposal of soiled dressings. Clinical handwashing facilities are required, and X-ray viewing will be via an illuminator or computer terminal.

Many more than five staff may be working at speed and under pressure around the patient. The zone indicated around the patient trolley reflects this possibility.

The ceiling height should be 3000 mm to aid positioning the supply unit and to prevent a potential clash with optional overhead X-raygantry.

A hands-free telephone and intercom should be provided.

3

4

6

7

1

1. Escorts’ stacking chairs2. Supply unit with medical gases, life support, monitoring equipment and examination lamp3. Drugs cupboard and fridge4. Lead/uPVC protective curtain5. Dressing trolley6. Worktop with storage beneath and access from corridor7. Clinical hand-wash basin with hands-free taps8. Optional X-ray viewer9. Computer terminal and printer

zone for washing1200

6300

cup

boa

rdsp

ace

to a

cces

s12

00

49004900

5

8

9

zone forworking at

head of patient1000

zone for grab boardand other wall

equipment and supplies200

zone forworking at

foot of patient1000

5

4

Accommodation for patients who arrive on a trolley seriously ill or injured to be assessed and resuscitated in visual privacy. Facilities for preforming emergency medical procedures by a minimum of five staff who require space to work at all sides of thepatient trolley, and space to use equipment. One or more escorts may be present.


56

independentwheelchair

passing

standingat counter

100

ambulantpassingkeyboard

and papers

computer

and stationery

shelffor

bags

space for wheelchairambulantpassing

writing shelf,wheelchair turning circle

and access to andwithdrawal from counter

withdrawal

at counterperson seated

600

and knee hole forwheelchair users

700 shelf for bags

space for900

access and

600800600900

500space for1200600

1500 300

250

housing

1200

600

800

to printer and storagespace for access

1200

1750 eye-leveltall man

seat height adjustablefrom 430 to 530

700 work top height

1100 seated eyelevel, small woman

Reception Counter

Sheet 6

1200 mm width for the computer workplace will allow for screen, keyboard, mouse mat, papers and telephone. Clear width for legs under desk is 600 mm, so storage space and bins can beaccommodated.

Patients, escorts and staff should be able to talk and exchange information with ease. A counter depth of 800 mm will allow adequate space for the computer and help to protect staff whilst still allowing receptionist and patient to hear each other. A raised area should protect the back of the computer, with an area for writing along the top. A shelf for bags is useful on the patient side.

There is evidence that violence occurs less at welcoming, open-plan reception desks than at enclosed ‘secure’ offices. If a glass screen is fitted, account should be taken of people with hearing difficulties.

An adjustable height (430–530 mm) swivel chair with castors is required for the receptionist. A footrest should be provided.

Each workstation should incorporate an alarm for staff to summon assistance.

1150 eye-levelsmall womanin wheelchairheight

1000 counter

small woman1420 eye-level

security screenoptional

printer

worktop workspace

worktop workspace

One or more reception staff will greet patients and direct them to the assessment room or waiting area. The reception area should be located in an open space directly inside the entrance and be immediately visible, and in full view of the security office. Patients may be adults or children, walking, with or without aids, or using a wheelchair and may be accompanied.

The position of the reception area should allow staff to see all patients and escorts entering the department and have vision to the main waiting and children's waiting/play areas.

The desk height to be 700 mm to allow staff to sit and use computers comfortably, with a desk thickness of 20 mm. This height is appropriate for those who use wheelchairs, and for children.

57

ACTS AND REGULATIONS

Building Regulations 2000, Approved Document M– Access to and use of buildings. The StationeryOffice, London, 2003.

Construction (Design and Management)Regulations 1994. SI 1994 No 3140.http://www.hmso.gov.uk/si/si1994/Uksi_19943140_en_1.htm

Construction (Design and Management)(Amendment) Regulations 2000. SI 2000 No 2380.http://www.legislation.hmso.gov.uk/si/si2000/20002380.htm

The Control of Substances Hazardous to Health(COSHH) Regulations. SI 2002: 2677. The StationeryOffice, 2002.

Disability Discrimination Act 1995.http://www.hmso.gov.uk/acts/acts1995/1995050.htm

Environmental Protection Act 1990.http://www.hmso.gov.uk/acts/acts1990/Ukpga_19900043_en_1.htm

The Gas Safety (Installation and Use) Regulations.SI 1886:1994. HMSO, 1994.http://www.hmso.gov.uk/si/si1994/Uksi_19941886_en_1.htm

Health and Safety at Work etc Act 1974.

Health and Safety (Safety Signs and Signals)Regulations. SI 341:1996. The Stationery Office, 1996.http://www.legislation.hmso.gov.uk/si/si1996/Uksi_19960341_en_1.htm

Ionising Radiation (Medical Exposure) Regulations2000. SI 2000 No 1059. http://www.hmso.gov.uk/si/si2000/20001059.htm

Ionising Radiations Regulations 1999. SI 1999 No3232. http://www.hmso.gov.uk/si/si1999/19993232.htm

Management of Health and Safety at WorkRegulations 1999. SI 1999 No 3242.http://www.hmso.gov.uk/si/si1999/19993242.htm

Noise at Work Regulations. SI 1790:1989. HMSO,1989.http://www.legislation.hmso.gov.uk/si/si1989/Uksi_19891790_en_1.htm

Pressure Systems Safety Regulations. SI 128:2000.The Stationery Office, 2000.http://www.legislation.hmso.gov.uk/si/si2000/20000128.htm

Pressure Equipment Regulations. SI 2001:1999. The Stationery Office, 1999.http://www.hmso.gov.uk/si/si1999/19992001.htm

Provision and Use of Work Equipment Regulations1998. SI 1998 No 2306. http://www.hmso.gov.uk/si/si1998/19982306.htm

Radioactive Substances Act 1993.http://www.hmso.gov.uk/acts/acts1993/Ukpga_19930012_en_1.htm

Workplace (Health, Safety and Welfare)Regulations 1992. SI 1992 No 3004.http://www.hmso.gov.uk/si/si1992/Uksi_19923004_en_1.htm

BRITISH STANDARDS

BS 2881:1989 Specification for cupboards for thestorage of medicines in health care premises.

BS 4737-2:1986 Intruder alarm systems. Specificationfor installed systems for deliberate operation.

BS 5979:2000 Code of practice for remote centresreceiving signals from security systems.

BS 6651:1999 Code of practice for protection ofstructures against lightning.

BS 7042:1988 Specification for high security intruderalarm systems in buildings.

BS 7671:2001 Requirements for electrical installations.IEE Wiring Regulations. Amendment No 1 AMD 13628published February 2002 and AMD 14905 March 2004.British Standards Institution, 2001.

BS 8300:2001 Design of buildings and their approachesto meet the needs of disabled people. Code of Practice.

Appendix 2 – References

http://www.hmso.gov.uk/si/si1994/Uksi_19943140_en_1.htm

http://www.legislation.hmso.gov.uk/si/si2000/20002380.htm

http://www.hmso.gov.uk/acts/acts1995/1995050.htm

http://www.hmso.gov.uk/acts/acts1990/Ukpga_19900043_en_1.htm


http://www.legislation.hmso.gov.uk/si/si1996/Uksi_19960341_en_1.htm

http://www.hmso.gov.uk/si/si2000/20001059.htm



http://www.legislation.hmso.gov.uk/si/si1989/Uksi_19891790_en_1.htm

http://www.legislation.hmso.gov.uk/si/si2000/20000128.htm



http://www.hmso.gov.uk/acts/acts1993/Ukpga_19930012_en_1.htm



58

BS EN 12056-1:2000 Gravity drainage systems insidebuildings. (issued in 5 parts).

BS EN 12464-1:2002 Light and lighting. Lighting ofwork places. Indoor work places.

BS EN 60598-2-25:1995, IEC 60598-2-25:1994Luminaires. Particular requirements. Luminaires for usein clinical areas of hospitals and health care buildings.

BS EN 60601-1-2:2002, IEC 60601-1-2:2002 Medicalelectrical equipment. General requirements for safety.Collateral standard. Electromagnetic compatibility.Requirements and tests.

BS EN 60601-2-4:2003 IEC 60601-2-4:2002 Medicalelectrical equipment. Particular requirements for safety.Particular requirements for the safety of cardiacdefibrillators.

BS EN 60601-2-26:2003, IEC 60601-2-26:2002Medical electrical equipment. Particular requirements forsafety. Particular requirements for the safety ofelectroencephalographs.

BS EN 60601-2-33:2002, IEC 60601-2-33:2002Medical electrical equipment. Particular requirements forsafety. Particular requirements for the safety of magneticresonance equipment for medical diagnosis.

DEPARTMENT OF HEALTH PUBLICATIONS

Capital Investment Manual, NHS Executive, 1994.http://www.nhsestates.gov.uk/capital_procurement/index.asp

National Service Framework for Children, YoungPeople and Maternity Services, 2004. http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ChildrenServices/ChildrenServicesInformation/fs/en

Effective management of security in A&E,Department of Health, 1997.

Modernising dentistry, Department of Health, 2000.

Planning for major incidents: the NHS guidance,Department of Health, 1998.

NHS ESTATES PUBLICATIONS

(NOTE: As guidance documents are being constantlyupdated, it is advisable that readers check the NHSEstates website for the most up-to-date publications listand the latest information on the more recent revisions:

http://www.nhsestates.gov.uk/publications_guidance/index.asp)

Health Building Notes

HBN 4: In-patient accommodation: options forchoice, HMSO, London, 1997.

HBN 4 Supplement 1 Isolation facilities in acutesettings, The Stationery Office, London, 2005.

HBN 6: Facilities for diagnostic imaging andinterventional radiology, The Stationery Office,London, 2001.

HBN 23: Hospital accommodation for children andyoung people, The Stationery Office, London, 2004.

HBN 40: Common activity spaces, Vols 1–4, HMSO,London, 1995.

Health Facilities Notes

HFN 14: Disability access, The Stationery Office,London, 2005.

HFN 30: Infection control in the built environment,The Stationery Office, London, 2002.

Health Guidance Notes

“Safe” hot water and surface temperatures, HMSO,London, 1998.

Structured cabling for IT systems, HMSO, London,1996.

Health Technical Memoranda

HTM 55: Windows, TSO, London, 2005.

HTM 56: Partitions, TSO, London, 2005.

HTM 57: Internal glazing, TSO, London, 2005.

HTM 58: Internal doorsets, TSO, London, 2005.

HTM 59: Ironmongery, TSO, London, 2005.

HTM 61: Flooring, TSO, London, 2005.

HTM 63: Fitted storage systems, TSO, London,2005.

HTM 81: Fire precautions in new hospitals, HMSO,London, 1996.

HTM 82: Alarm and detection systems, HMSO,London, 1996.

HTM 83: Fire safety in healthcare premises –general fire precautions, HMSO, London, 1994.

HTM 85: Fire precautions in existing hospitals,HMSO, London, 1994.

http://www.nhsestates.gov.uk/capital_procurement/index.asp

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ChildrenServices/ChildrenServicesInformation/fs/en

http://www.nhsestates.gov.uk/publications_guidance/index.asp

HTM 86: Fire risk assessment in hospitals, HMSO,London, 1994.

HTM 87: Textiles and furniture, HMSO, London,1999.

HTM 2005: Building management systems, HMSO,London, 1996.

HTM 2007: Electrical services supply anddistribution (Management policy, Designconsiderations, Validation and verification, Operationalmanagement), HMSO, London, 1993.

HTM 2009: Pneumatic air tube transport systems(Management policy, Design considerations and Goodpractice guide), HMSO, London, 1995.

HTM 2011: Emergency electrical services(Management policy, Design considerations, Validationand verification, Operational management), HMSO,London, 1993.

HTM 2020: Electrical safety code for low voltagesystems (Escode – LV) (Vol 1 – Operationalmanagement; Vol 2 – Electrical safety rulebook), HMSO,London, 1998.

HTM 2021: Electrical safety code for high voltagesystems (Escode – HV). HMSO, London, 1994 (issuedin 2 parts).

HTM 2022: Medical gas pipeline systems (Design,installation, validation and verification, Operationalmanagement), HMSO, London, 1997.

HTM 2023: Access and accommodation forengineering services (Management policy, Goodpractice guide), HMSO, London, 1995.

HTM 2025: Ventilation in healthcare premises(Management policy, Design considerations, Validationand verification, Operational management), HMSO,London, 1994.

HTM 2027: Hot and cold water supply, storage andmains services (Management policy, Designconsiderations, Operational management, Validation andverification), HMSO, London, 1995.

HTM 2040: The control of legionellae in healthcarepremises – a code of practice (Management policy,Design considerations, Operational management,Validation and verification, Good practice guide), HMSO,London, 1994

HTM 2045: Acoustics. The Stationery Office, London,1996.

Other NHS Estates publications

A&E design evaluation, The Stationery Office, 2004.

Environmental strategy for the NHS, The StationeryOffice, London, 2005.

Firecode: policy and principles, HMSO, London,1994.

Healthcare Capital Investment (supplement toQuarterly Briefing Volume 12 No 1 2002/2003.http://www.nhsestates.gov.uk/download/publications_guidance/HCI-Report_new.pdf

Improving the patient experience: Friendlyhealthcare environments for children and youngpeople, The Stationery Office, London, 2004.

Improving the patient experience: The art of goodhealth – a practical handbook, The Stationery Office,London, 2002.

Improving the patient experience: The art of goodhealth – using visual arts in healthcare, TheStationery Office, London, 2002.

Improving the patient experience: Welcomingentrances and reception areas, The Stationery Office,London, 2004.

Lighting and colour for hospital design: A report onan NHS Estates-funded research project (Dalke etal), The Stationery Office, London, 2004.

Modernising A&E environments, The StationeryOffice, London, 2004.

National Health Service Model EngineeringSpecifications. The Stationery Office, London, 1999(available in Mechanical and Electrical volumes or asseparate parts).

Quarterly Briefinghttp://www.nhsestates.gov.uk/publications_guidance/index.asp?submenu_ID=quarterly_briefing

Supporting patient care in Accident & Emergency –redesigning housekeeping and support facilities,NHS Estates, 2004.

Sustainable development in the NHS, The StationeryOffice, London, 2001.

Sustainable Development: NHS EnvironmentalAssessment Tool (NEAT).http://www.nhsestates.gov.uk/sustainable_development/index.asp?submenu_ID=neat

The impact of the built environment on care withinA&E departments, The Stationery Office, 2004.

Wayfinding: effective wayfinding and signingsystems – guidance for healthcare facilities, TheStationery Office, London, 2005.

APPENDIX 2 – REFERENCES

59

http://www.nhsestates.gov.uk/download/publications_guidance/HCI-Report_new.pdf

http://www.nhsestates.gov.uk/publications_guidance/index.asp?submenu_ID=quarterly_briefing

http://www.nhsestates.gov.uk/sustainable_development/index.asp?submenu_ID=neat


60

OTHER PUBLICATIONS

Accident & Emergency Modernisation Programme(AEMP), General principles for the planning ofaccident and emergency departments (AEMP,2001).

BAEM, The way ahead, British Association forAccident and Emergency, London, 1998. http://www.baem.org.uk/wayahead.pdf

BISRIA, TN 9/92 Space and weight allowances forbuilding services plant – inception stage design,1992.

BISRIA, TN 10/92 Space allowances for buildingservices distribution systems – detail design stage,1992.

Chartered Institution of Building Services Engineers(CIBSE), Guide F: Energy efficiency in buildings,CIBSE, London, 2004.

The Chartered Institution of Building Services Engineers(CIBSE), Lighting Guide LG3: The visualenvironment for display screen use, CIBSE, London,1996.

Chartered Institution of Building Services Engineers(CIBSE), Air distribution systems, Commissioningcode A, CIBSE, London, 1996.

Chartered Institution of Building Services Engineers(CIBSE), CIBSE GVG: Public health engineering,CIBSE, London, 2004

Chartered Institution of Building Services Engineers(CIBSE), Water distribution systems,Commissioning code W, CIBSE, London, 2003

Collins D, Tank M, Basith A, Concise guide tocustoms of minority ethnic religions, PortsmouthDiocesan Council for Social Responsibility, AshgatePublishing Ltd. England, 1993.

Health and Safety Executive, Occupational exposurelimits (EH40), updated annually.

Institute of Healthcare Engineering and EstateManagement, Guide to engineering commissioning,1995.

Institution of Electrical Engineers, Guidance Note 7:Special Locations, 2nd Edition. 2002.

King’s Fund, Enhancing the healing environment,2002.http://www.kingsfund.org.uk/eGrants/html/enhancing_the_healing_environm.html

Murray Parkes C, Laungani P, Young B, Death andBereavement Across Cultures, Routledge, London,1997.

National Audit Office, Improving Emergency Care,The Stationery Office, London, 2004.http://www.nao.org.uk/publications/nao_reports/03-04/03041075.pdf

Neuberger J, Caring for people of different faiths,Radcliffe Medical Press, Abingdon, 2004

NHS Modernisation Agency, See and Treat, 2002.http://www.modern.nhs.uk/emergency

Royal College of Psychiatrists College Research Unit,Management of imminent violence: clinicalpractice guidelines to support mental healthservices, Occasional Paper OP41, London, 1998. http://www.rcpsych.ac.uk/publications/guidelines/index.htm

Tope R, Isaac S, Isaac W, Rowley E, Relieving thewait: A community prototype for A&E services.HERC Associates & Anthony Hartley Associates, Cardiff,on behalf of NHS Estates, DH, 2001.

http://www.baem.org.uk/wayahead.pdf

http://www.kingsfund.org.uk/eGrants/html/enhancing_the_healing_environm.htm

http://www.nao.org.uk/publications/nao_reports/03-04/03041075.pdf

http://www.modern.nhs.uk/emergency

http://www.rcpsych.ac.uk/publications/guidelines/index.htm

A&E Accident and Emergency

AEMP Accident and Emergency ModernisationProgramme

AGS Anaesthetic gas scavenging

AHPs Allied health professionals

AVSU Area Valve Service Unit

BAEM British Association of Accident andEmergency Medicine

BMS Building Management System

BS British Standard

CAD Computer Aided Design

CCTV Closed circuit television

CCU Coronary care unit

CDU Clinical decision unit

CHD Coronary heart disease

CHPs Combined heat and power systems

CIBSE Chartered Institute of Building ServicesEngineers

CPD Continuing professional development

CR Computed radiography

CT Computed tomography

DCAGs Departmental Cost Allowance Guides

DH Department of Health

DVT Deep vein thrombosis

ECA Essential complementary/sharedaccommodation

ECG Electrocardiogram

EMC/EMI Electromagnetic compatibility/Electromagnetic interference

EME Electronics and medical engineering

ENT Ear nose and throat

EPO Emergency planning officer

EU European Union

GP General Practitioner

HAI Hospital-acquired infection

HBN Health Building Note

HFN Health Facilities Note

HGN Health Guidance Note

HTM Health Technical Memorandum

HWS Hot water system

IDEA Idealised Design of Emergency Care

LAN Local Area Network

MDA Medical Devices Agency

MIU Minor injury unit

NSF National Service Framework

PACS Picture Archiving and Communication System

PEU Paediatric Emergency Unit

PVC Polyvinyl chloride

RPA Radiation protection advisor

SSD Sterile Services Department

TRV Thermostatic radiator valves

UNICEF United Nations International Children’sEmergency Fund (United Nations Children’sFund)

UPS Uninterrupted Power Supply

WiC Walk-in Centre

61

Appendix 3 – Glossary of abbreviations


62

The Agency has a dynamic fund of knowledge which ithas acquired over 40 years of working in the field. Ourunique access to estates and facilities data, policy andinformation is shared in guidance delivered in fourprincipal areas:

Design & Building

These documents look at the issues involved inplanning, briefing and designing facilities that reflect thelatest developments and policy around service delivery.They provide current thinking on the best use of space,design and functionality for specific clinical services ornon-clinical activity areas. They may contain schedulesof accommodation. Guidance published under theheadings Health Building Notes (HBNs) and DesignGuides are found in this category.

Examples include:

HBN 22, Accident and emergency facilities for adults and children

HBN 57, Facilities for critical careHFN 30, Infection control in the built environment:

design and planning

Engineering & Operational (including FacilitiesManagement, Fire, Health & Safety andEnvironment)

These documents provide guidance on the design,installation and running of specialised building servicesystems and also policy guidance and instruction onFire, Health & Safety and Environment issues. HealthTechnical Memoranda (HTMs) and Health GuidanceNotes (HGNs) are included in this category.

Examples include:

HTM 2007, Electrical services supply and distributionHTM 2021, Electrical safety code for high voltage

systemsHTM 2022 Supplement 1Sustainable development in the NHS

Procurement & Property

These are documents which deal with areas of broadstrategic concern and planning issues, including capitaland procurement.

Examples of titles published under this heading are:

EstatecodeHow to cost a hospitalDeveloping an estate strategy

NHS Estates Policy Initiatives

In response to some of the key tasks of theModernisation Agenda, NHS Estates has implemented,project-managed and monitored several programmes forreform to improve the overall patient experience. Thesepublications document the project outcomes and sharebest practice and data with the field.

Examples include:

Modernising A & E EnvironmentsImproving the Patient Experience – Friendly healthcare

environments for children and young peopleImproving the Patient Experience – Welcoming

entrances and reception areasNational standards of cleanliness for the NHSNHS Menu and Recipe Books

The majority of publications are available in hard copyfrom:

The Stationery Office LtdPO Box 29, Norwich NR3 1GNTelephone orders/General enquiries 0870 600 5522Fax orders 0870 600 5533E-mail [email protected]://www.tso.co.uk/bookshop

Publication lists and selected downloadable publicationscan be found on our website:http://www.nhsestates.gov.uk

For further information please contact our InformationCentre:e-mail: [email protected] tel: 0113 254 7070

About NHS Estates guidance and publications

http://www.tso.co.uk/bookshop




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Documents

HEALTH BUILDING NOTE 22 Accident and emergency ... 22 v2 ed2005.pdfFor queries on the status of this document contact [email protected] or telephone 029 2031 5512 Status Note amended