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Planning and Designing a
Hospital
Parnab Roy
MHM(1st year)
SMU
Hospital must meet two basic fundamental needs-
• Must meet the needs of the patient it is going to serve adequately.
• It must be in a size and proportions which the owners or promoters will be able to build and operate.
Basic objectives which are to be met by the hospital-
• Sound architectural plan• Economic viability• Effective community orientation• Quality patient care
Principles of hospital planning-
• Protection from unwanted and unnecessary disturbances in order to help speedy recovery
• Separation of dissimilar activities• Control – the nurses station should be positioned
strategically to enable proper monitoring of visitors entering and leaving the ward, infants and children should be protected from theft and infection etc.
• Circulation- all the departments of a hospital must be properly integrated.
(“separate all departments, yet keep them all together; separate types of traffic, yet save steps for everybody; that is all there is to hospital planning “– Emerson Goble)
Selection of site-• Needs of the community
Ease of accessibility
Range of services offered
Availability of specialists
Availability of technology
• Study of existing hospital(if any)
• Requirements of staff and services
Type of hospital-
• Private• Partnership• Public charitable trust• Cooperative society
• Primary • Secondary • Tertiary
Bed planning-
Bed: Population=A S 100
365 PO
A= number of inpatient admissions/1000 population/year
S= average length of stay
PO= percentage occupancy
Planning of finances-
• Funds required for constructing, furnishing and equipping the hospital.
• Operating funds- salaries, loans and interest, other maintenance expenses.
• Arranging financial assistance-patient fees, bed charges, and other modes of revenue generation process.
Equipment planning-Built in equipment These include counters and cabinets
in laboratory, Pharmacy and other parts of the hospital,elevators,incinerators,coolers,fixed sterilizing equipment etc.These are usually included in the construction contract and the planning of these equipments is the architect's responsibility.
Depreciable equipment This includes equipment that has a life of five years or more and is not purchased through construction contracts. These are large pieces of furniture which have a relatively fixed location and are capable of being moved e.g., diagnostic and therapeutic equipment, laboratory instruments, office furniture etc.
Non depreciable equipment These are small items with a low unit cost and life span of less than five years. These are generally under the control of the store room and are bought through other than construction contracts. They include kitchen utencils,surgical instruments,linen,waste baskets etc.
Operation programme-Admission Human resource
Administration Stores
General engineering Purchasing
Laundry Maintenance
Clinical services Waste disposal plant
Pharmacy Fire and safety
Nursing services Disaster plan
House keeping information
Records Dietary services
Public relations Clinical engineering
Employee facilities Sanitation
Planning of departments-
• In patient department-Patient room- These may be private/semi private
rooms or multibed general wards. They should be designed to be safe and aesthetically pleasing so as to assist in quick recovery of patient. They must contain space for equipments, staffs and various need of the patient.
Nurses control station- should be located and designed in such a way that the nurses can observe the patient room.
The work area- related to handling materials necessary for patient care, maintaining communication and records etc.
• Economical• High quality patient care• Comfort to the patient• Efficient operation of the unit• Meeting the needs of the visitors
Facilities and space required-
• Examination and treatment room with wash basin etc.
• Cupboard for clean linen.• Basket for soiled linen with sink, waste receptacles.• Equipment storage room for walkers,IV stands etc• Space for storing stretchers and wheel chairs• Lockers for staff personal belongings• Staff toilet• Small laboratory
Out patient department-
• Preferably on the ground level with a separate entrance and adequate parking facilities.
• It should be close to admitting area , MRD,emergency,radioogy /,lab services and pharmacy.
• Attention should be paid to circulation, which results in the smooth flow of various traffic lines Traversing the department.
• Properly signed
Emergency department-
• Should be located on the ground floor with easy access for patients and ambulances
• Separate entrance for the department• Well marked with proper lighting and
signs.shoud be easily visible and accessible from the street.
• Should be close to the admitting department, medical records and cashier’s booth, radiology department, lab services, blood bank,elivators and wards
Intensive care unit-
• Should preferably be located on the ground floor with convenient access from the operation theatre suit and emergency department and easy accessibility for wards.
• It consists patient area, staff area, support area.
• Four basic requirements- Direct observation of the patient by nursing and
medical staff Surveillance of physiological monitoring Provision and efficient use of routine and emergency
diagnostic procedures and interventions. Recording and maintenance of patient information.
• Monitoring equipment• Cardiovascular therapy• Respiratory therapy• Dialysis equipment• Radiological equipment• Laboratory equipment• others
Obstetrical unit-
• The obstetrical unit should ideally be located close to the labour and delivery room as also to the nursery to avoid the exposing the bodies to infection.
• A room for patient education and group discussions is essential with cheerful decoration is desirable
Newborn unit-
• An area of 30sq.ft/ infant with a space of at least three feet around is recommended
• All partition should be made of clear glass to permit observation.
• Furnishing in the full term nursery include a bed side cabinet,incubator,utility table, wash basin, waste receptacles, outlets for oxygen and suction, facilities for examination etc.
Pediatric unit-• Equal space should be provided for beds.• If patients are allowed to stay with the parents, provision must be
made for toilets, sleeping and storage of personal belongings• Separate provision for examination and treatment of infants.• Each pediatric unit have isolation room with other necessities like
washing facilities and sterile gowns and masks.• Single room for critically ill and uncontrollable patients• Recreation or play room• Storage space for toys,linen,recreational materials• Walls between patient room and the corridor should have glass
panels for viewing• Lighting decoration and equipment must create a cheerful
atmosphere.
Psychiatric unit-• Consultation area containing staff offices for individual
and family care sessions.• Conference therapy area for group therapy session.• Inpatient area for hospitalizing patients• Activities area for occupational recreational therapy.• The number of beds should be between 20-24 I order to
permit proper observation and treatment and private rooms are preferred.
• One room for the management of violent patients are desirable.
• There should be no object which can be used to hurt one self.
Radiology and laboratory services-
• Should be easily accessible to the OPD, casualty and the inpatient wards.
• Preferably be sited on the ground floor.• Adequate reception and registration area• Convenient patient flow with minimization of criss cross
traffic.• Adequate waiting area• Separate entrance for accident and emergency cases in
busy hospital• Provision of room for technical functioning• Flexibility, expandability and upgradability need to be
kept in mind while siting the department.
Pharmacy-• Out patient should have ready access to the hospital pharmacy to
collect prescription.• Staff of wards and department can access it without having to travel
a long distance thorough other crowded areas.• Collection of indents and dispensing of prescription for inpatients
can be carried out in a central dispensing area which is accessible to hospital staff when they come to consult the pharmacist or to obtain stocks for ward use.
• Suppliers have an access to it from out side • Space required for-
Dispensing counter Cash counter Drugs storage including dressings Cool and cold storage Administrative office Circulation space Space for compounding and bulk preparation
Hospital store It should be located centrally to the hospitalApproachable by supply vehicles and should have separate service entranceRisk of fire and explosion in a medical supplies storehouse, storage of acids, inflammable materials and oxygen and other gas cylinders will require special attention
CSSD CSSD mostly serves the operation theatre, emergency, casualty department, wards, maternity suit and should be so cited as to be central to all this
Hospital dietary service Should be located taking into consideration the prevailing wind direction so that smoke and kitchen odours are not constantly wafted to patient care areaShould be sited at ground level and connected to store with lift
Hospital work shop/BME department
A large quantum of various types of mechanical and electrical equipment is installed in a hospital and requires repair and preventive maintenance.
Laundry Used linen from wards, operation theatres and delivery suites maybe infected, and therefore needs careful handling at an area remote from all other clinical and supportive services areasSpace for washing, storing, drying shades and ironing rooms have to be catered for at an appropriate area with plentiful supply of water
MRD Should be located immediate to the admission and registration area.Enough space for keeping/storing of patient filesAdequate safety .
Space requirements of some basic departments-Area Sq .ft / bed
Nursing unit 250-280
Nursery 12-18
Delivery suite 15-20
Operation theatre 30-50
Physical medicine 12-18
Radiology 25-35
Laboratory 25-35
Pharmacy 4-6
CSSD 8-25
Dietary 25-35
Medical record 8-15
Area Sq .ft / bed
House keeping 4-5
Laundry 12-18
Mechanical installation 50-75
Maintenance work shop 4-6
Stores 25-35
Public areas 8-10
Staff facilities 10-15
Administration 40-50
Total 567-751
Circulation 115-751
Total net area 682-891
Project costing-• The most common method of estimating hospital
construction costs has been the “ per bed” method,i.e.,if the total cost of a 100 beded hospital has been Rs.400 lakhs,the cost/ bed is Rs.4,oo,ooo.
• Break up of project cost- Acquisition of site
Site survey, investigation Landscaping Construction contact-building with fixed equipment Supervision and inspection Equipping the hospital-diagnostic and therapeutic equipment Movable equipment, furniture etc. Architect's fee Consultant’s fee Site engineer’s fee
Phasing -
• The necessity to bring facilities into use as quickly as possible for operational reasons.
• The necessity to split a major project into a smaller units as a contractual consideration
• The necessity of having certain departments ready before others
• Limitation on availability of capital funds
Commissioning-• Formation of commissioning team
Hospital consultant Hospital administrator Chief of clinical services Senior nurses Supplies officer Others
• Activities- Bring the hospital building, plant and equipment to a state of the
operational readiness Development operational system Testing of equipments Coordinate training of staff Ensure good communication
Hospital project staging-Stage AFunctional content:Outline brief:
Project teamAssessment of functional contentSubmission of owners( Govt,private organization etc.)for approvalSite appraisal, gross floor areasBuilding space. Draft master planEstimation of cost and phasingAppraisal of work by owners
Stage BOperational policies:Developmental plan:
Operational policiesDepartmental and inter related activitiesDepartmental and hospital policiesDevelopment control planBudget costContinuous informal discussion with owners
Stage CSchedules of accommodation, sketches,Final cost estimate:
Schedules of accommodationSketch drawingEquipment schedules component estimatesCost revenue and staffing estimatesFinal cost approval
Stage DDetail design working drawings, tender action:
Working drawingsEngineering detailsBills of quantitiesCalling tenders
Stage EContract and construction: Assessments of tenders
Award of contractConstructionEngineering commissioning
Stage FCommissioning: Staff assembly and training
Equipment and supplies assemblyTesting of installation
Conclusion-
• Technology requirement must be met
• Clinical needs must be considered• Safety is a major factor• Standards and Guidelines are
essential• Importance of the role of Hospital
Staff in construction and design.
THANK YOU
