Tarlac State University

College of Architecture and Fine Arts

Department of Architecture

San Isidro Campus, Tarlac City

Submitted by:

Dumalaon, Micahelle Joy

Gando, Zedric C.

Tiglao, Reynell S.

Soliman Jr., Jesus

Ugale, Lara Mae

Submitted to:

Ar. Arlen M. Guieb

ARCHITECTURAL DESIGN 5RESEARCH WORK NO. 1

(Space planning 2)Level 2 Hospital

Clinical Establishment Act Standards for Hospital (Level 2)

Definition

A hospital is a clinical establishment providing patient treatment by qualified and trained staff and equipment through Allopathic - Modern system of medicine; where the patients are 'admitted' and stay overnight or more and they are referred as 'inpatients'; while some patients may go to a hospital just for diagnosis, treatment, or therapy and then leave, they are referred as 'outpatients' without staying overnight. In a hospital, treatment by staff from AYUSH may also be provided.

Hospitals usually have facility to admit and care for inpatients whilst the others often clinical establishments are described as clinics or day care centers. There are other exceptions too like Hospice etc.

The general hospital, may have multiple departments taking care of many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent care.

Specialized hospitals may include trauma centers, rehabilitation hospitals, children's hospitals, Mental hospitals or, and hospitals for dealing with specific medical needs such as psychiatric problems (psychiatric hospital) or Sanatorium, certain disease categories such as neuro, cardiac, oncology, or orthopedic, IVF and so forth.

Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Guidelines lay down by MCI or other legal bodies shall be applicable to such hospitals

A hospital can be situated in rural or urban setting. It can be run by Public Sector (Central government/State government/Local government/Public Sector undertaking/Registered Society etc.) or by Private Sector (Individual Proprietorship/ Registered Partnership/Registered Company /Co-operative Society/Trust /Charitable etc.).

Hospital Level 2 is the clinical establishment that provides secondary healthcare services by various health professionals such as doctors, nurses, allied health workers, dentists, pharmacists, and pathology and imaging professionals. It can be a general hospital providing multi-specialty services having facility for surgery, anesthesia, and emergency management. Secondary health care is provided by public and private health care organizations both.

These hospitals may provide following services as per the requirement of the community viz. General Medicine, General Pediatrics, General Surgery, Obstetrics & Gynecology, Orthopedics, Emergency Medicine, Critical Care Medicine (e.g. HDU, ICU), ENT, Ophthalmology, Dermatology, Community Health, Palliative Medicine, Geriatric Care, Family Medicine, Dentistry including sub specialties, Blood Storage Centre/Blood Bank etc.

Hospitals are the most complex of building types. Each hospital is comprised of a wide range of services and functional units. These include diagnostic and treatment functions, such as clinical

laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; and the fundamental inpatient care or bed-related function. This diversity is reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialized knowledge and expertise. No one person can reasonably have complete knowledge, which is why specialized consultants play an important role in hospital planning and design. The functional units within the hospital can have competing needs and priorities. Idealized scenarios and strongly-held individual preferences must be balanced against mandatory requirements, actual functional needs (internal traffic and relationship to other departments), and the financial status of the organization.

In addition to the wide range of services that must be accommodated, hospitals must serve and support many different users and stakeholders. Ideally, the design process incorporates direct input from the owner and from key hospital staff early on in the process. The designer also has to be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not generally have direct input into the design. Good hospital design integrates functional requirements with the human needs of its varied users.

The basic form of a hospital is, ideally, based on its functions:

bed-related inpatient functions outpatient-related functions diagnostic and treatment functions administrative functions service functions (food, supply) research and teaching functions

Physical relationships between these functions determine the configuration of the hospital. Certain relationships between the various functions are required—as in the following flow diagrams.

These flow diagrams show the movement and communication of people, materials, and waste. Thus the physical configuration of a hospital and its transportation and logistics systems are inextricably intertwined. The transportation systems are influenced by the building configuration, and the configuration is heavily dependent on the transportation systems. The hospital configuration is also influenced by site restraints and opportunities, climate, surrounding facilities, budget, and available technology. New alternatives are generated by new medical needs and new technology.

In a large hospital, the form of the typical nursing unit, since it may be repeated many times, is a principal element of the overall configuration. Nursing units today tend to be more compact shapes than the elongated rectangles of the past. Compact rectangles, modified triangles, or even circles have been used in an attempt to shorten the distance between the nurse station and the patient's bed. The chosen solution is heavily dependent on program issues such as organization of the nursing program, number of beds to a nursing unit, and number of beds to a patient room. (The trend, recently

reinforced by HIPAA, is to all private rooms.)

"A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels.”... Hardy and Lammers

BUILDING ATTRIBUTES

Regardless of their location, size, or budget, all hospitals should have certain common attributes.

Efficiency and Cost-Effectiveness

An efficient hospital layout should:

Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces

Allow easy visual supervision of patients by limited staff Include all needed spaces, but no redundant ones. This requires careful pre-design

programming. Provide an efficient logistics system, which might include elevators, pneumatic tubes, box

conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient handling of food and clean supplies and the removal of waste, recyclables, and soiled material

Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces

Consolidate outpatient functions for more efficient operation—on first floor, if possible—for direct access by outpatients

Group or combine functional areas with similar system requirements

Provide optimal functional adjacencies, such as locating the surgical intensive care unit adjacent to the operating suite. These adjacencies should be based on a detailed functional program which describes the hospital's intended operations from the standpoint of patients, staff, and supplies.

Flexibility and Expandability

Since medical needs and modes of treatment will continue to change, hospitals should:

Follow modular concepts of space planning and layout Use generic room sizes and plans as much as possible, rather than highly specific ones Be served by modular, easily accessed, and easily modified mechanical and electrical systems Where size and program allow, be designed on a modular system basis, such as the VA Hospital

Building System. This system also uses walk-through interstitial space between occupied floors for mechanical, electrical, and plumbing distribution. For large projects, this provides continuing adaptability to changing programs and needs, with no first-cost premium, if properly planned, designed, and bid. The VA Hospital Building System also allows vertical expansion without disruptions to floors below.

Be open-ended, with well-planned directions for future expansion; for instance positioning "soft spaces" such as administrative departments, adjacent to "hard spaces" such as clinical laboratories.

Therapeutic Environment

Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment. A hospital's interior design should be based on a comprehensive understanding of the facility's mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness. Some important aspects of creating a therapeutic interior are:

Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs

Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients.

Admitting ample natural light wherever feasible and using color-corrected lighting in interior spaces which closely approximates natural daylight

Providing views of the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes are helpful where outdoor views are not available

Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage.

Cleanliness and Sanitation

Hospitals must be easy to clean and maintain. This is facilitated by:

Appropriate, durable finishes for each functional space Careful detailing of such features as doorframes, casework, and finish transitions to avoid dirt-

catching and hard-to-clean crevices and joints Adequate and appropriately located housekeeping spaces Special materials, finishes, and details for spaces which are to be kept sterile, such as integral

cove base. The new antimicrobial surfaces might be considered for appropriate locations. Incorporating O&M practices that stress indoor environmental quality (IEQ)

Accessibility

All areas, both inside and out, should:

Comply with the minimum requirements of the Americans with Disability Act (ADA) and, if federally funded or owned, the GSA's ABA Accessibility Standards

In addition to meeting minimum requirements of ADA and/or GSA's ABA Accessibility Standards, be designed so as to be easy to use by the many patients with temporary or permanent handicaps

Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are wide enough for two wheelchairs to pass easily

Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious.

Controlled Circulation

A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled.

Outpatients visiting diagnostic and treatment areas should not travel through inpatient functional areas nor encounter severely ill inpatients

Typical outpatient routes should be simple and clearly defined Visitors should have a simple and direct route to each patient nursing unit without penetrating

other functional areas Separate patients and visitors from industrial/logistical areas or floors Outflow of trash, recyclables, and soiled materials should be separated from movement of food

and clean supplies, and both should be separated from routes of patients and visitors

Transfer of cadavers to and from the morgue should be out of the sight of patients and visitors Dedicated service elevators for deliveries, food and building maintenance services

Aesthetics

Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include:

Increased use of natural light, natural materials, and textures Use of artwork Attention to proportions, color, scale, and detail Bright, open, generously-scaled public spaces Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices Compatibility of exterior design with its physical surroundings

Security and Safety

In addition to the general safety concerns of all buildings, hospitals have several particular security concerns:

Protection of hospital property and assets, including drugs Protection of patients, including incapacitated patients, and staff Safe control of violent or unstable patients Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or

because they may be highly visible public buildings with an important role in the public health system.

Sustainability

Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design.

Abstract

Since the second half of the twentieth century to today, the architectural design of the hospital building has undergone great changes. These are related to the role that it plays within the city and the community, but also to the recovery of values that are different from those of quantity and function, characterizing modern hospitals in the first half of the twentieth century. These ‘new values’, really recovering from the past and agreeing to a humane and humanistic vision of reality, together with the recent technological discoveries and new ways of treatment and care, influence the design choices in hospitals contemporaries.

The proposed research Architectural of hospital space: Changes and Design Methods seek to define the characteristics and the architectonic qualities of the contemporary hospital. It is care center and hub of scientific and medical knowledge and it is also the important place for observations on the relationship between the man and the built environment.

The study of typological and theoretical contribution, the analysis of representative examples of recent architecture, Italian and international, give scientific basis - to the reflections that define the variant and invariants typological characters, (1) to explain the meaning of the changes, specifying the architectural quality, (2) to provide the guidelines for design.

Architectural value of the hospital building

Functional aspects of a hospital building often overshadow the others that characterize its architecture. The reason for of this “inattention” in favor of the fictional aspects concerns the difficulty to define the quality of the architecture is and how this can be assessed. Once, the architectural quality was synonymous with safety and functional efficiency. Now, it is searched in the aesthetic and cultural values. Moreover, there isn’t a scale of absolute values of quality depending on the different "users" and aims. Specifically in hospital buildings, assessment tools and related quality indicators are numerous. They are referred more to specific sanitary functions than others. These appraise the hospital only as a building system and not as architecture. As such, the hospital building has to consider the physical and psychological needs of the person (the sick in particular). The hospital plays a catalytic role within urban environment, carries out some positive correspondences for the city and the citizens. It works to promote the recovery of the values of belonging and integration with the socio-cultural context.

A Level 2 hospital shall have as minimum, all of Level l capacity, including, but not limited to, the following:

1. An organized staff of qualified and. competent personnel with Chief of Hospital/Medical Director and appropriate board certified Clinical Department Heads;

2. Departmentalized and equipped with the service capabilities needed to support board certified/eligible medical specialists and other licensed physicians rendering services in the specialties of Medicine, Pediatrics, Obstetrics and Gynecology, Surgery; their subspecialties and ancillary services;

3. Provision for general ICU for critically ill patients.

4. Provision for NICU (Neonatal Intensive Care Unit)

5. Provision for HRPU (High Risk Pregnancy Unit)

6. Provision for respiratory therapy services;

7. A DOH licensed tertiary clinical laboratory;

8. A DOH licensed level 2 imaging facility with mobile x-ray inside the institution and with capability for contrast examinations.

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES

A hospital and other health facilities shall be planned and designed to observe appropriate architectural practices, to meet prescribed functional programs, and to conform to applicable codes as part of normal professional practice. References shall be made to the following:

• P. D. 1096 – National Building Code of the Philippines and Its Implementing Rules and Regulations

• P. D. 1185 – Fire Code of the Philippines and Its Implementing Rules and Regulations

• P. D. 856 – Code on Sanitation of the Philippines and Its Implementing Rules and Regulations

• B. P. 344 – Accessibility Law and Its Implementing Rules and Regulations

• R. A. 1378 – National Plumbing Code of the Philippines and Its Implementing Rules and Regulations

• R. A. 184 – Philippine Electrical Code

• Manual on Technical Guidelines for Hospitals and Health Facilities Planning and Design. Department of Health, Manila. 1994

• Signage Systems Manual for Hospitals and Offices. Department of Health, Manila. 1994

• Health Facilities Maintenance Manual. Department of Health, Manila. 1995

• Manual on Hospital Waste Management. Department of Health, Manila. 1997

• District Hospitals: Guidelines for Development. World Health Organization Regional Publications, Western Pacific Series. 1992

• Guidelines for Construction and Equipment of Hospital and Medical Facilities. American Institute of Architects, Committee on Architecture for Health. 1992

• De Chiara, Joseph. Time-Saver Standards for Building Types. McGraw-Hill Book Company. 1980

1. Environment: A hospital and other health facilities shall be so located that it is readily accessible to the community and reasonably free from undue noise, smoke, dust, foul odor, flood, and shall not be located adjacent to railroads, freight yards, children's playgrounds, airports, industrial plants, disposal plants.

2. Occupancy: A building designed for other purpose shall not be converted into a hospital. The location of a hospital shall comply with all local zoning ordinances.

3. Safety: A hospital and other health facilities shall provide and maintain a safe environment for patients, personnel and public. The building shall be of such construction so that no hazards to the life

and safety of patients, personnel and public exist. It shall be capable of withstanding weight and elements to which they may be subjected.

3.1 Exits shall be restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair.

3.2 A minimum of two (2) exits, remote from each other, shall be provided for each floor of the building.

3.3 Exits shall terminate directly at an open space to the outside of the building.

4. Security: A hospital and other health facilities shall ensure the security of person and property within the facility.

5. Patient Movement: Spaces shall be wide enough for free movement of patients, whether they are on beds, stretchers, or wheelchairs. Circulation routes for transferring patients from one area to another shall be available and free at all times.

5.1 Corridors for access by patient and equipment shall have a minimum width of 2.44 meters.

5.2 Corridors in areas not commonly used for bed, stretcher and equipment transport may be reduced in width to 1.83 meters.

5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas located on the upper floor.

5.4 A ramp shall be provided as access to the entrance of the hospital not on the same level of the site.

6. Lighting: All areas in a hospital and other health facilities shall be provided with sufficient illumination to promote comfort, healing and recovery of patients and to enable personnel in the performance of work.

7. Ventilation: Adequate ventilation shall be provided to ensure comfort of patients, personnel and public.

8. Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable sound level and adequate visual seclusion to achieve the acoustical and privacy requirements in designated areas allowing the unhampered conduct of activities.

9. Water Supply: A hospital and other health facilities shall use an approved public water supply system whenever available. The water supply shall be potable, safe for drinking and adequate, and shall be brought into the building free of cross connections.

10. Waste Disposal: Liquid waste shall be discharged into an approved public sewerage system whenever available, and solid waste shall be collected, treated and disposed of in accordance with applicable codes, laws or ordinances.

11. Sanitation: Utilities for the maintenance of sanitary system, including approved water supply and sewerage system, shall be provided through the buildings and premises to ensure a clean and healthy environment.

12. Housekeeping: A hospital and other health facilities shall provide and maintain a healthy and aesthetic environment for patients, personnel and public.

13. Maintenance: There shall be an effective building maintenance program in place. The buildings and equipment shall be kept in a state of good repair. Proper maintenance shall be provided to prevent untimely breakdown of buildings and equipment.

14. Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall allow durability, ease of cleaning and fire resistance.

15. Segregation: Wards shall observe segregation of sexes. Separate toilet shall be maintained for patients and personnel, male and female, with a ratio of one (1) toilet for every eight (8) patients or personnel.

16. Fire Protection: There shall be measures for detecting fire such as fire alarms in walls, peepholes in doors or smoke detectors in ceilings. There shall be devices for quenching fire such as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas.

17. Signage: There shall be an effective graphic system composed of a number of individual visual aids and devices arranged to provide information, orientation, direction, identification, prohibition, warning and official notice considered essential to the optimum operation of a hospital and other health facilities.

18. Parking: A hospital and other health facilities shall provide a minimum of one (1) parking space for every twenty-five (25) beds.

19. Zoning: The different areas of a hospital shall be grouped according to zones as follows:

19.1 Outer Zone – areas that are immediately accessible to the public: emergency service, outpatient service, and administrative service. They shall be located near the entrance of the hospital.

19.2 Second Zone – areas that receive workload from the outer zone: laboratory, pharmacy, and radiology. They shall be located near the outer zone.

19.3 Inner Zone – areas that provide nursing care and management of patients: nursing service. They shall be located in private areas but accessible to guests.

19.4 Deep Zone – areas that require asepsis to perform the prescribed services: surgical service, delivery service, nursery, and intensive care. They shall be segregated from the public areas but accessible to the outer, second and inner zones.

19.5 Service Zone – areas that provide support to hospital activities: dietary service, housekeeping service, maintenance and motor pool service, and mortuary. They shall be located in areas away from normal traffic.

20. Function: The different areas of a hospital shall be functionally related with each other.

20.1 The emergency service shall be located in the ground floor to ensure immediate access. A separate entrance to the emergency room shall be provided.

20.2 The administrative service, particularly admitting office and business office, shall be located near the main entrance of the hospital. Offices for hospital management can be located in private areas.

20.3 The surgical service shall be located and arranged to prevent non-related traffic. The operating room shall be as remote as practicable from the entrance to provide asepsis. The dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments. The nurse station shall be located to permit visual observation of patient movement.

20.4 The delivery service shall be located and arranged to prevent non-related traffic. The delivery room shall be as remote as practicable from the entrance to provide asepsis. The dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments. The nurse station shall be located to permit visual observation of patient movement. The nursery shall be separate but immediately accessible from the delivery room.

20.5 The nursing service shall be segregated from public areas. The nurse station shall be located to permit visual observation of patients. Nurse stations shall be provided in all inpatient units of the hospital with a ratio of at least one (1) nurse station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size to allow for work flow and patient movement. Toilets shall be immediately accessible from rooms and wards.

20.6 The dietary service shall be away from morgue with at least 25-meter distance.

21. Space: Adequate area shall be provided for the people, activity, furniture, equipment and utility.

Space Area in Square MetersAdministrative ServiceLobby

Waiting Area 0.65/personInformation and Reception Area 5.02/staffToilet 1.67

Business Office 5.02/staffMedical Records 5.02/staffOffice of the Chief of Hospital 5.02/staffLaundry and Linen Area 5.02/staffMaintenance and Housekeeping Area 5.02/staffParking Area for Transport Vehicle 9.29

Supply Room 5.02/staffWaste Holding Room 4.65Dietary

Dietitian Area 5.02/staffSupply Receiving Area 4.65Cold and Dry Storage Area 4.65Food Preparation Area 4.65Cooking and Baking Area 4.65Serving and Food Assembly Area 4.65Washing Area 4.65Garbage Disposal Area 1.67Dining Area 1.40/personToilet 1.67

Cadaver Holding Room 7.43/bedClinical ServiceEmergency Room

Waiting Area 0.65/personToilet 1.67Nurse Station 5.02/staffExamination and Treatment Area with Lavatory/Sink 7.43/bedObservation Area 7.43/bedEquipment and Supply Storage Area 4.65Wheeled Stretcher Area 1.08/stretcher

Outpatient DepartmentWaiting Area 0.65/personToilet 1.67Admitting and Records Area 5.02/staffExamination and Treatment Area with Lavatory/Sink 7.43/bedConsultation Area 5.02/staff

Surgical and Obstetrical ServiceMajor Operating Room 33.45Delivery Room 33.45Sub-sterilizing Area 4.65Sterile Instrument, Supply and Storage Area 4.65Scrub-up Area 4.65Clean-up Area 4.65Dressing Room 2.32Toilet 1.67Nurse Station 5.02/staffWheeled Stretcher Area 1.08/stretcherJanitor’s Closet 3.90

Nursing UnitSemi-Private Room with Toilet 7.43/bedPatient Room 7.43/bedToilet 1.67Isolation Room with Toilet 9.29

Nurse Station 5.02/staffTreatment and Medication Area with Lavatory/Sink 7.43/bed

Central Sterilizing and Supply RoomReceiving and Releasing Area 5.02/staffWork Area 5.02/staffSterilizing Room 4.65Sterile Supply Storage Area 4.65

Nursing ServiceOffice of the Chief Nurse 5.02/staffAncillary ServicePrimary Clinical Laboratory

Clinical Work Area with Lavatory/Sink 10.00Pathologist Area 5.02/staffToilet 1.67

RadiologyX – Ray Room with Control Booth, Dressing Area and Toilet 14.00Dark Room 4.65Film File and Storage Area 4.65Radiologist Area 5.02/staff

Pharmacy 15.00

Notes:

1. 0.65/person – Unit area per person occupying the space at one time.

2. 5.02/staff – Work area per staff that includes space for one (1) desk and one (1) chair, space for occasional visitor, and space for aisle

3. 1.40/person – Unit area per person occupying the space at one time

4. 7.43/bed – Clear floor area per bed that includes space for one (1) bed, space for occasional visitor, and space for passage of equipment

5. 1.08/stretcher – Clear floor area per stretcher that includes space for one (1) stretcher

Level 2 Hospital

Model Organizational Structure for a Level 2 Hospital(100 to 200 Bed Capacity)

Organizational UnitNumber of PositionsBed Capacity100 150 200

A. Office of the Medical Center Chief 4 4 5 1. Office of the Medical Center Chief 2 2 2 2. Integrated Hospital Operations and Management Program 2 2 3

B. Medical Service 122 161 192 1. Office of the Chief of Medical Professional Staff 2 2 2 2. Outpatient Department 9 11 12 3. Emergency Medicine Department 19 26 31 4. Clinical Departments 26 35 48 5. Special Care Areas 4 6 6 6. Department of Pathology a. Blood Bank b. Anatomic and Clinical Laboratory

2 2 2 6 8 913 18 20

7. Department of Radiology 8 11 11 8. Dental 3 3 4 9. Health Information Management a. Admitting/Information

5 7 95 6 7

10. Nutrition and Dietetics 9 13 15 11. Pharmacy 7 8 10 12. Medical Social Work 4 5 6

C. Nursing Service 122 180 227 1. Office of the Chief Nurse 4 4 4 2. Clinical Nursing Units 55 83 108 3. Operating Room 14 21 26 4. Delivery Room 11 17 21 5. Special Care Areas

a. Post Anesthesia Care Unitb. Intensive Care Unitc. Neonatal Intensive Care Unit (NICU)d. Pulmonary/Respiratory Unit

7 10 116 9 1014 21 275 7 9

6. Central Supply and Sterilization 6 8 11

D. Hospital Operations and Patient Support Department 44 59 69 1. Office of the Administrative Officer 2 2 2 2. Human Resource Management 4 5 6 3. Procurement 4 5 5 4. Materials Management 5 6 7 5. Engineering and Facilities Management a. Housekeeping/Laundry

8 13 153 5 5

6. Budget 3 3 3 7. Accounting 5 6 7 8. Cash Operations 5 7 9 9. Security To be contracted Total Number of Positions 292 404 493

Organizational ChartLevel 2 Hospital

100, 150 and 200 Bed Capacity

Basic Structure

Office of the Medical Center Chief

Integrated Hospital OperationsAnd Management Program

(IHOMP Unit)

Medical Service Medical Service Medical Service

Medical Service

Special Care Areas:Intensive Care Units (ICU), Surgical Intensive Care Unit (SICU), Post-Intensive Care Unit (PICU), Neonatal

Intensive Care Unit (NICU), etc.

Nursing Service

Office of the Medical Center Chief

Medical Service

Outpatient Department

Emergency Medicine Department

Clinical Departments

Special Care Areas

Outpatient Department Outpatient Department

Anatomic and Clinical Laboratory

Admitting/Info

Blood Bank

Department of Radiology

Dental

Nutrition and Dietetics

Pharmacy

Medical Social Work

Office of the Medical Center Chief

Nursing Service

Operating Room Delivery RoomClinical Service Unit

Special Care Areas Central Supply & Sterilization

Hospital Operations and Patient Support Service

Office of the Medical Center Chief

Hospital Operations and Patient Support Service

Budget

Accounting

Cash Operators

Billing & Claims

Human Resource Management

Materials Management

Procurement

Housekeeping, Linen and Laundry

CHECKLIST FOR REVIEW OF FLOOR PLANS LEVEL 2 HOSPITALS

1. PHYSICAL PLANT

1.1 Administrative Service

1.1.1 Lobby

1.1.1.1 Waiting Area

1.1.1.2 Information and Reception Area

1.1.1.3 Toilet

1.1.2 Business Office

1.1.3 Medical Records Room

1.1.4 Office of the Chief of Hospital

1.1.5 Laundry and Linen Area

1.1.6 Maintenance and Housekeeping Area

1.1.7 Parking Area for Transport Vehicle

1.1.8 Supply Room

1.1.9 Waste Holding Room

1.1.10 Dietary

1.1.10.1 Dietitian Area

1.1.10.2 Supply Receiving Area

1.1.10.3 Cold and Dry Storage Area

1.1.10.4 Food Preparation Area

1.1.10.5 Cooking and Baking Area

1.1.10.6 Serving and Food Assembly Area

1.1.10.7 Washing Area

1.1.10.8 Garbage Disposal Area

1.1.10.9 Dining Area

1.1.10.10 Toilet

1.1.11 Cadaver Holding Room

1.2 Clinical Service

1.2.1 Emergency Room

1.2.1.1 Waiting Area

1.2.1.2 Toilet

1.2.1.3 Nurse Station

1.2.1.4 Examination and Treatment Area with Lavatory/Sink

1.2.1.5 Observation Area

1.2.1.6 Equipment and Supply Storage Area

1.2.1.7 Wheeled Stretcher Area

1.2.2 Outpatient Department

1.2.2.1 Waiting Area

1.2.2.2 Toilet

1.2.2.3 Admitting and Records Area

1.2.2.4 Examination and Treatment Area with Lavatory/Sink

1.2.2.5 Consultation Area

1.2.3 Surgical and Obstetrical Service

1.2.3.1 Major Operating Room

1.2.3.2 Delivery Room

1.2.3.3 Sub-sterilizing Area/Work Area

1.2.3.4 Sterile Instrument, Supply and Storage Area

1.2.3.5 Scrub-up Area

1.2.3.6 Clean-up Area

1.2.3.7 Dressing Room

1.2.3.8 Toilet

1.2.3.9 Nurse Work Area

1.2.3.10 Wheeled Stretcher Area

1.2.3.11 Janitor’s Closet

1.2.4 Nursing Unit

1.2.4.1 Patient Room

1.2.4.2 Toilet

1.2.4.3 Isolation Room with Toilet

1.2.4.4 Nurse Station

1.2.4.5 Treatment and Medication Area with Lavatory/Sink

1.2.5 Central Sterilizing and Supply Room

1.2.5.1 Receiving and Releasing Area

1.2.5.2 Work Area

1.2.5.3 Sterilizing Area

1.2.5.4 Sterile Supply Storage Area

1.3 Nursing Service

1.3.1 Office of the Chief Nurse

1.4 Ancillary Service

1.4.1 Secondary Clinical Laboratory

1.4.1.1 Clinical Work Area with Lavatory/Sink

1.4.1.2 Pathologist Area

1.4.1.3 Toilet

1.4.2 Radiology – 1st Level

1.4.2.1 X – Ray Room with Control Booth, Dressing Area and Toilet

1.4.2.2 Dark Room

1.4.2.3 Film File and Storage Area

1.4.2.4 Radiologist Area

1.4.3 Pharmacy

2. PLANNING AND DESIGN

2.1 Floor plans properly identified and completely labeled

2.2 Conforms to applicable codes as part of normal professional service:

2.2.1 Exits restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair

2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the building

2.2.3 Corridors and ramps for ingress and egress at least 2.44 meters in clear and unobstructed width

2.2.4 Exits terminate directly at an open space to the outside of the building

2.2.5 Minimum of one (1) toilet on each floor accessible to the disabled

2.3 Meets prescribed functional programs:

2.3.1 Main entrance of the hospital directly accessible from public road

2.3.2 Ramp or elevator for clinical, nursing and ancillary services located on the upper floor

2.3.3 Administrative Service

2.3.3.1 Business office located near the main entrance of the hospital

2.3.4 Emergency Room

2.3.4.1 Located in the ground floor to ensure easy access for patients

2.3.4.2 Separate entrance to the emergency

2.3.4.3 Ramp for wheelchair access

2.3.4.4 Easily accessible to the clinical and ancillary services (laboratory, radiology, pharmacy, operating room)

2.3.4.5 Nurse station located to permit observation of patient and control of access to entrance, waiting area, and treatment area

2.3.5 Outpatient Department

2.3.5.1 Located near the main entrance of the hospital to ensure easy access for patients

2.3.5.2 Separate toilets for patients and staff

2.3.6 Surgical and Obstetrical Service

2.3.6.1 Located and arranged to prevent non-related traffic through the suite

2.3.6.2 Operating room and delivery room located as remote as practicable from the entrance to the suite to reduce traffic and provide greater asepsis

2.3.6.3 Operating room and delivery room arranged to prevent staff and patients to travel from one area to the other area

2.3.6.4 Dressing room arranged to avoid exposure to dirty areas after changing to surgical garments

2.3.6.5 Nurse station located to permit visual observation of patient and movement into the suite

2.3.6.6 Scrub-up area recessed into an alcove or other open space out of the main traffic

2.3.6.7 Sub-sterilizing area separate from the operating room and accessible to the clean-up area

2.3.7 Separate toilets and rooms for male and female patients

2.3.8 Nursing Service

2.3.8.1 Nurse station located and designed to allow visual observation of patient and movement into the nursing unit

2.3.8.2 Nurse station provided in all nursing units of the hospital with a ratio of at least one (1) nurse station for every thirty-five (35) beds

2.3.8.3 Toilet immediately accessible from each room in a nursing unit

2.3.9 Dietary, maintenance and other non-patient contact services located in areas away from normal traffic within the hospital, or located in separate buildings within the hospital premises

2.3.9.1 The dietary service shall be away from morgue with at least 25-meter distance.