300 Beded

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DESIGN OF 300 BEDED HOSPITAL Introduction The hospital you have to build has to be very usable from the point of view of your patients and staff. This part of the Clinic gives you counseling on rooms so that you can design a better hospital. Some rooms clearly fulfill a single function; others play a more important role in the running of the hospital, acting as hubs about which patients flow. It is essential to understand their operation before you go about designing your level. The planning of the hospital depends on its objectives/purpose. Once the objective/ purpose of the hospital have been identified, a project coordination team is appointed. The team is responsible for the planning and designing the hospital. The team consists of financers, architects, engineers, medical doctors, health planner/hospital administrator, finance manager.

Stages In Planning And Designing A Hospital. 1. Identifying available finance and other possible sources of finance. 2. Deciding on the area/ location of the hospital. 3. Identifying the needs of the area by carrying out a survey. 4. Deciding on the present and proposed services to be offered. 5. Preparing the design. 6. Getting the design approved. 7. Starting construction. 8. Identifying and hiring the required personnel and working out a schedule for training. 9. Working out a schedule for purchase of required equipment/ material. 10. Commissioning the hospital. 1

1. Finance:-. An assessment should be made of available finances and possible sources of arranging finance. Bank loans and there are also donors who give grants specifically for setting up charitable hospital. 2. Location:- A need assessment survey of the community should be done before deciding the location of the hospital. This helps in deciding the location of the hospital and determines its catchment area. According to the purpose of hospital the area should be selected for profit select the area where people have paying capacity and for charitable purpose decide the location according to the need of people. 3. Preparing The Design:a.

Site Selection:-

Site selection is very important part of

the hospital planning process. At times, availability of land, supporting services and finance become the main factors which decide site selection. b. Legal Requirements:- No objection certificate from local government. There should be a proper map of the land. The land should be in an authorized colony/market only. c. Proper Electrical And Water Connections should be available. For this, the electricity load required should be worked out and doubled at the time of applying. d. Permission for sewage connection should be obtained. e. Size of the land:- for 100 bedded hospital 1 acre or 400 meter square per bed. f. Plot Ratio:- in urban area a single storey hospital can have up to 150 beds. 2

g. Designing Consideration:- in designing a hospital two approaches can be used- the biologic and the artistic. Both approaches have their advantages and drawbacks. Biological Approach:- in the biological approach

i.

the hospital is designed according to its functional needs. A balance

attempted

between

the

hospital

and

its

environment. In this approach, a linear spire system is followed in which the entry to various departments is through a central spire which may have several levels. There is no thoroughfare through departments. This system absorbs hospital growth easily and departments do not

strangle

themselves.

Also,

when

an

obsolete

department has to be updated it is delegated to a temporary structure in the hospital complex till it is dismantled and an updated department erected. Since the circulation core is independent and separate from the departmental areas, activities within the hospital are not disrupted. The biologic approach allows an outside view and natural light, even when a department needs to be expanded or changes made in it. ii.

Artistic

Approach:-

the

artistic

approach

is

creative, based on focus, patterns and determined space. These

overtly

monumental

and

systematic

hospital

buildings are more admirable as pieces of large scale sculpture than the common older hospitals and are also much less useful.

Location And Physical Facilities

3

1. Location:- The OPD is the showcase of any hospital and reflects its image. It should have an independent approach at the entrance of the hospital and should be on the ground floor for easy access. It should be segregated from IPD, so that OPD patients need not pass through inpatient areas. Some treatment facilities like radiology, pathology, physiotherapy and blood bank should be interposed between the OPD and IPD so that they are equally accessible to both. 2. Physical Facilities And Space Requirements:S.N o 1. a.

Facility

No. rooms

General Entrance

hall

counter,

cash

with

enquiry 1

counter

of Area in (Msq) 98

and

b.

record area. Room with toilet for officer in 1

17.5

c.

charge Room with toilet for Nurse-in- 1

17.5

d. e. f. g.

charge Sanitary inspector’s room OPD medical record room Canteen Lavatories – separate for gents

14 35 28 35

1 1 1 2

and ladies (common for patients f. 2. a.

and staff) Janitor’s closet 1 Medical clinic Consultation and examination 3

b. c. 3. a.

room Cardio-graphic examination 1 Waiting room 1 Surgical clinic Consultation and examination 3

7 17.5 14 49 17.5 4

S.N

Facility

No.

o d. e. 4. a.

rooms room Dark room 1 Waiting room 1 Orthopedics clinic Consultation and examination 1

b. c. d. e. f. 5. a.

room Plaster and splint storage room Fracture and treatment room Plaster cutting room Recovery room Waiting room Eye clinic Consultation and examination

b. c.

room Refraction room 1 Minor surgery and treatment 1

d. e. 6. a.

room Dark room 1 Waiting room 1 ENT Clinic Consultation and examination 1

b. c. d. 7. a.

room Treatment room Audiometry room Waiting room Dental clinic Consultation and examination

b. c. d. e. 8.

room Dental hygienists room Recovery room Dental workshop Waiting room Obstetric and gynecological

of Area in (Msq) 14 49 17.5

1 1 1 1 1

14 17.5 14 14 35

1

28 17.5 17.5 14 21 28

1 1 1

14 14 14

1

17.5

1 1 1 1

14 14 17.5 21

a. b.

clinic Reception and registration area 1 Consultation and examination 2

17.5 17.5

c. d.

room Treatment room Clinical laboratory

17.5 14

1 1

5

S.N

Facility

No.

o e.

Toilet

f. 9. a.

room(attached to treatment) Waiting room 1 Family planning clinic Consultation and examination 1

b. c.

room Treatment room Health educator

d. e. 10. a.

worker’s room Recovery room 1 Waiting room 1 Pediatrics clinic Consultation and examination 2

b.

room Dressing

c. d. 11. a.

dispensing room Immunization room 1 Waiting room 1 Skin and STD clinic Consultation and examination 1

b. c. d. e. 12. a.

room Treatment room Superficial therapy room Skin laboratory Waiting room Psychiatric clinic Consultation and examination

b. c. d. e. 13. a. b.

room ECT room Psychologist’s room Social worker room Waiting room Supporting facilities Central injection room Specimen collection

c. d.

clinical laboratory Social worker’s room Waiting room

rooms changing 1

cum

and

treatment

1 social 1

and 1

room

of Area in (Msq) 10.5 28 17.5 17.5 17.5 14 21 17.5 17.5 17.5 28 17.5

2 1 1 1

17.5 14 21 21

1

17.5

1 1 1 1

21 17.5 17.5 21

1 / 1

14 17.5

1 1

14 21 6

Planning Allocation of area (in square feet) for various utilities. S.N

Areas

300

Bedded

o 1. 2. 3. 4. 5. 6.

Hospital Public areas 3400 Clinical area 14695 Administrative areas 5280 Circulation areas 6625 Total net area 30000 Wall and partition 3000 areas(10%) Gross area for total 30000 Sq.Ft. building

1. The Public Area Includes traffic, main entrance, reception and information, registration and records area, non clinical areas and entrance hall, waiting room, public toilets and washrooms, snacks bar, consultation room, special examination room, treatment/dressing room. 2. The Clinical Area Includes •

Clinics for various medical disciplines, medical clinics, surgical clinics, orthopedics clinic, eye clinic, ENT clinic, dental clinic, obstetric and gynecological clinic, family planning clinic and pediatrics clinic.



Ancillary facilities include injection clinic and pharmacy.



Auxiliary facilities are laboratory, radiology, blood bank, health education, social services, and screening clinic, preventive and social medicine.

7

3. Administrative Area is administrator’s office, business office and house keeping.Storage facilities are general stores, drug stores and linen storage.

Inpatient Services Inpatient services are the most important in the hospital based health care delivery system. Inpatient hospital services are under constant pressure of increasing demand and their capital and operational costs are very high, which directly affects the hospital. In patient care units are grouped as follows:•

General Ward:- These wards are the traditional type and have patients who are not critically ill but need continuous care or observation and have to be in bed. These include wards for the disciplines of medicine, surgery, ENT and ophthalmology.



Specialty Ward:- These wards are for patients who need hospitalization in particular specialties such as orthopedics, pediatrics’, psychiatry, infectious diseases, skin, obstetrics and gynecology and other specialized disciplines.



Intensive Care Units:- These wards are for critically ill patients.

Planning And Organizing An Inpatient Unit 1. Physical Facilities:- The inpatient area should be located away from main road and the OPD area.

8

Important measurements to keep in mind while designing a ward. •

The size of hospital bed is 6’6” x 3’3”.



The minimum distance between the centre of two beds should be 0.25m, space at the foot-end 0.09m, space at the head-end 0.25m. thus the space required would be 3.15m x 2.25m =7.19m2(75 sq.ft)



The area per bed in award is 70-90 sq.ft(7m2)



The area per bed in the ICU is 100-120 sq. ft per bed.



A single bedroom with an independent toilet should have a minimum space of 125 sq. ft (14m2) and a double bedroom 21 m2.



The space between two rows of bed is 5 ft.



The distance between two bed should be 3 ½ to 4 ft.



Clearance between the bed head and wall should be 1 ft and between the side of a bed and wall about 2 ft.



The width of the dormitory should be 20ft.



The average size of a toilet should be 3.50 m2.



The size of an isolation unit should be 14 m 2, and should contain a bed, bedside locker, chair for the patient’s attendant and a built-in-cupboard. These units should have separate toilets.



Width of the hospital corridor should be 3m wide to accommodate two passing trolleys and the ceiling height should be 7 ½ to 8 feet.

2. Size:- The size of a ward or nursing unit varies in different hospitals. The maximum activity in a ward takes place between 8 a.m and 12 noon, less during the rest of the day and least at night. The requirement of staff of staff in the night shift will be 9

the same as in an average-size unit. The modern trend is to have a head nurse for a unit of 35-35 beds. 3. Shape/design •

Open Ward:- About 30-35 patients were housed in such wards and the length of the ward was not less than 96 feet. Advantages are- nurses have ample visibility and can observe patients directly, adequate cross-ventilation, natural light is available and economical to construct and maintain.



Rig’s Ward:- In this design, the ward unit is divided into small compartments or cubicles separated from each other by low partitions, each cubicle having 1,2,3,4 or 6 beds arranged parallel to the longitudinal walls. In India it is not practical due to shortage of finances and nursing personnel.

4. Types Of Ward Design •

Nightingale Ward:- This is an open ward with 20-30 beds. The services are located at either end of the ward.



L-Shaped Ward:-In this, the nursing station is placed at the 900 junction of the L. The visibility is better with less walking distance between the nursing station and the patient.



T-Shaped Ward:- The nursing station is at the vertical arm and the patient’s area are located on the horizontal arm. Serious patients are kept in section A.



Circular Ward:- This design occupies the minimum space and reduces the walking distance between patient and nurse to the minimum.

5. Ancillary Accommodation 10



Nursing Station:- The nursing station should be 20’x20’ and should have sister’s room with attached toilet, cupboards for medicines, a large work table and stools, build in cupboards to hold medicines, stationary, forms etc.



Treatment

Room:-

Required

for

physical examination,

dressing and certain procedures which cannot be carried out conveniently at the bedside. •

Clean Utility Room:- This room(100-200 sq.ft) is used for clean storage, e.g drugs, intravenous sets and solutions, CSSD articles, packing dressing.



Bathrooms And Toilets:- Adequate bathroom and toilets should be provided. Toilets for a individual room in a ward unit shall be 3.5 m2 comprising a bath, wash basin.

Staffing Norms For Medical Personnel For A General Hospital S.N

Specialty

o 1. 2. 3.

General medicine General surgery Gynecology

4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Obstetrics Paediatrics Anaesthisia Dentistry Radiodiagnosis Pathology Orthopedics Ophthalmology ENT Skin and STD Psychiatry

300

bed

strength 2 2 and 2 2 4 2 2 2 2 2 2 1 1 11

14.

Chest

disease

and 1

15. 16. 17.

Tuberculosis Biochemistry 1 Microbiology 1 General Duty Medical 20 Officer

Staffing

Norms

For

Nursing

Staff

And

Nursing Supervisors S.N

Nursing Personnel

Staffing Norms

o 1. 2.

Nursing superintendent Dy.Nursing

1 per hospital 1 up to 400 beds

3.

superintendent Asst.

4. 5.

Superintendent Ward sisters Staff nurse

1 for 25-30 beds or 1 per ward. 1 nurse for 3 beds

For ICU/ICCU

1 nurse for 1 bed(+ 30% leave

6.

Nursing 1 for 100-150 beds or 3-4 wards

reserve) It is suggested that for each 250 beds there should be one infection control nurse.

Norms For Class ‘D’ Employees In 300 beded hospital we need 150 class ‘D’ employees as per the ratio of 1employee per 2 beds.

Conclusion

12

"A

hospital

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

Bibliography 1. Cedric B. Finch, Dr. D.K Sharma, Dr.R.C Goyal. Hospital Planning and Management.1999. Voluntary Health Association Of India.

13

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