hospital case study

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HOSPITALS

NATIONAL INSTITUTE OF TECHNOLOGY, HAMIRPUR

Hospital

CATEGORY A : (25-50 BEDS)

CATEGORY B : (51-100 BEDS)

CATEGORY C : (101-300 BEDS)

CATEGORY D : (301-500 BEDS)4

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A hospital is an institution for providing health care treatment to the patients with specialized staff and equipments.

A general hospital is divided into operational areas of administration, examination, treatment, supply, disposal, residential areas, and support

areas for service operation.

CATEGORY E : (501-700 BEDS)5

Functional Planning Norms by Medical Council of India

Selection of Site for Hospital

Treatment rooms

Nursing Wards

Special rooms

Aligned along North-West and North-East direction

Aligned along South to South-West direction

Aligned along North direction

Quite Place

Future Expansion area

Almost sq. area

No loss of amenity

No contaminated land

Location

Connectivity b/w Areas

Space RequirementsSpaces Areas

Supply/disposal 40-80 sqm. PA/planned bed-care area

Nursing area 19-25 sqm. PA/planned bed

Intensive therapy 30-40 sqm. PA/bedSurgical area 130-160 sqm. PA/surgical unitRehabilitation 19-22 sqm. PA/treatment place

Physiotherapy 68-75 sqm. PA/treatment place

X-ray 60-70 sqm. PA/diagnosis roomRadiotherapy 300-350 sqm. PA/equipment

Recovery area 25-30 sqm. PA/recovery bed

NMR diagnosis 100-150 sq. PA/diagnosis room

Clinical physiology 80-100 sqm. PA/diagnosis roomClinical neurophysiology 78-100 sqm. PA/diagnosis roomCentral reception 140-160 sqm. PA/examination/treatment room

Delivery area 85-100 sqm. PA/delivery room

Dialysis 70-80 sqm. PA/dialysis bedSpecialist departments 55-75 sqm. PA/examination/treatment room

PA = Productive area

Corridors, Doors, Stairs and Lifts

CorridorsCorridors

• Normal door – 2.2m

• Vehicle entrance – 2.5m

• Transport entrance – 2.8m

• Lift car – 0.9-1.2m

• Shaft – 1.25-1.5m

DoorsDoors StairsStairs LiftsLifts

• Access corridors – 1.5 m wide

• Patient’s corridors – 2.25m wide

• Width – 1.5-2.5m

• Step height – 170mm

•Tread depth – 280mm

Dimensions of Bed Lift

Circulation

External Traffic Control

Out Patient Department (OPD)

The OPD has facilities for screening, counseling, clinical examination, treatment and referral.

It consists of the following:

The Examination Room should be close to the nurses station and the consultation room.

Consultation Room is mostly used when lengthy conversation is involved between the doctor and the patient.

Clinical Department of OPD includes clinics which can use standard accommodation, general medicine, surgery, etc.

Types of clinics: surgical, orthopedic, medical, pediatric,skin, ophthalmic, ENT, dental, chest, psychiatric, cardiology clinic.

OPD for the surgical department should be located on the ground floor and near the emergency with direct access to it.

Minor Surgery Room may be used as a cast room, ECG room, minor operations. It should have a separate entrance.

Support services includes clinics which can use standard accommodation, general medicine, surgery, etc.

In Patient Department (IPD)

Inpatient- means that the procedure requires the patient to be admitted to the hospital so that he can be closely monitored during the procedure and afterwards for recovery.

Isolation unit- An area of 14m2 for such rooms to contain a bed, beside locker, etc and separate toilet facilities.

Wards for the particular specialties, should be located closer to their respective department, self contained centers.

Ward unit shall comprise 24-36 beds. Isolation rooms should be present for 15% of the patients in a hospital.

Aim is to minimize the works of the nursing staff and provide basic amenities to the patients with in the unit.

Orientation of rooms should face south-east or south for the adequate day lighting in the wards

Size- Width of the doors > 1.2 m, dado to a height of 1.2 m. Effective corridor width of 2.40 m up to 3.10 m.

Size- Area of 7 m2 per bed is recommended, arranged with a minimum distance of 2.25 m between centers of two beds.

Emergency

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Should be located on the ground floor with separate access for the patients and ambulances, away from the outpatient entrance

Should be well marked with proper lighting and signs and should be easily visible and accessible from the street

Raised platform for ambulance discharge, ramps provided for wheelchair and pedestrian access

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Close to admission, medical records, cashier’s booth, laboratory services, and the blood bank

Proximity to elevators is also important in order to proceed to surgery without loss of time.

Renders services right from the elementary first aid to sophisticated management of surgical and medical emergencies

and full scale trauma care.

Radiology

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Should always be close to the ambulance entrance and because of the great weight of the equipment should be on ground floor.

A connecting corridor which can be used simultaneously as a store, dictating room and switch room for staff is desirable.

Sonography, mammography and jaw X-ray require about 12-18 sqm. Whereas standard X-ray and admission rooms need to be 20-30 sqm.

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The access route for the patients should be through 2 changing cubical.

WC’s should be installed in the X-ray room used for stomach/intestinal inspection.

Radiology includes the specialist areas which use ionizing radiation for diagnostic and therapeutic purposes. This includes

X-Ray diagnosis, radiotherapy and nuclear medicine.

Flow Chart of X-Ray Department

ICU

X-Ray X-Ray Room

OT

Waiting

Toilet

ChangingRoom

Reception Control

Dark RoomDark Room

Reading & Interpretation(Radiologist)

Doctor’s Viewing

File Collection&Storage

Radiotherapy

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It comprises of reception, waiting area, doctor’s room (18 sqm.), switch room (15 sqm.), localization room (20-25 sqm.), service room (20 sqm.), film developing room (10 sqm.), stores and cleaner’s room.

Each treatment room requires a changing cubicle for patients.

If the department includes a linear accelerator, a workshop (15 sqm.) and at least one physics laboratory (15-18 sqm.)

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The clear height of the radiation rooms must be 4.3m.

For hygiene reasons the patient waiting area , examination, localization, preparation and radiation rooms must be well ventilated.

In radiotherapy, conditions diagnosed in the radiography department (e.g. tumors) are treated.

Physiotherapy

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Should be accessed through the main reception area.

Additional rooms – changing rooms, WCs, rest rooms, linen stores, waiting areas, cleaner’s room and service room.

A gymnasium to be included in it.

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Because of the high internal temperatures (28-30 degree) construction physics problems should be anticipated.

Should be arranged on basement floor where natural lighting can be admitted through roof lights and light shafts.

This department contains a wet area consisting of an exercise pool (4X6m), a four cell bath, a butterfly bath, inhalation rooms, a

massage bath, hand and foot baths as well as necessary subsidiary rooms. Slip resistant tiles to be used.

Flow Chart of Surgical Unit

Post-operative Recovery

Wards

ICU

OT

Theatre Sterile Supply UnitFrozen Section

Laboratory

Doctor’s Changing

room

Clean-upScrub-up

Anesthesia room

Nurse’s Changing

room

Central Sterilization &

Supply Unit

PatientsDoctors

Nurses Other Hospital Areas

Operation Theatre

Freedom from noise and disturbances.

Freedom from contamination and possible cross infection.

Independent of general traffic movement from

rest of the hospital.

OT

Correct & convenient relationship with ICU, CSSD, Radiology & Pathology Lab.

Freedom from noise and disturbances.

Adequate glare free natural light is required which has

psychological impact. Hence north light is desirable.

Temperature range should be between 23 to 24 deg C.

Most present day operations use artificial light, but good light and ventilation are of

added advantage.

Operation Theatre

Washroom

Plaster room

Equipment roomSub-

sterilisation room

Size of room – 3.8x3.8m. Electric sliding door of clear width 1.4m. Room should be equipped with a refrigerator, draining sink, rinsing line, cupboards, connections for

anesthesia equipments and emergency power.

Size of roughly 10 sqm. Must be directly accessed by the OT.

For hygiene reasons this is not located in the surgical zone but

in the outpatient area. In emergencies the patient must be channeled through lobbies

in order to get to the OT.

Size of approximately 20 sqm. Should be as close as possible to

the OT.

Min. width – 1.8m. For each OT there should be 3 non-splash

wash basins with foot controls.

It contains a non-clean area for non-sterile material and a clean area for prepared sterile items. Should be

equipped with a sink, storage surface, work surface and steam sterilizer.

Anesthetics room

Sterile goods roomAttach-Attach-

mentsments

Ward Facilities

Examination & Treatment

room

Pantry

Ward store

Linen room

Storage for the stretcher

Room for the Head

nurse

Nursing station

Laboratory

Room for the staff

nurse

Workroom for nursing

staff

Sluice room

SanitaryCloakroom

Intensive Care Unit (ICU)

• It should have an OT for minor interventions (25-30 sqm.), Laboratory spaces, Kitchenette, Substerilisation (20 sqm.), clean material room, non-clean workroom, cleaning room, lounge for relatives, Duty doctor’s room, Documentation room, Consulting room and Sanitary facilities.

Arrangement

Description of ICU

The task of intensive care is to prevent life-threatning disruption of the vital bodily functions. The services of ICU include monitoring and

treatment as well as care of the patient.

Arrangement of Bed Spaces

Auxiliary Functions

• The beds may be placed in an open, closed or combined arrangement.• Beds in clear view of central nurses’ station.

• Must be a separate area and only accessed through lobbies. • For economical care of OT patients, recovery room is located in ICU. • Number of patients/unit should be 6 to 10

ICU n CCU

Patient’s Room

One-bed room with service panel Section of the room

Section of 3-bed room set

Patient’s cupboard

Side view

Nursing Services

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Double corridor nursing floor provides closer relationship between beds, nursing stations and other service areas.

Clean utility is designed to accommodate carts for storing linens, utensils and other supplies .

Elevators are located outside the nursing unit to cut down noise.

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Nursing services can be integrated into the same module which includes the typical patient room.

Greater flexibility in segregation of patients for various medical reasons.

Nursing station is given in a ward in such a way that nurse keeps an eye on all patients. Nurse work room is used to sterilise the instruments along with storage of necessary instruments and

machinery.

Nursing Services

Flow chart

detail of nursing station and utility

ward type depth width 1 bedroom 3.4m 3.15m 2 bedroom 3.3m 3.5m 3 bedroom 7m 3.5m 4 bedroom 5.3m 6.4m 6 bedroom 7m 6.4m 8 bedroom 5.55m 2x6.4m

Sizes of Nursing rooms

Admitting Department

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Maintain bed index showing current occupancy status. Prepare admission and discharge lists and midnight census.

It should be situated on the same level as hospital’s main entrance, be readily identifiable, and provided with a sign(easily seen).

Admitting patients’ waiting area, large enough to accommodate patients and relatives accompanying.

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Clerical work area for maintaining hospital occupancy directories, records, forms,, notices, etc.

Wheelchair and stretcher alcove. Space for computers and office equipment.

Functions of the admitting department revolve around admitting, transfer and discharge of patients. This department coordinates patient’s arrival, registration, medical records and initial tests.

Admitting Department Flowchart

Medical Department

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Maintaining proper facilities and services for accurate and timely production, processing,checking,filing and retrieval of medical records.

It should be close to or on the corridor leading to doctors’ lounge so that they can stop by and complete their records and study.

It should be so designed with the best possible means of transportation of medical records thorough all stages of their use.

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Reception-cum-registration area, space for copier. Work area for record processing, assembling, numbering, indexing, etc.

Storage area for medical carts. Staff facilities.

The medical records department maintains records and documents relating to patient care.

Medical Flowchart

Flowchart of medical records on discharge of patient

Flowchart of medical records on admission of patient

Central Sterilisation and Supply Department (CSSD)

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This method basically involves cleaning, disinfecting and sterilizing before use all instruments, materials and equipment utilized in patient care. . Is performed by heating them with pressurized steam of by gas

sterilization.

Carrying out the process of decontamination or disinfection prior to sterilizing

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Packing all materials for sterilizing,Sterilizing,Labelling and dating materials,Storing and controlling inventory,Issuing and distributing .Accessiblity to elevators, dumbwaiters and stairs is of utmost importance..

Despite of the advancement, hospital acquired infection remains the hospital’s single most serious concern that negated some of

its otherwise good work.

Food Service Department

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Provide best possible food at a cost consistent with the policy of the hospital..

The department should be close to the materials management department.

In general the important factor to be borne in mind is the logical workflow.

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Plan and implement patient therapy, education and counselling. .

A ground floor location is preferable, and is also convenient to deliver supplies..

Good food is important in the treatment of the patient and is a part of his total care. The food service department in today’s

modern hospitals ranks one of the major departments.

Food Service Flowchart

Delhi Bye-LawsThe Medical Facilities In Delhi are provided by various agencies operating at various hospitals, dispensaries, clinics and nursing homes. These agencies includes Delhi government, Central Government, Local bodies, Statuary Bodies, Voluntary Organizations and Private Sectors. A six Tier system of health facilities has been proposed in MPD-2001 as given below:

S.No. Category Population

Covered Capacity Area Of Hospital

Residential Area Total Area

1 Gen. Hospital 2.5 lakh 500 Beds 4 Ha. 2 Ha. 6 Ha.

2 Intermediate Hospitals (A) 1 lakh 200 Beds 2.7 Ha. 1 Ha. 3.7 Ha.

3 Intermediate Hospitals (B) 1 lakh 80 Beds 0.6 Ha. 0.4 Ha. 1 Ha.

4 Polyclinics 1 lakh 0.2 – 0.3 Ha. - 0.2 – 0.3 Ha.

5Nursing HomeChild Welfare and Maternity

1 lakh 25-30 Beds 0.2 – 0.3 Ha. - 0.2 – 0.3 Ha.

6 Dispensary 0.15 lakh 0.08 – 0.12 Ha. - 0.08 – 0.12 Ha.

For 500-200 bedded hospital

•Maximum Ground Coverage : 35%•Maximum Far : 200•Maximum Height: 33M

Case Study: Bhagwan Mahavir Hospital

INTRODUCTION:INTRODUCTION:Bhagwan Mahavir Hospital is located in Bhagwan Mahavir Hospital is located in Madhuban Chowk near Pitampura Metro Station, Madhuban Chowk near Pitampura Metro Station, Delhi. It is a two side open site. There is 60m wide Delhi. It is a two side open site. There is 60m wide road in front and 5m wide road on the side.road in front and 5m wide road on the side.As the name suggests Bhagwan Mahavir Hospital As the name suggests Bhagwan Mahavir Hospital is dedicated to Bhagwan Mahavir and it runs is dedicated to Bhagwan Mahavir and it runs under Maha Sati Devi Jain Educational Trust. The under Maha Sati Devi Jain Educational Trust. The Hospital was inaugurated by the President Of Hospital was inaugurated by the President Of India Giani Zail Singh on the 23 October 1986. It India Giani Zail Singh on the 23 October 1986. It is a 40 Bedded Hospital.is a 40 Bedded Hospital.

CLIMATE:CLIMATE:Delhi is in the group of composite climateDelhi is in the group of composite climate•Maximum Temperature : 41̊CMaximum Temperature : 41̊C•Minimum Temperature : 7 ̊CMinimum Temperature : 7 ̊C•Rainfall : 1.73MRainfall : 1.73MIn comparison, Delhi has high rainfall and In comparison, Delhi has high rainfall and less air movement, which in turn gives rise less air movement, which in turn gives rise to high humidity round the year.to high humidity round the year.

FACILITIES AVAILABLE:FACILITIES AVAILABLE:Ground Floor: Ground Floor: •OPD ChambersOPD Chambers•LaboratoryLaboratory•UltrasoundUltrasound•ICUICU•ReceptionReception•ChemistChemist•X-RayX-Ray


AREA STATEMENT :AREA STATEMENT :Total Site Area: 3000 SQ.M.Total Site Area: 3000 SQ.M.Total Covered Area : 990 SQ.M.Total Covered Area : 990 SQ.M.F.A.R. = 100F.A.R. = 100

First Floor:First Floor:•Operation TheatreOperation Theatre•Staff RoomStaff Room•WardsWards•StoreStore•Nursery roomNursery room

SITE PLANSITE PLAN

The total area of site is 3000SQ.M. . The The total area of site is 3000SQ.M. . The front set back is 10M., rear set back is front set back is 10M., rear set back is 5M., side set back is 3M. and the other 5M., side set back is 3M. and the other side is 18M. left for future extension.side is 18M. left for future extension.

Saroj HospitalSaroj Hospital R.S. InstituteR.S. InstituteOf AdvancedOf AdvancedStudiesStudies

TecniaTecniaInstituteInstitute

L/O/G/O

National Institute of Technology, Hamirpur

hospital case study

Design