wbdg hospital

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Hospital

OVERVIEW

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

Hospitals are the most complex ofbuilding types.Each hospital is comprised of a wide range of services

andfunctionalunits. These include diagnostic and treatment functions, such as clinicallaboratories,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.

VAMC Bay Pines, FL

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

designintegratesfunctional 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
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Physical relationships between these functions determine the configuration of the hospital. Certain relationships

between the various functions are requiredas 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 logistic 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.)

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

Efficiency andCost-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-designprogramming. 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 makingprudent use of multi-purpose spaces

Consolidate outpatient functions for more efficient operationon first floor, if possiblefor 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.

VAMC Albuquerque, NM

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 theVA 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 administrativedepartments, adjacent to "hard spaces" such as clinical laboratories.

Therapeutic Environment
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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. Theinterior designerplays

a major role in this effort to create atherapeutic 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. (SeeVA Interior Design Manual.) 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 approximatesnaturaldaylight

Providingviewsof the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes arehelpful 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 theirdestination 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. (As an example, seeVA Signage Design Guide.)

For an in-depth view seeWBDGTherapeutic Environments.

Cross-section showing interstitial space with deck above an occupied floor

Cleanliness and Sanitation

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

IncorporatingO&M practicesthat stress indoor environmental quality (IEQ)AccessibilityAll areas, both inside and out, should:

Comply with the minimum requirements of the Americans with Disability Act (ADA)and, if federally funded or owned,theGSA'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 easyto 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 topass easily

Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass wallsand 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 illinpatients

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 ofnatural 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
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Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or because they may be highly visiblepublic 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 ofenergyandwaterand produce large amounts of waste. Because

hospitals place such demands on community resources they are natural candidates forsustainable design.

Section 1.2 of VA's HVAC Design Manual is a good example of health care facility energy conservation standards

that meetEPAct 2005(PDF 1.3 MB, 550 pgs)andExecutive Order 13423requirements. TheEnergy Independence and Security

Act of 2007 (EISA)(PDF 740 KB, 310 pgs)provides additional requirements for energy conservation. Also see LEED's

(Leadership in Energy and Environmental Design) USGBCLEED for Healthcare

Related Issues

TheHIPAA(Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of

"protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy, and may affect

location and layout of workstations that handle medical records and other patient information, paper and electronic,

as well as patient accommodations."

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EMERGING ISSUES

Among the many new developments and trends influencing hospital design are:

The decreasing numbers of general practitioners along with the increased use of emergency facilities for primary care The increasing introduction of highly sophisticated diagnostic and treatment technology Requirements to remain operational during and after disasterssee, for example, VA'sPhysical Security Manuals State laws requiringearthquake resistance,both in designing new buildings and retrofitting existing structures Preventative care versus sickness care; designing hospitals as all-inclusive "wellness centers" Use of hand-held computers and portable diagnostic equipment to allow more mobile, decentralized patient care, and a general

shift to computerized patient information of all kinds. This might require computer alcoves and data ports in corridors outsidepatient bedrooms. For more information, see WBDGIntegrate Technological Tools

Need to balance increasing attention to building security with openness to patients and visitors Emergence of palliative care as a specialty in many major medical centers A growing interest in more holistic, patient-centered treatment and environments such as promoted byPlanetree.This might

include providing mini-medical libraries and computer terminals so patients can research their conditions and treatments, and

locating kitchens and dining areas on inpatient units so family members can prepare food for patients and families to eat together.

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RELEVANT CODES AND STANDARDS

Hospitals are among the most regulated of all building types. Like other buildings, they must follow the local and/or

state general building codes. However, federal facilities on federal property generally need not comply with state and

local codes, but follow federal regulations. To be licensed by the state, design must comply with the individual state

licensing regulations. Many states adopt theFGI Guidelines for Design and Construction of Hospitals and Health Care

Facilities,listed below as a resource, and thus that volume often has regulatory status.

State and local building codes are based on the model International Building Code (IBC). Federal agencies are

usually in compliance with the IBC except NFPA 101 (Life Safety Code), NFPA 70 (National Electric Code), and

Architectural Barriers Act Accessibility Guidelines (ABAAG) or GSA's ABA Accessibility Standards takes precedence.
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Since hospitals treat patients who are reimbursed under Medicare, they must also meet federal standards, and to be

accredited, they must meet standards of the Joint Commission on the Accreditation of Healthcare Organizations

(JCAHO). Generally, the federal government and JCAHO refer to the National Fire Protection Association (NFPA)

model fire codes, including Standards for Health Care Facilities (NFPA 99) and the Life Safety Code (NFPA 101).

The American with Disabilities Act (ADA)applies to all public facilities and greatly the building design with its general

and specific accessibility requirements. The Architectural Barriers Act Accessibility Guidelines (ABAAG)orGSA's

ABA Accessibility Standardsapply to federal and federally funded facilities. The technical requirements do not differ

greatly from the ADA requirements. See WBDGAccessible

Regulations of the Occupational Safety and Health Administration (OSHA)also affect the design of hospitals,

particularly in laboratory areas.

Federal agencies that build and operate hospitals have developed detailed standards for the programming, design,

and construction of their facilities. Many of these standards are applicable to the design of non-governmental facilities

as well. Among them are:

Department of Veterans Affairs (VA),Office of Construction & Facilities Management Technical Information Librarycontainsmany guides and standards, including:

o Design Guides for planning many different departments and clinics, design manuals of technical requirements, equipment lists,master specifications, room finishes, space planning criteria, and standard details.

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MAJOR RESOURCESWBDG

Federal Mandate

Executive Order 13423 Technical Guidance

Products and Systems

Building Envelope Design GuideWebsites

See WBDGHealth Care Facilitiesfor generic health care facilities websites

Publications

Design Details for Health: Making the Most of Design's Healing Potential, 2nd Editionby Cynthia A. Leibrock and DebraHarris. New York: John Wiley & Sons, Inc., 2011.Innovative design solutions in key areas such as lighting, acoustics, color,

and finishes

Design Guide for Improving Hospital Safety in Earthquakes, Floods, and High Winds: Providing Protection to People andBuildings.FEMA, 2007.

Development StudyVA Hospital Building Systemby Building Systems Development and Stone, Marraccini & Patterson.Washington, DC: U.S. Government Printing Office, rev. 1977.

Emergency Department Design: A Practical Guide to Planning for the Futureby John Huddy and Michael T. Rapp. Irving,Texas: ACEP (American College of Emergency Physicians) 2000.

Healthcare Facility Planning: Thinking Strategicallyby Cynthia Hayward, AIA, FAAHC, ACHA. Health Administration Pressand the American College of Healthcare Executives, 2005.

Hospitals, The Planning and Design Process, 2nd ed. by Owen B. Hardy and Lawrence P. Lammers. Rockville, Md.: AspenPublishers, 1996.

Hospital Interior Architecture: Creating Healing Environments for Special Patient Populationsby Jain Malkin. New York: JohnWiley & Sons, Inc., 1992.

Healthcare DesignA quarterly magazine with design articles and presentations of recent projects
http://www.jcaho.org/http://www.jcaho.org/http://www.jcaho.org/http://www.nfpa.org/http://www.nfpa.org/http://www.nfpa.org/http://www.ada.gov/http://www.ada.gov/http://www.ada.gov/http://www.wbdg.org/ccb/browse_doc.php?d=1351http://www.wbdg.org/ccb/browse_doc.php?d=1351http://www.wbdg.org/ccb/browse_doc.php?d=1351http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/aba-standardshttp://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/aba-standardshttp://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/aba-standardshttp://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/aba-standardshttp://www.wbdg.org/design/accessible.phphttp://www.wbdg.org/design/accessible.phphttp://www.wbdg.org/design/accessible.phphttp://www.osha.gov/http://www.osha.gov/http://www.osha.gov/http://www.cfm.va.gov/TIL/http://www.cfm.va.gov/TIL/http://www.cfm.va.gov/TIL/http://www.wbdg.org/design/hospital.php#tophttp://www.wbdg.org/design/hospital.php#tophttp://www.wbdg.org/references/sustainable_eo.phphttp://www.wbdg.org/references/sustainable_eo.phphttp://www.wbdg.org/design/envelope.phphttp://www.wbdg.org/design/envelope.phphttp://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/design/health_care.phphttp://www.tkqlhce.com/click-2191068-10438326?url=http%3A%2F%2Fwww.wiley.com%2Fremtitle.cgi%3Fisbn%3D0470524715&cjsku=0470524715http://www.tkqlhce.com/click-2191068-10438326?url=http%3A%2F%2Fwww.wiley.com%2Fremtitle.cgi%3Fisbn%3D0470524715&cjsku=0470524715http://www.wbdg.org/ccb/browse_doc.php?d=7233http://www.wbdg.org/ccb/browse_doc.php?d=7233http://www.wbdg.org/ccb/browse_doc.php?d=7233http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2050http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2050http://www.amazon.com/Hospital-Interior-Architecture-Environments-Populations/dp/0471289760http://www.hcdmagazine.com/http://www.hcdmagazine.com/http://www.amazon.com/Hospital-Interior-Architecture-Environments-Populations/dp/0471289760http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2050http://www.wbdg.org/ccb/browse_doc.php?d=7233http://www.wbdg.org/ccb/browse_doc.php?d=7233http://www.tkqlhce.com/click-2191068-10438326?url=http%3A%2F%2Fwww.wiley.com%2Fremtitle.cgi%3Fisbn%3D0470524715&cjsku=0470524715http://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/design/envelope.phphttp://www.wbdg.org/references/sustainable_eo.phphttp://www.wbdg.org/design/hospital.php#tophttp://www.cfm.va.gov/TIL/http://www.osha.gov/http://www.wbdg.org/design/accessible.phphttp://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/aba-standardshttp://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/aba-standardshttp://www.wbdg.org/ccb/browse_doc.php?d=1351http://www.ada.gov/http://www.nfpa.org/http://www.jcaho.org/


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Medical and Dental Space Planning: A Comprehensive Guide to Design, Equipment, and Clinical Procedures, 3rd Edition,byJain Malkin. New York: John Wiley & Sons, Inc., 2002.

Sound & Vibration: Design Guidelines for Health Care Facilitiesby the Acoustics Research Council. 2010. UFC 4-510-01 Design: Medical Military Facilities See WBDGHealth Care Facilitiesfor generic health care facilities publications

Tools

SpaceMedGuide-A Space Planning Guide for Healthcare Facilitiesa popular planning tool providing state-of-the-art planningmethodologies, industry benchmarks, and planning tips.
http://www.anrdoezrs.net/click-2191068-10438326?url=http%3A%2F%2Fwww.wiley.com%2Fremtitle.cgi%3Fisbn%3D0471385743&cjsku=0471385743http://www.anrdoezrs.net/click-2191068-10438326?url=http%3A%2F%2Fwww.wiley.com%2Fremtitle.cgi%3Fisbn%3D0471385743&cjsku=0471385743http://speechprivacy.org/joomla/index.php?option=com_content&task=view&id=33&Itemid=43http://speechprivacy.org/joomla/index.php?option=com_content&task=view&id=33&Itemid=43http://www.wbdg.org/ccb/browse_doc.php?d=5095http://www.wbdg.org/ccb/browse_doc.php?d=5095http://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/design/health_care.phphttp://www.spacemed.com/details-overview.htmlhttp://www.spacemed.com/details-overview.htmlhttp://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/ccb/browse_doc.php?d=5095http://speechprivacy.org/joomla/index.php?option=com_content&task=view&id=33&Itemid=43http://www.anrdoezrs.net/click-2191068-10438326?url=http%3A%2F%2Fwww.wiley.com%2Fremtitle.cgi%3Fisbn%3D0471385743&cjsku=0471385743

wbdg hospital

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