HOSPITAL PLANNING

INTRODUCTIONHospitals form an integral part of the health care

delivery system and play an important role in providing curative services.

Efficient management of hospital is essential, so that there is proper utilization of resources available within the constraints existing in the present health care delivery system and also to provide quality services to the community.

PLANNING A HOSPITAL

The hospital planning process concentrate more on the :-

designing of buildings and their architectural appearance.

planning of organisation and equipment as well as accommodating them and generating spaces to meet policies.

PRINCIPLES OF HOSPITAL PLANNINGProtection from unwanted and uneasily disturbance to helps in speedy recovery.

Control:The nursing station should be positioned strategically to enable proper monitoring of visitors entering and leaving the ward

Circulation: all the departments of the hospital must be properly intégrate.

Separtion from disimilar activity

Characteristics of Hospital Organization Every organization has a head.

In every organization there should be a clear line of authority for every individual.

In a hospital, there are dual lines of authorityThe Administrators are responsible for solving

management problem and health care personnel are involved in patient care.

Cont….The hospital is in continuous operation which

requires high operating costs and substantial personnel and scheduling problems.

The diversity of personnel ranges from highly skilled and educated administrators and doctors to unskilled and uneducated employees like the staff involved in sanitary functions.

Cont….Hospitals are characterized by having wide diversity

of objectives and goals for different personnel, professional groups and subsystems.

For example: The house keeping department works towards maintaining cleanliness and sanitation, the clinical team focus on patient care.

Cont….The hospital organization is characterized

by interdependence. For example: An orthopaedic surgeon

cannot perform an orthopaedic surgery without the findings from the radiology department and the assistance of the nurses and technicians.

Types of hospital1. General

The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health.

2.District

•A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth bioassay laboratories, and so forth.

3.SpecializedSpecialized hospitals include:-• Trauma centres, rehabilitation hospitals, children's

hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems.

4.Teaching•A teaching hospital combines assistance to patients

with teaching to medical students and nurses and often is linked to a medical school, nursing school or university

5.ClinicsA medical facility smaller than a hospital is generally

called a clinic, and often is run by a government agency for health services or a private partnership of physicians

Clinics generally provide only outpatient services.

PLANNING OF UNITOutermost zone, which is the most community oriented

Primary health care support areasOut-Patient DepartmentEmergency Department Administration Admitting Office Reception

Second zoneWhich receives workload from•Diagnostic X-Ray•Laboratories•Pharmacy Middle zone between outer and inner zones•Operating Department• Intensive Care Unit•Delivery area•Nursery

Cont…..Inner zone:• In the interior but with direct access for the public•Wards And Nursing UnitsService Zone, Disposed Around A Service Yard •Dietary Services•Laundry And Housekeeping•Storage maintenance and engineering• laboratory•x-ray,Medical shop, carrying common drugs,

vaccines, serum and surgical items

ORGANIZATION OF THE UNIT1. Outpatient department The design of the out-patient department of the

hospital depends on the scheduling of consultations• Consultation Rooms• Examination Rooms• Treatment Rooms,• Staff and Supply Areas.

SOURCE OF

PATIENTS IN OPD

FOLLOW UP

PATIENTS

EMERGENCY

PATEINTS

UNREFFERAL PATIENTS WALK IN

REFFERRED

PATIENTS

Front office

Registration

Waiting area

1 2 3 4 5

X-RAY

LABINJ

ROOM

DRESSING ROOM

Pharmacy

IP AdmissionIP WARDS

WORK FLOW OF

OPD

Emergency medical servicesEmergency service dedicated to providing out-of-

hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency.

CONT…Term emergency medical services may refer solely to

the pre-hospital element of the care, or be part of an integrated system of care, including the main care provider, such as a hospital.

Emergency medical services may also be locally known as: first aid squad, emergency squad, rescue squad, ambulance squad, ambulance service, ambulance corpsor life squad

Administration Block

•The administrative department is orientated to the public but is at the same time private. Areas for business, accounting, auditing, cashiers and records, which have a functional relationship with the public must be located near the entrance of the hospital

Radiology and imaging departmentThe term "radiology department" usually refers to the

department in which diagnostic imaging is provided. It is distinct from that in which radiotherapy and

radiation oncologist are carried out.

Work flow in radiology department

X-ray room Dark room

Toilet

Change room

Reading and interpretation

Doctor’s viewing

File correction and storage room

Waiting room

Reception room

X-ray film flowPatient

Traffic flow

Cont…

•The X-ray department should consist of three rooms:•The X-Ray Room;•The Dark-Room and•Office And Storage Space.

Medical record roomWell-kept medical records form an integral and vital

part of an efficient hospital system.Full-scale computerized data bank should be created

in which all data relating to hospital patients are retained

Laboratory servicesModern medicine is increasingly dependent on

laboratory services for the prevention, diagnosis and control of diseases.

Pathology laboratories play a central role in the hospital and and each hospital must have an adequate laboratory service under the direction of a medically qualified pathologist.

LAB LAY OUTRECEPTION /REGISTRATION

WAITING AREA

FE

SAMPLE COLLECTION

ROOM

TOILET

MALE FEMAL

E

SAMPLE STORGAE/REFI

RIGRATION STORAGE

PATH LAB

PATHOLOGIST ROOM/PATIEN

T REPORT

Pharmacy• In designing the pharmacy, the following considerations should be kept in mind:

• (1) location: accessible to the out-patient department,•convenient for dispensing, accessible to the central

delivery yard.• (2) Traffic within the department must be economical

and flexible.• (3) Its size is determined by its organization and

operational policies.• (4) Provision for security of dangerous drugs.

Work flow of pharmacy

Manufacturer dealer suplier

Main stores

Sub stores or pharmacy

wards outpatients

Blood bank•A blood bank is a cache or bank of blood, gathered

as a result of blood donation, stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a division of a hospital laboratory where the storage of blood product occurs and where proper testing is performed to reduce the risk of transfusion related events.

Operating theatreThe design of operating theatres has become more

and more complex.The latest technology in OT Bacteria-free environments in which surgery can be

undertaken under almost completely aseptic conditions.

Sophisticated provision of equipment.

Location of operating department•The preferred location is on the same floor as the

surgical wards, which may be the ground floor. It should be connected to the surgical ward by the simplest

•Possible route, it should also:•Adjoin The Central Sterile Supply Department

O.t layout•c autocla

ve

stores

Nurses office

Female change room

Male change room

Reception room

Anesthetists room

Doctor’s lounge

Recovery room

Operating room1

Operating room 2

Operating room3

Operating room4

Intensive care unitThe intensive care unit is for critically ill patients who need constant medical attention and highly specialized equipment

to control bleeding, to support breathing, to control toxaemia and to prevent shock.

LOCATION CONT…Be Easily Accessible From The Accident And

Emergency DepartmentBe Easily Accessible For The Delivery SuiteAdjoin the intensive care unit.

Paediatrics unit

•The nursery should be located adjacent to the delivery department to ensure protected transport of newborns .Areas must be provided for cribs for both well and ill babies and for support services that include formula and preparation rooms.

Geriatric services•The older population of any community is usually best cared for in community-based facilities where their special needs and requirements are provided for in sensitive and Rooming-in caring designs that allow them to lead independent and dignified lives for as long as possible

Inpatient nursing wards•These wards provide accommodation for patients who are dependent on

•others because of their illness. They have the following functions:

• to substitute for the home for regular eating, bathing, sleeping, etc;

• to allow examination, treatment and cure of patients.• to prepare patients to return to domesticlife.

Dietary services•  Apart from parenteral feeding (not considered here),

hospitals should provide dietary services for those in special need of them (i.e., infants and other patients unable to eat normal meals). These services should be provided whether or not the local custom is for the family to provide regular meals for the patient.

CONT..The department should contain the following facilities:

•Prepared diets and service, meals and/or disposable items are used: food preparation centre, food serving facilities, for both patients and staff, dishwashing facilities (or room),pot-washing facilities

•Refrigerated storage-3-day supply, day storage-3-day supply, cart-cleaning facilities, cart storage area waste disposal facilities, dining facilities.

Central sterile supply department•(C.S.S.D.) is a integral department in the hospital ,the

purpose of CSSD is to supply all departments of a hospital theatres, wards, out-patient and casualty departments with complete, sterile equipment ready and available for immediate use in the treatment of patients.

CONT… The basic equipment consists of steam pressure sterilizers and hot-air ovens, which provide a

uniform standard of sterility of supplies throughout the hospital.

decentralized boiling-water sterilizers, used for instruments, bowls, syringes, etc.,

RECEIPT

Accounting Sorting

EGloves Instruments Needles And Syringes

Packing

Awaiting Sterilization

Autoclaves Dry ovens

Check for sterility

Sterile storage

ISSUE

Work flow of CSSD

CSSD LAY OUTSORTING RECEIVIN

G ROOMCHANGE ROOM

OFFICE ISSUES

WASHING

AUTOCLAVES

STERILE STORGAE

Laundry service

•Laundry service is responsible for providing an adequate, clean and constant supply of linen to all users.

•The basic tasks include: sorting,washing,extracting, drying, ironing, folding, mending and delivery. A reliable laundry service is of utmost importance to the hospital.

WORK FLOW OF LAUNDRY

barrier wall with double door

Reception

Soiled linen

Storage Staff uniform ward department articles

Marking and classification classification

infected linen

Central disinfection

area

storage

washing

Washing and extracting

Pressing drying calendaringAssembling ,packi

ng

Distribution

Housekeeping facilitiesThe housekeeper's office should be on the lowest floor, adjacent to the central linen room.

The central linen room supplies linen for the whole hospital. It must have shelves and spaces for sewing, mending and marking new linen. If laundry is to be handled in the hospital, the central linen room must be adjacent to the "clean" end of the laundry room

RESEARCH ABSTRACT ON HOPITAL UNIT

• Hyun-Bo Seo,Young-Seon Choi2011 reported in an exploratory study compares nurses’ trips to procure medications in a smaller intensive care unit (ICU) and those in a larger ICU designed for patient-centered care. The smaller unit observed has global visibility to most of patient rooms, and the larger unit has local visibility from distributed substations to patient rooms. The comparison showed that nurses did not walk longer and spend more time getting medication in the larger unit. They did interact less and made fewer extra stops than the smaller unit. Unlike some studies, nurses did not walk further in a larger unit. This study suggests that visibility, the presence of substations, and location of medications can reduce walking. This needs verification in further research.

RESEARCH ABSTRACT ON Hospital capacity planning: from measuring stocks to modelling flows•Bernd Rechel,Stephen Wright reported in a study of

innovative hospital projects in Europe stated that hospital capacity planning should not be based on beds, but rather on the ability to deliver processes. using approaches that are based on manufacturing theory such as “lean thinking” that focuses on the value that different processes add for the primary customer, i.e. the patient. it is beneficial to look at the hospital, not from the perspective of beds or specialties

References •Reddy S.S .hospital administration and planning volume 3 page no.184-190

•Joshi hospital administration and planning .volume 2 page no.670-677

•Basvanthapa BT. Nursing Administration.volume 3 page no.543

http://www.wikipedia.comHospital ,types, and services

http://ctb.ku.edu CSSD,laboratory, hosekeeping,lay out.