Very Complex Building Types

Published Date: 02 Nov 2017

Hospital:

Hospitals layout can be a very complex building types because hospital includes a wide range of functional units and services such as Hospitality functions, diagnostic and treatment functions, and the bed-related function or fundamental inpatient care. The specificity of codes, regulations or oversight which is governing hospital operations and construction can reflect this diversity. Specific knowledge and expertise are needed because of these wide-ranging and evolving functions of a hospital but those functional units will compete for the priorities or needs. Ideally, the preferences must be balanced against actual functional needs, mandatory requirements, and the financial status of the organization.

Apart from the wide range of services which must be accommodated, hospitals support and serve different users. Ideally, the design process is integrated with direct input from key hospital staff and from the owner in the process. The designer has to be an advocate for the visitors, patients, support staff, suppliers, and volunteers also who do not have direct input into the design generally. All in all, a well hospital design combines functional needs and constraints with the human needs of its various users.

Physical relationships between these functions decide the construct of the hospital. These relationships between the various functions are needed which is shown as in the following flow figure.

Flow diagram of general hospital relationships. Inpatient gives and receives to/from outpatient, research & teaching, diagnostic & treatment, and administration. Service gives to administration, diagnostic & treatment, and research & teaching; and receives from research & teaching. Administration gives and receives to/from inpatient, diagnostic & treatment and outpatient; and receives from service. Diagnostic & treatment give and receives to/from administration, outpatient, research & teaching, and inpatient; and receives from service. Research & teaching give and receives to/from diagnostic & treatment, inpatient, service; and receives from outpatient. Outpatient give and receives to/from inpatient, research & training, diagnostic & treatment, and administration.

Flow diagram of major clinical relationships. Reception & registration receive records and post hospital care patients and deal with admittance. Admission receives from reception & registration and services inpatient wards and outpatient wards. Records go to reception & registration, outpatient, diagnostic & treatment, and inpatient wards. Inpatient wards receive from records and admittance and in turn lead to discharge and pharmacy. Inpatient wards' divisions (medical, surgical, and psychiatric) link to diagnostic & treatment's divisions (laboratories, morgue, surgery, x-ray department, P.M.E.R.). Dignostic & treatment receive from records, and its divisions (laboratories, morgue, surgery, x-ray department, P.M.E.R.) link to inpatient wards' divisions (medical, surgical, and psychiatric) and outpatient wards' divisions. Outpatient receives from admittance and records and in turn lead to discharge and pharmacy. Outpatient's divisions (outpatient clinics and emergency) link to diagnostic and treatment's divisions (laboratories, morgue, surgery, x-ray department, P.M.E.R.). Pharmacy receives from outpatient and inpatient wards and gives to discharge from both outpatient and inpatient. Inpatient wards' discharges receive from inpatient wards and pharmacy and gives to post hospital care. Outpatient discharges receive from outpatient and pharmacy. Post hospital care leads back to reception & registration.

These flow figures show the communication and movement of materials, waste, and people. Therefore the transportation and logistics systems and physical configuration of a hospital are intertwined inextricably. The transportation systems are affected by the building configuration, and this configuration depends on the transportation systems heavily. The hospital configuration is affected by site opportunities and restraints, surrounding facilities, climate, available technology and budget. Now, new technology and medical needs generate new alternatives.

The one significant example which must be mentioned is Emergency Department in United Hospital. The Emergency Department (ED) has become the ‘Front Door’ to the hospital. But the flow to and through the Emergency Department is fraught with bottlenecks in many hospitals, with conflicting and confusing messages surrounding ED. Hospitals with poorly placed dual or only one entrances experience the inefficient operation of those coming in emergency vehicles and self-arriving patients. Many EDs have poor first encounter systems. For example, poorly designed treatment zones inhibit efficient operations. Moreover, there are many layout examples which require excessive walking to manage the patient record, to get patients to an x-ray room, or to take supplies simply. These requirements lead to increased length of stay within the department and delays in treatment, which also lead to put much stress in staff alike and patients. Inefficient patient throughput causes costly and flawed patient dissatisfaction and operations.

http://www.asianhhm.com/facilities_operations/emergency_department_streamlining.htm

Arrival

initially, the layout of the ED begins to show separate entrances for the two types of traffic and they were side-by-side today. However, if they are in close proximity, it can still have chance of uncertainty and confusion for the self-arrival patients as to which is the correct zone. But now, apart from the ambulatory, the layout is to show clear pathways for the ambulance. This separation begins at the arrival zone to the campus and continues to each entry. The ambulance entrance is spotted so as to not be in sight from those who come to the ambulatory entry. Direction to ED only points to the Ambulatory Entrance. The need for self-arriving patients to decide which entry would be correct is eliminated by this arrangement.

The Ambulatory Entrance is unmistakably obvious and has a system to cover arriving patients from the elements. A supply of wheelchairs should be accessible readily and doorway should have hands-free operation. There should be staff from the hospital at this point to assist the patient to enter the hospital which is often done by security personnel.

Electronic health records

In order to improve and streamline patient flow, the usage of the electronic health record is needed. The record of patient must remain closely to the unit clerk who manages the record, when a ‘paper’ chart is used. Because doctors, ancillary care-givers and nurses must access this unique and singular set of documents, there are frequent usages but when the location of the chart is hard to determine, much time is wasted by looking for it. The electronic record is allowed to take in anywhere within the hospital, especially at bedside of a patient. Simultaneous and multiple access permits retrieval and faster entry of data from the hospital and from remote diagnostic services like he lab.

Diagnostics

If we can get diagnostic information in a timely manner, it would have significant impact upon patient flow through the ED. Sending the patient who requires x-rays to the Radiology Department has becomes too troublous in terms of time including waiting for a radiologist’s reading, queuing in the department or transport time. This quest to enhance patient throughput causes placing medical imaging within the ED. A lot of patients seen in the department will determine the number of radiographic devices required, but multiple devices can be expected in ED. As for the case of decentralized supplies, by means of decentralization of diagnostic tools, the benefit of improved throughput can be generated, especially if digital radiographic devices are used. Although digital medical imaging is filmless, multiple devices do not need to be clustered for operational efficiency. And turnaround time for image acquisition will be increased by placing a DR in proximity to the ‘fast-track’ zone greatly. It can also result in quicker diagnoses. A second DR can then be placed to serve more critical patients conveniently. Placing a CT scanner near to trauma bays can save time in dealing with life-threatening situations. 

Discharge process

After medical clearance, the patient and his family are given discharge instructions and are released to leave the hospital or are admitted to the hospital. Several steps must be taken to place patients in a bed if the patient is admitted. The movement of the patient out of the ED and into the bed will affect the overall patient flow greatly. The admitted patients become ‘boarders’ in the ED, if beds can’t be found or location and assignment of beds is slowed. Then boarded patients will occupy space that could be used to treat the next incoming patient and reduce the number of beds which is available to do so.

The handling of inpatient beds is a very complex issue, but it is fundamental that the hospital be committed to a policy of timely bed availability for those who need.

Contemporary Emergency DepartmentFirst encounter

Upon arrival, the ambulatory patients must be recognized and given the time to state his problem. This is done by staff who conducts ‘quick registration’ which is a basic set of identifiers to register the patients into the hospital’s record system but it takes a few minutes. The patient is placed quickly there when beds are available and the registration process can be finished at the bedside.

Supply System Configuration

After the quick registration, the patients are given a first assessment by a clinician. This triage will judge the level of the patient’s condition and allow the emergency personnel to determine the priority to provide care. The patient is shown to an ‘internal waiting area’ in the treatment zone. The patients can be reprioritized and observed, so it can get the right patients into a bed quickly.

In order to improve patient flow, a policy for treating patients with lower risk problems such as lacerations should be developed. This notion of a ‘fast-track’ needs to be incorporated within the context of the total treatment zone. And all beds should be capable of dividing any acuity levels. The fast track patients can be grouped in one area of the department but not isolated in a discreet unit. Based upon the variation in volumes throughout the day, this will increase flexibility in assigning patients to rooms.

However, ambulance patients have different tracks into the ED. The condition of these patients is communicated to the ED generally by the ambulance personnel who is an emergency medicine technician. Their arrival is anticipated and care protocol can be implemented promptly. However, there are situations when multiple arrivals occur at the same time essentially. A triage of these incoming patients will become necessary, when this happens. In high-volume ED, for example trauma centers, planning for an ambulance triage station will afford sufficient space to solve with this problem.