Professional Documents
Culture Documents
INTRODUCTION
Health care delivery is the diagnosis, treatment, and prevention of disease,
illness, injury, and other physical and mental impairments in human beings.
Health care can contribute to a significant part of a country's economy.
CLASSIFICATION
Primary care refers to the work of health professionals who act as a first
point. example, General physician etc.
Secondary care is the health care services provided by medical specialists
and other health professionals who generally do not have first contact with
patients, for example, cardiologists, urologists and dermatologists etc.
Tertiary care is specialized consultative health care that has personnel and
facilities for advanced medical investigation and treatment usually for
inpatients. Examples of tertiary care services are cancer management,
neurosurgery, cardiac surgery etc.
1.1 HOSPITAL
A Hospital is a health care institution providing patient treatment with specialized
staff and equipment. Hospitals can either be Government owned or Private. Many
Government hospitals also function as Medical colleges.
Building a hospital today is a very complicated procedure. A
large number of or hospitals have been built in crowded areas and with increase
in modernization of medical equipment and advances in diagnostic and
thereapeutic technology it is inevitable that need for increased space will arise.
In building new hospitals it is necessary to resort to very careful and detailed
planning, as hospitals are very expensive to build and run, and once it build
cannot be easily re modelled without further considerable expenditure.
Fortunately in the last three decades, mainly due the complexity of modern
hospital and increasing demand in aspects such as treatment and care facilities,
maintenance costs effective planning considerations have to be adopted.
Hospitals in India can be classified on the basis of studies based on their
ownership pattern or the speciality of the hospital.
Emergency
Urgent
Non emergency
Vertical Layout
The vertical layout of the hospital should be structured to allow easy
patient flow and services.
CANCER CENTER'S
http://www.healthcaredesignmagazine.com
Cancer treatment affects essentially three groups: The doctors, patients and
their loved ones.
Cancer Patient's
Every cancer patients journey is personal no two patients or diagnoses
are exactly alike. The disease has no bias as to age, ethnicity, or gender.
However, many cancer patients do share similar treatment experiences
that include an array of physical trials, emotional challenges, and spiritual
journeys.
Changes in physical appearance are a common result of chemotherapy
and other cancer treatments. Many patients experience hair loss, scars,
skin changes, weight loss or gain, sensitivity to smells and temperature,
and loss of muscle tone, creating limitations in activity and altering
familiar daily life.
People who underwent diagnosis and treatment have the longest
inpatient stays as these groups of patients are given immunosuppressive
drugs as a part of their treatment. These long stays and isolation can be
very depressing for them.
It is important to design uniquely responsive places that have the potential
to aid the healing process and to provide a place that reinforces respect,
dignity and security.
Caregivers
Role Of Hospital Staf
A focused and compassionate care team has proven to be one of
the best remedies for patient recovery and healing.
For each unique patient, the mix of cancer care giving team
members will vary and may include many different specialists, such
http://www.cancerinstitute.org.au
CANCER STAGE
STAGE 0,1
SATGE 2,3,4
TYPE OF TREATMENT
SURGERY
CHEMO,RADIATION,SURGEY
Process
Inducing antineoplastic drug at the treatment regiment
surgical management to remove cancerous cells
Using radiations on the effected part, less painful
Inducing hormones that binds the cancer cells and develop
antigens
http://www.cancerinstitute.org.au
The impact of cancer in India is far greater than mere number of cancer
cases.
If detected early, treatment is effective and cheaper. However, if detected
late, it is more expensive (can even lead to bankruptcy) and also reduces
chances of survivals.
Its diagnosis causes immense emotional trauma and its treatment a major
economic burden. The initial diagnosis of cancer is perceived by many
patients as a grave event with more than one third of them suffering from
anxiety and depression.
Cancer is equally distressing for family as well. It could affect both familys
daily functioning and economic situation.
Several research's had found that having direct access both visual and
physically to the outdoors helps speed up the recovery process for most
cancer patients.
In India, it has been noticed that often patients travel from fringes of the
country to the perceived treatment centers at metropolitan cities.
This results in overcrowding which can be solved by equal distribution of
quality hospitals. India is also increasingly becoming a destination of
medical tourism.
HEALING ENVIRONMENT
1 INTRODUCTION
MONASTERY COURTYARD
The greatest impact on the hospital design in the past century, was
evidence regarding the effects of treatments or services on patients'
satisfaction gained much more importance.
All hospital users experience positive health outcomes from connection to
natural environment, access to daylight and landscape views and also
interior environment created at various spaces such as treatment areas,
patients wards etc.
These spaces should offer an experience that they might have a
significant impact on one's health improvement.
To illustrate, in an evaluation of four hospital gardens in San Francisco, a
team of experts used a combination of behavioural observation and
interview methods. The results showed that, after spending time outside,
79% of the patients felt "more relaxed and calmer", 25% sensed
"refreshed and stronger", 22% were "able to think and cope" and only 5%
did not feel any particular
change.
There are three distinctive groups of users of both indoor and outdoor
hospital spaces patients, employees and visitors, each having its own
requirements and patterns of use.
Patient group which consists of various categories depending on type of
patients' disabilities, their length of stay (e.g., short-term and long-term
inpatients or outpatients) and physical and psychological needs (e.g.,
paediatric, rehabilitation, radiation therapy ,post-surgery patients, those
with sunlight sensitivity or with immune suppression).
Employees, varying from the medical to administrative and supporting
staff, are critical group of users since they spend every working day within
the hospital environment. All of them use outdoor space as an effective
means for achieving a restorative escape from stressful jobs and aversive
conditions in the hospital.
Visitors as the third user group are also in need of positive distractions
while spending time with their family members or friends. These visits are
frequently reassuring, but may as well be emotionally intense, and thus
require a supportive environment.
Healing environments are associated with certain physical
elements - such as access to natural daylight, views of nature, and fresh
air - as well as social and psychological elements - such as a sense of
control, positive attitude and hope, and respectful medical staff.
Hospital's site is certainly one of the most significant generators of its form
in many aspects. In an ideal case, optimal distribution of the total site area
of a hospital complex should be the following: 30% for the buildings, 15%
for internal communication routes and parking, 50% for vacant area (2530% in case of hospitals with a limited capacity for future growth) out of
which 10% is reserved for recreational areas.
While planning suitable locations for different types of outdoor areas, there
are several issues that need to be taken into account, such as:
environmental factors (e.g., orientation, wind exposure, views); distance
from distractions (e.g., urban noise, parking lots, mechanical systems);
physical configuration of the complex; internal traffic system and its
access points; specific needs of different user groups; etc. Proper
acknowledgment and implementation of these factors may generally
enhance beneficial value of the outdoor space.
Bremerton
View out The outdoor hospital areas should be visible from patients'
rooms, interior public spaces and corridors, for both security and medical
purposes. View out is also psychologically therapeutic, since it reduces
feeling of isolation and claustrophobia by providing a constant contact
with the outside world.
MUSIC
1. Provision of music in healthcare settings, as well as providing a way to
distract from other noise, can calm and soothe the patients mood.
2. Music therapy effectively reduces anxiety, stress and the experience of
pain.
HOMELY ATMOSPHERE
Screens around treatment machine (left) and corridor toward treatment room
(right) at the hospital
COLOUR THERAPY
1. Colour in healthcare settings, can make the environment seem less
institutional, and that warm colours make objects look heavier than cool
colours. Furthermore, cool colours tend to be relaxing while warm colours
offer stimulation.
2. It is recommended to use warm ,soft, natural colours in hospitals.
`
Suggested Flow Charts for OPD Source: Time Saver Standards for Building Type
B.Inpatient's Department
The In-patient wards must have restricted access to only patients, doctors
and nurses. The admission on visitors should be restricted to different
times.
The wards should be spacious to prevent a feeling of claustrophobia. Their
should be adequate entertainment facilities and privacy. At the same time
all wards must be in sight of a nurses station to detect an emergency
situation.
The Nurses station forms the focus of the wards.
services
Ward typology
3. OT Complex
Complex
A two-passage circulation:
A separation between different working units is required to reduce germs
transmission,
A separation between circulation of non-sterilized and sterilized patients
and implements is also required.
sqft
Nurses' Station..............150+ sqft
Patient Toilets................50 60 sqft
Family Waiting Areas.....15 sqft per person
Examination Rooms......120 sqft
6.Diagnostic department:
A. X Ray department:
B. MRI
A typical lay out for nuclear medicine facility having both gamma camera and positron emission
tomography-computed tomography (PET-CT) installations. Source:AERB Guidelines
D. Endoscopy
Endoscopy allows the doctor to look into the body through a thin, lighted
tube called an endoscope. The exam is named for the organ involved (for
example, colonoscopy to look inside the colon). During the exam, the
doctor may collect tissue or cells for closer examination.
This department carries out tests on patients and patient specimens; the
test results are a crucial aid to diagnosis.
Laboratory tests such as blood and urine tests give the doctor important
information. If cancer is present, the lab work can show the effects of the
disease on the body.
In some cases, special tests are used to measure the amount of certain
substances in the blood, urine, and other body fluids, or tumour tissue.
The levels of these substances may become abnormal when certain kinds
of cancer are present.
8. Treatment Department
Radiation therapy
Radiation therapy incorporates an initial examination and consultation
with the patient, treatment planning with the staff, and simulation
treatment to confirm that the treatment will be successful. Radiation
therapy is performed in a highly technical area with large equipment
which is controlled by specialists.
The treatment is usually distributed by large linear accelerators. The
equipment used for radiation therapy is extensively large and requires a
large enough space to allow the machine to rotate 360 degrees. This
typically calls for nothing smaller than a ten foot ceiling height and in most
cases it is taller than that.
Since the treatment gives off radioactive waves in most cases, extensive
shielding is required within the walls. While lead and steel can be
considered highly effective shields to prevent the waves from entering
surrounding areas, concrete is typically recommended because of its
density and lower cost.
In order to shield the surrounding spaces an 8 foot thick concrete wall is
poured which calls for the radiation therapy treatment spaces to be
located either on ground level or underground due to their shear size.
Typical Spaces for Radiation Therapy Treatment:
- Therapy Vaults(high energy)......600 sqft
- Therapy Vaults(low energy).......500 sqft
- Control Areas..............................130 sqft
- Equipment...................................100 sqft
- Entry lobby...................................140 sqft
- Simulator.......................................300 sqft
- Treatment Planning.....................200 sqft
- Specialist Office.......................120 sqft
- Patient Toilets.................................60 sqft
- Sub Waiting Areas........................20 sqft per person
- Family Waiting Areas................18 sqft per person
a. Cobalt Therapy
Cobalt therapy or cobalt-60 therapy is the medical use of gamma rays
from cobalt-60 radioisotopes to treat conditions such as cancer. Layout
includes restrictions on occupation in and around the units, Extra Thick
Concrete Walls for Cobalt Unit.
e. Brachy- Therapy
Brachytherapy also known as internal radiotherapy, sealed source
radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy
where a radiation source is placed inside or next to the area requiring
treatment.
Diagrammatic Representations of
Brachytherapy unit
normal phenomenon.
8. Rehabilitation department
To encourage an integrated approach to patient treatment, the rehabilitation
department encompasses a number of therapies.
The increasing recognition of occupational therapy as an integral part of the
medical rehabilitation program has resulted in its becoming an increasingly
important element of hospital planning .
Physiotherapy: dealing with problems of mobility and function using natural
approaches such as movement and manual therapy, supported by
electrotherapy, cryotherapy and hydrotherapy.
Occupational therapy: improving patients function and minimising handicaps
through the holistic use of selected activities, environment and equipment
adaptation so they can achieve independence in daily living and regain
competence in work and leisure.
Speech therapy: dealing with communication problems, either individually or in
groups, if necessary by introducing alternative methods of communication;
family members may be involved and family counselling plays an important part.
HAPTERI
I:LITERATURESTUDY
9.Mortuary
Here the hospital takes the deceased person for temporary holding and
then handover the body to the next of kin.
It should be located in a separate building ,easily accessed and preferably
away from general traffic routes used by public. It must have a separate
entrance and exit route for the hearse vans and relatives .
An area of 0.6-0.8m2 /bed is recommended and usually 4 body holding
spaces are required for every 100beds.
Corridors should be minimum 2400mm wide to allow easy passage of
trolleys.
The temperature of cold room is to be maintained between 5.5 0c-6.50c.
10.Pharmacy
In the hospital pharmacy, drugs are received, stored, dispensed to outpatients and issued to wards and other departments.
It should be easily accessed to all areas of the hospital and should be close
to lifts and pneumatic dispatch systems.
minimum space requirement for the pharmacy units should be around
20sqm and it varies depending on the number of beds in the hospital.
11.Reception/information desks
The reception area, should be visible from the main entrance.
Receptionists need to oversee the waiting area and the main circulation
routes.
Allow 1.5 m counter length for each receptionist, and space in front of the
counter for patients to stand without encroaching on circulation routes or
waiting space.
The height of the counter should be adapted to the needs of wheel chair
patients.
It should be adjacent to triage area.
12.Waiting areas
These waiting areas should provide sufficient and comfortable space for
waiting patients and relatives/escorts.
The area should be easily observed from reception and triage areas.
Waiting areas should be planned to accommodate more than the number
of people expected during peak hours. visible from reception but
sufficiently separated to provide some privacy for patients at the reception
desk.
Six seats should be allowed for each consulting room and treatment room,
allowing 1.4 m2 for each.
This can be reduced for larger premises, particularly when appointment
systems are operated. Arrangements can be made to screen off part of
large areas to provide space for other activities at times when it is not all
required for waiting.
Patients should not wait in corridors nor outside consulting or treatment
room doors. Sub-waiting areas should usually be avoided.
1.
4.
2.
3.
1.Housekeeping
2.BMW collection containers
3.Needle incenarator
4.Hand wash station
5.Microwave
5.
13. Laundry service
Hospital laundry system is an integral part of the health care institution.
Laundry services have an important function in the cleanliness and
disinfection process of linen.
The location should be convenient to the service staff units and close to
the service elevator. Generally located in the basement.
The average floor area requirement per bed varies from 0.10sqmm0.45sqm with ceiling height of 4.5m.The door widths should be minimum
1500mm.
14. Administration
This is where the main administration of the hospital has their offices.
There should be appropriate checks to ensure that not everyone enters
this area.
Some medical staff require offices for full-time use. Others, such as health
visitors, district nurses and midwives, need to return to an office base
once or twice a day.
Sn
o
0.65/person
5.02/staff
1.67
5.02/staff
5.02/staff
5.02/staff
5.02/staff
5.02/staff
9.29/vehicle
5.02/staff
4.65
5.02/staff
4.65
4.65
4.65
4.65
4.65
4.65
1.67
1.40/person
1.67
7.43/bed
Qualitative factors
Entrances:
Corridors:
Access passages: 1.5m wide,
Passages for lying patients transfer: 2.25m wide minimum,
Ceilings in passages: 2.40m high minimum,
Maximal distance between two windows in a passage way: 25m,
Width of passage ways mustnt be reduced by any object or post,
According to the regulations fire doors are required in passage ways.
Doors/windows:
Doorways should have minimum 90cm width clear opening width to allow
easy patients/visitors/staff and 115cm width clear opening for those on
wheel chairs. A level space of at least 152cm wide should extend about
45cm on either side of the door way for facilitating opening/closing by a
wheel chaired person.
Coverings have to be resistant to the maintenance and disinfectant
products.
The same sound insulation as the one for walls is required: a leaf with two
walls
can absorb noises up to 27 dB minimum.
Height of doors: 2.1-2.2m,
Height of over designed doors for cars: 2.5m,
Height of doors for the passage of transport vehicles: 2.7-2.8m,
Minimal height of doors for access to a hall for lying people: 3.5m.
Each window/glazed door should have direct glazed area of not less than
15% of the floor area of the room.
Lifts:
Lifts transport people,medicines,laundry meals and hospital beds between
floors .At least two lifts should be provided and should be sufficient to
accommodate a bed and two accompanying people.One multipurpose lift should
be provided for every 100 beds along with a minimum of two for smaller
hospitals.
Clear dimensions for lift car - 0.90mx1.20m
Clear dimensions for lift shaft - 1.25mx1.50m
Stairs/Ramps:
Recomended height of risers is 0.15mhaving 30m treads for stairs case is to be
provided.
For ramps the gradient should be between 1:12 and 1:20 .Pedestian ramps must
have handrails one at 0.9m and the other at 0.5m for ease of people in wheel
chairs, the minimum width of ramps should be 1.6m to allow easy passage of
patients/visitors including those on wheel chairs.There should be a linding
planned at every 9m.