Our term repot is to design a 50-bed hospital and equipment it with all the needed facilities of fire fighting

and safety needs, layout plan for the facilities is needed.

Introduction
Hospitals are to healthcare what Gothic cathedrals are to religion. They are constructions of fallible man to inspire and encompass healing by reaching heavenward. And like the Gothic cathedral, the flying buttresses of technology, knowledge, and process, keep the edifice from collapse. Through the rose window the entering patient sees a vision of health and happiness, but the window is merely a thin screen, which distorts the reality of life. The reality of life is that human frailty, manifest in the work within the hospital, often leads to unintended events with harmful conse!uences. A modern hospital in "caring for its# patients" must always strike a balance between the need to speciali$e health care with the need for fle%ibility on organi$ation, a fle%ibility imposed by technological development and the evolution.

&esign in the health care field today means'

(nowing today#s health care process, with an eye to the near future) Integrating health e%igencies with technological limits *structures, plant, machines+) ,lending a comple% organi$ation with the "patient#s" human face. -or Hospital .onsulting, hospital design and planning means, primarily, providing health care management and operations managers with the specialist skills to identify, by agreement, the best suited functional solutions for that specific operation. The preliminary plan cannot but spring from a meeting of health organi$ation specialists and architectural, plant and technology e%perts, with those who will work daily within that structure. Hospitals are comple%. The physical environment in which that comple%ity e%ists has a significant impact on health and safety) however, enhancing patient safety or improving !uality has not been integrated in to aspects of the design of hospital buildings. &espite the recent discussions in architectural literature regarding design of

patient/centered health care facilities and evidence based design, little assessment has been conducted of the impact of the built environment on patient outcomes. 0tudies have focused primarily on the effects of light, color, views, and noise, yet there are many more considerations in facility planning that can influence the safety and !uality of care. The hospital industry is in the throes of the largest building boom in its history. In the ne%t decade, an estimated 1233 billion will be spent on new hospital construction across the 4nited 0tates. Analysis of more than 533 research studies shows a direct link between !uality of care, patient health, and the way a hospital is designed. Here are a few e%amples of how changes in design can improve the !uality of care' 6atient falls declined by 78 percent in the .ardiac .ritical .are 4nit at 9ethodist Hospital in Indianapolis, Indiana, which made better use of nursing staff by dispersing their stations and placing them in closer pro%imity to patients# rooms. The rate of hospital/ac!uired infections decreased :: percent in new patient pavilions at ,ronson 9ethodist Hospital in (alama$oo, 9ichigan, which was attributed to a design that featured private, rooms and specially located sinks. 9edical errors fell ;3 percent on two new inpatient units at The ,arbara Ann (armanos .ancer Institute in &etroit, 9ichigan after they allocated more space for their medication rooms, re/organi$ed medical supplies, and installed acoustical panels to decrease noise levels. The evidence is overwhelming. The healthcare environment // where care is actually provided and received // has substantial effects on patient health and safety, care efficiency, staff effectiveness and morale. The 4nited 0tates spends appro%imately :5 percent of its Gross <ational 6roduct on healthcare, much of which is provided in hospitals. =et, despite this enormous e%penditure and the available technological resources, today>s hospital care fre!uently runs afoul of the cardinal rule of medicine / above all else, do no harm . Hospitals also create stress for patients, their families, and staff. The negative effects of stress are psychological, physiological, and behavioral.

These effects include'

An%iety, depression, and anger *psychological+) Increased blood pressure, elevated levels of the body>s stress hormones, and reduced immune function *physiological+) and, 0leeplessness, aggressive outbursts, patient refusal to follow doctor#s

instructions, staff inattention to detail, and drug or alcohol abuse *behavioral+. 6oor design of the hospital environment contributes to all these problems. 6oor air !uality and ventilation, together with placing two or more patients in the same room, are ma?or causes of nosocomial infection. Inade!uate lighting is linked to patient depression as well as to staff medication errors. @ack of a strong nursing presence can result in patient falls. 0eldom does an opportunity emerge to build a new hospital) indeed most hospitals are in a continuous cycle of remodeling and e%panding their e%isting facilities to adapt to changing demands.

Autline for Hospital @ayout

Hospitals are the most comple% of building types. Bach hospital is comprised of a wide range of services and functional units. These include diagnostic and treatment functions, such as clinical laboratories, 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. Bach of the wide/ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, re!uires speciali$ed knowledge and e%pertise. <o one person can reasonably have complete knowledge, which is why speciali$ed consultants play an important role in hospital planning and design. The functional units within the hospital can have competing needs and priorities. Ideali$ed scenarios and strongly held individual preferences must be balanced against mandatory re!uirements, actual functional needs *internal traffic and relationship to other *departments+, and the financial status of the organi$ation. 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 design integrates re!uirements with the human needs of its varied users.

functional

The basic form of a hospital is, ideally, based on its functions'

,ed/related inpatient functions Autpatient/related functions &iagnostic and treatment functions Administrative functions 0ervice functions *food, supply+ Cesearch and teaching functions

6hysical relationships between these functions determine the configuration of the hospital. .ertain relationships between the various functions are re!uiredDas in the following flow diagrams.

Ee then ask ourselves several guiding !uestions'

How and via what mechanisms does the physical environment participate in patient safetyF How does the environment of the preoperative system effect safetyF Ehat e%actly is the preoperative environmentF Ehat characteristics are used to describe an environmentF Ehat process creates the physical environmentF Is it possible to change either the creation process or the result to improve safetyF

Today>s Hospital &esign process

Global performance, in terms of outcome, risk management and safety, is influenced to a great e%tent by local interactions and synchroni$ation of system components *e.g., providers, patients, technologies, information and material resources, physical and temporal constraints+. As a result, adverse events and unintended conse!uences are impossible to understand.

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Ceductionism approaches, to date, towards hospital constructions, have failed to ade!uately control risk or reduce the number of adverse events in these settings. .onditions in which we work such as fatigue from 25/hour duty rotations, double shifts, high workloads, confusing labels, noisy environments, look alike names, poor handwriting, poorly design e!uipment and health care builds can lead to errors. These are open or ill/posed problems that best understood through controlled observations, cases study and modeling, with insights drawn from other comple% adaptive systems such as emerging economies and dynamic social systems. Cecogni$ing this, we feel that comple% system theory can be the basis for a new principled approach to optimi$ing hospital design, performance and outcomes, managing risk and guiding health policy. The traditional hospital design process re!uires that architects be given program ob?ectives, *function and program+ which are then translated in room re!uirements *a space program+ and followed by the creation of department ad?acencies *block diagrams+. Ance this preliminary information has been provided, room/by/room ad?acencies are developed and then a detailed design of each room is completed *schematic and design development+. Architects then convert room/by/ room design to construction documents that represent how individuals, e!uipment, and technology in hospitals will function together. B!uipment and technology planning generally occurs in the later stages of the design process. Typically, no discussions of patient safety or designing around precarious events are raised at this stage. This creates an opportunity to repeat latent conditions e%isting in current hospital designs that contribute to active failures *adverse events or sentinel events+. Human factors, the interface and impact of e!uipment, technology and facilities, is also not typically discussed or e%plored early in the process.

6atient 0afety .hallenge

In the early :GG3>s researchers such as @eape and ,rennan started !uestioning the safety of healthcare institutions.H;I The IA9 report in 2333 posited that between 55,333 and GJ,333Americans die in 40 hospitals due to preventable errors. To put these numbers in perspective, hospitali$ation is more dangerous than flying in an airplane, operating a nuclear reactor or flying off the deck of an aircraft carrier. 0taying in the hospital is more dangerous than driving there. There are two possible responses to this challenge K a personal or a systems approach. Aur primary response to this epidemic has been to focus on the personal approach in which after an error or accident we search for the guilty parties. The legal system is most willing to help in this righteous cause as it rids the system of incompetent doctors and punishes bad hospitals. The concept of systems is important in the discussion of health care safety and health facility design. A system is a set of components, sometimes called subsystems or 9icrosystems, which are related or a comple% whole formed from related parts, or an organi$ation of people, tools, resources and environment. This last term, environment is the focus of our study, specifically the physical environment in which components are housed as opposed to the cultural environment. -ire precautions in the design, construction and use of buildings. .ode of practice for means of escape for disabled people. ,ritish 0tandards Institution, :GGG. Ehere escape lifts are considered necessary, a minimum of two lifts should be provided, sufficiently remote from each other to ensure that at least one is always available. Additional guidance can be found in Health Technical memorandum 38/3;' 6art B K LBscape bed lifts> and ,0 88JJ/J.

The .hartered Institute for ,uilding 0ervices Bngineers .I,0B

6rovides further info in its Guide The ,uilding Cegulations Approved &ocument 9' Access and facilities for disabled people *@ondon' H90AM&epartment of the BnvironmentMEelsh Affice+*:GG2+

According to some e%perts'

0ome situations re!uire variations from the normal strategy of direct escape for e%ample' The provision of protected areas where people with disabilities can await assistance in relative safety, i.e. protected from the effects of fire and smoke. It is current practice to avoid the use of lifts for evacuation purposes unless they are specifically designated and constructed for the evacuation of people with disabilities andMor hospital patients. This is because of the potential dangers of smoke ingress into the lift, loss of power and the possibility of discharging at the fire floor. Ehilst it is not permitted by current codes, in certain types of building, particularly high rise buildings and those with deep basements, it may be advantageous to use suitably designed and constructed lifts in the evacuation of the less active members of the population as well as people with disabilities.

.haracteristics of 0ystems
A healthcare system includes several sub/components. The foremost are the medical or clinical processes, which are undertaken. Another component is technology, medical and nonmedical. This would include information systems, diagnostic systems, imaging systems as well as mundane technologies such as floor cleaning e!uipment, supply ordering and distribution technologies. <e%t there is organi$ation, the administrative arrangement that includes policies, procedures, strategies and tactics, management tools, business plans, etc. 6roviders are another subsystem. They include professional, technical, administrative, management, patient, public, government and others. -inally, the designed, built environment is a subcomponent. It includes a large number of characteristics. .harles 6errow studied ma?or accidents and discovered that systems, rather than individuals, were often at fault. 6errow and Names Ceason re/defined how we should proceed to understand causes of accidents and fi% problems. Ane of 6errow>s contributions was to describe how the components of systems relate. He defined two scales, comple%ity and coupling, which e%plained how components of systems react. .omple%ity can range from low comple%ity to high comple%ity. 9aking a sandwich is a low comple%ity undertaking. -lying a fighter ?et off an

aircraft carrier is highly comple%. .oupling ranges from loose to tight. If an activity is not highly dependent on the e%actness of preceding activities, it is loosely coupled. The steps of making a sandwich are loosely coupled. The steps in flying off the carrier are tightly coupled. Healthcare, for e%ample, is a system that is highly comple% and tightly interrelated.

&esigning an operation theater

&esigning an operating theatre outlines the intricacies of the hospital design process. An operating theatre suite consists of the Theatre, the Anesthetic room, 0crub room and the &irty 4tility *or ?ust 4tility+ room. Ee will look at planning ?ust the Aperating Theatre itself in this hospital design guide article. The si$e and room dimensions vary but as an indication it should be about 7 meters wide by J meters long *8O s!uare meters+. Any surgeon will tell you that over/riding principles while designing an operating theatre are' -le%ibility of use of the space) Base of cleaning the theatre K including the floor, walls, surgeons panel and any e!uipment such as pendants and theatre lights) Base of use of surgeons panels, theatre lights and pendants. There are different arguments for either having all e!uipment and instruments on mobile trolleys to allow :33P fle%ibility on use of the theatre and ease of cleaning the theatre versus mounting a great ma?ority of e!uipment on ceiling mounted theatre pendants. The ceiling slab must be able to hold the weight of the theatre lights, pendants and the e!uipment if mounted on the pendants. It is highly recommended that you check with your structural engineer.

.eiling 9ounted B!uipment'

1. Pendants B%pect a 0urgical and an Anesthetic 6endant in any theatre, which have power, data, and various gas outlets. There are several ma?or suppliers on the market with numerous different types. 6endants can be rigid, rigid, retractable or fully articulated. Theatres re!uire fully articulated pendants for ma%imum fle%ibility. A lot of co/ordination is re!uired between medical gas, electrical, and pendant trade contractors together with electrical, mechanical and structural engineersMconsultants while installing pendants to ensure all structural steel support is in place, gas pipes are properly connected and power and data cables run at the correct programmed dates. Qarious lives saving e!uipment must be powered off 4n/interruptible 6ower 0ocket*s+ K 460, in case of power failure during surgery. 2. Theatre Lights There used to be the Gas &ischarge lights or Halogen lights. Aspects to consider were bulb life, costs associated and Theatre down time while bulbs were changed. There is a new kid on the block in the last couple of years K @B& technology. About ;3P more e%pensive compared to the e%isting technology but very long life bulbs *over 23,333 hours+, ease of maintenance *couple of minutes to replace an @B&+, cheap cost of replacement *fraction of older technology+ and ability to vary light temperature hence helping to diagnose cancerous cells etc. A battery must back up theatre @ights back up in case of power failure during surgery. 0uggested time can be ; hours back up. <ote that general lighting and emergency escape lighting should also be on similar batteryM460 back up time. 3. Camera In a teaching facility, a camera *now a days High &efinition .amera+ and microphone is also re!uired for one way video *from Aperating Theatre to @ecture Theatre andMor 0eminar Cooms+ and two/way audio for surgeons and students to communicate. The camera can either be installed in the handle of the main Theatre @ight of installed on a separate ceiling mounted arm. .onsider all implications for power and data transfer *H& re!uires much higher bit rate transfer+. .onsider a

wireless Ceality TQ M ,ig ,rother style microphone on the surgeon to allow freedom of movement. In Arthopaedic Theatres you would need to consider the largest ceiling mounted item K The @aminar -low or the 4ltra .lean Qentilation *4.Q+ .anopy. This item will need a separate article as we are planning a general Theatre in this article. 4. Radiation Protection &epending on the e!uipment, room si$e and location of the e!uipment and ad?acent areas, a !ualified Cadiation 6rotection Advisor must be employed to advise on what materials must be used for walls and doors *and floor and ceiling if re!uired+ to ensure the R/Cay e!uipment radiation is contained an does not harm anyone. *The operator in the room operates from behind a lead screen+. I hope that the above main points will help you think and plan ahead when you want to addMupdate your ne%t imaging room and will allow you to !ui$ manufacturers, builders, architects and engineers involved to give you the best and most effective and economical solution for your money.

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Bmergency &epartment Bmergency &epartment @ayout 6atient B%perience .ritical .onditions Handled o .ardiac arrest o Heart attack o Trauma o 9ental Illness o Asthma Hospital Bmergency B!uipments S -acilities

Bmergency &epartment

The Bmergency &epartment *B&+, also termed Accident S Bmergency *ASB+, Bmergency Coom *BC+, Bmergency Eard *BE+, or .asualty &epartment is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and in?uries, some of which may be life/threatening and re!uire immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. 0taff teams treat emergency patients and provide support to family members. The emergency departments of most hospitals operate around the clock. Bmergency department layout 6atient e%perience 0pecial facilities, training, and e!uipment

Bmergency &epartment @ayout

A typical emergency department has several different areas) each speciali$ed for patients with particular severities or types of illness. Ane body of e%pertise that seems particularly applicable to emergency medicine services is Aperations 9anagement. Aperations management utili$es a systems approach to the provision of a service, including the definition of the particular characteristics of a service *such as the service package, the service process, and the virtual value chain embedded in that service+, structured planning for service !uality, appropriate service metrics, selected management tools, and consideration of strategies for interdisciplinary collaboration, as well as cultural change. It is important to link clearly the service function to the institutions missionMstrategic plan, as well as the e%pectations and needs of B& patients who are served there. 0ome departments employ a therapist whose ?ob is to put children at ease to reduce the an%iety caused by visiting the emergency department. 9any hospitals have a separate area for evaluation of psychiatric problems. 6sychiatrists and mental health nurses and social workers often staff these. There is typically at least one room for people who are actively a risk to themselves or others *e.g. suicidal+.

 Intangibility: 0ervices are not manufactured according to precise standards, nor can they be stored. How consumers perceive services is very sub?ective, since they are a performance rather than a tangible good. Variability: .onsistent service delivery is very difficult, particularly in fields such as medicine, due to the high labor contribution of the service along with the variation between clinicians. Inseparability: 0ervice !uality is e%tremely difficult to control since it is produced and consumed at the same time. There is no opportunity to measure or inspect the service prior to actually delivering it. Additionally, the consumer *patient+ significantly impacts the !uality of the service provided. -or e%ample, the description of a patient#s symptoms can significantly affect the outcome of the visit. The better the description, the more likely a better outcome.

6atient B%perience
If the patient#s service e%pectation is not met, there are ways to remedy this shortcoming. 0ervice recovery is an effective tool to prevent patient defection, but it is necessary to have a well/crafted plan in place before the actual event occurs. 6atient retention can have a significant financial impact. 6atients are becoming more difficult and demanding and the health care industry may decide that it wishes to take notice of this. Ather sectors of the economy are providing an ever/higher !uality of service and are raising consumers# e%pectations along with it. 6atients always

will only come to e%pect that much and more from high/tech and high/ cost medical encounters.

.ritical .onditions Handled

0ome of the critical conditions are discussed in order to e%plore the urgent need of facilities that have to be place in Hospital. Cardiac Arrest: .ardiac arrest may occur in the B&MASB or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic life support and advanced life support as taught in advanced life support and advanced cardiac life support courses. This is an immediately life/threatening condition which re!uires immediate action in salvageable cases. Heart Attack: 6atients arriving to the emergency department with a heart attack, they will receive o%ygen and monitoring and have an early B.G) aspirin will be given if not already administered by the ambulance team. Trauma: 9a?or trauma, the term for patients with multiple in?uries, often from a road traffic accident or a ma?or fall, is sometimes handled in the Bmergency &epartment. 0ome emergency departments in smaller hospitals are located near a helipad, which is used by helicopters to transport a patient to a trauma center. This inter/hospital transfer is often done when a patient re!uires advanced medical care unavailable at the local facility. In such

cases the emergency department can only stabili$e the patient for transport. Mental Illness: 0ome patients arrive at an emergency department for a complaint of mental illness. 6atients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department for psychiatric e%amination. The emergency department conducts medical clearance rather and treats acute behavioral disorders. -rom the emergency department, patients with significant mentally illness may be transferred to a psychiatric unit. Asthma Asthma are urgent chest assessed as emergencies blood and gases treated and with o%ygen an referred are therapy, bronchodilators, steroids or theophylline, R/ray and arterial for intensive care if necessary. have

Eall 9ounted B!uipment'

1. urgeons Panel

The panels can the older style steel type or the more current 9embrane Type panels, which allow ease of cleaningMdisinfections. The membrane can be made anti/microbial by inclusion of silver nitrate. A newer version of panels can be touch screen however its not proving very popular as it can take several screen touches to reach a certain function, whereas other two panel types have all the buttons available in the panel. -or ease of cleaning and aesthetics, the panels should be flush mounted. <ote that all the pendants, theatre lights, general lights, gas alarm panel, I60M460, and warning signs for R/Cay in/use M @aser in/use signs outside Theatre, air sampling ducts, clocks etc need considered and carefully co/ordinated among the trade contractors and design consultants for services and wiring.

-loor 9ounted B!uipment'

1. Theatre Table Generally these are rechargeable and don>t necessarily re!uire power socket close by. 2. Trolleys Trolleys are used for instruments and e!uipment such as video endoscopes and anesthetic e!uipment. Ee mentioned ease of cleaning at the start. To enable this the walls should have special plastic enamel paint to allow chemical cleaning if re!uired in case of disinfections. The ceiling is generally constructed of plasterboard or special metal to ensure it is air/tight and easily cleaned. Airflow regime is an important part of moving the air from clean areas towards dirty and out of the Aperating Theatre suite to ensure the Theatre is the cleanest environment for operating on the patients. I trust the above has given you some basics to consider when planning your ne%t operating theatre. Af all the clinical areas in any hospital, R/ Cay, .T, and -luoroscopy need much more planning and co/ordination than any other thing imaginable. This is mostly due to the fact that the e!uipment used and its implications on the building structure and services is much more comple% with the e%ception of the 9CI. Ee will deal with 9CI in another article and will only discuss factors to be considered while designing an R/Cay room, which, in principle will hold for the .T S -luoroscopy rooms as well.

Coom &imensions, Bntrance and Access Coute

As R/Cays are large and heavy pieces of kit, first and foremost consideration should be' .an the largest part be brought to its intended location from the entrance via any corridors and liftsF =ou should consult the e!uipment manufacturer>s specific model pre/ installation guide before you make the purchase and involve an architect to ensure the kit will pass through all doors and corners and will not get stuck in the lift doors *if the location is not on *ground floor+T The manufacturers will advise of the critical room dimensions for the e!uipment to work and intended clinical procedures to be carried out successfully with regards to the prevailing local regulations.

0tructure
As clinicians will know, R/Cay e!uipment consists of the floor mounted table, wall mounted chest bucky and *mostly+ ceiling mounted R/Cay tube. In addition, there is the operator>s control console and the generator cabinet with a couple of Bmergency 0top buttons. The ceilings and walls must be strong enough to not only take the weight of these items but have proper pattresing to attach the e!uipment as recommended. All these pieces of e!uipment re!uire power and interaction hence cables run between these items. Eith the table being in the middle of the room, there is a need for having a floor trunking with removable lid between the wall and the table to house any cables. The e%act location, dimensions and details of this trunking must be established with the e!uipment manufacturer. If your hospital is a new build, you need to pass that information together with the floor loading and ceiling slab deflection and minimum vibration re!uirements to your structural engineer and the architect. If it is an e%isting building, you are best advised to establish the above re!uirements and involve your builder, architect and a structural engineer before purchasing the e!uipment. 9ost probably, the services between the floor mounted e!uipment and the ceiling mounted tube will be run on surface mounted floor to ceiling wall trunking with removable lid. 9ake sure that the ceiling is strong enough to take the load of the tube and that the area above does not have any e!uipment or plant that makes vibrations. In addition, the veiling mounted tube glides along the length of the table on two rails. These rails are mounted on secondary steel attached to the ceiling. This secondary steel is usually Instruct or 9ars 0trut which are registered trademarks and you will normally employ specialist sub/ contractors to install these as the radiographic e!uipment suppliers work once the room is complete with all services available, secondary steel installed and floor and wall trunkings and high level cable trays in place and room finished to builder>s clean.

0ervices S Bnvironment
Eill suffice to say that you will re!uire power and data *check if broadband+ as per the manufacturer>s specification. The e!uipment will generate significant heat and hence cooling will also be re!uired. 9ake sure you ask whether humidity control is also re!uired as

generally people do not understand differences between comfort cooling, air/conditioning and humidity control. There will usually be an emergency stop button at the control console and another possibly near the table. The actual location of all services and e!uipment will have to be precise according to the supplied drawings provided specifically for your pro?ect by the e!uipment manufacturer.

.onclusions
The design process for health care environments needs to be radically changed to address patient safety challenges. .reating an environment in which a culture of patient safety can flourish is a daunting challenge. It will never happen if participants in the process are unwilling to think outside the constraints of convention and if they are unwilling to challenge the rigor mortis which characteri$es the cultural and intellectual development of so many of our professional and commercial institutions.

Ee suggest a patient safety driven process that has the following characteristics'
6rocess starts with a complete team including designers, users, clinicians, contractors, e!uipment vendors, human factors specialists, managers, patients, and others. .onsiders and respects the many environmental constraints that influence patient safety. Includes continual training and learning. Eorks through collaboration and sharing of ideas. Is encouraged to e%periment, simulate, test and research. Has patient safety as a core focus. 9easures and tracks all processes and outcomes.