Mapa Institute of Technology

School of Architecture, Industrial Design & the Built Environment

Muralla St., Intramuros, Manila, 1002 Philippines
(02) 247-5000

A PROPOSED GENERAL HOSPITAL

WITH EMERGENCY COMPLEX

A Thesis Presented to the

School of Architecture, Industrial Design & the Built Environment
Mapa Institute of Technology

In Partial Fulfillment of the Requirements

in Architectural Design 9
for the Degree of BACHELOR OF SCIENCE IN ARCHITECTURE

Presented by

Margarita Yap Pasion

2011103148

Architect Junar Pakingan Tablan, UAP, MSAE

Adviser

December 12, 2014

CHAPTER I.I
The Problem and Its Background

General Overview
Finding the right hospital in the Philippines is not considered too difficult as
there are a number of options to choose from. The Philippines has both private and
public healthcare institutions. Most of the government hospitals provide quality
healthcare in the same way private hospitals do.
Although some people may have misconceptions, most of them are
unfounded. The main difference between public and private hospitals is the
facilities and technologies offered. Most of the public hospitals would not be
equipped to the same standard as the private ones. However, some of the best
doctors are serving in the government hospitals. Also, most Filipinos would seek
advice from these government hospitals because fees are not charged. Private
hospitals are located in key cities throughout the nation and there are also tertiary
hospitals that have the latest in medical technologies. However, as you would
expect, private hospitals are more expensive.

Introduction
A visit to a general hospital traumatizes many people. The basis for the fear,
even more than lack of familiarity with procedures and a feeling of helplessness,
may stem from the perception of invasion of ones personal space.
During an emergency, a person is most vulnerable, both emotionally and
physically. One factor is that a persons territorial limits are invaded by strangers
who poke and push. Is it any wonder that a visit to the hospital can intimidate even

the strongest among the people? How, then, can architects break through this
barrier for the

doctors

to examine

and treat patients without arousing

uncomfortability and anxiety?

Patient satisfaction is the buzzword. Its the difference between providing
what a patient needs and what a patient wants. Once the patient walks in the
hospital, the lobby or the receiving area should establish immediate rapport and
put the patient at ease. First impressions are very important. Overcrowding, grimy
spots on floors and walls, and other nauseating / disarranged sights may give
patients a message that the hospital does not care about patient comfort. No doubt,
its more a matter of heavy workloads. But perception is reality. It may subliminally
suggest that the hospital is out dated on medical matters as well, which can lead to
a lack of confidence and breed anxiety in the patient.
Waiting is one of the frustrations that often accompanies a visit to the
hospital. Regular patients who visit their doctors from time to time will accept
waiting, realizing that doctors cannot always schedule appointments accurately.
Some patients, however, especially those in an emergency situation, have a
different attitude and are not willing to accept discomfort or inconvenience without
complaints.
Excessive waiting leads to anxiety and great worries, and hospitals that
make a continual practice of overbooking are, perhaps without realizing it,
offending their patients concluding their failure in medical service.

Background of the Study

Hospitals serve as the locus of health care delivery in the Philippines. Survey
data shows that most households go directly to hospitals for treatment of illnesses.

With the breakdown of referral networks due to devolution, tertiary level hospitals
which are designed to cater to more serious diseases are also accommodating cases
that can be handled by lower level facilities. This leads to tertiary hospitals
requiring more resources to be able to attend to all its patients.
When most people need a hospital, they generally wind up at a big, public
one. Public hospitals can't turn anyone away, so you're sure to receive treatment
when you visit one. Because they are publicly funded and not for profit, they are
usually a lot more affordable than private hospitals. Due to their size, they also
usually have a lot more beds than private hospitals.
As for the drawbacks of public hospitals, their sheer size is a big one.
Although they have way more employees than private hospitals, patient-to-doctor
ratios don't tend to be very good. You are almost certain to wait for a while when
visiting the emergency room. Depending on the time of day and the nature of your
emergency, you could wait for hours before being seen. There doesn't tend to be
much in the way of personalized care because nurses are often overloaded with
patients. After all, public hospitals can't refuse anyone, and they must accept
patients who have been turned down by private hospitals.

Statement of the Problem

Hospitals are the most complex of building types. Each 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.

In this study, the proposed general hospital seeks to answer the following
questions:
1. How will it solve the disarranged and nauseous condition of existing
emergency departments of public hospitals in the Philippines?
2. How will the proposed general hospital be effective in terms of healing
quality as with a private medical institution?
3. What will be the innovation/outstanding feature of this project compared
to other hospitals?

Project Goals, Objectives and Strategies

The emphasis of the research is to (1) provide an architectural solution to
the disarranged and tousled emergency department of general hospitals that leads
to mistreatment and slow recovery of the patients; and (2) to offer the povertystricken people the same healing environment as with a private medical institution.
The proposed general hospital is addressed to all public, especially to the urban
poor whom lifestyles are hazardous and involves life-threatening activities in their
everyday life.
The study will focus more on the hospitals most direct and immediate reach
of public which is the Emergency Department.
Unlike any medical institutions, this project will have an emergency complex
which will include facilities and amenities deemed necessary to cater the patients,
their kin, and as well as the whole emergency team.

Significance of the Study

The proposed study is aimed to be the Philippines first general hospital that
specializes in Emergency Medicine. It appears that the ultimate aim to create a
healing environment is not given attention by healthcare designers. With this
research, proper designing of the facility could be further studied for future
application towards a functional hospital with an efficient emergency complex.

Scope and Limitation

This study will only be limited on the architectural design and planning of a
general hospital and it will be focused on the emergency facility: its structural
design, functionality, space planning, and circulation that incorporate an effective
healing quality. It will also be subjected to further exploring of new ideas
concerning health facility designing.

Assumptions
Several methods of research will be used in completing the study. The
researcher assumes that these methods will help and will be able to ensure a
strong and successful outcome of the proposed project.

Conceptual Framework

The Problem
and Analysis

Data Gathering
and Methods
of Research

Summary of
Results &
Findings

Formulation of
Architectural
Solutions

Conclusion

Definition of Terms

1. General Hospital - a hospital in which patients with many different types

of ailments are given care.
2. Emergency Department - a medical treatment facility specializing
in acute care of patients who present without prior appointment, either
by their own means or by ambulance. The emergency department is
usually found in a hospital or other primary care center.
3. Public Hospital - a hospital which is owned by a government and
receives government funding. In some countries, this type of hospital
provides medical care free of charge, the cost of which is covered by the
funding the hospital receives.
4. Healthcare Facility - in general, any location where health care is
provided.

Health

offices to urgent

facilities
care centers

range
and

from

small clinics and doctor's

large hospitals with

elaborate

emergency rooms and trauma centers.

5. Health Services - include all services dealing with the diagnosis and treatment of
disease, or the promotion, maintenance and restoration of health.
6. Hospital - a health care institution providing patient treatment with
specialized staff and equipment. The best-known type of hospital is the
general hospital, which has an emergency department. 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.
7. Innovation - is a new idea, device or process. Innovation can be viewed
as the application of better solutions that meet new requirements, in
articulated needs, or existing needs.

8. Healing the process of the restoration of health to an unbalanced,

deceased, or hurt person.
9. Complex- a group of similar buildings or facilities on the same site.
10. Department of Health the executive department of the Philippine
government responsible for ensuring access to basic public health
services by all Filipinos through the provision of quality health care and
the regulation of all health services and products. It is the government's
over-all technical authority on health.
11. Medical Institution an institution created for the practice of medicine.
12. Sustainable Design - is the philosophy of designing physical objects, the
built

environment,

and

services

to

comply

with

the

principles

of social, economic, and ecological sustainability.

Acronyms
1. DOH Department of Health
2. PCEM Philippine College of Emergency Medicine
3. AREMP Asosasyon ng mga Residente ng Emergency Medicine sa
Pilipinas

CHAPTER I.2
Review of Related Literature and Studies
Related Literature
The following article is a review about the Philippine General Hospitals Condition,
taken from http://www.reviewstream.com/

The Philippine General Hospital, the largest government hospital in the

Philippines has been operating for almost 100 years. It is in a very
conspicuous location along Taft Avenue, Ermita Manila. People are so
familiar with this very popular hospital which is tagged as the biggest
hospital for the poor people. However Ive seen many people who are
not poor and yet going to this hospital because of the proven expertise
of the doctors and all health care providers here.
But one thing discouraging about this hospital is its inability to cope
with the number of patients. Ive experienced this hospital so many
times in the past and each time Id go to there, I could not help but pity
the poor people who could not afford private hospitals. Indeed this
hospital is the biggest in the country as according to record, it occupies
10 hectares of land with 45 interconnected and stand-alone buildings,
and 125,000 square meters of floor area.
It has 19 clinical 1500 patient beds of which 1000 are for charity, 500
are for paying patients and special units. However, the number of poor
people different illness is overflowing and PGH could not give them
immediate care. The poor patients have to bear the long queue at the
admission before they could be admitted.

It will take you hours before you could be attended to because the
patients are just too many that the health care providers could not
really cope. Another discouraging thing about this government hospital
is only the fact that patients have to pay for the medicine. Only the
ward and the doctors services are free so if you dont have money to
buy medicine you will die just the same.
Ive witnessed many patients who died on that kind situation when my
mother was once admitted in that hospital. My mother once suffered a
mild stroke and was rushed in this Hospital one time. While we arrived
there at 5:00 pm my poor mother was only given the chance to have a
room at past midnight.
Even if we were actually not getting a free ward, no available pay room
was given immediately to her either. It was disheartening to see my
mother on a stretcher and yet could not be given immediate attention.
And while we were on queue, many emergency cases on queue ended
up at the morgue.
It was really a terrible experience to see people dying without having
given enough immediate attention. Another problem is that never
ending queuing. It is not only during admission, even for all laboratory
tests, the patients have to queue.
It was really so hard. We had to bear the long queues for many times
and the results even took too long. If there is one thing that really made
me sad about this hospital this is the extremely slow procedures.
Yes the doctors and staff are mostly nice but I wish they could be faster
in serving and much more caring of their patients difficult state.

Despite the hard and long procedures to go through, this hospital can
boast of the best doctors in town and has managed to acquire state-ofthe-art medical equipment. Ive seen how the renovation of facilities has
been undergoing over and again but despite this I have yet to see
promptness in the way they deliver the medical services.

Next is a review for the existing condition of St. Lukes Medical Center, BGC. Joyce
Santos wrote:

Around 8 am, my mom was admitted at the ER of this hospital for high
blood pressure (200/105). They had her undergo an MRI. I arrived at
the hospital around 11am. The doctor arrived shortly and told us the
the MRI results revealed she was ok, there were areas in her brain that
were cloudy but these could have been blockages that resolved on their
own. Then he asked my mom if she wanted to be confined overnight for
observation, we agreed. We waited for a room until 3pm. Around this
time two doctors (1 consultant and 1 resident) came in and did a
physical exam (some tapping here and there). Then the consultant said
mom was ok. After a few minutes the resident doctor came back and
told us mom was ok (AGAIN...) BUT they wanted her to stay at the
Acute Stroke Unit (ASU).
Naturally, me and my mom asked why. They could not give a
categorical answer. They just kept repeating that she needs close
monitoring. Note that a few hours ago my mom's attending physician
informed us that my mom was free to go OR she could stay overnight
IF SHE WANTS TO. My mom refused to be confined at the ASU. At this
point, I noticed that the doctors were showing signs of agitation over

the issue. They even told us to get a private nurse if my mom insists to
be admitted in a private room.
Around 4pm, they wheeled my mom to undergo MRA (Magnetic
Resonance Angiogram). The procedure costs roughly 19k. Since my
mom was out of earshot, I talked to one of the doctors. I insisted they
tell me the basis for their recommendation that my mom should be
confined at the ASU. After persistent probing, the resident doctor
reluctantly told me "she thinks" my mom suffered a mild stroke. I was
beyond shocked. I angrily told them they should have told my mom or
us relatives earlier and reminded them that the purpose of bringing my
mom to the hospital was to seek medical opinion and treatment.
My mom arrived from MRA, and I instantly saw she was beyond upset.
She told me she overheard the doctors conversing about her being
stubborn for refusal to be confined at the ASU. She wants to be
discharged and just go home. I told the doctors my mom wants to be
discharged and that we will seek 2nd opinion at St. Luke's Quezon
City. And because they could not do anything, they let us go after
signing a waiver. The attending physician who initially told us we could
go home or stay overnight for observation now told me he mentioned
my mom suffered a mild stroke. I was no longer paying attention to
their attempt of damage control. We just wanted to go home. My mom
was admitted because of high blood pressure; but this hospital, staff
and doctors were stressing my mom instead of making her feel better.
End note: Through my mom's medical insurance (Intellicare), we were
billed Php42k for my mom's stressful stay at the ER of this hospital. I
was informed that my mom won't even be getting any prescription
because of her refusal to be confined at their ASU. The results of the

MRA was not explained to her despite payment of 19k for the
procedure. The doctors were unprofessionally conversing within
earshot about my mom and her resistance

to their baseless

recommendations. I honestly thought this hospital is at competitive

level with Asian Hospital. Well the answer is a big NO.

Related Studies
Ambulatory Care
In the last 30 years or so, the health care industry has increasingly
been moving toward greater emphasis on ambulatory care. The
increasing availability of procedures that can be successfully
completed without an overnight stay in the hospital has led to a
proliferation of freestanding ambulatory care centers. Many of these
centers are performing sophisticated surgeries and complicated
diagnostic procedures. Frequently, these centers are not affiliated, or
are only loosely affiliated with, other hospitals in the community. The
emphasis on the ambulatory care had a profound effect on the
healthcare industry, leading to the reduction in the number of
hospital beds and, in many cases, closing of hospitals because of the
reduced demand for overnight stays. At the same time, hospitals had
to increase their own role in ambulatory care to remain competitive.
As the freestanding ambulatory facilities took an ever-increasing
market share, many hospitals had to downsize, and in some cases,
scale back even their surgical capacity. In many respects, this
development has diminished the capacity of medical facilities to care
for the casualties in the event of a disaster, because most of the

freestanding ambulatory care centers are not suitable for postdisaster emergency care. There are several reasons for this:

They do not have dedicated emergency departments or

adequate facilities and equipment to deal with trauma patients.

They are not available or staffed on a 24-hour, 7 days-a-week

basis.

They

are

not

adequately

equipped

with

emergency

communications systems.

The staff is not experienced or well trained to care for the types
of patients and injuries expected in post-disaster emergencies.

Major Issues and Trends Impacting Health and Hospital Planning,

Design, Construction, Operation and Maintenance
Basic questions such as environmental, physical, mental and
spiritual health and wellbeing are often overlooked in the rush to
design health and hospital facilities.
Access
If the public cannot reach a healthcare facility because of its location
or lack of infrastructure, it might as well not exist. Easy access by
foot, bicycle, scooter and motorcycle, public transportation (buses,
jitneys, taxis, vans, trains, ambulance), automobile and/or helicopter
is vital.
Quality
Once people arrive, there must be a high level of quality and
competent care, qualified and available physicians and allied health
professionals that are readily available and accessible. Quality care

can be measured and compared to national and international norms,

average life spans and causes of illness and death.

Alignment of care and expertise

Designing and building health facilities without thoroughly thinking
through the patient population and their health problems. The type of
allied professionals needed, and the type and scope of health and
hospital facilities needed is simply not solving the 'whole' problem.
Care

providers

must

develop

comprehensive

disease-fighting

strategies, rather than just constructing new buildings. This requires

an understanding of the causes of illness and death in a region of the
world and how to prevent, diagnose and treat and rehabilitate people
from the effects of these diseases.
Funding, staffing and operating health and hospital facilities
In some parts of the world more competition between health networks
effectively lowers costs. In other parts of the world, collaboration and
cooperative approaches work better in controlling costs. When
designing and building health and hospital facilities one must keep in
mind that the life cycle project costs over the years dwarf the original
construction costs. In some cases, expensive health and hospital
facilities have been built and a country has not budgeted for the
operating costs, or coordinated and planned the allied health
professionals or the proper staffing requirements.
Demographics
Trends in demographic facts and the life expectancy of population
sectors have to be determined. Some regional populations are growing

at an accelerating rate, while others have a significant aged

population and fewer births.
Understanding the causes of and prevention of illness and death
Different parts of the world face diverse threats to human existence,
ranging from water-borne diseases to malaria and chronic diseases;
each cause of illness and death requires a unique prevention and
treatment approach. Many diseases can be prevented by undertaking
proper and appropriate education and environmental measures.
Numerous areas of the world have built an excellent system of
curative care, but much more must be done to create an equally
excellent system of preventive care. Health education in the home,
community at large and particularly in the school systems is vital.

Trends
Patient safety
One of the greatest issues in healthcare design and operation is
patient safety, and a great amount of evidence demonstrates that
planning and design decisions have a direct impact on this. Evidencebased design strategies to reduce safety concerns such as patient falls
may include providing handrails, designing flush flooring transitions
and requiring direct, unobstructed pathways to frequently-used areas
such as bathrooms.
Sustainability
A hospital building is one of the highest consumers of energy, and
sustainable design is essential in reducing the consumption of
natural resources and reducing a facilitys life cycle costs. It is vital

that the principles of lean design, lean operations and standardized

design be applied to minimise waste of all types.
Impact and opportunities of technology
The changes that have occurred and will occur due to constantly
accelerating rates of technological advances are enormous. These will
include changes in:

Communications

Telemedicine

Energy

Innovations in facility planning and management

Hand-in-hand with design, construction and operation there must be
qualified innovations in facility management and planning such as
Building Information Modeling and Integrated Project Delivery.
Speciality facilities and / or departments
Critical care inpatient hospitals will have speciality units for (ICU)
Intensive Care Units, (CCU) Coronary Care Units, (MICU) Medical
Intensive Care Units, (SICU) Surgical Intensive Care Units, recovery
rooms, and emergency rooms that require specialised facilities and
departments.
Advances in research
Genetic research and advances are in their infancy and will play a key
role in preventing and predicting disease. New breakthroughs in the
early detection of disease, new pharmaceuticals and treatment of
disease will constantly change the way health and hospital facilities
will need to be designed, built, managed and operated.

Conclusion
The design of appropriate health and health facilities for large
populations requires above all a broad understanding of the overall
culture, specific health issues and available health professionals
before

appropriate

facilities

can

be

successfully

planned,

programmed, designed, built, operated and maintained.

Related Projects
St. Lukes Medical Center, Bonifacio Global City
The Bonifacio Global City branch in Metro Manila opened on 16
January 2010, and has become a favored hospital for politicians,
businessmen, celebrities, and medical tourists. It also has several
restaurants and basements. Located in the midst of business,
commercial establishments, and residential communities, St. Luke's
Medical Center-Global City has 14-story, 628-bed nursing tower with a
helipad and a sprawling podium that houses the ancillary services. It
also has a multilevel parking area with more than 1,100 slots.

A Total Approach to Healing

St. Luke's provides patients with the best quality healthcare by
combining the most advanced medical equipment and technology with
the expertise of the highly trained, skilled, and experienced physicians
and professionals. On top of its unparalleled patient care, St. Luke's
offers a wide range of support services to address patients' every
possible need.

Emergency Services
The St. Luke's Emergency Department is composed of a group of adult
emergency physicians trained in Emergency Medicine and pediatric
specialists with a background in Pediatric Emergency. It can handle
medical, surgical and toxicologic emergencies in adults and children 24
hours a day. The latest in diagnostic modalities and therapeutics can
be made available to patients on a timely basis.
Classification of Emergency Patients
A. Primary - patient with non-emergent problems that do not pose life
threats now or in the future. Little treatment is necessary.
B. Acute - patient needs immediate medical attention because of
urgent but not life-threatening problems.
C. Critical - patient needs immediate evaluation and/or treatment due
to the life-threatening nature of his condition.
D. Isolation Room - a truly negative pressure area where patients with
airborne diseases (Tuberculosis, Chicken Pox, etc.) are seen before they
are admitted to respective isolation rooms in the hospital.

CHAPTER I.3
Research Methodology

Research Design & Instruments

Basically, the design of research explores and describes the situation or
experiences of people in different types of hospitals, events and their relationships
as a case study. Moreover, research allows the exploration and understanding of
complex issues and the life experience of a phenomenon for a person or group of
people. Consequently, a hospital is a complex design and service to meet a variety
of categories and type of end-users.
Descriptive research method is used in this study. The research is focused
on current problems and issues of existing public hospitals in the Philippines. Case
study, interview, and survey are involved in the research design.
As mentioned, the researcher used a walkthrough to observe behaviors and
activities being done by hospital users. Environment and activities related to
spatial-relationship and surrounding is used to determine the usability variables.
The case study will be done by analysis of the space and movements of the hospital
assessing different qualities of functions of environment.
At the same time Interviews had been used to support patients and medical
staff without disturbing their activities, and it took place in a personal meeting,
according to the expressed wish of the researcher.
Lastly, survey is involved to gather the patients satisfaction on the hospital.
It will know in-depth personal information around the topic and related issues.

The methods aim to know the uses, new uses and misuses of design,
recognized needs by getting the story behind a respondents experiences.

The Case Study

Amang Rodriguez Medical Center, Marikina City

Amang Rodriguez Medical Center (ARMC) is a 150-bed medical center

located in Marikina City. It caters to residents of Marikina, Antipolo, part
of Pasig and the municipalities of Cainta, San Mateo andRodriguez in Rizal. It also
serves as a research and training venue for health personnel in their chosen field of
expertise.
The hospital was initially conceived in the minds of then Rizal Governor
Isidro S. Rodriguez and the late Mayor Osmundo de Guzman of Marikina, who
dreamed of a community hospital that would provide the necessary health services
for the residents of Marikina and its adjoining towns. This gained the support of
Senator Jovito R. Salonga who then sponsored a bill which was approved by
Congress

as

Republic

Act 3662 of 1964 which

mandated the

creation,

establishment, operation and maintenance of Eulogio Rodriguez Sr. Memorial

Hospital.

Construction started in 1965 and by May 15, 1966, it was blessed and
inaugurated as the "Marikina Emergency Hospital" with an authorized bed capacity
of 25. It was opened the following day to dispensary patients with Dr. Jose Paz,
Senior Resident Physician from Morong Emergency Hospital, as Officer-in-Charge.

How emergency room works:

Emergency Room Patients
One of the most amazing aspects of emergency medicine is the huge range of
conditions that arrive on a daily basis. No other speciality in medicine sees the
variety of conditions that an emergency room physician sees in a typical week.
Some of the conditions that bring people to the emergency room include:

Car accidents

Sports injuries

Broken bones and cuts from accidents and falls

Burns

Uncontrolled bleeding

Heart attacks, chest pain

Difficulty breathing, asthma attacks, pneumonia

Strokes, loss of function and/or numbness in arms or legs

Loss of vision, hearing

Unconsciousness

Confusion, altered level of consciousness, fainting

Suicidal or homicidal thoughts

Overdoses

Severe abdominal pain, persistent vomiting

Food poisoning

Blood when vomiting, coughing, urinating, or in bowel movements

Severe allergic reactions from insect bites, foods or medications

Complications from diseases, high fevers

Understanding the ER Maze

The classic emergency room scene involves an ambulance screeching to a
halt, a gurney hurtling through the hallway and five people frantically working to
save a person's life with only seconds to spare. This does happen and is not
uncommon, but the majority of cases seen in a typical emergency department
aren't quite this dramatic. Let's look at a typical case to see how the normal flow of
an emergency room works.
Triage
When a person arrives at the Emergency Department, the first stop is triage.
This is the place where each patient's condition is prioritized, typically by a nurse,
into three general categories. The categories are:

Immediately life threatening

Urgent, but not immediately life threatening

Less urgent

This categorization is necessary so that someone with a life-threatening

condition is not kept waiting because they arrive a few minutes later than someone
with a more routine problem. The triage nurse records vital signs (temperature,
pulse, respiratory rate and blood pressure). She also gets a brief history of your
current medical complaints, past medical problems, medications and allergies so
that she can determine the appropriate triage category.

Registration
After triage, the next stop is registration - not very exciting and rarely seen
on TV. Here they obtain your vital statistics. You may also provide them with your
insurance information, Medicare, PhilHealth or HMO card. This step is necessary to
develop a medical record so that your medical history, lab tests, X-rays, etc., will all
be located on one chart that can be referenced at any time. The bill will also be
generated from this information.
If the patient's condition is life-threatening or if the patient arrives by
ambulance, this step may be completed later at the bedside.
Examination Room
Now is the exam room. Some emergency departments have been subdivided
into separate areas to better serve their patients. These separate areas can include
a pediatric ER, a chest-pain ER, a fast track (for minor injuries and illnesses),
trauma center (usually for severely injured patients) and an observation unit (for
patients who do not require hospital admission but do require prolonged treatment
or many diagnostic tests).
Once the nurse has finished her tasks, the next visitor is an emergencymedicine physician. He gets a more detailed medical history about your present

illness, past medical problems, family history, social history, and a complete review
of all your body systems. He then formulates a list of possible causes of symptoms.
This list is called a differential diagnosis. The most likely diagnosis is then
determined by the patient's symptoms and physical examination. If this is
inadequate to determine the diagnosis, then diagnostic tests are required.

Diagnostic Tests
When the tricky diagnosis of appendicitis is considered, blood tests and a
urinalysis are required.
The patient's blood is put into different colored tubes, each with its own
additive depending on the test being performed:

A purple-top tube is used for a complete blood count (CBC). A CBC

measures: 1) The adequacy of your red blood cells, to see if you are
anemic. 2) The number and type of white blood cells (WBCs), to
determine the presence of infection. 3) A platelet count (platelets are a
blood component necessary for clotting)

A red-top tube is used to test the serum (the liquid or non-cellular half of
your blood).

A blue-top tube is used to test your blood's clotting.

Diagnosis and Treatment

When the emergency physician has all the information he can obtain, he
makes a determination of the most likely diagnosis from his differential diagnosis.
Alternately, he may decide that he does not have enough information to
make a decision and may require more tests. At this point, he speaks to a general
surgeon -- the appropriate consultant in this case. The surgeon comes to see you

and performs a thorough history, physical exam, and review of the lab data. She
examines the symptoms: pain and tenderness in the right, lower abdomen,
vomiting, low-grade fever and elevated WBC count.
Who's On First
The vast array of people caring for patients in an emergency department can
be quite confusing to the average health care consumer -- as confusing as if you
were watching your first baseball game ever and no one was around to explain all
those players.
Additionally, most people are uncertain of the training and background
necessary to become a member of the emergency-department team. Well, here's the
scorecard.
Emergency Physician
The emergency physician comes to the team after spending four years in
college studying hard to get as high a GPA (grade point average) as possible in
order to get accepted into medical school.
Medical school is a four-year course of study covering all the essentials
of becoming a physician. It generally includes two years of classroom time, followed
by two years rotating through all the different specialties of medicine.
Toward the end of medical school, each medical student must select a
particular specialty (emergency medicine, family practice, internal medicine,
surgery, pediatrics, etc.). The medical student then completes an internship (one
year) and residency (two to three additional years) in order to be a specialist in
emergency medicine.

Physicians must pass an all-day written exam and an all-day oral exam to
become

board

certified in emergency medicine. As

of

2001,

there

were

approximately 32,000 emergency physicians practicing in the Philippines, of which

17,000 were certified by the DOH.
Emergency Nurse
The emergency nurse comes to the team in a number of ways. One way is
completing a four-year degree in college to obtain a BSN. (bachelor of science in
nursing). Alternately, a nurse may complete a three-year diploma program (usually
at a hospital) or a two-year associates degree program (usually at a community
college). After completing any of these academic endeavors, the nursing graduate is
eligible to take a licensing exam. After passing this exam, the nursing graduate
becomes an RN (registered nurse) and can practice nursing. Many emergency
nurses take an additional exam to become a CEN (Certified Emergency Nurse).
Physician Assistant
Many emergency departments utilize physician assistants (PA). PAs work
under the supervision of an emergency physician. They can examine, diagnose and
treat patients (usually the less complicated ones) and review their findings with the
physician. In most states, they can prescribe medications. Typically, a PA has at
least two years of college (most have a four-year degree) and some health-care
experience before completing a two-year program to become a physician assistant.
An exam is required to become licensed.
Emergency Department Technician
Many emergency departments have emergency technicians who perform a
variety of tasks depending on the institution and state laws. Some of these tasks
may include taking your vital signs, drawing your blood, starting your IV,
performing EKGs, transporting you to and from various tests, and providing aid

and comfort to family and friends. Training varies widely, but these technicians are
often ambulance personnel or else are trained through the hospital.
Unit Secretary
This essential member of the team is one you don't hear about very often.
He/she often handles the communication needs of the ER. A few important
examples of important communication needs include the emergency physician
needing to speak to the patient's family physician, families calling about their loved
ones, family physicians needing to inform the emergency department about
patients being sent in, or patients calling in needing medical advice. Also, he/she
coordinates the ordering of diagnostic tests.
Physicians in Training
At teaching hospitals, you may be examined by an intern or resident.
Teaching hospitals are hospitals that have training programs for physicians and
are usually affiliated with a medical school. Interns are in their first year of training
after graduating medical school. After the first year, the physician in training is
called a resident. These physicians are supervised by an attending physician who
usually has extensive experience in emergency medicine.

Tools of the Trade

Emergency Departments are stocked with a huge array of strangely named,
oddly shaped, beeping and blinking equipment. Here's a quick look at a typical
lineup.
Stethoscope
A stethoscope doesn't beep or blink, but it is an incredibly useful diagnostic
tool. A stethoscope lets a nurse or physician listen to heartand respiratory sounds.

One heart sound that can be easily heard with a stethoscope is a heart murmur.
The presence of a murmur can be a sign of an abnormal heart valve. Heart sounds
are also used to help the physician decide on the rhythm of the heart. If a friction
rub is heard, this can be a sign of pericarditis (inflammation around the heart.)
Extra heart sounds can be a sign of heart failure.
A stethoscope is also used to listen to the lungs. A physician can diagnose
various diseases such as pneumonia, asthma, pneumothorax (collapsed lung),
or congestive heart failure this way.
A stethoscope is used to take your blood pressure (BP) by listening to the
flow of blood through your arteries. A BP is obtained when a BP cuff is wrapped
around your arm and inflated to a pressure high enough to stop the flow of blood in
the artery in your arm. The stethoscope is then placed over the artery. Air is slowly
let out of the cuff. Blood flow starts when the pressure in the cuff becomes lower
than the pressure in the artery. This creates a sound that can be heard with a
stethoscope. The pressure on the BP gauge is the upper number in a BP reading.
The lower number is the pressure at which the artery is no longer compressed and
the sound stops. A normal BP is less than 140 for the upper number (systolic BP)
and less than 90 for the lower number (diastolic BP).
Cardiac Monitor
A cardiac monitor gives a visual display of the rhythm of the heart. A person
is connected to the monitor by three sticky patches on thechest, attached to the
monitor via wires. Cardiac monitors are set to alarm if the heart rate goes above or
below a predetermined number. Some monitors also have an automatic blood
pressure cuff and a pulse oximeter (which measures the oxygen saturation of your
blood).

Suture Tray
This tray contains the sterile equipment needed to place sutures (stitches) in
a patient with a laceration. These include: needle holder (the instrument that holds
the needle containing the suture material), forceps (used to hold the lacerated
tissue), sterile towels (used to drape off the non sterile areas which are not being
repaired), scissors, and small bowls (to hold antiseptic solutions).
Orthopedic Equipment
Most emergency departments have a generous number of orthopedic devices
for many purposes. These include plaster and/or fiberglass materials to splint
extremities that are fractured or severely injured. You'll also find pre-made splints
for specific joints, such as knee immobilizers, aluminum finger splints, Velcro wrist
splints, shoulder slings, air splints (for ankles), and cervical collars, as well as cast
cutters to use when a cast has become too tight.

Disposition
Depending on a patient's specific medical condition, physicians will either
admit the patient to the hospital, discharge the patient, or transfer the patient to a
more appropriate medical facility.
If you are discharged, you will receive discharge instructions (either written
specifically for you or pre-printed) that explain your medications and other
treatments. If medications are prescribed, you may receive a beginning dose if there
are no pharmacies open in your area at that particular time. You will also be
referred for follow-up care should your condition continue or worsen.

You may need to be transferred if your condition is better treated at another

institution. You may have to sign a consent form if your condition or mental state
allows.
The modern emergency department performs an important role in our
society. It really is a marvelous invention that has saved countless lives. Hopefully,
the information in this article will help ease your fears should you need the services
of an emergency department in the future.

The Interview - Reynante E. Mirano, MD, FPCEM

Dr. Ryan, as he is often called by his colleagues

and friends is one of the pioneers of Emergency Medicine
in the Philippines. As one of the founding members of
the Philippine College of Emergency Medicine and Acute
Care (PCEMAC), he worked tirelessly to promote and
advance the practice of emergency medicine in our

country.

Notwithstanding humble beginnings, Doc Ryan finished his medical

degree at the University of Santo Tomas and proceeded to complete his emergency
medicine residency training at the Makati Medical Center.
He recalls it was not easy to practice EM in the past. He juggled several
duty shifts in between family activities and hospital administrative tasks. Early in
his practice, he was entrusted with the care of the Emergency Department (ED) as
chair

of

the

St.

Lukes

Medical

Center

(SLMC),

Emergency

Department

Services. Recognizing the need to develop future EM specialists, he and his fellow
EM consultants established the residency training program in SLMC. Since then, a
long line of doctors have experienced his firm yet quiet leadership as well as his

warm and encouraging mentorship. His passion for teaching is reflected not only
in the ED but also in the College of Medicine (SLMC-William H. Quasha Memorial)
where he is clinical associate professor. In spite of his busy schedule, he has even
found the time to educate and train health care professionals on disaster risk
management as HOPE (Hospital Preparedness for Emergency) instructor and on
resuscitation as Advanced and Basic Life Support Instructor.
Stay focused and committed to your career, is his advice to younger
consultants who he continues to inspire with his hard work and perseverance.

Population and Sampling

The study was conducted on 30 patients in the selected hospital. Study
sample of 30 patients was selected using convenient sampling technique, where 30
patients were selected from each hospital by taking 10 patients from each ward i.e.
emergency (10), orthopedics (10) and maternity and pediatrics (10).
Patients recruited who were of more than 18 years of age, conscious, had a
stay of more than a week in hospital and were willing to participate in study.
However, patients with sensory impairment, disoriented patients, patients with
psychiatric illness and who were not willing to participate in study were excluded
from study sample.
This was a non-experimental study; however, permission was obtained from
the medical director, competent authorities of the hospitals and departments.
Furthermore, an informed consent was from each study subject and confidentiality
of information and anonymity of subjects was ensured. The respondents were given
freedom to participate or quit out the study without any harm or discrimination;
furthermore, patients' comfort was maintained during survey.

CHAPTER I.4
Summary of Findings and Analysis

Presentation of Collected Data

Patient satisfaction has become an important indicator to measure the
quality of care rendered to the patients while in hospital. Healthcare
institutes have often used patients' outcome as measures to evaluate the
health care services provided to patients. Patient satisfaction surveys can
help identify ways of improving nursing and health care services. However,
in this scenario there is a lack of empirical evidences on this subject of
inquiry. Therefore, this study was planned to assess the patient satisfaction
with healthcare facilities. It was found that in government hospitals mean
percentage of patients' satisfaction score was 67.6 percent of the total score;
while in private hospitals mean percentage of patients' satisfaction score
was 84.2 percent of the total score. This shows that patients in private
hospitals were more satisfied with nursing care as compared to government
hospitals; t-test was applied to see the statistical difference in these
satisfaction scores, this difference of patients' satisfaction in government
and private hospitals was found statistically significant (p<0.001). The
patients

recruited

from

selected

private

and

public

hospitals

were

significantly different as per their age, religion, educational status and

occupation. These variables are considered as potent contributing factors in
satisfaction; however this was not explored in present study.

In government (91.8 percent) as well as private hospitals (99.3

percent) patients reported high level of satisfaction with hospitals. This
difference was found statistically significant (p<0.001). Explanation of high
level of satisfaction among patients in government hospitals was provided by
mentioning that only the poor, migrated population, less educated, and
occupation of more in non-skilled category visited the public hospitals,
besides, their own daily living conditions are several times worse than the
general conditions existing in the public hospitals. As such they feel grateful
to whatever care comes in their way. Present study compared patients'
satisfaction with service in government and private hospitals, where patients
in private hospitals were more satisfied with nursing care as compared to
government hospitals.

It was found that in all selected clinical specialties patients'

satisfaction was higher in private hospitals as compared to government
hospitals, which was found statistically significant (p<0.001). Among four
selected clinical specialties in government hospitals, orthopedic patients
(60.6 percent) were having lower mean satisfaction score, followed by
medicine (63.3 percent), surgery (67.5 percent) and maternity (68.1 percent).
In private hospitals, patients' satisfaction was not much different in four
selected clinical specialties viz. surgery (79.1 percent), medicine (80.6
percept), orthopedics (81 percent) and maternity (82.7 percent).

Mean satisfaction score of patients with different dimensions of

healthcare was studied and it was found that in government hospitals

satisfaction score for different dimensions of nursing care ranged between,

6.83 to 8.97 (maximum 12 for each category). Mean percentage of
satisfaction score ranged between 56.9 to 74.6 percent, where lowest mean
percentage of satisfaction score was observed for communication (56.9
percent), followed by emotional support (60.8 percent), interpersonal
relationship (68.8 percent),
percent),

availability

(69.6

personnels' professional knowledge (68.8

percent),

attentiveness

(70.9

percent),

professionalism (70.9 percent); and highest mean percentage of satisfaction

score was found for clinical skills of nurses (74.6 percent). In private
hospitals the mean satisfaction score was higher in all the dimensions of
nursing care as compared to government hospitals, which ranged between
9.22 to 10.34 (maximum 12 score for each dimension), which was found
statistically significant (p<0.001). Whereas the lowest mean satisfaction
score was observed for communication and in contrary, highest satisfaction
score was observed for interpersonal relationship dimension of health care.
Improving the building design could increase patients' satisfaction which
was likely to have a positive effect on treatment adherence and health
outcome.

The overall patient satisfaction with healthcare was high in selected

public as well as private hospitals. However, patient satisfaction with
healthcare was high in all the dimensions of hospital care in private
hospitals as compared to government hospitals. Furthermore it was found
that patient satisfaction with healthcare in medical, surgical, orthopedic and
maternity wards was not significantly different in selected public and private

hospitals. However, it was found communication and emotional support

dimension of healthcare needs improvement to further enhance patients'
satisfaction with nursing care in selected public and private hospitals.
Qualitative Analysis
Emergency Patients

Enters
emergency
facility

Laboratory
Tests

Triage

Test
Results

Healing

Pharmacy

Release

Walk in Patients

Enters
hospital

Goes to
doctors'
clinics

Laboraroty
Tests

Test Results

Pharmacy

Out

Visitors

Enters hospital

Nurse Station

Goes to
patient's room

Goes home

Enters
hospital

Goes to
clinic

Conduct
s rounds

Goes
home

Doctors

Nurses

Enters
hospital

Nurse
Station

Goes to
patient's
room

Does
rounds

Goes
home

Quantitative Analysis
There were total thirty-two items to collect data regarding patients'
satisfaction with the general hospital, consisting of four items under each
dimension/ category of satisfaction. Each statement was judged to rate on four
points scale i.e. Highly satisfied, Moderately satisfied, Uncertain, dissatisfied and to
each rating 3, 2, 1, 0 score was given respectively making a total maximum score of
96 and minimum zero. Patients' overall score between 65-96 was considered highly
satisfied with the overall condition of the hospital, score between 33-64 considered
moderately satisfied and score between 0-32 was considered as undecided/
dissatisfied. For each category maximum score was 12 and minimum was zero. For
each individual category score between 9-12 was considered as highly satisfied,
score between 5-8 was considered as moderately satisfied and score between 0-4
was considered as undecided/dissatisfied.
Content validity of the tool was established by seeking the inputs from 2
experts from the field of emergency department and healthcare administration.
Reliability of the data collection tool of patient satisfaction with nursing care
interview schedule was computed on the data of 30 patients using split half
technique; it was found reliable (r=0.89).

After minimum of one week stay in hospital, patients were surveyed for data
collection to know their satisfaction with the hospital using the questionnaire. Each
patient was privately interviewed at their bedside as per their convenience and it
took about 8-10 minutes to interview each patient. Furthermore, patients were
interviewed in the absence of any of the healthcare provider of the institute but
patients were given liberty to provide information in the present of their family
members as per their choice.

Socio-demographic profile of the patients under study is presented in Table

1. Total 1200 patients were selected form both government and private hospitals.
Nearly half of the patients were in age group of 18 to 30 years, followed by about
one fourth of the patients in the age group of 31 to 40 years. Nearly 20 percent of
the subjects were in the age group of 46 to 50 years, which included 25 percent
from private hospitals and 14.3 percent from government hospitals. 10 percent
patients belonged to the age group of sixty plus, which included 13 percent from
private hospitals and 6.5 percent from government hospitals. As per gender of
patients, nearly equal number of male (53.8 percent) and female (46.2 percent)
patients were included in the study. Majority of the patients i.e. 83.5 percent were
married followed by 12.8 percent unmarried, 2.7 percent widow/widower and one
percent divorced/ separated. Similar pattern was observed in both government and
private hospitals.
In present study two-third of urban patients visited both public (61.7%) and
private (61.8%) hospitals, while rural patients constituted only 37.2% in public
hospitals and 38.3% in private hospitals. However, few patients (1.0%) from slums
only visited public hospitals. As preferences of health care facility was concerned,
majority of the Filipino were seeking their health care from private hospitals and
little less than fifty percent were seeking their health care from government
hospitals. About 50 percent of the patients seeking inpatient services in
government hospitals, while only 6.8 percent of them were seeking health care from
private hospitals.
Majority of patients in government hospitals, i.e. 87.6 percent were metric or
below educated, whereas in private hospitals only 66.6 percent patients were in
this category. In government hospitals there were only 4.3 percent patients who
were graduates or above, while in private hospitals this category included 17.3

percent patients. Higher number of patients (38.3 percent) were illiterate, who were
seeking care in government hospitals as compared to private hospitals (20.5
percent). Nearly equal number of nonworking people were seeking health care from
government and private hospitals. Higher number of non-skilled people were
seeking health care from government hospitals (40.7 percent) as compared to
private hospitals (24.2 percent). More number of professionals/businessmen were
seeking health care from private hospitals (17.8 percent) as compared to
government hospitals (2.5 percent). Distribution of patients as per selected sociodemographic variables such as age, religion, educational status and occupation
was not homogenous in selected public and private hospitals.
Mean patients' satisfaction score with nursing care in selected hospitals may
be perused from Table-2. It was found that in government hospitals mean
percentage of patients' satisfaction score was 67.6 percent of the total score; while
in private hospitals mean percentage of patients' satisfaction score was 84.2
percent of the total score. This shows that patients in private hospitals were more
satisfied with nursing care as compared to government hospitals; t-test was applied
to see the statistical difference in these satisfaction scores, this difference of
patients' satisfaction in government and private hospitals was found statistically
significant (p<0.001)

Level of patients' satisfaction with nursing care in selected government and

private hospitals is illustrated in Table-3. It was found that 91.8 percent of the
patients were satisfied with nursing care in government hospitals (48 percent
highly satisfied, and 43.8 percent moderately satisfied), while in private hospitals
99.3 percent patients were satisfied with nursing care (68.5 percent highly
satisfied, and 30.8 percent moderately satisfied). In government (91.8 percent) as
well as private hospitals (99.3 percent) patients reported high level of satisfaction
with nursing care. However, there were more number of patients dissatisfied with
nursing care in government hospitals (8.2 percent) as compared to private hospitals
(0.7 percent). This difference was found statistically significant (p<0.001).

CHAPTER I.5

Mean patients' satisfaction score with nursing care in different clinical

specialties of selected hospitals may be perused from Table-4. It was found that in
all selected clinical specialties patients' satisfaction was higher in private hospitals
as compared to government hospitals, which was found statistically significant
(p<0.001). Among four selected clinical specialties in government hospitals,
orthopedic patients (60.6 percent) were having lower mean satisfaction score,
followed by medicine (63.3 percent), surgery (67.5 percent) and maternity (68.1
percent). In private hospitals, patients' satisfaction was not much different in four
selected clinical specialties viz. surgery (79.1 percent), medicine (80.6 percent),
orthopedics (81 percent) and maternity (82.7 percent).

Mean satisfaction score of patients with different dimensions of nursing care

is depicted in Table-5. It was found that in government hospitals satisfaction score
for different dimensions of nursing care ranged between, 6.83 to 8.97 (maximum
12 for each category). Mean percentage of satisfaction score ranged between 56.9 to
74.6 percent, where lowest mean percentage of satisfaction score was observed for
communication (56.9 percent), followed by emotional support (60.8 percent),
interpersonal relationship (68.8 percent), Nurses' professional knowledge (68.8
percent), availability (69.6 percent), attentiveness (70.9 percent), professionalism
(70.9 percent); and highest mean percentage of satisfaction score was found for
clinical skills of nurses (74.6 percent). In private hospitals the mean satisfaction
score was higher in all the dimensions of nursing care as compared to government
hospitals, which ranged between 9.22 to 10.34 (maximum 12 score for each
dimension), which was found statistically significant (p<0.001). Whereas the lowest
mean satisfaction score was observed for communication and in contrary, highest
satisfaction score was observed for interpersonal relationship dimension of nursing
care.

Need Analysis
Computation of the Unmet Bed Need. The following steps should be used in
determining the Unmet Bed Need, which is the maximum number of beds that the
proposed hospital may be allowed to put up.

1. Determine the Projected Primary and Secondary Catchment Population (P) of

the proposed hospital.
1.1.

The Primary Catchment Area is the municipality/urban district for Level 1

Hospital; the rural district/city for Level 2 Hospital; the province for Level 3
Hospital; and the region for Level 4 Hospital.

1.2.

The Secondary Catchment Area/s is/are other geographic area/s that have
access or contiguous to the Primary Catchment Area.

2. Determine the Inventory Hospital Beds (IHB), which is the number of

existing beds being provided by existing government and private general

hospitals plus the number of beds being proposed by previous applicants for
license to operate. Hospital beds being provided by special hospitals,
hospitals under the Department of National Defense, penitentiary hospitals,
and special research centers (i.e. Research Institute of Tropical Medicine)
shall be excluded from the Inventory Hospital Beds.

3. Determine the Bed-to-Population Ratio (BPR), or the ratio of Inventory

Hospital

Beds

to

the

Projected

Primary

and

Secondary

Catchment

Population.
BPR= IHB/P X 1,000

3.1. If the BPR is more than 111,000, the proposed hospital cannot be given
a Certicate of Need.

3.2. If the BPR is less than 111,000, proceed with the computation of the
Unmet Bed Need.

4. Determine the Projected Bed Need (PBN) or the projected total number of
hospital beds needed for the primary and secondary catchment
population

by

multiplying

the

Projected

Primary

and

Secondary

Catchment Population (P) by the bed-to-population ratio of 1:1,000.

PBN = P x 1/1,000

5. Compute for Unmet Bed Need (UBN) by subtracting the Inventory Hospital
Bed from the Projected Bed Need. using the formula:
UBN = PBN - IHB

CHAPTER I.5
Conclusions and Recommendations

Based on the empirical study on the last chapter, the building design
and planning greatly affects the healing process of patients.
The researcher recommends that the future public hospitals should
be designed to meet the patients satisfaction.

CHAPTER III
Site Identification and Analysis

Site Selection Process

Criteria for Site Selection
Criteria for the selection of site are evaluated thoroughly by the
researcher. The following are the main characteristics that the site should
have:
1. The locale must be densely populated
2. The site should be high enough that it is not prone to flooding
3. The site should have an adequate lot area for the proposed general
hospital
Site Option Description (at least 3 sites)
The first proposed site is located in Las Pias, along Alabang-Zapote
Road. Lot area is 30,992 sqm or approximately 4 hectares. Land use is in
industrial and the market value is 154,960,000 pesos.

The second proposed site is located in Marikina City, along

Sumulong highway. 11,661 sqm. Its land use is commercial.

The third proposed site is in Pasay City. Its land use is commercial.
Lot area is 53161 sqm. It is situated along Diosdado Macapagal Avenue.

Site Selection and Justification

The researchers choice will be the site in Las Pias because first of
all, there are no near hospitals near the vicinity. Second, it is flood resilient.
Third, it satisfies the major site criteria of having an adequate size for the
proposed general hospital. And lastly, the location is very accessible by
everyone since it is along a highway which is the Alabang-Zapote road.
Site Evaluation and Analysis
The Macro Settings
Metropolitan Manila, commonly known as Metro Manila, the National
Capital Region (NCR) of the Philippines, is the seat of government and the most
populous region and metropolitan area of the country which is composed of
the City

of

Manila

and

the

cities

of Caloocan, Las

Pias, Makati, Malabon, Mandaluyong, Marikina,Muntinlupa, Navotas, Paraaque,

Pasay, Pasig, Quezon

City, San

Juan, Taguig,

and Valenzuela,

as

well

as

the Municipality of Pateros.

Located at 1440' N 1213 E, Metro Manila is situated on an isthmus bound
by Laguna de Bay to the south-east and Manila Bay to the west. The metropolitan
area lies on a wideflood plain composed mainly of alluvial soil deposits. The area is
bounded

by Bulacan to

and Cavite to

the

the

north, Rizal to

southwest.

The

the

swampy

east, Laguna to
isthmus

on

the
which

south
the

western metropolitan area partly lies has an average elevation of 10 meters. The

eastern area lies on a ridge gradually rising towards the foothills of the Sierra
Madre and overlooks the Marikina River valley, which is part swamp.
The Pasig River bisects the isthmus and links the two bodies of water. From
Laguna

de

Bay,

it

enters Taguig,

and

flows

east-west

through Pateros, Pasig, Makati, Mandaluyong and Manila before draining in Manila
Bay. Its main tributary, the Marikina River, originates in the Sierra Madre
mountain range in Rodriguez to the northeast of the city. The Marikina River runs
north-south and meets with the Pasig in Pateros. Traversing the course of the
Marikina River is the Marikina Valley Fault System, part of the seismically active
network of fault lines surrounding Metro Manila, placing it at serious risk
of earthquakes.
Under the Kppen climate classification system, Metro Manila is split
between a tropical wet and dry climate and a tropical monsoon climate. Manila,
which features less rainfall than Quezon City, has a tropical wet and dry climate
while Quezon City features a tropical monsoon climate. Together with the rest of
the Philippines, Metro Manila lies entirely within the tropics. Its proximity to
the equator means that the temperature range is very small, rarely going lower
than 20 C or higher than 38 C. However, humidity levels are usually very high,
making it feel much warmer. It has a distinct, albeit relatively short dry
season from January through May, and a relatively lengthy wet season from June
through December.

The Micro Setting

Las Pias, officially the City of Las Pias is a city in the National Capital
Region of thePhilippines with a population of 552,573 as of the 2010 Census. It is
bounded to northeast by the Paraaque; to the southeast by Muntinlupa; to the
west and southwest by Bacoor; and to the northwest by the Manila Bay. Half of its

land area is residential and the remaining half is used for commercial, industrial
and institutional purposes. The present physiography of Las Pias consists of three
zones: Manila Bay, coastal margin and the Guadalupe Plateau. Like neighbouring
Muntinlupa, Las Pias has banned the use of plastics and styrofoam in packaging.

Related Laws and Ordinances

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER
HEALTH FACILITIES
A hospital and other health facilities shall be planned and designed to observe
appropriate architectural practices, to meet prescribed functional programs, and to
conform to applicable codes as part of normal professional practice. References
shall be made to the following:

P. D. 1096 National Building Code of the Philippines and Its

Implementing Rules and Regulations

P. D. 1185 Fire Code of the Philippines and Its Implementing Rules

and Regulations

P. D. 856 Code on Sanitation of the Philippines and Its

Implementing Rules and Regulations

B. P. 344 Accessibility Law and Its Implementing Rules and

Regulations

R. A. 1378 National Plumbing Code of the Philippines and Its

Implementing Rules and Regulations

R. A. 184 Philippine Electrical Code

Manual on Technical Guidelines for Hospitals and Health Facilities

Planning and Design. Department of Health, Manila. 1994

Signage Systems Manual for Hospitals and Offices. Department of

Health, Manila. 1994

Health Facilities Maintenance Manual. Department of Health, Manila.

1995

Manual on Hospital Waste Management. Department of Health,

Manila. 1997

District

Hospitals:

Guidelines

for

Development.

World

Health

Organization Regional Publications, Western Pacific Series. 1992

Guidelines for Construction and Equipment of Hospital and Medical

Facilities. American Institute of Architects, Committee on Architecture
for Health. 1992

De Chiara, Joseph. Time-Saver Standards for Building Types.

McGraw-Hill Book Company. 1980

1 Environment: A hospital and other health facilities shall be so located that it is

readily accessible to the community and reasonably free from undue noise, smoke,
dust, foul odor, flood, and shall not be located adjacent to railroads, freight yards,
children's playgrounds, airports, industrial plants, disposal plants.
2 Occupancy: A building designed for other purpose shall not be converted into a
hospital. The location of a hospital shall comply with all local zoning ordinances.
3 Safety: A hospital and other health facilities shall provide and maintain a safe
environment for patients, personnel and public. The building shall be of such
construction so that no hazards to the life and safety of patients, personnel and
public exist. It shall be capable of withstanding weight and elements to which they
may be subjected.
3.1 Exits shall be restricted to the following types: door leading directly outside the
building, interior stair, ramp, and exterior stair.
3.2 A minimum of two (2) exits, remote from each other, shall be provided for each

floor of the building.

3.3 Exits shall terminate directly at an open space to the outside of the building.
4 Security: A hospital and other health facilities shall ensure the security of person
and property within the facility.
5 Patient Movement: Spaces shall be wide enough for free movement of patients,
whether they are on beds, stretchers, or wheelchairs. Circulation routes for
transferring patients from one area to another shall be available and free at all
times.
5.1 Corridors for access by patient and equipment shall have a minimum width of
2.44 meters.
5.2 Corridors in areas not commonly used for bed, stretcher and equipment
transport may be reduced in width to 1.83 meters.
5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas
located on the upper floor.
5.4 A ramp shall be provided as access to the entrance of the hospital not on the
same level of the site.
6 Lighting: All areas in a hospital and other health facilities shall be provided with
sufficient illumination to promote comfort, healing and recovery of patients and to
enable personnel in the performance of work.
7 Ventilation: Adequate ventilation shall be provided to ensure comfort of patients,
personnel and public.
8 Auditory and Visual Privacy: A hospital and other health facilities shall observe
acceptable sound level and adequate visual seclusion to achieve the acoustical and
privacy requirements in designated areas allowing the unhampered conduct of
activities.
9 Water Supply: A hospital and other health facilities shall use an approved public
water supply system whenever available. The water supply shall be potable, safe for

drinking and adequate, and shall be brought into the building free of cross
connections.
10 Waste Disposal: Liquid waste shall be discharged into an approved public
sewerage system whenever available, and solid waste shall be collected, treated and
disposed of in accordance with applicable codes, laws or ordinances.
11 Sanitation: Utilities for the maintenance of sanitary system, including approved
water supply and sewerage system, shall be provided through the buildings and
premises to ensure a clean and healthy environment.
12 Housekeeping: A hospital and other health facilities shall provide and maintain
a healthy and aesthetic environment for patients, personnel and public.
13 Maintenance: There shall be an effective building maintenance program in
place. The buildings and equipment shall be kept in a state of good repair. Proper
maintenance shall be provided to prevent untimely breakdown of buildings and
equipment.
14 Material Specification: Floors, walls and ceilings shall be of sturdy materials
that shall allow durability, ease of cleaning and fire resistance.
15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be
maintained for patients and personnel, male and female, with a ratio of one (1)
toilet for every eight (8) patients or personnel.
16 Fire Protection: There shall be measures for detecting fire such as fire alarms in
walls, peepholes in doors or smoke detectors in ceilings. There shall be devices for
quenching fire such as fire extinguishers or fire hoses that are easily visible and
accessible in strategic areas.
17 Signage. There shall be an effective graphic system composed of a number of
individual visual aids and devices arranged to provide information, orientation,
direction, identification, prohibition, warning and official notice considered
essential to the optimum operation of a hospital and other health facilities.

18 Parking. A hospital and other health facilities shall provide a minimum of one
(1) parking space for every twenty-five (25) beds.
19 Zoning: The different areas of a hospital shall be grouped according to zones as
follows:
19.1 Outer Zone areas that are immediately accessible to the public: emergency
service, outpatient service, and administrative service. They shall be located near
the entrance of the hospital.
19.2 Second Zone areas that receive workload from the outer zone: laboratory,
pharmacy, and radiology. They shall be located near the outer zone.
19.3 Inner Zone areas that provide nursing care and management of patients:
nursing service. They shall be located in private areas but accessible to guests.
19.4 Deep Zone areas that require asepsis to perform the prescribed services:
surgical service, delivery service, nursery, and intensive care. They shall be
segregated from the public areas but accessible to the outer, second and inner
zones.
19.5 Service Zone areas that provide support to hospital activities: dietary service,
housekeeping service, maintenance and motorpool service, and mortuary. They
shall be located in areas away from normal traffic.
20 Function: The different areas of a hospital shall be functionally related with
each other.
20.1 The emergency service shall be located in the ground floor to ensure
immediate access. A separate entrance to the emergency room shall be provided.
20.2 The administrative service, particularly admitting office and business office,
shall be located near the main entrance of the hospital. Offices for hospital
management can be located in private areas.
20.3 The surgical service shall be located and arranged to prevent non-related
traffic. The operating room shall be as remote as practicable from the entrance to

provide asepsis. The dressing room shall be located to avoid exposure to dirty areas
after changing to surgical garments. The nurse station shall be located to permit
visual observation of patient movement.
20.4 The delivery service shall be located and arranged to prevent non-related
traffic. The delivery room shall be as remote as practicable from the entrance to
provide asepsis. The dressing room shall be located to avoid exposure to dirty areas
after changing to surgical garments. The nurse station shall be located to permit
visual observation of patient movement. The nursery shall be separate but
immediately accessible from the delivery room.
20.5 The nursing service shall be segregated from public areas. The nurse station
shall be located to permit visual observation of patients. Nurse stations shall be
provided in all inpatient units of the hospital with a ratio of at least one (1) nurse
station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size
to allow for work flow and patient movement. Toilets shall be immediately
accessible from rooms and wards.
20.6 The dietary service shall be away from morgue with at least 25-meter distance.
21 Space: Adequate area shall be provided for the people, activity, furniture,
equipment and utility.

Site Development Options

Site Analysis

The blue arrow marks the flow of rain water

Proposed Site Development Plan (with massing)