Hospitals come in all shapes and sizes. This diversity is meant to accommodate the flexibility and informal state of human life, where most of the times cues are taken from Nature to build the right form.
As for hospitals, four areas which are often dealt with in their designing are planning, designing, production and delivery; and the finest combinations to bring these together have been the attempts of hospital planners across the globe. The best results are subjective to clients/planning advisors.
A hospital will require good bones to work from/it will also require sound planning of zones (clinical-nursing-support), grids, circulation, service and functional process to achieve the end, making it the beginning. The inpatient’s room is a dedicated space for people who are required to be treated or made to rest and looked after beyond a surgery or under observation, which can be after tests conducted at the time of delivery and so on. This is specialised care where the health-care trends that will influence the room’s features to deliver the optimum design include the characteristics of future patients, resource limitations, economics and technology.
The past has seen such accommodation to have been in the scope-work of wards-Nightingale wards where the injured were taken in during war or victims of epidemics were housed. Such wards had as much as 50 beds in each hallway. Current trends though have single and double rooms for specialised care, and look at patients’ privacy and reduction in chances of cross-infection. The key to saving money through the design of the patient room is to understand that the unit must be universal enough to allow changes as hospital needs evolve.
- A patient’s room need
- Space for family
- Patient support in/around the inpatient room
- Accessibility and treatment in the room
- Room functionalities arranged for time saving
- Homely comfort and ease
- Care-centered attention/awareness
- Wellness through colour schemes
- Connecting with nature
Four distinct zones make up the patient’s room – one each for caregivers, the patient, family members and hygiene.
This zone, from outside the room entrance, includes space for staff to perform electronic charting and a window for them to see into the room. Nurses can monitor several patients at once from this location in case of multiple occupancy and single rooms alike. This zone has the nurse stations, patient records storage, medical and supplies store, hand-washing sink, equipment alcoves and should be provided with connections to the hospital servers for carts to be plumed in.
This has a bed with a cabinet as the main feature and one that allows easy transporting to the bathroom to property caregiver injuries. The other essentials are medical unit, curtain for privacy, indirect lighting, and space around beds for workability by medical staff. Positive visual and auditory elements can be introduced by providing a video screen, and hence, giving control to patient for video-conferencing with their children at home, speaking to medical specialists, communicating with nursing staff and even can lower stress and aid recovery by watching favourite channels.
A day bed provides sleeping arrangements. Provision of a desk enable family members to continue work while looking after the patient and a cabinet in the same area can contain lockable safe, open shells, and a small refrigerator for storing food and beverages. Wireless technology enables network access throughout the room. This is designed for overnight stay – in few cases, this may extend to day-care spaces outside of the patient room – especially in the case of a father waiting outside at the time of the arrival of his new born. A small pantry is also made accessible in some single rooms and suites.
This is typically dedicated to the toilets and bath areas linked with the room. The washrooms are to allow wheelchair accessibility. Special features such as accessories which aid the patient to use the toilet safely and grab bars installed along the walls near the WC section of the washroom, water mixers, safe shower areas, anti-skid tiling, dry & wet segregation, nurse call systems installed and etc. It is necessary to take care to open the washroom door to the outside and not inwards into the toilet/bathing space.
THE PLANNING GRID
Planning grids are usually taken on the basis of the inpatient’s configuration. A planning grid is an architectural design tool which is a network of uniformly spaced horizontal and vertical lines. Healthcare designers derive their planning grids at conceptualising the overall design of the hospital. In urban zones, where the hospital takes the form of vertical building comprising a podium containing diagnostic/therapeutic and interventional services and a tower housing the inpatient facilities, the planning grid is largely determined by the layout of the inpatient tower. The modules used to determine the shape and size of this grid is the modules used to house the various kinds of inpatient facilities, conceptualised by the designer. A properly designed planning grid provides the flexibility and modularity to accommodate all kinds of room typology – ie: single room, double room, VIP suites and also wards. The grids filter to the rest of the hospital through to the clinical floors – be it the radiology department, OT suite, intensive care units, doctor’s clinic, ambulatory care service, administration and etc.
INPATIENT DEPARTMENT TOILETS CONFIGURATIONS
There are 3 types of room toilet configurations that are majorly prominent. They are Inpatient Department Configuration 1, Inpatient Department Configuration 2, Inpatient Department Configuration 3.
Inpatient Department Configuration 1
Toilets are designed inwardly at corridor wall allowing more natural light and extra space for family members. Care should be taken to provide service shafts that are adequate in size.
Inpatient Department Configuration 2
Toilets are planned along exterior wall on the periphery of the building, which facilitates greater patient visibility for hospital staff but cuts the access to nature. It can give space to the nurse work desk outside each room bay, This kind of toilet gets the advantage of natural light and ventilation too. Also, this can be accessed externally.
Inpatient Department Configuration 3
Toilet located along mid-board or inter-locking toilet configuration. This design provides view to the outdoors and family spaces. It is able to maintain staff visibility into the patient room for better patient care. It is also flexible to remodel to accommodate unit changes.
DESIGN OF CIRCULATION THROUGH THE INPATIENT DEPARTMENT
Hospitals, like the small cities they are likened to, contain main circulation routes often described as hospital streets, The way in which the different parts of the hospital are assembled, as a coherent whole, but with the parts differentiated, make for analogies with urban design: the way in which traffic moves, and the routes that are taken by mechanical and electrical services are fundamental generators of the plans. In a vertically stacked hospital, which could also be called a functionally stratified hospital, almost always the inpatient areas are placed on the upper floors, to allow for a more pleasant, naturally-lit environment. The layouts are designed with breaks in room along the external walls to bring in natural light. The planning grid is determined by these inpatient floors. Another important planning feature – the vertical circulation core, is also to some extent located within the building by the layout of the inpatient floors. In many cases, to benefit environmentally, patient rooms are provided with open balconies with green spaces to reduce dependence on artificial lighting and ventilation. The windows can be recessed to allow for ingress of natural light. The glazing is planned with high performance glass for the patient room opening.
SPECIALISED CARE IN INPATIENT AREAS
Neonatal Intensive care units
Specialised patient services, like the NICU are open layout and cubicles which require progressively clean zones. These also require 3 stage filtration exhausting air systems to maintain the passage of clean air to dirty and not vice-versa. Stringent temperature control is maintained for the comfort of the patients.
In an ante room, caregiver can don masks and gowns when caring for isolated, highly infectious patients. Low-wall exhaust quickly removes bad air, while supply vents near the ceiling continually import good air to better protect room occupants immediately inside the room. Also there is a sink with laminar flow wall faucet and hands-free infrared controls, a work counter and easy access to the patient’s headwall.
Paediatric Inpatient Room
These rooms are designed for 1+1 people. Aesthetics are important and the attempts are made to bring in the child closer to the home-like environment. Beds and toilet accessories can be customised; LED and LCD screens on ceiling can be mounted for visual delights. Play areas are developed closed to the patient room in the department. Future trends are also accommodating the design of the paediatrics by planning for the parents and other associations.
The patients’ room of the future will be need to be sensitive to customer’s needs: internal and external – technologically advanced, cost-effective, flexible and green in terms of energy efficiency and designed for overall patient safety. Durable, sustainable design, if implemented properly, can enable future healthcare managers to hold the line on cost while continually improving the quality of patient care.