COLLEGE OF ARCHITECTURE

900 San Marcelino St., Ermita, Manila,

Philippines Tel. No.: 524 2011 loc. 203/134

Research
Fifty (50) bed Level 1 Government General Hospital

A Research
Submitted to the College of Architecture
Adamson University

In partial fulfillment
of the requirements for
Architectural Design 5

Submitted by:
Gerardo, Liano Ezekiel N.

Submitted to:
Ar. Allan Christopher Luna

October 14, 2021

Part 1: Background on Healthcare Facilities
Healthcare facility planning and design

While the capital development process has many aspects, we have framed
our discussion around the following broad phases of work:
1. Strategic planning
2. Master programming and master planning
3. Functional programming
4. Design development and contract documentation
During each of these phases, planners, designers, staff, and the facility's
decision-makers are responsible for exploring possibilities for flexibility appropriate to
that phase and for clearly directing the subsequent phase. Each phase has its own
set of questions and possibilities for incorporating strategies for flexibility. If these
strategies are carefully considered during each step of the planning and
documentation of the building, the result will be a dynamic solution that solves
current demands, responds to changing needs, and welcomes the future for the next
generation.

1. Flexibility in Strategic Planning

Hospitals will never be tomorrow exactly what we think they will be. The
corporate strategic plan and mission and vision statements will define the long-term
role of the organization, yet they must be fluid and changeable. They must anticipate
shifts in program and service delivery. These shifts will result from new program
opportunities, changing demographics, new technologies, new approaches to
service delivery, and other inevitable changes. The strategic plan should be revisited
every few years and adjusted as appropriate.

2. Flexibility in Master Programming and Master Planning

Master programming and master planning is the first planning phase
undertaken toward the realization of a physical hospital plan. The master program is
developed based on the strategic plan describing programs and services at a high
level and completing basic workload and staffing projections. This information is
used to develop broad-brush estimates of space requirements for each block of
space (i.e., programs, services, or departments) that will make up the facility.
Relationships between these blocks of space are also documented.
Master planning provides essential information regarding the current and
future expandability and flexibility requirements of the facility. It is, however, a living
document and will require continual review and updating to make it useful as a
planning guideline.
3. Flexibility in Functional Programming
A functional program Is a detailed document that describes the future
functions and operations of a functional facility are (i.e., programs, services, and
departments); describes current and projected workload; identifies the staff
complement that supports the projected workload; and outlines detailed design
considerations, including special design concepts to be incorporated by the architect,
internal and external adjacency requirements, and a room-by-room space list.
Flexibility-related Issues in this phase include the following:

Operational trends
Consultants can provide benchmarking, but staff should also be up-to-date on
the latest operational trends in the area of expertise, whether it is admission
procedures, delivery of nursing care, clinical management, materiel distribution,
communication systems, patient records management, or food services. New ways
of doing things often can achieve operational efficiencies or promote client- and
family-centered care. Managers and staff should have informed opinions about the
pros and cons of the implementation of these new processes.

Equipment choices
The location and selection of equipment must be considered. For example, is
the volume of activity in a particular area sufficient to warrant an ultrasound room
there? Alternatively, portable units may be used and moved to both locations instead
of having all patients go to where the equipment is located; installation and
dismantling costs are also avoided. Considering this kind of operational flexibility for
diagnostic imaging services will take the pressure off the centralized space as
volume and activity increase in that area.

Service consolidation
Where both adult and pediatric services are being planned, for example,
planning will need to investigate if and what aspects of these services can be shared
In such areas as the ORs, diagnostic services, and emergency services. Operational
efficiencies can be achieved by sharing some support. In addition, there is added
flexibility because the primary activity may spill over into the adjacent area If
required. For example, if a pediatric operating room is available, an adult case may
be handled in that room.

Utilization patterns
Some spaces such as clinic space may be shared by accommodating
different clinics on different days. Generic clinic space is best suited to sharing, but
additional storage may be required if supplies vary widely between clinics or
supplementary rooms are added to house equipment that Is specific to one clinic.

Internal and external adjacency requirements

Generally, adjacency requirements will have been determined during the
master programming or master planning phase but should be confirmed during
functional programming because there will still be opportunities to move things
around. If new information or ways of thinking highlight the need (i.e., the master
plan must be flexible to consider some immediate changes). While location and
adjacencies must first serve the function of the components (i.e., program, service,
or department), documentation could also reiterate the need for future expansion
and adjacent "soft space" if required and could also indicate those rooms within the
component that are most likely to require expansion.

Open concept planning

Wherever applicable, open concept planning should be highlighted in the
preparation of design concepts, for the architect's consideration during the design
phases. The use of open space that may be configured in many ways can be
promoted in areas such as labs, offices, and the pharmacy. Modular furniture can be
used to define workspaces, and if walls are necessary, demountable structures may
be used if cost-effective. Standardized service grids including power and
communications, supporting a variety of configurations, should be considered. This
is discussed further in the section on the design below, in the context of building
materials and systems.

Standardization of room sizes

Plans typically recommend that room sizes be standardized as much as
possible. The more that room sizes are tailored to certain functions, the less flexibility
exists. If, for example, all exam rooms are planned at a standard size (e.g., 120
square feet), then the rooms can be used by any clinical service for this function. In
addition, if all offices are planned to be 120 square feet, then clinic office space could
be converted to exam space in the future.

Flexibility at the patient bedside

Inclusion of space for flexible bedside use has become imperative due to the
following trends, among others: family members as caregivers, increased acuity,
increased need for isolation, access to electronic charts at the patient bedside, and
an increase in the number and complexity of mobile equipment for bedside use.
The universal room concept represents one means of achieving this flexibility.
The universal room has recently been promoted to increase flexibility in the handling
of patients with the full spectrum of acuity, including telemetry (Spear 1997). This
generic room offers a high degree of adaptability to changes in demand and uses
patterns without the need for remodeling. Each universal room is a private room, and
providing only private rooms promotes patient privacy, maximizes overall occupancy,
and minimizes patient transfers and associated costs such as tracking records and
billing. On the other hand, an Inpatient unit with all-private rooms increases the unit
size and staffing costs, and the accommodation of all patient facilities requires
constant staff reassignment. There is also an increased cost to distribution systems,
housekeeping, and other support services.

Modular Space Planning

Considering how different services expand, space allocations may be based
on modules or uniform blocks of spaces that may be repeated within a component or
constitute a planning unit that can easily be added later. Labs work well in the
module format, as do general medical and surgical units of uniform numbers of beds.
4. Flexibility in Design and Construction Documentation
During schematic design, the client begins to see the facility take shape.
While the space requirements have been laid down in the functional program, there
is still ample opportunity to allow flexibility in the design itself. The architect, using
the functional program as a guide, creates alternative solutions (showing the
proposed location of each room specified) and works closely with the users to
develop a layout that is both functional in the present and flexible for future uses.
Flexibility-related issues to consider during the design and construction
documentation phases include the following:

Departmental/room adjacencies
Locating departments that are expected to experience growth adjacent to
exterior walls, along with due consideration to shafts and mechanical rooms, allows
for major changes in technology and support space. However, for the more frequent
minor changes, other strategies can be used. For example, a generically sized room
will allow a change In functions with minor alterations. A 120-square-foot office can
easily become an appropriate exam room. Also, a 240-square-foot meeting room,
with minor alterations, becomes two offices or exam rooms.

Building materials and systems

The selection of building materials can profoundly affect patients' well-being
but can also severely limit the facility's ability to effect change quickly and
economically. Detailed analysis is required to ensure that materials selected for one
use are not too restrictive should the use of the space change. For example, vinyl,
and linoleum flooring can serve multiple uses, from exam rooms to offices to meeting
rooms; terrazzo also can serve many uses provided that coved terrazzo bases are
restricted to very specific areas (the relocation of doors along corridors with coved
terrazzo bases Is disruptive, noisy, dusty, and costly).
Simple materials, used well, will serve the facility by providing consistent
surfaces for maintenance, repair, and change. Wall systems, using standard
construction materials and designed and engineered to provide appropriate
acoustical and visual separation, will dismantle and reconfigure easily when change
is required.

​Hospital design trends in the twentieth century

​ Rather than working towards a universal look, in the 1980s architects

focused on making hospitals that would fit into their various communities. These
were friendlier, accessible, and, above all, ‘less institutional’. They rejected the model
of the office tower with identical floor plates and instead prescribed massive atriums
that made hospitals appear less serious. Since libraries, museums, and airports also
donned atriums at this time, everything began to look like malls.
​ Part of the pitch for accessibility was what healthcare architecture
specialist Professor Stephen Verderber calls ‘horizontalism’, where hospitals spread
out across their sites and sometimes multiply, in lower-rise pavilions. Colour also
returned to the language of hospital design, and many projects in the 1980s included
playful, almost whimsical color combinations, inviting patients to de-stress upon
entry. Concurrently, the spaces between hospital buildings became significant, giving
rise to ‘healing gardens’ and other therapeutically charged landscapes. Even the
views from hospital windows could be deemed healthful. All these features, a
campus-like plan, polychromy, and links to nature were intended to distract patients
from the business of being seriously ill.
​ Sustainable approaches to hospital design are producing interesting
alternatives to the mall. An example is Herzog & de Meuron’s 2014 design for the
New North Zealand Hospital in Hillerød, Denmark. This 660-bed hospital, set in a
Danish forest, is set to open in 2020. Its low-rise solution offers a distinctive spatial
experience whereby all patient rooms are stacked on the perimeter of a
subterranean base that houses two stories of medical services. In the way the
building maximizes air and light – all patient rooms have views of the forest – it looks
back to the ubiquitous pavilion-plan hospital of the late 19th century. Its
cross-section, however, is refreshingly novel. Engaging the site itself as inspiration
for the design is an outward-looking alternative to the inward-looking mall plan. It is
certainly no ordinary hospital.

Making hospitals that looked like office towers or shopping malls succeeded in
shifting expectations about illness and medicine. The point of those buildings was to
make visiting them seem normal. However, today people expect more from
hospitals. With the belief that good hospital design should inspire wellness,
architecture has taken on a new role as part of the toolkit that makes patients better.
Improving hospital architecture requires fresh perspectives. When firms that do not
necessarily specialize in healthcare design major hospitals, the results are often
imaginative. Healthcare architecture advances when architects embrace medical
technology and landscape as inspiration, rather than as constraints or things to be
disguised. Despite the benefits of the consumer turn in healthcare, illness is still a
very serious subject. Healthcare thus deserves dignified buildings, inspired by the
world around us.

​Disaster-proof architectural design for hospitals

​ Making Hospitals Safe From Earthquakes

​ Earthquakes create horizontal pressure on buildings, causing them to
collapse. To design an earthquake-proof building, engineers need to reinforce the
structure and counteract an earthquake’s forces. Since earthquakes release energy
that pushes on a building from one direction, the strategy is to have the building push
the opposite way. Here are some of the methods used to help buildings withstand
earthquakes.
1. Create a Flexible Foundation
2. Counter Forces with Damping
3. Reinforce the Building’s Structure
4. Earthquake-Resistant Materials

​ Making Hospitals Safe From Flooding

​ A progressive approach to planning must be applied where measures
are taken to reduce the impact of floodwaters first at site > structure > planning >
interior levels. This will ensure safety at all levels, and the after-effects of floods will
keep on decreasing at each stage. The following are the key features of disaster
resiliency in the project:
​ Upside-down planning: All the structure is constructed above the
base flood elevation (BFE). However, in case of massive flooding, the lower floors
are likely to get affected the most. Therefore, an ‘upside-down’ planning strategy is
adopted where all the non-critical, easily movable activities like administration, the
outpatient department is placed on the lower floors, and the critical, hazardous,
non-movable activities like services (control room, electrical room, gas manifold,
communications), ICU, pharmacy, etc. are placed on the upper floors.
​ Airways and waterways provision: During flooding, roadways are
blocked. Thus, the ramp leading to the emergency department can double up as a
boat launch area to receive patients requiring treatment and sending off the cured
ones. Also, a helipad on the roof can receive critically ill patients via helicopter.
​ Cafeteria cum triage area: In case of a disaster, when the number of
patients increases exponentially, a large open space like a cafeteria can be
transformed to triage (a place where patients are treated according to the degree of
emergency). The seating of the cafeteria is such that those seats can be transformed
into beds as and when needed.
​ Low height plants and lights: In the case of cyclones, since tall trees
and electric poles are more susceptible to breakage leading to more damage, only
low height plants and lights are used as landscaping elements.
​ Cyclone-proof façade design: In the case of cyclones, a sloped
surface behaves better since it breaks the flow of wind and poses less pressure.
Therefore, a sloped façade element here acts as a protective shield from high-impact
objects/debris that might hit the building in case of cyclones while also breaking the
flow of wind and slowing it down.

Synthesis

In conclusion, the objective of the planning and design process is to support

the efficient and effective use of space. Incorporating flexibility into the planning of
the physical space of the hospital allows the:
• Changes in programs provided by the organization change in how service is
delivered.
• Operational changes such as new workflow methods and the reorganization
of services as well as staff roles and responsibilities.
• Changes in future workload (increased or decreased) Optimum utilization of
current or available space.
• Sustainable use of an expensive resource-the hospital facility.
The perfect balance is found between the functionality of the space and the
generic parameters that afford its flexibility. Staff and patients will enjoy a pleasant
and effective work/care environment. Planning a new healthcare facility affords an
opportunity to create a dynamic and long-term solution in a manner that will allow the
hospital to explore innovative and exciting ways to deliver healthcare in its
community. An opportunity is provided to create a facility that delivers an inventive
and flexible environment that will accommodate both the predictable and the
unknown changes in a sustainable manner-serving the organization, its patients and
staff, their families, and the community.
Hospital design in the twentieth century concludes that a campus-like plan
and a sustainable architecture approach are more suitable when designing a hospital
in modern times. This approach is suitable to create a sense of comfortability and
ease to the patients to lessen the fact that a hospital’s environment is more likely to
create a dramatic emotion from patients regarding their health matters.
In the Philippine context, there are major natural disasters that are most likely
encountered by the community, earthquakes, typhoons, and flooding. This is the
reason why structures in the Philippines must consider building a disaster-proof
design to lessen the damages and commodities. The building design professionals
should consider some factors such as elevating the finished floor line of the building
to avoid flooding penetrating the interior, and upside-down planning by putting those
spaces that are not critical - an active user space and placing those critical spaces
on upper floors.

Part 2: Healthcare Planning and Design Standards for a Level 1 Hospital

Emergency Room (ER) department

Every hospital with an emergency department aims to provide you with

high-quality care as efficiently as possible. In the emergency department, the staff
understands that being there is stressful and they take the best possible care of all of
their patients. You will be treated as soon as possible, but someone who arrives in
the emergency department after you may be seen before you if they need treatment
more urgently.1
In planning the Emergency Activity, particular attention must be paid to
movements of people (patients and staff) and material (equipment and supplies).
The first priority, of course, must be the movement of those patients who require
immediate or urgent medical attention and the responding members of the medical
staff. The time factor in terms of minutes can make the difference between life and

1
“Emergency Department - What to Expect.” Emergency Department - What to Expect -
Better Health Channel,
https://www.betterhealth.vic.gov.au/health/servicesandsupport/emergency-department-what-to-expect.
death. All necessary equipment and life saving apparatus must be located in
designated spaces so as not to impede the movement of staff yet be readily
accessible when needed.2
The Emergency Activity should be located on the ground floor to ensure easy
access for patients arriving by ambulance or auto. A separate entry for walk-in
patients is required . These entrances, which are separate from the Outpatient
Activity, must be easily identifiable, protected from inclement weather, and
accessible to handicapped patients. The emergency facility also must be easily
accessible from the hospital to patients and to the house staff performing their
routine duties or being summoned for consultation or emergency action.3
Since they share some supportive facilities, the emergency and outpatient
facilities are adjacent to each other. Good planning practice requires that the
Emergency Activity be easily accessible to the hospital's surgical suite, coronary
intensive care unit, and the primary radiological facilities.
The relationships within any Emergency Activity may be arranged according
to individual preference and needs. The following should be considered for any
complete emergency activity :
Public Sector Areas
○ Entrance for patients arriving by ambulance, other modes of
transportation, or conveyances
○ Entrance for walk-in patients
○ Control station
○ Public waiting space with appropriate public amenities
Treatment Facilities
○ Patients' observation room
○ Treatment cubicles
○ Examination rooms
○ Cast room
○ Critical care rooms
○ An Emergency Activity may also include a patient's security room and
areas providing supportive services and staff accommodations.

2
Chiara, De Joseph, and John Hancock Callender. Time-Saver Standards for Building Types.
McGraw-Hill International Book, 1983.
3
Time-Saver Standards for Building Types.
Synthesis
In conclusion, the main priority of planning an Emergency Room (ER) is the
movement of the users in the spaces, the planning should have an easy flow within
the spaces. The designer should plan the spaces correctly and put each space that
has relation to each other adjacently. It is important that the emergency room (ER)
should be located at the ground floor to be easily accessible to the patients that need
immediate treatments. In addition, the zoning of spaces has two groups, the public
sector and the treatment facilities. Technically, the public sector area should be
placed on the entrance of the building, it should be accessible to the public while the
treatment facilities should be located on the inner parts of the building. The ER
should have two entrances, one should be big enough for the stretcher to enter and
the other entrance for walk-in patients. The public sector also has a control station
with a radio room and the public waiting area. The treatment facilities in the private
parts of the building should include the patients observation room, treatment
cubicles, examination rooms, cast room, critical care rooms, and a patient's security
room with areas providing supportive services and staff accommodations.

Operating Room (OR)

The surgical suite of the general hospital is a very complex workshop. It is one
of the most important departments of any hospital, and its planning is complicated by
the diversities of opinion and experience of the many persons involved in policy
decisions essential to the development of a good program of requirements.4
The number and type of operating rooms is the first major decision . In the
general hospital, the tendency is to have all major operating rooms as nearly
identical as possible to facilitate scheduling of various surgical procedures . Free
floor space should be 18 ft by 20 ft, or approximately 350 sq ft . Many surgeons and
surgical supervisors recommend 20 ft by 20 ft free floor space.5
The planning and equipping of each operating room are based on a series of
questions, such as: (a) size, (b) usage, (c) environmental control, (d) lighting-surgical
and general illumination`, (e) intercommunications and signal systems-, (f) electronic
equipment and monitoring system', (g) service lines, such as suction, oxygen, nitrous
oxide, compressed air, (h) provision for x-ray, not only x-ray tube stand but control,

4
Time-Saver Standards for Building Types, p. 403.
5
Time-Saver Standards for Building Types, p. 403.
transformer, and necessary lead protection, (i) provision for TV camera, movie
cameras, other recording equipment, (j) safety precaution in hazardous areas, (k)
cabinet work, supply cabinets and storage for operating table appliances, (I) need for
clocks, film illuminators .6
Outer zone: Administrative elements and basic control where personnel enter
the department, patients are received and held or sent to proper holding areas of the
inner zone ; conference, classroom areas, locker spaces, any outpatient reception,
etc .
Intermediate zone: Predominantly work and storage areas ; outside personnel
will deliver to this area but should not penetrate the inner zone . The recovery suite,
if completely integrated with the surgical suite, is an intermediate or outer zone
activity.
Inner zone: The actual operating rooms, the scrub areas, the patient holding
or induction areas. All alien traffic should be eliminated. Here we want to maintain
the highest level of cleanliness and aseptic conditions.

6
Time-Saver Standards for Building Types, p. 403.
Typical plans of Operating Rooms

Synthesis
According to the gathered data, the priority when planning an OR is to first
know the number and type of the Operating Room. The recommended size of
medical professionals is 20 ft. (6096 mm) by 20 ft. (6096 mm) of free floor space in
an OR. The zoning of spaces in an OR is categorized by outer zone, intermediate
zone, and inner zone. Outer zone areas are mainly administrative elements. This is
the space where personnel enter the department. It includes the lockers, conference
rooms and the reception, the receiving of patients are held in this area. Intermediate
zone is the service area and the storage of equipment. Inner zone is where the
operation of patients happens. The planning of the inner zone should minimize traffic
flow of the users.
Maternity Facility

The delivery suite includes three areas of activity : labor, delivery, and
recovery. Proper sequential arrangement of labor, delivery, and recovery areas within
the labor-delivery unit facilitates patient care and aids the staff in carrying out proper
medical techniques and practices.
Labor, delivery, and recovery rooms should be located and related for easy
movement of patients from one area to another and for good patient observation . In
large suites, locating service facilities on subsidiary corridors may help to reduce and
control traffic.7
Admitting and Preparation
Various methods are used to admit maternity patients:
1. Through the main hospital admitting desk and then either to a maternity
nursing unit or to a labor room in the delivery unit.
2. Directly to labor rooms in the delivery suite.
3. In an admitting and preparation unit.
Labor Rooms
Labor rooms should provide maximum comfort and relaxation for the patient
and should have facilities for examination, preparation, and observation . Unless an
admitting and preparation unit outside the labor-delivery unit is available, the patient
may be admitted directly to the labor room.
Although traditional practice has permitted two or more beds in labor rooms,
single occupancy rooms are recommended. They eliminate the necessity for a
patient preparation room, separate infectious patients, provide greater privacy, and if
in accordance with hospital policy, permit the husband to visit the patient during
labor. These rooms should have a minimum floor area of 100 sq ft. Multiple
occupancy rooms should have not less than 80 sq. ft. per bed. If only one delivery
room is required, one labor room should be arranged as an emergency delivery
room and should have a minimum floor area of 180 sq ft.8
Delivery Room In designing and equipping the delivery room, every facility for
the welfare and safety of the mother and the newborn child should be incorporated.
Basic considerations include the immediate availability of equipment and supplies,

7
Time-Saver Standards for Building Types, p. 437.
8
Time-Saver Standards for Building Types, p. 438.
built-in protection against anesthetic explosion, auxiliary electrical systems in case of
power failure, an adequate air-conditioning system, and finishes that promote
aseptic conditions .
Space allowance for equipment and for the staff to circulate freely is a primary
factor in determining the size of a delivery room . A clear floor area approximately 17
ft. 6 in. is generally large enough.
Recovery Room
The recovery period, after delivery, is critical and may last from 1 to 3 hours.
During this period the mother requires close observation and special care by the
labor delivery nursing staff . Some hospitals insist on continuous bedside attendance
during this time. Various locations may be used for patients during the recovery
period: a delivery room, a labor room, a bed in the maternity nursing unit, or a
recovery room used exclusively for this purpose .
The recovery room has generally been accepted as s necessary facility in the
delivery suite end should be considered for any hospital requiring three or more labor
beds A recovery room provides a location for recovering patients, frees the delivery
or labor room for cleanup prior to occupancy by another patient, concentrates
patients in similar condition, and facilitates the special nursing care required.
Nurses' Station
The nurses' station is the administrative end control center of the labor
delivery unit. Its size, complexity, and location will be determined by the extent of
responsibilities charged to the obstetrical supervisor as well as by the size and
staffing of the suite.

Synthesis
The zoning of spaces in a maternity facility unit is categorized by the labor,
delivery, and recovery. The planning of labor rooms should be near the delivery room
since it is convenient to reduce the amount of time in travelling, labor rooms should
have facilities like examination, preparation, and observation areas. The
recommended bed for a labor room is one but two or more beds in one labor room is
possible. The minimum size of a one bed labor room is 100 sq.ft. (9.3 sq.m.) and not
less than 80 sq.ft. (7.4 sq. m.) for labor rooms with multiple beds. A dressing room
with toilet and lavatory should be provided for the labor rooms. Labor room doors
should be 4 ft. (1219.2 mm) for the stretcher and beds to enter. In planning a
delivery room, it should have a minimum space allowance of 17 ft. 6 in. (5.3 m)
square. Take note of those patients who will be cesarian is assumed to be performed
in the surgical suite. The patient's recovery period may span in 1 to 3 hours, the
mother requires observation and special care during this period. The recovery of the
patients may be conducted to other rooms; it may be a delivery room, labor room or
a bed in the maternity nursing unit, although the provision of recovery rooms is
possible. The nursing station should be placed accessible to the public and to the
patients rooms. Nursing station is also the administration and control center of the
maternity facility

Isolation Facilities

Dental Clinic

Dental educators today favor the adoption of the cubicle clinic. The privacy of
the cubicle, a factor appreciated by patients as well as students, and the overall
atmosphere of the cubicle clinic engender self-confidence and efficiency on the part
of the student.
The arrangement of the many elements of a school is determined largely by
the movement of students, faculty, patients, and materials. Clinics are the most
common and effective way of reducing traffic within the school by physical separation
of the clinical facilities from the remainder of the school Staffed by a separate faculty
and visited daily by large numbers of patients whose presence elsewhere in the
school could be disruptive, the clinical facilities are logically a physical entity. For this
reason, physical separation will continue to be advisable even though efforts to
break down the rigid separation which exists between the clinical and basic science
teaching programs are successful. However, if they are successful, there probably
will be a need to locate certain clinical areas so that students can move between the
clinics and the basic science areas without disturbing the clinical routine. Planning
committees should therefore consider the possible
Typical dental clinic floor plan

Synthesis
For a level 1 hospital with 50 beds, dental clinics staff have 2 positions. The
provision of dental clinics has a minimum space requirement of 25 ft. (7.6 m) with
dental equipment. Modular planning is recommended to have a functional dental
clinic. Modular design provides a basis for determining the width of laboratories and
offices. In estimating depth, at least 24 or 25 ft should be allowed. The bay depth is
28 ft. (8.5 m), the equivalent of six modules, a sufficient allowance when utility shafts
are located along the corridor wall.

Blood Station

There is a set of common functions that can be customized to the individual

facility when planning and designing a new or renovated blood transfusion service.
These functions include:
● Receipt of blood products
● Storage of blood products
● Receipt of patient specimens
● Testing of specimens and products
● Preparation and distribution of blood products
● Integration into supply chain
● Proper management of waste stream
These functions are illustrated in greater detail in the diagram below.
Transfusion blood products including, but not limited to red blood cells, plasma, and
platelets, flow into the transfusion service department from outside sources and must
be received, removed from shipping containers, in-processed, and moved to storage.
The product flow also includes testing of blood products for proper blood type to
verify labeling, and identifying a location to store containers before returning them to
vendors. Once in-processed, products are moved to storage areas pending the need
for preparation and distribution.
For blood banks and transfusion services, there are identified four major
functions:
1. Receiving
Areas are designated for receiving blood and blood products from couriers or
pneumatic tube stations with donor segments, products are logged in, routing to
product storage or to ABO testing area is designated, transport container coolant
and waste are disposed, and empty containers are routed back to the entry area
To encourage lean, efficient operations, the receiving area is best located
adjacent to product storage and testing areas
2. Storage
Workspace is allotted for in-processing activities related to product storage.
Products are placed in refrigerators, freezers, and platelet incubator/rotators
expeditiously for storage under proper conditions
3. Testing
a. Ideally, testing areas are adjacent to test preparation areas and proximate to
product storage areas
b. Initial testing is completed using automated instruments when possible
c. If additional testing is not required, specimens are stored (refrigeration)
d. If additional testing is required, specimens are transported to non-automated
testing areas.
4. Distribution
a. Blood product orders are submitted from critical locations in the hospital, such
as surgery and the ED, to the blood bank through the LIS
b. Crossmatch testing is performed
c. Compatible units are retrieved from blood product storage and are labeled for
distribution
d. Distribution is acknowledged in the LIS
e. Blood products are provided to the customer through a service window,
pneumatic tube station, or other method

With the understanding of the functions and adjacency relationships, the

architect develops a block concept plan according to the diagram below. A written
program is used to develop a function checklist and determine the proper size of
each area.9

9
Lopatka, Michael J. “Planning and Designing a Hospital Transfusion Service.” Planning and
Designing a Hospital Transfusion Service : September 2016 - Medicallab Management Magazine,
Sept. 2016, https://www.medlabmag.com/article/1305.
Typical floor plan layout

Synthesis
Designing and planning a transfusion service from scratch offers the
opportunity to create efficient layouts based on well-defined workflow diagrams that
describe each activity in the process and organize the workplace. Understanding the
context, the regular environment, and the notion of providing a comfortable and
enlightening place to work also are required for a successful transfusion service
environment. A concept can be developed and used to organize and fuse all the
parts together into a transfusion service that relates all its necessary functions to
each other, as well as the greater hospital environment. Future transfusion service
planners can utilize the process described herein to successfully plan and design
lean and efficient facilities as a team with transfusion service input and architectural
expertise. A standard module is assigned to the hematology-blood bank unit. One
half of this module is provided with a workbench for procedures such as hemoglobin
tests, sedimentation rates, staining, and washing of pipettes. Knee space and
storage cabinets are provided below the counter. In the other half of the module, a
workbench 30 in. (800 mm) high, with three knee spaces is provided for
technologists who are seated during tests, such as those involving microscopic
procedures.
Pharmacy Department

Hospital pharmacy departments require adequate space to dispense

medications in a safe and effective manner. The use of a “standard” facility plan for
each hospital is not possi-ble because of variations in physi-cal layouts, differences
in state reg-ulations, and changing national standards. For example, in
theCommonwealth of Pennsylvania,very specific information required square footage
is included in the Pharmacy Act, which speci-fies the following: minimum size of the
prescription area must be at least 250 square feet; within the prescription area, there
must be a prescription working counter of at least 10 linear feet in length and 2linear
feet in width. Moreover, if more than 2 pharmacists are on duty simultaneously, the
minimum counter length should be increased by 5 linear feet for an additional
pharmacist. Finally, proper facility design is important to patient safe-ty, staff
satisfaction, and positive quality outcomes.10
Posted below are the typical floor plan layout of a pharmacy department
located in a hospital.

10
Lin BY, Leu WJ, Breen GM, Lin WH.Servicescape: physical environment of hospital
pharmacies and hospital phar-macists’ work outcomes. Health CareManage Rev. 2008;33(2):156-168
Synthesis
Hospital pharmacies are a combination of constantly changing regulatory
requirements and the number of pharmacy facilities, it is likely that most pharmacy
directors will be asked to redesign a pharmacy in the upcoming years. A working
diagram developed internally by a pharmacy department can be an effective tool for
conveying workflow concepts and details that match a strategic plan. Proper
planning with many considerations primarily, workflow, current and potential
automation, and staff is essential for ensuring that the resulting space allows for
growth and remains functional.

Secondary Clinical Laboratory

The following is an outline of the procedure which may be used in estimating

needed laboratory space, based on the number of tests performed, personnel, and
equipment.
1. Break down the total volume of work into units, such as hematology,
urinalysis, chemistry, as previously noted
2. Determine the number of technologists required in each department.
3. Determine the necessary equipment and space for the number of
technologists required
Laboratory Module for Tachical Area Maximum flexibility is desirable in the technical
work areas of the laboratory department. In the plans, this has been achieved by
using a module of approximately 10 by 20 ft, with a similar arrangement for each
module. Each one consists of two standard laboratory workbenches 12 ft long, 30 in
. deep, with a working surface or counter of about 23 in ., and a reagent shelf Knee
spaces are indicated where needed for
Posted below are the typical floor plan layout that a Secondary Clinical
Laboratory needs to allocate for a hospital with less than 100 beds.
Synthesis
According to the gathered data, the floorplan layout above shows the required
spaces needed for a level 1 hospital. The minimum space allowance required for a
laboratory is 10 ft. (3 m) by 20 ft. (6 m) for each space in the laboratory. The plan
above shows the suggested guide for a general hospital laboratory service having an
anticipated annual workload of 40,000 to 75,000 tests. The estimated technical staff
required to handle this workload is 4 to 7 medical technologists, based on the annual
workload per technologist. The nontechnical staff would include one or more
laboratory helpers in the glass washing and sterilizing unit and a secretary to handle
the administrative work. This plan provides for a laboratory department having a
full-time pathologist. It is assumed that a histology unit will be needed. A laboratory
service performing a yearly volume of 40,000 to 75,000 tests requires the same
types of technical units as one that handles 70,000 to 120,000 laboratory tests. The
space requirements for the technical work areas of the units are reduced, however,
because the workload is less and fewer technologists are needed.
First Level X-ray Department

In a recent study it was found that many hospitals allotted inadequate space
to the x-ray department, and expansion was often impractical . Adequate space for
waiting, toilets, and dressing rooms helps ensure continuous routines in handling
patients. The lack of adequate space results in needless waste of effort and time in
efficiently scheduling examinations. An unsatisfactory layout is a handicap to both
the hospital and the radiologist since the hospital loses potential revenue, and the
radiologist's time, as well as that of the staff, is needlessly wasted . This is
particularly important to a small hospital which has a visiting radiologist for it is to the
advantage of the hospital and radiologist to schedule as many examinations as
possible during his visit.
X-Ray Equipment Booth rooms are equipped with combination x-ray and
fluoroscopy machines with spot film devices. An overhand type tube support is
indicated in the plan, as this facilitates x-raying a patient in bed or on a stretcher. For
economic reasons, however, it may be desirable to equip one room with a
floor-ceiling track . If an overhead mounted track is used, it may be supported from
the floor by columns or may be bracketed from the wall, although a ceiling
suspension makes a neater installation. The optimum size of the x-ray room is about
14 by 18 ft . Ceiling height requirements vary for different x-ray machines, but a
minimum of 9 ft 6 in . recommended . The machine and transformer should be
placed so as to allow adequate space for admittance of a bed or stretcher in the
room . Mounting the transformer on the wall is recommended to save floor space .
However, sufficient clearances (at least 2 fl above the transformer) for servicing the
transformer should be provided. The sink and drainboard, for handwashing and
rinsing utensils and barium equipment, is equipped with a gooseneck spout. It is
located near the foot of the x-ray table . The drainboard can also be used as a
barium counter. It is recommended that the control panel be wired to a signal outside
each x-ray room to indicate when the machine is on, to prevent other personnel from
inadvertently entering the room A red light bulb will be satisfactory as a signal for
most installations.
Control Booth is essential that the control booth be located to the right of the
machine so that the patient may be observed when the table is inclined, since
machines with end pivoted tables tilt to the right . In the plan, no door is shown on
the control booth as the radiation will have scattered at least twice before it reaches
the control booth area. This is in accordance with Handbook 60, as amended, issued
by the National Bureau of Standards. The arrangement of the control booth to the
right and the cassette changer to the extreme left, as shown in the plan, fully meets
this requirement . In addition, since the beam is directed toward the outside wall,
radiation exposure to other personnel is lessened, and the amount of shielding
required is decreased. If the cassette changers are placed to the right of the machine
(on the wall opposite to that indicated on the plan), a door on the control booth or a
baffle placed in the room is required to protect the technician in the booth.
Furthermore, additional shielding is required to protect films and personnel in the
department because the primary beam would not be directed toward the outside wall
. In the present scheme, the shielding necessary in the interior walls is principally to
safeguard against the scatter radiation .
Synthesis
The x-ray department should be located on the first floor, accessible both to
outpatients and inpatients. It is also desirable to locate the department close to the
elevators and adjoining the outpatient department and near other diagnostic and
treatment facilities. The functional requirements of the department are usually best
satisfied by locating the x-ray rooms at the end of a wing. In this location, the activity
within the department will not be disturbed by traffic to other parts of the hospital,
and less shielding will be required because of the exterior walls. As shown in the
diagram above. The standard size of the x-ray room is about 14 ft. (4.3 m) by 18 ft.
(5.5 m). Ceiling height requirements vary for different x-ray machines, but a minimum
of 9 ft 6 in (2.9 m) is recommended. Mounting the transformer on the wall is
recommended to save floor space. However, space clearances with at least 2 ft.
(600 mm) above the transformer for servicing the transformer should be provided.

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