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DESIGN OF 300 BEDED HOSPITAL

Introduction

The hospital you have to build has to be very usable from the point of

view of your patients and staff. This part of the Clinic gives you

counseling on rooms so that you can design a better hospital. Some

rooms clearly fulfill a single function; others play a more important role

in the running of the hospital, acting as hubs about which patients

flow. It is essential to understand their operation before you go about

designing your level. The planning of the hospital depends on its

objectives/purpose. Once the objective/ purpose of the hospital have

been identified, a project coordination team is appointed. The team is

responsible for the planning and designing the hospital. The team

consists of financers, architects, engineers, medical doctors, health

planner/hospital administrator, finance manager.

Stages In Planning And Designing A Hospital.

1. Identifying available finance and other possible sources of

finance.

2. Deciding on the area/ location of the hospital.

3. Identifying the needs of the area by carrying out a survey.

4. Deciding on the present and proposed services to be offered.

5. Preparing the design.

6. Getting the design approved.

7. Starting construction.

8. Identifying and hiring the required personnel and working out a

schedule for training.

9. Working out a schedule for purchase of required equipment/

material.

10. Commissioning the hospital.

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1. Finance:-. An assessment should be made of available

finances and possible sources of arranging finance. Bank loans

and there are also donors who give grants specifically for setting

up charitable hospital.

2. Location:- A need assessment survey of the community should

be done before deciding the location of the hospital. This helps in

deciding the location of the hospital and determines its

catchment area. According to the purpose of hospital the area

should be selected for profit select the area where people have

paying capacity and for charitable purpose decide the location

according to the need of people.

3. Preparing The Design:-

a. Site Selection:- Site selection is very important part of

the hospital planning process. At times, availability of land,

supporting services and finance become the main factors

which decide site selection.

b. Legal Requirements:- No objection certificate from local

government. There should be a proper map of the land. The

land should be in an authorized colony/market only.

c. Proper Electrical And Water Connections should

be available. For this, the electricity load required should be

worked out and doubled at the time of applying.

d. Permission for sewage connection should be obtained.

e. Size of the land:- for 100 bedded hospital 1 acre or 400

meter square per bed.

f. Plot Ratio:- in urban area a single storey hospital can have

up to 150 beds.

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g. Designing Consideration:- in designing a hospital two

approaches can be used- the biologic and the artistic. Both

approaches have their advantages and drawbacks.

i. Biological Approach:- in the biological approach

the hospital is designed according to its functional needs. A

balance attempted between the hospital and its

environment. In this approach, a linear spire system is

followed in which the entry to various departments is

through a central spire which may have several levels.

There is no thoroughfare through departments. This

system absorbs hospital growth easily and departments do

not strangle themselves. Also, when an obsolete

department has to be updated it is delegated to a

temporary structure in the hospital complex till it is

dismantled and an updated department erected. Since the

circulation core is independent and separate from the

departmental areas, activities within the hospital are not

disrupted. The biologic approach allows an outside view

and natural light, even when a department needs to be

expanded or changes made in it.

ii. Artistic Approach:- the artistic approach is

creative, based on focus, patterns and determined space.

These overtly monumental and systematic hospital

buildings are more admirable as pieces of large scale

sculpture than the common older hospitals and are also

much less useful.

Location And Physical Facilities

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1. Location:- The OPD is the showcase of any hospital and reflects

its image. It should have an independent approach at the

entrance of the hospital and should be on the ground floor for

easy access. It should be segregated from IPD, so that OPD

patients need not pass through inpatient areas. Some treatment

facilities like radiology, pathology, physiotherapy and blood bank

should be interposed between the OPD and IPD so that they are

equally accessible to both.

2. Physical Facilities And Space Requirements:-

S.N

o

Facility No. of

rooms

Area in

(Msq)1. Generala. Entrance hall with enquiry

counter, cash counter and

record area.

1 98

b. Room with toilet for officer in

charge

1 17.5

c. Room with toilet for Nurse-in-charge

1 17.5

d. Sanitary inspectors room 1 14e. OPD medical record room 1 35f. Canteen 1 28g. Lavatories separate for gents

and ladies (common for patients

and staff)

2 35

f. Janitors closet 1 72. Medical clinica. Consultation and examination

room

3 17.5

b. Cardio-graphic examination 1 14c. Waiting room 1 493. Surgical clinica. Consultation and examination 3 17.5

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S.N

o

Facility No. of

rooms

Area in

(Msq)room

d. Dark room 1 14e. Waiting room 1 494. Orthopedics clinica. Consultation and examination

room

1 17.5

b. Plaster and splint storage room 1 14c. Fracture and treatment room 1 17.5d. Plaster cutting room 1 14e. Recovery room 1 14f. Waiting room 1 355. Eye clinica. Consultation and examination

room

1 28

b. Refraction room 1 17.5c. Minor surgery and treatment

room

1 17.5

d. Dark room 1 14e. Waiting room 1 216. ENT Clinica. Consultation and examination

room

1 28

b. Treatment room 1 14c. Audiometry room 1 14d. Waiting room 1 147. Dental clinica. Consultation and examination

room

1 17.5

b. Dental hygienists room 1 14c. Recovery room 1 14d. Dental workshop 1 17.5e. Waiting room 1 21

8. Obstetric and gynecological

clinic

a. Reception and registration area 1 17.5b. Consultation and examination

room

2 17.5

c. Treatment room 1 17.5d. Clinical laboratory 1 14

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S.N

o

Facility No. of

rooms

Area in

(Msq)e. Toilet cum changing

room(attached to treatment)

1 10.5

f. Waiting room 1 289. Family planning clinica. Consultation and examination

room

1 17.5

b. Treatment room 1 17.5c. Health educator and social

workers room

1 17.5

d. Recovery room 1 14e. Waiting room 1 2110. Pediatrics clinic

a. Consultation and examination

room

2 17.5

b. Dressing treatment and

dispensing room

1 17.5

c. Immunization room 1 17.5d. Waiting room 1 2811. Skin and STD clinica. Consultation and examination

room

1 17.5

b. Treatment room 2 17.5c. Superficial therapy room 1 14d. Skin laboratory 1 21e. Waiting room 1 2112. Psychiatric clinica. Consultation and examination

room

1 17.5

b. ECT room 1 21c. Psychologists room 1 17.5d. Social worker room 1 17.5

e. Waiting room 1 2113. Supporting facilitiesa. Central injection room 1 14b. Specimen collection room /

clinical laboratory

1 17.5

c. Social workers room 1 14d. Waiting room 1 21

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Planning

Allocation of area (in square feet) for various utilities.

S.No

Areas 300 BeddedHospital

1. Public areas 34002. Clinical area 146953. Administrative areas 52804. Circulation areas 66255. Total net area 300006. Wall and partition

areas(10%)

3000

Gross area for total

building

30000 Sq.Ft.

1. The Public Area Includes traffic, main entrance, reception and

information, registration and records area, non clinical areas and

entrance hall, waiting room, public toilets and washrooms,

snacks bar, consultation room, special examination room,

treatment/dressing room.

2. The Clinical Area Includes

Clinics for various medical disciplines, medical clinics,

surgical clinics, orthopedics clinic, eye clinic, ENT clinic,

dental clinic, obstetric and gynecological clinic, family

planning clinic and pediatrics clinic.

Ancillary facilities include injection clinic and pharmacy.

Auxiliary facilities are laboratory, radiology, blood bank,health education, social services, and screening clinic,

preventive and social medicine.

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3. Administrative Area is administrators office, business office

and house keeping.Storage facilities are general stores, drug

stores and linen storage.

Inpatient Services

Inpatient services are the most important in the hospital based

health care delivery system. Inpatient hospital services are under

constant pressure of increasing demand and their capital and

operational costs are very high, which directly affects the hospital.

In patient care units are grouped as follows:-

General Ward:- These wards are the traditional type and have

patients who are not critically ill but need continuous care or

observation and have to be in bed. These include wards for the

disciplines of medicine, surgery, ENT and ophthalmology.

Specialty Ward:- These wards are for patients who need

hospitalization in particular specialties such as orthopedics,

pediatrics, psychiatry, infectious diseases, skin, obstetrics and

gynecology and other specialized disciplines.

Intensive Care Units:- These wards are for critically ill patients.

Planning And Organizing An Inpatient Unit

1. Physical Facilities:-The inpatient area should be located away

from main road and the OPD area.

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Important measurements to keep in mind while designing a

ward.

The size of hospital bed is 66 x 33.

The minimum distance between the centre of two beds

should be 0.25m, space at the foot-end 0.09m, space at

the head-end 0.25m. thus the space required would be

3.15m x 2.25m =7.19m2(75 sq.ft)

The area per bed in award is 70-90 sq.ft(7m2)

The area per bed in the ICU is 100-120 sq. ft per bed.

A single bedroom with an independent toilet should have a

minimum space of 125 sq. ft (14m2) and a double bedroom

21 m2.

The space between two rows of bed is 5 ft.

The distance between two bed should be 3 to 4 ft.

Clearance between the bed head and wall should be 1 ft

and between the side of a bed and wall about 2 ft.

The width of the dormitory should be 20ft.

The average size of a toilet should be 3.50 m2.

The size of an isolation unit should be 14 m2, and should

contain a bed, bedside locker, chair for the patients

attendant and a built-in-cupboard. These units should have

separate toilets.

Width of the hospital corridor should be 3m wide to

accommodate two passing trolleys and the ceiling height

should be 7 to 8 feet.

2. Size:- The size of a ward or nursing unit varies in different

hospitals. The maximum activity in a ward takes place between 8

a.m and 12 noon, less during the rest of the day and least at

night. The requirement of staff of staff in the night shift will be

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the same as in an average-size unit. The modern trend is to have

a head nurse for a unit of 35-35 beds.

3. Shape/design

Open Ward:- About 30-35 patients were housed in such

wards and the length of the ward was not less than 96 feet.

Advantages are- nurses have ample visibility and can observe

patients directly, adequate cross-ventilation, natural light is

available and economical to construct and maintain.

Rigs Ward:- In this design, the ward unit is divided into

small compartments or cubicles separated from each other by

low partitions, each cubicle having 1,2,3,4 or 6 beds arranged

parallel to the longitudinal walls. In India it is not practical due

to shortage of finances and nursing personnel.

4. Types Of Ward Design

Nightingale Ward:- This is an open ward with 20-30 beds.

The services are located at either end of the ward.

L-Shaped Ward:-In this, the nursing station is placed at the

900 junction of the L. The visibility is better with less walking

distance between the nursing station and the patient.

T-Shaped Ward:- The nursing station is at the vertical arm

and the patients area are located on the horizontal arm.

Serious patients are kept in section A.

Circular Ward:- This design occupies the minimum space

and reduces the walking distance between patient and nurse

to the minimum.

5. Ancillary Accommodation

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Nursing Station:- The nursing station should be 20x20 and

should have sisters room with attached toilet, cupboards for

medicines, a large work table and stools, build in cupboards to

hold medicines, stationary, forms etc.

Treatment Room:- Required for physical examination,

dressing and certain procedures which cannot be carried out

conveniently at the bedside.

Clean Utility Room:- This room(100-200 sq.ft) is used for

clean storage, e.g drugs, intravenous sets and solutions, CSSD

articles, packing dressing.

Bathrooms And Toilets:- Adequate bathroom and toilets

should be provided. Toilets for a individual room in a ward unit

shall be 3.5 m2 comprising a bath, wash basin.

Staffing Norms For Medical Personnel For A

General Hospital

S.N

o

Specialty 300 bed

strength1. General medicine 22. General surgery 23. Gynecology and

Obstetrics

2

4. Paediatrics 25. Anaesthisia 46. Dentistry 27. Radiodiagnosis 28. Pathology 29. Orthopedics 210. Ophthalmology 211. ENT 212. Skin and STD 113. Psychiatry 1

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14. Chest disease and

Tuberculosis

1

15. Biochemistry 116. Microbiology 117. General Duty Medical

Officer

20

Staffing Norms For Nursing Staff And

Nursing Supervisors

S.N

o

Nursing Personnel Staffing Norms

1. Nursing superintendent 1 per hospital2. Dy.Nursing

superintendent

1 up to 400 beds

3. Asst. Nursing

Superintendent

1 for 100-150 beds or 3-4 wards

4. Ward sisters 1 for 25-30 beds or 1 per ward.5. Staff nurse

For ICU/ICCU

1 nurse for 3 beds

1 nurse for 1 bed(+ 30% leave

reserve)

6. It is suggested that for each 250 beds there should be one

infection control nurse.

Norms For Class D Employees

In 300 beded hospital we need 150 class D employees as per the

ratio of 1employee per 2 beds.

Conclusion

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"A hospital functional design can promote skill, economy,

conveniences, and comforts; a non-functional design can impede

activities of all types, detract from quality of care, and raise costs to

intolerable levels." ... Hardy and Lammers

Bibliography

1. Cedric B. Finch, Dr. D.K Sharma, Dr.R.C Goyal. Hospital Planning

and Management.1999. Voluntary Health Association Of India.

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