ADVANCED TRAUMA CARE CENTRE ‘A PROJECT REPORT Submitted by C.SARAYU in partial fulfillment for the award of the degree of BACHELOR OF ARCHITECTURE SCHOOL OF ARCHITECTURE, MEENAKSHI COLLEGE OF ENGINEERING, CHENNAI 60078 ANNA UNIVERSITY : CHENNAI 600 025 MAY 2016ACKNOWEDGEMEN’ Thereby express my sincere gratitude to School of Architecture, Meenakshi College of Engineering, Chennai for giving this opportunity to carry out this Thesis Report as part of my course work. Lalso owe my thanks to DATE: 11" May 2016 Signature of the CandidateSCHOOL OF ARCHITECTURE MEENAKSHI COLLEGE OF ENGINEERING ANNA UNIVERSITY CHENNAI 600 025, BONAFIDE CERTIFICATE Certified that this project report “ADVANCED TRAUMA CARE CENTRE” is the bonafide work of SARAYU C_ who carried out the project work under my supervision. Signature Signature HEAD OF THE DEPARTMENT THESIS CO-ORDINATOR Signature DIRECTORDESIGNING AN ADVANCE TRAUMA CARE CENTER submitted by SARAYU C 311411251052 of BACHELOR OF ARCHITECTURE in SCHOOL OF ARCHITECTURE MEENAKSHI COLLEGE OF ENGINEERING ANNA UNIVERSITY CHENNAI 600 025 MAY 2016SCHOOL OF ARCHITECTURE MEENAKSHI COLLEGE OF ENGINEERING ANNA UNIVERSITY CHENNAT 600 025 DECLARATION This is to certify that the Thesis Report of SARAYU C V year (Batch 2011-216) School of Architecture, Meenakshi College of Engineering, Chennai has been approved on 11.05.2016. Submitted for the university Thesis VIVA — VOCE Examination held on INTERNAL EXAMINER EXTERNAL EXAMINER‘TABLE OF CONTENTS Topic ‘ABSTRACT INTRODUCTION > RATEOF DIFFERENT TRAUMA INJURIES > IMPROVEMENTS THROUGH ARCHITECTURE. > ‘THRUST AREA > HIERARCHY LEVELS OF TRAUMA CENTERS LITERATURE STUDY > PLANNING ASPECTS ZONES INFECTION CONTROL. LAYOUT OF A SURGICAL FLOOR ZONING AND FLOW OF OPERATING FLOOR SPACE PLANNING & CRITICAL DESIGN FEATURES > HEALTH CARE SCENARIO > ELEMENTS OF A LEVEL I TRAUMA CENTER CASE STUDY > CASE STUDY 1 — SPARSH HOSPITAL, BANGALORE > CASE STUDY 2— JIPMER, PONDICHERRY NET STUDY > NETSTUDY 1 © ZAYED MILITARY AND TRAUMA HOSPITAL, ABHUDHABI © STRATEGIC PLANNING INITIATIVES > NET STUDY2 + RESTON HOSPITAL, VIRGINIA, USA ‘* ENHANCING PATIENT SAFETY & SATISFACTION SITE ANALYSIS AND STUDY > SITE DETAILS vv vy v INFERENCEABSTRACT Atrauma center is a hospital, equipped and staffed to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced ‘multidisciplinary treatment and specialized resources. A Trauma Center is also called an temergency department (EDy*, also known as ‘accident & emergency (A&E)', “emergency room (ER)*, or ‘casualty department’, The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center. WHY ADVANCED TRAUMA CENTER Everyday around the world almost 16,000 people die from various injuries. Injuries represent 12% of the global burden of disease. It is startling to note that the lower and middle income groups of India contribute about 90% of the global burden of injury mortality, thus highlighting the disparities in outcome of trauma between the high, middle, and lower ittcome nations. Injuries affect the productive youth of the country. In addition to excess mortality; there is a tremendous burden of disability from extremity, head, and spinal injuries. ‘Therefore, trauma effects the productive youth of the country, which is otherwise healthy and free from. chronic disease. In India, most of the available literature regarding trauma epidemiology is pertaining to road traffic injuries and there are hardly any studies done on the other causes of trauma. Trauma is caused by a wide variety of risks eg. fall (common in pediatric patients, firearm injuries, poisoning, burns, drowning, intentional self-harm (suicides), assault, falling objects, and natural and man-made disasters. The improvement and organization of trauma services or systems is a cost effective way of improving patient outcome and is achievable in almost all settings SCOPE Healthcare in India is in a developing stage and it needs a radical policy shift at government level to usher in the changes to face the challenges of the future. Under the umbrella of health care providers are outpatient set-ups, nursing homes, hospitals, medical colleges, health spas, diagnostic centers, hospices, old age homes and more. Most of these institutions will have varied needs, which will differ vastly in terms of their planning needs. Health care provision in India is different in rural and semi urban settings where it is more unorganized to today’s super specialty centers where it more institutionalized. The sector suffers from long years of neglect by the government in terms of priority funding despite being a basic need of the community. The rapid growth of the insurance sector is equally helping the community to face the problem of spiraling health care costs. ‘The organization of a trauma system has four impact pillars. organization of pre-hospital care facilities, hospital networking, communication systems, and organization of in-hospital care (acute care anddefinitive care). An integrated approach is required at all Ievels: human resources (staffing and training), physical resources (infrastructure, equipment, and supplies) and the process (organization and administration), Compared to the western world, the trauma care services in India lack each of the elements listed above. ‘Most of the physical resources for in-hospital care in terms of infrastructure and equipment are already available at secondary and tertiary care hospitals and need moderate upgrades. ‘Therefore, the thrust areas in the field of trauma services are as follows. Provide physical resources for pre-hospital care and communication systems. Provide well-trained staff at all levels of care from pre-hospital to definitive trauma care. Providers should be well trained and should understand the critical needs of a trauma victim. Organize and integrate pre-hospital services with definitive care facilities (hospital) so that a patient is shifted to an appropriate facility in the shortest possible time. ‘The Government of India has planned this organization in an apex to the base format. ‘The establishment of the Jai Prakash Narain Apex Trauma Center (JPNATC) at the All India Institute of Medical Sciences in New Delhi is a step forward in providing an apex institution for quality ‘trauma patient care facilities, which will act as a role model for other institutions and centers providing trauma care in the country. ‘More than providing the best patient care facilities, the role of this apex trauma center has been envisaged as an apex research and training institution that will help the nation’s administrators formulate policies regarding the organization of trauma care facilites throughout the country. Focal areas. Hospital planning has a lot of areas that has to be taken care. The building invokes a sense of cleanliness in one’s mind. So, obviously any kind of hospital design has to be thought about, allotting a space for services, Beyond technical requirements that modern medicine demands, the designer has to cope with a host of ‘more subjective issues like the anxiety of the patient, the stressful work environment of the staff and the need to build a sustainable and healing building which brings us to; designing an environment targeted at the patient’s psychology that helps them feel comfortable and at home. The thesis aims at developing, a concrete relationship between built-environment with the reactions of traumatic patients and to that of the city itis builtinHIERARCHAL LEVELS TRAUMA (esa Taye eases HIERARCHAL REQUIREMENTS. A level I trauma center is required to have a certain number of the following people on duty, 24 hours aday at the hospital ‘+ surgeons ‘= emergency physicians + anesthesiologists © nurses ‘+ aneducation program ‘+ Preventive and outreach programs. A Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a Level 1 institution with 24-hour availability of all essential specialties, personnel, and equipment. A Level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients.A level IV trauma center exists in some states where the resources do not exist for a Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. A evel V provides initial evaluation, stabilization, diagnostic capabilites, and transfer to a higher level of care. It may provide surgical and critical-care services, as defined in the service's scope of trauma care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department [Not available for 24 hours]INTRODUCTION A trauma Center is a hospital equipped and staffed to provide comprehensive emergency medical services to patients suffering traumatic injuries. The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center 10,000 520,000 380,000 100,000 PER EVERY | PER EVERY, 600,000 600.000 | 150,000 2002 2012 = [otal umber of people injured HB Total Road Accidents EB Total Number of Persons killed RATE OF DIFFERENT TRAUMA INJURIES As per the records of the surveys taken by the Indian Journal of Critical Care Medicine, there has been a tremendous scale of crease in the trauma rates. Their reports state that the death rates are also alarmingly increasing every year for the past ten years, due to the nascent stage of development in the Trauma Care industry. Their charts compare three major aspects; Number of njured versus the Number of Accidents and the Mortality rate due to improper care. Further, a more detailed study was conducted in 2012, by the Indian Society for Trauma and Acute Care. According to the ISTAC, there is a 1.4 ratio of road accident to all trauma incidents, and a deathevery 1.9 minutes duc to trauma; making road Accidents 22.8% responsible for overall trauma Incidents in India. —@® Road Accidents |= fills @® Agricultural related trauma @® Firearms/Intentional Self-harm IMPROVEMENTS THROUGH ARCHITECTURE => Assault/Fall of objects <—® Bums/Drowning <= Natural Disasters = TerrorismPOSITIVE DISTRACTION Elements like art and activities helps to Jescape the “hospital” environment which would serve as a break in the routine, NATURE and LIGHT| The view or perception of nature borings the patient a sense of calm and reduces stress levels None Its reduction affects not just the pa~ tients, but also helps the staff com- ‘municate and translate in a unerr- ing way. AIR Air borne diescases is a serious issue since it plays a major role in extended stays due to new compli- cations. CONTROL. is an important factor for the patient to feel at ease during his stay. SAFETY environment not only re- duces stress and gives the patient his calm, but also avoids unnecess risks or complications. SOCIAL SERVICE isan important factor for the pa~ tient to feel at ease during his stay. ‘THRUST AREA ‘The thrust areas in the field of trauma services are as follows. 1. Physical resources for pre-hospital care and communication systems. 2. Organize and integrate pre-hospital services with definitive care facilities (hospital) so that a Patient is shifted fo an appropriate facility in the shortest possibie time. HIERARCHY LEVELS OF TRAUMA CENTERSSurgeons : Cardio, Neuro, Ortho, Plastic and General. 24/7 ER Physicians Anesthesiologists An Education Program Preventive & Outreach Programs. Does not have the full availability of special ists, but does have re- sources for emergen- cy resuscitation, sur- gery, and intensive care of most trauma patients. Works with a Level I center; provides com- prehensive trauma care and supplements of a Level | institution with 24-hour availability of just the essential spe- cialties and equipment. Exists where the re- sources do not exist for a Level III center. It provides initial evaluation, stabiliza- tion, diagnostic capa- bilities, and transfer to a higher level of care.2. LITERATURE STUDY PLANNING ASPECTS- LOCATION- “Quiet environment sAway from traffic Away from contamination & cross infection Close proximity to Emergency, OT, Recovery rooms, and nursing units Closer to vertical transportation ‘Isolated from traffic & noisy area. -Away from contamination & cross infection *At close proximity to Emergency /cathlab «Dedicated lift & dumb waiter to CSSD CONSIDERATIONS “Segregation of clean & dirty traffic -Sub-zone to ensure sterility “Triple corridor system Dirty / Clean Sterile Circulation pattern. -Separation of movements ~Doctors/staff / patients / materials Unidirectional air flow (clean to unclean) *Selection of good materials “Sharing of sub sterile /scrub | sluice with other OR with hatch opening «Isolation rooms for air borne diseases +Step down ICU or HDU *Double corridor system-Outer corridor & sterile corridor Centralized nursing station ICU ZONES Zones are area of varying degrees of cleanliness in which the bacteriological count progressively diminishes from the outer to the inner zones (operating area) and is maintained by a differentialdecreasing positive pressure ventilation gradient from the inmer zone to the outer zone. They are of following types. L Protective Zone, + Reception + Waiting area + Trolley bay + Changing room Sterile Zone, . Operating Suite : Scrub Room . ‘Anesthesia Induction room, : Set up Room. I __ Clean Zone, : Pre-op room : Recovery room, : Plaster room . Staff room : Store IV.__ Disposal Zone, . Dirty Utility + Disposal corridor ‘The essential principles that should be followed in planning the physical layout of operating room suite are: ~ Exclusion of contamination from outside the suite with proper traffic patterns within the suite and separation of clean areas from contaminated areas within the suite. ~ ORs require specialized planning because surgical facilities represent a central life saving activity. ~ Depending on their functional efficiency, it is a major cost center in the establishment of the hospital,are responsible for an appreciable quantum of quality in private sector and no one plan suits all hospitals. ~ A scientific and detailed planning is required while designing an OT in order to ensure its smooth functioning, efficiency and effective utilization. CLEAN CORRIDOR OPERATING ROOM DIRTY CORRIDOR ON ADJOINING THE ORS THE REAR SIDE INFECTION CONTROL It is important to have an infection free atmosphere. © DEFINED CIRCULATION CORRIDORS- Identified corridors for-staffs/ doctors / pationts &materials + STAFFS/ DOCTORS a. Shoe change area b. Slippers & Dress change room Air showers © PATIENTS a. Separate transfer area (Change over of stretchers) b. Transfer zone links Pre-operative areas+ MATERIALS a. Exclusive transportation route b. Handling Clean/ Dirty materials . Connectivity of functions LAYOUT OF A SURGICAL FLOORZONING AND FLOW OF OPERATING FLOOR eieaeaee | i eee a tena ee ary = Soe) erat H Tog aces) eet Peed eral n Nua ‘SPACE PLANNING & CRITICAL DESIGN FEATURES ~ Inadequate for serving the needs of growing population = Efforts are made up to create Infrastructure and to provide Manpower ~ Built up Appropriate linkages between the various centers HOSPITALS Government Hospitals 4475 - <> Charitable Trusts Hospitals -335 - Private/ Corporate Hospitals ~10289 -HEALTH CARE SCENARIO- HOSPITAL BEDS TO POPULATION 16 4 nt 10 ‘ a s rol India -0.9.1000 Developed Countries Japan-14:1000 US.A-5:1000 UK-5.5:1000 German-10,1000 France-9.1000 Italy-7.1000 Canada-6,1000 Sweden-6.5:1000 South Korea-5.1000 eSZONING “Hospital / institutional /residential / service Separate parking for visitors / staff Separate entry for staff / patients / visitors | material Separation of OPD & IPD with negative space in between with courtyard(OUTER ZONE “Reception, Registration +Admission, Administration -OPD / Emergeny INTERMEDIATE ZONE ‘Diagnostic/Pathology “Therapeutical & “Pharmacy NUCLEUS Surgery suite sicu INNER ZONE “PD pee «Patient rooms ELEMENTS OF A LEVEL I TRAUMA CENTER 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as. ~ Orthopedic surgery ~ Neurosurgery ~ Anesthesiology ~ Emergency medicine = Radiology = Internal medicine ~ Plastic surgery = Oral and maxillofacial ~ Referral resource for communities in nearby regions. ~ Provides leadership in prevention, public education to surrounding communities.~ Provides continuing education of the trauma team members. ~ Incorporates a comprehensive quality assessment program, ~ Operates an organized teaching and research effort to help direct new innovations in trauma care. ~ Program for substance abuse screening and patient intervention, ~ Meets minimum requirement for annual volume of severely injured patients DETAILS OF FACILITIES TO BE OFFERED IN THE HOSPITAL Medical Services Emergency Medicine General Medicine icuiecu Minor OR Casualty Consulting rooms Minimum 2 major OTs ‘Nursing Stations X-Ray Imaging Physiotherapy Mobile xray(100 mA) - Nursing home and Infrared therapy.UV Frequency 500 mA xray - OPD, CT Sean Traction, stimulation Machine Physical fitness Surgery ————___________ Operation suites & ICUs 2 major OTs with facilities for Anaesthesi9, Orthopedic, Neurology, S ‘Ventilation, Monitoring, Defibrillation Emergency gynaecology, Plastics Multibed, multi parameter monitoring3. CASE STUDY CASE STUDY -1 ‘SPARSH HOSPITALS, BANGALORE Location-Bangalore, Bommasandra Industrial Area ‘Area — 1700 sqm per floor Year of completion-2006 Beds, 150 PHYSICAL SETTING ‘The hospital isa part of a envisioned med city, flanked by five different entries for the five different hospital.Sparsh Hospitals is located somewhat in the rear of the campus, allowing emergency entrance also easily. Along with Sparsh, the campus also houses, A Heart Care Foundation. ‘An Bye care hospital, A super specialty hospital 4. A genetic research center. 5. Mazumdar medical center 6 - Sparsh Trauma Care Basement floor is easily accessed through the secondary entrance. The basement floor is exclusively built for all the services unit, diagnostic department, and administration and education department,‘The areas includeCT- Scan, X-Ray.MRD, Ultrasound,UPS room, Maintenance room, Manifold room, Pump & Sump Room, Electric Panel room, CSSD, Prosthetics room Gym & Physiotherapy and Admin block. GROUND FLOOR ‘The entry into the hospital can either lead to the OPD with a center atrium and a reception or the connecting corridor to Emergency department, The hospital has an area for Resuscitation & Emergency room, Diagnostic department, the insurance department and a plastics room. ‘The ground floor also has: Consultation rooms, Plaster room ‘Treatment room, Seceretary room Cafeteria FIRST FLOOR ‘The first floor has the in-patient department with the OR complex. the pre-op and Post-ops. the ICU, Pre-operation room, HDU, the visitor lounge, the MD and Chief Surgeon’s cabin, all circumscribing the central atrium. The OR complex is completely shut off from the other parts.‘SECOND FLOOR ‘The second floor is designed to give patients a sense of calm as the entire floor is alloted to house different types of patient rooms. General. Semi-Private, Private and special private rooms. The atrium below is covered with a therapeutic garden that gives an amazing view of the entire med-city.‘TERRACE ‘The terrace is fully equipped with the complete services: The AHU unit, seperately for the ORs and the ICUs. They have three water tanks; one for raw water(Restrooms and Flushers); one for RO water(Drinking and washbasins), and the other one for equipment operation. They have four tanks on the ground level; of capacities 100,000 | - firework, two 75,000 I tanks for raw water, and one 75000 I for RO.HOSPITAL SERVICES ELECTRICITY, ~ 1000 KVA Transformer- EP Room(HT - 11KV)- LT 440 KV Panel room 2nd SOURCE, Generator of 625 KVA Std SOURCE - 2 UPS of 40 KVA (used only for ORs and ERs) ‘The electricity is supplied from the transformers to the EP room, to each floor with a circuit box, through the false ceiling, AIR CONDITIONING ~ 100 Tons chiller - Water coded chiller ~ mainly for ORs and ICU CASE STUDY - 2 JIPMER PONDICHERRY Location- Pondichenry Area ~ 195 acres campus Year of establishment, 1863 (by the French Imperial Govt) Beds. 1600 beds in total; 200 bedded trauma center Architects - Larson & Turbo (L&T) PHYSICAL SETTING ‘The hospital isa part of a medical campus with its entry located on the west of Pondicherry. The campus has a vast education institute and hospitals which take in interns from the same campus. JIEMER trauma center is located on the straight stretch that has a super specialty block.oj C8) |. An outpatient center, with orthopedic center co 2. Accntral library ‘Administration block SITE PLAN Institute block Kitchen Infectious disease block 3 4 5. Mortuary 6. i 8. A super specialty hospital I GROUND FLOOR The ground floor has the emergency room and resuscitation area, and the diagnostics. The trauma triage chart dominates all the actions in the flow of patients. The rear side also has a ramp up and down, and a set of staircase and elevator. GROUND FLOOR‘The first floor is equipped with more labs. The floor also has a temporary ward for female and male: the ‘medicine wards. Used in case of level $ trauma, The flow of the hospital in these areas is quite simple, IIL SECOND FLOOR, ‘The second floor has the minor and trauma Operation suites - 2, which is used to bring the emergency people from the triage assessment or the observation beds/ICUs in case of a sudden fiasco. The floor also has the post-op room, the Coronary Care Unit and a cath lab, The operation suite is secluded with glass doors visible from the stairway, right next to the post-op. On the right said, the CCU and Cath Lab are placed within yet seclusion. The floor, in general is sterile and only for critical flow. Patient flows are contained only within the corridors.Flow. 1. DOCTOR ENTER COMPLEX - DOCTOR’S/NURSE CHANGING SUITES - SCRUBS - OR - SCRUB. 2. PATIENT. ENTER COMPLEX FROM THE FLOORS BELOW - OR - POST OP - RECOVERY ROOMS IV. THIRD FLOOR ‘The third floor is much similar to the second floor in its critical level and the restriction of patient flow. ‘This floor contains the major ORs, again in a separate complex secluded from the other parts. Apart from the ORs, the floor has the supporting facilities like the ICU/CCUs, Post-ops to house the patients to observe them, immediately after the surgery. For convenience purposes, all the murse lounges, stations etc, are also given in the near vicinity. ‘The design of the OR is okay on the facade, but on deeper analysis, we find that that though there is, provision of a sluice room, there is no separate - dirty corridor to carry them to the CSSD. We'd have totake the clean corridor to go out, thereby defeating the purpose of a sterile OR V.FOURTH FLOOR ‘The fourth floor has the recovery unit, for the final goodbyes of the stay. There is a surgical counter, the wards, and the required bathrooms. Also, there is a small seminar room, which is now being put to use asa discussion room,Jooeeeee TREATMENT/DRESSING UNITS: weet DISCUSSION ROOM. ‘THE ECS TRIAGE SYSTEMAq io if @ LEVEL 4&5 = @ LEVEL3 @ LEVEL 1&24. NET STUDY NET STUDY-1 ‘ZAYED MILITARY AND TRAUMA HOSPITAL - Location. Abu Dhabi, United Arab Emirates. Beds, 500 Architects. Cathryn Bang + Partners, New York Area, 117000 Sq. M ~ 28 Acres (Campus Area) ‘STRATEGIC PLANNING INITIATIVES ‘The proposed Stacking Plan promotes Quality and Efficiency through. ‘Minimize Patient Movement & Optimize efficiency Decrease space by eliminating unnecessary redundancies Separate, yet connected four pillars, Inpatient. Diagnostic and Treatment, Outpatient & Dental Road ways are shown within the complex with driveways to the following; = Loading Dock - Main Hospital Entrance - Secondary Entrance from Parking Structures - Emergency and Trauma Center - Walk-in Entrance - Emergency and Trauma Center Ambulance Entrance ~ Dedicated Psychiatrie Medicine Entrance - Outpatient Clinic - Building Entrance - VIP dedicated- entrance,SITE PLANNING Clear Site Entries Clear Circulation Routes ‘Zoned Building Development Linkage of IP, D&T. ‘Support and OP Services (Open Park-like Setting Concems for Residential Neighborhoods Curve massing will minimize the negatives of linear building; not consists of visible long corridors and. doors that constitue conventional institutional environment Road ways are shown within the complex with driveways to the following. ~ Loading Dock - Main Hospital Entrance - Secondary Entrance from Parking Structures - Emergency and Trauma Center - Walk-in Entrance - Emergency and Trauma Center Ambulance Entrance Dedicated Psychiatric Medicine Entrance - Outpatient Clinic - Building Entrance - VIP dedicated entrance.BASEMENT FLOOR Most of the general support departments are located in the basement level. A connecting corridor connects the D&T building with the Outpatient Building thus achieving optimal consolidation, integration and collaboration of the general support services. The inpatient pharmacy will dispense medication through the ‘dumb waiter’ to D&T departments above for vertical transport and via pneumatic tube system throughout the Medical Center. CSSD is dedicated ‘2 smart elevators’ (separate clean and soiled) for vertical transport of case carts to Endoscopy and Surgery Departments.GROUND FLOOR RGENCY: Radiology, Surgery, Endoscopy, IP Elevators, Trauma Elevator REHAB: Surface Parking, Dedicated Rehab Entrance, IP Elevators DIALYSIS: OP Entrance, IP Elevators NEPHROLOGY: Dialysis, IP Elevators, ADMITTING: Hospital Entrance SOCIAL WORK: Hospital Entrance, IP Elevators ECT / OP PSYC! IP Psych, Ds IP PSYCH: Dedicated Psych Entrance, ECT GROUND FLOOR, ed Psych Entrance, FIRST FLOOR ‘The Radiology Department, located above the emergency department for easy access by a dedicated elevator to some of the most sophisticated equipment.RADIOLOGY> Emergency, Non-Invasive Cardiology, Invasive Cardiology, Endoscopy NEUROLOGY TESTING: Radiology, IP Elevators ENDOSCOPY: IP Elevators, OP Clinic Entrance NON -INVASIVE CARDIOLOGY: Invasive Cardiology, Radiology INVASIVE CARDIOLOGY: CCU, Surgery, Non-Invasive Cardiology, Radiology RESPIRATORY THERAPY: ICU/CCU, IP ICU/CCU: FIRST FLOOR Respiratory Therapy, Emergency, Surgery, Pharmacy, Laboratory, jology CARDIAC ACUTE CARE: CCU, Invasive Ca SECOND FLOOR MANAGEMENT: Surgery Emergency ICU/CCU Radiology OP Clinics LABORATORY: CSSD IPICU/CCU: Staff Elevators IP Elevators Respiratory Therapy Surgery ‘Trauma Elevator Emergency Surgery Pharmacy Laboratory SECOND FLOOR THIRD FLOOR &ABOVE Executive Administration, Nursing Administration, Financing. and Quality Control/Utilization Review/Risk Management Services are proposed to be located on this top floor of the D&T Block that provides both required privacy as well as public access to provide high patient relations services. The proposed location has direct adjacency to Education. Alllof the Acute Care areas are located from the third floor and above.‘This vertical connectivity will promote the desirable collaborations and cooperation between similar services. ‘The Triangular effect of the Acute Care areas will provide greater visibilities from the Nurse Station to the Patients rooms and improved patient care, THIRD FLOOR SHELLED ‘QUARANTINE AP BURN CENTER: a Surgery AUesiNc AbativioreaT10% Emergency aes Admin, Use Emery Radiology fvairry ssumascritenisk Mow rout IPACUTE CARE UNIT: itn Cis ern Cnr Surgery Sine Rady ACU Radiology reureeu SIXTH FLOOR, AP ACUTE CARE UNITS: Surgery Radiology Icviecu | ‘CLINICAL ADMINISTRATION: oP ci Education Center ‘TENTH FLOOR ELEVENTH FLOOR IPVIP UNIT: Dedicated VIP Elevator Dedicated YIP Entrance =f ‘Multi-story high Atrium Lobby 2 Energy efficient Atrium is located between the Front Entrance and the Diagnostic and TreatmentBuilding which opens from the roof to the ground floor thus creating a modem ambience. Courtyard as Place of Respite Bi Courtyard is located on 3rd Floor to provide secured, respite space for patients, staff, and family ‘members. Nursing Unit Design 1 Curved triangular nursing units where the visibilites from the Nurse Station to the Patients rooms are greater to meet the increasing higher acuity patient populations’ needs. NET STUDY-2. RESTON HOSPITAL, VIRGINIA, USA The hospital has four entries in total, each for its own purpose. The main entry is dedicated for its basic outpatient rooms, with a generalized waiting place for the patients and relatives. On either sides of the ‘main entrance, the hospital has its entry for Emergency entrance and an admin entry on the west that leads to the HR department, The core of the hospital has its operating room complex (OR, Fre-op, Post- op. and waiting.) ‘The first floor and above occupies only a quarter part of the entire building, with just enough facilities. The first floor is dedicated for uncontrolled matemal-neuro complications‘The sccond floor has sterile continuity from the floor below with patient rooms and a couple of pediatric center rooms. ‘The third floor is solely built for the purpose of private and semi private rooms for the patients. An orthopedic center was opened in 2013 to accommodate the then current rate of bone injury. ‘The final and the fourth floor were recently renovated to housing a community education center for the interns that the hospital has started taking in. GROUND FLOOR ee Rear Entrant enivancers NAAN Frerserer aed * i, iy ae aM ance (7) Bsus Bi cottee stop Jf) Restrooms — ER Valer Parking Bets Eversna Weng Aen @feiCe! sae eon DYE Sin DionHeit, ines abe rin at pet FIRST FLOOR Total Joint Center Rooms 400-427 Surgical Family Waiting Area ENHANCING PATIENT SAFETY & SATISFACTION ‘A connection to the outdoors and natural light is known to speed up the healing process and increase patient, family, and staff satisfaction, Naturally lit spaces also have operational and sustainable benefits by decreasing reliance on electrical energy. A major design goal was to bring daylight as deep into the space as possible and provide views to gardens and the Virginia cityscape. Patient rooms feature full-height windows, and a five-story garden atrium and exterior bamboo garden. bring daylight deep into the patient tower, providing rooms along the core of the building access to natural light and views to the outdoors.5.SITE ANALYSIS AND STUDY SITE DETAILS R224 Doe Bo Soot ONO Usa an Sree iat) ose TEU eeneNa TONE Noyes eon rer LIVE PROJECT SET cosa AREA. Primarily residential and industrial. The surrounding hospitals in and around a couple of kms are cither children’s hospital or just a clinic. The existing southern railway hospital is on the verge of demolition, just as soon as the project goes up fully. ‘The justification lies in the fact that the area is known for its industrial sector: the loco works, ICF. Carriage works, where the accident is almost prevalent every day. Also, the road accidents are prevalent around the flyover region and on the Konnur High Road (about 3 kms away).ROAD ACCESS The roads around the proposed project are all ‘Two way roads, enabling easy access within 5-10 minutes from the accident nodes to the hospital, Apart from the patient/public access, there are Gm roads abutting the site, that can be used for service paths. ‘TRAUMA DATA PER DAY The trauma (accidents, burns, other injuries) go upto a maximum rate of 30 patientscases per day, which are now taken by the existing hospital. Other neighboring areas are also attended by this hospital, from time to time.LAND USE CLASSIFICATION For detailed drawings of the site, please refer to the appendix.6. INFERENCE A comparison of Indian hospitals and the way they are built, comparing them with foreign diverse location are given in the following tables A basic comparison of the net case studies and live studies show the minds of different planners work ‘when it comes to serving the best to patients. PLANNING AND CIRCULATION. FACIIMIES AESTHETICS 1,0PD, Bs = Dental TENT zeit | “payen + Pain Management INET CASE STUDIES ‘The aesthetics include sooth- ~ Quarantin . id ny ing interiors and courtyar - Education center laced at suitable location to |. = Maltispecialty clinic # ‘motivate a healing ambience Most courtyards are designed next t0 the patient roms and ICUs to instil a sense of ealm. RESTON |) opp | 2: Basie Diagnostics 2 3PD. On a site planning level, the = Trauma, entire campus has been planted {Maternal ca by balfers of tees to reduce ee al. Points center rose levels and garden spaces ms = Edcation center are prominent In the case of Reston Medical Cemtr, the whole campus is a tobacco free center, anda envi- From bith the plans, we ean see that | The mentality of NBBJ and Cath-| ronmentally safe area: ne the planning strategies have one | ryn Bang architects has the same] heavy vehicles are allowed ‘thing in common, train of thoughts inside. ‘The planning is done bby seperate | Providing just what trauma needs zones: on a horizontal level ‘may suffice, but what happens in ‘The same horizontal level is divid- | case of a mass trauma? It makes ed info OPD, IPD And EMTS. | no sense 1o send patients away, vincrsta, Usa, AAs the floor rises above, ether the | while they are holding their heats same services extends above, or a | because of our ignorance. new department starts, which will be its 0 levelPLANNING AND CIRCULATION, FACILITIES. AESTHETICS, CASE STUDIES 1.0PD 2 EMIS 5 Basic Diagnostics 41° = Surgery = Recovery = Sia rooms = Education center The aesthetics include soothing interiors. Apart from that, the JIPMER former case has a courtyard on the 2nd floor, to still @ sense |. TRIAGE ROOM wats 2. ERS AND EMTS 3. Observation rooms Both the hoeptals have the above On a site planning level, the scheme as the focal module as their | * 2° cain capes has ben plated tanning node : a vertical cored | ”Surieal units ny bullers of tees to reduce aes Icus noise levels, and garden spaces Each floor is dedicated to one spe-| Recovery are prominent. cialized area, with elevators and | * Gener! wards airs connecting them : no conte son ls pated saree The mentality of Indian architects hhave the same train of thoughts. “0 OPD AND EMTS. 1 OR COMPLEXES, 2- PATIENT ROOMS, B- MAINTENANCE Providing just what trauma needs| is what has been given in both cases, probably because both the| hospitals are a part of a medcity and other hospitals may also come into use, especially in HPMER: Though ean not be as- sumed likewiseAPPENDIX