Course Code: HLTM 503 Course Title: HOSPITAL ORGANISATION AND PLANNING

Course Instructor : Mr. Sunny Kumar Academic Task No.: 1

Date of submission: 5 December, 2022

Student Name: SYED MUBASHIR Section: Q2251

Student’s Roll No: A15 Student’s Reg. No: 12216911

Registration no. Roll. No. NAME PEER RATING

12216931 A16 Rohit Kumar 10

12210031 A19 Riya 10

12200973 A05 Milisha Mishra 10

12216911 A15 Syed Mubashir 10

12215598 A13 Owais nazir 10

 Declaration:

I declare that this Assignment is my individual work. I have not copied it from any other
student’s work or from any other source except where due acknowledgement is made
explicitly in the text, nor has any part been written for me by any other person.

Student’s Signature:MUBASHIR

Marks Obtained: _____________ Max. Marks : _______________

 Being as a team, we went to TAGORE HOSPITAL,
JALANDHAR for our live project on planning and
designing of hospital departments. It is INDIA’S FIRST
NABH ACCREDITED hospital. We chose the
EMERGENCY DEPARTMENT for the view of planning
and designing by hospital.

TAGORE HOSPITAL AND HEART CARE CENTRE

( A PREMIERE MULTISPECIALITY AND CARDIAC CARE
CENTRE OF NORTHEN INDIA )

 Tagore Hospital & Heart Care

Centre, a renowned multispecialty
hospital of North India was
established in 1979 at Jalandhar,
(Punjab) with the most advanced
medical facilities concerning
General Medicine, General Surgery,
 Gynae and Obstetrics, Orthopedics and Skin & VD. A team of highly qualified
and experienced medical personnel totally dedicated to the service of humanity
joined the institute & continue to work till date.
 To further its commitment to provide better healthcare to society, more
specialties and super specialties were added later.
 Most significant achievement was the start of heart surgery centre in the year
1991, which was later upgraded to an open heart surgery centre in 1996.
 This 148 bedded hospital offers high quality, cost effective patient care founded
on the pillars of ethics and excellence.

India’s First NABH Safe-ITSM certified hospital

First to start heart surgery in North India after Delhi

Multispeciality Hospital with CGHS recognition

First centre in the world to use the Radial artery in Popliteal bypass operation

DNB PROGRAMME IN MEDICINE

The hospital runs D.N.B programme in the department of Medicine. Regular classes
are held along with seminars in a various subjects. Latest developments in the field
of Medicine are regularly discussed in the “Journal Club” meetings. Bed side
discussion is a regular feature in the hospital. Consultants in the department of
Medicine & allied super specialities like Cardiology, Nephrology, Chest diseases &
Neurology participate the teaching programme of the DNB students. There is 12
beded Emergency & 12 beded ICU in the hospital to provide training to the students
in managing critical ill patients. Both the last two students have cleared DNB
examination. They have published their research work in the two indexed Medical
Journal. The hospital also provides well furnished & comfortable accommodation to
students. The hospital has a special teaching hall & a library for the benefit of its
students.

SCOPE OF SERVICES
 GENERAL MEDICINE
 GENERAL & LAPAROSCOPIC SURGERY
 ORTHOPAEDICS & JOINT REPLACEMENT
  GYNAECOLOGY & OBSTETRICS
 CARDIOLOGY & CARDIOTHORACIC SURGERY
 NEPHROLOGY & UROLOGY
 GASTROENTEROLOGY & GASTRO SURGERY
 NEUROLOGY & NEUROSURGERY
 DIABETES CARE CENTRE
 OPHTHALMOLOGY (EYE)
 SKIN, V.D. & COSMETOLOGY
 ENT

 PAEDIATRICS
 PULMONOLOGY (CHEST)
 ANAESTHESIA
 CASUALITY SERVICES
 BLOOD BANK WITH APHRESIS UNIT
 RADIOLOGY
 LABORATORY SERVICES
 DIETETICS
 PSYCHOTHERAPY
 PHYSIOTHERAPY
 MOBILE CARDIAC AMBULANCE

Concept of hospital planning and designing:

The main guideline while designing the hospital is ‘form’

 The last few decades have seen a spectacular development in the health and hospital
consciousness of the indian public.
 Essential hospital service required for community can be met economically only with
adequate thought given to planning, design, construction and operation of healthcare
facilities.
 A design expert says-“we’ve got to design ‘smart’ hospitals that respond to present
needs while anticipating future changes."
 Planning is forecasting and organizing the activities required to achieve the desired
goals.
 All successful hospitals, without exception, are built on a triad of good planning, good
design and construction, good administration.
 To be successful, a hospital requires a great deal of preliminary study and planning.
 It must be designed to serve people and for promoters to build in first place and sustain
later.
 It must be staffed with competent and adequate number of efficient doctors, nurses and
other professionals.
 A strong management is essential for daily functioning of a facility and this must be
included in the plans of a new hospitals.

 Hospital building differs from other building types in the complexity of functional
relationships that must exist between various parts of the hospital.
 Apart from providing right environment for patients and care providers, it should also
be sensitive to needs of visitors.
 It is thus imperative to examine the emerging issues, analyze the challenges, appreciate
the emerging trends and study the various strategic options available for planning,
designing and constructing a hospital.

OBJECTIVES OF
PLANNING

EMERGING HEALTHCARE
DESIGNS:

Adaptable patient rooms

In board v/s outboard toilet

Same handed patient rooms

Accesses to Radiology & OT.

Adequate Space for 360 Degree movement of healthcare

provider during need.
 PLANNING TEAM DESIGNNING TEAM

 Specialists from various clinical  Hospital Consultant

branches

 Hospital administrator  Architect

 Nursing advisor  Engineers.

 HR Manager
 Structural Engineers Electrical
Engineers

o  Plumbing Engineers
 Civil and electrical engineers

 Representative of local body

 Hospital Administrator

 Senior architect

STEPS IN PLANNING
i. Need assessment MASTER PLAN:
 Departmental
ii. Feasibility report boundaries
iii. Architects brief  Major entry and exit
points
iv. Request for proposal  Vertical transport
 Inter-departmental
v. Appointment of consultant corridors
 Location of critical
vi. Detailed project report zones
vii. Notice inviting tender  Energy conservation
 Future site
viii. Award of work development
 Appropriate way
ix. Construction of building, services and facilities, equipment finding
 Services master plan
purchase and  Project decision
x. Manpower selection and recruitment  Outline brief
 Opportunities and
xi. Stage of commissioning constraints
 Options considered
xii. Shake down process evaluation criteria
 Recommended
options
 Executive summary
and recommendation.
We chose emergency department for our live project and interacted
with CEO of the hospital, MR. BRIJESH SINGH BISHT.

EMERGENCY DEPARTMENT:
DEFINITION:
• Emergency has been defined as a condition determined clinically or considered by patient
or his/her relatives as requiring urgent medical services, failing which, it could result in los of
life or limb....WHO

Medical emergency is a situation when patient requires urgent and high quality medical care
to prevent loss of life or limb and/ or to initiates action for the restoration of
normal healthy life.

EMERGENCY DEPARTMENT
IS:

an integral part of an hospital

Microcosm of the hospital as

whole

front door of the hospital

Portal of entry that interacts

with the highest volume of
patients
requiring critical care.
FUNCTION EQUIPMENTS LOCATION INTERRELATIONSHIP(close
relationship with :)
Provision of All essential and Should be located on OT
immediate & functional the ground floor •
correct life saving equipments, Direct access from the
treatment at all ventilators, main road
times and for all defibrillator,
situations monitors,OT
Facilities, X-ray,
USG,CT, path
labs,EKG
machines.

Collection of • Central gas Separate approach, ICU, OPD

casualties pipelines, plenty other than OPD with a
of fluids. • Crash spacious parking area
cart &
Emergency
medicines

Rapid institution IV lines and Location adjacent to Laboratory, Blood bank

of BLS to critically catheters OPD Well lightened
ill at site, en route and boldly sig posted
and in hospital both for day and night

Information centre Vital essential A helipad is required Radiology, endoscopy

to render advice on medicines, for major trauma
telephone or in nebulizers centre, hilly or
person on simple unapproachable areas
medical queries

Capacity and Dressing mortuary

capability to materials
provide effective plasters, dressing
management trolley • Minor
during operation
disaster situations. theaters
equipments
TRIAGE

It is the process by which patients are classified according to the type and urgency of their
condition to get the right patient to the right place at the right time with the right care provider

 Routine Triage
(depending on the condition of the patients).

 Mass Influx Triage.

Priority I (Immediate): life threatening injuries or conditions

Priority II (Delayed): Patients may remain stable for 10 to 20 mins.eg: Limb injuries

Priority III (Minimal): minimal injuries or minor conditions, and are ambulatory.

Priority 0 (Expectant/Dead): Victims are dead or have lethal injuries and will die
despite treatment.
Emergency department of TAGORE HOSPITAL
and our observations:

 Emergency department Tagore hospital is on ground floor and its entrance is easily
accessible.

 The front entrance of the emergency is wide enough for easily moving two or more
stretchers at the same time

 The doors of the emergency department were open outside and not locked from
inside. door is broad enough to let stretchers and wheelchairs in.

 it is having 16 operational bed capacity. inter-bed distance is maintained at around 6

feet in emergency observation ward.

 Hand washing area is easily accessible to healthcare staff

 Accessibility of fire-fighting equipment

 Bio-medical waste bins are arranged as per BMW rules. Also segregated storage area
for clean and dirty supplies

 there are dedicated areas for triage, emergency processes for instance- wound care,
fracture handling etc. Other support areas there in emergency includes, nursing
station, store (separately for clean and dirty items) and duty doctor room
and isolation room.
CREATION OF EMERGENCY DEPARTMENT
DESIGN:

PATIENT’S FLOW IN EMERGENCY DEPARTMENT:

 Patients must first register when they arrive at the hospital, and a registered nurse then
triages them. If a room is not available after patient registration, the patient is sent to
the patient room, where the registered nurse triages the patient.
 After being triaged, patients who are less seriously ill are sent to the fast track, and
those who are seriously ill are sent to the emergency room.
 A complete assessment is performed by a registered nurse in both the fast track and
the ED room, and initial tests are requested.
 In fast track, nurses see patients and provide care, whereas doctors see and tend to
patients in emergency rooms and additional testing is then ordered for both patients.
 Doctors or nurse practitioners will dispose of the patients following these tests.
 Depending on the patients' conditions,
a. they may be admitted to the hospital or
b. transferred to another hospital if the first one is unable to treat them or
c. released to their homes if they are in good health.
PLANNING OF EMERGENCY DEPARTMENT

I. INFRASTRUCTURE
Infrastructural requirements in ED are divided into two parts CLINICAL AREAS AND
NON-CLINICAL AREAS.
 CLINICAL AREAS:
A specific geographic area of the hospital designated for the diagnosis, treatment, and care of
patients on an in-patient, out-patient, or daycare basis is referred to as the clinical area.
It includes:
Ambulance facilities, Ambulance entrance, Ambulance equipment storage area,
Decontamination area, Walking entrance, Reception area, Triage area, Ambulance patient
triage area, Waiting room.
 NON-CLINICAL AREAS:
Non-clinical positions include those in human resources, IT, biomedical technicians,
administrative assistants, transcriptionists, hospital executives, receptionists, medical billers
and coders, and transcriptionists.
Staff changing rooms, Staff shower and toilets, Staff dining area, Administrative support,
Multi-person offices, Individual offices, Seminar room, Library/ computer access, Storage
area, Switch cupboard, Area for fire alarm control board, Electrical systems, IT equipment,
CCTV system equipment.
II. TOTAL SIZE OF THE EMERGENCY DEPARTMENT

The quantity and range of services offered will determine the ED's overall size. The area
necessary for the smooth operation of the offered services, not the overall departmental floor
space, is what matters.
Factors which influence overall floor space requirements include:
 Attendance numbers and patterns
 Patient acuity
 Overall length of stay
 Admission rates and practices
 Turnaround times for imaging and laboratory investigations,
 The proportion of patients aged over 65 years
 Academic activities
 The range of imaging undertaken within the ED

III. ACCESS TO EMERGENCY DEPARTMENT

Never let personnel or patients who aren't in the ED use the ED entrances as main entrances
or as a way to move around the facility. To guarantee that all access routes are kept clear,
security guards must be on duty around-the-clock. Young children's access requirements are
comparable to those of individuals with disabilities. There should be free parking spots next
to the ED that are designated for the elderly, the disabled, and caregivers of infants and young
children.
  AMBULANCE ACCESS
 To reduce the distance between the ambulance and the resuscitation facilities, the
ambulance entrance would be near to the emergency department resuscitation room.
 In order to register patients or send them to the proper waiting area, relatives who
arrive in an ambulance may also need a route. It would be useful to have a special
place for receiving and triaging EMS patients.
 A security guard should be in charge of this location to keep the ambulance bay free
of vehicles.

 WALK-IN ACCESS
 To safeguard patient privacy, the walk-in entrance would be kept separate from the
ambulance entrance.
 The entry needs to be well marked.
 Patients who arrive by private vehicle must also have access to be dropped off close
to the ED door.
 Wheelchair accessibility facilities must be close to the entrance because patients
arriving by car may need them to enter the emergency department.

a. DECONTAMINATION AREA
 In the case of a radiation, chemical, or biological hazard incident, ED clinical
facilities may not get polluted.
 To disinfect patients exposed to poisons, insecticides, or radiation, a tiled bathing area
is used. It may also be utilized to meet some patients' hygiene demands.

b. RECEPTION AREA
 The ED ought to have a separate reception space.
 The spacing between patient waiting areas and the front desk must be enough.
Separate waiting areas and reception areas are recommended.
 The design should take into account having a reception booth that is accessible to
people in wheelchairs.

EMERGENCY DEPARTMENT PLAN :

WALK-IN ENTRANCE:
ED has separate entrance for ambulance and walk-in.
WAITING GUEST AMENITIES AND QUIET ROOM:
Waiting room is provided with TV where as quiet room also has aquarium.
TRIAGE:
Triage is located with registration for periodic coverage.
 SECURITY:
The security desk is best located with the ED and in the night time it is the entrance of
the hospital.
FAMILY CONSULT:
Staff/ Family consult room should be accessible from the waiting or treatment area.
SECURE CARE:
Behavioral health and prisoner treatment rooms would be somewhat segregated.
PEDIATRIC CARE:
Provide for segregation of pediatric areas when possible.
DECONTAM:
One-way flow from exterior to interior in required through the decontamination
room.
EMS:
EMS work room with entrance from ambulance staging area.
TRAUMA:
Trauma would be located near the ambulance entrance.
SURGERY:
The ED trauma room would be proximal to the surgery and ICU area.
LAB AND DIAGNOSTIC:
Diagnostic testing would be located close to the treatment area.
CDU/OBSERVATION/SHORT-STAY:
An observation unit is appropriate with justified volume.
MINOR CARE AND MAJOR CARE:
Collocate major and minor care areas for flexible usage.

TRIAGE:
To evaluate the patient's condition and level of urgency, a triage or evaluation area is offered.
The patient will be escorted directly to the appropriate exam or treatment location if immediate
care is required. The majority of patients who arrive by ambulance or helicopter require
emergency medical attention, therefore they are transferred to a large trauma unit.
The admitting/waiting room and the triage are next to each other. There may be storage space
here for a stretcher or wheelchair.
When "traditional" triage is used, it is essential to make sure that each triage cubicle has two
exits (to protect the safety of the assessment nurse) and is equipped with a specific alarm.