Hospital Design

Introduction and Data Collection

Accident and Emergency Ward

SUBMITTED TO – RICHA MISHRA MA’AM

SUBMITTED BY –
VIKRAMADITYA SHAH BUNDELA
ARJUN VISHWAKARMA
ANMOL GAYAKWAD
RAHUL SAHANI
OVERVIEW 01.
An emergency department (ED), also known as an 
accident & emergency department (A&E), emergency
room (ER), emergency ward (EW) or casualty department, is
a medical treatment facility specializing
in emergency ward, the acute care of patients who
present without prior appointment; either by their
own means or by that of an ambulance.

Microcosm of the hospital as a whole .

“Front door” of the hospital .

Portal of entry that interacts with the highest

volume of patients requiring critical care.
 The function of the Emergency Unit is to receive, stabilise and
manage patients (adults and children) who present with a large
variety of urgent and non urgent conditions whether self or
otherwise referred. The Emergency Unit also provides for the
reception and management of disaster patients as part of the
Unit's role within each region.

It is recommended that Hospitals that do provide an Emergency

Service display a prominent exterior sign at the main entrance
stating this and giving the location of the nearest Hospital with
an Emergency Service.

Credit - Indian Health Facility Guidelines

Overview
 Provision of immediate & correct life saving
treatment at all times and for all situations
 Collection of casualties.
 Information centre to render advice on
telephone or in person on simple medical
queries
 Capacity and capability to provide effective
management during disaster situations.
TYPES 02.
 TYPE OF EMERGENCY

Major Emergency & Stand-by

Basic Emergency Referral emergency
Disaster Emergency
Management
 OPERATIONAL MODELS
The Emergency Unit may be configured in a number of models that may influence facility design including

FAST-TRACK
Specific patient groups may be assessed and treated via a separate
‘fast’ track to other EU presentations. This may occur at the triage point, or immediately after triage but in a separate
zone. Patient types suitable for this area may include contagious diseases, minor injuries, ambulatory paediatrics.
Assessment and treatment may be carried out in Consult / Examination rooms.

GROUPING BY PATIENT ACUITY

Patients of similar acuity (urgency) or staff intensity may be treated in the same zone. Facilities for this model will
include separate areas for resuscitation, acute monitored beds, acute non monitored beds and ambulatory treatment
spaces. There may be separate entrypoints (or triage points) for the different areas. Staff may be separately allocated to
different areas for each shift, and may require separate Staff Stations and private workspace.

Credit - Indian Health Facility Guidelines

 OPERATIONAL MODELS
GROUPING BY SPECIALTY
Patients may be managed in different areas according to the specialty of service they require e.g. acute treatment,
complex investigation, complex discharge planning, or paediatrics. Patients may be triaged from a central arrival point, or
from separate ambulance and ambulant entry points. Within each Functional Area, patients would be prioritised according
to acuity. In this model, separate staffing for each area is required, which would also include separate workspaces for
staff.
OTHER SPECIAL FUNCTIONS
Short Stay Wards /Emergency Medicine Unit/ Observation Units may be located adjacent or incorporated into the
Emergency Unit. This may allow sharing of administrative, staff and
support facilities.

Credit - Indian Health Facility Guidelines

ADMINISTRATION 03.
Credit - Indian Health Facility Guidelines
Duties of staff in Emergency Department

1. Chief Medical Officer In-charge -

- checks the punctuality of the other Medical officers and Resident
Doctors
- prepares the duty rooster for the doctors
- Supervisory rounds of equipment's and drugs
- Checks registers, documents, Medico legal register and
registration register
- Supervise the maintenance of sanitation and Bio medical
waste management
- Responsible for training re-organization classes of all
categories.
- Drill for emergency management/ disaster action plan

National Quality Assurance Standards -

Standard Operating Procedure for Accident and Emergency Management –
National Rural Health Care Mission.
Duties of staff in Emergency Department

 1. Senior Resident -
-examine and give prompt treatment
-he is responsible for certifying death certificates and
getting it countersigned by CMO i/c of casualty

 2.Junior Resident -
-He carries out treatment as advised by the senior doctor
-take rounds along with senior resident
-Perform minor operations and write patient’s case sheet in
legible handwriting.

 3,Specialist -
-he will be in regular duty or on call
-put his notes in the case sheet when he is consulted
-Give expert guidance
-Guide his subordinate staff
-Train junior doctors in handling emergency cases

National Quality Assurance Standards -

Standard Operating Procedure for Accident and Emergency Management –
National Rural Health Care Mission.
Duties of staff in Emergency Department

 D.N.S/ A.N.S/ Sister-in-charge

-She is responsible for the efficient working of the Emergency
Department
-Prepare duty rooster
-Store essential drugs, i.v. fluids, ensure all the
equipment's are in working order.
-ensures that all equipment's are in working order. E.g, suction
apparatus, Central oxygen supply, Boyles apparatus.
-Nursing Personnel will seek guidance of Nursing
Superintendent and appraise her day to day problems.

 Nursing staff.
-carry out Doctor’s orders
-maintain the vitals
-pack dead bodies

National Quality Assurance Standards -

Standard Operating Procedure for Accident and Emergency Management –
National Rural Health Care Mission.
Duties of staff in Emergency Department

 Nursing Attendants/ward boy/Aya’s

-assist nursing staff in patient care
- Getting the indent from stores and also sterilized items from
C.S.S.D
-transferring patient to other ward/units
-assist Nursing Personnel in packing dead body
-carry out any work assigned by superiors
 House Keeping.

-keep the area neat and clean

-perform all the duties as required by the supervisor.
-change soiled linen
-transport dead bodies to the mortuary

National Quality Assurance Standards -

Standard Operating Procedure for Accident and Emergency Management –
National Rural Health Care Mission.
Duties of staff in Emergency Department

 Stretcher Bearer.
-He will be on duty near the entrance of the casualty.
-He will assist in transferring the patients from Ambulance
to Casualty.
-Trained in First Aid Treatment.

 Security Guards.
Duty as per rooster prepared by the Security
officer/CMO
-Regulating the flow of patients or their attendants
-Security of the area is answerable to CMO casualty for any
untoward incidence
-He will perform any other duty as required by his
supervisor/Security officer.

National Quality Assurance Standards -

Standard Operating Procedure for Accident and Emergency Management –
National Rural Health Care Mission.
FUNCTIONAL AREAS 04.
1. ENTRANCE / RECEPTION / TRIAGE :
- Receiving of patients and visitors and administration .
- Assessment for patients.
Triage 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.

Credit - Indian Health Facility Guidelines

Functional Areas -

PATIENT TREATMENT STAFF AND SUPPORT ENTRANCE AREA

AREAS: AREAS
Assessment and treatment areas including The entrance to the Emergency Unit must
Resuscitation, Acute Treatment bays/ rooms,
 Clean and Dirty Utility be at grade-level, well-marked,
Seclusion Room and Decontamination Rooms illuminated, and covered.
Facility, Paediatric patient areas, Procedure It shall provide direct access from public
Rooms,
 Store rooms roads for ambulance and vehicle traffic,
 Linen with the entrance and driveway clearly
 Short-Stay Ward/ Emergency Medicine marked.
Unit/ Observation Unit;  Primary Care Area
 Waste Holding/ Cleaners A ramp shall be provided for pedestrian
- for patients with low acuity conditions; rooms and wheelchair access.

 Stepdown Area - for patients awaiting test

 Staff amenities, The entrance to the Emergency Unit shall
results, considered safe, but requiring administrative and teaching be paved to allow discharge of patients
observation prior to admission or discharge. from cars and ambulances.
functions; Temporary parking should be provided
 Ambulance facilities. close to the entrance.

Credit - Indian Health Facility Guidelines

Functional Areas -

WAITING AREA RECEPTION / ACUTE

• The Waiting Area should provide CLERICAL AREAS TREATMENT
sufficient space for waiting patients as AREAS
well as relatives/ escorts. • The Reception Area is required to Acute Treatment Areas are used for the
• The area should be open and easily accommodate: management of patients with acute
observed from the Triage and • Reception of patients and visitors. illnesses. Requirements are as follows:
Reception areas. • Registration interviews of patients . • Areas to fit a standard mobile bed .
• Seating should be comfortable and Collation of clinical records Printing • Storage space for essential
adequate. of identification labels. equipment Space to allow
• Space should be allowed for • The counter should provide seating monitoring equipment to be housed .
wheelchairs, prams, walking and be partitioned for privacy at the • Minimum space between beds is 2.4
aids and patients being assistd interview area. m.
• There should be an area where children • There should be direct communication • Each treatment area must be at least
may play. with the Reception / Triage area and 9 m2 in area.
• Support facilities, such as a television the Staff Station in the Acute
should also be available. Treatment / Observation Area.
• Fittings must not provide the
• opportunity for self harm or harm
towards staff.

Credit - Indian Health Facility Guidelines

Functional Areas -

PATIENT TOILETS/ CONSULTATION AREAS DECONTAMINATION AREA

SHOWERS
• Up to eight treatment bays – two • Consultation Room/s are to be • An Isolation Room should be
Patient Toilets/ Ensuite, one each for provided according to Unit size available for patients who are
male/ female and requirements for contaminated with toxic substances.
• Between nine and 20 treatment bays examination and treatment of • In addition to the requirements of an
– four Patient Toilets/ Ensuite, two
ambulant patients. Isolation Room, this room must:
each for male/ female.
• Between 21 and 40 treatment bays – • Be directly accessible from the
six Patient Toilet/ Ensuite, three each • Consult Rooms are to comply ambulance bay without entering any
for male/ female. with Standard Components - other part of the unit.
• More than 40 treatment bays – eight Consult Room. • Have a flexible water hose, floor
Patient Toilet/ Ensuite , four each for drain and contaminated water trap.
male/ female.

• At least two of the above Toilets/

Ensuites to be Accessible for
wheelchairs, one each for male/
female.

Credit - Indian Health Facility Guidelines

 Functional Areas -

PHARMACY / MEDICATION RESUSCITATION AREA SHORT STAY WARD /

AREA EMERGENCY MEDICAL UNIT
The Resuscitation Room/ Bay is
used for the resuscitation
(EMU)
• A Pharmacy / Medication area is and treatment of critically ill or • This facility may be provided either within
required for the storage of injured patients. or adjacent to the Emergency Unit for the
medications used within the
Each Resuscitation Bay should be equipped with: prolonged observation and ongoing
Emergency Department. • Service panel, service pendants or pods to treatment of patients who are planned for
• Entry should be secure with a maximise access to patients
subsequent discharge (directly from the
self-closing door. • Physiological monitor with facility for ECG,
printing, NIBP, SpO2, temperature probe, invasive EU).
• The area should be accessible to
pressure, C02 monitor • Patients may be kept in this Unit for
all clinical areas and have • A light similar to a small, single arm operating diagnosis, treatment, testing or for medical
sufficient space to house a light
• Resuscitation patient trolley stabilization.
refrigerator, which is essential for
• Wall mounted diagnostic set (ophthalmoscope/ • The length of stay in the Unit is generally
the storage of heat sensitive auroscope) between 4 and 24 hours, although Unit
drugs. • Overhead IV track
policy may require longer stays.
• Imaging facilities should include:
• Overhead X-ray • The Unit may also be situated separately
• X-ray screening (lead lining) of walls and to the Emergency Unit, although
partitions between beds functionally linked.
• Resuscitation trolley with X-ray capacity

Credit - Indian Health Facility Guidelines

 EQUIPMENTS
1. All essential and functional equipments, ventilators,
defibrillator, monitors ,OT Facilities, X- ray , USG
,CT ,path labs ,EKG machines.
2. Central gas pipelines, plenty of fluids.
3. Crash cart & Emergency medicines
4. IV lines and catheters
5. Vital essential medicines , nebulizers
6. Dressing materials plasters, dressing trolley.
7. Minor operation theaters equipments
8. Fire fighting equipments
 Informal
Space Standards and Components

BED SPACING CORRIDORS COMMUNICATIONS

ROOM-AMBULANCE

The total corridor area within the Location and Relationships - The
department should be minimised to room should be immediately
optimise the use of space. Where adjacent to the Ambulance entry of
In the Acute Treatment Area there
corridors are necessary, they should the Emergency Unit with direct line
should be at least 2.4 metres of clear
be of adequate width to allow the of sight to incoming ambulance
floor space between beds.
cross passage of two hospital beds vehicles and the parking bays.
The minimum length should be
without difficulty. There should be Considerations
three metres.
adequate space for trolleys to enter The room will include:
or exit any of the Consulting  Workstation benches and chairs
Rooms, and to be turned around. for 3 persons
Standard  Telephones, computer and radio
corridors should not be used for communications systems
storage of equipment.

Credit - Indian Health Facility Guidelines

Activity Mapping :
Patients arrival
Registration
Examination by CMO/Nurse Patient
Medico Legal Triage
Cases to be
documented.
Includes:
Placement in
-continued
ED
physical
assessment
Physicians arrival, Diagnostic evaluation and Treatment -consultants
orders
-Tests Ordered
Observation by Specialist & -Test Results
Disposition Decision

Patient teaching
-Constant monitoring until bed/unit
and Discharge
available
after
-Handoff communication with Patient’s
Treatment.
case sheet to the next Unit/Ward.

Credit - Indian Health Facility Guidelines

Activity Mapping :
PLANNING / LOCATION

 Should be located on the ground floor.

 Direct access from the main road.

 Separate approach , other than OPD with a spacious

parking area.
 Location adjacent to OPD.

 Well lightened and boldly signage posted both for

day and night.

 A helipad is required for major trauma centre,

hilly or unapproachable areas if possible.

PLANNING /ACTIVITY -
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 .

Credit - Time Saver Standards for Building Types

 INTERRELATIONSHIP
IN CLOSE RELATIONSHIP WITH –

 Operation Theater
 ICU
 Blood bank
 Laboratory
 OPD
 Mortuary
 Some authorities recommend a close
relationship with CCU as well.
 Radiology
 Endoscopy

Credit - Time Saver Standards for Building Types

 EXEMPLAR LAYOUT

Credit – Neufert’s Architect Data [4th Edition]

 CIRCULATION AREAS

CORRIDOORS STAIR
RAMPS S

CIRCULATIO
N AREA

TROLLEYS
LIFTS
Design Considerations -
1. The design and planning should done so as to not hinder the movement of patients and staff and equipment. The equipment should be located in
designated spaces to be readily accessible when needed.

2. It should provide privacy during management of patients.

3.There should be minimum criss-crossing of patient traffic. A separate entrance and exit may be planned to facilitate unidirectional
patient flow.

4. It should provide easy access for ambulances, patients and general public. There should be distinct, ideally separate, access for
Ambulances and ambulant cases.

5. The entrance should be easily identifiable protected from inclement weather and accessible to disabled patients.

6. Depending on type and location of hospital a helipad may be planned.

7.Ground level location is best since it avoids need for patient access by stairs or elevators, and provides easy access for patients and
Ambulance.

8. It should be ideally situated near ICU and operating rooms .

Design Considerations -
9. Patient waiting area should be visually welcoming and comfortable
10. It should have multiple walled in rooms or multi-bed bays.
11. It should have acute care rooms arranges around the main nursing work area
12. Door should be wide enough to accommodate stretcher , trolleys and portable X-ray machine. A door of width 1.6 m allows attendants to walk on
either side of a stretcher or trolley.
13. Clinical care areas should have exposure to maximum feasible day light.
14. Hence for safety and security of staff patients and visitors. It is essential to plan and design security features. An office for security personal near
the entrance should be considered. Duress alarm should also be positioned at suitable places.
15. Departments using telemedicine facilities should have a dedicated room with appropriate power and communication cabling.
16. Emergency departments must have provision for emergency X-ray and ultrasound examination. It should also have provision for round-the-clock
emergency imaging investigations
17. a laboratory room may be provided in emergency department or laboratory medicines department should provide round-the-clock srvices.
18. Blood bank facilities should be available.
19. The floor finishes in patients care areas and corridors should have nonslip surfaces impermeable to water and body fluids and should be easy to
clean.
20. it will be ideal to provide a separate fracture treatment and plaster room.
21. The emergency operation room should be self-contained.
22. There should be a porch outside the lobby to protect the onloading of the patients from rain and sunlight and approach to lobby should be in the
form of ramp and steps.
23. Approach and access should be appropriate to usage by the disabled.
Reception and Information area

1. It should be adjacent to triage area

2. It should be close to waiting area.

3. it should have communication link such as telephones, pagers.

4. it may also be utilized for storage of records.

Waiting Area

1. The waiting area should provide sufficient comfortable space for waiting patients and relatives/escorts.

2. The should be easily observed from reception and triage area.

3. It should appropriately furnished with displays on health education and hospital related information

4. it should have public telephones booth coffee/tea vending machine, as well as toilet facilities separately for men and
women
Nursing Work Station -
1. It should be centrally located to enable staff to
monitor patient care areas.

2. It should be preferably include central cardiac monitor

station.

3. It should have communication links to triage and

resuscitation areas.

4. It should have desks that will enable staff to work

from either side.
Doctors Work Area
1. It should be centrally located to enable staff to monitor patient care areas.

2. It should provide privacy.

3. The location should be such that doctors and nurses are able to
view central cardiac monitoring station.

4. It should have desks that will enable staff to work from either side.

5. The Doctors on duty must be available for all the 24 hours.

For their convenience a retiring room with amenities along with bath and
toilet should be provided.
Acute Treatment Areas
1. The acute treatment areas are utilized for the management of
patients with acute illness.

2.. The areas should be able to fit a standard mobile bed with
sample and usage space for essential
equipment . The area should include a light wall mounted
sphygmomanometer, patient and emergency
call facilities.

3. There should be at least 2-4 m of clear floor space between beds.

4. Each treatment area requires space of 15 meter square.

Resuscitation Room
1. The patient is to be stabilized in resuscitation room. Immediate attention is also given to patients who requires
restoration of blood volume of the body and clearance of air passages

2.. The resuscitation room/bay should have space to accommodate specialized resuscitation bed, allow 360 degrees
access to all parts of the patient for facilitating procedures , monitoring and for resuscitation equipment.

3. Imaging Facilities should include overhead X-ray, lead lining of walls partitions between beds, radiolucent
resuscitation trolley with cassette trays, X- ray viewing/ digital electronic imaging system.

4. Ceiling-mounted power columns simplifies access of monitoring lines and devices.

5. An OT light should be made available.

6. ALL electric power should be on emergency stand-by circuits.

Observation Ward
1. This is utilized for patients who have been evaluated and need extend
treatment, observation, re-evaluation or time consuming procedures. A 6-
8 bedded ward is recommended.

2.. Planned depending on the type of hospital are as follows:

Obstetric rooms:-
This should be equipped for pelvic examination, evolution of patients in
labour and emergency delivery. Decontamination room, this
room should have a flexible hose shower

4. each treatment area requires space of 15 meter square.

 Emergency Unit Generic Schedule of Accommodation Schedule
of
Accommodation for an Emergency Unit Levels 1 to 6.

Is on page no. 112 to 116 of Indian National Health Facility Guidelines Part B Draft 1.2
2014.

http://india.healthfacilityguidelines.com/Guidelines/ViewPDF/
HFG-India/part_b_emergency_unit
DESIGN OF WARD
ADMISSION -
 Entering a health care institution for nursing care and medical and/or surgical treatment.
 Hospital admission involves staying at a hospital for at least one night or more.
› An individual may be admitted to the hospital for a positive experience, such as having a baby, or because they
are undergoing an elective surgery or procedure, or because they are being admitted through the emergency
department.

ADMISSION CHECK LIST- WARD -

• Put on the patient an identification band
• Apply allergy band (if necessary)
• Initial patient assessment/nursing history
• Allergy History and Allergy Record
• Medication History/Medication Reconciliation
• Braden scale
• Sanitary-hygienic procedures (bathing, changing Cloths)
HOSPITAL WARD [DEFINITION] -
Block forming a division of a hospital (or a suite of rooms) shared by patients who need a similar kind of care.
 
TYPES OF WARDS -
1. General wards.
2. Specialized wards (maternity, pediatrics, psychiatric, geriatrics, oncology, and detoxification wards).
 Constituents -
1.Patient space
2.Nursing space
3. Corridors.

DESIGN FACTORS -
• Movement space.
• Number of beds in a room .
• Bed spacing – 6 feet max.
• Position of nursing station .
• Category of the ward .
• Ancillary rooms .
• Ratio of toilet accommodation.
  TYPES OF WARD

• Open ward or Nightingale Ward

• Modified Nightingale Ward
• Rig’s Pattern Ward (Unilateral or Bilateral)
• T-Shaped Ward
• L-Shaped Ward
• Cruciform type of ward
 Nightingale Ward

 This is an open-plan ward containing 25-30 beds.

 Patients’ beds are located in two row in a long, rectangular ward.
 It may have side rooms for utilities and perhaps one or two side rooms, that can be used for patient
occupancy when patient isolation or patient privacy is important.
 Nursing Station, Doctor’s room and others facility at one end. Bathroom and WC at the other end.
 
Advantages -
 Good visibility;
 Economical benefits (easy to construct);
 Good possibilities for ventilation.
Disadvantages -
 This is the noisiest type of ward;
 No privacy for the patients;
 High risk of cross- infections.
 
Main features of the modified Nightingale ward
 This type of ward has a nursing station in center of ward;
 Ancillary and Auxiliary service are located at one end and utility service at other end of the ward;
 The nurse travel time has been reduced and the supervision over patients condition also improved in
modified pattern of ward.
Rigg’s Ward -
• Ward unit is divided into small compartments separated from each other.
• Each compartment having 4-6 or more beds arranged parallel to the longitudinal wall.
• Bed may be on one side or both sides of nursing station.
• Isolation room (1 or 2) can be kept in ward.
 
Advantages:
•Patient beds not visible to outside visitors except for visiting hours.
•Gives a more clean and tidy look .
•It provides as a barrier against psychological shock for other patients during.
emergency situations.
• More privacy.
 
Disadvantages:
•Communication between nurses and patient becomes more difficult.
•Patients deprived of direct observation from nurses .
•Wards become longer, consequently nurses have to run more
•More nurses are required .
•Expensive to build and maintain.
Accommodation -  
 
 Primary Accommodation.
Consists of single bedroom or multiple bedroom for patients
and a nursing station.
 
 Ancillary accommodation.
Service for direct support of treatment (portable x-ray, Pantry,
Dietician service in ward, mobile pharmacy).
 
 Auxiliary accommodation.
Service for indirect support of treatment (Store,
housekeeping, doctor’s room, nurse’s room, seminar –
teaching room).
 Sanitary accommodation.
Consists of WC, Bathroom, sluice room.
What should be considered in designing different types of wards:
 
 General ward :Healthy Environment
 Pediatrics / psychiatric ward- Safety
 Geriatric ward- Safety/ comfort
 Obstetrics/Gynecology ward – Privacy
 ICU- Nursing Care
 OT-Infection control
 
Hygienic requirements in wards are:
 Optimal temperature in the ward should be 18- 20C;
 Wiping(the floor, windows, furniture) at least 2 times a day – in the morning and evening.
 In some departments — more often, for example, in the infectious departments — 4 times a day.
 Morning wiping should be finished till 9 a.m.
 •Ventilation of wards not less than four times a day.
PHYSICALLY
CHALLENGED
FACILITIES
 Provision of the disabled facilities
provided in public hospital
Staircase
The staircase is also one of the crucial facilities as it will
be used by the disabled people to travel from one level to
another. Hence, these facilities need to be disabled
friendly as it will ease the movement of all categories of
people. provided with the tactile floor that to inform the
Visually impaired people regarding the floor or the staircase.

Ramp
Another medium of access that usually will be used by
the disabled people is a ramp. Ramp will be used by
physically impaired people and visually impaired people.
Ramp can ease the movement of PWD especially those
on a wheelchair.
Signage
Based on the technical visit, all signage on disabled
facilities is visible, clear, simple, and easy to read and
understand by all people.

Entrance
According to MS1331:2003, the entrance of the building
must be free from any obstacles and must be easily
accessible by everybody especially disabled people.
Based on the observation, all the three hospitals followed
this requirement. Besides, the entrance also connected
with the pathway that leads to the entrance. Also, none of
the hospitals provide the tactile floor for visually
impaired people. The tactile floor is one of the
requirements that hospital does not comply with.
Pathway
The pathway is one of the media of travelling
from one place to another. Because of that, the
pathway must sizeable and free from any
obstruction according to the standard
requirements.

Parking
It is a requirement to provide parking space for
Disabled people as stated in the standard requirement
that has been used worldwide. This requirement is
important as disabled people must have a special
privilege to access to the public building.
Elevators
All hospital fulfils the requirements by providing
elevators at the hospital. However, some of them did not
fulfil the requirements that come with the elevator.

Toilet
Observation found that those three hospitals provide the
special toilet for disabled people at the hospital area.
However, there are still some improvements that need to
be done by the hospital management as the facilities
provided not fully comply with the standard
requirements.
HEALTHCARE
FACILITIES
Healthcare facility –
It is that constituent of the infrastructure of the healthcare
(delivery) system which facilitates an environment in which
a person can seek and receive healthcare.

Generally, these are related to the level and pattern

of healthcare, represent a sizeable part of the
system and have multiplicity of functions to perform.
Importance -
The importance of having a proper system in place
for planning and designing primary and secondary
level healthcare facilities can be gauged from the
fact that costly mistakes committed at one place
can be avoided at other places.

At this juncture, it would be worth emphasizing the

imperative need to have a core planning team
comprising of a medical officer, a public health
specialist, an architect, a hospital administrator and
a biostatistician, for evolving a "bottom up"
approach to planning of healthcare facilities.

Similarly, there is a vital need to define the tasks to

be performed at various levels so that facilities can
be designed, which reduce the bypassing of the
referral systems. The inter- sectoral dimensions of
health also necessitate proper co-ordination and
liaison with other health related departments like
public works, public health, water supply,
sanitation department.
FUNCTIONS :
The primary level healthcare facilities in our country include the
primary health center(s) and community health center(s); both of
which have the facility for indoor patient beds.

This would be possible if the following criteria are

applied during evaluation of existing healthcare
facilities:
• The justification; whether such a facility should
have been built at that place?
• Its functional adequacy and effectiveness, i.e. type
and volume of activities performed, relevance to community and ,

This would be possible if the following criteria are applied during evaluation of existing
Healthcare facilities:

• Its economic efficiency, i.e. are capital and

recurring costs affordable?

As healthcare facilities are essentially shelters where healthcare staff perform specific tasks,
"real" building needs can only be identified after the functions have been defined. Hence, the
building needs would vary at a sub-center, primary health center or community health center
level.
GENERAL FACTORS

The factors which affect the planning and designing

of healthcare facilities should be based on the
philosophy of shared resources and multiple
use areas. These include:

• Size of the healthcare facility.

• Building material and methods.
• Contents (parts) of the healthcare facilities.
• Climatic factors.
• Socio-economic factors.
• Staffing principles and procedures.
• Flexibility.
GENERAL FACTORS
Size of the healthcare facility:
Depends upon the location, level of care provided,
functions performed, national standards (if available),
expectation of staff, space required for machinery and
equipment.

Building material and methods:

Instead of using a facility in another developed nation as a
template for primary level facilities, It is prudent to rely on
local materials and available skills and technology. This is
expected to increase the acceptance for services, besides
decreasing costs.

Contents (parts) of the healthcare facilities:

This refers to the diagnostic and therapeutic facilities being
provided; engineering inputs in the form of
air conditioning, mechanical and electrical
installation; costs involved, and finally, reliability
of operation and maintenance in the long run.
GENERAL FACTORS
Climatic factors: Flexibility:
These include heat and rainfall (humidity) in the tropical regions; This should be the cornerstone of the
exposure to cold (snow fall, etc.) in temperate regionsIn areas design as flexibility allows the facility to grow
experiencing regular floods/water inundation it would make (expand) in case of upgradation and also
sense to locate the healthcare facilities at higher accommodate changes in internal function.
level.

Socio-economic factors:
These include local customs and habits, needs, usage patterns,
distances and communications, religious and value
systems.

Staffing principles and procedures:

This is essential, as the right (optimal)staff mix should be
provided based on qualification, and job requirements.
This will help in proper Staffing principles and procedures:
supervision and optimal utilization of the healthcare facility.
PITFALLS IN PLANNING AND DESIGNING :
The following problems or pitfalls have been identified which should be kept in mind:

• Multiplicity of design making agencies & bodies.

• Lack of planning capabilities.
• Shortage of architects/designers specialized in
Health.
• Lack of appropriate technical literature.
• Hiring of "consultants“.
• Use of standard (type) design.
• Cost and Maintenance.
• Multiplicity of design making agencies & bodies • Lack of planning capabilities
Rarely is the planning and designing of a This generally results from communication gaps between
healthcare facility limited to "Health" department the potential end users of the facility; the planners (usually
or ministry, and generally intersectional at the level of Ministry/department) and the actual
co-ordination is required, For example, supply of agencies responsible for physical design and construction;
safe (potable) water and basic sanitation is and later on maintenance. One of the solutions could be
looked after by public health engineering formation of 'core' teams at the basic user level with
department and good co-operation and "bottom up" planning.
co-ordination is required.

• Lack of appropriate technical literature: It is

another sad fact that most of the published
literature in this area is applicable to developed
nations; and although some useful "concepts" can
be borrowed from them and 'adapted to suit local
conditions in most cases these are copied without
modification, hence result in costly mistakes.
If these occur in "templates“ being used for multiple
facilities, the mistakes also get replicated.
• Shortage of architects/designers specialized in • Hiring of "consultants” :
health: Hiring of foreign based (usually from developed nations)
In most developing countries this is a real based on Impressive CVs and huge experience, often
problem which occurs not only at central level, misfires due to local conditions. Hence, it maybe better to
but also at state and district level. This shortage is hire local consultants with some experience in the country.
usually aggravated by lack of experience and/or
training in the field of health; and more so primary
healthcare.

• Cost and Maintenance: • Use of standard (type) design:

In general, a detailed cost Although use of standard design is advantageous as it
analysis should be carried out keeping in mind the one time economizes on architectural manpower during
capital expenditure and recurrent Implementation, it is prudent to have several types of
expenditure on maintenance. design, so that regional variations in climate, habits,
customs, etc. can be catered to- Besides, it is advisable not
It has been estimated that in some to go in for a large number of buildings of standard design,
cases three years maintenance cost a till the first few have been evaluated after the shake down
reequal to capital (construction) period.
costs.
GENERAL PLANNING AND DESIGN
FEATURES OF PRIMARY HEALTH
CENTER :
• Entrance zone, i.e. reception and waiting.

• Outpatient examination/consultation room(s),

dispensary with injection room.

• Indoor facility with one cubicle and six beds,

minor OT and/or labor room.

• Diagnostic and laboratory facility.

• Facility for outreach services, e.g. multipurpose

hall for meetings, records and documentation.
Functional Areas -

Building should be single Floor area ratio (FAR) Room Height should be
storeyed, spacious should be less than or standard 3 meters
and taken into consideration equal to 0.5 to 1 in (10 feet) and doors
the local climate, rural and suburban should be wide enough
topography and areas; and 2 to 1 is the (1.2 m) to allow entry of
prevailing winds. maximally acceptable beds.
limit in urban areas.
PHYSICAL LAYOUT OF PHC -

At the outset it must be emphasized However, model "type plan“ consisting In this endeavor, an imaginative
that in view of the vast of arrangement of spaces required to and Intelligent grouping of the
geographical diversity in the fulfil certain specific needs identified areas taking into consideration
country, it will not be possible to by users, and properly designed; may location, materials, manpower, cost
provide a master plan type layout be evolved which can be replicated in and time for construction is a
which can be constructed at all other parts. laudable objective.
places in the country.
GENERAL PLANNING AND DESIGN FEATURES
OF A COMMUNITY HEALTH CENTER [CHC] -
Broadly a community centre in India will be
catering to a population of about
80,000 to 1,20,000 and will be expected
to provide specialist services to the
Four primary health care facilities in its
jurisdiction.

Normally CHC will be established at

Block Headquarters level.
• It should comprise of the following parts/ areas:

• Entrance, reception- • Supportive services If space permits, it is preferable

registration and waiting including laundry , to have single storey buildings,
space. diabetics. Sanitation etc. which must take into
• OPD facilities including which may be in-house or consideration local topography
consultation rooms; Out-sourced. climate conditions and
laboratory facilities; • Facilities for outreach prevailing wind conditions.
pharmacy, dispensary, activities , national health • It is prudent to have the longer
minor procedure room, programs , records and walls of the building face in a
etc. reports. north-south direction in hot
• Indoor facilities for 30 • The floor area ratio in tropical climate, so as to limit
indoor beds, isolation • rural and suburban areas entry of sunlight and heat into
room (s), operation should less than or equal to rooms.
theatre complex and 0.5 to 1 and in urban areas
diagnostics. should be 2 to 1.
Functional Areas -

Parts/ Areas - Physical Layout Plan of a Space Requirements -

CHC -
General zoning concepts of As in the case of planning health In view of the aforementioned,
ambulatory facilities (OPDs) being center, there can be no single model laying down final and absolute
near the entrance area (more 'type' plan which can be used all space requirements for Primary
crowded); and indoor areas being over the country, in view vast healthcare facilities is fraught
further away, with critical areas geographic variations, climate with risks.
being most inaccessible should be conditions and availability of space.
followed. The 'type' plan will be suitable for
suburban and rural areas;
These area/space requirements are on the higher side and may be reduced depending upon outsourcing of
certain support services, specialist services availability, etc.
Flowchart
Flowchart
Bubble Diagram
CONCLUSION
 Conclusion

• In view of the recently launched Natural Rural Health Mission, and the prioritization of the public health
activities in rural areas, it is essential to be aware of the problems faced by other developing countries, so that
same/ similar mistakes are not repeated.

• The health and hospital administrators need to be aware of their responsibilities in the ‘Core Planning’ Team
and help the process achieve its goal in a proper manner.

• They should not lose sight of the fact that unless the primary healthcare facilities are functioning optimally ; and
the population has confidence in these, there is bound to be a “bypass” phenomenon and self referral system
which will overburden the secondary Or tertiary level healthcare facilities and finally be detrimental to the
health of the nation.
 Thanks !
Credits

Indian Health Facility Guidelines

Part B; Draft 1.2, July 2014
Page No. 101 to 116.

National Quality Assurance Standards -

Standard Operating Procedure for Accident and Emergency
Management –
National Rural Health Care Mission.

Time Saver Standards for Building Types

Page no. 456-457.

Emerging Areas In Hospital Planning Design

Construction And Facilities Management
By Prof. Dr. Anil Dewan | School of Planning and
Architecture Delhi
ARP19 AP47

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