Multispeciality university medical center space programming by ashwini rangaraju

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Theory of Function, Programming and Design- Final Report Arch 576- Fall 2017 Prof. Michael K. Kim

Ashwini Rangaraju Sowmya Singh Jingjing Xu Jan Concepcion

Acknowledgement We would like to thank Dr. Michael Kyong-il Kim for patiently guiding and teaching us throughout this seminar. We are forever grateful for this opportunity to learn under him. Without his tremendous teachings, help, guidance and support, the realization of this report would have been a very difficult task. We deeply appreciate the valuable documents of Operational and Space program final report we received from Kurt Salmon Associates for a University Medical Center through our Professor, Dr.Michael Kim. We gained tremendous wealth of knowledge and we used this report as our reference from which we were able to learn comprehensively about the detailed spatial programming and were able to apply the science of logic and programming to this material. This has helped us to gain capacity and confidence to handle such projects without fear of failure in future. We would also like to extend thanks to our seminar members for their continuing support during this semester. Lastly, we would like to express gratitude towards the Graduate school of Architecture, for providing us with this opportunity.

Introduction The theory of function, programming and design is an advanced course including logics of Design, Design teleology, Science of function and functional space organization, and the strategies of designing for greater functionality. Through a semester long project on an University Medical center, we explored in detail the building programming and its interrelationships and their functional activities in support of which the building is to be designed. We had semester long lectures, creative research for the advancement of the theories and strategies, research on its functionality and understanding and configuring the inter-functional unit relationships that will best support the Institutional mission and vision of the client. For this report, we studied several well-established Urban medical Centers in Chicago, Illinois and with its programming documents, mission and vision statements, we explored further the knowledge we obtained from the lectures and the creative research we conducted under the guidance of our professor.

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 1a: Clientâ&#x20AC;&#x2122;s Institutional Goals & their implications on Project Goals and Design objectives

http://ak6.picdn.net/shutterstock/videos/15562726/thumb/1.jpg

BUILDING IDENTIFICATION Hospital Type : It is a not-for-profit comprehensive healthcare, education and research center teaching medical, nursing, allied health, management and biomedical research. Location : Urban Areas Client and Primary Occupant : Well-established Project Year : 2012 EstiArea: 830000.0 sf https://www.rush.edu/giving-rush/about-rush-philanthropy http://news.feinberg.northwestern.edu/wp-content/uploads/site s/15/2016/04/RIC-AbilityLab.jpg http://www.scb.com/app/uploads/2015/12/063293_040-876x12 00.jpg

Source : James Steinkamp, Steinkamp Photography

BUILDING IDENTIFICATION Site History : ●

Buildings are often part of a Master Plan and is likewise an addition to already well established institutions such as actual hospitals.

Hospital Offers : ●

It has 100+ specialised departments and programs and a separate children’s hospital.

Source : Google Maps

https://www.rush.edu/about-us/about-rush-university-medical-center/history

CLIENT’S MISSION & VISION IT'S HOW MEDICINE SHOULD BE® Mission: The mission of this medical institution is to improve the health of the individuals and diverse communities we serve through the integration of outstanding patient care, education, research and community partnerships.

Vision: To be the leading academic health system in the region and nationally recognized for transforming health care.

Values: ● ● ●

Innovation, collaboration, accountability, respect and excellence are the roadmap to our mission and vision. These five values convey the philosophy behind every decision Rush employees make. Rush employees also commit themselves to executing these values with compassion. This translates into a dedication to providing the highest quality patient care.

https://www.rush.edu/about-us/about-rush-university-medical-center/mission-vision-and-values

CLIENT’S MISSION & VISION IT'S HOW MEDICINE SHOULD BE® How medicine should be: “When you’re sick, you want someone on your side. You want solutions — and, ultimately, you want to feel better. Clinicians [must be] driven to help you find those solutions. And while we really like seeing our patients, we like it even more when they are home getting back to their lives.”

● ●

This states what medicine should mean for the patients, in short, what can be expected from this hospital. This is what is to be delivered and so this forms their tagline.

https://www.rush.edu/about-us/how-medicine-should-be

CLIENTâ&#x20AC;&#x2122;S INSTITUTIONAL GOAL Modernization of a medical institution envisions the following:

To set the standard for customer service, interdisciplinary clinical development, patient safety, and operating efficiency.

Source: RUMC space program-kurtsalmon.com

BASIC DESIGN GOALS

Source: Perkins +Will

PROGRAM OVERVIEW ●

Emergency department

●

Adult acute care

●

Adult critical care

●

Obstetrical services

●

NICU

●

Inpatient Therapies

●

Respiratory Therapy

●

Interventional Platform

●

Diagnostic Platform

●

Clinical Laboratory/ Pathology

●

Sterile Processing

●

Patient Access

●

Food Service

●

Pharmacy

●

Basement/ Logistics

●

Lobbies and Amenities

Source: RUMC space program-kurtsalmon.com

Source : greenbuildingelements.com

OPERATIONAL INTENT

Source: RUMC space program-kurtsalmon.com

OPERATIONAL INTENT

Source: RUMC space program-kurtsalmon.com

OPERATIONAL INTENT

Source: RUMC space program-kurtsalmon.com

GENERAL GOALS A.

Functional Utility - become a leading academic health center â&#x2014;&#x2039; Functional Efficiency i. There will be a relentless pursuit of efficiency. 1. Programming will dictate the structure and form of the building. 2. Strict adherence to functional adjacencies will drastically reduce wait-time and allow resources to be shared between departments wherever possible. â&#x2014;&#x2039; Environmental Comfort i. Give patients an environment designed to maximize daylight and views ii. Bring in greenery into the space without compromising plant-borne infections

GENERAL GOALS A.

Functional Utility â&#x2014;&#x2039; Safety and Protection i. Circulation must be optimized for safety of patients ii. Create spaces that can be easily converted to fully functional emergency response areas â&#x2014;&#x2039; Usability i. The staff must be able to use the facilities efficiently and seamlessly ii. Multiple specialists can attend

GENERAL GOALS B.

Aesthetic Value ○ The building must be a “city-scaled civic building” that is both iconic and unique ○ Create a welcoming space for both visitors and patients using greenery. ○ For both indoors and outdoors, the building must reflect a high-end private facility reflecting innovation, collaboration, accountability, respect and excellence.

GENERAL GOALS C.

Meronic Value ○ Value to the current medical campus i. A new addition that will tie the existing facilities into a more cohesive one, ii. more specifically, renovate and expand existing adjacent medical facility, and iii. address both health and educational needs, as some of the campus-wide enhancements are designed to augment teaching programs and medical research. ○ Value to the Neighborhood District i. This new facility will be a landmark and wayfinder for the entire district. ○ Value to the City: This facility should be viewed as “City’s Hospital” i. This facility can be a landmark or gateway to the city ii. This facility will reflect on the network of care facilities and providers Chicago area.

throu

GENERAL GOALS D.

Constructability ○ This new facility is estimated to cost $500 million dollars; it must be economical to build ○ The facility will meet LEED Gold standards and must therefore meet the minimum LEED requirements regarding construction. i. Meet minimum requirements for usage of recycled materials

Investment Value ○ The facility must meet return on investments through revenue obtained from operations, debt, and fundraising. ○ Cost of running the facility is predicated on people’s time travelling from one space to another; therefore, travel time and wait time must be optimized.

GENERAL GOALS F.

Social Responsiveness ○ Environmental sustainability - facility must meet minimum standards for LEED Gold i. Incorporate water conservation and energy conservation ○ Usually a member among a group of medical facilities, this facility must preserve the mission of the local district and medical and healthcare profession in general. i. It’s worth noting that medical facilities such as the IMD has more than

29, employees, 50,000 daily visitors and generates $3.4 billion in economic o IMD is the largest urban medical district in the United States, and has the

○

patient population in the country. Advancement of medical education i. Medical facilities can be a means of educating future medical practitioners

Preservation and Designed Value ○ This facility must maintain

its functional, aesthetic, meronic, investment, and s 20

SOURCES ● ●

●

From Perkins + Will: ○ https://perkinswill.com/files/Architect%20Magazine_Jan%202013_Rush%20Article.pdf From Rush University: ○ https://www.rushu.rush.edu/about/fast-facts ○ https://www.rush.edu/news/press-releases/rushs-new-hospital-largest-new-construction-health-care-facility-world-receive ○ https://www.rush.edu/about-us/about-rush-university-medical-center/mission-vision-and-values From the Illinois Medical District ○ http://www.imdc.org/about/facts-figures ○ http://www.imdc.org/about/welcome From Healthcare Finance: ○ http://www.healthcarefinancenews.com/news/rush-university-medical-center-build-500-million-outpatient-center

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 1b: Project Goal, Design Objectives, and Appropriate/Required Design Characteristics

PROJECT GOALS General Goal - To fulfill core values in health care system and emerge as a pioneer in customer service, interdisciplinary clinical development, patient safety, and operating efficiency.

Functional Utility â&#x2014;&#x2039; Functional Efficiency - To relentlessly pursue efficiency in space organization of the hospital to provide a productive environment. i. Design Objective: 1. To create form and structure that follows from the programming of the building. 2. To encourage resource sharing among facilities by efficient planning. 3. To follow a uniform layout while designing inpatient facilities. ii. Design Characteristics 1. The design should strictly adhere to functional adjacencies that will drastically reduce wait-time and allow resources to be shared between departments wherever possible. 2. Identical patient room should be planned for uniformity and ease of usage. 23

GENERAL GOALS A.

Functional Utility â&#x2014;&#x2039; Environmental Comfort - To maximize comfort for patients, visitors and staff. i. Design Objective: 1. To provide a comfort and control in thermal conditions. 2. To maximize daylight and views 3. To bring in greenery into the space without compromising plant-borne infections. 4. To provide acoustic comfort - a silent and clean environment for patients. ii. Design Characteristics: 1. Site climatic conditions should be taken in account while zoning the orientation of facilities. 2. The design of the envelope should ensure thermal, visual and acoustic comfort. 3. Waste disposal should be organised to prevent contamination.

GENERAL GOALS A.

Functional Utility â&#x2014;&#x2039; Safety and Protection - To protect and keep occupants safe i. Design objective: 1. To optimize circulation for the safety of patients 2. To ensure privacy and psychological comfort for the users. 3. To be responsive and adaptable during an emergency ii. Design Characteristics: 1. Public areas should be adaptable to act as emergency response areas 2. Inpatient departments should be designed to include private rooms for the privacy of the patients, especially in adult acute and critical care. 3. Circulations of visitors and faculties should be separated.

GENERAL GOALS A.

Functional Utility â&#x2014;&#x2039; Usability - To create a facility where specialist and standard staff can attend to patients efficiently and seamlessly i. Design Objectives 1. To create form and structure that follows from the programming of the building. 2. To provide ease in circulation. 3. To enhance resource sharing through design 4. To guarantee accessibility of the building ii. Design Characteristics: 1. Space should be organised for an intuitive and easy wayfinding. 2. Space should be designed for the easy usage of people with special needs. 3. Facilities should adhere to functional adjacencies that will reduce wait-time and allow resources to be shared between departments wherever possible.

GENERAL GOALS B.

Aesthetic Value ○ To create an iconic and unique “city-scaled civic building” that symbolizes the medical advancement. i. Design Objective: 1. To Implement a unique form that is recognisable while preserving the building’s functional utility. 2. To keep in harmony with the surrounding context. ii. Design Characteristics: 1. The building should use materials of high quality to be visually appealing. 2. The effect of the form on the wind movement around the building should be considered. 3. Site and neighborhood context should be considered when designing the form of the building. 27

GENERAL GOALS C.

Meronic Value â&#x2014;&#x2039; To add value to the medical campus i. Design Objectives: 1. To tie the new addition to existing facilities effectively 2. To create a more cohesive medical campus in a multiblock level 3. To address both health and educational needs, as some of the campus-wide enhancements are designed to augment teaching programs and medical research. â&#x2014;&#x2039; To add value to the Illinois Medical District i. Design Objectives: 1. To add prestige to the Illinois Medical District with a sleek new facility that replaces the well-known but deteriorating facade of the unused Cook County Hospital nearby ii. Design Characteristics: 1. Building footprint should conform to the current urban fabric 28

GENERAL GOALS C.

Meronic Value ○ To add value to adjacent neighborhoods i. Design Objective: 1. To create a facility that relates to the United Center neighborhood such that facilities in this neighborhood can work synergistically with the new facility in an urban scale ○ To add value to the City: the facility should be viewed as “Chicago’s Hospital” i. Design Objective: To add prestige and grow Rush’s network of care providers throughout the Chicago area. 1. To create a city landmark or gateway for those coming from the western suburbs towards the Loop ii. Design Characteristic: 1. The form of the building is effectively a billboard for the facility.

fac

GENERAL GOALS D.

Constructability â&#x2014;&#x2039; Design objective: i. To allow construction to be within budget; this new facility is estimated to cost $500 million dollars ii. To meet LEED Gold Standards including minimum requirements in construction â&#x2014;&#x2039; Design Characteristics: i. The construction should use recycled and sustainable materials ii. The building structures should take formwork of standard and repeated sizes iii. The envelope should be designed with the uniformity of curtain glass units in mind for easy constructability.

GENERAL GOALS E.

Investment Value ○ Design Objective: To design the facility such that it can produce return on investments through revenue obtained from operations, debt, and fundraising. i. To ensure that employees’ travelling time from one space to another is reduced. Time is money. ii. To expedite the return on investment for the client. ○ Design Characteristics : i. Circulation within the hospital should be optimised. ii. The construction process should be planned to allow early move in for certain facilities.

GENERAL GOALS F. ●

Social Responsiveness To design a building that helps in the progression of the society. ○ Environmental sustainability - To meet minimum standards for LEED Gold rating i. Design Objectives: 1. To incorporate water conservation and energy conservation ii. Design Characteristics: 1. To use recycled material through the Construction process ○ To advance the humanitarian mission of its partner i. As one of its members, the facility must preserve the mission of the Illinois Medical District (IMD) and medical and healthcare profession in general. 1. It’s worth noting that the IMD has more than 29,000 employees,

50,0 visitors and generates $3.4 billion in economic opportunity. The IMD urban medical district in the United States, and has the most diverse population in the country. 32

GENERAL GOALS F.

Social Responsiveness â&#x2014;&#x2039; To aid the advancement of medical education - The University is currently edu students and has more than 25,000 alumni since its inception i. Design Objective: 1. To be a resource for nearby universities with medical programs (ex. M College)

Preservation and Designed Value â&#x2014;&#x2039; To maintain its functional, aesthetic, meronic, investment, and social value i. Design Objective: 1. To design spaces so that they can adapt to future expansion, emerge new technology. 2. To design the building which will act as a catalyst for the welfare and development in this region. 33

SOURCES ● ●

●

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case Study Phase 2a: Function and Requirements of Major Department/Functional Unit A: Emergency Department

FACILITIES

FACILITIES FUNDAMENTALITY

Emergency Department- Service Scope

EMERGENCY DEPARTMENT - SERVICES

FUNCTIONAL PROGRAM ●

AMBULANCE TRAFFIC: Separate Ambulance traffic for easy access to the ED and the other departments.

●

ROOM MODULES: The department is to be organized into 12 room Modules. ○ Modules 1-3: ■ 3 Critical Care treatment rooms ■ 9 General Care treatment rooms ○ Module 4: ■ 6 General Care treatment rooms ■ 6 ED observation rooms ○ Module 5: 12 treatment rooms ○ Other spaces might include Employee health, pre-surgical testing or admission unit.

FUNCTIONAL PROGRAM ●

EXAMINATION ROOMS: To maximize flexibility over time. ○ Standardised exam rooms: Critical & Standard. ○ Pediatrics & Special Equipment rooms like ENT, psych rooms, etc

●

NO- WAITING MODEL: Triage as a process to provide patient with a bed in 30 minutes.

●

IMAGING: CT, general radiology, Ultrasound and Fluoroscopy located directly for ED support.

●

ED OBSERVATION UNITS: 6 bed units with staff. Future expansion to include direct admits. 42

Space Drivers The following Emergency Department volumes have been projected by the Planning Department of the facility in order to meet 2019â&#x20AC;&#x2122;s medium

VOLUME AND CAPACITY

2005

2019 Projected

STAFFING

Current Peak Shift

Visits

Rooms

Visits/Room

Observation Rooms

45,568

1,627

65,000

Planned Total

Peak Shift

Total

TOTAL

47.0

98.7

83.25

192.0

Registered Nurse

17.6

44.0

26.0

65.5

ED Attending Physician

7.5

17.5

11.25

26.25

Patient Care Technician

3.8

9.6

6.0

15.0

Clerical Coordinator

3.5

9.1

6.0

13..2

1,548

ORGANIZATION

●

ADJACENCY Immediately adjacent included within the department DIRECT ACCESS Easily accessible via direct path horizontal or vertical

ORGANIZATION

PATIENT FLOW ACTIVITY CHAIN Emergent & Minor Care

PATIENT FLOW ACTIVITY CHAIN Critical Care

PATIENT FLOW ACTIVITY CHAIN Decontamination Room

MATERIAL FLOW

Multispeciality university medical center Case study Phase 2b: Function and Requirements of Major Department/Functional Unit B: Interventional Services

FACILITIES FUNDAMENTALITY

GUIDING PRINCIPLES 1.

Optimize the patient family experience.

Staff and patient safety must be conscientiously considered throughout the design and build process.

Organize services around the processes of care delivery.

Standardize where possible.

Utilize technology to optimize patient care, throughput, and staff efficiency.

Ensure integration of research and education in the support of care delivery

Use adaptability and flexibility best practices to anticipate change.

The design should be comfortable, uplifting, and support the Rush core values.

The design should embrace the community.

10.

Incorporate sustainable (green) within budget.

Interventional Service- Service Scope

FUNCTIONAL PROGRAM ●

Interventional Platform: It co-locates the main procedural area (OR’s, interventional labs & GI suites) and patient preparation & recovery. It serves surgery, invasive cardiology, radiology, gastroenterology and pulmonology.

●

Perioperative area: (Prep & recovery) Flexible rooms for patient movement and volume fluctuation.

●

Point of Service: Preregistered scheduled patients will be checked in and verified in each platform.

●

Procedure Suite: This serves both the inpatient and outpatient. Hence both their movement have to be separated and provide maximum flexibility.

FUNCTIONAL PROGRAM ●

Scope Cleaning: Centralized scope cleaning close to point of use and adjacent to surgery, endoscopy or bronchoscopy.

●

Scheduling: Routine review and evaluation of urgency. It should also accommodate special needs of radiology and cardiology.

●

Material Movement: Automated guided vehicles can be used to pick up and distribute various materials including food, linen and trash.

Space Drivers - Interventional Services The following Emergency Department volumes have been projected by the Planning Department of the facility in order to meet 2019â&#x20AC;&#x2122;s needs. The chart below only shows the top 3 biggest. VOLUME AND CAPACITY

2005

2019 Projected

Surgery (incl. inpatients and outpatients and excl. cystoscopy)

17,391

24,799

Interventional Radiology

7,895

9,726

Endo and Bronch

6,496

11,914

35.630

51,801

INTERVENTIONAL TOTAL

Space Drivers - Base on Surgical Specialty Operating Parameters ●

● ● ● ● ●

Surgery - 254 days/yr; 9.8 hrs/day ○ 26 ORs 7am to 3pm ○ 15 ORs 3pm to 5:30pm ○ 4 ORs 5:30pm to 7:30pm ○ 2 ORs 7:30 pm to 7am Cysto - 254 days/yr; 4.5 hrs/day Cath Lab - 250 days/yr; 8 hrs/day EP - 250 days/yr; 8 hrs/day IR - 250 days/yr; 10 hrs/day Endo/Bronch - 250 days/yr; 8 hrs/day

ORGANIZATION

OPERATIONAL GUIDELINES Interventional Platform will be arranged on the 4th and 5th floors of the building.

● ● ●

Each floor to have a Sterile and Non- Sterile zone. The image guided labs should have the infrastructure equivalent to an OR for conversion to sterile zone if needed. Layout of facilities in clean zone should be flexible for operation change into OR. Clean Zone

Sterile Zone

Inpatient and Outpatient Surgery

Image guided Procedures

GI/ Endoscopy/ Bronchoscopy

Cardiac Cath ElectroPhysiology

Minor Procedures

Other external Relationships Imaging, ED, Other

ICU

Sterile zone

Clean zone

PACU Peri-Procedural Zone & Extended Care Inpatient Access Zone

Operational Flow

PATIENT FLOW ACTIVITY CHAIN (current)

PATIENT FLOW ACTIVITY CHAIN (future)

MATERIAL FLOW

INFORMATION FLOW ●

Patient information should precede patient

●

Electronic Medical Records (EMR), Radio Frequency Identification (RFID), barcoding and PACS will be operational

●

Data will be sent and retrieved electronically whenever possible

●

Informations must be transparent across all locations, departments, and systems to maximize efficiency

●

Each staff should have access to terminal/computer station to view patient information, schedules, etc

●

Progress should be updated in Interventional Suites via communication screens

●

Scheduling systems should be automated and include instructions

●

IT system should allow for remote entry of information

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 2c: Function and Requirements of Major Department/Functional Unit B: Adult Acute Care

FACILITIES FUNDAMENTALITY

Adult Acute Care- Service Scope â&#x2014;?

â&#x2014;?

It provides high quality care to medical and surgical patients who require inpatient care or continuing observation and treatment Meet inpatient admission criteria consistent with the clinical, educational and research mission of the institution.

http://www.archdaily.com/443648/new-hospital-tower-rush-university-medical-center-perkins-will/5721bedae58ece0bda000010-new-hospital-tower-rush-univ 75 ersity-medical-center-perkins-will-photo

FUNCTIONAL PROGRAM

FUNCTIONAL PROGRAM ●

Adult Acute Care: “Prototype” units to care for patients across the care continuum. ○ Minimize in-house patient transfer. ○ Flexibility in use with unique block of space to service every floor-PT/OT for Orthopedics, etc.

●

Patient Rooms: ○ It should follow standard configuration to support staff efficiency and patient safety. ○ Sized to be acuity adaptableMaximize flexibility to support 2 or 3 acuity nursing model & to be readily converted into ICU. ○ Private rooms with dedicated patient, caregiver & family support zones to encourage family involvement. 77

FUNCTIONAL PROGRAM ●

Hospital based Non-inpatient population (Observation, etc): Distinct space to be designed to care for them- not to be placed in inpatient Units except rare Occurrences.

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Services: Wherever practicable, services of testing and treatment is to be brought to the patient’s bedside.

●

Nursing Station: Continued improvement in technology supports decentralized nursing care.

●

Scalable nursing units based on volume fluctuation to easily staff up or down without any physical barricades. 78

Space Drivers - Interventional Services The following Staffing have been projected by the Planning Department of the facility in order to meet 2019â&#x20AC;&#x2122;s needs. The chart below shows the the Prototype Staffing for a 32-Bed Acute Care Unit: Future Prototype Staffing for 32-Bed Acute Care Unit

Position

PT/OS/ST

Peak Shift

Staff Nurse

Environmental Services

Patient Care Tech

Pharmacist

Consultant

Chaplain / Psych Liaison

Attending

Unit Director

Intern

Clinical Nurse Specialist

Resident

Clinical Nurse Coordinator

Clinical Resource Coordinator

Dietary

0.5

Unit Clerk

TOTAL

48.5

ORGANIZATION

PATIENT FLOW ACTIVITY CHAIN

Elevator -----------

Patient rooms ----------------Inpatient care Observation treatment

ENT./EXIT

Consultation room ----------------consultate

Refer to operating standards

Family lounge ----------------Meet family

MATERIAL FLOW

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 2d: Function and Requirements of Major Department/Functional Unit D: Pharmacy

FACILITIES FUNDAMENTALITY

10 Guiding Principles ● ● ● ● ● ● ● ● ● ●

Optimize the patient and family experience Staff and patient safety must be conscientiously considered throughout the design process Organize services around the processes of care delivery Standardize where possible Utilize technology to optimize patient care, throughput, and staff efficiency Ensure integration of research and education in the support of care delivery Use adaptability and flexibility best practices to anticipate change The design should be comfortable, uplifting and support the Rush core values The design should embrace community Incorporate sustainable (green) design within budget parameters

Pharmacy- Scope of Services

Pharmacy- Scope of Services Service Delivery Model

FUNCTIONAL PROGRAM ●

Pharmacy: ○ The central pharmacy is staffed 24 hours and all through the year. ○ It will service all the patient areas.

●

Primary Services: ○ It services inpatients and hospital based outpatients. ○ It supports all pharmacy operations in the campus. ○ Outpatient pharmacy services will be provided only when the outpatient pharmacy is closed.

●

Satellite Services: ○ It is for a fixed shorter period of time. ○ The main pharmacy services the satellite locations too. ○ OR Satellite- 6am-6pm

FUNCTIONAL PROGRAM ●

Satellite Services: ○ Critical Care Satellite- 7am-11pm ○ NICU/Critical Care satellite will also cover PICU between 6pm and 11pm via the tube system and floating the staff to the OR satellite.

●

Sterile Production: ○ It will be centralized in the main pharmacy. ○ In limited locations, provisions for STAT sterile production will be provided.

●

Automated Dispensing Machines (ADM): ○ It will be used in Clinical Area (near inpatient beds, interventional platforms, etc) for storing pharmaceutical supplies.

FUNCTIONAL PROGRAM ●

Interventional Platform & Inpatient Units: ○ Pharmacists are an integral part of the clinical care team. ○ Pharmacies are production facilities. ○ Pharmacists are in care delivery areas.

●

Automated Guided Vehicles (AGV): ○ The movement of supplies from from loading docks to main department and/from the department to the clinical areas.

●

Outpatient and retail pharmacy will be available in campus but not included in this program.

Space Drivers - Pharmacy The pharmacy primarily services inpatient and hospital-based outpatients but will support all pharmacy operations on campus. The following capacity assumptions have been projected to meet 2019’s needs. ●

● ●

The pharmacy supports approximately 725 to 750 beds in critical and acute care, obstetrics, neonates, pediatrics, psych, rehab, and geriatrics The pharmacy also supports 63 rooms for Interventional Services department. Pharmacy includes 92.2 full-time equivalent employees

Position

Administration Staff

Number of Staff

11.5

Pharmacists

Technicians

Specialists

7.7

TOTAL

92.2

ORGANIZATION â&#x2014;?

â&#x2014;?

Physical Adjacencies will become less critical in the future due to automated conveyance systems, decentralised pharmacy and computerized ordering and result reporting. Direct Access (physical or pneumatic tube) is necessary to patient floors and other diagnostic and treatment areas.

OPERATIONAL GUIDELINES

PATIENT FLOW Majority of consults and interaction of pharmacists with patients and staff will occur in the clinical areas and will not impact the pharmacy space in the basement.

INFORMATION FLOW ●

● ●

The physician will enter medication orders directly online, which will be approved by a pharmacist and filled by pharmacy techs. First doses will be dispensed from the pharmacy whenever the medication is not available by ADM of stocked by unit. Systems to track inventory and indicate whenever replenishment is required have to be put in place. Pharmacy staff should have access to all pharmacy systems in multiple locations through multiple media.

MATERIAL FLOW

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 2e: Function and Requirements of Major Department/Functional Unit E: Sterile Processing

FACILITIES FUNDAMENTALITY

● ● ●

is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumables handles thousands of reusable surgical instruments and devices every day has an essential role in the delivery of safe patient care.

https://www.google.com./search?q=sterile+processing&rlz=1C2CHZL_enUS744US760&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi92qT4opbXAhWl3oMKHS QHAbUQ_AUICigB&biw=1536&bih=686&dpr=1.25#imgrc=rkOBSYOFka88IM:

10 Guiding Principles ● ● ● ● ● ● ● ● ● ●

Same as other departments.

Sterile Processing Department(SPD)- Services Scope SPD will process instruments for the following departments: •surgery •anesthesia •Interventional radiology •Interventional cardiology •Labor and delivery •endoscopy

Currently-- pumps from inpatient units are transported to SPD for cleaning In the future-- this will occur on inpatient units in designated wipe down areas

https://www.google.com./search?q=sterile+processing&rlz=1C2CHZL_enUS744US76 0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi92qT4opbXAhWl3oMKHSQHAbUQ _AUICigB&biw=1536&bih=686&dpr=1.25#imgrc=2qYSlkbW5uBpBM:

FUNCTIONAL PROGRAM Centralized ● This program assumes that most reprocessing and routine sterilization functions will be centralized to support future operations. ● Scope cleaning completed close to the point of use and proposed to centralized on the interventional platform, adjacent to both 5th floor surgery and endoscopy/bronchoscopy. ● May be used for rapid turnaround of select items that require decontamination/ sterilization. Sized, equipped, staffed ● to support the needs of the entire hospital. ● A limited supply of mission-critical instruments and supplies will be maintained within the interventional platform, Labor and Delivery, and the emergency department. 100

FUNCTIONAL PROGRAM Case -specific supplies handled via an advanced surgical supply system ● Including direct vendor delivery, custom procedure packs, a procedure based delivery system(PBDSTM, or equivalent), or some combination to meet the unique demands of each service line. ● The distribution of instruments and sterile supplies will be handled via closed case carts. Automated information systems ● Direct communication from operating and interventional rooms to SPD is required. ● Direct communication may involve the use of wireless headsets or other advanced technology in lieu of personal paging or intercoms. ● One “pre-vac” sterilizer and a sink per two interventional rooms

101

FUNCTIONAL PROGRAM 24h continuous coverage ● Anticipated to operate 3 full shifts ● Including Saturdays, Sundays,holidays ● Peak processing time- from 10:30a.m. to 10:00 p.m. Monday- Friday Technology and equipment ● Incremental equipment, new technology and items not feasible for relocation, will be purchased new, as part of this project ● Selected, existing equipment may be reused ● The use of ethylene oxide(EtO) sterilization will phased out ● In favor of new technologies such as gas plasma and/or ozone sterilization

102

ORGANIZATION

SPACE DRIVERS Capacity Assumptions ● ● ●

The Sterile Processing Department has approximately 105 carts/exchange carts, and receives up to 27 skids of sterile supplies per day and processes up to 80 loaner carts per day. Space within the interventional suites should accommodate a footprint of 12-15 NSF/Cart Up to 60 scopes require cleaning on a daily basis including 16 endoscopes, 5 cystoscopes, and 40 for anesthesia (intubation).

Exchange Carts

Skids

Scope for intubation

ORGANIZATIONAL FLOW Soiled Elevators from Surgery

●

For all Operation rooms, interventional spaces : Supplies available from SPD on case specific basis. Supplemental supplies available from : case work or ADMs, storage carts. Flash sterilization should be minimised, with sterilizer units positioned strategically. New Surgical suites to have alternatives to traditional sub-sterile areas.

ETO Steril.

Decontam . Holding/St aging/Wor k Area Administration Staff Support

Steam Steril.

Plasma Steril.

Clean Room Instrumentation/ Wrapping

Break Down Room

Clean Storage Area

Cart Washer

Case Cart Assembly Wipe Down Decontamination Support, EVS, Storage, Staff

Clean Cart Holding

Clean Elevators to Surgery

MATERIAL FLOW Y

Material/ Equipment/ Instrumentation Arrive at loading docks

MaterialsSorted & Bundled

MaterialsSent to SPD for processing

MaterialsReceived in SPD; unpackaged & sorted

Decontamination/ Wrapping/ Sterilization

Non Stocked items returned to vendor

Case packs sent to SPD on case carts

SPD adds Instrumentation to case carts

Case cart completed on interventional platform by nursing/ decentralized SPD staff

Sterilization required?

MaterialsStored in Sterile Supply on wire racks

Soiled materials from clinical areas sent to SPD for processing

Unused sterile supplies returned to SPD

Case / Procedure

Items stored in SPD or Sterile Supply as appropriate

INFORMATION FLOW ● ●

●

The infrastructure has to be adaptable to future changes in technology and clinical care delivery. The infrastructure will be capable of supporting wireless technology , EMR (Electronic Medical Records), RFID (Radio Frequency Identification), PACS (Picture Archiving and Communication System), CPOE (Computerized physician order entry). Specific Communication systems include: ○ Wireless technology for communication between interventional staff and SPD core staff. ○ A comprehensive SPD (Sterile Processing Department) management information system capable of tracking physical location of sets, enhance overall management of instrumentation and automate aspects of SPD documentation (sterilization loads, time/temp.parameters, volume, etc.) ○ SPD should have access to the OR info system to facilitate seamless flow of instruments 7 case carts to/from the SPD.

PLANNING & DESIGN CONSIDERATIONS Reception, Registration & Waiting

PLANNING & DESIGN CONSIDERATIONS Staff Work & Support Space

PLANNING & DESIGN CONSIDERATIONS Materials, Logistics and Storage ●

Receiving and staging area is required for all incoming supplies. Area should be designed such that corrugated shipping containers, pallets, and other unsanitary material do not enter SPD environment.

●

To the extent possible, routinely used supplies should be de-cased and the shipping cartons be disposed prior to being delivered to SPD

●

Supply and instrument storage system should incorporate moveable, high-density shelving where appropriate. The shelving/cart/rack layout should have access from both ends and adequate aisle space

PLANNING & DESIGN CONSIDERATIONS Building Systems: HVAC, Plumbing, Electrical/Lighting ●

De-ionized water systems should be anticipated in the Decontamination Room.

●

The HVAC system will be designed to meet State health and hospital infection control standards. There should be sufficient sufficient air changes, humidity control, and ample air conditioning to mitigate heat dissipation from SPD equipment.

●

HVAC Air return ducts must be coated, galvanized steel or treated to aluminum to prevent corrosion and rust

●

Redundant systems and emergency back-up power will be required to keep certain equipment operational at all times.

●

Emergency eyewash stations and separate hand wash sinks should be provided in the Decontamination area. Multiple hand washing sinks should be located throughout the department.

PLANNING & DESIGN CONSIDERATIONS Special Requirements ●

Equipment and activities within SPD require unique environmental and mechanical requirements. The area should be located, planned and designed to mitigate potential damage to adjacent areas from water leakage or water vapor accumulation.

●

Equipment require specialized power, enclosure system, and water, steam, and drain lines.

●

Floor and wall surfaces must be slip resistant, waterproofed and finished with non-organic materials.

●

Current steam provisions are inadequate for current and future capacity. Steam quality is poor and pressure is poor and pressure is inconsistent. Consideration should be given to generation of steam on site to maintain proper pressure and thus, continuous operations in SPD

Steam Sterilizer

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 2f: Function and Requirements of Major Department/Functional Unit F: Obstetrical Services Department

FACILITIES FUNDAMENTALITY

● ●

relating to the care and treatment of women in childbirth and during the period before and after delivery. relating to childbirth or obstetrics. has an essential role in the delivery of safe patient care.

https://www.google.com./search?q=obstetrical+service&rlz=1C2CHZL_enUS744US760&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj9yLaT2KXXAhWU3oMKH ePFC8QQ_AUICigB&biw=1536&bih=735&dpr=1.25#imgdii=K2kqQooQlFEeaM:&imgrc=O6jeY2YutvY0EM:

10 Guiding Principles ● ● ● ● ● ● ● ● ● ●

Same as other departments.

Obstetrical Services Department- Services Scope Obstetrical Services provides a full range of patient care services to mothers and babies before, during, and after the birthing process in a pleasant and safe atmosphere.

118

FUNCTIONAL PROGRAM Horizontal Adjacency ● OB Triage, Antepartum, LDR (labor, delivery, recovery room), C-Section, and NICU desire horizontal adjacency

Prototype unit ● Post Partum rooms will be aggregated as a “prototype unit” with adjacency to the Newborn Nursery ● Ante Partum rooms will be aggregated as half a “prototype unit”

119

SPACE DRIVERS In Order to determine the number and type of key rooms required the projected volumes and operating models are studied and projected to 2019 medium scenario volumes.

ORGANIZATION

INTER-DEPARTMENTAL RELATIONSHIP

EMERGENCY ACCESS

ANTE-PARTUM

POST- PARTUM

LDRs ANTEPARTUM ROOM

TRIAGE

D&T

VISITOR/ PATIENT ENTRY

SUPPORT

NURSERY

C- SECTION / PAR

NICU

TRANSITIONAL ROOM

SUPPORT

PATIENT FLOW ED

MATERNAL TRANSPORT

WALK-INS

OVERFLOW GYN PATIENT

DEDICATED PARKING/ DROP OFF

PATIENT ARRIVES VIA AMBULANCE GARAGE

ARRIVE AT MAIN ENTRANCE

TRANSFER VIA PATIENT ELEVATORS

GREET PATIENT/ OFFER WHEELCHAIR

TRANSFER VIA PATIENT ELEVATORS

RECEPTION & OB TRIAGE

GREET PATIENT/ OFFER WHEELCHAIR

FALSE LABOR

EXIT

OVERFLOW GYN

PATIENT FLOW RECEPTION & OB TRIAGE REASON FOR VISIT

PERI-NATAL DIAGNOSTIC & TESTING

ANTE-PARTUM TESTING

CHILDBIRTH EDUCATION/C LASSES TO CLASSROOM/ EDUCATION AREA

TO EXAM ROOM FOR DIAGNOSIS, TESTING OR TREATMENT

EXIT

LABOR

OVERFLOW GYN

TO POST PARTUM DISCHARGE OR TRANSFER

PATIENT FLOW LABOR

DELIVERY TYPE OR STATUS

LDR

SCHEDULED C SECTION ?

POSTPARTUM

ANTE-PARTUM

N READY TO DELIVER?

N COMPLICATIONS ?

C- SECTION

N RECOVERY IN LDR

RECOVERY IN PAR

COMPLICATION ?

N BABY TO NURSERY

MOTHER TO POST PARTUM

CRITICAL CARE ONGOING ORDERS & CARE; EDUCATION; SCHEDULE FOLLOWUP, GIVE INSTRUCTIONS; PAYMENT OR FIN COUNSELLING

DISCHARGE HOME

MATERIAL FLOW ● ●

● ●

●

● ●

Separate circulation of patient, public and service traffic. Service traffic should have horizontal traffic pattern, distinct from patient and nursing areas. Sufficient vertical transportation should be planned. Clean and soiled material flows must be segregated during elevator transport. Pneumatic tube system , close to the clerical area should have appropriate capacity. An integrated call centre is proposed. AGVs for material transport are also being explored. https://commons.wikimedia.org/wiki/File:IntelliCart1.jpg

SPACE ALLOCATION- OBSTETRICAL DEPT.

https://www.rush.edu/sites/default/files/rush-campus-map-062217.pdf

Planning and Design Considerations Patient/Family/Visitor Arrival and Wayfinding ● Designated entry for Obstetrical patient in close proximity to street with short-term parking (for women in labor) ● Women in labor have direct access to appropriate procedure zone bypassing public reception and family lounge ● Separate staff and visitor entries for patient unit and separate patient and public vertical transport ● Good signage Reception, Registration, and Waiting ● Have green spaces (fountain, garden, etc) for respite & quiet ● Reception will control triage and assessment. It must also be secured by locked/accessed control doors ● Receptionist should have view of family area and patients ● Provide play areas for siblings as well as computer access ● Registration will occur by “bedside”

Emergency Entrance - Possibly used for Obstetrics as separate entry bypassing public reception and lounge

Lobby

Main Entrance

https://images.adsttc.com/media/images/526e/cf9a/e8e4/4ef4/c200/05f7/large_jpg/ Rush_Perkins_Will_44.jpg?1382993808

https://www.rush.edu/sites/default/files/rush-campus-map-062217.pdf

Planning and Design Considerations Patient Care and Direct Support ● Triage and Assessment Area is open 24/7, enclosed/private, adjacent to clinical work station equipped with sinks and ultrasound ●

Surgical delivery suite should be a sterile area separated clearly with automatic doors and adjacent to soiled utility room

●

The maternity unit must provide area where fathers will scrub and wear a gown before entering sterile area. Private prep and recovery areas must be designed for high patient visibility.

●

Newborn nursery must be adjacent to maternity units, be visible to central caregiver support station, have handwashing sinks in strategic locations, and contain an examination room, room for circumcision, and office for lactation consultant.

●

Caregiver support station must be center for patient care units and newborn nursery in order to fulfill its roles of patient monitoring, central communication, storage for reference material, and administrative supply storage,

COMPREHENSIVE UNIVERSITY MEDICAL CENTER Case study Phase 3a: Inter-departmental Relationships and their space organizational implications

FACILITIES FUNDAMENTALITY

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ADJACENCY MATRIX

INTER-DEPARTMENTAL SPACE ADJACENCY

FUNCTIONAL PROGRAM The various departments within this proposed medical center are: