The Patient Room. Planning, Design, Layout by Birkhäuser

The Patient Room Planning, Design, Layout

Wolfgang Sunder Julia Moellmann Oliver Zeise Lukas Adrian Jurk

Birkhäuser Basel

Preface 7

Fundamentals

The Emergence of Hospitals 10 From the Monastic Hospice to the Modern Clinic The Nursing Ward Environment 15 Current Care Settings and Their Challenges Healthcare-Associated Infections 21

Typologies of the Patient Room

The Floor Plan of a Two-Bed Room 28 Qualitative Evaluation of Two-Bed Rooms 38 Typological Evaluation of Two-Bed Rooms 44

Rasmus Leistner

Material Applications and Material Ageing in Hospitals 24 Inka Dreßler, Katharina Schütt

Selected Case Studies General Hospitals Trillium Health Centre Mississauga, Canada 66 Zollikerberg Hospital – New West Wing Zollikerberg, Switzerland 70 Zollikerberg Hospital – Renovation of East Wing Zollikerberg, Switzerland 74 Hvidovre Hospital Hvidovre, Denmark 78 Lauf District Hospital Lauf an der Pegnitz, Germany 82 AZ Zeno Knokke-Heist, Belgium 86 Haraldsplass Hospital Bergen, Norway 90 Solothurn Public Hospital Solothurn, Switzerland 94 New North Zealand Hospital Hillerød, Denmark 100 Südspidol Esch-sur-Alzette, Luxemburg 104

Specialised Hospitals Jugenheim District Hospital Seeheim-Jugenheim, Germany 108 Sana Clinic Munich Munich-Sendling, Germany 112 BGU Accident and Emergency Hospital Frankfurt am Main, Germany 118 Princess Máxima Center Utrecht, the Netherlands 122 St Joseph-Stift Dresden Dresden, Germany 128 St Gallen Geriatric Clinic St Gallen, Switzerland 132 Uster Hospital Uster, Switzerland 136 University Hospitals Surgical Centre Erlangen University Hospital Erlangen, Germany 138 Crona Clinic Tübingen University Hospital Tübingen, Germany 142 Erasmus MC Rotterdam, the Netherlands 146 Oncological Centre Leuven University Hospital Leuven, Belgium 150 Paediatric Clinic Freiburg University Hospital Freiburg, Germany 154 Children’s University Hospital Zurich Zurich, Switzerland 158 Münster University Hospital Münster, Germany 161

Building Structures in German Hospitals 164

Prototype of a Patient Room – the KARMIN Project Architecture of the Patient Room 170 Planning and Design 178 Colour and Materials Concept 183 Lighting Concept 185 Building the Prototype 196 Completed Prototype and Use Scenarios 198

Furniture and Equipment 206 The Disinfectant Dispenser 210 The Patient Bedside Cabinet 224 The Bedside Terminal 230

Conclusion 237 KARMIN Project Team 239

Appendix 240 Glossary 240 About the Authors 245 Subject Index 246 Index of Names, Places and Projects 249 Illustration Credits 250 Acknowledgements 252

Typologies of the Patient Room

The Floor Plan of a Two-Bed Room

8 m² 1.2 m

8 m²

1 Mindestanforderung Minimum standard

Typologies

1.2 m

barrierearm/-frei 2 Barrier-free/low-barrier

The design of patient rooms is a particularly demanding task that generations of architects, hospital planners and interior designers have grappled with. The challenge is to accommodate a wide range of specific needs and users’ interests in a room of limited size. Despite its small floor area, the patient room is the most frequently reproduced unit in a hospital and can quickly become the primary determinant for a hospital design. The repetition of the rooms in a ward is not only legible from outside on the building’s façade; it can also define the typology, for example in the case of a “bed tower block” through vertical repetition where the upper floors are typically exclusively patient wards. The patient room is therefore a central element of the planning of a hospital. This section discusses the planning principles for designing a two-bed room and examines its constituent structural elements. First and foremost, the design of a patient room is always a specific, individual response to the existing needs and prevailing contextual conditions. Whether the design is for a new building, for an extension to an existing building or for the renovation and upgrading of existing facilities, the context and the available budget are key determining factors for the room design. Likewise, regulations and guidelines have a direct impact on room planning and floor plan design and can sometimes be very constraining by defining minimum distances and optimised care provision pro cedures that must be ensured without exceeding a certain room size or financial parameters. While this may create the impression that there is little remaining scope for design, a wide range of different patient room designs have been created over the past few decades. Architects and hospital planners have succeeded in developing and implementing various original concepts, especially for two-bed rooms, often in the context of clinical studies. A study of these room types reveals the entire spectrum of design possibilities. Two-bed rooms are a particularly interesting typology to study. This chapter examines the different options in the design of a patient room and the design principles that guide them. It details the design possibilities available to the planner when designing a patient room and presents them in a scheme with the aid of a corresponding example. This study takes the floor plan as its basis and therefore describes only those aspects that actually manifest themselves in or influence the floor plan, and that can be seen as design principles. Likewise, it also considers the essential fittings and equipment that influence the room layout. A key aspect that has a decisive impact on the floor plan design of two-bed patient rooms is the wet cell – the patient’s bathroom within the room. It determines the remaining layout of the patient room and often also the placement of other key fittings within the room. To understand how the different elements in the room interact, it is instructive to look at each part of a room configuration and identify how these can be grouped according to recognisable interdependencies or principles.

1.2 m

Patient Bathroom Floor area of wet cells

51 Minimum standard Mindestanforderung

5 2 Barrier-free/low-barrier Barrierearm/-frei

The floor area of wet cells is determined largely by requirements for freedom of movement and minimum distances within the patient bathroom. In this study, we classify them into two groups: Minimum standard The bathroom complies with the prescribed minimum distances between the individual bathroom components and the passage width of the door, but this does not guarantee barrier-free access → Fig. 51.

innenliegend 53 Inboard

außenliegend 5 4 Outboard

Barrier-free/low-barrier standard In terms of the floor plan, the focal consideration is the provision of sufficient freedom of movement. An area of at least 120 × 120 cm must be provided in front of sanitaryware such as the toilet bowl, wash basin, bathtub and shower area (DIN 18040-2). As not all accessibility requirements can be evaluated using the floor plan, we use the term “low- barrier” to denote the minimising of barriers → Fig. 52.

Position of wet cells In this study, we only evaluate two-bed rooms that comprise a wet room. Within these units, the position of the wet room is of central importance as it determines the remaining disposition of the floor plan. Four basic configurations are commonly used: 5 Alternating inboard/outboard 5 innen- und außenliegend im Wechsel

Inboard An inboard wet room is placed next to the room entrance adjoining the corridor and is the standard and therefore most common arrangement seen in hospitals → Fig. 53. Outboard An outboard wet room is located along the exterior wall. This much less common arrangement reduces the size of the window opening of the two-bed room, and thus limits the degree of light entering the room but has the advantage of being able to naturally ventilate and illuminate the bathroom → Fig. 54.

56 Nested nested

Alternating inboard/outboard Inboard and outboard wet cells can be employed alternately in a row of rooms with the room constellation switching. Alternatively, one room can have two bathrooms → Fig. 55. Nested In the nested arrangement, two bathrooms are placed between two patient rooms. This has the advantage of allowing the patient rooms to be open and rectangular. A minimum planning unit therefore comprises two patient rooms and two intermediate wet cells → Fig. 56.

Floor Plan

Additive principles for wet cells

57 Same-handed Same-handed

Additive principles apply equally to the serial repetition of wet cells as they do to the patient rooms. Although the bathroom arrangement is linked to that of the patient rooms, it is not identical and therefore warrants its own consideration. The following patterns of repetition apply to patient bathrooms and echo those of the patient rooms described earlier. Same-handed The size, orientation and fittings of the wet rooms are identical throughout the ward. Because of the identical layout, carers can always approach patients from the same side → Fig. 57.

58 Mirrored floor plan Spiegelung

59 Floor plan combination Kombination

Mirrored floor plan The wet cell and the orientation of fittings and equipment within it are mirrored along the dividing wall. As previously mentioned, this configuration is encountered frequently because it allows a common vertical duct to serve two adjacent wet cells, effectively halving the amount of plumbing and supply lines, saving materials and costs. The repetition principle is like that of the same-handed configuration, except that each repeated unit comprises two cells with mirrored layouts → Fig. 58. Floor plan combination or variation With this configuration, two different wet room configurations are used in combination within a row. Alternatively, variations of a single type of bathroom are also possible, for example when additional requirements need to be met or the size or equipment is adapted to meet a specific need (e.g. rooms for obese patients) or where modifications are necessary for design reasons → Figs. 59, 60.

Use of wet cells

60 Floor plan variation Variation

Bathrooms may be used by patients in different ways. One bathroom for shared use A two-bed room usually has a single shared bathroom, which is about 3–4 m² in size → Fig. 61. Two bathrooms for shared use Two bathrooms in a patient room can be equipped differently to serve two different purposes. They are used by both patients → Fig. 62.

61 One bathroom for shared use Eine Nasszelle - Gemeinsame Nutzung

62 Two bathrooms for shared use Zwei Nasszellen - Gemeinsame Nutzung

Typologies

Two identical bathrooms for separate use In this configuration, two identical bathrooms are created, one for each patient → Fig. 63.

AZ Zeno New hospital

Despite its considerable size, the design concept for the AZ Zeno in Knokke-Heist is applied consistently at all scales, from the building to the patient rooms to every last detail of the fittings. The architects have achieved a good balance between modern appearance and the impression of clinical cleanliness.

Architects AAPROG Boeckx B2Ai Interior designers B2Ai Client AZ ZENO Location Knokke-Heist, Belgium Completion 2018 Beds per floor 80 Net area, single room 20.62 m² + 3.5 m² bathroom Net area, two-bed room 28.62 m² + 3.5 m² bathroom

The new building for the AZ Zeno (AZ is the abbreviation for algemeen ziekenhuis, or general hospital) with its organic building form is the product of a collaboration between three Belgian architectural offices – AAPROG, Boeckx and B2Ai – who together won the competition for its design in 2007. Opened in 2018, the new hospital building comprises a rehabilitation centre, nursing wards with a total of 270 beds, an outpatient clinic, lecture halls, event areas and a helicopter landing pad. The building’s design needed to meet the requirements of a modern, sustainable, forward-looking hospital while respecting the rural character of its surroundings. Raised off the ground and enveloped in a curved exterior, the three-storey and four-wing volume has the futuristic appearance of a floating object that has alighted nimbly on the existing landscape. Three of the wings house patient rooms with views out over the dunes while the fourth facing the road and parking areas contains the medical facilities. A 600 m² roof garden on the second floor can be reached from the cafeteria. All transitions between inside and outside and between the wards and public areas within the building are fluid. Warm colours, bright daylight and art in the interiors create a homely environment for the patients. The design of the patients’ rooms is simple and restrained. In addition to a regular door, a movable panel in the single rooms can be slid to one side to provide direct access to the patient bathroom. It also acts as a room divider, closing off the entrance area from the room when more privacy is required. The split two-panel door – with separate upper and lower opening sections – was especially conceived for the geriatric wards to allow patients to feel connected and in contact with people in the ward corridor when in their room. A particularly space-saving solution is the fold-out bed for relatives to stay overnight incorporated into the fitted wall cupboards. Instead of the desk in the single rooms, the two-bed rooms have two rounded shelves for placing pictures and greeting cards as well as a shared table. In the bathroom, all components, including the polycarbonate swinging shower partitions, are wall-mounted to avoid contact with the floor, preventing colonisation with germs and making it easier to clean the floors. The bathroom flooring in bright colours such as green or violet contrasts with the otherwise white rooms. The bathrooms in the two-bed rooms have two washbasins, one for each patient. The solid oak window frames harmonise with the wood-effect flooring in the rooms and some surfaces, such as the sliding door panels, are printed with photographic motifs. The interior design aims to create a calm and comfortable atmosphere for the patients so that the clinical functions recede into the background.

1 Site plan, 1 : 20,000 2 The building façade with the roof terrace adjoining the cafeteria 3 The mass of the building is raised off the ground. 4 Ward floor plan, 1 : 1000

Typologies

Case Studies

Typologies

5 Bathroom 6 Nurses’ station with waiting area 7 Floor plans of single and two-bed rooms, 1 : 100 8 Single room looking towards the split-leaf entrance door 9 The sliding bathroom door panel can act as a room divider. 10 Room in the mother and child ward with nurses’ work area

AZ Zeno