Upgradation of DHQ to General Teaching Hospital

Upgradation of DHQ to General Teaching Hospital, Sialkot

SUBMITTED BY:

Iqbal Javed BACHELOR OF ARCHITECTURE

DEPARTMENT OF ARCHITECTURE SCHOOL OF ART, DESIGN & ARCHITECTURE UNIVERSITY OF GUJRAT

DEDICATION Dedicated to My Parents And Grand Parents, With love.

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ACKNOWLEDGEMENTS

I am greatly thankful to ALLAH, the most merciful and the knower of all things, who helped me in completing this report on teaching hospital.

I want to express my gratitude and appreciation to my adviser Professor Dr. Abdul Rehman for their expert guidance and help throughout the course of my study Thanks is also due to the all people, for the assistance in obtaining the information required for my research and for their generous support in making this report possible.

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PREFACE The subject of health care is one, which is being given increasing attention through the world. Today the problem is the increasing number of ill people who need care. The role of medical care in the pattern of developing and developed countries increasing. The role of the architect in producing buildings for health care, which will be efficient, economical and pleasant places, is one, which will remain important in the future. The continuous expansion of the health care in one form or another to a widening range of the population seems inevitable.

Buildings are not the main source of health care, although shelter is generally necessary but care depends on people, doctors, surgeons, nurses and auxiliaries, chemists, cooks and social workers, technicians and administrators and on an organized hierarchy of establishments within which they can work in an interrelated manner. All these must be supported by finance and supplies and backed by a system of education and training that is adequate to provide continuous reinforcements to their numbers.

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Dedication

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Acknowledgements

III

Preface

IV

Contents

V

List of Figures

VII

1 INTRODUCTION

(1 – 5)

Introduction

Project Background

Importance of the project

Project Title

Client

Location

Area of Site

Reason of project Selection

Objectives

Scope of work

Research Methodology

2 LITERATURE REVIEW

(6 – 16)

Historical Background

Hospitals

Types of Hospitals

Difference

Basic departments

Hospital Design

Hospital Planning

Spaces in Hospital

Way Finding

Interior Designing

Hospital System

Supporting Services

Patient Care

Different Standards

Conclusions

3 CASE STUDIES

(17– 43)

QUEEN ELIZABETH UNIVERSITY HOSPITAL, ENGLAND SANT JOAN DE REUS UNIVERSITY HOSPITAL, SPAIN AGA KHAN UNIVERSITY HOSPITAL, PAKISTAN

4 RESEARCH ASPECTS O.P.D.

(44 – 61)

Accident and Emergency IV

Operating Department

Zones of O.T.

Planning Principles

Types of Wards

C.S.S.D

I.C.U

Diagnostic Department

Inpatient Department Labor & Delivery Suites Major Elements for Master Planning General Services Department Creating Healing Environmental Conclusions

5 BUILDING PROGRAM

(62– 81)

6 SITE ANALYSIS

(82 – 88)

Profile of Sialkot

Boundaries

Population

Location of site

Feasibility

Nature of site

Features

By Laws

Detail of area

Wind Direction

Climate

Conclusions

7 DESIGN BRIEF

(89 – 91)

8 BIBLOGRAPHY

(72)

V

List of Figures 2 Literature Review

6

Fig: 2.1 Relationship Diagram Fig: 2.2 Hospital System

3 Case Studies

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3.1 Queen Elizabeth University Hospital Figure: 3.1 QEUH View Figure: 3.2 Master Plan Figure: 3.3 Ground Floor Plan Figure: 3.4 First Floor Plan Figure: 3.5 Second Floor Plan Figure: 3.6 Third to Sixth Floor Plan Figure: 3.7 Seventh Floor Plan Figure: 3.8 Ground Floor Flow Chart Figure: 3.9 First Floor Flow Chart Figure: 3.10 Second Floor Flow Chart Figure: 3.11 View of QEUH Figure: 3.12 View of QUEH Figure: 3.13 Ward Shape Figure: 3.14 View of Bridge Figure: 3.15 View of Helipad Figure: 3.16 View of Reception Figure: 3.17 View of Main Corridor VI

3.2 Sant Joan De Reus University Hospital Figure: 3.18 View of Sant Joan Hospital Figure: 3.19 Master Plan Figure: 3.20 Basement Floor Plan 01 Figure: 3.21Basement Floor Plan 02 Figure: 3.22 Ground Floor Plan Figure: 3.23 First Floor Plan Figure: 3.24 Basement Floor flow chart 01 Figure: 3.25 Basement Floor flow chart 02 Figure 3.26 Ground floor flow chart Figure 3.27 Conceptual sketch Figure 3.28 View of Sant Joan Hospital Figure 3.29 North View Figure 3.30 South View Figure 3.31 Ventilation conceptual sketch Figure 3.32 View of Corridor Figure 3.33 Natural light in interior Figure 3.34 Public circulation space

3.3 Aga Khan University Hospital

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Figure 3.35 View AKUH Figure 3.36 Master Plan Figure 3.37 Ground floor plan Figure 3.38 First floor plan VIIÂ Â

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Figure 3.39 Second floor plan Figure 3.40 Master plan flow chart Figure 3.41 Ground floor flow chart Figure 3.42 Conceptual sketch Figure 3.43 Section Figure 3.44 Entrance view Figure 3.45 Conceptual entrance sketch Figure 3.46 Courtyard in student`s hostel Figure 3.47 Auditorium

4 Research Aspects

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Figure 4.1 Accident & Emergency Figure 4.2 Surgical Suite Flow Diagram Figure 4.3 Types of Wards Figure 4.4 C.S.S.D Figure 4.4 Pathology Labs Figure 4.5 Delivery Suite Flow Diagram Figure 4.6 Services Department

6 Site Analysis

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Figure 6.1 Google map of site

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1.1 INTRODUCTION Among the factors that influence the progress of a country and its development, the importance of health is the most governing. The health of the individual determines his efficiency which will ultimately enhance the efficiency of the whole nation. Without this, social welfare and peace can hardly be achieved. Pakistan is one of the countries, which is in a big need of hospitals.

Government is trying to provide better health facilities to common citizen.

1.2 PROJECT BACKGROUND There are two district headquarter hospital (DHQ) in Sialkot, Allama Iqbal Memorial Hospital (AIMH) and Government Sardar Begham Hospital (GSBH) out of which AIMH is the biggest hospital of the district and has been functioning without any intensive care unit (ICU) since its establishment in 1964. It has no burn unit while its coronary care unit (CCU) of cardiac ward is also not working properly and the patients are referred to hospitals in other cities of Punjab.

Also, it is 400 bed hospital but number of patients in wards and also in OPD becomes double due to the rapid increase in population as well as diseases.

1.3 IMPORTANCE OF THE PROJECT Secondly government of Punjab recently built a medical college named Khawaja Muhammad Safdar Medical College (KMSMC) in Sialkot due to which the need for an attached Teaching hospital rose, as the existing hospital AIMH is overcrowded and could not be used conveniently for this purpose. The service of hospitals in teaching of medicine has become a matter of primary importance. A modern medical school can hardly be defined apart from hospitals. So, the government of Punjab decided to build a new general and teaching hospital of 400 bed near the medical college.

1.4 PROJECT TITLE Upgradation of DHQ to General Teaching Hospital, Sialkot

1.5 CLIENT “Planning and development department, Government of Punjab” The client desires to build a Teaching hospital near a newly built medical college (KMSMC) in Sialkot. The client, after consulting various specialists, come up with the requirements of a hospital. Generally, they have categorized hospitals as under.

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  

Basic health unit.

Tehsil headquarter hospital District headquarter hospital which can be a teaching hospital.

The size and requirement, allocation of staff, doctors and departments are pre-planned for these categories. Client wants to incorporate sub specialized facilities of most use in order to increase its efficiency according to common needs of health care.

1.6 LOCATION Sialkot, Punjab, Pakistan.

1.7 AREA OF SITE 20.00 acre.

1.8 REASON OF PROJECT SELECTION Hospital designing has become a specialized field of architecture throughout the world and any such exercise demands manifold studies of intricate details of different functions of hospital.

While designing a health building, the primary concern is the patient as the whole building and staff are mean to serve him during the course of his sickness.

Today the innovations in architectural style demand a fair justification and attention.

Function is more important and beauty will add to its prestige.

But the architecture should be according to one`s need. Function, society, psychology, culture and ideology affect the architecture. These factors should always be kept in mind before designing. As I believe in functionalism and I am a patron of functionality, therefore I decided to design a building fully portraying functionalism.

Although there are other projects regarding functionalism, like air-port etc., but hospital is a project that can very easily be accessed and for me it is very difficult to collect information on project like air-port than to collect information about hospital which is easily accessible.

1.9 OBJECTIVES The main aim of the project is to help the sick and injured to make them a productive member of society. This aim can only be achieved by fulfilling the following objectives.

Understanding the psychology and behavioral aspects of sick person and to improve the health condition is the city. To reduce the mortality rate in the city and to incorporate both high and low income groups by providing wards, private rooms. To arrive a set of design parameters for a sensitive and responsive environment and to create a real meaning of hospital by establishing a more interactive relationship with the environment.

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1.10 SCOPE OF WORK Scope of work include following:     

           

Master Planning Landscape Emergency Department O.P.D Diagnostic Department  Radiology  Pathology Surgical I.C.U C.C.U Inpatient Wards Central Sterile Supply Department Blood Bank Administration Library Private rooms Parking Masjid Residences for staff

1.11 RESEARCH METHODOLOGY It involves research and data collection for proposed teaching hospital through study of relevant literature, survey of the existing general teaching hospitals and interviews with the knowledgeable persons were undertaken. In the light of these surveys, interviews and opinion of professionals, the recommendations proposed and conclusions derived which are based on the context, concept and theories for the design of hospital.

The procedure will be done through:  Book Reading 

Hospital administration and human resource management



Hospital facilities planning and management



Hospital administration and management



Modern trends in planning and designing of hospitals

 Study of technical data UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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Time Saver Standards



Live observation of equipment.

 Case Studies 

Queen Elizabeth University Hospital Birmingham, England



Sant Joan De Reus University Hospital, Tarragona, Spain



Aga Khan University Hospital, Karachi, Pakistan

 Interviews from doctors, staff and patient  Discussion with professionals  Questionnaire  Site Analysis  Hospital Reports Design will be based on conclusions.

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2.1 HISTORICAL BACKGROUND The word “hospital” is derived from Latin word “hospitals” which comes from hopes, meaning a host. The English word “hospital” comes the French word “hospital” meaning a hostel and hotel, all the originally derived from same Latin. The three word, hospital, hostel and hotel although derived from the same source, are used with different meanings. The term “hospital” means “an establishment for temporary occupation by the sick and the injured”. Today hospital means “an institution in which sick or injured persons are treated”. R.C. Goyal and D.K Sharma In addition to other needs of mankind, the treatment of human body had been one of his primary need to keep his soul and body intact. Motivated by the strong human desire of selfprevention man tried to understand the therapeutic values of various materials and used them.

The earliest hospital was built in Damascus, Syria by Caliph Al-Walid in 707. Eighty years later the Caliph of Baghdad Haroon Al-Rasheed attached a college (madrassa) to every masjid and a hospital to every college. From its earliest inception, the college, hospital and masjid were linked.

Teaching and the advancement of medicine were seen as integral parts of a hospital`s function. By the twelfth century, hospitals were in use throughout the Islamic world and made their way to Europe by way of Crusaders, who marveled at these new institutions

2.2 HOSPITAL A hospital is an institution providing medical and surgical treatment and nursing care for ill or injured people. It is an organization for the provision of health care to the people.

2.3 TYPES OF HOSPITALS There are generally three types of hospital: 1. General Hospital 2. Teaching Hospital 3. Specialized Hospital

2.3.1 GENERAL HOSPITAL A general hospital is one that is organized to deal with a variety of conditions of illness needing specialized skills or equipment that cannot economically be provided in the patient`s home or in small medical centers. It brings together in a concentrated form of most of the specialist services otherwise performed by a number of separate hospitals with more limited functions.

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2.3.2 TEACHING HOSPITAL A teaching hospital is a place where medical students are taught to become physicians or surgeons. It has three interdependent functions.

1. Treatment of sick.

2. Undergraduate and postgraduate education including nursing.

3. Research

2.3.3 SPECIALIZED HOSPITAL A specialized hospital is one that includes highly specialized services, including superspecialties such as plastic surgery, neurosurgery and heart surgery.

2.4 DIFFERENCE BETWEEN GENERAL AND TEACHING HOSPITAL A teaching hospital is generally understood as a center of secondary or tertiary care in a major city that is affiliated with a medical school, often with an academic department and a reputation for excellence in research. A district general hospital, although a major provider of secondary care in the local area, traditionally lacked the research focus. However, in recent years this distinction has become blurred, as many district general hospitals have now become part of medical schools and are actively involved in research.

2.5 BASIC DEPARTMENTS OF A HOSPITAL Hospitals contain three basic categories of accommodation, all different in function and physical requirements.

1. Department which contain beds organized in wards of a size appropriate to their specialty and the nursing team that look after them, to each ward is attached the accommodation necessary for its day-to-day clinical and domestic servicing.

2. Department which provides the diagnostic, surgical, medical and therapeutic services, needed to support the wards and minister to out-patients.

3. Department that look after the establishment as whole, providing it with medical and domestic supplies, food and energy, and maintaining the physical structure and equipment.

2.6 HOSPITAL DESIGN Hospital is the most complex of building types. Each hospital is comprised of a wide range of services and functional unit. These include diagnostic and treatment function, such as clinical laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food services and housekeeping; and the fundamental inpatient care or bed related function.

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This diversity is reflected in the breadth and specificity of regulations, code, and oversight that government hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, and electrical, and telecommunication systems, requires specialized knowledge and expertise.

No one person can reasonably have completed knowledge, which is why specialized consultant play an important role in hospital planning and design. The functional unit within the hospital can have completing needs and priorities. Idealized scenarios and strongly-held individual preference must be balanced against mandatory requirements, actual functions need “internal traffic and relationship to other departments”. And the financial status of the originations.

The traditional hospital lobby has given way in some hospitals to a newer concept in design, such as a concourse or expanded central Public street, that allows for multiple entrances to the desired hospital area. The concourse centralizes and controls each type of traffic flow, yet through a series of short hallways allows traffic to flow to all areas of the hospital. This design permits more flexibility in developing interdepartmental plans and should be given serious consideration when planning the design.

Visitors' elevators to patient units need surveillance and control: Stairwells should not be visible from the lobby or concourse, and they should be difficult for visitors to find. A desk area near the elevators for volunteer control might he considered. Exterior courts and placement of a fine arts program should be integrated into these important public spaces.

2.7 HOSPITAL PLANNING The planning of a hospital based on interrelationship between various departments which function independently but connect with each other. The hospital complex is arranged according to function and supporting services. More public area such as OPD, emergency and diagnostic department should be located at the front of hospital while the less public areas such as IPD, administration and services department should be accommodated at the back of building. But the connection of all these departments should be compulsory.

Certain relationships between various functions are required as in the following flow diagram.

Figure 2.1 Relationship Diagram

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2.8 SPACES IN HOSPITAL 2.8.1HOSPITAL ENTRANCES The three major entrances are  Outpatients entrance for dropping and picking up patients and visitors.  Emergency entrance for emergency patient and ambulance cases  Services entrance for delivery of supplies and for pick up or removal of trash and garbage from facility. In some hospital removal of dead bodies takes this route.

These entrances are determined by the traffic flow inside the facility, and in turn will determine traffic flow outside and location of parking lots.

2.8.2 MAIN ENTRANCE In most of our hospital there is one main entrance that is used by every one – outpatients, inpatients, visitors, medical staff and personnel. One can imagine the confusion caused by the merging of the outpatient crowd with the other traffic at the main hospital entrance. In many hospitals, a separate entrance is provided for staff, and patients.

2.8.3 EMERGENCY ENTRANCE There should be a separate entrance to the emergency department also called ambulance entrance for cases brought in by ambulance or private vehicles. There should be adequate reserved parking space for ambulances and cars of patients and medical staff. In many hospitals, especially where there is no separate entrance to the main hospital, or where the main entrance remains closed, emergency entrance becomes the main entrance for the hospital during the night.

2.8.4 PARKING The type of parking required and an exact parking count for each entrance are extremely difficult to produce as both are related to the entrances function. Also, each hospital facility has a different mix of public and private transportation and parking and traffic patterns will vary accordingly.

The following figures are a guide to design:   

Visitors: one space for every three to five patients Patients: included in visitor's count Ambulatory care: live spaces per doctor in the outpatient suite, plus emergency parking

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 

Hospital staff: one space for every three employees during the peak daytime shift Medical staff: one space for each one and a half-stall-members

2.8.5 EDUCATIONAL SPACES Additional space must be designed for functions, which are not specifically in administering, supporting, or providing patient services, but are required of any technological institution in modem society. Examples of such services are education-in-service, public relations.

2.8.6 SOCIAL SPACES The public spaces of a hospital are a reference point in the overall traffic and spaces concept of the entire facility. The hospital lobby should he a spacious one, and the traffic and confusion should be minimal, since good planning diverts much of the traffic to other entrances. The purpose of the lobby will be solely to accommodate visitors. Patient admissions and discharges will be directed away from the lobby, and outpatients are provided with waiting areas in the respective departments. Physicians and employees should have their own entrances and exits but it is not necessary. The family member who enters the lobby should be considered an adjunct to the patient within the hospital. Every attempt to properly care for and please the family, as well as the patient, falls within the overall objective of providing for total patient care.

2.8.7 CIRCULATION Circulation is the space within the hospital administrative and support services that is not common to a specific department. This includes corridors between departments, stairwells, public toilets, courts, elevators and lobbies, and the material handling system space. This space must be considered in determining the total square footage of building concept design.

2.9 WAY FINDING Hospital corridors are often referred to as mazes. Traveling through them to a destination can be an exhausting and frustration experience. Getting lost in a hospital may mean missing an appointment or finding a child in emergency. Anxiety and stress can impair the ability to process information. Behavioral scientists agree on three major conditions for case of way findings (Galling 1984).

Degree of differentiation: The degree of sameness or variation of interior spaces affects a person ability to recognize it and use it as a landmark.

Visual Access: Being able to see one part of the building from another or being able to see lobby, atrium, a bridge or any other architectural feature, which may become a point of reference.

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Complexity of Special Layout: The number of possible routed to a destination and the frequency of intersection with odd angles. The geometry and architecture of hospital building should facilitate way finding.

Specific consideration is given to first impressions created in entrance areas. Usage should be made by an art in creating focal points both for internal and external areas. Design solutions should create a series of views to external spaces and internal points of reference that will enable patients, visitors and staff to navigate around the hospital and understand its basic layout without depending on signage systems. Such solutions should be an integral part of any way finding strategy.

Entrances to the hospital are to be clearly identified to promote ease of way finding and distinctive ‘landmarks’ created through use of art or other distinguishing features should be incorporated into the design, particularly at main entrances. All sign-posting and instructions must be capable of being understood by the community that the site serves. Consideration should be given to using overhead rather than wall mounted gadgets to facilitate infection control.

2.10 INTERIOR DESIGNING We are in an era in which interior architectural design has become an integral part of the architectural process. It begins with the earliest architectural concepts and ends with the client occupying the completed space. What does this mean to the administrator and his committee, who have been charged with the responsibility of completing the interior of their hospital? The subject of interior design is a vastly involved and complicated one, thus, we must look into many of its aspects from many directions.

Before the early 1950s, the design and furnishings of a new hospital were usually not considered until after the building had been started. A committee would be formed to search for a supplier of equipment and furniture, one who would provide the hospital with a "turnkey job" (that is, a completed interior). If the equipment supplier could do this, he was usually asked to "decorate the hospital". If he did not provide this service, a local decorator, or the volunteer committee, might be called upon to judge the color coordination. If this procedure sounds rather loose and sketchy, it was. It shows the lack of care exercised in making these seemingly simple judgments that are actually crucial to the elective functioning of a hospital.

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2.11 HOSPITAL SYSTEM

HOSPITAL

MEDICAL SERVICES DIAGNOSTIC & TREATMENT

MEDICAL SUPPORT SERVICES

OTHER SERVICES

EMERGENCY, OPD, IPD

RADIOLOGY

PHARMACY

CENTRAL ADMIN

RADIOTHERAPY

CENTRAL STERILE SUPPLY

GENERAL SUPPLY & DISPOSAL

PHYSICAL MEDICINE

CENTRAL MEDICAL RECORDS

MORTUARY

ENGINEERING SERVICES

PATHOLOGY LABS Figure 2.2 Hospital System

2.12 SUPPORTING SERVICES 2.12.1 CENTRAL STERILE SUPPLY (CSSD) The central sterile services department (CSSD), also called sterile processing department (SPD) is an extremely important part of the service group. Traditionally, it was a part of the surgical operating suite because most sterile supplies were used there, but recently it has been grouped with other service department to establish centralized control of the distribution of all goods. In this unit, all the items which have been returned from the departments are cleaned, put in packs, sterilized and stored for the distribution as needed.

2.13 PATIENT CARE The patient is admitted to a facility at his doctor' s choice, but the patient is the most important customer in the entire system. A patient profile reflecting current preferences, tastes, UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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and specific needs is a valuable tool in planning and daily performance. Such intangibles as a neat appearance and friendliness on the part of the staff, unwavering respect for the dignity of the patient, and tender loving care are at the top of list for the patient' s overall comfort.

Fear of pain, separation from family, death, and unknown changes in life-style directly affect the patient' s adjustment and recovery. In addition, the patient will experience an increased awareness of his physical environment. Noise, color, lighting, odors, and air temperature are amplified; combined with the lack of privacy, delays, and attitudes of the staff, these stimuli can seem alien to the patient. The architect must be aware of these anxieties and environmental factors in order to design a medical facility that will promote the patient' s recovery.

Most patients undergo a set sequence of events during their hospitalization. Because of the complexity of diagnostic and therapeutic services a patient may receive, it is vital that the departments providing these services are physically close to each other; speed, comfort, and efficiency must be at a maximum. The following is a typical sequence of events, written by Jody Taylor, a specialist in health care architecture. Although the patient does not physically go to majority of the departments, staff and supplies from these departments are utilized in his care and are usually brought to him.   



  





The patient is transported to the hospital by private vehicle, public transportation, or ambulance (emergency).

He enters (emergency, public spaces, outpatient department) by wheelchair, on stretcher (equipment storage), or on foot.

He is assisted (auxiliary) to his room on the ward (nursing administration, medical, surgical, and gynecological bed unit, obstetrical bed unit, pediatric bed unit, psychiatric bed unit, intensive care, long-term care).

He changes into hospital gown (laundry). His clothes are placed in his individual wardrobe or locker. He is given a receipt for any valuables (nursing administration), and they are taken (nursing administration, auxiliary) to the securely stored (business office).

He is examined (central sterile supply, central storage and distribution) by a physician (medical staff facilities).

He undergoes diagnostic tests (laboratories, radiology, nuclear medicine, physical medicine, EEG, EKG, cardiopulmonary function).

The patient is wheeled on a stretcher (equipment storage) to surgery (operating suite, delivery suite), where he may be anesthetized (nursing, administration, anesthesiology).

Medical staff (physicians, nursing administration) performs surgery with the aid of sterile supplies (central sterile supply, central storage and distribution). While in surgery, a section (laboratories) or X-ray may be taken (radiology).

The patient goes to the recovery room (operating suite or delivery suite) for observation or is moved to an intensive care unit (central storage and distribution, pharmacy, dietary, radiology, inhalation therapy, laboratories).

He is wheeled on a stretcher (equipment storage) back to nursing unit for additional care (nursing administration, dietary, pharmacy), physical comfort (laundry, housekeeping),

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 

psychological comfort (telephone, solarium, meditation area, library, and reading room), therapy, and recovery.

He leaves the nursing unit (auxiliary) and is discharged from the hospital (admit-creditinsurance, business office, medical records).

He dies. An autopsy may be performed (laboratories, morgue). His body is removed to a private funeral home. His family is comforted (meditation area). His records are cleared (admit-credit-insurance, business office, medical records).

2.14 DIFFERENT STANDERDS  Distance between two beds =1.25 meter (4.1 ft.)  Patients bed size = 2 meter x 1 meter.  Distance between the bed end and the wall is 0.25 m.  Floor to ceiling height of the ward should not be less than 3.00m. The minimum space between the floor and beams should not be less than 2.6m.  If windows are located only on one wall it should be 20% of the floor area. If windows are on opposite walls at the same level, it should be 15% of floor area.  The width of door should not be less than 1.2 meter.  Minimum width of corridor should be 2.40 m.  The gradient of ramps should be between 1:12 to 1.20.  Minimum width of ramps should be 1.6 meter.  Recommended size of elevator for normal people is 5’X6’ and 6’X8’ for patient.

1 meter = 3.27 ft.  Urinals: 1 required for 16 beds.  Water closets (WC): 1 required for 8 beds.  Bath rooms: 1 required for 12 beds.  Wash basin: 1 required for 10 beds.  Parking ratio: bikes 1 per bed and car for 2 beds.  Parking area 

128 sq. ft. for 1 car



24 sq. ft. for 1 bike

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CONCLUSIONS While designing a hospital, the main concern is a patient. He is the client requiring a new and better hospital but unfortunately, he cannot express his needs in the form of a brief to the architect. The patient is the architect's client and so in the design of this building the patients comfort and the efficient working conditions for the staff will be the prime consideration. This can be achieved by clean and simple design, by the separation of the traffic routes and above all by the correct departmental relationship.

The general hospital will he designed on a standard pattern of hospital planning.              

Special consideration for the pedestrian traffic should be kept in mind during general hospital designing.

Proper space should be provided for car parking motor/cycle bicycle parking.

A simple circulation and communication pattern which will make the sense of orientation simpler to the patients, visitors and staff will be provided.

Proper segregation in vehicular and pedestrian traffic.

Centralizing the volume of hospital building to reduce air conditioning load will be considered.

The vertical stock of similar accommodation to simplify all services and to save cost and future maintenance problems will be observed Problems of patients, visitors, staff, time, distance will be minimized.

Local traditions will be kept in mind while designing the hospital.

There will be privacy for males and females in whole building.

Location of blocks will be carefully designed or place that the blocks will have close relation to each other.

Traffic in the whole site for hospital will be carefully considered.

Buffer zones will he provided to add to esthetic and to control the noise.

Unity in the design will be achieved through consistency of forms.

Hospital will be designed to a human scale and the progressive special transformation from smaller space to bigger space be provided.

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INTERNATIONAL 3.1 QUEEN ELIZABETH UNIVERSITY HOSPITAL BIRMINGHAM, ENGLAND

Figure 3.1 QEUH View

LOCATION Mindelsohn Way, Edgbaston, Birmingham, England.

CLIENT University Hospitals Birmingham NHS Foundation Trust

DESIGNED BY BUILDING DESIGN PARTNERSHIP Founded in 1961, BDP is an interdisciplinary practice employing over 900 architects, designers, engineers, urbanists and sustainability experts in studios across the UK, Ireland, the Netherlands, UAE, India and China.

FACTS AND FIGURES The 1,37,000 sq. m. (34 acre) building houses an emergency department, 30 operating rooms, 15 specialist imaging suits, 15 laboratories, 300 teaching rooms, 100-bed critical care department, the largest in Europe and 1,213 inpatient beds. Hospital provides direct clinical services to nearly 700,000 patients every year, serving a regional, national and international population. It is a regional center for cancer, trauma, renal dialysis, burns and plastics and has the largest solid organ transplantation program in Europe. Its architecture style is modern and cost was £582m

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MASTER PLAN LEGENDS

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1. Main Entrance 2. Visitor and Patient Parking 3. Staff Parking 4. Clinical Decision Unit Entrance 5. A & E Entrance and drop-off 6. Three oval cores I.P.D 7. O.P.D 8. Ambulatory care and education center 9. Bridge to old heritage building

Figure 3.2 QEUH Master Plan

FLOOR PLANS

Figure 3.3 QEUH Ground Floor Plan GROUND FLOOR PLAN

Visitor and patient entrance. Primary circulation routes run from east to west and lead to departmental reception areas which coincide with points of architectural interest.

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FigureFIRST 3.4 QEUH First Floor Plan FLOOR PLAN

Accident & Emergency entrance, Acute Assessment and Therapies. Education, including auditoria, is to the south-west. The creation of two entrances at different grades meant that the ground floor – and therefore the whole building could be as compact as possible.

Figure 3.5 QEUHFLOOR Second Floor Plan SECOND PLAN

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Critical Care is north of the narrower east-west circulation route, which is for clinical staff only. Operating theatres are to the south-west, and Burns to the south-east.

Figure 3.6SIXTH Third to Sixth Floor Plan THIRD TO FLOOR PLAN

Semi-elliptical wards provide 36 beds, comprising 16 single rooms and five four-bed bays. Shared facilities are at the apex of each ward with lift cores at each end, connected by glazed bridges.

Figure 3.7 QEUH Seventh FloorPLAN Plan SEVENTH FLOOR

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FLOW CHARTS

Figure 3.8 Ground Floor Flow Chart

Figure 3.9 First Floor Flow Chart

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Figure 3.10 Second Floor Flow Chart

AWARDS RIBA Regional Award 2012, RICS Regional Award 2012 (Design and Innovation Winner & Project of the Year) LABC Building Excellence Award 2011 Constructing Excellence West Midlands Award 2011 (Project of the Year)

PROJECT DETAILS Hospital design sets on teaching and healing standards. Functional concept of the hospital is developed through intensive consultation with patients, visitors, staff and the trust’s clinical review groups. Design team also analyzed the trust’s clinical care model, developing ‘disease groupings’ to cut patients’ movement around the hospital and reduce the number of healthcare professionals they have to meet during their stay. These findings enable them to design a compact hospital with distinct, efficient realms for the public, patients, staff and services. Meanwhile, masterplan created a green, open hospital campus featuring characterful quarters and a public plaza.

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DESIGN PHILOSOPHY The building has been conceived in motion, not just in terms of circulation during its occupancy but in the build program too. The new design is like a surge out of the fabric which will struggle to reconcile the two requirements, the patients care and the teaching.

Figure 3.11 View of QEUH

Smooth, white, story-height cladding is relieved by varied blocks of color ‘consistent with the projection of an aesthetic with connotations of caring, cleanliness, expertise, and technology that is reassuring rather than alienating.

OVAL SHAPED IPD The central circulation spine at ward level is open and airy. Windows to the south look out onto the lower side of the hospital and those to the north look out at the higher parts, giving a clear point of orientation. The dipping roof profile also allows sunlight from the south into the central wells of the oval floor plans. A simple decision about the geometry Figure 3.12 View of QEUH of the buildings solves a whole host of potential problems, including overly institutionalized spaces and lack of natural light.

The building is designed so that each pod has its own network of entrances, exits, lifts and corridors. Each pod can be sealed off from the other two in a lockdown situation, making it relatively easy to isolate particular areas of the hospital.

Figure 3.13 Ward Shape UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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SKY BRIDGE

HELIPAD

Figure 3.14 View of Bridge

A sky-bridge connects the new Queen Elizabeth Hospital building to the old UHB site where the cancer center, pharmacy and welcome Trust are based.

Figure 3.15 View of helipad

There are helipad facilities above a multistory car park. The helipad facilities include a room with a bed which is used as a first point of treatment.

RECEPTION The main hospital reception and information desk is situated on the ground floor directly ahead at the main entrance. The reception counter is at an accessible height with appropriate knee recess sections. There is a variety of seating in the main reception area.

The top-lit outpatient concourse runs east-west from the entrance and is lined with retail and coffee shops.

Figure 3.16 View of reception

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CONCLUSIONS Separate entrances provided for O.P.D and emergency. Also, the emergency is on the first floor but the excess is directly from the outside and also the road is built for the ambulance. Ambulance parking is also provided at some distance after dropping at the emergency dock.

O.P.D is divided into 4 blocks to manage the crowd of the people and to ensure the proper flow of the patients traffic. Traffic load is distributed by designing separate entrances for visitors and staff.

Figure 3.17 View of main corridor

A sky-bridge connects the new Queen Elizabeth Hospital building to the old UHB site where the cancer center, pharmacy and welcome Trust are based. The building has been conceived in motion, not just in terms of circulation during its occupancy but in the build program too.

To ensure the proper treatment of the people, the departments are not divided on separate stories rather every department is completed on one floor. Inpatients wards and private rooms are well planned and airy. Natural light and ventilation is easily approached to all rooms, wards and corridors. The central circulation spine at ward level is open and airy. Also, the whole building is airy and lighted down to the ground floor by using the large opening in the building.

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3.2 SANT JOAN DE REUS UNIVERSITY HOSPITAL

Figure 3.18 View of Sant Joan Hospital

As far as institutional buildings go, the new Sant Joan de Reus Hospital in Barcelona, Spain is as sublime as it gets. Designed by Mario Corea Arquitectura, the 104,910 m² facility houses a total of 400 beds. The building is jettisoned by six cantilevered volumes, a rigid construct that acts to inform the rest of the disciplined architecture. As massive as the volumes are, the place feels airy rather than vacuous. Above all, it is an intervention which means that it is clean, graceful and well-proportioned in its scale.

LOCATION Avinguda Bellissens, 30, 43204 Reus, Tarragona, Spain.

DESIGNED BY Pich-Aguilera Architects and Mario Corea Arquitectura.

PROJECT AREA 86,013.0 m2

PROJECT YEAR 2009

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MASTER PLAN

Figure 3.19 Master plan

1. Auditorium 4. Lecture Halls 7. Helipad

2. Cafeteria 5. Private rooms

3.Pharmacy 6. I.P.D

FLOOR PLANS

Figure 3.20Basement Floor Plan 01

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Figure 3.21Basement Floor Plan 02

Figure 3.22 Ground Floor Plan

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Figure 3.23 First Floor Plan

FLOW CHARTS

Figure 3.24 Basement Floor flow chart 01

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Figure 3.25 Basement Floor flow chart 02

Figure 3.26 Ground floor flow chart

DESIGN CONCEPT The Sant Joan de Reus University Hospital was conceived as one of the principle elements that would compose the expanding area on the border of the city of Reus where a new technological district is being developed. This urban dimension was reflected in the utilization of the grid as the Figure 3.27 Conceptual sketch generator of the design, capable of establishing internal routes in the hospital as well as connections with the city.

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At the same time, the project sought to modulate the scale of such a large healthcare facility from the urban scale of the access and the public circulation spaces to the scale of hospitalization, with its needs for proximity between the patients, visitors and the medical personnel. Therefore, the facade plane that covers the whole building is bent over, optically reducing the physical presence of the building and increasing its perspective effect. The project aims to modulate the scale of a large hospital equipment, from urban scale characteristic of the access areas and public circulation until the proper scale of hospitalization, with their needs of proximity and withdrawal. In this sense the public area is both functional and climatically, as if it was a covered street and the area of inpatient grouping around three landscaped courtyards, where the rooms are oriented to, trying to humanize the life of this area.

DETAILS The new Sant Joan de Reus University Hospital is conceived as an engine for the widening area of the municipality where it is intended to generate a new technological district. This urban dimension marks its gridded conception, capable of generating routes and connections with the flows of the city.

The building is designed as a great horizontal bar with two basements and a ground floor, over which stand 6 internment bars of two levels each. The north facade supports one of the rapid access highways to the city through cantilevered bodies that house the internment spaces. The public circulation axis of the hospital is oriented to the south and is conceived as a great avenue, a space of transition between the exterior and interior.

Figure 3.28 View of Sant Joan Hospital

Figure 3.29 North View

Figure 3.30 South View

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The public circulation axis of the hospital is oriented towards south and it is conceived as a great avenue, transitional space between the exterior and interior. The architecture is also an infrastructure capable of producing directly the weather and lighting conditions to its inner life. On this sense, for instance, the main covered street is designed to get interior comfort with 0 energy. No hot or cool air has to be added to get comfort, so energy savings are huge.

Figure 3.31 Ventilation conceptual sketch

The new Sant Joan Hospital is a building designed to provide a contemporary response to the hospital program. It takes special care in the comfort of the patient and the staff who have to use it, and responds to the needs of eco-efficiency by decreasing energy consumption by 35% respect the average consumption of a hospital. This was achieved without using large active energy saving facilities (geothermal, solar fields, etc.) that would have further increased the levels of savings.

Figure 3.32 View of Corridor

The project seeks to modulate the scale of a large hospital facility, from the urban scale of the access and public circulation spaces, to the scale of hospitalization, with its proximity needs.

Figure 3.33 Natural light in interior

Figure 3.34 Public circulation space

In this sense, the public area is designed both functionally and climatically as a covered street, gathering the internment area around three landscaped courtyards, which the bedrooms overlook, trying to humanize life in this area. The hospital is designed as a great system that organizes service subsystems. The public, medical, and technical needs are hierarchically organized and connected through circulations that make up a sequence where access restrictions are defined, enhancing clarity in the circuits and avoiding interferences.

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CONCLUSIONS Emergency is on the basement floor in order to give it a direct access from outside without disturbing or distracting from pedestrian of the O.P.D. Ambulance parking is also provided in front of the emergency department. Services block is also provided in the basement. Green lawns are provided on the roof of the building as these lawns are the landscape area for the inpatient department located on the first and second floor. Private rooms are provided more as compared to the wards and all these are fully ventilated and natural light is used maximum as the architecture is also an infrastructure capable of directly producing the climatic and light conditions for its interiors. Public, medical, and technical needs are hierarchically organized and connected through circulations that make up a sequence where access restrictions are defined, enhancing clarity in the circuits and avoiding interferences. The architecture is also an infrastructure capable of directly producing the climatic and light conditions for its interiors.

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3.3 AGA KHAN UNIVERSITY HOSPITAL, KARACHI, PAKISTAN

LOCATION Stadium Road, Karachi, Sindh, Pakistan.

CLIENT Aga Khan University Hospital and Medical College.

Operator: Aga Khan Health Services Figure 3.35 View AKUH

DESIGNED BY PAYETTE ASSOCIATES with MOZHAN KHADEM (design consultant) Associated Professionals, BHAMANI ASSOCIATES LTD. KARACHI (local consulting architects).

FACTS AND FIGURES The Aga Khan University Hospital (AKUH) begun construction in 1972, comprises on 84 acres campus in Karachi, Pakistan. The complex consists of a School of Nursing (which opened in 1980), a Medical College (started in 1983), a 721-bed hospital with departments of medicine, surgery, pediatrics, obstetrics, gynecology, ENT, ophthalmology, and other specialty clinics.      

295 beds in 5 bed general wards.

192 beds in 2-bed semi private wards.

32 beds in special care units.

202 private rooms.

10 operating theaters with central sterile supply.

12 radiology rooms.

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MASTER PLAN

Figure 3.33 AKUH Master plan

Figure 3.36 Master Plan

FLOOR PLANS

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Figure 3.37 Ground floor plan

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Figure 3.38 First floor plan

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Figure 3.39 Second floor plan

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FLOW CHARTS

Figure 3.40MASTER Master plan flow chart PLAN

Figure 3.41 Ground floor PLAN flow chart FIRST FLOOR

DESIGN CONCEPT The complex has been designed as an architecture of continuous spaces that surround the observer, as in this sketch of roof scapes in the Iranian village of Murchekhort. This concept, which is also to be found in other Islamic art forms such as miniature paintings and rug designs, is

Figure 3.42 Conceptual sketch

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in contrast to the idea of the building as object, and was considered by the Payette design team as a more appropriate expression.

Figure 3.43 Section

The basic building forms were configured in an L shape and oriented toward the prevailing westerly and southerly breezes from the Arabian Sea. The sloped roofs and integrated air scoops catch the air currents that travel over the buildings, causing the breeze to pass through and cool the shaded attic spaces. In air-conditioned arms, such as clinical and treatment moms, a deep plan was acceptable.

Entrance portals have been significant features in traditional Islamic buildings, and were often the only means by which mosques could be distinguished from caravanserais or other building types. Just as importantly, such portals announced the beginning of the esthetic experience.

These doorways have traditionally received very special volumetric and surface design.

Inspired by this custom, all the entrance portals and gates of the hospital and medical college have been designed with great care.

Most have calligraphic ornamentation comprising Koranic verses. The main entrance of the complex Figure 3.45 Conceptual entrance sketch Figure 3.44 Entrance view like all the other entrance portals, covered in marble with the quotations from the Quran incised in mirror image to form a border motif Offering further guidance to the Payette team is the fact that in traditional Islamic buildings, transitions from portals to passageways to courtyards are handled with great artistry, as the sketch of a mosque in Cordoba, Spain, indicates In the medical complex, entrance portals lead to transition spaces which prepare the visitor for succeeding architectural experiences. These openings and passages partially or completely conceal the full spatial impact of courts that lie beyond.

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The student housing is organized around courtyards and divided into separate facilities for men and women. Each offers private rooms, which function as study areas as well as bedrooms. To eliminate the necessity of air conditioning, the rooms are located on single-loaded corridors for cross ventilation. The open side of each gallery is partially covered by a trellis of bougainvillea, which provides shade and privacy for students walking along the corridor to the common toilet and shower facilities at building junctions.

Figure 3.46 Courtyard in student`s hostel

The auditorium is decorated with jail screens of teak combined with a ceiling of patterned plaster panels.

Although these surfaces closely resemble handwork, they are a result of a semi-industrialized process carefully worked out by the Payette team in collaboration with local craftsmen.

Figure 3.47 Auditorium

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CONCLUSIONS The complex has been designed as an architecture of continuous spaces that surround the observer as the one moves in the hospital, he has a complete feeing on one building or complex rather than the feeling of different departments by placing them in separate blocks. The basic building forms were configured in an L shape and oriented toward the prevailing westerly and southerly breezes from the Arabian Sea. These L shaped tapered roof cater the prevailing winds and allows them to move through the building and keep the temperature of inside to be moderate.

In non-air-conditioned areas such as patient wards and public corridor, shallow planning allows for the maximum use of cross ventilation is used. Landscaping and shadows cast from the adjacent structures, all help to cool the air before it enters the building. Like in traditional Islamic Architecture, entrance portals are very volumetric surface design. Separate entrances are provided for patients and medical students and staff. This entrance is also used by the inpatients of private rooms. Nursing school and girls hostel are provided at the back end of the complex. The entire complex is laid horizontally, rather than vertically, to avoid dependence on elevators. To achieve quality and flexibility in the direct care of hospitalized, rooms are designed for privacy, incorporating space for controlled treatment. The ward units are located on a quite section of the site, within easy reach of the necessary services of the main hospital. All the surgical beds are located on level one with access to surgery immediately adjacent.

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The planning of a hospital based on interrelationship between various departments which function independently but connect with each other. The hospital complex is arranged according to function and supporting services. More public area such as OPD, emergency and diagnostic department should be located at the front of hospital while the less public areas such as IPD, administration and services department should be accommodated at the back of building. But the connection of all these departments should be compulsory.

4.1 O.P.D The function of the department is to treat home-based patients and if necessary to accept them as in-patients. A good deal of the diagnostic and treatment accommodation can he of a general nature used at different clinic sessions by different specialists. Too much separate accommodation for specializes is wasteful, for much of it will he underused most of the time.

For some patients, the department will be their first introduction to hospital and many may he nervous and need reassurance. It is important that the atmosphere should he welcoming, comfortable and humane. In a large department, or if there is no adequate referral or appointment system to control the influx of patients, there will be special design problems in retaining a human scale in the arrangement of the large reception and waiting spaces that are likely to be necessary.

In some climates shaded open-air area may be valuable.

The department should he situated so that it is easily reached by both the walking public and vehicles. It should also be close to public transport routes if there are any. A separate entrance is desirable and this should not be located too near the reception point for ambulance and accidents or other department, such as the mortuary, which are likely to have distributing associations. Out patients should not have to pass through any other part of the hospital to reach the department.

4.2 ACCIDENT AND EMERGENCY Injury or sudden illness beyond the capacity of the first —aid box drives most people to a doctor or, if they are near a hospital. to its Accident and Emergency department, where they expect immediate attention and reassurance. All hospitals must be able to deal with casualties and emergencies without mixing them with other out-patients. For this they need as a minimum a waiting space, a consulting room, examination and treatment cubicles, a small operating theatre and a few beds for recovery.

Because the department deals with patients who are the victims of accidents or sudden illness it is subjected to unpredictable peaks of activity at any time of the day or night. Incoming patients may be ambulant or brought by vehicle. They may come direct or may be referred by a doctor. After examination (which may include X- ray) or resuscitation, patients may he treated within the department and either kept under observation and discharged after a few hours or may be transferred to the wards. Others may go direct to the wards after diagnosis. After discharge some patients may return to the department for follow-up examination or treatment. Certain injuries may have to he referred to specialist hospitals elsewhere. Because seriously injured UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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patients should he kept separate from others the department requires two independent entrances from outside, one for walking patients and the other for those brought by ambulance. Walking patients are either attending for the first time or are coming for follow-up procedures. After reception at a counter where particulars are taken or checked, patients in these two categories can, in a large department, be separated into two distinct waiting areas, sharing lavatories, and telephones.

If the department has its own operating suite it should he adjacent, probably containing two theatres with scrub-up and gowning rooms, an anesthetic room and disposal room. A plaster room for the reduction of fractures and the application and removal of plaster casts should be near the operating suite.

Figure 4.1 Accident & Emergency

4.3 OPERATING DEPARTMENT The function of the department is to receive patients after diagnosis, to anaesthetize them either before or after transfer to the operating table, to operate, and to supervise their post-operative condition before returning them to the wards. The department consists of one or more operating suites, which shares ancillary accommodation such as staff changing and rest rooms, arrangements for the reception of patients, and facilities for the disposal of soiled material. The suites may also share a unit for the supply of sterile material and instruments. Each operating suite normally consists of theatre, an anesthetic room, a preparation room and a scrub-up. These give

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opportunities for better organization and throughput, more economical use of staff and centralized engineering plant. The exceptions sometime are: a) A separate theatre in the maternity delivery suite for emergency caesarian section, and b) An emergency theatre in the accident department However, the trend is now to eliminate separate theatres if possible by placing these departments where they have quick and direct access to the main theatre suite (which does not necessarily have to be on the same level). A rigid separation of clean and dirty traffic for reasons of control of infection imposes limitations on the plan form of the department, which usually need to embody a two-corridor system. There are three major circulation patterns; patients, staff and supplies (including theatre instruments), further major influence on planning is the shape and content of individual clusters consisting of the operating theatre with its ancillary rooms. These repeats to form departments of different size, the normal range being from 4 to 12. It is usual to group these clusters to form twin theatre suite.

4.4 ZONES OF OPERATION THEATER 4.4.1 CLEAN ZONE  Preoperative room  Recovery room  X-Ray  Plaster room  staff room  Store room

4.4.2 STERILE ZONE  Operating suite  Scrub room  Sterilization room  Instrument area

4.4.3 PROTECTIVE ZONE  Reception & waiting area  Trolley bay  Lift  Ramps  Stair cases  Changing room

4.4.4 PROTECTIVE ZONE  Reception & waiting area  Trolley bay  Lift  Ramps  Stair cases  Changing room

4.4.5 DISPOSAL ZONE  Dirty room  Disposal area  Janitors room

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Figure 4.2 Surgical Suite Flow Diagram

4.5 GENERAL PLANNING PRINCIPLES The internal layout should be based on the traffic flow within the department. A single corridor may be used to carry patients, staff and clean and used equipment (suitably bagged) to and from the operating theaters. This corridor should lead to each operating theater via an anesthetic room, a scrub-up facility and a separate exit. Alternatively, clean and dirty streams of traffic can be segregated. An enclosed, traffic-restricted room close to the operating theater must be provided for sterile theater supplies; it should lead directly into the operating theaters.

1. Room should be arranged in continuous progression from the entrance through zones of increasing sterility, following the concept of progressive asceticism.

2. Staff with in the department should be able to move from one clean area to another without passing through unprotected or unclean areas.

3. Patients, staff and services should enter through the same control point.

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4. Air for air-condition should move from cleanest to less clean areas.

5. The operating theater should be at positive pressure in relation to adjacent rooms.

6. Air movement in the operating theater should be reduced so that airborne infections do not reach the patient.

4.6 ROOM PLANNING REQUIREMENTS The following areas should be provided: Reception and office: ln a two or three- theater suite, the reception and the theater sister's office can be merged. Transfer area: This area should be large enough to allow for the transfer of a patient from a bed to trolley. A line should be clearly marked in red on the floor, beyond which no person from outside the operating department should be permitted to set foot without obtaining authority and putting on protective clothing. Holding bay: This space is required when the corridor system is used and should be located to allow supervision of patients waiting to go into the theater.

One bed per two theaters should be foreseen. Staff changing rooms: Access to staff changing moms should be made from the entry side of the transfer area. At both the transfer area and the theater side of the changing rooms, space must be provided for the storage, putting on and removal of theater shoes. Operating theaters: Each theater should be no less than 18 x 18 ft. in area and should have access from the anesthetic room, scrub-up room and supply room. Separate exit doors should be provided. Scrub-up room: Scrub-up facilities may be shared by two theaters. A minimum of three scrub-up places is required for one theater, but five places are adequate for two theater. A clean area within the scrub-up room, at least 2.1 x 2.1 ran, must be provided for growing and for trolley or shelf space for gowns and masks. Sub-clean-up: In suites of four or more operating theaters, a small utility area is required for each pair of operating theaters, for the disposal of liquid wastes, for rinsing dropped instruments and to hold rubbish, linen and tissue temporarily until they are removed to the main clean-up room. Sub-sterilizing: An area for sterilizing dropped instruments should be provided to serve two theaters. Trolley parking: Parking space outside the theater and clear of all doorways is required for patient trolleys and beds. Recovery room: The recovery room should be located on the hospital corridor near the entrance to the operating department. The number of patients to be held, until they come out of anesthesia, depends on the theater throughput; two beds per theater are usually satisfactory. In hospitals where there is an intensive care unit, additional room and facilities will be needed.

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4.7 DIFFERENT TYPES OF WARDS DESIGN

H-SHAPED PLAN

E-SHAPED PLAN

T-SHAPED PLAN

L-SHAPED PLAN

BOX SHAPED PLAN

RIB PATTERN PLAN

Figure 4.3 Types of Wards

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4.8 CENTRAL STERILE SERVICES DEPARTMENT (CSSD)

Figure 4.4 C.S.S.D

4.9 INTENSIVE CARE UNIT (ICU) Intensive care units cater to patients with severe and life-threatening illnesses and injuries, which require constant, close monitoring and support from specialist equipment and medications in order to ensure normal bodily functions. They are staffed by highly trained doctors and nurses who specialize in caring for critically ill patients. ICU's are also distinguished from normal hospital wards by a higher staff-to-patient ratio and access to advanced medical resources and equipment that is not routinely available elsewhere.  Monitoring + Treatment + Care of patients  The ICU is for critically ill patients who need constant medical attention.

4.10 DIAGNOSTIC DEPARTMENT 4.10.1 RADIOLOGY DEPARTMENT The department uses various X-ray techniques to produce photography film of various parts of the body for diagnostic purposes. X-rays have great penetrating power and can harm living UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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organisms if received in excess quantities. For this mason radio-diagnosis rooms require special protective measures against radiation spread, e.g. lead or barium plaster wall finishes. Related techniques also used in this department do not present the same problem, e.g., Thermograph which uses heat waves, and ultrasonic which uses sound waves.

There are two main circulation flows, (a) patient and (b) X-ray films for processing. The design for (a) can be interpreted quite flexibly, the major requirements being good patient supervision and reduction of staff walking times. The design for 09 is largely influenced by the type of film processing adopted; a popular method has been to use a mechanical cassette. Conveyor serving a group of X-ray rooms and terminating in a manual or automatic processing room, but this is now beginning to be superseded by day light film loading techniques.

Although the department serves the whole hospital there is a strong relationship between it and the fracture clinic of the outpatient department, and even more so with the accident department. Direct access from the latter to the X-ray room designated for accident and emergency work will be required unless the accident department contains its own X-ray facilities.

DIFFERENT AREAS Directing medical imaging technologies, X-Ray, Ultrasound, C.T. Scan, MRI, EEG, ECG, Audiology, Angiography

4.10.2 PATHOLOGY DEPARTMENT The department uses specimens taken from patients (blood, tissue, urine etc.), which are investigated by a variety of laboratory techniques to confirm or establish diagnosis. The major clinical divisions of the department (morbid anatomy, histology, hematology, bacteriology, chemical pathology, microbiology etc.). Tend to work in fairly self-contained sections consisting of a mixture of large open areas of laboratory benching and smaller spaces such as offices for heads of-divisions, chief technicians. There is some sharing of common support serves such as central wash-up for laboratory glassware. The strongest relationship is to the outpatient department.

DIFFERENT AREAS Hematology, Histopathology, Microbiology, Immunology, Chemical Pathology, Genetics Test

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Figure 4.4 Pathology Labs

4.11 INPATIENT DEPARTMENT 33% to 55% of structure of the hospital construction. IPD gives maximum output of services.

To provide highest quality of medical and nursing care. Maximum medical care, teaching, training and research is concentrated in this. It should be situated away from main roads and from OPD to avoid disturbance. It should be approachable for supporting services.

4.12 THE LABOUR & DELRVIERY SUITES The in-patient accommodation fall into two closely related divisions, one concerned with labor and birth, and the other with lying in. The labor suites, which should be accessible without passing through the ward, consist of 1st stage room, each with one bed, and delivery rooms, and both on a scale of one room to about 10 post-natal beds. A pair of delivery rooms can share a washup and scrub-up, at least one delivery room should be suitable for caesarean n section with scrubup, sub-sterilization room and general anesthesia facilities. The delivery suite should be well insulated and caustically &pm the first the rooms and from the ward. A comfortable day room for

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visitors is needed near the entrance of the labor suites. if possible, the delivery room should be in a cul-de-sac horizontally contiguous to the maternity-nursing units.

The other elements comprising the delivery suites are:  Nurses work room.  Doctors and nurse’s lockers, shower and changing facilities.  Rest room and toilets.  Premature nursery with incubators.  A circumcision room.

Most of the components of the delivery suites are like those of the operating suites.

The main points of differences to be considered are:   

Anesthesia room or pre-operative room is not needed as most of the work is done in labor room.

The doctor's rest room should have space for one or two beds where obstetricians could take rest while awaiting a case to be ready for delivery.

The delivery room should be equipped with a fluoroscopy.

Figure 4.5 Delivery Suite Flow Diagram UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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4.13 MAJOR ELEMENTS FOR MASTER PLANNING  Circulation routes  Internal circulation  External circulation  Landscape and garden  Parking  Roads Zonal distribution and arrangement of different departments.

OUTERMOST ZONE: which is the most community oriented Primary health care support areas.

Outpatient department Emergency department Administration department SECOND ZONE: that receives workload from Diagnostic X-ray Laboratory Pharmacy Blood bank MIDDLE ZONE: between outer inner zones Operating department Intensive care unit Delivery Nursery INNER ZONE: is the interior but with direct access for the public (wards and nursing units).

SERVICE ZONE: Disposed around a service yard Dietary service Laundry Storage Maintenance Mortuary

4.14 GENERAL SERVICES DEPARTMENT 4.14.1 DIETARY FACILITIES 4.14.2 LOCATION The dietary department should be located on the ground floor, dietary accessible frog TT. the services court to receive daily deliveries of meat, vegetables and dairy products. Direct deliveries to the refrigerated section eliminate traffic through corridors d cooking areas.

The direction of the prevailing wind must also be considered: kitchen must be located such that heat and odors are not directed towards areas of high population. They should also not be located under wards, especially those for n n-ambulant patients, as a fire safety precaution.

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4.14.3 COMPONENTS The dietary department has the following main components:  Food refrigeration and storage  Cooking  Serving  Special diets  Dishwashing  Dining The department should contain the following facilities, unless commercially prepared diets and service, meals and/or disposable items e used:           

Food preparation center Food serving facilities, for both patients and staff Dishwashing facilities Pot-washing facilities Refrigerated storage Day storage Cart-cleaning facilities Waste disposal facilities Dining facilities (1.5 sq. m per seated person) Dietician's office Janitor's cupboard, storage for housekeeping supplies and equipment, with a service sink Some of those activities can be combined, so as to save space, without compromising the norms of cleanliness.

4.14.4 HOUSE KEEPING FACILITIES The housekeeper's office should be on the lowest floor, adjacent to the central linen room.

The central linen room supplies linen for the whole hospital. It must have shelves and spaces for sewing, mending and marking new linen. if laundry is to be handled in the hospital, the central linen room must be adjacent to the clean end of the laundry room. The soiled linen area is for sorting and checking all soiled laundry from the hospital. It must be next to the dirty end of the laundry are and provided with sorting bins. Laundry can either be done in house or contracted to an outside enterprise. If it is to be contracted out, areas must be provided for receiving clean and dispatching dirty linen and for sorting. The facilities must thus include a soiled linen room, a clean linen and mending room with a laundry-cart storage room. A laundry processing room, with equipment sufficient to take care of 7days linen. Janitor's closet, with storage space for housekeeping supplies and equipment and a service sink is also required. Overall storage space for laundry supplies.

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4.14.5 STORAGE FACILITIES As hospitals are regular consumers of a large variety of good, adequate space must be provided for their storage, inventory and distribution. Many different types or storage facilities will be required, e.g., for some live virus vaccines at —20 c, for large equipment and furniture, for crude disinfectants, for must obtain all the relevant information to meet the requirements. The standard for central storage space is 2 sq. m per bed; in smaller hospital, this value is usually increased.

The following compartment must be provided in the hospital storage areas:     

Pharmacy storeroom Furniture room Anesthesia store room Records storage Central store room

Figure 4.6 Services Department UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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4.15 CREATING A HEALING ENVIRONMEN 4.15.1 ENVIRONMENTAL STRESS The 6 qualities of the environment most likely to contribute to stress are according to Saegert's theory.      



Physical threat; filth, heat or cold, exposure to elements.

Stimulus information overloads; negative only when it is unpredictable or uncontrollable.

This would include on-the-job stress associated with high performance careers, too many decisions, too much to do, too little time, pushing oneself too hard etc.

Suitability of Environment the ability of the environment to support or frustrate people’s goals, as a building with way finding problems create this type of stress.

Psychological and social environments are coded with messages the convey feelings of social worth, security, identity, and self-esteem, as well as indication of status.

Demand of the environment amount of effort, energy, or resources required interacting with it, this can mean physical effort, time, or money, and an example might be stress associated with the cost of hospitalization.

Stimulus or information deprivation; occurs in isolated environments, to function normally, people need tension and challenge.

4.15.2 HOSPITAL STRESS FACTORS The experience of hospitalization itself is a source of psychological stress for most patients, regardless of the nature of the illness. A designer can better understand the sources of stress by viewing the facility through the patient's eyes. Isolation from family and friends, lack of familiarity with the environment, medical jargon, fear of procedures, loss of control, lack of privacy, 'worries about job or finance and in accessibility to information.

A hospital stress rating scale was developed in America listing 49 events event to the experience of hospitalization. Researchers analyzed and controlled variables such as gender, age, marital status, education, previous hospitalization, and severity of illness in making comparisons.

The studies set out analyze differences between medical and surgical patient's reaction to the experience of hospitalization.

4.15.3 NOISE REDUCTION Any attempt to reduce stress on a hospitalized patient must include noise reduction. Cleary noise is one of the most noxious of environmental stressors, it produces a generalized stress reaction that con increase blood cholesterol levels, increase the need for pain medication by lowering an is individual's pain, threshold, and keep the brain stimulated so that a patient cannot rest or sleep, which impedes healing.

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4.15.4 ART AS THERAPY The arts are expressions of humanity that carry the legacy of a culture and can touch and stir individuals in their times of deepest need to help them transcend their pain. As an example, World War II a decision was made, to close the theatres in par is and turn them into After the German occupation, authorities recognized the importance of the theatre for healing the emotional wounds of the populace, who were stressed by battle and personal losses.

4.15.5 COLOUR Every aspect, of our life involves color, traffic is directed by color; instrument panels are regulated, by color; electrical wires are color coded; advertising is printed. In color; medicines and capsules are in color; office files folders have colored tabs; clothing has color, uniform have Color' the list is in finite. Biological and physiological reactions to color are the most susceptible to testing and the most valuable from a pragmatic point of view, particularly in relation to design.

The scientist Goldstein studied the effects on various colors. He noted that the effect of red in patients was of tropic refraction, abnormal deviated of the' arms when held out form the body, increased loss of equilibrium. In all these cases, green had the opposite effect, that of reducing the already present abnormal conditions.

Other investigators have noted that blood pressure and respiration increased ring, exposure to red light, but decreased in blue illumination Red light has been said to reduce the pain of rheumatism and arthritis. It dilates the blood vessels and produces heat in the tissues. Birren1 postulates that red color of mercurochrome hay: be effective in the healing of wounds due to its absorption of blue light, Blue lights aids headaches and lowers blood pressure, and its tranquilizing effect ma Leven aid insomniacs. Blue light is currently sued with high success in the treatment of Jaundice. Yellow has been said, to stimulate the appetite and to raise blood pressure associated with anemia.

4.15.6 SMELL In a hospital medicine smells produce anxiety and irritation. Unpleasant odors are known to increase heart rate and respiration whereas pleasant fragrances actually lower blood pressure and heart rate. Some, research has shown that of factory messages reach the brain faster than auditory or visual ones.

4.15.7 LIGHTING Light is another highly significant environmental factor, whether natural or artificial.

Lighting known to Affect hormonal and metabolic balance and entrainment of circadian rhythms.

In fact, neuroscientist Richard Wuriman believes that is the most important environmental impute, after food, in controlling bodily function)' The illumination of our environment effects our metabolic functions affecting, among other things, milk produced, the quality and quantity of eggs laid, and stimulation or inhibition of sexual activity. Studies have shown that subjects who are forced to live in darkness for prolonged period suffer sensory deprivation.

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The sensations that we call color and light are our psychological interpretations of certain portions of the electromagnetic spectrum. How well the colors depend on, how closely the ingredients of artificial light sources match the ingredients of sunlight. Artificial sources of light have varying degree of each color some have more warm wavelengths and some more cool, an incandescent bulb, for e.g., is high in orange and red and low in blue and violet; thus, it imports a warm glow, but it is far from the color of daylight.

4.15.8 NATURE AS HEALER Urban life-style and pressure to produce more work in less time do not encourage an application of nature. However according to Anita Olds (1955) ' Many people hold" subconscious of nature as a primal soured of nourishment hand rejuvenation " In "her workshop 'paces can heal' designed for health care professionals (designer, therapists, nurses, architects) she asked participants to visualize conditions of wontedness and healing. When asked to draw pictures of their healing spaces 75% of these spaces had common elements: Outdoor scenes, growing things, and nature are healer. People saw themselves as alone, perhaps with a pet, but able to experience connectedness with the universe. Causing Olds to speculate about the universal significance or collective unconsciousness of nature as healer people seem to have an intuitive awareness of what constitutes a healing environment. However, disillusioned modem man has largely not wiped over his primal connections to the earth, sky, water, and all living matters.

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CONCLUSIONS Design of a hospital will mainly dependent on a standard pattern of hospital planning. Special consideration for the pedestrian traffic should be kept in mind during general hospital designing. Proper space should be provided for car parking motor/cycle bicycle parking.

A simple circulation and communication pattern which will make the sense of orientation simpler to the patients, visitors and staff will be provided. Proper segregation in vehicular and pedestrian traffic. Centralizing the volume of hospital building to reduce air conditioning load will be considered. The vertical stock of similar accommodation to simplify all services and to save cost and future maintenance problems will be observed. Problems of patients, visitors, staff, time, distance will be minimized. Local traditions will be kept in mind while designing the hospital.

There will be privacy for males and females in whole building. Location of blocks will be carefully designed or place that the blocks will have close relation to each other. Traffic in the whole site for hospital will be carefully considered. Buffer zones will he provided to add to esthetic and to control the noise. Unity in the design will be achieved through consistency of forms. Hospital will be designed to a human scale and the progressive special transformation from smaller space to bigger space be provided.

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5.2 SIZE OF HOSPITAL According to international standards, there should be one bed for 1000 population.

As my hospital is a general teaching hospital, so for a teaching hospital, I have to follow the rules of Pakistan Medical and Dental Council (PMDC).

According to PMDC, the affiliated teaching hospital should have a ratio of 1 to 5 beds to one student admission per year.

In a 5-year M.B.B.S degree, the students start visiting the hospital from 3rd but the actual practice starts form 4th year.

Number of students admitting to KMSMC are 100 per year.

So, the number of students for house job are 200 (3rd year and 4th year).

The client decides to allot 2 beds each student for their house job.

So, the total number of beds for teaching hospital are 400.

As 200 beds are already existing in the hospital, so upgradation of 200 beds is required.

5.1 MAJOR DEPARTMENTS EMERGENCY DEPARTMENT OUT PATIENT DEPARTMENT (O.P.D) OBSTECTRICS AND GYNAECOLOGY DEPARTMENT DIAGNOSTIC DEPARTMENT SURGICAL DEPARTMENT INTENSIVE CARE UNIT (I.C.U) INPATIENT DEPARTMENT ADMINISTRATION DEPARTMENT SERVICES DEPARTMENT RESIDENTIAL AREA PARKING LANDSCAPE AREA

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5.2 EMERGENCY DEPARTMENT Average number of casualty cases of one month are 4,441.

Details

Age

Number

<1 Year 1-4 5-14 15-49 50+

734 820 967 1024 896

No. of Patients 1200 967

1000

1024 896

No of Patients

820 800

734

600 400 200 0 <1 Year

1 to 4

5 to 14

15‐49

50+

Age of Patients Figure 5.1 Patient Chart

According to above data, average number of patients coming in one day are 4441/30 ≈ 148 patients approximately.

According to the survey of the existing hospital, maximum number of patients coming during day timings of 8am to 10pm includes  Road Traffic Accident (RTA)  Dog Bite  Scabies  Chronic Liver Disease (CLD)  Hypertension (Abnormally high blood pressure) So, the approximate number of waiting patients (ambulant and non-ambulant) considered for waiting area are 50.

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NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

SPACE Reception/ Registration/ Discharge Waiting for 50 persons Wheel chair/ Stretcher Storage Casualty Medical Officer C.M.O Toilet Surgeon`s Office Surgeon`s Toilet Duty Doctor`s room Resuscitation room Police room Police toilet Triage/ Exam room Treatment room (150 sft) Plaster room (150 sft) Minor operating theatre (400 sft) Scrub-up room Sub-sterilization room Anesthesia room Mobile X-ray Medical Ward 24 Beds Surgical Ward 24 Beds Ward Toilets M/F (2/2) Nursing Station (100 sft) Staff lounge M/F (200 sft) Staff lavatories M/F (40 sft) Patient lavatories (40 sft) Changing room + lockers M/F (150 sft) Pharmacy Linen Store Clean Utility Dirty Utility Janitor closet Equipment store Pantry Sub-total Adding 35% circulation Total

UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

QUANTITY 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 1 1 1 1 1 1 2 2 2 2 2 2 1 1 1 1 1 1 1

AREA IN SFT 100 750 200 200 30 200 30 150 400 200 30 400 300 300 800 100 100 150 100 2,400 2,400 100 200 400 80 80 300 200 60 60 60 60 100 100 11,140 3,899 15,039

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5.3 BLOOD BANK NO. 1 2 3 4 5 6 7 8

SPACE Reception/ Registration Waiting Area Record room Bleeding room (10 couches) Office Cross match area Processing room Blood Freezers room Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1 1 1 1 1

AREA IN SFT 100 400 100 800 150 150 150 300 21,50 752 2,902

5.4 OUT PATIENT DEPARTMENT An outpatient department will provide the consultancy/ treatment to the patients who attend the hospital without staying overnight.

Average number of patients coming to the O.P.D in one month is given in the table below.

Specialty

1-4

5-14

15-49

50+

<1 Year

1-4

5-14

15-49

50+

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Female

<1 Year

Male

Medicine Surgery Eye ENT Orthopedics Psychiatry Dental Urology OB/GYN Cardiology TB Neuro Total

317 15 45 196 12 5 0 0 0 0 6 596

412 35 61 195 35 19 6 0 0 0 72 835

496 239 120 200 390 71 27 3 29 0 107 1682

1232 577 730 300 575 251 311 150 317 537 275 5255

990 245 864 300 345 217 273 67 378 433 379 4491

370 11 52 175 9 3 0 0 0 0 10 630

482 47 48 185 30 17 5 0 0 0 95 909

510 285 95 295 355 67 35 0 63 45 0 115 1865

1264 635 660 200 446 269 415 132 1961 289 634 312 7217

1147 221 562 215 365 251 289 126 671 167 187 370 4573

UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

Total

Followup

7220 2310 3237 2261 2562 1170 1361 478 2695 1225 1791 1741 28051

906 99 210 217 1812 171 0 70 763 134 315 318 5015

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Percentage of Patients

Percentage of Average Patients in one Month 30

25.6

25 19

20

16 16.3

15 10 5

2.1 2.2

3 3.2

<1 Year

1 to 4

6 6.6

0 5 to 14

15‐49

50+

Age of Patients Male

Female

Figure 5.2 Average Patients in 1 month

Ratio of Diseases in One Month 4.4

4.2 1.8

5

25.7

6 6.2

11.5

8 8.2 9

10

Mdeicine

Eye

Gyne

Orhopedics

Surgery

ENT

TB

Neuro

Dental

Cardiology

Psychiatry

Urology

Figure 5.3 Ratio of Diseases

Total number of patients are 28051 + 5015 =33,066 patients in one month.

So, the number of patients in one day are 33,066/ 26 (Total working days) = 1271 patients.

NO. 1 2 3

SPACE Main Reception/ Registration Main Waiting area Wheel chair/ Stretcher Storage

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QUANTITY 1 1 1

AREA IN SFT 100 1500 100 67

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4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Record room Attendant room Security room O.P.D incharge room Incharge washroom Sub reception Sub waiting Specialist (150 sft) Toilet (30 sft) M.O room (120 sft) M.O toilet (30 sft) Immunization room Staff lounge Staff toilets Nurse`s lounge Nurse`s toilets Public toilets Changing room + lockers M/F (150 sft) Pharmacy Linen Store Clean Utility Dirty Utility Janitor closet Sub-total Adding 35% circulation Total

1 1 1 1 1 12 12 12 12 12 12 1 1 2 1 2 6 2 1 1 1 1 1

100 100 100 200 30 200 1800 1800 360 1440 360 400 200 40 200 40 200 300 200 60 60 60 60 10010 3503 13513

5.5 DIAGNOSTIC DEPARTMENT 5.5.1 RADIOLOGY DEPARTMENT NO. 1 2 3 4 5 6 7

SPACE Reception/ Registration Medical record room Waiting Chief Radiologist Chief`s washroom Technician`s room X-ray

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QUANTITY 1 1 1 1 1 1 2

AREA IN SFT 100 100 500 200 30 200 600 68

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8 9 10 11 12 13 14 15 16 17 18 19 20 21

Dark room Film store Ultrasound E.C.G Mammography M.R.I Control room M.R.I Electric Room C.T Scan Control room Staff toilets Nurse`s lounge Nurse`s toilets Public toilets Changing room + lockers M/F (150 sft) Sub-total Adding 35% circulation Total

2 2 1 1 1 1 1 1 1 1 2 1 2 4 2

200 200 200 200 200 500 500 200 200 200 40 200 40 100 300 5010 1753 6763

QUANTITY 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 2

AREA IN SFT 100 100 500 200 30 200 400 100 500 500 500 500 500 200 100 100 40

5.5.2 PATHOLOGY DEPARTMENT NO. 1 5 2 6 7 10 11 12 13 14 15 16 17 18 19 20 21

SPACE Reception/ Registration Medical record room Waiting Chief Pathologist Chief`s washroom Technician`s room Sample collection Scrub up Hematology laboratory Histology laboratory Immunology laboratory Microbiology Biochemistry Chemical Storage Sterilization room Disposal Area Staff toilets

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22 23 24 25

Nurse`s lounge Nurse`s toilets Public toilets Changing room + lockers M/F (150 sft) Sub-total Adding 35% circulation Total

1 2 4 2

200 40 100 300 5210 1,823 7033

QUANTITY 1 1 1 2 2 2 2 4 8 8 2 8 4 2 1 1 2 2 2 1 2 4 1 1 1 1 1

AREA IN SFT 100 500 100 400 60 150 60 1600 800 200 800 4000 400 200 1000 1000 130 130 40 200 40 100 60 60 60 60 100 12350

5.6 SURGICAL DEPARTMENT NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

SPACE Reception/ Registration Waiting Medical record room Surgeon`s room Surgeon`s toilet Anesthesiologist room Toilet Doctor`s lounge Scrub-up Sub-sterilization Anesthesia room Operation theater (500 sft) Disposal Area Mobile X-ray Pre-operative ward (10 beds) Post-operative ward (10 beds) Male changing room Female changing room Staff toilets Nurse`s lounge Nurse`s toilets Public toilets Clean Utility Dirty Utility Janitor closet Equipment store Pantry Sub-total

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Adding 35% circulation Total

4,306 16656

5.7 OBSTECTRICS AND GYNAECOLOGY NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SPACE Reception/ Registration Waiting Gynecologist Office Toilet Pre-Natal ward Post-Natal ward Private rooms Wash rooms Labor room Scrub-up room Sub-sterilization room Anesthesia room Caesarean section room (500 sft) Disposal area Changing room Demonstration room Staff toilets Nurse`s lounge Nurse`s toilets Public toilets Clean Utility Dirty Utility Janitor closet Pantry Sub-total Adding 35% circulation Total

UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

QUANTITY 1 1 2 2 1 1 10 10 2 1 1 2 2 1 2 1 2 1 2 4 1 1 1 1

AREA IN SFT 100 400 400 60 1500 1500 1500 500 400 100 100 100 1000 100 130 400 40 200 40 100 60 60 60 100 8950 3,132 12082

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5.8 INTENSIVE CARE UNITS 5.8.1 INTENSIVE CARE UNIT (I.C.U) NO. 1 2 3 4

SPACE 20 Bed I.C.U Doctor`s room Doctor`s toilet Nursing Station Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1

AREA IN SFT 2,000 200 30 50 2,280 798 3,078

5.8.2 PEDIATRIC INTENSIVE CARE UNIT (P.I.C.U) NO. 1 2 3 4

SPACE 10 bed P.I.C.U Doctor`s room Doctor`s toilet Nursing Station Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1

AREA IN SFT 1500 200 30 50 1,780 623 2,403

5.8.3 NEONATAL INTENSIVE CARE UNIT (N.I.C.U) NO. 1 2 3 4 5 6

SPACE Incubator ward (10 incubator) Mother lactation room Doctor`s room Doctor`s toilet Nursing Station Dress changing room Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1 1 1

AREA IN SFT 200 250 200 30 50 50 780 273 1,053

5.8.4 CORONARY CARE UNIT (C.C.U) UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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NO. 1 2 3 4 5

SPACE 10 bed C.C.U Cath lab Doctor`s room Doctor`s toilet Nursing Station Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1 1

AREA IN SFT 750 250 200 30 50 1,280 448 1,728

5.8.5 OTHER REQUIREMENTS OF INTENSIVE CARE UNITS NO. 1 2 3 4 5 6 7 8

SPACE Nurse`s lounge Nurse`s toilets Public waiting Public toilets Clean Utility Dirty Utility Janitor closet Pantry Sub-total Adding 35% circulation Total

QUANTITY 1 2 4 4 1 1 1 1

AREA IN SFT 200 40 1000 100 60 60 60 100 1620 567 2187

Total Area of Intensive care units 8,828 SFT.

5.9 INPATIENT DEPARTMENT (I.P.D) 5.9.1 DETAIL OF EXISTING AND PROPOSED I.P.D NO. 1 2 3 4 5 6

WARD NAME General Medicine General Surgery Pediatrics OB/GYN Eye ENT

UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

EXISTING PROPOSED 30 40 25 20 10 10 10

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7 9 10 11 12 13 14 15 16

Orthopedics Cardiology Neuro Surgery Psychiatry Oncology Nephrology Urology Dermatology Burn Unit Total

20 20 15 10

10

200

30 40 20

15 25 30 20 200

5.9.2 OTHER REQUIREMENTS OF I.P.D NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

SPACE Main Reception/ Registration/ Visitor`s waiting Mother feeding room Wheel chair/ Stretcher Storage Record room Attended room Security room I.P.D incharge room Incharge washroom Doctor`s room Doctor`s toilet 10 bed wards (800sft) Ward toilets (2 for 1 ward) Shower (1 for 1 ward) 4 Bed wards (320 sft) Private rooms (120 sft) Private toilets (30 sft) Nurses station Staff lounge Staff toilets Nurse`s lounge Nurse`s toilets Public toilets Changing room + lockers M/F (150 sft) Pharmacy

UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

QUANTITY 1 1 1 1 1 1 1 1 1 4 4 20 20 20 20 20 20 12 1 2 1 2 6 2 1

AREA IN SFT 100 1,500 200 100 100 100 100 200 30 200 100 16,000 1000 400 6,400 2,400 600 1,200 200 40 200 40 200 300 200 74

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26 27 28 29 30 31 32

Linen Store Clean Utility Dirty Utility Janitor closet Equipment store Pantry Children`s play area Sub-total Adding 35% circulation Total

1 1 1 1 1 1 1

60 60 60 60 100 100 1,000 33,350 11,672 45,022

QUANTITY 1 1 1 1 1 1 1 1 2 1 1 1 1 2 1 3 1 2 2 1 1 1

AREA IN SFT 100 400 200 30 200 100 150 30 200 500 400 400 400 800 200 60 200 40 50 60 100 100 4,720 1,652 6,372

5.10 ADMINISTRATION DEPARTMENT NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

SPACE Reception Visitor`s waiting M.S room M.S toilet D.M.S room D.M.S toilet P.A room P.A toilet Record room Conference room Library Administrator`s office Accountant office I.T room Staff lounge Staff toilets Nurse`s lounge Nurse`s toilets Public toilets Janitor closet Equipment store Pantry Sub-total Adding 35% circulation Total

UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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5.11 MORTUARY NO. 1 2 3 4 5 6 7 8 9 10 11 12 13

SPACE Reception Waiting Clerk`s room Police room Record room Preparation room Autopsy room Mobile X-ray Dead body room (50 x 18sft) Clean Utility Dirty Utility Janitor closet Equipment store Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1 1 1 1 1 1 1 1 1 1

AREA IN SFT 30 100 100 100 50 100 200 100 400 60 60 60 100 1,460 546 2,006

5.12 SERVICES DEPARTMENT 5.12.1 CENTRAL SERILE SERVICES DEPARTMENT (C.S.S.D) NO. 1 2 3 4 5 6 7 8 9 10 11 12

SPACE Reception Clean trolley area Dirty trolley area Sorting area Sterilization area Drying area Sterile goods store Non-sterile goods store Staff lounge M/F Staff lavatories M/F (40 sft) Changing room + lockers M/F (150 sft) Janitor closet Sub-total

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QUANTITY 2 1 1 1 1 1 1 1 2 2 2 1

AREA IN SFT 80 400 400 400 800 500 500 500 400 80 300 60 4,420 76

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Adding 35% circulation Total

1,547 5,967

5.12.2 PHARMACY AND GENERAL STORE NO. 1 2 3 4 5 6 7 8 9 10 11 12

SPACE Accountant office Receiver office Receiving area Drugs store Instruments store Stationary General storage Linen shop Staff lounge M/F Staff lavatories M/F (40 sft) Janitor closet Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1 1 1 1 1 2 2 1

AREA IN SFT 100 100 500 1000 1000 500 2000 500 400 80 60 6,240 2,184 8,424

QUANTITY 1 1 1 1 1 1 1 1 2 2 2 1

AREA IN SFT 200 400 200 1000 1000 100 500 200 1000 400 80 60 5,140 1,799 6,939

5.12.3 LAUNDRY NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14

SPACE Reception/ receiving area Dirty linen area Sorting area Laundry washing area Laundry drying area Chemical storage area Pressing area Repair and sewing area Clean linen storage area Staff lounge M/F Staff lavatories M/F (40 sft) Janitor closet Sub-total Adding 35% circulation Total

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5.12.4 KITCHEN NO. 1 2 3 4 5 6 7 8 9 10 11 12 13

SPACE Reception/ receiving area Supervisor’s room Crockery store Fruits and Vegetable storage Meat and fish storage (cold store) Dry store Cutting and washing area Main Kitchen Pan washing Garbage disposal Staff dining Staff lavatories M/F (40 sft) Janitor closet Sub-total Adding 35% circulation Total

QUANTITY 1 1 1 1 1 1 1 1 1 1 1 2 1

AREA IN SFT 200 100 100 100 100 100 500 1000 500 200 1000 80 60 4,040 1,414 5,454

QUANTITY 1 1 1 1 1 3

AREA IN SFT 150 100 100 200 1000 100 1,650 577 2,227

5.12.5 CAFETARIA NO. 1 2 3 4 5 6

SPACE Storage Cutting Washing Cooking Sitting Washrooms M/F (40 sft) Sub-total Adding 35% circulation Total

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5.13 RESIDENTAL AREA 5.13.1 APARTMENTS FOR DOCTORS AND PROFESSORS NO. A 1 3 4 5

B 1 3 4 5 6

1 2

SPACE 1-Bed Apartment Bed room Bath room Living room + Dining room Kitchen Sub-total For 20 families 2-Bed Apartment Bed room Bath room Living room + Dining room Kitchen Store Sub-total For 20 families Communal Space Main lobby Total for 40 families

QUANTITY AREA IN SFT 1 1 1 1 20

2 2 1 1 1 20 1 1

168 42 324 100 634 12,680

336 84 324 120 80 944 18,880 500 400 32,460

5.13.2 APARTMENTS FOR PARAMEDICAL STAFF 1 3 4 5

Bed room Bath room Living room + Dining room Kitchen Sub-total For 40 families

1 1 1 1

168 42 324 100 634 40 12,680 25,360 Independent residence for M.S and other BPS-20 (10 residences) = 3,000 x 10 = 30,000 TOTAL AREA FOR RESIDENCES = 90,000 SFT.

5.14 PARKING No. of visitor cars = 200 UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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No. of staff cars = 150 Parking area needed for one car = 8 x 16 = 128 sft.

Parking area needed for 350 cars = 350 x 128 = 44,800 sft.

No. of visitor bikes = 150 No. of staff bikes = 150 Parking area needed for one bike = 3 x 7 = 21 sft.

Parking area needed for 300 cars = 300 x 21 = 6,300 sft.

No. of visitor cycles = 50 No. of staff cycles = 50 Parking area needed for one cycle = 2 x 7 = 14 sft.

Parking area needed for 100 cars = 350 x 14 = 4,900 sft.

Total Parking area in hospital = 44,800 + 6,300 + 4,900 = 56,000

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5.15 TOTAL AREA OF ALL DEPARTMENTS NO. 1 2 3 4 5 6 7 8 9 10 11 13 14 16 17 18 22 23

SPACE EMERGENCY DEPARTMENT BLOOD BANK OUT PATIENT DEPARTMENT (O.P.D) OBSTECTRICS AND GYNAECOLOGY DEPARTMENT RADIOLOGY DEPARTMENT PATHOLOGY DEPARTMENT SURGICAL DEPARTMENT INTENSIVE CARE UNIT (I.C.U) INPATIENT DEPARTMENT ADMINISTRATION DEPARTMENT MORTUARY C.S.S.D PHARMACY AND GENERAL STORE LAUNDRY KITCHEN CAFETERIA RESIDENTIAL AREA PARKING TOTAL AREA

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AREA IN SFT 15,039 2,902 18,751 5,845 7,668 8,208 10,260 8,828 45,022 6,372 2,006 5,967 8,424 6,939 5,454 2,227 90,000 56,000 3,05,912

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6.1 PROFILE OF SIALKOT Sialkot is situated in the northern part of the Punjab province in Pakistan. It lies close to Snow covered peaks of Jammu and Kashmir near the river Chenab. Sialkot is located about 110 km north of Lahore and about 330 km South East of Capital Islamabad. A cornered city of Pakistan, yet Sialkot is one of the most important city and a hub business and industrial activities.

Most of the population belongs to adjacent small towns and villages. Sialkot is also known as City of Iqbal (being birth place of poet Allama Muhammed Iqbal, who also gave Muslims of subcontinent a vision for a separate country). Sialkot is well-known for its industry such as sporting goods, leather garments & accessories, knitwear, surgical & beauty care instruments, musical instruments and several other manufactures with an export up to $1bn. It has its own Dry port and a near completion Sialkot International airport with the longest runway of Pakistan.

Location: Altitude: Area:

32.30.19 N, 74.32.03 E 256 meters AMSL (above mean sea level) 3,016 km²

6.1.1 BOUNDRIES District Sialkot shares international border with India in the North-East, District Narowal in the East while Gujrat lies in the West. District Gujranwala and Sheikhupura lie in the South.

River Chenab, which is one of the major rivers of the country, also flows through its soil.

The district has been divided into 4 Tehsils and 124 union councils. The district comprises of following Tehsils:    

Tehsil Sialkot.

Tehsil Daska Tehsil Sambrial Tehsil Pasrur

6.1.2 POPULATION The population of District Sialkot 3.4 Million according to the census of 2008 in which 74% is Rural and 36% is Urban.

6.2 LOCATION OF SITE 6.2.1 MACRO LEVEL Proposed site for teaching hospital in Sialkot. Tehsil and District Sialkot.

6.2.2 MEZO LEVEL Distances of site to other tehsils.  

Daska 26.3 km.

Sambrial 17.7 km.

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

Pasrru 30.1 km.

Also, distance of site from other DHQ and teaching hospital are:  

Government Sardar Begham Hospital 3km.

Islam Central Teaching Hospital (Private) 8km.

6.2.3 MICRO LEVEL Site is located on commissioner road next to DHQ hospital.

N

SITE

Figure 6.1 Google map of site

Neighborhood context of the site are     

Open green land and Khawaja Safdar Road is located on North side.

Existing Civil hospital is on South side.

Commissioner Road on West side.

Graveyard on east side.

Newly built Khawaja Muhammad Safdar Medical college is located on the south east of the site.

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6.3 FEASIBILITY The site is feasible for teaching hospital as it is located on the back side of the Khawaja Muhammad Safdar Medical College and next to the existing civil hospital. Also, the road (commissioner road) on which the site is located is also known as hospital road as maximum hospitals and pharmacy of the city are locate on this road which shows that this is the medical hub of the city.

6.4 NATURE OF SITE Nature of site includes:   

Topography Services Accessibility

6.4.1 TOPOGRAPHY The land of the site is flat as there are no any contours on the site.

6.4.2 SERVICES Water, gas, electricity, drainage and sewerage system, all services are available on the site.

6.4.3 ACCESSIBILITY Site is easily accessible from whole city. Local transportation is available to the public to easily reach on site. Road width leading to the site is of 40ft, so there is no any traffic problem.

6.5 FEATURES There are two types of features.  

Natural Features The only natural feature on site are trees.

Manmade Features There are several one-story flats existing on site allocated to the government servants. These are going to be demolish in order to construct proposed teaching hospital.

6.6 BY LAWS The minimum spaces required to be left open within the plot area more than 3 acres shall be 30’, 20’ and 10’ from front, back and sides respectively. No building or structure shall be allowed in front, rear and sides of the plot and electric installations, public utility installations, landscaping, gatekeeper/ guard room and boundary wall not exceeding 10 feet in height. The height of any building measured from top of the plinth to the top of the parapet wall shall not UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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exceed 60’ and it shall consist of not more than 6 stories. The minimum effective height of each story shall not be less than 9’-6”.

6.7 DETAIL OF AREA Total are in sq. ft.

In marlas In kanals In acre

6,79,536 2,498.29 124.91 15.6

6.8 WIND DIRECTION Winter Winds: North-East to South-West Summer Winds: South-west to North-East

6.9 CLIMATE The climate of the district is hot in summer and cool in winter. The summer season starts from April and continues till October, while the duration of the winter season is from November to March. June is the hottest month. The mean maximum and minimum temperature during the month of June is about 40 and 25 degrees Celsius respectively. January is about 19 and 5 degrees Celsius respectively. The months of November and March are pleasant.

6.9.1 SEASONS IN SIALKOT Weather Autumn Winter Spring Summer Monsoon

Months 1 Oct -15 Nov 15 Nov - 15 Feb 15 Feb - 1 Apr 1 Apr – 30 Sep Jul - Sep

6.9.2 WEATHER RECORDS IN SIALKOT Average Rainfall Heaviest Rainfall Lowest Rainfall Most intensive cloud burst

20 inches 37.43 inches in 1882 6.21 inches in 1889 9 inches in 1954

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6.9.3 MONTH-WISE TEMPERATURE AND PRECIPITATION Month January February March April May June July August September October November December

Mean Temperatures © Maximum Minimum 19 1 22 5 28 11 35 16 40 20 44 23 40 24 36 25 33 21 31 15 26 9 21 4

Precipitation (millimeters) 15 26 54 30 18 39 186 114 60 18 12 15

Relative Humidity 76 % 71 % 64 % 48 % 40 % 54 % 75 % 78 % 74 % 65 % 67 % 74 %

6.9.4 WIND SPEED The wind speed data of Sialkot shows that the conditions are mostly calm.

Month January February March April May June July August September October November December

Maximum 57 76 81 93 74 74 74 67 70 83 67 74

Minimum 3 5 5 6 6 5 4 3 3 3 2 2

6.9.5 RAIN FALL Month January February March April May June

(Millimeters) 15 26 54 30 18 39

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July August September October November December

186 114 60 18 12 15

CONCLUSIONS Building blocks will be constructed far apart from the main entrance to avoid noise problem as the site is located on a very busy road. Secondly the sun shades will be provided on the south side of the building. Operation theaters and I.C.U`s will be placed on the north side of the site as it is away from the road and it’s a quite zone of the site. To avoid hot breeze in summer, trees will be used as these also purify the environment of the hospital and prevent the noise to enter in to the hospital. To ensure maximum use of natural light in inpatient department and proper flow of air, this department will be provided above the ground or the first floor.

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The design of a hospital complex incorporates features that are an intentional part of the healing process. From the planning stages to the construction phase and through to the administration of the facility, everything has been designed to reduce the anxiety of the patient’s experience and to increase the efficiency of care. From the way you enter the building to the way you access services, even down to the color scheme, the building promotes healing atmosphere.

7.1 DESIGN PHILOSOPHY PATIENT CENTERED DESIGN Patient-centered care focuses on the patient's and family's experience in the hospital, and the design of the healthcare environment should support the patient-centered care concept. The building’s design, along with the comprehensive list of services available, facilitates collaboration.

The easy-to-navigate layout places complementary services next to each other to maximize collaboration among specialty physicians. Patients benefit greatly in terms of both treatment and convenience by having all their doctors in one location. The purpose of this philosophy is to giving the patients a voice in the development of healthcare spaces.

Figure 7.1 Focus on Patient

One of the innovative design aspects of the building is the separation of patient areas and work areas. Patients have separate hallways, their own entrance to the exam rooms, and a unique experience away from the action that sometimes happens behind the scenes. Patients see only the personnel they need to see. This attention to traffic flow makes for a safe, accessible, soothing environment. This concept is established to improve the environment of care by addressing the needs of patients and their families through design.

Figure 7.2 Patient Centered Design UPGRADATION OF DHQ TO GENERAL TEACHING HOSPITAL, SIALKOT

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The clinic’s work spaces are located on the opposite side of the exam rooms from the patient corridors. The building’s design opens up in the work areas to promote collaboration and increase efficiency. Desks are built low to increase sight lines and there are no walls or obstructions to block views. This allows the nursing staff to continually assess the needs of the entire area. The physician work areas are adjacent to the nurses’ work spaces, so the doctors have a unique vantage point to monitor work flow and can better communicate with the nurses and medical assistants.

This integration of staff minimizes the steps for the physician and improves the care given to each patient.

1. Unit configurations and layouts — When considering which approach from a race track configuration to a compact triangle, the designers should measure which model creates an optimal environment for staff travel distances, patient safety, patient visibility and easy communication with staff, proximity of patient rooms to nurses’ stations, standardization in same-handed configurations, and use of on-stage/off-stage areas, along with the pros and cons for varying approaches to each.

2. Decentralized nursing — While the traditional approach of using a centralized model has long been a design staple, research supports the move toward a decentralized (or possibly a hybrid of centralized and decentralized) stations that can improve staff efficiency, reduce walking distances, and increase the time nurses can spend with patients.

3. Family-centered care — Since patient`s health is often linked to the health of their family members, creating spaces where relatives can have a sense of self-efficacy and empowerment is a significant component of patient-centered design. There are four key concepts to family-centered care: active participation of patients and family in the healthcare decision-making process; relevant information provided to patients and their family to make those decisions; a choice offered on what level of participation is preferred in decision-making; and involvement on institutional issues, including facility design and delivery of care.

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BIBILOGRAPHY 1. Chiara, Joseph (1987), Time Saver Standards for Buildings, London: Mc-Graw Hill Publications.

2. Hugh Gainsborough, John Gainsgorough, Principles of hospital design, London (1964).

3. Geol, S.N & Kumar, Rd. (2001), Hospital Administration and Management: Theory and Practice, India: Deep & Deep 4. Anthony Cox, Philip Groves, Design for health care, Norfolk (1981).

5. E. Todd Wheeler, Hospital design and function (1985).

6. Kant, Sunil & Sidhart (2007), Modern trends in planning and designing of hospitals: Principals and practices, India: Jaypee medical publications (pvt). Ltd. 7. Pena, William.M & Parshal, Steven.A (2001), Problems seeking: An Architectural programming perimer, London: John-willey & sons.

8. William Dudley hunt, Hospitals, clinics and health centers, New York (1960).

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