Have you ever wondered why there is significant variation in the nursing unit space per bed from project to project? Particularly when the number of beds is the same. Historically, this variation was attributed to the mix of private, semiprivate, and multiple-bed patient rooms. However, even today when most hospital building projects in the U.S. have all private patient rooms, the nursing unit space per bed continues to vary. Contributing factors include the size and layout of the private patient room and adjoining toilet/shower room, the specific grouping of the patient rooms within the unit, and the overall design and layout of the floor itself. The amount of family, visitor, and staff amenities provided on the floor and the extent of point-of-care clinical and support services are also factors.
Instructive case studies from real-life challenges faced by healthcare organizations in North America.
Case Study: Planning a Medical Procedure Unit
Historically, same-day medical procedures at Midwest Medical Center have been provided by a variety of different departments and scattered throughout the hospital with redundant patient reception/waiting, preparation, treatment, and recovery spaces. As demand for same-day medical procedures continued to grow, the hospital leadership was concerned that outpatient satisfaction was being compromised while operational costs were increasing dramatically. Department staff were inpatient-focused and reluctant to alter pre-established protocols and processes. They were also reluctant to consider any changes to their existing “turf.”
Case Study: Planning an Ambulatory Care Facility
Prudent Health System planned to construct a new ambulatory care facility on its main hospital campus to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics. The organization needed space to accommodate the following ten-year workload projections and corresponding clinical services:
- Urgent care center with 32,000 annual visits
- Ambulatory surgery center with 4,200 annual surgical cases
- Hospital-sponsored clinics: medicine (23,000 annual visits), surgery (15,000 annual visits), neurosciences (6,000 annual visits), orthopedics (16,000 annual visits)
In addition, Prudent Health planned a small express testing area to consolidate routine, quick-turnaround outpatient testing in a single area—including X-ray, electrocardiogram, and specimen collection — along with a small satellite laboratory.
Case Study: Planning a Prototype Health Center
Northern Health Authority delivers healthcare to the residents of 20 different communities that are a mix of settlements, towns, and villages. With many of the existing remote health centers in need of replacement, Northern Health decided to develop a prototype community health center that could be replicated to serve communities of less than 1,500 people — some of which are accessible only by air.
Case Study: Evaluating Emergency Expansion
Midwest Hospital planned to expand and potentially replace its ED in response to increased crowding and congestion. Although the current number of annual visits (40,000) was not expected to grow significantly in the near future, the patient and visitor waiting room was frequently overflowing during the evening hours. ED staff also began creating “hall beds” by labeling and assigning defined stretcher bays in the hallways to gain additional treatment space during peak periods. The relocation of an adjacent occupational medicine clinic was viewed as an option for ED expansion in lieu of total ED replacement.
Specific facility expansion goals included expanding the patient and visitor waiting space with enhanced amenities; providing adequate exam and treatment space; triaging nonurgent patients in a separate, fast-track area; and developing a holding area for patients to be admitted who are waiting for an available inpatient bed. Although facility expansion and operations improvement were deemed necessary by all members of the planning team, the CFO was concerned about spending significant capital dollars when ED revenues were relatively flat. ED staff were also not in agreement regarding the extent of required expansion; some wanted to almost double the size of the current ED, while others were concerned that significant expansion would require additional staff at a time when budgets were tight and recruiting was difficult. Others were concerned about the long ED length of stay and its impact on customer satisfaction. However, all members of the planning team agreed that a detailed analysis of the relationship between improvements in exam and treatment room turnaround time and resulting space need and construction cost was warranted prior to initiating the detailed operational and space programming process.
Case Study: Planning a New Outpatient Clinic
University Hospital (UH) planned to replace three outpatient clinics, currently in different locations, in a new freestanding building. Although the number of annual visits (30,000) was not expected to grow significantly, there was considerable debate among the physician leadership regarding the planning of the new facility. Some wished to maintain the status quo regarding their current productivity and wanted to simply replace the three separate clinics in new construction. Others wanted to consolidate the clinics into a single, efficient ambulatory care space ― recognizing that reducing their staff and facility costs would make them more profitable while potentially improving customer service with more streamlined and better coordinated processes. The physician leadership agreed to evaluate the impact on overall space need (and resulting construction cost) of planning a lean facility versus a more generous facility.