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.
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.
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.”
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.
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.
Ocean Health System includes three acute care hospitals with a total capacity for 670 beds although each hospital staffs significantly less beds:
- Valley Hospital with 245 beds
- Coast Hospital with 360 beds
- Rural Hospital with 65 beds
Valley Hospital and Coast Hospital are located six miles apart in a scenic northeast region. Acute care beds are currently located at both sites along with duplicative emergency departments, surgical suites, and various diagnostic and support services. Both of these facilities share essentially the same market along with a competitor hospital to the northeast.
Rural Hospital, although only eight miles away from Valley Hospital, requires travel via a congested and winding road with the travel time averaging between 20 and 30 minutes. Rural Hospital also has a distinctly different patient catchment area than Valley and Coast Hospitals. Most of Rural Hospital’s patients come from the west where it competes with hospitals bordering a large urban area.