Every hospital emergency department (ED) is different because it reflects the community’s needs and resources. Some hospitals offer the full continuum of emergency services — including trauma and emergent care, nonurgent care, an observation unit, a chest pain unit, pediatric services, and a behavioral health crisis unit — while others provide only basic services. To estimate the numbers and types of ED treatment spaces, you first need to calculate the number of general treatment spaces (for both the emergent/urgent care area and nonurgent/fast track area). Some of these spaces can then be designed for use by special patient populations. Finally, you need to add other unique and specialty treatment spaces to arrive at the total number of patient care spaces to be planned.
Facility Components
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Nursing Unit Space Per Bed Can Vary Significantly
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.
How Many ORs? It’s Complicated
Planning a surgery suite used to be fairly simple. General operating rooms (ORs) were used for a wide range of procedures and dedicated operating rooms were limited to cardiac surgery and orthopedics. At the same time, interventional radiologists and cardiologists created their own workplaces. Today, planning surgical and endovascular suites is complicated by the convergence of diagnostic imaging and surgical procedures, rapidly changing technology, increasing specialization, and strict distinctions between operating rooms and procedure rooms. From a facility planning perspective, the number, size, and specialization of ORs and endovascular procedure rooms is the single most significant factor contributing to the overall footprint of the suite (and project cost). Moreover, the numbers and sizes of related patient care and support spaces are driven by the number and types of operating/procedure rooms. More importantly, the number of operating/procedure rooms drives ongoing staffing and related operational costs.
Sizing Imaging and Procedure Rooms
Imaging and procedure rooms fall into several size categories — small procedure rooms, typical imaging rooms, or larger specialty imaging rooms. Diagnostic equipment has generally become more compact over time. For example, equipment used for chest X-rays, mammography, ultrasound, and pulmonary and neurodiagnostic testing is compact and commonly mobile, requiring only a small procedure room. Most general radiographic and fluoroscopic equipment can be accommodated in a typical imaging room. Computed tomography (CT) units are also becoming more compact but require a contiguous control room. Magnetic resonance imaging (MRI) and interventional procedure suites require a larger footprint that includes the procedure room, control room, and adjacent space for equipment (or system) components. Imaging equipment may also require lead shielding, enhanced floor loading capacity, and other unique design features. The FGI Guidelines also classify imaging rooms based on different levels of patient acuity and intervention.
The Hospital Pharmacy — Now a Sophisticated Manufacturing Plant
Automation — with the barcode as the foundation — has transformed the hospital pharmacy into a high-tech manufacturing plant that allows pharmacists to focus on direct patient care. Although automation in the pharmacy requires a significant capital investment, it reduces labor costs, lowers the risk of dispensing errors, optimizes inventory control, and provides better security, among other benefits.
Physician Offices and Outpatient Clinics: How Many Exam Rooms?
Physician offices and outpatient clinics typically consists of a patient intake area with space for reception, check-in/check-out, and waiting; exam/treatment space with a number of identical exam rooms, several office/consultation rooms, and one or more special procedure rooms; and associated clinical and administrative support space. Physician office space may be located in a medical office building (either freestanding or connected to a hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an institute or center organized along a specific service line — such as a Sports Medicine Center, Heart Center, or Cancer Center. Planning space for physician offices (also referred to as physician practice space) and outpatient clinics begins with determining how many exam rooms are needed and two different approaches are commonly used.