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.
Healthcare facilities need to provide a sufficient number of parking spaces for patients, staff, service traffic, and the public. At a minimum, parking standards or requirements developed by local authorities having jurisdiction should be consulted since these will reflect the availability of public transportation, public parking facilities, or other alternatives. This article provides some general rules-of-thumb for estimating the number of parking spaces for patients being admitted/discharged, visitors to inpatient nursing units, hospital staff, outpatients, and emergency patients and their escorts.
Sometimes a preliminary space estimate is needed to evaluate location alternatives, conduct a feasibility study, or develop a preliminary cost estimate for construction or renovation. Once the number of procedure rooms is determined, an estimate of the total footprint required for the diagnostic imaging suite can be made using the range of DGSF (DGSM) per procedure room shown in this post.
Starting in the 1980s, healthcare strategists and policy experts encouraged hospitals to reduce their surplus inpatient bed capacity in response to declining admissions, use rates, and lengths of stay — as a result of the advent of Medicare’s diagnosis related groups (DRG) payment methodology in the public sector and managed care in the private sector. Hospitals responded to changes in demand by shifting their resources. Between 1980 and 2003, community hospitals in the United States took 175,000 inpatient beds out of service — an 18 percent reduction — through downsizings, consolidations, and closures. At the same time, skilled nursing and subacute care facilities were developed to provide a less expensive and less resource-intensive alternative for patients requiring a lengthy recuperation. Home health agencies also proliferated. Since 2003, the number of hospital beds has declined less dramatically — a reduction of another 12,700 beds. Although, nationally, inpatient admissions rose from 1992 to 2012, both the rate of inpatient admissions per 1,000 population and the average length of stay have declined to an all time low — resulting in an overall decline in the demand for inpatient beds.
Planning a surgery suite used to be fairly simple. General operating rooms were used for a wide range of procedures with dedicated operating rooms limited to cardiac surgery and orthopedics. Today, the question “How many operating rooms are needed?” is complicated by more stringent distinctions between operating rooms and procedure rooms, changing technology and increasing specialization, and the convergence of diagnostic imaging and surgical procedures. From a facility planning perspective, the number, size, and specialization of the operating rooms (ORs) is the single biggest factor contributing to the overall footprint of the surgery suite (and project cost). Moreover, the numbers and sizes of related patient care and support spaces are planned based on the number and types of ORs. And, from an operational standpoint, the number of ORs drives ongoing staffing and related operational costs.
Imaging and procedure rooms fall into several size categories — small procedure room, typical imaging room, or larger specialty imaging room — and diagnostic equipment has generally become more compact over the last decade. 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 including the procedure room, control room, and adjacent space for equipment components. Imaging equipment may also require lead shielding, enhanced floor loading capacity, and other unique design features.