Korean hospital design, state of the art

This paper analyzes the architectural characteristics and trends and suggests some tasks for better hospitals. Hospital design has been improved qualitatively in architectural form and interior. Although overall forms of most buildings have a vertical concept, horizontal concept hospitals have been attempted. In ward plan, various shapes have appeared and interior space has been more dynamic. Special clinics and centres have been established and operated to meet the high level of patients' demand. Suggestions for better hospital could be the increase of private rooms, decreasing the size of the nursing unit, the use of the horizontal concept, supplement of safety-privacy-hygiene, and some sensory factors.

A decade of adult intensive care unit design: a study of the physical design features of the best-practice examples

This article reports a study of the physical design characteristics of a set of adult intensive care units (ICUs), built between 1993 and 2003. These ICUs were recognized as the best-practice examples by the Society of Critical Care Medicine, the American Association of Critical Care Nurses, and the American Institute of Architects. This study is based on a systematic analysis of the materials found on these ICUs in the booklet and videos jointly published by the above organizations in 2005. The study finds that most of these examples of best-practice adult ICUs have the following negative characteristics: (1) they are built as renovation projects with more health and safety hazards during construction; (2) most of them are mixed-service units with more safety and staffing problems; (3) the overall layout and the layout of staff work areas in these ICUs do not have any common design solutions for improved patient and staff outcomes; and (4) in these ICUs, family space is often located outside the unit, and family access to the patient room is restricted, even though family presence at the bedside may be important for improved patient outcomes. Some of these negative characteristics are offset by the following positive characteristics in most ICUs: (1) they have only private patient rooms for improved patient care, safety, privacy, and comfort; (2) most patient beds are freestanding for easy access to patients from all sides; (3) they have handwashing sinks and waste disposal facilities in the patient room for improved safety; and (4) most patient rooms have natural light to help patients with circadian rhythms. The article discusses, in detail, the implications of its findings, and the role of the ICU design community in a very complicated design context.

Spatial requirements in hospital shower and toilet rooms

AIM

To determine the spatial requirements for hoist use in an assisted shower-toilet facility.

METHOD

A simulation of two shower-toilet facilities (built since 2000) was constructed in a laboratory to compare a mobile hoist and a gantry (overhead) hoist for the task of transferring a patient from a wheelchair to the toilet. Twenty participants were recruited and trained in the use of both hoists. Data were recorded using video cameras and analysed for the space used to complete the task, time taken and postural risk scores.

RESULTS

The mobile hoist needed significantly more space, took significantly longer and exposed the handlers to higher postural risks than the overhead hoist.

CONCLUSION

Larger shower-toilet rooms should be planned and built as accessible facilities with sufficient space for independent and assisted wheelchair users. The findings will have an impact on the recommendation for increased numbers of single rooms with ensuite facilities in new hospitals. Healthcare planners and designers may need to consider building specific facilities for assisted wheelchair users rather than providing a 'one space fits all' solution.

Patient-centred improvements in health-care built environments: perspectives and design indicators

OBJECTIVE

To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs.

DESIGN

Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients.

SETTING AND PARTICIPANTS

The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires.

RESULTS

The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space around the bed area, supportive of privacy and dignity, ward noise and other disturbances.

CONCLUSIONS

Patients perceived sustainable health-care environments to be supportive of their health and recovery. The design indicators developed from their perspectives and from their considerations for improvements to the health-care built environment were based on their visions of the role of the health-care facilities. These were homely environments that supported normal lifestyle and family functioning and designs that were supportive of accessibility and travel movements through transitional spaces.

The aesthetic dimension in hospitals--an investigation into strategic plans

BACKGROUND AND RATIONALE

The underlying assumption was that the aesthetics of the hospital surroundings are often neglected.

AIMS

This article is the first part of a larger study into the aesthetics of general hospitals. The aim of the study is to throw light on the influence of aesthetics on the health and well-being of patients and the professional personnel, and to examine how aesthetic considerations are dealt with. We present a survey of how the aesthetic dimension is planned and it is considered important in the strategic plans of Norwegian general hospitals.

METHODS

Data were sampled by analyzing the strategic plans of somatic hospitals. Sixty-four of 86 hospitals responded (74%). Concepts were categorized in a matrix of 11 main categories, each with subcategories. The method was quantitative, in that the analyzed material was amenable to counting.

RESULTS

Very few concrete guidelines or directions for the aesthetic dimension have been included in written documents. This indicates that the aesthetic area is a neglected field in the directions for the daily management of hospitals.

CONCLUSIONS

The research available today on the contribution of environmental aesthetics to health, rehabilitation, and well-being suggests that it is important to have concrete guidelines recorded in strategic plans. This field concerns the maintenance of high quality in the caring professions.

Sound level exposure of high-risk infants in different environmental conditions

PURPOSES

To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU.

DESIGN

Descriptive and comparative design.

SAMPLE

Convenience sample of 134 infants at a southeastern quarternary children's hospital.

MAIN OUTCOME VARIABLE

A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions.

RESULTS

The renovated NICU was, on average, 4-6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels.

CONCLUSION

Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.

Building new hospitals: a UK infection control perspective

Infection control input is vital throughout the planning, design and building stages of a new hospital project, and must continue through the commissioning (and decommissioning) process, evaluation and putting the facility into full clinical service. Many hospitals continue to experience problems months or years after occupying the new premises; some of these could have been avoided by infection control involvement earlier in the project. The importance of infection control must be recognized by the chief executive of the hospital trust and project teams overseeing the development. Clinical user groups and contractors must also be made aware of infection control issues. It is vital that good working relationships are built up between the infection control team (ICT) and all these parties. ICTs need the authority to influence the process. This may require their specific recognition by the Private Finance Initiative National Unit, the Department of Health or other relevant authorities. ICTs need training in how to read design plans, how to write effective specifications, and in other areas with which they may be unfamiliar. The importance of documentation and record keeping is paramount. External or independent validation of processes should be available, particularly in commissioning processes. Building design in relation to infection control needs stricter national regulations, allowing ICTs to focus on more local usage issues. Further research is needed to provide evidence regarding the relationship between building design and the prevalence of infection.

Operating Room Management: Operative Suite Considerations, Infection Control

An operating room's condition is rarely directly implicated in dis-ease transmission. Even so, to prevent such rare transmissions,hospitals must be thoughtful in designing operating rooms as important adjuncts to infection control. Proper ventilation in and near the operating room is the single most important component in establishing an environment that stops the spread of infection. Other considerations include attention to traffic control, equipment maintenance and storage, and construction materials that enhance the ability to maintain clean rooms. Hospitals can avert potential infectious problems through preventive maintenance and the use of infection control risk assessments (ICRAs) for preemptive consideration of infectious risks before renovations, repairs and new construction. Guidelines should be consulted and incorporated into each operating room's policies and procedures.

Who's got what? A benchmarking exercise for tertiary neonatal units

OBJECTIVES

To determine the current facilities available in level-3 neonatal units (NNU) in Australia and New Zealand to assist with establishment of standards for new NNU design.

BACKGROUND

Many current NNU in Australia and New Zealand are planning new or redesigning existing facilities. There are no adequate local standards for NNU design available which reflect changing neonatal practices.

METHODS

All level-3 neonatal units belonging to the Australia and New Zealand Neonatal Network (ANZNN) were invited to respond to a survey on NNU facilities. Questions were based around obtaining information on whether the NNU were planning to build or redesign the space and clinical facilities available in their existing facilities and what support and family spaces were provided.

RESULTS

Twenty-six (six in New Zealand and 20 in Australia) of the 29 tertiary NNU in the ANZNN responded the survey. The oldest facility was built in 1960, with the most recent NNU being commissioned in 2003. Of the 26 responders, 18 indicated that they were planning to rebuild or renovate, with 13 anticipating completion within 6 years. The median floor area for existing level-3 cots was 11.1 m(2) (range 5.5-18.0 m(2)) and 5.8 m(2) (range 2.3-15.6 m(2)) for level-2 cots, respectively. Most units responded that storage space was insufficient (median 1.5 m(2) per cot, range 0.4-3.3 m(2) per cot). Most units had facilities for parents including a family lounge and parent overnight rooms, although 16 units indicated that they needed more overnight rooming in facilities. Noise levels in level-3 areas were described as being 'generally' or 'mostly noisy' in 14 of 25 responses, but noise levels in level-2 areas were less in the majority of responses. Privacy was cited as an issue for 80% of responding NNU with comments directed at either the layout or space constraints interfering with confidentiality or interactions with families.

CONCLUSIONS

The majority of NNU have inadequate space and environmental control. The lack of space particularly impacts on infection control aspects, parental privacy and participation and staff satisfaction. Level-2 areas, where parent participation in the care of infants is often greater, should receive as much attention as higher technology level-3 areas. Furthermore, work should be undertaken to develop appropriate local recommendations for NNU design which are acknowledged by local government agencies and professional bodies and take into account the changes in neonatal care practices, integration of family in the care of infants and the needs of the staff.

Design with dignity

Adapting facilities to accomodate obese patients calls for thoughtful design that allows for comfort flexibility and safety--and, above all, is respectful to the individual.

Awareness needed of Legionella risk

A profile of the work of David Harper, global authority on Legionnaire's disease in engineering terms, whose investigations into new-build hospital water systems have uncovered a number of risk factors which could expose patients to the Legionella bacterium.

Access inequalities addressed by audit

The Disability Discrimination Act (1995) protects disabled people from discrimination in access to services, facilities and goods as well as in education and employment. All hospitals have an inherent duty to enable access to services but this will now be enshrined in law. As the health sector has most contact with disability, it may be expected that most hospitals would already be in a good position to comply with the Act, especially one treating many patients with disability. However we identified many problems in a rehabilitation hospital setting by means of a simple access audit in March 2004. Recommendations were set out and by March 2005 considerable improvements had been made costing Pound 100,000. Although many necessary changes will be expensive, not all problems identified require costly correction. Many simply involve a change in staff attitudes and practices. We recommend that all hospitals start to identify the changes needed under the Act by means of a simple access audit that can be carried out by hospital staff with no specialist equipment.

Northern ProCure21 scheme wins prize

The Newcastle, North Tyneside and Northumberland Mental Health NHS Trust and the Laing O'Rourke Team were awarded the best practice runner-up prize at the recent North East Constructing Excellence Awards for their Adult Forensic Psychiatry Development (Phase 1) at St. Nicholas Hospital, Gosforth. Report by Rob Smith, estates manager at the Trust.

Avoiding 'builder's remorse'. Maximizing the value of your facilities investments

To make sure big health care facility investments don't end up as big capital mistakes, building projects must be linked to long-term organizational goals.

Hospital construction 101: Blueprints for success

Nursing input from beginning to end proves crucial to success of new healthcare construction or remodeling projects. Here, explore pointers to ensure optimal results.

Implementing best construction practice

In this article, based on a speech given at last November's Healthcare Estates Conference, Minister for Construction Nigel Griffiths sets out the challenges facing healthcare estates in the context of NHS reform and modernisation in the 21st Century.

Patient sociality in hospital architectural space: a qualitative case study in Namibia

The article presents research on the relationship between admitted patients' social needs and hospital architectural space in an African context. Interaction with relatives and fellow patients is very valuable to the well-being of the patient. The results show inflexible and restrictive spatial conditions that disturb this interaction, for instance, by aggravating the ubiquitous overcrowding and people leaving the ward. One important reason for leaving the ward is to socialise with other people. Relatives, who assist with caring tasks in the ward, stay overnight in a yard in the hospital grounds under uncomfortable and health threatening conditions. The results illustrate how patients' well-being can improve by removing inflexibility and restrictions on space.

Monte Carlo evaluation of kerma in an HDR brachytherapy bunker

In recent years, the use of high dose rate (HDR) after-loader machines has greatly increased due to the shift from traditional Cs-137/Ir-192 low dose rate (LDR) to HDR brachytherapy. The method used to calculate the required concrete and, where appropriate, lead shielding in the door is based on analytical methods provided by documents published by the ICRP, the IAEA and the NCRP. The purpose of this study is to perform a more realistic kerma evaluation at the entrance maze door of an HDR bunker using the Monte Carlo code GEANT4. The Monte Carlo results were validated experimentally. The spectrum at the maze entrance door, obtained with Monte Carlo, has an average energy of about 110 keV, maintaining a similar value along the length of the maze. The comparison of results from the aforementioned values with the Monte Carlo ones shows that results obtained using the albedo coefficient from the ICRP document more closely match those given by the Monte Carlo method, although the maximum value given by MC calculations is 30% greater.

A new RVH for a new century: maintaining clinical excellence. Annual oration: Royal Victoria Hospital, Belfast, October 2003

Images

Guidelines and levels of care for pediatric intensive care units

The practice of pediatric critical care medicine has matured dramatically during the past decade. These guidelines are presented to update the existing guidelines published in 1993. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education.

Room for improvement

First announced in 1992 by the then Conservative Government, the Private Finance Initiative is a contract whereby private companies finance, design, build and manage public buildings, such as hospitals and schools, and lease them to the public sector for a set period--typically 30 years. In healthcare, the scheme has been particularly prolific, with 34 hospitals and 119 other PFI health schemes built to date. PFI projects are also expected to account for the majority of the 15 NHS hospital developments worth over pound 4 billion, that were recently announced by Health Secretary John Reid. Arguments aside, few could deny that PFI has been instrumental in facilitating the biggest NHS hospital building programme ever seen.