Inpatient Services- Introduction, Planning and Designing
Dr.Sharad H. Gajuryal
Basically People go to hospital for two purpose; either
seek out door consultation in OPD or for admission in
hospital. Inpatient ward are for those patients who
need treatment under healthcare personal’s
Patient are admitted in Inpatient Ward for short and
long term depending on severity of their disease.
Inpatient Department consists of a wards with
Nursing Station, Beds, and all other facility & services
necessary for good patient care.
It is one of the important aspects of hospital as every
ratios and calculation for hospital planning and
designing process is based upon the no. of bed it
To provide highest possible quality of medical and
To make a provision of essential equipment, Drugs,
and other material required for patient care.
To provide comfortable and desirable environment to
patient on temporary substitution of home.
To provide facilities for visitors.
To provide suitable atmosphere for highest possible
degree of job satisfaction among healthcare personal
and high level of patient satisfaction.
To provide opportunity for education, Training and
The IPD forms 33%-50% of the structure of
hospital construction and most of the equipment
and staffs are in this department with maximum
amount of patient care, training, medical teaching
and research concentrated in this department .
IPD is the area which gives maximum output of
services and name and fame to the hospital too
and so maximum vigilance is required to prevent
litigation and to gain patient satisfaction.
There are different types of ward design;
1.Open ward or Nightingale Ward
2.Rig’s Pattern Ward (Unilateral or Bilateral)
3.Modified Rig’s Pattern Ward
4. “T” and ‘Y” Shaped Ward
5. ‘L” , ‘H’, ‘E” Shaped Ward.
This type of ward was designed in 1770 by Frenchman,
Later it was adopted by Florence Nightingale and is known
by her name. The characteristics of Nightingale ward is :
Patient Bed in two row at right angle to the longitudinal
It may have side rooms for utilities and perhaps one or two
side rooms, that can be used for patient occupancy when
patient isolation or patient privacy is important.
Nursing Station, Doctor’s room and others facility at one
end. Bathroom and WC at the other end.
Good Visibility and economical and easy to construct,
plenty of fresh air & ventilation.
Noisy and no privacy for patient
Risk of cross infection
Fatigue of Nurses
Space between bed reduced
It has got a nursing station in centre of ward, Ancillary
and Auxiliary service at one end and utility service at
other end. The nurse travel time has been reduced and
the supervision over patients condition also improved
in modified pattern of ward.
It was first made in Rigg hospital in 1910 in
Ward unit is divided into small compartments
separated from each other . Each compartments
having 4-6 or more beds arranged parallel to the
longitudinal wall. Bed may be on one side or both side
of nursing station. Isolation room (1 or 2) can be kept
Advantage of RIG’s Ward /Bay Ward is there would be
privacy for patient, Risk of cross infection minimized,
less noisy, Isolation of infectious cases can be easier.
Disadvantage of RIG’S ward include
Communication between patient and nurse is more
Direct observation of patient is difficult.
More staffing required
Costly and difficulty to maintain than Open ward.
Changes in the design of hospital wards have usually been determined by
architects and members of the nursing and medical professions; the views and
preferences of patients have seldom been sought directly. The Hospital Anxiety
and Depression scale and the Disturbance Due to Hospital Noise questionnaire
were administered to 64 female patients on bay and Nightingale wards together
with a questionnaire designed for this study. Perceptions of social and physical
factors of ward design were examined, and their relationship to psychological
well-being and sleep patterns. The results show that the bay ward seemed to
offer a more favourable environment for patients but some of the disadvantages
of bay wards are balanced by better staffing levels and better and more modern
facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward
was perceived as significantly noisier than the bay ward and noise levels were
significantly correlated to anxiety scores. Paradoxically the increase in noise
levels appeared to improve the perceived level of privacy on the Nightingale
ward. Seventy-five per cent of patients were found to prefer the bay ward design,
and since neither design appears to have major disadvantages their continued
introduction should be encouraged. However, recommendations are made
concerning the optimizing of patients' well-being within the bay ward setting.
of Ward Unit
Primary Accommodation: It consists of single bedroom or
multiple bedroom for patients and a nursing station.
Ancillary accommodation: service for direct support of
treatment. Eg: portable x-ray, side lab,Pantry,Dietician
service in ward, mobile pharmacy.
Auxiliary accommodation :Service in indirect support of
treatment . Eg:Store, housekeeping, doctor’s room, nurse’s
room, seminar –teaching room.
Sanitary accommodation : Consists of WC, Bathroom,
Janitor’s room ,sluice room.
Hospital policy and plan
Function and location
Relationship with other departments
Emergence of hospital infection
Dignity and privacy of patient
Location :Away from parking and crowd area, adjacent to
support and diagnostic services, should be away from
Circulation: Vertical or horizontal
Vertical circulation can be arranged with less space with
central vertical spine for lifts, conveyers and stairs and pipe
lines. Reduces patient errors and cross infections.
Horizontal circulation: eliminates requirement of expensive
vertical transportation system. suitable for inpatient up to
300 bed strengths.
Aim of ward design:
General ward :Healthy Environment
Pediatric/ psychiatric ward- Safety
Geriatric ward- Safety/ comfort
Obs/Gyne ward – Privacy
ICU- Nursing Care
Size of ward :depending upon type of patient , kind of nursing
NHS,UK recommends 24 bed/ward
Traditionally it’s 32(+/-)10 beds/ward
Area of ward :90 -110 sq.feet /bed (8-10 sq.meter)
Distance between center of two bed -2.25 meter,not less than 2
Distance between two bed -1.25 meter
Width of corridor -2.4 meter
Distance between bed end and wall-0.25m
Distance between bed wall and bed nearest to side wall-0.65
0.65 m Nursing
Modular grid-1.6 m i.e 3 grid unit for each bed space / 1.5 grid unit for toilet
Ceiling Height : at least 3 meter.,Height of suspended
ceiling fan –at least 2.6 meter.
Windows: if only in one wall then it should be 20% of floor
area , if multiple windows then 15% of floor area.
Corridors: the width of corridor recommended is 2.4 m to
faciliate movement of trolley,bed ,stretchers
Door : should not be less than 1.2 meter wide and 2.25 m
Bed side locker/cupboard-must
Chair sofa/sofa cum bed- for visitors
Other facilities-depending upon
Nurse station: should not be less than 60 sq. feet with
nursing table ,sisters room and build in cup board.
with provision of large glass window for observation is
Doctors room :120 sq ft
Nurse room :120 sq feet
Space for stretcher trolley 21 sq ft
Store room :200 sq ft
Clean utility room -80 sq ft
Sluice room -120 sq ft
Toilet with washroom/bathroom & WC-50-70 sq ft
Only WC -4-5 sq ft
Only shower -6.5 sq ft
Dirty utility -120 sq ft
Janitors closet -7 sq ft
Recommended- urinal (1 for 16 bed ) WC- (1 for 8 bed )
bathroom (1 for 12 bed ) wash basin (1 for 10 bed )
Water & electricity supply :300 ltr water /bed/day
round the clock supply
For electricity, Point should be carefully designed with
every cubicle having switches / one industry switch for
machine like portable x ray/ natural lights should be
planned / provision of night light
Communication: There should be effective
communication source between nurse and patient and
nurse and other units.
Fire safety : there must be provision for fire
extinguisher ,with fire exit stairs with ramp
Ramp width-1.5 meter (1:12 feet ) ( (4.8 degree angle;
Hot and cold water supply
Nurse call system
Oxygen cylinder/suction pipe /thermometer holder.iv