Several patient characteristics associated with vulnerability were identified. Socio-demographic condition, legal status and financial means seem to be the most important determinants. These characteristics were often linked, as if the costs prevent the system from adapting to the patient's needs.

1. CARE OF FEATURES OF A DISABLED FRIENDLY
HOSPITAL SETTING AS PER NABH GUIDELINES
DR.ANJALATCHI MUTHUKUMARAN
M.SC (N) PH.D, MD (AM), MBA(HA), MA(SOC)
ERA UNIVERSITY

2. INTRODUCTION
 A disabled friendly hospital is one which enables
people with disabilities to freely and safely move
and access facilities within the hospital. Such
hospital building provides an environment of
independence to individuals with disability, which is
their right granted under Persons with disability act,
2016. Patient with a disability is considered as
a vulnerable patient and hospitals are required to
take care of their safety. Being disabled friendly
uplifts the image of a hospital and is also expected
by various accreditation agencies.

3. CONTINUED
 So what are those features that makes a hospital,
‘disabled friendly’? Well, such hospital building typically
accounts for the need of two kinds of disabilities, i.e.
loco-motor disability and visual disability. People with
loco-motor disability will either be on wheelchair or
crutches and which requires a disabled friendly hospital
to make its interior easily accessible for wheelchair.
People with limited vision will need mechanism to
understand ways and areas within the hospital. This is
typically achieved by strategically placing tactile floor
(guiding block) and using braille, which the visually
disabled person can sense.


4. VULNERABLE PATIENT
 DEFINITION OF VULNERABLE PATIENT A
patient who is or may be for any reason unable
to protect and take care of him or herself,
against significant harm or exploitation.

5. LIST OF VULNERABLE PATIENTS

6. ASSESSMENT

7. HERE IS A LIST OF FEATURES THAT GOES INTO
MAKING OF A DISABLED FRIENDLY HOSPITAL.
Entrances of the hospital
1. The doorways in the entrances should open
sufficiently (at-least 35 inches wide) to allow easy
wheelchair movement through it. Tactile floor /
Guiding block
2. The entrances should be accessible with
pathways. If there is a step or kerb to access
entrance, a step ramp must be provided

8.  3. The entrances shall be provided with tactile
floor for blind people
 4. The door knob of the entrance (where
equipped) shall not be located higher than 1.2
meters from the floor, for a wheelchair bound
patient to control it. The doors shall also open
easily on slight push.

10. PATHWAYS / CORRIDORS
1. The pathways are at-least 1-meter-wide for
easy movement of wheelchair and people on
crutches
Step Ramp
2. Tactile floor shall be placed on pathways for
blind people. Guiding block shall be used at turning
points.
3. If the corridor is long, provision for seating must
be made for people on crutches to rest
4. Pathways shall be devoid of any in between
steps. In case a step in unavoidable, step ramp
must be provided

11. STEP RAMP

12. STAIRCASES
 1. Tactile floor must be located around 16 inches
before start of staircase (both at upper and lower end of
the staircase)
 2. The first and last step of the staircase shall have a
bright coloured paint line and an embossing for people
with low vision.
 3. A continuous handrail must be provided
throughout the staircase. The height of the handrail shall
be maintained at 35 inches from the floor. A minimum
gap of 2 inches must be maintained between adjacent
wall and the rails of the staircase. The rails shall extend
for 12 inches on level floor after staircase ends
 4. The height of each step shall not be more than 6
inches. The length of each step shall be not less than 12
inches.

13. RAMPS
 1. Ramps access must be provided to areas
within the hospital where a patient may need to go,
if the elevator access is not provided.
 2. The ramps must be at-least 1.8 meter wide.
 3. The gradient (slope) of the ramp shall be not
more than 1:12, i.e. 1 unit of rise for every 12 unit of
distance.
 4. Double hand rails must be provided on both
sides, at a height of 31 inches and 35 inches. A
minimum gap of 2 inches must be maintained
between adjacent wall and the rails of the ramp.
The rails shall extend for 12 inches on level floor
after ramp ends

14. CONTINUED
 5. The length of the ramp shall not extend more
than 9 meters at one continuous stretch.
 6. A flat surface landing space shall be
provided at beginning and end of the ramp and
after every 9-meter length of the ramp. The flat
surface shall be of minimum 1.5-meter length.
 7. Step ramp must be provided wherever ramp
crosses a step or a kerb

15. SIGNAGE
 1. The signage shall be clearly seen by all people.
Important signage such as emergency department and
emergency exit routes shall be illuminated
 2. The signage shall be marked with universal
symbols
 3. Important instructions for patients/public must also
be displayed in braille and at a height at which it can be
easily touched by a sitting person
 4. Contrast colours of text and background shall be
used
 5. The font size of text in signage shall be adjusted
as per the estimated distance from which it will be
viewed. Below table can be used as reference

16. SIZE OF THE SIGNAGE

17. ELEVATORS (LIFTS)
 1. The door of the elevator shall open wide
enough (at-least 35 inches). The internal width and
depth of elevators shall be as per the capacity.
 2. Inside elevator a handrail must be provided
at a height of around 1 meter.
 3. The time of an automatically closing door of
lift shall be minimum 5 seconds
 4. The buttons and switches inside lift shall be
accessible by a wheelchair bound patient
 5. The numbers on switches shall be embossed
for a blind person to sense

18. TOILETS FACILITIES
 1. There shall be separate toilets for people with disabilities.
At-least one such toilet on every floor shall be provided. The
number must be increased if the floor is large or has high
occupancy
 2. Minimum size of the toilet shall be 1.5 x 1.75 meters
 3. The door of toilet shall open at-least 1 meter wide. The
door shall swing out
 4. Vertical and horizontal handrails with 2 inches clearance
from wall must be provided inside toilets
 5. The W.C. height shall be 20 inches from ground
 6. The toilet floor shall be non-slippery or fitted with anti-skid
mats
 7. The WC shall be installed with water jet
 8. A call alarm switch shall be installed in these toilets to call
for help, if required. The switch shall be close to ground level
 9. There shall be sufficient space adjacent to W.C. for parking
wheelchair and shifting

19. OTHER CONSIDERATIONS
 1. The flooring of the areas that are accessed by
public shall be made up of non-slippery materials
 2. Sufficient seating provision shall be made at
waiting areas. Reserved seating for people with
disabilities shall be provided. These seats shall be firm
and shall allow for the person to easily stand from it
 3. Sufficient space shall be provided in-front of
drinking water equipment. The height of tap shall be
accessible for wheelchair bound patient
 4. Dedicated parking space for people with
disabilities shall be provided. These parking spots shall
be as near to the entrance as possible.

20. THANK YOU