2. INTRODUCTION
• A hospital
establishment
is a residential
which provides
short-term and long-term medical
care consisting of observational,
diagnostic, therapeutic and
rehabilitative services for persons
suffering or suspected to be
suffering from a disease or injury
and for parturients. It may or may
ambulatory
not also provide services for
patients on an out-
patient basis.
3. • WHO expert committee, 1956: ‘The hospital is an
integral part of a social and medical organization, the
function of which is to provide for the population
complete healthcare, both curative and preventive, and
whose out- patient services reach out to the family in its
home environment; the hospital is also a centre for the
training of health workers and for bio- social research’.
4. FEATURES OF A HOSPITAL
1.A hospital is an open system which interacts with its
environment.
2.A hospital system is to be dynamic and in equilibrium with
wider social system.
3.A hospital system is not an end in itself, it must function as a
part of the larger health care system.
4.A hospital system tends
grows,
towards elaboration and
it needs to become more
differentiation i.e. as it
specialized in its elements.
5. TYPES OF HOSPITAL
1. Based on Objective
a. General hospitals
b. Special hospitals
c. Teaching cum Research Hospital
2. Based on Administration, ownership, control or financial income
a. Governmental or public
b. Non-governmental or private
c. Semi Govt Hospital
d. Voluntary Agency Hospitals
6. 3. Based on Length of Stay
a. Short-term or short-stay hospitals (Stay less than 30 days)
b. Long-term or long-stay hospitals: (Stay more than 30 days)
4. Depending on Type of Medical Staff
a. Closed-staff hospital
b. Open-staff hospital
5. Based on bed capacity (Size):
a. Small hospital (Up to 100 beds)
b. Medium hospital (More than 100 to less than 300 beds)
c. Large hospital (More than 300 beds)
7. 6. Based on type of care:
a. Primary Care
b. Secondary Care
c. Tertiary Care
7. By teaching affiliation:
a. Teaching hospital
b. Non-teaching hospital
8. Based on system of medicine:
a. Allopathic hospital
b. Ayurvedic hospital
c. Homeopathic hospital
d. Unani hospital
e. Hospitals of other system of medicine
8. 9. Based on regionality:
a. Regional
b. District
c. Upazila Health Complex
d. Union Health and Family Welfare Centres
e. Community Clinics
10. As per WHO Classification:
a. Regional Hospital
b. Intermediate/ District Hospital
c. Rural Hospital
9. FUNCTIONS OF A HOSPITAL
– Concerned with health promotion –
•Preventive
Participate with community/peripheral health care
delivery systems
•Curative – Patient care – Includes health education
•Training – Continuing and on the job training
•Research – Health related researches
10. AIMS OF HOSPITAL PLANNING
•To increase utilization of hospital facilities.
•To increase population coverage.
•To enlarge the existing hospital by introducing new
facilities.
•To increase productivity of hospital.
•Modernization of the already existing facilities.
•To reduce the cost of operations and maximize efficiency
of services.
11. GUIDING PRINCIPLES IN PLANNING
Patient care of high quality:
•Provision of appropriate technical equipment’s and
supplies.
•An organizational structure that assigns responsibility
and requires accountability for various functions within
the organization.
•A continuous review of adequacy of care provided by
physicians, nursing staffs and paramedical personnel.
12. Effective community orientation:
•A governing board made up of persons who have
leadership
demonstrated concerns for community and
ability.
•Policies that assure availability of services to all people.
•Participation of the hospital in community programmes to
provide preventive care.
13. Economic viability:
•A corporate organization that accepts responsibility for
sound financial management in keeping with desirable
quality of care.
•A planned programme of expansion based solely on
demonstrated community need.
•An annual budget plan that will permit the hospital to keep
pace with times.
14. Orderly planning:
•Selection of a site large enough to provide for future
expansion and accessibility of population.
•Recognition of the need of uncluttered traffic patterns
and visitors and
within for movement of staff, patients
efficient transportation of supplies.
Medical technology and planning:
•Development in medical technology is taking place so
sophisticated technology
rapidly that now the use of
determines the professional status.
16. Internal medical treatment division
• Operation Theatres
• Intensive Care unit
• Maternity section
• Central Sterilization Department
Inpatient division
• Patient wards
• Nursing station
• Work area
18. HOSPITAL PLANNING TEAM
• The hospital consultant: He should be from the medical field. He helps in
locating departments, rooms, and utilities, equipment’s and service in a
manner that ensures the better patient care and smooth functioning of
administration.
• The core group: It is composed of hospital consultant, two medical
administrative personnel and, financial experts who work without other
member in early stage, but later the core team has to be enlarged as the
project is progressed and once clinical service are taken up.
19. • The architect: Architect must have enough technical knowledge about
planning layout of hospital. The role of architect is site evaluation, cost
estimation, drawing design, list of movable and non-movable
equipment, engineering service and construction documentation.
• Engineers: Engineer in hospital mainly deals with electrical, mechanical
and plumbing section. Engineer check the materials used in the
construction and other equipment required in term of quantity and
quality. They discuss with team and negotiate in the market.
20. • Hospital administration: He is one of the important
members of the core group to give his valuable suggestion
regarding the plan. He is kept informed about the details
of planning at every step. His role is to guide, give
suggestions, selecting equipment and other materials,
formulate policies, procedure and strategies and other
matters related to development of hospital.
22. Preliminary survey: To determine the character, needs and liability
towards community to which the hospital is going to provide
services. Various points in survey are :
•size of community
•economic status in general
•extent of availability of health service
•occupation and income of community
•need of health services
•transport system commonly used
•general attitude of people towards health and health service
23. There are certain characteristics which make people turn away from
a hospital:
•Building not constructed as a hospital
•hospital not clean
•hospital is inaccessible or is in poor location because of security risk,
nuisance or parking facilities
•inadequate medical care, staff and equipment limited service
•non availability of 24 hours service
Preliminary survey is very necessary, as it gives a basic idea of what is
to be done based upon the needs of the community it is going to
serve.
24. Study of existing hospital: This study should be comprehensive and
involve both short- and long-term needs and objectives.
It should cover the following areas:
•bed capacity of the institute
•physical condition
•hospital occupancy
•bed ratio
•volume and kind of hospital service
•quality of facilities and service
This study will help the core team to understand the strength and
limitation of existing facilities and also facilitates the planning of the
hospital.
25. Study of required staff and service: The consultant or the committee
must make a study of human resources, doctors, nurses and other
professional staff required for the proposed hospital. It is generally
agreed that in addition to traditional service such as internal
medicine, general surgery, pediatrics, obstetrics and gynecology,
specialists in the discipline of eye, ENT, dermatology, radiology,
pathology, urology must be provided.
26. The architect should make the
estimation of the cost of the
project. The area needs for
financial planning are construction,
equipping and furnishing the
hospital. The funds should be
planned in excess keeping in view
that the price will hike.
27. Expenses on
funds:
salaries and wages,
Operating
account of
repayment of loans, payment of
interest and other operational and
maintenance expenses
initial stage are
during this
the
revenues. There
higher than
should be proper
planning and distribution of funds to
prevent loss to the organization.
28. Equipment and material planning: A
equipment list is compiled and reviewed
by administrator and departmental staff.
This information also helps in financial
planning. Material management should
be done in a such a way that the
resources are available always in a good
condition and adequate quantity so as to
facilitate proper care to the client.
29. Patient Bed planning: It depends on
the size of the community around the
hospital. In cities more bed required
because of increasing urbanization.
The bed
privacy
planning should provide
between the beds and
enough space between each bed to
give patient a conducive
environment.
30. Site selection:
• Land selection: There must be
enough land for constructing a
hospital. Plentiful land should
be available for future
important factors in
expansion of the hospital.
• Soil selection: The two
soil
selection is subsoil water level
and structure of the soil. It will
help to determine the bearing
quality of the soil.
31. • Public utility: Availability of public utility should be
considered such as water supply, sewage disposable and
electricity.
Water supply: 300-400 liter /bed/day
Electricity supply: 1kw/ bed/day (include every department)
Sewage disposable: liquid effleurage same as water
consumption per day and solid disposable 1 kg /day/bed.
32. Circulation: utility and success of the hospital depends on
circulation route within and outside the hospital.
•Internal circulation: the departments should be interrelated
with in the hospital.
•External circulation: only one entrance and one exit for
hospital to avoid traffic.
Parking facility: adequate parking facility for patient visitors
and ambulance is considered.
33. PATIENT CARE UNITS
Planning a Patient Care Unit
• Patient care unit is defined as a part of the
hospital which is designed in a specific
manner to provide care to specific types of
patients. e.g., General wards, Intensive Care
Unit, Coronary Care Unit, Burn Unit,
Paediatric Unit, Causality, Neurosciences Unit
etc.
34. • An ideal patient
provide the best
care unit
facilities
shall
and
optimal work environment which
eventually will lead to high quality
care provision.
35. Advantages of Proper Planning of Patient Care Unit
1.It enhances the work efficiency of staff.
2.It meets the basic and functional requirement of the hospital.
3.It increases and facilitates nurse patient interaction and helps in
standardizing the care.
4.It gives aesthetic look to the hospital.
5.It helps in meeting expectations of the patients through good
environment during their stay.
6.It helps in reducing fatigue factor among the staff if properly
planned.
36. Types of Patient Care Units
• The designing of the units should be in such a way that it should
facilitate the nurse for better observation of her patients. The
design, type, location, physical facilities and layout should help
in smooth running of the ward functions.
• The capacity of the unit i.e. bed occupancy should be based
upon type of conditions of patient, requirements, availability of
doctors, and staff available.
41. Elements of Planning Patient Care Units
1. Size and shape of the unit
2. Patient's room: General, private or semi-private
3. Treatment room
4. Sluice room (store room)
5. Nurses' station
42. Requirements in Patient Care Units
• Medication trolley having an ampoule cutter, syringes, needle
burner, water for injection, nebulizer machine, kidney dish etc.
• Crash cart for the emergency management with all the articles
like oxygen catheters, suction catheters, emergency drugs,
laryngoscopes, endo-tracheal tubes, defibrillator along with
pads, E.C.G. electrodes, water soluble jelly, ties, syringes,
kidney dish etc.
• Various containers having different identification for proper
waste segregation and disposal as per the hospital policy.
43. •Spacious bathroom and toilet facility having bedpans, urinals and pint
measures for the bed ridden patients and urine measurement.
•Visitor's room for the patients' visitors and attendants during the
visiting hours. It should not be too noisy that it disturbs the other
patients on the unit.
•Diagnostic room for urine analysis and for the other sample storage.
•Dietary trolley for the patient's feed, naso-gastric tubes, feeding glass,
feeding syringe.
44. Ward/Unit Management
1.Help the ward in charge to carry out her/his work or acts as ward
in charge during their absence.
2.Maintain general cleanliness of the ward and the sanitary
annexure.
3.Supervise the duties of group "D" employees and guides them and
report accordingly.
4.Writes the diet register and supervise the distribution of diet
and report if any, necessary.
5.Maintain scheduled poisonous drug registers.
6.Supervise nursing care and other tasks carried out by the students.
45. 7.Maintain duty room trays, sterilize instruments and see that
procedural trays are in readiness.
8.Take over from duty of the previous, new and serious patients,
instruments, supplies, drugs etc. and handover the same
accordingly.
9.Maintain all the records pertaining to the ward/unit.
a. Maintain case papers, investigation reports etc.
b.Maintain vital sign charts, intake-output charts and
special charts if necessary.
c. Take special care of medico-legal case papers and records.
d. Write day and night orders and maintains ward statistics.
other
46. Floor plans
A floor plan is a drawing to scale, showing a view
from above, of the relationships between rooms,
spaces, traffic patterns, and other physical features
at one level of a structure.
47. Emergency department
• EDs need to be placed in an area of
the hospital that is easily accessible to
Emergency vehicles entering the site.
Emergency department needs to be
essentially situated on ground floor,
as near as possible or in front of
entrance gate of the hospital. The
overall size of the ED will depend on
the volume and scope of services
provided.
48. Entrance and reception area:
•Conceptually, it is desirable to have three separate areas with
separate entrance for casualty services, outpatient services and
indoor services.
•It must have proper sign board which can be illuminated at night
or can have adequate lighting for easy visibility.
•Not to have other human traffic.
•Reception need to be situated at the entrance, clearly visible &
reachable without blocking human or trolley traffic.
•Entrance to casualty area should be broad enough to permit two
ambulances.
49. Waiting Area:
•Adequate sitting accommodation, drinking
water, toilets, telephones, public address system
•Space for trolleys & Wheel Chairs.
•When the patient is brought to casualty by an
ambulance, taxi, private car, stretcher, staff at
reception counter should quickly arrange for
wheel chair or trolley depending on the
situation.
•Crash cart
•The waiting area should measure at least 4.4
m2 / 1000 attendances per annum.
50. Triage:
•The minimum acceptable floor area
per Triage/Assessment Cubicle is
16meter sq.
•Minimum combined Reception and
Triage area must be 1.8-meter sq.
/1000 patient attendances per
annum.
51. Resuscitation Area:
•Area for immediate care of patients and
victims in cardiac arrest, airway and
breathing and circulation compromise.
area consists of two or
•The ‘Resus’
more resuscitation beds (sometimes
upto 12) with all resuscitative equipment
(monitors,
intubation &
defibrillators,
surgical
airway,
equipment)
available at an arm’s distance including
pediatric resuscitation kits.
•All priority I patients are managed here.
52. Space for Security & Police Constable:
•Casualty department is likely to get
victims of assaults, riots etc.
•As medicolegal cases need to follow
prescribed procedural formalities, it is
necessary to have police constable’s
counter at the waiting hall entrance.
53. Space for patient brought dead:
Keep the body at a place which is not
visible to other incoming patients &
persons waiting in the waiting hall.
In the event of disaster, number of dead
bodies is likely to be more. After labelling
the bodies, they may be sent to mortuary &
handed over relatives or police after
completing procedural formalities.
54. Examination Room:
•Two or three examination tables separated
by curtains are available.
•It should be possible to carry out life-
saving first aid procedure like
cardiopulmonary resuscitation on this table
before sending the patient to observation
ward.
Treatment Room:
Minor procedure like catheterization,
suturing of small wounds, dressing,
bandaging etc. can be carried out.
55. Observation Area:
•Depending on the patient load 4 to 8 beds
may be placed in this area.
•Those patients may be kept in observation
ward who are waiting to be evaluated by a
particular speciality, waiting for emergency
medical procedure etc.
Storage Space:
•Linen,
dressing
stored.
consumable items like drugs,
material, equipments can be
•Minimum floor area for storage is
attendances
2.2meter sq. /1000 patient
per annum.
56. Operation theatre
• An operation theatre is the "heart" of any major hospital. An
operating theatre, operating room, surgery suite or a surgery
centre is a room within a hospital within which surgical and other
operations are carried out. The aim is to provide the maximum
benefit for maximum number of patients arriving to the operation
theatre. Both the present as well as future needs should be kept in
mind while planning OT.
60. • Specialty grouping plan - The "specialty grouping" plan is
simply a variation of the hotel or race track plan, in which
ORs are grouped by specialty (e.g., neurosurgery, general
surgery), each with its own closely associated clean storage
areas and, in some cases, each with its own soiled
instrument work area.
61. Structure of OT
OT can be divided into clearly demarcated four zones to indicate
specific precautions to be practiced before crossing the border of
each zone. This zone indicate:
• Relatively clean area
• Absolutely clean area
• Absolutely clean & aseptic area
• Unclean area
62. Outermost Zone: This zone is called as protective zone. This zone is
clean, but not sterile area. In this area following activities are housed:
• Administrative area
• Office of operation theatre superintendent or manager
• Office of the anesthesia chief
• Space for surgeons to write or dictate operation notes
• Frozen section biopsy laboratory
• Dark room for developing X-Ray films
• Changing room
• Surgeon’s room
• Trolley bay
• Waiting area for relatives
63. Intermediate Zone: This zone is clear, but not sterile. Entry for people
bringing supplies, patients etc. can be permitted after changing foot-
wear. It includes following:
•Storage area for equipment's & instruments
•Supply received from central sterilization & supply department
•Medicines, intravenous fluids, other consumable items and linen
•Post-operative recovery room having 1 to 2 beds per operating table
•Preoperative waiting patients
64. Inner most zone: This area is kept absolutely clean & sterile. No
one other than persons actually involved in doing surgery or
assisting in surgery should be allowed to enter. In teaching
hospitals 4 to 5 students are permitted after changing. This zone
includes:
•operating room (minimum size 18ft* 20 ft)
•Anesthesia induction room
•Patient holding areas
•Scrub area for surgeons & nurses
65. Unclean zone for disposal: This zone is used for temporary
storage of:
•Used linen
•Used instruments
•Waste material
•Cleaning gloves, instruments
66. Sub areas in OT
•Pre-operative check in area (reception):
This is important with respect to
maintaining privacy, for changing from
street clothes to gown and to provide
lockers and lavatories for staff.
•Staff room: Men and women change
dress
•Holding area: Planned for IV-line
insertion, preparation, catheter / gastric
tube insertion, connection of monitors, &
shall have O2 and suction lines. Facility for
CPR should be available in this area.
67. •Post anaesthetic care units (PACU): These should contain a
medication station, hand washing station, nurse station, storage
space for stretchers, supplies and monitors / equipment and gas,
suction outlets and ventilator.
Additionally, 80 sq. ft. (7.43 sq. m) for each patient bed, clearance
of 5 ft. (1.5 m) between beds and 4 ft. (1.22m) between patient bed
sides and adjacent walls should be planned.
•Sanitary facility for staff: One wash basin and one western closet
(WC) should be provided for 8-10 persons.
68. •The anesthesia gas / cylinder manifold room / storage area: It
should be in a cool, clean room that is constructed of fire-resistant
materials. Conductive flooring must be present but is not required if
non inflammable gases are stored. Adequate ventilation to allow
leaking gases to escape, safety labels and separate places for empty
and full cylinders to be allocated.
•Rest rooms
69. Idle OT should have following characteristics:
•Operative room for routine work (18ft * 20 ft).
•Super specialty departments like neurosurgery & cardiac surgery require
bigger area i.e. about 500ft to 600ft, as these theatres need to have more
equipments.
•Effecting air conditioning should maintain the temperature as per
requirement.
•Efficient & sincere paramedical & non-medical staff to carry out
necessary instructions promptly.
70. •Walls: Smooth wall which is impermeable to moisture having finish
of epoxy resin or vinyl sheets type of painting.
•Doors: Main door to the OT complex has to be of adequate width
(1.2 to 1.5 m). The doors of each OT should be spring loaded flap
type, but sliding doors are preferred as no air currents are generated.
•Flooring: The flooring must be slip resistant, strong & impervious
with minimum joints or jointless conductive tiles/ terrazzo, linoleum
etc., The recommended minimum conductivity is 1m ohm and
maximum 10m ohms.
71. Isolation ward
• An isolation facility aims to control the airflow in the
room so that the number of airborne infectious
particles is reduced to a level that ensures cross-
infection of other people within a healthcare facility is
highly unlikely.
72. Types of Isolation Rooms:
•Airborne infection isolation (AII)/Negative pressure isolation refers
to the isolation of patients infected with organisms spread via
airborne droplet nuclei <5 μm in diameter. These include patients
suffering from measles, chickenpox, tuberculosis, etc.
•Protective environment (PE)/Positive pressure isolation is a
specialized area for patients who have undergone allogeneic
hematopoietic stem cell transplant (HSCT), etc.
73.
74.
75. Planning Premises of Isolation Rooms
• Location: The isolation rooms should be located at one end of
ward. Isolation wards for infectious cases to be kept out of routine
circulation.
• Number of beds for isolation beds: About 2.5% of the beds of a
large hospital in a special unit would probably be adequate except
during periods of unusually high demand.
76. •Space: An isolation room has to provide uncluttered space around the
bed for equipment and the increased number of personnel involved in
emergency care. A room area of about 22 m2 is adequate within an
isolation unit.
•Adequate number of wash hand basins should be provided within the
patient care areas and nursing stations with a view to facilitate hand
washing practice.
•Separate arrangements for garbage and infectious waste removal from
wards and departments in the form of separate staircases and lifts.
77. • One to two standard isolation rooms per ward unit should be
planned throughout the hospital with wash basin in room,
shower, toilet and wash basin in bathroom. Door with self-
closing device and a normal window AC to be provisioned for
these rooms.
78. Bed Management System
•Bed centers should be at least 3.6 m apart.
•Minimum possible number of beds should be kept in a cohort as to
prevent chances of cross-infection.
•Spacing must take account of access to equipment around the bed
and access for staff to hand-wash facilities.
•Provision of permanent screens between bed spaces should be there
as an aid to prevent frequent traffic and thus the potential for
microorganism transfer.
79.
80. Intensive care unit
• Intensive Care is a dedicated unit for critically ill patients who
require invasive life support, high levels of medical and nursing
care and complex treatment. The intensive care unit provides a
concentration of clinical expertise, technological and
therapeutic resources which are coordinated to care for the
critically ill patient.
81. Space programme
The guidelines for ICU design should be based on criteria set by
ISCCM, India given below.
•Level I, six to eight beds —small district hospital, small private
nursing homes, rural centres.
•Level II, six to eight beds — larger general hospital
•Level III, 10 to 16 beds-tertiary level hospitals
The new level III ICU are further planned based on type/ usage of ICU
i.e. general or speciality-based like medical, cardiac, neurosurgical,
transplant, paediatric. The location of ICU should be close to the
operation theatre, imaging diagnostic services and laboratory.
82. • The floor spaced per ICU bed can be planned 3 m X 4 m (12 sq. m)
to maximum of 5 m X 5 m (25 sq. m) based on consideration of
application of ICU including services and equipment positioning.
• The outside environment viewing window for each patient bed is
strongly suggested as part of the design.
• A minimum of one to two metre distance should be kept between
two beds as per NABH standard.
83. • The height between floor and false ceiling should be three
metres.
• The ideal single leaf door size for each ICU cubicle or separate
room having clear space of 2.1 m X 1.2 m height and width with
wide view panel for visual access to patient is suggestive.
• It is indicative to have 12-16 beds per ICU area for optimal design
considering all essential support functions. The total area of ICU
should be 2.5 to 3 times the total space of ICU beds which
includes supply and service corridor/ passageway of 2.4 m width.
At least one patient cubicle as isolation with anteroom facility
having negative pressure is recommended within the ICU.
84. • The overall design of the ICU should consider. The other
essential areas inpatients, staff and visitor movement, storage
space of equipment and medicine, location of essential areas
like nurse station, clean and dirty utility etc. Floor plan of ICU
may contain nourishment room, stat lab, linen storage, staff
lounge and utility services.
85. The civil structure
• The walls for separate room should be finished plaster wall of
six-inch block/ brick wall. The wall finish should be durable,
tough wearing and should withstand water and routine cleaning
by chemicals. Two coats of anti-bacterial paint with approved
shade on primer applied wall and ceiling will help to kill harmful
bacteria that can cause hospital superbugs, including MRSA and
E. coli.
86. • Imperforated false ceiling with good acoustics and monolithic
finish need to be installed in ICU area. The flooring of ICU should be
smooth, seamless and durable as there will be heavy movement of
patient beds and medical equipment like portable X-Ray.
• The flooring should be able to sustain wet things like water,
chemical solutions without losing its characteristics. As per
International Noise Council, the noise level in an ICU should be
under 45 dB in the daytime, 40 dB in the evening and 20 dB at
night.
87. Lighting
• The lighting distribution illumination control should be planned
based on routine physical examination (around 350 lux), during
procedure of patient (around 1000 lux), during night time (around
5 lux).
• The emergency lighting should be connected to few light fixtures
to avoid a complete black out scenario.
• The energy conservation aspect like LED lights and more natural
daylight should also be considered.
88. Air-conditioning, heating, ventilation services
• Sterile air having low velocity with 21-240 C should be planned. The
central air conditioning system or ICU specific air conditioning system
has to be planned such that for ICU cubicle the requirement of six
minimum air changes/hour with two minimum outside air
changes/hour having positive pressurization.
• It is better to have dedicated air handling unit (AHU) having 99%
efficiency down to five microns for each ICU unit. The fresh air for
AHU unit must not be located near potential contaminated air like
Kitchen exhaust hood, vehicle parking area or laboratory hood.
89. Water supply
• Water supply inside the ICU with sufficient
pressure can be broadly classified into three
types i.e. domestic soft water (hot and cold)
for sinks and scrubs, RO water for dialysis port
and for drinking purpose and treated sewage
water for flushing in commodes. The
provision of hand free sinks having hot and
cold-water facility at major functional area
like nurse station, clean and dirty utility and
ICU with cubicles has to be planned.
90. Piped medical gas system
• Each patient should have provision for
oxygen, vacuum outlet and compressed
air outlet. Audible and visible low- and
high-pressure alarms must be installed
both in the ICU along with manual shut-
off valve provision for each medical gas
system.
91. Firefighting and detection system
• The National Building Code (NBC) has given norms on fire-related
infrastructure like installation of extinguisher, sprinkler and alarm,
water storage tank and pump capacity based on building height and
plot area.
• In high rise building where ICU is located, the fire escape routes should
be clearly indicated. Location of various types of fire extinguishers
should be placed at prominent place. Smoke, heat sensors, sprinklers,
manual call points and hydrant systems should be tested on a regular
basis.
92.
93. ANCILLARY SERVICES
• Hospital ancillary services are those supplemental or auxiliary
services that are provided to patients in order to support the
diagnosis and treatment of conditions. Ancillary services refer
to health care services provided exclusive of room and board.
Ancillary departments form the backbone in the functioning of
a tertiary care hospital without which doctors, dentists, and
nurses would not be able to function effectively.
94. Ancillary services can be divided into three categories-
•Diagnostic
•Custodial
•Therapeutic
Diagnostic hospital ancillary services may be providedin the
hospital in the case of radiology, audiology, clinical lab services
services. Custodial
hospice, nursing
and pulmonary testing
home
services
and home health ancillary
include
services.
Therapeutic services include physical therapy, occupational
therapy, speech therapy, radiation therapy, nutrition and weight
management. Many physicians provide in-office ancillary services.
95. Importance of Ancillary Healthcare
Service Providers
•It helps clinicians organize into Integrated Practice Units.
•Ancillary services enable physicians or organizations to measure the
outcomes.
•It promotes a shift towards bulk payments for care cycles.
•Ancillary care providers facilitate the integration of care delivery
systems by defining the scope of services and concentrate volume in
a few places.
•These services also play a vital role in expanding the geographic
reach of healthcare delivery.
•It helps build a supporting information technology platform.
96. Advantages of Ancillary Services
Ancillary care services comprise around 30% of the
total medical spending, making it essential for every
healthcare service provider. These services help reduce
the core workload as all the secondary care is
facilitated by ancillary providers. Additionally, these
providers are cost-saving and prudent, making them an
ideal alternative to the outpatient physician and
hospital services.
97. 1. Administrative Resources
Ancillary services for primary care play
a vital role in
costs.
saving time and
The providers,
independently,
and receive
operational
instead of
work for
payment
operating
hospitals
processing, collections,
resolution management, and appeals
from hospitals.
98. 2. Increased Patient Access
By connecting to a wider patient base insured under worker
compensation, group health, secondary group health, auto medical, and
medicare plans.
3. Credentialing
Ancillary care allows the hospital to be in a company of well-skilled
experts and technicians. These services are certified in providing stringent
quality and control standards. They regularly monitor the network to
ensure the patients are receiving excellent-quality care.
99. 4. Education and Support
Ancillary service providers
are medical experts too, and
readily educate the patients
and payers
advantages of
on the
how their
services can bear a change in
the overall clinic operation.
100. Challenges in Implementing Ancillary Technology in
the Healthcare Sector
Lack of Interoperability
• Absence of compatibility in the computers or systems
utilized by ancillary care providers for coding, billing, and
monitoring patient care.
• Patient satisfaction, utilization management, and
adequate care are some of the major aspects that can
affect the service, providing the ability of ancillary care
providers.
101. Lack of Consumer Ability to select delivery of care
• The large deductible of patients is a substantial influence on
their decisions on how and where to get the care and how much
money do they wish to spend.
• From the price at which they need an x-ray to the location at
which they want to receive physical therapy, consumers
nowadays are more conscious and want the best options at the
best price.
102. Limited Leverages
• If ancillary providers operate as independent businesses, they
will have to face limited leverages.
• Healthcare providers want to pay less for materials and better
business solutions, which is possible only if ancillary providers
agree on sharing the same goals and increased authority.
103. Other ancillary services:
• Medico-legal/post mortem
• Ambulance services
• Dietary services
• Laundry services
• Security services
• Waste management including Biomedical Waste
• Ware housing/central store
• Maintenance and repair
• Electric Supply (power generation and stabilization)
• Water supply (plumbing)
104. • Heating, ventilation and air-conditioning
• Transport
• Communication
• Medical Social Work
• Nursing Services
• CSSD - Sterilization and Disinfection
• Horticulture (Landscaping)
• Refrigeration
• Hospital Infection Control
• Referral Services
105. RESEARCH ARTICLE
Staff working in ancillary departments at a tertiary care hospital in Bengaluru,
Karnataka, India: How healthy are they?
A study was conducted by Bhavya Balasubramanya, Catherin Nisha, Naveen Ramesh, and
Bobby Joseph in 2016 to study the morbidity profile of the staff working at ancillary
departments of a tertiary care hospital in Bengaluru, Karnataka, India. They conducted
study in a 1,200-bedded tertiary care hospital in Bengaluru, Karnataka, India. Annual
medical check-up (AMC) for all the staff working at the ancillary departments has been
started in recent years and is provided free of cost and during working hours. A total of 150
employees from ancillary departments underwent AMC in the year 2013. The most
common morbidities were diabetes mellitus (11%), hypertension (10.6%), musculoskeletal
disorders (9.3%), surgical problems (8.6%, hemorrhoids, varicose veins), and dental caries
(6.6%). On stool microscopy, 12% of the dietary workers showed ova/cyst. There was a
significant positive correlation between age and the number of chronic morbidities (P <
0.01). The study concluded that lifestyle disorders such as diabetes mellitus and
hypertension were the major morbidities among the staff in the ancillary departments of
the hospital. Regular follow-up, adherence to medication, and lifestyle modifications in
terms of diet and exercise were ensured.
106. SUMMARY AND CONCLUSION
Although to treat the patients, hospitals need to have a team of
experienced and professional doctors, but the other factor that plays a
great role in treating the patients is the infrastructure of the hospital.
The infrastructure design of the hospitals plays a crucial role in the
safety of the patient.
No matter how much money is spend on the infrastructure of the
hospital because one cannot renovate the hospital so frequently.
Therefore, infrastructure must be kept in mind before building a
hospital. The infrastructure of the building should be designed in such
a way that it looks attractive, functional and safer for the patients. This
is why hospital planning and designing plays a crucial role.
107. REFERENCES
• Shabnam Masih. Essentials of Nursing Management in service and education.
2017. New Delhi. LOTUS Publishers. Second edition. Pg. No. 83-94.
• PubMed. Staff working in ancillary departments at a tertiary care hospital in
Bengaluru, Karnataka, India: How healthy are they? Available from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922276/ Journal ListIndian J
Occup Environ Medv.20(1); Jan-Apr 2016PMC4922276 [cited 29 Aug 2020]
• PHYSICAL LAYOUT THE OPERATING ROOM. Available from
https://rajnursing.blogspot.com/2018/09/physical-layout-operating-room.html
[cited 9 Sep 2020]
• PubMed. Staff working in ancillary departments at a tertiary care hospital in
Bengaluru, Karnataka, India: How healthy are they? Available from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922276/ [cited 10 Sep 2020]
