SpaceMed Newsletter

For any given number of beds to be accommodated in new construction or in a reconfiguration of existing space, there is significant variation in the nursing unit space per bed from project to project. Historically, this variation was attributed to the mix of private, semiprivate, and multiple-bed patient rooms. Even though most hospital building projects in the U.S. today strive to achieve all private patient rooms, the total space required to support a specific number of beds 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, the amount of family, visitor, and staff amenities provided on the floor, the extent of point-of-care clinical and support services, and the overall design and layout of the floor itself.

A review of two different building projects with the same number of private patients rooms per floor (48) reveals the factors that influence space allocation and the overall space per bed. The space allocation and design of the patient care floors at each hospital to accommodate 48 acute medical/surgical patients results in a low space allocation of 500 department gross square feet (DGSF) per bed for Hospital A and a high space allocation of 800 DGSF per bed for Hospital B. Key differences in the planning approach for each project are as follows:

Hospital A was programmed and designed to accommodate the 48 private patient rooms in two 24-bed nursing units with traditional patient rooms accompanied by a combined toilet/shower room. The two 24-bed nursing units share a common family/visitor reception area and limited clinical and staff support services are provided on the floor.
Hospital B was programmed and designed to accommodate the 48 private rooms in eight-bed pods ― decentralizing the nursing staff and selected support space closer to the patient ― while providing increased flexibility to accommodate different types of patients and levels of acuity. The private patient rooms are sized to provide ample space for family members and care providers. Additional support spaces and amenities are provided on the patient care floor for families, patients, and staff.

Review of the Detailed Space Programs

A review of the actual space allocation for each of the two projects reveals the sensitivity of various programming and design decisions relative to the corresponding space per bed. As shown in the following diagram, the size of the patient room module has the greatest impact on the DGSF per bed followed by the amount of nursing unit support space.

Comparison of Department Gross Square Feet Per Bed

Specific variances between the space programmed for Hospital A versus Hospital B are as follows:

Patient room module. The private patient rooms in the Hospital A project provide code-compliant patient care space along with a recliner chair for a family member or visitor. A combined toilet/shower room provides a wheelchair accessible toilet room with the ability to use the room as a shower if required. The larger private patient room at Hospital B includes an expanded area for family and visitors and slightly more space around the patient bed. A separate shower stall is provided as part of the toilet room and the entrance vestibule provides a charting area for the care provider.
Nursing unit support space. At Hospital B, the patient rooms are organized into eight-bed pods whereby each pod has a decentralized nurse sub-station and alcoves for linen, medication, and emergency response carts. A larger multipurpose room with a contiguous toilet room is provided for each 24-beds at Hospital B. Point-of-care laboratory and respiratory care satellites are programmed along with more generous space for the administrative communication center, team conference room, and staff lounge/break room. Additional support spaces are also provided at Hospital B.
Common staff support space. At Hospital A, additional staff office space, staff lockers, and conference/classroom and on-call facilities are all be provided in a central location off of the patient care floor. These spaces are located on the patient care floor at Hospital B.
Common family/visitor amenities. A small family/visitor lounge with male and female toilet rooms is provided on the patient care floor at Hospital A. At Hospital B, a more generous lounge is provided with additional amenities including a family consultation/ grieving room, family kitchenette, and an education center.

Impact of the Net to Gross Conversion Factor

The design and layout of the bed floor at Hospital A results in a net to department gross square feet conversion factor of 1.45 to accommodate nursing unit circulation corridors and the width of walls and partitions. This ratio increases to 1.55 at Hospital B where the nursing unit layout necessitates additional corridor space. The variance in the net to gross conversion factor alone results in a need for an additional 50 DGSF per bed for Hospital B compared to Hospital A.

What if Some Semiprivate Patient Rooms Are Provided?

Sometimes it is not possible to provide all private patient rooms due to site constraints, the project budget, or other factors. In this case, a common approach is to provide enough patient rooms to accommodate the average daily census such that the semiprivate patient rooms only need to be deployed for two patients during high census periods. If Hospital A and Hospital B were to each provide 16 privates and four semiprivates per 24-bed unit, the DGSF per bed ratios would decrease to 460 and 745 respectively.

Conclusion

This analysis is not meant to suggest that less space per bed on a patient care floor is more efficient or necessarily the goal. Many factors influence decisions on the size of the patient room, nursing unit support space, and family and staff support space to be provided on a particular nursing unit ― including the types and acuity of the patients to be accommodated, required staffing ratios, operational processes and procedures, site constraints, and market dynamics. However, when making preliminary estimates of the space per bed during facility master planning or as part of a feasibility study, it is important to understand that these ranges can vary significantly. back to top

Cynthia Hayward, AIA, ACHA, FAAHC

Principal

Hayward & Associates LLC

chayward@hayward-assoc.com

►

In the News

Local Hospital System Puts ED Wait Times on Billboards and the Internet

A local hospital system in Ohio is publicly sharing the current average wait times to see a doctor at all of its emergency departments throughout town. Akron General Health System recently began advertising real-time wait times on six digital billboards in Akron, Ohio that are automatically updated every 20 minutes to show current average wait times at the main ED in downtown Akron and in satellite facilities in the Montrose area, Stow, and Lodi. The times are computer generated based on current patient information from the health system's electronic medical records. This information is also available to potential patients on Akron General's website. Summa Health System ― an Akron-based competitor ― is developing a plan to share updated ED wait times and other information via mobile devices. As hospitals around the U.S. are increasingly competing to grow their market share of emergency department business by using billboards, the Internet, text messages, or social media sites, some emergency medicine physicians see this as a potential dangerous trend. Patients with serious problems might mistakenly drive across town to see a doctor quicker when emergency department staff make sure that the most critical problems are seen immediately regardless of the posted wait times. back to top

Original article "Akron General Puts ER Wait Times on Billboard, Internet" posted by Cheryl Powell on February 4, 2010 at www.ohio.com.

►

Trendline Print (PDF)

What is the Most Effective Facility Planning Process? Bottom-Up or Top-Down

BACKGROUND

Historically, facility planning was often based on the wish lists of physicians and department managers. Unfortunately, some of the individuals who dominated the planning process move on to other organizations by the time the new or expanded facilities are ready for occupancy. Today, healthcare organizations realize that investments in facility expansion and reconfiguration must meet the needs of changing patient populations and providers over the life of the building. They cannot allow the planning process to be driven by the idiosyncrasies of a few individuals. Some healthcare organizations are challenging the more traditional “bottom-up” approach to functional and space planning and are choosing to embark upon a more “top-down” approach.

Bottom-Up Approach

The traditional bottom-up approach involves the establishment of department user groups based on strict adherence to the organization’s existing organization structure. For the traditional grass-roots or bottom-up approach to be successful, healthcare organizations must:

Deploy a multidisciplinary team or task force to encourage department staff to think outside their individual silos. Cross-departmental task forces, focused on common operational processes and patient needs, facilitate the planning of flexible space.
Prevent specific individuals from dominating the functional and space planning process.
Use some of the new collaborative planning tools to facilitate the gathering of input and the review of preliminary outputs. This allows multiple constituencies to participate in the process. For example, project websites can be constructed that accommodate online publishing of draft documents, 24-7 review at the participant’s convenience, and easy integration of their comments.
Use industry benchmarks and external consulting expertise to validate internally-generated space requirements and to introduce the planning team to new concepts and best practices in the industry.
Consider site visits by selected task force members to peer institutions who have implemented unique operational models or incorporated new technology as part of their facility planning effort.
Require approval and sign-off of the functional and space program prior to commencing the schematic design stage. A formal process should be established for use by facility management and the design architect to address proposed space program changes during the schematic design and design development phases.

Top-Down Approach

Some healthcare organizations prefer a more top-down approach, particularly when capital dollars are tight, when employee turnover at the department/service line manager level is high, or when market dynamics make program and workload forecasts difficult to discern. This approach is often used when a new or replacement healthcare facility is being constructed, particularly when the leadership team wants to implement entirely new and innovative operational processes and technology. For this approach to be successful, healthcare organizations must:

Have a senior leadership team with a well-thought out vision for the organization that can be communicated effectively.
Bring in outside expertise to translate a future vision for the organization into flexible facilities that can accommodate future changes in medical practice and technology, varying patient populations and providers, and promote quality and cost-effective patient care.
Re-educate department staff about the vision and the new operational concepts and technology to be implemented prior to occupancy.

CONCLUSION

Regardless of the facility planning approach, the planning process should facilitate the rethinking of the current organization of services, operational systems and processes, and the use of technology. back to top

Cynthia Hayward, AIA, ACHA, FAAHC

Principal

Hayward & Associates LLC

chayward@hayward-assoc.com

►

Technology

Pharmacy Automation is Being Used Throughout the Healthcare Facility

Pharmacy automation is becoming commonplace in many healthcare facilities including point-of-care medication dispensing devices located on nursing units and in other acute care areas, controlled substance dispensing and tracking systems, centralized robotic dispensing devices, and similar devices to support ambulatory care.

Point-of-Care Medication Dispensing Devices

Automated medication dispensing devices such as the Pyxis® Medstation are commonly used on inpatient care units. These point-of-care dispensing cabinets interface with the pharmacy computer system allowing for more medications to be stocked on the patient floor than in a traditional floor stock system. The majority of medications cannot be accessed by nursing personnel until the physician order has been reviewed and verified by the pharmacist. Other advantages of the system are reduced time spent by nursing personnel inventorying controlled substances, more efficient and timely re-supply of medications on the nursing unit, increased medication security and controlled substance accountability, and quick access to first doses for stat medication orders.

Bar code restocking verification systems are also utilized to add another layer of safety to the automated dispensing system. Bar code scanning devices are used within the pharmacy to ensure the correct item is removed from the stock shelves at which time a bar coded label is generated. When the items are delivered to the patient care unit, another bar code scanning device is used to ensure the medication is added to the correct location within the Pyxis Medstation and to ensure that the patient gets the correct medication and dosage.

Centralized Robotic Dispensing Devices

Robotic dispensing devices are frequently utilized to fill patient-specific bins for the 24-hour cart filling cycle within the central pharmacy. The center section of the robot can store over 15,000 unit-dose packaged medications with bar code identification on the labeling. The systems are multi-functional with the ability to individually package and store medications from bulk supplies, unload the medications into 24-hour patient medication bins to be delivered to specific nursing units, and can place back into storage medications that are returned following patient discharge.

Ambulatory Care Patients

State-of-the-art automation is also being used in outpatient pharmacies to process prescriptions with accuracy and efficiency. Robots prepare prescriptions to assist pharmacists in dispensing outpatient prescriptions. For example, the ScriptPro® Robotic Prescription Dispensing System delivers filled and labeled vials to the pharmacist for final approval. The system utilizes bar code technology throughout the various filling and checking steps for accuracy and quality control. Nearly 200 different tablet and capsule products are housed in the unit, each product in its own universal dispensing cell. The prescription vial the patient receives is automatically labeled with all required label components including instructions typed in by pharmacy staff. Automation improves the efficiency of prescription processing and allows pharmacists to focus on providing patients with education on their medication and working with prescribers on improving the selection and use of medications. back to top

►

Rule-of-Thumb

Cardiac Diagnostic Services Capacity and Preliminary Space Need

Component	Capacity	Department Gross Square Feet (DGSF)	Comments

Noninvasive Cardiology	2,000 to 2,400 annual visits per procedure room	500 to 900 DGSF per procedure room	Assumes average procedure room turnaround time of 60 minutes; higher range assumes extended hours of operation and/or a smaller facility.
Invasive Cardiology:
Diagnostic Catheterization	1,200 to 1,800 annual visits per procedure room	2,000 to 2,400 DGSF per procedure room	Assumes average procedure room turnaround time of 90 minutes with three prep/recovery bays per procedure room; higher range assumes extended hours of operation and/or a smaller facility.
Therapeutic Catheterization/ Electro-physiology	600 to 900 annual visits per procedure room	2,000 to 2,400 DGSF per procedure room	Assumes average procedure room turnaround time of 150+ minutes with three prep/recovery bays per procedure room; higher range assumes extended hours of operation and/or a smaller facility.

Note: DGSF represents the "footprint" of a department or functional area and includes the net square feet of the individual rooms as well as the space occupied by internal circulation corridors, walls/partition, and minor utility shafts; DGSF excludes common areas such as shared public corridors and lobbies, elevator banks, stairwells, major mechanical spaces, and the space occupied by the building's exterior wall.

Source: SpaceMed Guide (Second Edition).