090312 Sc Uts Presentation Part 1of2(2)

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Design Responses to Changing Clinical Practices

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Why a Re-think?

• Changing clinical practices and treatment patterns

• Multidisciplinary approach to care, clinical pathways

• Technology – clinical and support

• Staff shortages – optimum utilisation

• Patient expectations – well informed, competition

• Financial imperatives – Health $$$$ under pressure

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Hospital Space Allocation

1950s Now

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Ambulatory

23%

D&T

24% Inpatients

18%

Research

4%Education

2%

Administration

10%

Back of House

4%

Cricitical Care

5%

FOH/Family

10%

350 Beds[250 multi day + 100 day]

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Conceptual Functional Models

• Zonal Model– Horizontal– Vertical

• Institutional Model- Number of ‘mini’ hospitals

• Separation of Ambulatory Procedures

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Zonal Model - HorizontalAMBULATORY

D&T

WARDS

Norfolk & Norwich Hospital, UK

AMBULATORY

D&T

WARDS

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Zonal Model - VerticalINPATIENTS

PROCEDURES / INTENSIVE CARE

D &T/AMBULATORY

Royal North Shore Hospital

Sydney

INPATIENTS

PROCEDURES

D&T / AMBULATORY

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Institutional Model

GASTRO

RESPIRATORY

ORTHO

NEUROSCIENCES

CANCER

WOMEN’S & KIDS

VASCULAR

CARDIAC

HOT FLOOR

MENTAL HEALTH

GERIATRIC

RPA Hospital, Sydney

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Centre forHealth Communication

CSSD PaLMS plant

PlantAdminExecutive – RNSH, NSCCAHSMedical ServicesDivision of MedicineDivision of Surgery and AnaethesiaAllied Health

Plant

Inpatient units

Inpatient units

Diagnostic +Treatment

Clinical offices

Clinical officesClinical offices

Clinical offices

Administration

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Implications for Facility Planning

1. D&T Block with Inpatient Units 2. Horizontal ‘mini hospitals’

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Areas addressed today

• Inpatient Units

• Emergency Department

• Interventional Suite

• Workplace

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Inpatient Units

• Large number of beds on one floor – flexibility; resource sharing

• Greater numbers of 1-bed rooms

• Larger rooms• Acuity Adaptable - patient centred care - treatment and clinical

procedures at bedside - Family and carers - infection control

• Decentralised staff stations, taking advantage of communication systems

• Modules of 7 - 10 beds

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Inpatient Units - decentralised staff stationsSt Vincent’s Public and Private Hospitals Redevelopment, Sydney

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Typical Inpatient ArrangementTrondheim University Hospital, Norway

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Centre forHealth Communication

Bed Utilization

85 beds in single rooms=

100 beds in multi-bed rooms

Anecdotal evidence from America, quoted by BDPGroupe6 of UK/France

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Emergency Department

• Process Re-think Lean Thinking principles

• Patient processing Triaged according to - primary care, short stay or admitted

• Patient waiting Minimal – more numbers of walk-through triage stations; waiting in care area

• Short Stay unit 30-bed unit ; stays of upto 2 days?

• Imaging Dedicated, decentralised

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Interventional Suite

• Process Re-think Induction Rooms - why?Pre-op Holding - increase; patient prep

• Future Technology Real time Imagery – MRI in OR

• More Equipment Larger ORs; Control Rooms

• Barn Theatres Zurich; Liverpool UK; Oswestry UK - orthopaedic surgery,……