SOUTHERN DISTRICT HEALTH BOARD FEASIBILITY · PDF file7664 / southern district health board feasibility study ... reviewed by project architect ... 7664 / southern district health

SOUTHERN DISTRICT HEALTH BOARDFEASIBILITY STUDYUTILISATION OF BEDS IN DUNEDIN HOSPITAL WARD BLOCK—

6 SEPTEMBER 2016

76 6 4 / S O U T H E R N D I S T R I CT H E A LT H B O A R D F E A S I B I L I T Y S T U D Y—

U T I L I S AT I O N O F B E D S I N D U N E D I N H O S P I TA L WA R D B LO C K / R E V 1 /U T I L I S AT I O N O F B E D S I N D U N E D I N H O S P I TA L W A R D B L O C K / R E V 1 /6 S E P T E M B E R 2 0 1 6

T E A M—

I N S E R T T E A M H E R E

2

CONTENTS—

Prepared for—

SOUTHERN DISTRICT HEALTH BOARD

Document Revision Status—

Revision 1.0Date: 6 September 2016DRAFT for comment

Document Control—

Prepared by ArchitectJonathan Rae

Reviewed by Project ArchitectJonathan Rae

Approved by Principal or DirectorPhil Grey

On behalf of Warren and Mahoney Architects Limited

Disclaimer—

While Warren and Mahoney has endeavoured to summarise the Preliminary Design process in this document and appendices, the report format cannot represent the broad range and depth of information captured on the Preliminary Design Drawings, Specifi cations and Schedules. Approval of the specifi c issues contained in this report does not discharge the obligation of the client team to review the drawings and specifi cations in their entirety.

Contact—

Warren and Mahoney Architects Ltd

254 Montreal StreetChristchurch 8013T: + 64 3 943 0200E: [email protected]

01. DESCRIPTION 3

02. EXECUTIVE SUMMARY 7

03. BUILDING FORM 9

04. BED STUDY 10

05. RE-LIFE METHODOLOGY 12

06. APPENDICES 11

WARD BLOCK

LECTURETHEATRES.

ADMINISTRATIONBUILDING

CONCOURSE.

CLINICAL SERVICES BUILDING

CHILDREN'SPAVILION.

ONCOLOGYCENTRE.

CUMBERLAND STREET.

E.D. DAY SURGERY

376 6 4 / S O U T H E R N D I S T R I CT H E A LT H B O A R D F E A S I B I L I T Y S T U D Y A P P E N D I C E S—


T E A M—


01. DESCRIPTION—This study examines the suitability of the Dunedin Hospital ward tower for re-lifi ng as the potential inpatient component adjunct to a new clinical services building. It does this by fi rstly analysing the form of the existing building and examines some precedents for shape and size. It then looks at what typical ward can be achieved within the footprint and compares this with some precedents. Finally it looks at what the broad strategy and timeline for implementation might be and what impacts that has.

02. EXECUTIVE SUMMARY—Examining the re-lifi ng from the three broad categories of form, clinical function and physical implementation

FORMWhile the tee shape is not ideal from the point of view of horizontal evacuation in a fi re and the location of the cross over between back of house functions and public functions in the junction of the tee it is possible to make a functioning layout between the Clinics and an inpatient unit consisting of two wards and associated support spaces.

The fl oor to fl oor height, apart from a few local beams, is generally the same height as modern ward accommodation and will allow ceiling heights of 2700mm generally with some localised at 3000mm.

The building grid does pose some limitations on possible layouts as the new standard of four bed room encroaches across the zone that is currently allowed for circulation, and coupled with the relatively narrow centre grid creates a requirement for a single corridor arrangement rather than a racetrack. Additionally it causes the current fi re escape stair and risers to impede a potential ward layout so that at least one but preferably both of these features would be moved to the outside of the existing fl oor plate.

Finally the length of the perimeter restricts the number of possible bed rooms, with a limit to single beds of two 24 bed wards. In this confi guration no other parts of the ward have access to the window wall.

BED STUDYThe application of standard ward layouts shows that the maximum size ward that can be achieved is 30 beds in a 2 ward inpatient unit per fl oor arrangement that has a ratio of 47% singles (14 patients in Single rooms and 16 patients in 4 bed rooms). 28 beds would allow for a higher ratio of single rooms at 57% singles (16 single and 12 patients in 4 bed bays)

To allow this arrangement to work with the revised single corridor administration and shared support areas need to be brought to the centre junction of the tee block. The advantage to this is better distinction between on and off stage functions while the disadvantage is longer travel times for staff . Because of the constricted area at the junction of the Tee and the need to cross over public and service fl ows at this point this is not as fully possible as with a new build option.

This arrangement would also need to re-arrange the circulation core area for shared visitor and staff amenities however would not encroach into the clinics area, which is too far away to be useful in any case.

IMPLEMENTATIONThe two timeline diagrams summarise the thinking behind re-lifi ng the building.

This strategy is reliant on additional external plant risers and stairs to be constructed to facilitate maintaining the existing fl oors as operational while work takes place, and as the existing service ducts are inadequate in size for modern demands, particularly for separation of extract for isolation rooms.

As can be seen from the diagram the construction period is likely to be extensive, about 8 years in total, if the only small sections can be made available at once in order to keep the hospital operating. The assumption of two wards, one clinic and a lobby area at once (eff ectively a fl oor in total) is not unreasonable. Creating the spare space in the ward block relies on the completion of the new CSB or other building to house the population of the wards and clinics being worked on.

The building timeline shows the eff ect of the extended time frame and discusses some of the other costs to a prolonged renewal project. If it starts after the completion of a new CSB it could realistically be 15 years before the completion of the fi nal element of refurbishment. To make the degree of refurbishment worthwhile a reasonably long target lifespan would be needed at which point the underlying structure would be relatively old- at the start of its new life this is 50 years old, the default structural life specifi ed in the Building Code.

Due to the prolonged timespan and complicated movements if re-lifi ng the ward block was to be pursued further we would recommend that:

→ A structural engineer is employed to evaluate the existing condition of the concrete structure and precast panels and what extent of treatment and recladding is needed to protect them for the proposed future life.

→ A construction programmer look in further detail at the programme of works and its feasibility to enable a quantity surveyor to factor this into any cost based analysis. This should include the costs of decant and recant required.

→ That a serious attempt is made to quantify the cost to the health board in terms of staff time, disruption and ineffi ciency so that this can be included in any cost based analysis.

→ That the functional adjacencies of re-use in this location are compared with those achieved by any new build. It may or may not be possible to put a cost on not optimising them

IN CONCLUSIONIt is possible to create a new ward environment within the existing ward block with inpatient units based on 28-30 per ward. This will require extensive work including new areas outside the existing footprint and extend over a prolonged length of time. The duration will cause negative eff ects of its own on the whole organisation and these need to be included when analysing the various options. Additionally there are costs and complications to an extended refurbishment programme that need to be factored in when comparing with any new build.

The real determinant of whether the re-lifi ng is viable need to be the underlying reasons as to why it is being done, such as the current building is in the correct adjacency or the need to spread the cost over a number of years for example. This is critical to getting a realistic result out of an options appraisal, particularly against a new build option.



T E A M—


4

AREA OF THE WARD SECTION The building breaks down in the areas shown in fi gure 2. This gives 2218m2 for the Ward section if the Escape stairs and main central duct are omitted.

SUMMARY OF BUILDING FORMThe building has a limit due to the size of its perimeter to the number of single rooms that can be accommodated at approximately 48. At this number there is no available perimeter for other functions that require access to windows and daylight.

The main structure could support re-use for smaller and single rooms however the necessity for multi bed wards causes some confl ict without modifying the structure. Comparable modern New Zealand projects extend this extra size outside a grid of similar size to the ward building. In the Ward building without

03. BUILDING FORM—BASIC SHAPEThe building is constructed in a T shape with the long head of the T continuous and currently containing patient ward functions- hereafter referred to as Wards section and the body of the T containing Vertical circulation and clinic space. (Refer fi gure 2). The clinic leg of the T contains the main vertical circulation for the building and also the arrival point for the connection to the current clinical services building. The brief suggests that this area remains as clinics however connection to a new clinical services building would likely come from the opposite side. The implications of this will be investigated in the re-life methodology section.

PERIMETER LENGTHThe perimeter divides into approximately 47-51 room size units (depending on how the end is divided) where a room is an AHFG standard single bed room of 3900-4000 in width. Refer to fi gure 4.

STRUCTURAL SYSTEMThe building is a moment frame resisting in the longitudinal and transverse directions. The Ward area and the Clinic area are separated by a movement joint. In the Traverse direction there are larger frames with deeper beams at the end external walls and in the middle of the ward section, see Floor to Floor for implications.

STRUCTURAL GRIDThe structural grid parallel to the short axis of the building alternates between 6.68m and 7.6m wide while parallel to the long axis is circa 9m from the perimeter to the central columns and 5.48m between the central columns.

This confi guration suits the size of modern single rooms as a single room with en-suite plus a corridor fi ts between the perimeter and central columns. Because there is not a second column in the bed room zone the rooms can cope with the perimeter columns being roughly but not exactly multiples of two single rooms wide. This is also compensated for by the multi beds being slightly narrower than two rooms. A multiple of two rooms wide is the common grid spacing forward towers used almost universally in the comparator projects. Where the tower was on top of a podium or contained intensive clinical space the spacing of the grid becomes larger, such as for Christchurch Hospital.

This confi guration does not suite the depth of a modern four bed room however as a four bed room and en-suite almost reaches the inner column (refer Figure 1). While the depth of the building generally is similar the most comparable modern example at Taranaki extends the fl oor out of the basic grid at the four bed rooms allowing a straight corridor and compact service spaces in the smaller central grid. This is also the case at Middlemore. The new Christchurch Hospital Acute services building deals with this by having a larger grid and then infi lling the internal space for a deeper fl oor plan.

FLOOR TO FLOOR HEIGHTThe fl oor to fl oor height generally is 4200mm which is consistent with modern development for a ward function allowing 2700mm ceilings generally and 3000mm ceiling locally (procedure rooms and similar). It is compromised by extra low beams to the braced frames in the centre section of the T making passing of services into or across the area diffi cult and generally resulting is ceilings being lowered to 2400mm. Functions in this area will not meet the AHFG room heights. This is clearly visible in the current building by visiting the ICU area.

DUCTS AND STAIRSThere are two large central ducts serving either end of the ward section of building the full with of the central grid as well as a fi re escape stair at either end. These currently set the location of the corridors to suit single and not four bed rooms. The ducts in particular restrict the access area of the fl oor space and the stairs restrict access to the ends.

Both stairs and ducts are surrounded by concrete block walls that are not part of the main structure of the building (see structural system above) and could potentially be moved and fi lled in to provide fl oor space. Currently the walls provide fi re rating and hold up the stairs.

BASIC FLOOR FIRE PLAN The fl oor layout has been discussed with fi re engineers currently undertaking other works for ICU in the building. A more modern theoretical layout would often utilise a square divided into four to support progressive horizontal evacuation more extensively.

Ideally the plan will be divided in three sections, the clinic/circulation section and two inpatient sections with each having access to the other without going through the third space to facilitate progressive horizontal evacuation and each containing a fi re escape stair at the outboard ends. This can be achieved by dividing the ward footplate into two sections.

FIGURE 2

DB.7/1

Ward 7c730S15

Impedes Layout Badly

Move is Possible

CLINICS/ACADEMIC

BOH SHARED

FOH SHARED

WARD

WARD

MAIN SPACES DIAGRAM

extension larger rooms move inward across the current corridor necessitating less effi cient central areas for support services.

The presence of the main service risers and the stairs across the full width of the central grid exacerbate the issues with larger rooms on the perimeter wall as they dictate the current location of the corridors. This compromises the entry and shared zones of the wards and the ability to plan the larger rooms.

The concrete walls surrounding the stairs, ducts and lifts is independent of the main structure of the building making it possible to re-provide these in another location and fi ll in the fl oor to assist with planning an updated ward layout. The structure is a braced frame on the ends and central bay. Currently only the locations of these braces compromises the eff ective fl oor to fl oor heights within the structure that otherwise is comparable with modern practice.

FIGURE 1

Corridor2200-2400

6300-6500

7620 6682

Service Zone

1P 4P1P



T E A M—


S5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20

21

222324252627282930313233343536373839404142434445

46

47

SB16

SB15

SB14

SB13

SB12

SB11

SB10

SB9

SB17

SB18

SB19

S

SB

S

SB

S

SB

S

SB

S

SB

SB

19

SB1

17

9

B

SB1

5B1

SB1

3B1

SB1

1B1

SB1

B1

B9

7620

5488

6680

8195

9315

9195

66

82

9195

7239

9315

7824FIGURE 3 FIGURE 4

The structure by the T shape, location of access lifts, and low central beams implies the division into two units, one at either end in terms of fi re strategy, access, and servicing.

It is also understood that the current service lifts are too small and it is likely given the age of the building that in a re-lifi ng the mechanical parts would be replaced. The suggested remedial for this is to create new vertical circulation associated with any new connection to the clinical services building.

As suggested above the building does not physically preclude re-use however there are some sub-optimal items. To be most effi cient in terms of area and delivery of services ideally some modifi cations will be necessary. The suggested modifi cations that would make the fl oor area more usable are;

1. Moving the stairs outboard with new construction and fi lling in the stair location.

2. Erecting new service risers outboard next to the junction of the T and potentially with the stairs at either end to allow replacement and in fi lling of the central duct.

3. Potentially localised extension of the fl oor plate to accommodate the larger size

These are being investigated by a trial fi t of the ward function in the bed study section but the purpose is to have suffi cient fl oor area within the ward to facilitate the adjacency of the ward support spaces to the ward rooms. Currently this shows the location of the existing stairs and ducts causing ineffi ciencies in the layout requiring them to be moved. As noted in the re-lifi ng methodology there are other benefi ts to moving the ducts.

INTERNAL COLUMN GRID SPACING PERIMETER DIVISION BY SINGLE BEDROOMS



T E A M—


6

a widened four bed room divided in half, as it sees them as not off ering the advantages of a single while also not facilitating fully the social interaction and observation that are the desirable attributes of a four bed bay. Additionally each inpatient unit should provide for accessible and bariatric patients as well as isolation. It should be noted however that current New Zealand Elderly/Recovery Services type wards tend to have an increased number of two bed rooms and singles. Two be rooms are also common in Europe but the NHS again favours the single/four bed bay mixture.

CHRISTCHURCH HOSPITAL LINEAR MULTI-BED

This is a unique development for the new Christchurch hospital that attempts to combine the observation, staffi ng and social advantages of multi-bed rooms with the privacy advantages of single rooms. Beds in this arrangement can be closed off from one another with screens and curtains or opened up for good observation and company. Wards with this unit are 25% single, 50% Linear Multi-bed, and 25% four bed rooms. This gives 75% single type beds counting the Linear Multi-bed as a single. Note this balance can be altered for specialist wards such as Oncology listed in the table below. The other Christchurch Hospital innovation within some of the wards is that the character of the four bed areas can be changed with the incorporation of a directly observing nurse base to a step down level of care just below HDU.

BENCHMARKING

The table below compares the balance of single rooms to multi

04. BED STUDY—This section looks at the trends in bed provision, potential layouts and comparison of the fi nal unit of recently completed hospitals.

MIX OF ROOMS UTILISED IN OPTIONS. SINGLE, DOUBLE, FOUR AND OTHER MULTI BED VARIATIONSRoom mix tends to vary with the project. The trend has been towards increasing the proportion of single rooms to reduce HAIs, improve privacy, improve rest and patient experience. The new Glasgow Queen Elizabeth II University Hospital is essentially 100% single beds for standard adult inpatient units, in line with NHS Scotland guidelines presumption of 100% for new build unless there is a clinical reason to do otherwise, however the Midland Metropolitan Hospital currently under construction for Sandwell and West Birmingham Acute Services NHS Trust is 50% single, 50% 4 bed bays to facilitate social interaction. These four bed bays are also divisible into specials if required at the expense of 2 beds.

The AHFG recommend the use of single and four bed rooms, with the mix to be determined for the facility in question. It is not so enthusiastic about the use of two bed rooms, essentially

PROJECT M2/BED SINGLE (%) MULTI-BED (%)

Project Maunga General 34 53 4-Bed - 47

Christchurch Womens Ward A Gynae 43.3 52 2-Bed - 48

Manukau Surgery Centre

Surgery Ward 46.8 25 2-Bed - 75

Christchurch ASB Surgery Ward 46.8 25 - 50% Multi-Linear Bed

4-Bed - 25

Christchurch ASB Oncology 50 - 25% Multi-Linear Bed

4-Bed - 25

Sunshine Coast University Hospital

Med/Surgical Ward 64.2 69 31

Gold Coast Unversity Hospital

Surgery 45.5 71 29

University Hospital Birmingham

General Not Known 45 4-Bed - 55

Midland Metropolitan General Not Known for PPP 50 4-Bed - 50

Glasgow QEII General (Audit) Not Known for PPP 100 Only some special units (ICU, SCBU, L1 etc) and

Paediatrics

Maastad Hospital General Not Known 50 50

DB

.7/4

Diffi culty Accessing A For F.O.H

Diffi culty Accessing A For B.O.H

Evacuation

3 WARD UNITS

CLINICS/ACADEMIC

BOH SHARED

FOH SHARED

WARD A

WARD B

WARD C

EXISTING LAYOUT DIAGRAM

bed rooms in some more recent local and international hospitals. These were chosen based on being relatively recent, availability of information, and restricted to general medicine and surgery wards. Information on geriatric and recovery ward information is also available. Overall the trend is for Hospitals to have an increasing amount of single rooms with a mix of between 50% and 80% single bed rooms the most common to allow for some spaces with better social or passive observation problems. Typically four beds making up General medical/surgical wards while two beds are favoured for rehabilitation wards, as is occurring at Burwood Hospital in Christchurch which is a mix of 100% single and 47%single/53% double rooms wards (on plans reviewed).

For the purposes of this study a generic medical/surgery ward is called for therefore a mix of single and four bed rooms will be utilised

Refer table below left for bed confi gurations.

EXISTING WARD BEDROOM PROVISIONCounting rooms on level 4 and level 7 of the existing ward tower layout that could be used for one or four beds gives a total of 62 (68) to 74 beds per fl oor divided between three units. For Level 4 the ratio of single to total beds is 17/74 or 19%. Generally the four beds are undersized and the layout of the bathrooms is not consistent with good access for assistance. It is now

also common practice to allow one toilet/shower en-suite and one toilet only en-suite for use when the shower is in use. The single bed rooms are close to standard size albeit slightly narrow however there does not appear to be specifi c provision for the special rooms (bariatric and Independent accessible) that are larger, or for type N-isolation that has a lobby (Refer Figure 5).

THE GENERIC WARDThe study is based on the application of a generic template to the building. This has been derived from the AHFG along with reviewing the contents of Christchurch ASB and Taranaki wards that both use a pair of wards per fl oor to create an inpatient unit. The inpatient unit utilises the principle of clustering to

FIGURE 5



T E A M—


WARD TYPE NO. OF BEDS AREA (M2) RATIO COMMENT

Dunedin - Ward area with a 32-bed ward:

64 (2x32) 2218+ 34+ Tested - Support areas do not fi t in adequate proximity to core areas, therefore ratio does not accurately refl ect ward actual use.

Dunedin - Maximum number of singles at 100% single:

48 (2x24) 2218 46.2

Area/Bed ratio recent Wards giving number of beds

49 2218 45 Worked out backwards from fl oor area ratio that was midway in the benchmark range of wards

Maximum feasible number in Ward at 47% single (16 in 4-person and 14 singles)

60 (2x30) 2218 37 Two single rooms deleted from a 32-bed Ward. 47% single falls just below the range common in modern hospitals

12 4-person, 16 single bed room (57% single)

56 (2x28) 2218 39.7 Alternate ward, 1a 4-person room deleted from 32. This provides a higher ratio of single rooms at 57%, within the modern range.

share support by fl oor. It identifi es a core of ward space as core patient space (beds, en-suites etc.) and core support (nurse base, dirty utility, etc.) with shared support and patient rooms for the ward areas between. The shared patient areas have some rooms that can be customised to develop ward specialties. These relationships are represented in the Figure 6 adjacency diagram.

For any arrangement of wards on the fl oor it is assumed that there will be shared spaces between the two wards. These may vary to allow for some specialisation between the diff erent wards. These are rooms such as procedure rooms, therapy/gym spaces, shared assisted bathroom, ADL etc. It is also assumed that some ward functions like ward clerk would be shared and that back of house support functions would be co-located by fl oor centrally not interspersed with the patient bedrooms. Some general support areas such as meeting rooms and staff lockers that can be shared by fl oor with the clinics. It is anticipated that by clustering support a greater distinction can be made between the wards on-stage and off stage functions thereby improving patient and staff experience. An example of how this might work is shown on the heart space of the Christchurch Wards drawings attached in the appendix.

Public

Neighbour-

hood Hub

Function

Clinic Accommodation

Bed and Bed Support

IPU shared patient areas

-Whanau Lounge -Treatment -WT

-BTC

Bed and Bed Support

Patient and Patient Support

Public

Vert.

Circ.

Staff

Support

Areas

Clinical

Vert.

Circ.

Func.

Support

Areas

CLINIC/ACADEMIC

IPUIPU

Neighbourhood HUB

(Shared Space)

NEIGHBOURHOOD HUB MODEL

FEATURES OF THE GENERIC INPATIENT SCHEDULEThe generic inpatient unit consists of a pair of wards and associated support spaces. The full unit schedule is located in the Appendix. Notable features are:

→ There are two wards per inpatient unit and one inpatient unit per fl oor

→ Bedrooms are either single, single special, or four bed bays

→ The single rooms are scheduled to contain one type N isolation room, one independent accessible room and one Bariatric room per ward.

→ Nursing is provided from a work room, staff base and satellite staff base

→ The length of the footprint necessitates 2 Dirty utilities per ward.

→ Ward clerk and reception is identifi ed as a shared function along with the ward administration offi ces

→ There is provision for a shared procedure room, large rehab space, and assisted bathroom.

→ For infection control a cleaner’s cupboard is included in each ward area and the shared areas.

PROJECTED LAYOUTSThe building form suggests a layout for the inpatient unit by fl oor on the principle of two core ward areas at either end with shared functions in between. This also suits the shared support areas and where these don’t fi t and can be shared by fl oor to be located in the circulation end of the clinic leg.

The projected layouts also assume that new stairs will constructed and relocated to the end as well as the ultimate removal of the large central service ducts by the refurbishment programme. These are discussed further in the Re-Life Methodology section later. The reason for this is the stairs and ducts interfere with the relocated circulation space caused by the greater depth of modern four bed rooms.

TEST FIT: 100% SINGLE ROOMSThe perimeter of the building provides a constraint on the number of single rooms possible, with a maximum of two 24 bed wards at 100% single. The consequences of this room balance are;

→ Little to no external wall remaining for other functions such as lounges, whanau rooms, social space or for amenity value for corridors to access daylight.

→ Wards meet each other in the middle

→ Low number of beds per fl oor/high area per bed (see table).

→ Central column area can be used for support functions

→ No shared room on perimeter between wards

→ Long travel distance within ward

→ Removes patient spaces with social interaction and passive observation

FIGURE 6



T E A M—


8

TOTAL GENERIC BED POTENTIAL STUDY BRIEFING FLOORS

LG G 1 2 3 4 5 6 7 8 TOTAL

Support Clinic/Academic NICU 30 30 30 12 ICU 30 30 30 180

Support Clinic/Academic Paeds 30 30 30 12 HDU 30 30 30 180

360

This distributes the inpatient units within the ward tower as shown in the section schematics above.

TEST FIT: 32 BED WARDSAn attempt was made to lay out the ideal ward with 32 beds as this is a multiple of 4x 8 bed nursing units that is commonly utilised in modern hospitals. Regardless of the mix of single and four person rooms this showed:

→ Insuffi cient external wall for areas like lounges or to provide amenity to central areas

→ Four bed rooms disrupt the use of central column areas

→ Insuffi cient area in the ward ends for suffi cient core ward support space such as utility rooms and equipment alcoves

→ Excessive travel to ward amenities such as lounges and whanau rooms that were displaced to the shared zone

→ Excessive travel to utility spaces that were displaced to the shared zone.

TEST FIT: 30 BED WARDSThe maximum size of a ward that can be realistically fi t in the building is 30 beds (tbc), consisting of 16 beds in 4 bed rooms and 14 singles giving 47% single beds. Clearly a two bed further reduction would make this easier if the desired ward number was smaller and would facilitate a higher ratio of single rooms by allowing a four bed bay to be omitted instead of singles. This gives a 28 bed ward with a 57% ratio of single rooms.

NOTE:

→ This allows space for a lounge/whanau room within a reasonable travel distance for each ward.

→ This allows some window wall for lounges, family rooms and circulation to improve amenity.

→ Not a multiple of 4x 8 bed nursing units that is commonly utilised.

TOTAL GENERIC BED POTENTIAL STUDY BRIEFING FLOORS - 57% SINGLE

LG G 1 2 3 4 5 6 7 8 TOTAL

Support Clinic/Academic NICU 28 28 28 12 ICU 28 28 28 168

Support Clinic/Academic Paeds 28 28 28 12 HDU 28 28 28 168

336

CONSEQUENCES OF BED LAYOUTS FLOOR AREA

If we take the area of the building dedicated to wards and compare with the table (fi gure ) we see that at 32 beds per ward the ratio of area per bed matches the most effi cient benchmarked unit (refer Appendix and table 1). What characterises that unit is that the envelope is moved in and out to maximise the effi ciency of the fl oor plate. It also has a lowest amount of amenity and shared space with bath, procedure and staff amenities only. It is therefore not surprising that without the benefi t of adjusting the envelope this quantity of beds proved diffi cult to fi t. We can also see that the 28-30 bed to area ratio for Dunedin starts to move towards the middle of the range as identifi ed in the table below.

OFFICES

This arrangement assumes that no provision is made for offi ce space at the wards not directly associated with the ward (for example charge nurse manager, ward clerk and work room offi ces are included, offi ces for specialist consultants are not). It assumes that offi ces and administration for specialist departments will either be with the specialist clinics in the clinic tower or provided separately in an administration area.

SHARED SPACES

Shared services such as meeting/training rooms, staff amenities, lockers, disposal holds, and public toilets will need to be located in a neighbourhood hub in the lift area and shared with the clinics.

DISTRIBUTED ROOMS

The long footprint of the building suggest two smaller dirty utilities per ward unit and ideally some nurse sub-base areas. This will assist with keeping travel distances with dirty items to an acceptable level

FOUR BED ROOMS AND A SPECIAL ROOM TYPE

The standard four bed is not divisible into two two-bed rooms or two singles as it is too narrow. This is due to shared circulation at the end of the opposite beds halving its requirements. For reference the standard room layouts are included in the appendix. For future fl exibility a room the same width as two singles would be utilised but the space is not available.

To facilitate the use of the central space within the unit from a single corridor we have also utilised a four bed room based on the corner access English NHS P21 standard rooms’ layout. Not using this room creates a problem with utilising the central space in the unit and displaces the clinical work room towards the shared area.

DB.7/3

Ward 7a710S7

DB.7/3

4P 4P 4P

1P

ENEN

EN EN

ENEN

EN EN

EN

ENEN

EN EN

ENENEN

EN EN ENEN EN EN

1P1P

1P 1P

1P1P1P 1P1P

4P 4P

1P 1P

128m²

32-BED WARD

New escape stair

DB.7/3

Ward 7a710S7

DB.7/3

1P 1P 4P 4P 4P 4P

1P 1P 1P 1P 1P1P 1P 1P 1P 1P 1P

1P

EN

EN EN EN EN EN

EN

EN EN EN EN

EN EN EN ENEN EN EN EN

EN

ENEN

128m²

30-BED WARD

New escape stair



T E A M—


W3 W5 W7 W11 W13 W15 W1 W9

W4

CSB LINK &VERTICAL CIRCULATION

L2 L3 L4 L6 L7 L8 L9 L1 G

REMOVEDUCTS

L5

CSBMIGRATION

CSBMIGRATION

W6 W8 W12 W14 W16 W2 W10

C2DECANT

DECANT

DECANT

C3 C4 C6 C7 C8 C9 C1 C5 GROUND

ENVELOPE AND STRUCTUREEXTERNAL DUCTS,

STAIRS, LIFTS

SERVICES UPGRADES

SA

SA

CS

B C

OM

PL

ET

E

SA

TTSS

YE

AR

0

YE

AR

1

C

YE

AR

2

YE

AR

3

C

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SUMMARY OF BEDS AND WARD LAYOUTS.An inpatient unit with a more modern balance can be created in the straight section of the Dunedin hospital ward block. It will contain two ward units and shared spaces between with only directly ward related administration and staff spaces.

Each ward unit could contain 28 to 30 beds. This gives the ward tower a potential confi guration of generic wards of 60 beds over 6 fl oors for a total of 360. (A low target number at 28 beds per ward give 56 beds per fl oor on 8 fl oors for a total of 336).

Refurbishment to achieve the inpatient unit relies on moving the escape stair and ducts. The refurbishment and sharing of functions should also provide an opportunity to create a more on stage/ off stage split between visitor/patient and support functions however this is limited by the tee shape.

FIGURE 7



T E A M—


10

BLOCK BUILDING TIME LINE

FIGURE8

05. RE-LIFE METHODOLOGY —This section looks at the approach to re-life the ward block including scope, strategy for undertaking the work, timeframe and implications of a prolonged programme of refurbishment.

SCOPE OF REFURBISHMENTTIME

A projected timeline diagram is included and discussed later. This shows that the building structure will be approximately 50 years old at the conclusion of the re-life. The extent of work to the structure and cladding itself will to some extent be determined by the desired life beyond this date however for the study this is assumed to be 25 years after the conclusion of the refurbishment, however there will be an optimum design life for return on expenditure that will need to be studied.

INTERNAL LAYOUT

The internal layout for all the fl oors briefed for the bed study would be completely rebuilt and refurbished to accommodate a revised ward layout and model of care. The alterations necessary for this reconfi guration and the renewal of services will likely eff ect the other fl oors served for some degree of refurbishment, as will the optimisation of service locations between new and existing buildings. Additionally the fi t out for these areas is already well used. It is therefore reasonable to expect these fl oors to all be extensively refurbished as well.

LIFTS AND STAIRS

The service/bed lifts are reported as being undersize. Additionally the equipment will be dated. There is the opportunity along with the connection new to a new clinical services building. These may partially replace some of the core in the exiting building, after which the shafts could be utilised as ducts or fi lled in for additional shared space.

ENVELOPE AND STRUCTURE

As discussed in the timeline structure below some treatment of the exposed concrete structure and cladding is likely to be necessary. Additionally any required earthquake strengthening would be undertaken. If re-lifi ng is a realistic possibility it is recommended a structural engineer is commissioned to examine strengthening and remaining panel and structure life to determine what level of intervention is required to achieve the desired building life.

FIRE AND ACCESSIBILITY

Refurbishment triggers the need to upgrade accessibility and means of escape from fi re compliance “as near as reasonably practical”. With extensive alterations to layout upgrade to these items is likely to occur. Additionally fi re safety systems will need upgrading as a consequence.

SERVICES

To achieve the desired life the services will need to be extensively refurbished and some additional ones added for compliance.

New services are likely required to deal with smoke, and while the existing ducting in itself is in good condition dampers. Additionally adding correctly complying isolation rooms to each ward will require new ducts as has been revealed during the ICU refurbishment. The supply systems mains of some other services such as steam and hot and cold water would also need to be evaluated and potentially replaced. It is likely that at the same time the earthquake bracing of services systems would be improved to match the Importance Level of the building.

STRATEGY FOR REFURBISHMENTThe most rapid method for re-furbishing the ward building would be if a wing of the T could be made available from top to bottom as all of the servicing for the building runs vertically and this avoids problems with restricted access to the ceiling spaces of the fl oor below for drainage works and access to service risers. It is unlikely that this would be possible and still enable the hospital to function for the duration of the refurbishment as it would require a large amount of decant space.

As the hospital is serviced by wing vertically rather than by fl oor

the approach to re-life the building is suggested as many of the fl oors as can be made available by vertically by wings two at a time one above the other. It is likely to take nine months to upgrade a pair of wards above each other at a time. (We have based this on the construction time for ward refurbishment and extensions to Parkside at Christchurch Hospital). In the clinics wing it is assumed that one fl oor can be made available at a time, with two months for decant and six months for construction allowed for a total of eight.

From the structure analysis and bed study it is likely that some additional area will be required, or at least removal of obstacles within the main fl oor plate. Additionally it will be necessary to replace some services and add new ones and the current ducts are both full and will be required to be maintained for the fl oors yet to undergo refurbishment. Replacing services within the existing ducts will lead to multiple disruptive shutdowns for the existing hospital fl oors. For these reasons it is suggested that new services risers are constructed outside the existing fl oor plate designed for the revised confi guration at the start of the project along with installation of new plant. At the end

of the project or as they become empty the duct space in the centre of the existing fl oor space could be fi lled in either fully or partially and utilised as clinical space, alleviating the entry pinch point. Along with the risers plant may be installed by fl oor in some instances to assist with fl exibility. The interaction of these times can be seen in the project construction timeline

The access and lift area of the clinic wing potentially will need adjusting to suit any new connection from the clinical services building. At its most minimal this would involve connecting in however as it is on the other side there is the potential to mirror the service and public connections which may release some usable area from circulation and improve the onstage/off stage split. This would be facilitated by including new service lifts with the CSB connection, at the same time allowing size issues to be addressed.

The likely sequence is laid out below and represented on the construction timeline.

1. Construct additional areas at either end. This is as a



T E A M—


ACADEMIC SOUTH WING

NURSING

LG

3rd

8th

Grd

4th

9th

1st

5th

10th

2nd

7th

6th

Clinics

Plant room MS3 south

Clinics

Clinics

Clinics

ClinicsLecture Theatre

Clinics

Clinics

Clinics

Used to be Confi rmed



Gastroenterology30 BED IPU

11 HIGH ACUITY (ExICO)

30 BED IPU

USE TO BE CONFIRMED

USE TO BE CONFIRMED

USE TO BE CONFIRMED

USE TO BE CONFIRMED

30 BED IPU

30 BED IPU

CHILDREN’S PATIENT WARD

30 BED IPU

30 BED IPU

30 BED IPU

11 HIGH ACUITY (Ex HDU)FORMER CLINICAL

SERVICES BUILDING SITE

30 BED IPU

30 BED IPU

30 BED IPU

NICU

30 BED IPU

30 BED IPU

NORTH WING

minimum the staircase and new external service risers but potentially ends of four bed wards if this proves viable. Ideally at this stage the CSB connection and new vertical circulation would also be constructed.

2. Install new vertical services into new service risers

3. Commission new lifts

4. In pairs vertically up the fi rst wing of the T refurbish the generic wards.

5. In pairs vertically up the second wing of the T refurbish the generic wards.

6. Fill in old ducts and refurbish locally.

7. In parallel refurbish the shared and circulation space within the clinics block

8. In parallel if suffi cient decant space is available, refurbish the Clinics wing, otherwise this needs to follow the reconfi guration of the entry and the ward spaces.

This is assuming that works on the clinic area can be run concurrently by creating suffi cient decant space in the new CSB. It also assumes of the four wards currently identifi ed as moving out that there are two for refurbishment and two to make up the numbers in beds while the refurbishment is being undertaken as they have lower bed numbers than the fi nal ward. (Being potentially NICU/Paediatrics and ICU/HDU).

See Figure 7 for Construction Programme Diagram.

IMPLICATIONS OF CONSTRUCTION AND TRANSITION PROGRAMMEThe refurbishment of the wards will take time, and this needs to be coupled with the time to design and construct the new Hospital Clinical Services Building before any work starts on the ward block . For the purposes of this we are assuming that a new clinical services building is 7 years away (3 years to confi rm content and design, 3 years to build, 1 year commissioning and migration). These two timelines, the life of building timeline and the construction programme have implications for the Dunedin Hospital site.

See Figure 8 for Construction Programme Diagram.

LIFE OF PREVIOUSLY REFURBISHED WARDS AND DEPARTMENTSAs shown on the diagram the recently and currently being refurbished departments will have expended between 13 and 17 years of life at the conclusion of the Ward block refurbishment. Signifi cantly of these projects only the First Floor has had its windows replaced.

At these ages refurbishment of these fl oors will likely be required shortly after completion of the Ward Tower re-life.

LIFE OF THE STRUCTURE AND EXTERNAL ENVELOPECONCRETE FRAME AND CONCRETE CLADDING PANELS

The refurbishment Timeline diagram shows the expended life of the structure. For reference this places the structure beyond the 50 years NZBC design life for elements contributing to structural stability. Elements of the main frame and cladding are exposed concrete, for which the treatment is unknown. As concrete is subject to migration of chlorides over time causing decay of reinforcing it is recommended that a structural engineer is commissioned to look at the remaining life of the structure, panels and panel fi xings. Depending on the outcome of these investigations options for extending the life of the frame range from treating the concrete with chemicals to halt chloride migration only through to fully over-cladding with a systems such as Aluminium faced phenolic panel. For an extension of 25 years treatment and upgrade or over-cladding is likely. With the extent of the works proposed demonstration of compliance for H1 as reasonably practical upgrade of the insulation/thermal performance would be desirable.

FIGURE 9

WINDOWS

The current windows provide inadequate solar control and poor insulation. The hardware is also old, as are the seals and gaskets. These are being partially remediated for the current works however the life is not being extended nor replacement made. Observations from undertaking this work indicate that for a worthwhile extension of life and for building consent upgrades to meet H1 the windows will require replacing. These were replaced on the refurbishment of NICU/PAEDs for acoustic reasons, and depending on where the Helipad is moved in the new project acoustic upgrades of some existing facades may also be required.

COSTS OF DECANT PROGRAMMEMONETARY COSTS OF MOVING

With each move there is a cost to decant and move departments about, temporary works for screening, signage and decant, and setup work on each fl oor. These become disproportionately large with smaller movements and as can be seen from the construction timeline there are movements for both the clinic and wards within the tower. Extra staff may be required to organise the decanting and deal with the disruption. Additionally throughout the construction programme the hospital will not have its designed adjacencies so will be less effi cient.

ONGOING NOISE AND DISRUPTION

Keeping the hospital going means that some of the construction noise and disruption will need to be tolerated over a period of eight years. Additionally to mitigate disruption some techniques may not be able to be use or may be restricted in time (e.g. Impact drilling of structure) as they transmit some distance through the building. This generates additional stress for staff and patients which will be over a prolonged period of time.

HEALTH IMPACTS

Studies in America show an increase in airborne contaminants associated with construction work in hospitals. While steps can be taken to limit this it cannot be eliminated altogether- particularly for partial fl oor refurbishment. Coupled with noise and disruption to rest and sleep there is potential to impact health outcomes although this is extremely diffi cult to quantify. It should be noted that the disruption is both during the CSB construction period and the Ward block refurbishment so may be for a period of eleven years.

LOGISTICS OF PLANT SPACE

The need to run new services and keep the old ones going for a period at the same time is likely to lead to at least a period of time where servicing the building is much more expensive than running either the new systems or the old. Additionally the layout of the new plant may be compromised by the need to keep existing plant operating.

ALIGNMENT TO MODEL OF CARE AND CLINICAL ADJACENCIES

Throughout the construction programme the hospital will not have its designed adjacencies so will be less effi cient. Additionally it may not be possible to achieve complete alignment with the desired functional adjacencies or model of care within the existing building leading to the compromise being carried forward over the life of the ward block.



T E A M—


12

06. APPENDICES—01. SCHEDULE OF AREA

02. AHFG BED ROOM LAYOUTS

03. COMPARISON TABLE 9

04. COMPARATOR PLANS 10



T E A M—


Dunedin Hospital Ward BlockBed Utilisation Study

Schedule of Areas47% Single 30 Bed Theo (3)

9/09/2016

7521_SDHB Dunedin Wards Outline SOA.xlsx 1of2

Inpatient Unit, 30 Bed, 47% SingleAHFG Room Code

Room/Space Number Size m2 Remarks

Patient Areas4BR-ST Patient Room, 4P 4 42 168.0 42 base size

1BR-STPatient Room, 1P 11 15 165.0

This size assumes no stay over divan for family. This may be unsound and 16.5-18m2 for all rooms may be a safer assumption

Patient Room, 1P, Special, Bariatric 1 18 18.0

Patient Room, 1P, Special, Independent accessible 1 18 18.0

1BR-IS-NPatient Room, Special, 1P, type N 1 17 17.0 Consider PPVL for flexibility

ANRM Ante room 1 6 6.0ENS-ST En-suite, std 19 5 95.0ENS-ACC En-suite, Accessible 2 6 12.0 For Isolation and Accessible roomENS-BA En-suite, Bariatric 1 7 7.0

Bathroom 0 15 0.0 Shared per floor?moved to sharedToilet, Patient, Acc 1 5 5.0 Additional to En-suites. 1 near day room.Sub total 511.0

Discounted circulation 35% 178.9Increased from 32% for existing building and single rooms

689.9Total, Patient Rooms, 1P 14Support areas

Day room/Dining 1 15 15.0 Note. Operational policy discussion re- whanau room in addition or together.

INTF interview room 1 9 9.0 Here or shared?SSTN-14 Staff Station,14m2 1 14 14.0SSTN-5 Staff Station,5m3 1 5 5.0 Centralised included

Office, Clinical workroom 1 15 15.0WCST Toilet, Staff 3m2 1 3 3.0

Bay, PTS 1 1.5 1.5 Adjacent POCT and SStnBay, POCT 1 4 4.0 Or Meds/CU. Define policy

BLIN Bay, Linen, Clean 1 2 2.0 Assumes trolley rotation modelBLIN Bay, Linen, Dirty 1 2 2.0 Assumes trolley rotation modelBRES Bay, Resus Trolley 1 1.5 1.5BMEQ-4 Bay, Mobile Equipment 2 2 4.0 Number tbcBBEV-OP Bay, Beverage 1 4 4.0BMT-4 Bay, Meal Trolley 1 4 4.0 size tbc with trolley size.BHWS-B Bay, Handwash 4 1 4.0 1 at each entry, 2 at SS, Additional to roomsBHWS-PPE Bay - Handwash/PPE 1 1.5 1.5 At class S segregation rooms tbcCLUR-14 Utility, Clean 1 14 14.0

Medication Room 10 10.0 currently excluded and in CUDTUR-12 Utility, Dirty 1 12 12.0 2 Smaller may work bestSTEQ-20 Store, Equipment 1 20 20.0 Size required TBCSTGN-9 Store - General, 9m2 1 9 9.0

STPS-8Store - Photocopy/Stationary, 8m2 0 8 0.0 Moved to shared and reduced to 1

CLRM-5 Cleaner 1 5 5.0

0.0Sub-total 135.5Discounted Circulation 32% 43.4

178.9Ward size 868.7Ward 2 869 1737.4

Shared Spaces



9/09/2016



Public

WCPU-3 Toilet, visitor 3 0.0 In lift core area.Toilet/Shower 0.0 ? ASB provide next to whanau room

WCAC Toilet, Accessible 1 6 6.0Distance from core to end of unit likely too great, not currently in core

LNPF-20 family/whanau lounge 1 20 20.0 *Bay, public telephone 0.0 ?Clinical Areas

TRMT Treatment room 1 16 16.0 **Allied health Space 1 20 20.0

INTF interview room 12 0.0BATH bathroom 1 15 15.0

0.0

Staff Areas

MEET-L-20 Meeting Room 1 20 20.0PROP-2 Property bay-staff 2 3 6.0

SRM-15 Staff Room, 25m2 1 25 25.0Includes a beverage bay.nb SRM-15 is for 1 ward

WCST Toilet-Staff,3m2 0 3 0.0

Toilet-Shwr-Staff, 5m2 2 3 6.0

Staff Station, Ward Cerk 1 9 9.0 1 for both, *OFF-S9 Office, 1P, 9m2 4 9 36.0 Nurse manager, SMO 1 of each/ward

OFF-3POffice - Three Person Shared, 15m2 2 15 30.0

locate to facilitate re-use as clinic in specialist ward. Office approach TBC

OFF-2POffice - Two Person Shared, 12m2 12 0.0 office approach tbc

Support SpacesDISP-10 Disposal Hold 1 10 10.0

STPS-8

Store-Photocopy/Stationary, 8m2 1 8 8.0

STGN-9 Store, General 1 12 12.0CLRM-5 Clnr 1 5 5.0 may be in core

sub total 244.0discounted circulation 32% 78.1

322.1Plant

Air handling 1 15 15.0

Due to extra unit and existing duct space separate intake is likely to be required for at least on pod on the floor

Comms 1 7.5 7.5

Switch cupboards 3 1 3.0 Use existing, not measured in available area25.5

Total Shared Areas 347.6

Total Unit area 2085.0

* Additional space per ASB over AHFG. Requirement depends on operational policies** Extra over AHFG to facilitate use of trolleys/beds (sim. ASB)



T E A M—




9/09/2016



Public

WCPU-3 Toilet, visitor 3 0.0 In lift core area.Toilet/Shower 0.0 ? ASB provide next to whanau room

WCAC Toilet, Accessible 1 6 6.0Distance from core to end of unit likely too great, not currently in core

LNPF-20 family/whanau lounge 1 20 20.0 *Bay, public telephone 0.0 ?Clinical Areas

TRMT Treatment room 1 16 16.0 **Allied health Space 1 20 20.0

INTF interview room 12 0.0BATH bathroom 1 15 15.0

0.0

Staff Areas

MEET-L-20 Meeting Room 1 20 20.0PROP-2 Property bay-staff 2 3 6.0

SRM-15 Staff Room, 25m2 1 25 25.0Includes a beverage bay.nb SRM-15 is for 1 ward

WCST Toilet-Staff,3m2 0 3 0.0

Toilet-Shwr-Staff, 5m2 2 3 6.0

Staff Station, Ward Cerk 1 9 9.0 1 for both, *OFF-S9 Office, 1P, 9m2 4 9 36.0 Nurse manager, SMO 1 of each/ward

OFF-3POffice - Three Person Shared, 15m2 2 15 30.0

locate to facilitate re-use as clinic in specialist ward. Office approach TBC

OFF-2POffice - Two Person Shared, 12m2 12 0.0 office approach tbc

Support SpacesDISP-10 Disposal Hold 1 10 10.0

STPS-8

Store-Photocopy/Stationary, 8m2 1 8 8.0

STGN-9 Store, General 1 12 12.0CLRM-5 Clnr 1 5 5.0 may be in core

sub total 244.0discounted circulation 32% 78.1

322.1Plant

Air handling 1 15 15.0

Due to extra unit and existing duct space separate intake is likely to be required for at least on pod on the floor

Comms 1 7.5 7.5

Switch cupboards 3 1 3.0 Use existing, not measured in available area25.5

Total Shared Areas 347.6

Total Unit area 2066.1

* Additional space per ASB over AHFG. Requirement depends on operational policies** Extra over AHFG to facilitate use of trolleys/beds (sim. ASB)



9/09/2016


Inpatient Unit, 30 Bed, 57% SingleAHFG Room Code


Patient Areas4BR-ST Patient Room, 4P 3 42 126.0 42 base size

1BR-STPatient Room, 1P 13 15 195.0

This size assumes no stay over divan for family. This may be unsound and 16.5-18m2 for all rooms may be a safer assumption

Patient Room, 1P, Special, Bariatric 1 18 18.0

Patient Room, 1P, Special, Independent accessible 1 18 18.0

1BR-IS-NPatient Room, Special, 1P, type N 1 17 17.0 Consider PPVL for flexibility

ANRM Ante room 1 6 6.0ENS-ST En-suite, std 20 5 100.0ENS-ACC En-suite, Accessible 2 6 12.0 For Isolation and Accessible roomENS-BA En-suite, Bariatric 1 7 7.0

Bathroom 0 15 0.0 Shared per floor?moved to sharedToilet, Patient, Acc 1 5 5.0 Additional to En-suites. 1 near day room.Sub total 504.0

Discounted circulation 35% 176.4Increased from 32% for existing building and single rooms

680.4Total, Patient Rooms, 1P 16Support areas

Day room/Dining 1 15 15.0 Note. Operational policy discussion re- whanau room in addition or together.

INTF interview room 1 9 9.0 Here or shared?SSTN-14 Staff Station,14m2 1 14 14.0SSTN-5 Staff Station,5m3 1 5 5.0 Centralised included

Office, Clinical workroom 1 15 15.0WCST Toilet, Staff 3m2 1 3 3.0

Bay, PTS 1 1.5 1.5 Adjacent POCT and SStnBay, POCT 1 4 4.0 Or Meds/CU. Define policy

BLIN Bay, Linen, Clean 1 2 2.0 Assumes trolley rotation modelBLIN Bay, Linen, Dirty 1 2 2.0 Assumes trolley rotation modelBRES Bay, Resus Trolley 1 1.5 1.5BMEQ-4 Bay, Mobile Equipment 2 2 4.0 Number tbcBBEV-OP Bay, Beverage 1 4 4.0BMT-4 Bay, Meal Trolley 1 4 4.0 size tbc with trolley size.BHWS-B Bay, Handwash 4 1 4.0 1 at each entry, 2 at SS, Additional to roomsBHWS-PPE Bay - Handwash/PPE 1 1.5 1.5 At class S segregation rooms tbcCLUR-14 Utility, Clean 1 14 14.0

Medication Room 10 10.0 currently excluded and in CUDTUR-12 Utility, Dirty 1 12 12.0 2 Smaller may work bestSTEQ-20 Store, Equipment 1 20 20.0 Size required TBCSTGN-9 Store - General, 9m2 1 9 9.0

STPS-8Store - Photocopy/Stationary, 8m2 0 8 0.0 Moved to shared and reduced to 1

CLRM-5 Cleaner 1 5 5.0

0.0Sub-total 135.5Discounted Circulation 32% 43.4

178.9Ward size 859.3Ward 2 859 1718.5

Shared Spaces



T E A M—


AUSTRALASIAN HFG STANDARD COMPONENTS

This document is for advisory purpose only

AUSTRALASIAN HFG STANDARD COMPONENTS

This document is for advisory purpose only



T E A M—


7

ProCure21+ Reducing the cost of construction through standardisationREPEATABLE ROOMS CATALOGUE

For more details, please visit StandardShare on the ProCure21+ Club website www.procure21plus.nhs.uk/club

Clinical benefits

• 3600mm x 3100mm bed space reflects rigorous research by the Medical Architecture Research Unit at London South Bank University and the Health and Care Infrastructure Research and Innovation Centre at Loughborough University, indicating this space to be optimal in accommodating a full range of clinical activities taking place at the bedside or in the individual’s bed space, together with operating equipment at the bedside;

• two clinical hand wash stations located in a highly visible and convenient area with a shelf above the basin on which staff may place papers, etc while washing their hands;

• good daylight with sightlines to outside space from the bedhead, providing a brighter, more therapeutic environment;

• family space, including the option of an overnight stay for a relative or friend;

• space for artwork within the room;

• Multi-Bed Bay includes an en-suite shower and WC and separate en-suite WC, providing patients with immediate access to a WC even if the en-suite is occupied. Bed locations are designed to avoid direct sightlines into the WC from the bed space; en-suite shower room is spacious enough to accommodate a bariatric patient.

f li i l ti iti

Traditional arrangementwith reduced bay footprint, observation of three out

of four beds from the corridor, reduced distances to

en-suites, and space for artwork

Bedroom NIA 61.3sqm

En-suite NIA 6.3sqm

En-suite WC NIA 1.9sqm

Corridor run 7400mm

IPS 1.8sqm

Diamond arrangement providing a balance of small bay

footprint and corridor wall length, while

increasing the bedhead-to-bedhead and bed-centre-

to-bed-centre distances plus observation of all beds

from corridor and shortest distances to en-suites as

well as space for artwork

Bedroom NIA 58.5sqm

En-suite NIA 6.3sqm


Corridor run 2500mm

IPS 1.8sqm

T-form arrangementproviding the smallest bay

footprint, a shallow plan depth

and a window for each bed plus

space for artwork, but longer corridor length

Bedroom NIA 58.4sqm

En-suite NIA 6.3sqm


Corridor run 11150mm

IPS 1.8sqm

m

p

m NIA 61.3sqm

NIA 6.3sqm

WC NIA 1.9sqm

run 7400mm

m

q

me

n

artwork, but longer corridor length

NIA 58 4

r run 2500mm

qm

ementthe smallest bay

a shallow plan depth

ndow for each bed plus

k b l d l h

6

ProCure21+ Reducing the cost of construction through standardisationREPEATABLE ROOMS CATALOGUE

For more details, please visit StandardShare on the ProCure21+ Club website www.procure21plus.nhs.uk/club

Four-bed Multi-Bed Baywith en-suite and separate en-suite WC

Key features

• Head to head distance: at least 3600mm

• Full assistance in en-suite shower/WC

• Observation from corridor

• Average bed to en-suite distance no more than 5050mm

• En-suite access maintained when bed bay curtains closed

• Artwork

• Daylight factor (room average) c2%

Several design features may be added to the designs, depending on local policy, including:

• Ceiling-mounted overhead hoists;

• Interstitial blind within the glazed screen;

• Furniture options;

• A medication cabinet;

• Patient entertainment system.

The bedroom includes space for staff to work using a computer on wheels, but additional work space may be added.

Comparison table

Bed area nia 64.0sqm

Traditional layout

Design manual2011

Diamondlayout

‘T’ formlayout

61.3sqm 58.5sqm 58.4sqm

En-suite sh/WC niaWC nia

6.5sqm2.0sqm

6.3sqm1.9sqm

6.3sqm1.9sqm

6.3sqm1.9sqm

Corridor length 7700mm 7400mm 2800mm 11150mm

Views out (equiv. total window size)

Not stated 3900 x 2000 (3 windows)

3600 x 2000 (MBB corner location)

4700 x 2000 (2 corner windows)

Head to head distance 3600mm 3600mm 3700-

5000mm3600-

4400mm

Full assistance in en-suite sh/WC

Observation from corridor 2 of 4 3 of 4 4 of 4 2 of 4

Average distance bed to en-suites 5300mm 5050mm 3950mm 5050mm

Range of distance to en-suite sh/WC 3.8 - 7.2m 3.9 - 6.3m 2.5 x 5.5m 2.6 - 6.9m

Artwork

Daylight factor(room average) ~2% ~2% <2% >2%

Comparative cost factor savings 1.00 ~0.96 ~0.93 ~0.95

Completed projects using this arrangement

Lilac Ward, Scarborough Hospital – Diamond configuration

Description

Three arrangements of this repeatable design are available to suit local choice, with each using the same standard components and each being functionally compliant with the relevant HBN and Design Manual requirements.

onal Diamondlayout

‘T’ forformformormormormormormormormormrmrmrmrmforforrmlayout



T E A M—


BUILDING TYPOLOGY (BUILDING) TYPOLOGY (WARD) BATHROOMS BEDS/WARD BEDROOM CONFIGURATION AREA/BED (m2) % Single BUILDING GRID TYPOLOGY COLUMN GRID FAÇADE-COLUMN DEPTH OOR TO FLOOR HEIG YEAR COMPLETED

Auckland City HospitalEnsuites, inboard, single.

Ensuites, shared. 27 Single and 4bed 32

Christchurch Hospital Acute Services Building (L03 General

Surgery Ward)

Acute Podium with ward towers over

Racetrack. Perimeter beds with central services.

Shared amenitiesEnsuites, inboard 32 Single, 4 Bed,linear Multibed and

isolation. 57.5

Either 25% or 75% depending on classification of linear multi.

11.3 13.5 4.1m 2018

Christchurch Womens Hospital (Wards A and B)

Connected towers on Podiums

Block. Perimeter beds with central services En-suites, inboard Ward A : 31

Ward B : 45 Single, double and isolation. Ward A: 43Ward B: 50 52, 58% Irregular 10.5 11.2

Dunedin Hospital (Ward Block Level 07)

T shaped TowerRacetrack - perimeter

beds, central services with corridors either side.

Ensuites, inboard varies Single, 4 Bed 29 19% Irregular 7.7 9.2 4.2m 1980

Illawarra Elective Surgery Service, Wollongong Hospital

(Inpatient Ward 1)Block Racetrack. Perimeter

beds with central servicesEnsuites, inboard and

outboard. 25 Single, double, 4 Bed and isolation. Irregular 4.2m 2015

Manukau Surgery Centre (Ward A)

Low rise (2 storey) wing of Manukau Superclinic

Central corridor with perimeter beds. Central

Services hub .

Ensuites, outboard, shared. 26 Single and double 39 25% Regular 7.75

Middlemore Kids First Childrens Hospital - Ward A

Cruciform wings, single hung. Services between

wings.Ensuites, outboard. 45 Single, double and isolation. 42 24% Regular 7.8

Middlemore Kids First Childrens Hospital - Ward B

Cruciform wings, single hung. Services between

wings.Ensuites, outboard. 36 Single, double and isolation. 53.7 Regular 7.8

Project Maunga - Ward 2A L shaped ward tower Racetrack Ensuites, inboard and outboard. 29 Single and 4 Bed 34 53% 7.2 8.6 4.14m 2012

Project Maunga - Ward 2B L shaped ward tower Racetrack Ensuites, inboard and outboard. 20 Single and 4 Bed 34 53% 7.2 8.6 4.14m 2012

Thames Hospital Older Persons Rehabilitation Services

U shaped wings - uneven width wings. Ward B:

Perimeter beds, central services with corridors either side. Ward C: single hung corridor.

Ensuites, back-to-back and inboard.

Ward B : 20Ward C: 28 Single, double, 4 Bed and isolation. Ward B : 42.1

Ward C: 28.2 Irregular

Waikato Hospital Emergency Department (Wards A, B, C and

D)

U shaped wings, single and double hung.


Ward A: 26Ward B: 25Ward C: 25Ward D:25

Single, double, 4 Bed isolation.

Ward A: 50.4Ward B: 49.0Ward C: 52.4Ward D: 49.0

60 Irregular 7

Waikato Hospital Older Persons Rehabilitation Services (Wards

A, B and C)

Irregular block. Perimeter beds, central services with

corridors either side.


Ward A : 6Ward B : 27Ward C: 26

Single, double.Ward A: 74.8Ward B: 42

Ward C: 44.734 Irregular 6 6.7 2013

Waikato Hospital Older Persons Rehabilitation Services (Wards

D and E)

Irregular block. Ward E: Perimeter beds, central services with corridors either side. Ward D: single hung corridor.


Ward D: 15Ward E: 27 Single, double Ward D: 76.8

Ward E: 42.7 59 Irregular 6 6.7 2013

Grey Base Hospital and IFHC Redevelopment

Low rise, BlockRacetrack, Bedrooms on

outside wall, services central

Ensuites, back-to-back inboard and between. 36 13 double,6 single, 1 isolation, 3 critical

care IPU 21% (ex CCU) 3 grids wide 8.1 x 8.4 8.4 under construction

Burwood hospital (zone B)Low rise ward wings off

service spine

Central corridor with perimeter beds. Central Services hub with local

services one side .

Ensuites, back-to-back inboard and between. 36 double, single IPU Wing 1, 100%

Wing 2, 56% 2 grids wide 8.1 x 8.4 8.4 2016



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T E A M—


Documents

SOUTHERN DISTRICT HEALTH BOARD FEASIBILITY · PDF file7664 / southern district health board feasibility study ... reviewed by project architect ... 7664 / southern district health