Every hospital faces unique challenges, and there’s no single design solution for any specific hospital. However, there are common elements and departmental relationships that should be maintained at most hospitals. Our healthcare team has to have a developed understanding of a hospital's key departments to effectively plan and design an efficient and patient-friendly environment. We stay up-to-date on trends, as well as developments in technologies, including procedures, in the healthcare field.
In this blog, I’ll focus on planning a surgery department in a hospital. With that in mind, Design Collaborative’s mission – to improve people’s worlds – is the first thing our healthcare team would think about when we begin designing. To achieve our mission, we focus on how we can:
Reduce stress for patients, family, and staff
Maximize Infection Prevention
Promote efficient and timely care
Accommodate current and future technology and procedures
Provide a healthy environment
This diagram illustrates the key departments in a hospital, the primary and secondary relationships that each department has to each other, as well as key entry points for patients. Using this diagram, it’s easy to see how each department is positioned in relationship to others.
For a typical surgery department, you’ll need access for both inpatients and ambulatory outpatients. It’s desirable to have a separate discharge or exit point for outpatients to allow them more privacy as they leave post-procedure. Key amenities that should be available to patients and family in the surgery department include food service, consultation rooms, restrooms, and the chapel, among other spaces. Departments should be located and designed to prevent non-related public and staff foot traffic. Additionally, space should be planned to allow for future growth. Typically, this isn’t a centrally located department because you need space to potentially expand and add-on.
Rules of Thumb for Programming a Surgery Department
The main source of information for designing hospital spaces is programming data, referred to as the Rules of Thumb. This is the history or projected average annual cases the department experiences. With that in mind, a hospital would typically provide our team with this information. These numbers are also broken down by the type of cases, such as orthopedics, cardiology, and endoscopy, among other.
Let’s suppose a hospital sees 4,000 cases annually. The healthcare team uses the standard that each operating room has the capacity to handle 700 to 1,000 cases annually. This means this hospital would need 4 operating rooms. Each operating room and its individual support spaces will require between 2,800 to 3,500 gross square feet. In this example, the 4 required operating rooms would mean the department will be roughly 11,200 to 14,000 gross square feet.
Within a surgery department, there are many zones. There are 3 distinct zones: unrestricted, semi-restricted, and restricted. An unrestricted zone is a waiting room or reception area where you can wear your street clothes and patient and visitor traffic is not limited. A semi-restricted zone includes the quarters that lead to the restricted areas, as well as sterile storage, surgical prep sinks, areas for processing surgical instruments, and storage for surgical attire. Traffic in these areas is limited to staff and patients in surgical attire. The restricted zones are operating rooms, procedure rooms, and if included the clean core, which is a centrally located sterile zone located between surgical rooms. Surgical attire, including masks, is required in a restricted zone.
These zones are established to maintain asepsis control, which is the absence of bacteria, viruses, and other microorganisms. When you enter the hospital, you shouldn’t ever leave with a hospital acquired infection (HAI). Departments are specifically designed to minimize the risk of HAIs.
Key Areas for Patients
Within the department, there are three key areas for patients: pre- and post-operative patient care area, operating rooms, and post-anesthesia care units. Each of these require specific planning and criteria. Each needs different amounts of gross square footage for clearances around beds, stretching, and operating tables, among others. This is for the safety of both the patients and staff. Measures are planned in each area for patient privacy, as well. Operating rooms are unique because they require an extremely controlled environment, including temperature, air pressure, provisions for equipment, and structural requirements for ceiling-mounted equipment.
It’s the job of the healthcare team to work with hospitals to make them as safe and efficient as possible while providing a pleasant patient and staff experience. We recognize that what happens in hospitals can be stressful for patients and staff, and we work to improve the worlds of each person that steps inside the surgery departments we plan and design.
Bill Ledger AIA, ACHA, NCARB, EDAC, LEED AP