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APPENDIX 3A

CLINICAL SPECIFICATIONS AND FUNCTIONAL SPACE REQUIREMENTS

1 Interior Heart and Surgical Centre – Appendix 3A – June 2012

Interior Heart and Surgical Centre

Kelowna General Hospital

Appendix 3A

CLINICAL SPECIFICATION

KELOWNA GENERAL HOSPITAL

INTERIOR HEART AND SURGICAL CENTRE


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TABLE OF CONTENTS

1. DEFINITIONS: 4

2. BACKGROUND AND SCOPE 4

3. DESIGN CONCEPTS 5

4. BUILDING STACKING AND ORGANIZATION 5

4.2 SURGICAL FLOOR 5

4.3 MDR & PRE-OP/STG II RECOVERY 5

4.4 INTERNAL CIRCULATION AND LINKS 6

4.5 LOGISTICS AND SUPPORT SERVICES 6

4.6 FUTURE PATIENT FLOOR BEDS 6

5. EVIDENCE BASED DESIGN 7

5.2 ENHANCED PATIENT SAFETY 7

5.3 INFECTION CONTROL AND HOSPITAL AQUIRED INFECTIONS 8

5.4 EFFICIENT TRANSPORTATION AND CIRCULATION 9

5.5 SERVICE POPULATION 9

5.6 OPTMIZE CLINICAL UTILIZATION 10

5.7 ENHANCED ENVIRONMENTAL QUALITY 11

5.8 NATURAL LIGHT 12

5.9 DISTRACTION FREE ENVIRONMENT 13

5.10 EXTERIOR COURTYARD 13

6. FUNCTIONAL COMPONENTS 14

6.2 SURGICAL PROGRAM 14

6.3 ACTIVITY INDICATORS 15

6.4 SURGERY DEPARTMENTAL ADJACENCIES 17

6.5 DESIGN PRIORITIES 17

6.6 KEY DESIGN FEATURES 19

6.7 SURGERY STANDARDIZATION 22

6.8 PROCESS FLOW DIAGRAMS 24

6.9 CONCEPT DIAGRAMS AND INTRA-DEPARTMENTAL ADJACENCIES 34

6.10 CARDIAC SURGICAL INTENSIVE CARE UNIT 41

6.11 MEDICAL DEVICE REPROCESSING 48


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6.12 DESIGN PRIORITIES 52

6.13 KEY DESIGN FEATURES 52

6.14 STANDARDIZATION 53

6.15 DECONTAMINATION SINKS 53

6.16 ASSEMBLY WORKSTATIONS 55

6.17 PROCESS FLOW DIAGRAM 55

6.18 CONCEPT DIAGRAM 59

6.19 STAFF AND ADMINISTRATIVE SPACES 62

7. FUNCTIONAL SPACE REQUIREMENTS 65

8. REFERENCES 72


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PART 1. DEFINITIONS:

“Adjacent” means two directly adjoining spaces;

“Convenient” means that the item fits well with a person’s needs, activities, and plans. Especially

concerning clinical activities, operations and LEAN processes;

“Convenient Route” means a path of travel that follows LEAN principals, is appropriate and serves the

needs of the traveler;

“Direct Access” means a connection that is appropriate for its intended purpose;

“Direct Route” means a patient corridor path which is as short and straight as possible;

“Families” means persons that may be Significant Others and the Public in general, a group consisting

of parents and children living together in a household and a group of people related to one another by

blood or marriage;

“Internal Route” means an interior patient corridor connecting two spaces or departments;

“Non-restricted Corridor” means a corridor open to all public, patients, staff and services;

“Restricted Corridor” means a means a corridor that is limited to specific staff, patients and materials.

“Bypass Corridor” means a corridor that is not within a department that connects the Centennial Link to

the Strathcona Link. The Bypass corridor is for staff and patient use only. Level 1, north Strathcona

corridor is a public/mixeduse corridor and the Level 1, south Strathcona corridor is mainly a staff and

logistics corridor.

“Surgical Restricted Corridor” means the corridor within the surgical suite (often called surgical race-

track) that is restricted to surgical staff and patients. This corridor is identified from all entrances into the

Surgical Restricted Corridor by the “red line”.

PART 2. BACKGROUND AND SCOPE:

2.1 Appendix 3A is the Clinical Specification. Its purpose is to describe and outline the key needs

and building design attributes required by the Authority to successfully implement clinical

operations and achieve their desired model of care. The document describes both big picture

concepts and detailed specific clinical needs. It includes numerous data that will directly and

indirectly influence design decisions. Appendix 3A includes the Functional Space

Requirements, which outline the rooms that are required to be provided in the Building.

2.2 The Building consists of the following perioperative and clinical departments:

2.2.1 Surgical Procedures (Standard OR’s and Specialty OR’s)

2.2.2 Pre Op & Level II Recovery

2.2.3 Post Anesthesia Recovery Room (PARR)

2.2.4 Cardiac Surgical Intensive Care Unit (CSICU)

2.2.5 Medical Device Reprocessing (MDR)


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PART 3. DESIGN CONCEPTS:

3.1 This section of the document describes major design concepts related to the needs of

patients, staff, and visitors, which impact both specific groups of functional components or

the IHSC as a whole.

3.1.1 It is not the intention of this section to suggest physical planning solutions, but rather to

identify the functional requirements for planning that will assist the proponent Design Team

and User Groups to develop the most appropriate environment for people and systems as

design work proceeds.

3.1.2 The Authority will be consulted throughout the design and development of the IHSC through

the User Consultation Process as described in Schedule 2 Design and Construction

Protocols.

PART 4. BUILDING STACKING AND ORGANIZATION:

4.1 In order to understand the preferences and needs of the Authority what follows is a

description of concepts for the building stacking and general space organization.

4.2 SURGICAL FLOOR:

4.2.1 The surgical platform, including the Operating Rooms, CSICU and PARR, will be located on

the second floor. This will facilitate direct and level access to both the existing ICU in the

Royal Building as well as the adjacent cardiac services on the second floor of Strathcona.

The 2nd floor link to Strathcona will also be a vital route for transport of emergency c-section

patients from the 3rd floor maternity unit in Strathcona to the IHSC OR's and must be as

direct as possible. In the future, the second floor of Strathcona will include a Cardiac

Inpatient unit and a Coronary Care Unit. Ensure that the second and third floors have a

bypass corridor allowing circulation through the IHSC without entering into or passing

through any department.

4.3 MDR & PRE-OP/STAGE II RECOVERY:

4.3.1 Pre-Op/Stage II Recovery will be located on the first floor.

4.3.2 RESERVED

4.3.3 The MDR is to be placed on the third floor. Sterile supplies will be delivered down to surgery

on the second floor and across the link to the Centennial ORs on level 3. A group of three

service/patient elevators must serve the Pre-Op/Stage II Recovery and all other floors. The

fourth service elevator must be located in such a way as to eliminate potential traffic conflict

of logistics crossing the main public IHSC corridor. This service elevator could also carry

patients and must also serve all floors. The Pre-Op department will be located on the first

floor. Placing the Pre-Op on the first floor has excellent advantages for patient wayfinding and

shorter travel distances.


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4.4 INTERNAL CIRCULATION AND LINKS:

4.4.1 Centennial Links:

4.4.1.1 From the Centennial building a physical circulation connection will be required on

the first, second, and third floors of the new IHSC building. The Level one

connection will be a public, 24-hour thoroughfare and will be a primary public route

from parking into the campus. The link on the second and third floor will connect

into the pre-defined Centennial connection locations. The Level two link completes

a restricted access ring of circulation, which is already established between the

Strathcona, Royal, and Centennial Buildings. The link on Level three will provide a

transportation route between the IHSC OR's, the Centennial ORs and associated

support services.

4.4.2 Strathcona Links:

4.4.2.1 The IHSC will be connected to the existing Strathcona building on the Ground Floor

and on levels two, and three. The ground floor connection provides servicing from

the Strathcona loading docks. The Level two link is an essential connection

between the OR’s and the inpatient floor in the Strathcona Building, as well as

between the CSICU and the future Coronary Care Unit. These links also facilitate

the movement of maternity patients to the IHSC surgical suite for emergency C-

Sections.

4.4.3 Vertical Links:

4.4.3.1 Elevators will be centrally located for staff and patient movement including

transporting Centennial patients. Service elevators will be located to allow ease of

access for material movement. Stairwells should be located so as to shorten staff

travel distance between critical departments such as the ORs and Pre-Op/Stage II

Recovery.

4.5 LOGISTICS AND SUPPORT SERVICES:

4.5.1 The IHSC will be serviced completely through the existing shipping and receiving area in the

Strathcona Building. Logistics will utilize the existing corridor for the transportation of

supplies, materials and waste. The IHSC service route will tie directly into the Strathcona

Building service corridor, where goods and materials will be transported vertically to various

floors. Laundry and Food Services are currently located along the Strathcona Building

service corridor. These services will support the IHSC by directly accessing its horizontal

and vertical service routes.

4.6 FUTURE PATIENT BED FLOOR:

4.6.1 The future floor or area is intended to be a 32 bed Medical/Surgical unit having a ratio 75:25

private to semi-private rooms, i.e., 24 private rooms and 4 semi-private rooms. The intent is

to provide a unit design based on the race track model with a minimum two team care


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station zones. The patient rooms are to be same handed with outboard washrooms. The

future floor must have access to the service and public elevators with the industry standard

component of support space. The unit must accommodate minimum 2,210 floor gross area

of space.

PART 5. EVIDENCE BASED DESIGN:

5.1.1 In every instance possible, the design shall be guided and influenced by using credible data

in a manner consistent with evidence based design principles to help reduce the undesirable

patient outcomes such as infections, falls, errors, anxiety and stress. EBD should be used

to strengthen the focus on patient safety and reduce staff injury and stres. The design must

emphasize features that have qualities and quantitative benefits to patients, families and

staff while reducing interior Health's operating costs.

5.2 ENHANCED PATIENT SAFETY:

5.2.1 Environmental design can reduce the potential for medical and surgical errors. It is well

documented that the highest rate of preventable adverse events occurs in surgical areas.

Other types of frequent errors include medication errors, clinical management and

diagnostic interventions. The most serious of these events results in fatal consequences.

The circumstances surrounding medical and surgical errors vary considerably but there are

predictable indicators of how and when they are most likely to occur. Examples of these

indicators are as follows:

5.2.1.1 Staff feel rushed or distracted. Solutions include making ease of access to patients

via vertical and horizontal routes as quick and convenient as possible and reducing

overall staff travel distances through an efficient arrangement of a program’s

functional components.

5.2.1.2 Non Standardized Rooms: Working in unfamiliar rooms may require extra

concentration. Solutions include standardization strategies that reduce the reliance

on short-term memory or allow staff to work within a space more efficiently by

laying out a space in the same way for each occurrence . Specific strategies and

rooms that require standardization are outlined in this document. Examples

include:

5.2.1.2(1) Standard OR’s (same handed).

5.2.1.2(2) Cardiac OR’s (same handed).

5.2.1.2(3) CSICU patient rooms (mirrored).

5.2.1.2(4) PARR Bays (same handed).

5.2.1.2(5) Pre/post op bays (same handed).

5.2.1.2(6) Medication rooms (same handed when located in same department).


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5.2.1.3 Although same handedness appears to be the “ideal” it can, in certain instances,

create work zone issues. Examples include decentralized care centers. Consult the

Authority on all work zone standardization concepts.

5.2.1.4 Research suggests that healthcare environment standardization could substantially

affect patient risk factors. Errors in healthcare are often the consequences of

organizational factors or latent environmental conditions. The standardization of

spaces and room design, from the location of the outlets, to bed controls, to the

location of latex gloves, all have an impact on human behaviour and patient risk.

5.2.1.5 Provide clear sightlines to decentralized care stations and patient beds. Sightlines

allow staff to monitor patients and to support other staff members without leaving

the care stations or abandoning a task.

5.2.1.6 Provide appropriate task lighting to reduce medication-related errors in medications

rooms, to allow staff to read labels and prescriptions more easily. In areas such as

care stations, staff will be able to adjust the lighting levels in their work space.

Provide the ability to modify lighting levels in patient rooms to accommodate both

patient and staff needs during different times of the day.

5.2.2 The medication rooms shall be centrally located and convenient for quick staff access.

Research suggests that a fully enclosed medication room creates a distraction free

environment and reduces medical errors. All medication rooms are to be fully enclosed

unless otherwise directed by the Authority. However, there are instances where key patient

site lines may be blocked by full height walls. This may occur in the PARR and CSICU

departments. Maintain a direct line of sight from the Team Care Station to centrally located

medication rooms in these two departments through the use of large windows and automatic

sliding glass doors into the medication rooms.

5.3 INFECTION CONTROL AND HOSPITAL AQUIRED INFECTIONS:

5.3.1 The physical design of a hospital is an essential component of its infection control measures.

The design can help minimize the risk of infection and transmission of infectious disease. It

is important to consider a holistic view of the design as it relates to the hospital’s overall

infection control strategy. A consolidated design strategy which is multipronged is essential.

These include human behaviour, typical work processes, material selection and

housekeeping techniques.

5.3.2 Patients requiring surgical interventions are at a higher risk than other patient populations of

experiencing an adverse event such as acquiring hospital acquired infections (HAI). Each

HAI instance embodies a substantial organizational effort and financial burden. HAI have a

significant emotional and physical impact to the patient as well. It is critical to the Authority

that great care be given to crafting a design that contributes to a reduction in HAI’s by

facilitating best practice in all areas but especially MDR and Surgical Suite. Strategies

Include:

5.3.2.1 Optimal air quality for both negative or positive pressure areas.


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5.3.2.2 Optimal water quality.

5.3.2.3 Emphasis on separate public/patient/staff and materials flows.

5.3.2.4 Distinct decontamination/clean and sterile zones in MDR.

5.3.2.5 Sufficient number of and key locations of hand washing sinks and hand sanitizer

stations.

5.3.2.6 Easy to clean interior finishes such as; floor, wall and furniture coverings.

5.3.3 Studies have found that hand washing is one of the most important practices to control

hospital acquired infections. Multiple considerations are important to foster a culture of hand

hygiene. Handwashing compliance is often a behavioural issue which can be influenced by

the location and number of handwash sinks provided. The standardization of the sink and its

supplies (i.e. organization and layout) also significantly contributes to hygiene compliance.

Access to examination gloves, alcohol-based hand-sanitizers and trash receptacles is also

important. The design must allow hand hygiene stations to be arranged within zones of work

in ways that contribute to and accommodate staff work flow. Final placement of all hand

hygiene stations/pumps will be in consultation with the Authority.

5.4 EFFICIENT TRANSPORATION AND CIRCULATION:

5.4.1 Physical design can reduce travel distances by creating efficient circulation routes to be

used by both staff and for transporting critically ill patients. Certain surgical interventions

(e.g., open heart surgery and neurosurgery) place patients at a particularly high risk post-

surgery during patient transport. Additionally, these patients may be accompanied during

transport by a large number of staff and pieces of equipment. This is particularly the case

with cardiac surgery patients being transported to the CSICU. This group of staff and

equipment can be as large as 7’ wide by 14’ feet long and is often referred to as a “Convoy”.

It is essential that the route the convoy follows be designed to reduce travel distance,

corners or any points of constriction such as reduced doorway openings. Provide soft

corners for any corridor corners necessary along the convoy route. Additionally, provide soft

corners for corridor corners along the patient route between the OR’s and PARR.

5.4.2 Anaesthesiologists frequently travel to PARR and Pre-Op for almost every patient. This path

of travel should be as convenient and short as possible.

5.5 SERVICE POPULATION:

5.5.1 The Kelowna General Hospital service area includes a high population of resident seniors.

Their needs and challenges must be considered and ameliorated through the design where

appropriate and possible, including but not limited to:

5.5.1.1 Compromised mobility.

5.5.1.2 Decreased strength and stamina.

5.5.1.3 Decreased visual acuity.


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5.5.1.4 Reduced hearing acuity or heightened auditory sensitivity.

5.5.1.5 Narrowed temperature comfort zones.

5.5.1.6 Developmental, cognitive and linguistic needs.

5.5.1.7 Inability to process or protect oneself from environmental stimuli, light, noise and

movement.

5.5.1.8 These same needs and challenges also impact the disabled and ill populations KGH

serves.

5.5.2 A smaller percentage of patients will be paediatric. However there are paediatric friendly

spaces (rooms that can be closed off) in both Patient areas such as the Pre/post op area

and the OR patient holding area and public spaces such as the courtyard and waiting

rooms. Paediatric friendly design elements should reflect the importance of social and

private space for play and family time. Social spaces such as waiting and lobby areas are

located near patient areas and family zones. The design will combine comforting finishes

and positive distractions. Calming interiors and access to daylight, views, and nature are

important elements of a healing environment that must be incorporated into the design.

When sizing the building elements, the scale of these elements must be considered form the

perspective of a child; "human-scale" approach must recognize the view point of a smaller

human being. Oversized architectural features or large unbroken masses that could be

intimidating to a child must be avoided. The design solution for these considerations varies

considerably and as such details will be developed in consultation with the Authority through

the User Consultation Process as described in Schedule 2 Design and Construction

Protocols.

5.6 OPTIMIZE CLINICAL UTILIZATION:

5.6.1 The operational efficiency and effectiveness of caregivers in a hospital are greatly influenced

by the facility’s physical design. A hospital is a very labour-intensive institution requiring

considerable movement of materials, staff, patients and visitors. The planning and design

process must result in a physical plan and the organization of components that will minimize

operating costs and maximize the quality of service. Design features that positively impact

OR efficiency and turn over time are highly valued. Include the following design features:

5.6.1.1 Utilize existing process flow maps (including but not limited to flow of the patients,

families, stretcher/beds, medication, equipment/instrumentation, supplies/materials,

communication, patient belongings, patient chart/information) and lean principals

when designing spaces that will impact work flow.

5.6.1.2 Organize the surgical suite to positively impact operating room turn over between

cases.

5.6.1.3 Organize the surgical suite such that equipment is readily available in a protected

equipment alcove.


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5.6.1.4 Organize surgical supplies within the sterile core such that they are readily

available.

5.6.1.5 Location of key support spaces to ensure efficiency of movement of supplies and

materials throughout the new facility and the rest of the campus to reduce the use

of elevators and to optimize distribution, example of rooms such as medication

rooms, housekeeping, soiled utility and the satellite lab.

5.6.1.6 Allow direct visual supervision of patients in PARR from the care station.

5.6.1.7 Allow direct visual supervision of the decentralized nurse stations in CSICU from the

care station.

5.6.1.8 Integrate ergonomic principles throughout the design as outlined in Appendix K.

Alleviate the need for staff to experience awkward postures, forceful exertions,

contact stress, cognitive distraction and increased fatigue.

5.7 ENHANCED ENVIRONMENAL QUALITY:

5.7.1 All design strategies should be considered within the context of improving and enhancing

patient care and thereby reinforcing the reality that Kelowna General Hospital is a

humanistic and caring environment. Every effort should be made to make the hospital stay

as comfortable, and stress-free as possible. It is therefore highly valued to have the

following incorporated into the IHSC building design:

5.7.1.1 Enhancing patient and family control and independence by incorporating the

following: communication systems like smart boards in family waiting rooms,

patient control over their immediate environment (controlled by pillow speaker type

device), clear visual cues to orient patients and families such as building elements,

daylight, colour, texture, patterns, artwork and signage and storage

areas/containers for patient belongings that are conveniently located for patients,

families and staff.

5.7.1.2 Ensuring that patient privacy is optimized throughout the IHSC with additional

emphasis on CSICU rooms, pre/post op bays and washrooms.

5.7.1.3 Ensuring that staff privacy is optimized throughout the IHSC, e.g., in staff change

rooms

5.7.1.4 Recognizing the importance of families to the health and well-being of patients by

incorporating calm and healing environmental features into the family waiting

areas. Within waiting areas provide features which enable family members to hang

their coats, use a personal computer and/or read, etc.

5.7.1.5 Using familiar and culturally relevant materials wherever consistent with other

functional needs. Family zones in patient rooms must be positioned clearly outside

of the staff/patient zone. These family zones have furniture that allows for

lounging, reading or working with a laptop.


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5.7.1.6 Using cheerful and varied colors and textures, keeping in mind that some colors are

inappropriate and can interfere with care provider assessments of patients’ pallor

and skin tones, disorient older or impaired patients, or agitate patients and staff.

Avoid the use of yellow or greens in patient assessment/treatment areas/rooms

5.7.1.7 Healing elements such as artwork and sculpture can be positively correlated with

reduced patient and staff stress levels, incorporate artwork throughout the facility

that is relevant to the patient, families and communities served. The Authority will

be responsible for the purchase of all artwork in the Facility.

5.8 NATURAL LIGHT:

5.8.1 Research suggests that the psychological effects of natural light have a substantial impact

on patient, visitor and staff wellbeing. Spatial disorientation is reduced by windows as people

orient themselves with landmarks and directional views. Views of the exterior and natural

light should be provided from/to all patient care areas and staff work areas wherever

possible. The design will place patient and staff areas in locations that maximize daylight

opportunities, including use of light wells and tubes. Exterior window sizes and

configurations shall provide access to natural light while maintaining patient privacy and

acoustical requirements. Where ever possible major circulation corridors should have

natural light ‘nodes’ at their end points and ‘borrowed’ light from teh exterior building to the

internal hallways. These specific areas are listed in priority to have direct or indirect natural

light within the IHSC:

5.8.1.1 CSICU patient rooms – direct light in all 8 rooms.

5.8.1.2 Surgical and MDR staff lounge - direct.

5.8.1.3 Family waiting areas: Surgical and Discharge waiting to have direct natural light. It

is ideal to for all waiting room to receive direct natural daylight and have views of

the outdoors. If these rooms are positioned internally, light wells or light tubes are

recommended.

5.8.1.4 Pre/post OP patient bays - Direct natural light into 24 stretcher bays and indirect

natural light into 26 stretcher bays including use of light tubes.

5.8.1.5 MDR work zones

5.8.1.5(1) Decontamination Zone – direct natural light.

5.8.1.5(2) Clean Zone – indirect via skylights.

5.8.1.5(3) Sterile Zone – indirect via skylight and adjacent exterior windows..

5.8.1.6 PARR patient bays – direct natural light into 10 stretcher bays and indirect natural

light into 12 stretcher bays, 2 of which will be provided through a light tube

5.8.1.7 Sterile Core – indirect.


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5.8.1.8 MDR Staff Lounge - direct natural light

5.8.1.9 CSICU Care Station - indirect via light tube

5.8.1.10 PARR Care Station – indirect

5.8.1.11 Pre-Op Care Station 1- indirect via light tube

5.8.1.12 CSICU Central Care Station: Provide borrowed light via a light tube

5.8.1.13 PARR Care Station: Provide borrowed light via a light tube.

5.8.2 Research strongly suggests that patients with an exterior view to nature have positive reactions

to a variety of health metrics such as length of stay in hospitals and perceptions of pain.

5.9 DISTRACTION FREE ENVIRONMENT:

5.9.1 Noise and work place distraction is increasingly a serious threat to patient safety and staff

performance. Research suggests that noise interferes with communication, creates

distractions, affects cognitive performance and concentration, causes annoyance, and

contributes to stress and staff fatigue. Mental activities involving a demand on working

memory are particularly sensitive to noise and can result in degradation of performance.

Noise may elevate blood pressure, increase pain, alter quality of sleep, and reduce overall

perceived patient well-being Noise has also been found to negatively affect both staff and

patient’s feelings of satisfaction. Every effort should be made to create a noise and

distraction free environment. Strategies for creating distraction free environments include,

but are not limited to, deflection resistant materials, insulation between rooms, sound

absorbent ceiling tiles, quiet mechanical systems and quiet equipment and technology.

Acoustically rated walls that meet established performance criteria, fully enclosed

medication rooms (with glazing), on-call rooms located in a quiet, staff only space in the

building allowing staff to relax and sleep, use of wood acoustic panels in public areas, and

sound and vibration isolation of building service noises and building services rooms.

5.10 EXTERIOR COURTYARD:

5.10.1 The exterior courtyard is intended to foster clinical healing and staff restoration. As such, it

will be open to the public and staff. It shall be designed to comply with the ideas and

concepts around Healing Gardens and/or Therapeutic Gardens. The elements of a Healing

Garden shall be as follows but not limited to:

5.10.1.1 Plants, Flowers, Shrubs, Livings Walls, Vines, Trees, etc.

5.10.1.2 Winding Paved Walking Paths.

5.10.1.3 Seating with Tables, Chairs and Benches.

5.10.1.4 Landscape Lighting suitable for night usage.

5.10.1.5 Raised plant beds creating multiple planes and dimensions of interest.

5.10.1.6 A variety of soils, rocks, pavers, suitable for hospital patients and staff.


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5.10.1.7 Areas of shade and sunlight.

5.10.1.8 Art and sculpture that is integrated into the landscape design.

5.10.1.9 Gazebos or Pergolas.

5.10.1.10 Soothing Water features.

PART 6. FUNCTIONAL COMPONENTS:

6.1 The clinical departments within the IHSC building which are listed below:

6.1.1 Surgical Services Suite:

6.1.1.1 Surgical Procedures Area

6.1.1.2 PARR

6.1.1.3 Pre-Op / Level II Recovery

6.1.2 Cardiac Surgical Intensive Care Unit

6.1.3 Medical Device Reprocessing

6.1.4 Staff and Administrative Areas

6.2 Surgical Program:

6.2.1 KGH currently provides a full range of surgical services The following program-based

subspecialties will be included within the IHSC building:

6.2.1.1 Gynecology/obstetrics

6.2.1.2 Neurosurgery

6.2.1.3 Orthopedics

6.2.1.4 Dental/maxillo-facial surgery

6.2.1.5 General surgery

6.2.1.6 Ophthalmology

6.2.1.7 Otolaryngology (ENT)

6.2.1.8 Plastics

6.2.1.9 Thoracic surgery

6.2.1.10 Urology


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6.2.1.11 Vascular surgery

6.2.1.12 Cardiac Open-Heart Surgery.

6.2.1.13 Percutaneous valvuloplasty

6.2.1.14 Cardiac biopsy

6.2.1.15 Intra-aortic balloon pump insertions

6.2.1.16 Percutaneous transluminal coronary angioplasty (PTCA)

6.2.1.17 Coronary stents

6.2.2 Ophthalmology procedures are conducted within the Eye Care Centre in the Centennial

Building,

6.2.3 KGH has taken on a tertiary role in some surgical specialties such as neurosurgery, thoracic

and plastics, and regularly has referrals for other areas such as ophthalmology,

otolaryngology, vascular and general surgery.

6.2.4 The Surgical Procedures Area will provide facilities for the performance and support of all

scheduled inpatient and unscheduled emergency surgical procedures including preoperative

holding and immediate post-anaesthesia recovery. All procedures requiring general and

regional anesthetic will be performed in this Suite, all procedures requiring general and

regional anaesthetic will be performed in this suite.”

6.2.5 Surgical procedures performed in the Surgical Procedures Area will be classified as either

General Procedures or Special Procedures. General procedures will use basic operating

room configurations with specialized equipment incorporated for specific users. Special

Procedures will be provided with dedicated operating rooms, equipment, environmental

controls and support facilities necessary for the performance of a definitive range of types of

procedures included in that specialty.

6.3 ACTIVITY INDICATORS:

6.3.1 For various topics the activity indicators summarize the current and future state that is to

inform the design. These estimates are to be used when designing in consultation with the

Authority.

Technology Current 2016/17

Patient Tracking manual Picis Smart Track

OR Manager

Picis - data, OR electronic

charts, booking, slate

development, software

Picis OR Manager software


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Wireless Communication In Centennial and East

Pandosy

In Centennial, East

Pandosy and IHSC

Clinical Camera Currently none exist on

campus

One camera in each OR to

be monitored at several

locations: IHSC control

desk, PARR and other

Pre-Surgical Admission manual Picis Preoperative manager

software program

Instrument Tracking (MDR) manual Computer based system –

provincial standard(that was

established in 2011/12)

Hours of Operation 2009/10 2016/17

OR’s

Standard

Cardiac

Trauma / Emergency

07:30–15:30

24 hr

07:30-15:30

07:30-15:30

24 hr

PARR 24 hr 24 hr

Pre/post Op 24 hr 24 hr

CSICU - 24 hr

Staffing Levels 2011

(not including

cardiac)

2016 (including

2 cardiac OR

and 6 other

IHSC OR’s)

2030

(all 15 OR’s

open)

OR – RN/LPN ( full or part time) 71 82 129

OR - Physicians 80 84 133

CSICU 28 37*

Cardiac Nursing Practitioners 3

PARR – RN 35 35 58

Pre/post Op 18 18 32

Anaesthesia Assistant /

Respiratory

3 6

Perfusionist 5 5

OR Housekeepers 6 8 15

*due to 2 additional CISCU beds opening

Volumes 2009/10 2016/17 2030

# of overall surgical

procedures

15,900 15,900 19,500

# of open heart surgeries 155 630 630


17



6.4 SURGERY DEPARTMENTAL ADJACENCIES:

Department Adjacency Description

Cardiac OR’s to CSICU Direct route for movement of critically ill post cardiac surgery

patients, equipment and staff convoys.

Surgery to PARR Direct route and adjacent access for movement of critically ill

post surgery patients, equipment and staff convoys .

Pre-Op and Level II Recovery to

Surgery

Direct access and convenient route (vertical access route)

MDR to Surgery Direct access to sterile core and soiled utility room via

separate clean and soiled elevators: direct access to sterile

core via stairs

Emergency to Surgery Internal route for movement of critically ill patients.

Maternal Child Program (Birthing Area)

to Surgery

Internal route for selected c-sections.

Surgery to Intensive Care Units Internal route for movement of critically ill patients.

Surgery to Inpatient Units Internal route for patient movement.

Diagnostic Imaging to Surgery Internal route for movement of patients.

Laboratory to Surgery Direct access via pneumatic tube.

6.5 DESIGN PRIORITIES:

6.5.1 Through a series of user group meetings, the clinicians for various departments and

specialties have produced a list of clinical design priorities. These priorities are not exclusive

of other typical design features that may be necessary and desirable.. These priories were

deemed critical to the success of patient outcomes and staff efficiency. It is expected that

these priorities will be incorporated in the clinical design.

6.5.1.1 Surgical Suite Design Priorities:

6.5.1.1(1) Minimize travel distance from each OR to PARR refer to 6.7.2 Surgical

Specialty Organization.

6.5.1.1(2) Appropriate and convenient storage to accommodate the needs of

each OR (considering equipment needs of specialty OR’s).

6.5.1.1(3) Convenient access for staff to and from Pre-Op, PARR and staff

lounge. Access must be via restricted corridors or restricted stairwells.

6.5.1.1(4) Optimized layout/configuration of Standard, Cardiac, Hybrid, Urology,

and specialty OR’s.


18



6.5.1.1(5) Clean MDR elevator central to all OR’s; soiled MDR elevator

conveniently located , i.e.,locate soiled MDR elevator close to OR’s

which generate most soiled equipment.

6.5.1.1(6) Inpatient Holding Area effectively placed and accessible for use as

PARR overflow.

6.5.1.1(7) Natural Daylight is highly desirable to as many staff areas as possible.

6.5.1.1(8) Control desk visibility of all incoming patients and the Inpatient Holding

Area.

6.5.1.1(9) A minimum width of 2600 mm must be provided within the Sterile Core

between the OR Sterile Core door and any wall/fixed object across

from this door. This will allow adequate space to store and safely

maneuver carts into each OR from within the Sterile Core.

6.5.1.2 Cardiac Surgery Design Priorities:

6.5.1.2(1) Shortest Length of Travel from Cardiac OR’s to CSICU Patient Rooms.

6.5.1.2(2) Storage – Optimize and evenly distributed for each OR.

6.5.1.2(3) Configuration of the Cardiac OR and Hybrid OR.

6.5.1.2(4) CSICU is close to Strathcona CCU.

6.5.1.3 Pre-Op & Level II Recovery Design Priorities:

6.5.1.3(1) Quick and convenient access to and from OR and PARR.

6.5.1.3(2) Easy access to support spaces such as medication room, clean

supply, soiled utility, patient belonging storage and equipment storage.

6.5.1.3(3) Visibility of patients from main Team Care Station to the decentralized

nurse stations.

6.5.1.3(4) Natural daylight on Unit.

6.5.1.3(5) Optimize Storage; conveniently located close to point of use, ease of

access and retrieval, ability to house the size, shape and quantity of

equipment.

6.5.1.3(6) Close proximity of patient washrooms to patient bays.

6.5.1.3(7) Staff washrooms to be conveniently located in the work zones

6.5.1.3(8) The Discharge Seating Area is to have direct views of the IHSC vehicle

pick-up area.

6.5.1.3(9) Surgical Waiting Area, Room Code 104, must be located within the

Pre-Op and Level II Recovery Area and located adjacent to the front

entrance of this department.

6.5.1.3(10) The Pre-Op & Stage II Recovery Area shall have a staff and logistics

entrance that is separate from the patient entrance. This entrance shall

be a min of 2400 mm wide to accommodate carts and bins. The staff


19



and logistics entrance must have controlled access and door will be

auto opening.”

6.5.1.4 PARR Priorities:

6.5.1.4(1) Direct line of site from team care station to patient head in each PARR

bay.

6.5.1.4(2) Minimize travel distance from each OR to each PARR bay.

6.5.1.4(3) Natural Daylight on Unit.

6.5.1.4(4) The Inpatient Holding Area effectively placed and accessible for use as

PARR overflow.

6.5.1.4(5) Optimized storage for large amounts of equipment (monitors,

ventilators, infusion pumps, PCA’s, etc).

6.5.1.4(6) Easy access to support spaces such as medication room, clean

supply, soiled utility and equipment storage

6.5.1.4(7) Staff washrooms to be conveniently located in the work zones

6.6 KEY DESIGN FEATURES:

6.6.1 This section outlines specific design concepts related to the surgical suite that have been

identified by staff as having a design requirement or specific needs associated with

operations.

6.6.1.1 Corridor Circulation:

6.6.1.1(1) Provide a Surgical Restricted Corridor around OR suite. The Surgical

Restricted Corridor shall be directly accessible to the Staff Lounge. It is

acceptable for the Staff Lounge to access the Surgical Restricted

Corridor by controlled access stair (red line at stair).

6.6.1.1(2) Provide one sterile core. A split sterile core (maximum of two areas) is

an acceptable trade off in certain design situations through the User

Group Consultation Process. Project Co must receive prior approval

from the Authority.

6.6.1.1(3) Patients not going to PARR or CSICU must have direct access from

the OR racetrack corridor system by way of the surgical control desk

en route to the service elevators.

6.6.1.1(4) Soft chamfered corners (45 degree soft corners) should be

incorporated into all high traffic corridors (specifically stretcher/bed

transport routes).

6.6.1.1(5) It is desirable to have equipment storage outside each O.R. in a

protective equipment alcove, the depth of the alcove must be adequate


20



to house and manoeuvre the equipment in and out of the alcove

safely.

6.6.1.1(6) The Inpatient Holding Area must be directly adjacent to the PARR.

6.6.1.1(7) Ensure that the Biomedical & Anaesthetic Workroom is accessible

from both the surgical restricted and by-pass corridor.

6.6.1.1(8) Satellite Lab is accessible from both the surgical restricted and by-pass

corridor.

6.6.1.1(9) The Urology operating room is to have direct access from both the

surgical restricted and by-pass corridor – no access to the sterile core

is required from this operating room.

6.6.1.2 Elevators and Stairs:

6.6.1.2(1) It is required to have a convenient stair directly connecting these key

areas (if they are located on different floors): the OR suite and Pre-Op,

PARR and Pre-Op, the OR suite and the staff lounge and the MDR

sterile zone and the sterile core in surgery.

6.6.1.2(2) Service elevators within the surgical suite must have dual access from

both sides (OR suite & bypass corridor) if the patient transport flow and

OR access is more efficient with dual access elevators.. The elevator

controls must prevent “pass through” from the bypass corridor into the

restricted surgical corridor.

6.6.1.2(3) Service elevators should be located close to PARR and the surgical

control desk.

6.6.1.3 Surgery Control Desk Adjacencies:

6.6.1.3(1) Surgery Control Desk needs to have visual oversight of the inpatient

holding area.

6.6.1.3(2) The PCC office must be adjacent to or integrated into the surgery

control desk.

6.6.1.3(3) The surgery Control Desk requires a control board.

6.6.1.3(4) The surgical Control Desk needs direct access into the surgery

restricted corridor as well as the by-pass corridor for staff access.

6.6.1.3(5) The surgery Control Desk must be located such that it can observe all

patients entering the surgical suite, including suite access and service

elevators.

6.6.1.4 Surgery Adjacencies within the OR suite:

6.6.1.4(1) Place the clean elevator centrally to all OR’s within the sterile core.


21



6.6.1.4(2) If the sterile core is split into two rooms, the clean elevator must serve

the side with the most OR’s.

6.6.1.4(3) The perfusion work room must be located between the two cardiac

OR’s. This room must have doors to both cardiac OR’s. This room

must also have access to the clean core and the restricted corridor

(four total doors).

6.6.1.4(4) Distribute the dictation bays throughout the OR suite.

6.6.1.4(5) Each entrance into the OR suite needs a “clean zone” with a clinical

handwash sink, a gowning zone, mirror, coat hooks, soap and paper

towel dispenser..

6.6.1.4(6) Distributed and convenient placement of staff washrooms. This can

impact staff efficiency and comfort.

6.6.1.4(7) Ensure that the medication room can be accessed from both the sterile

core and the restricted corridor.

6.6.1.5 PARR Adjacencies:

6.6.1.5(1) Direct line of site from the team care station to the patient head in each

PARR bay is required.

6.6.1.5(2) PARR and the Inpatient Holding Area should be directly adjacent with

a patient door connecting the two spaces. The concept of this

arrangement is to allow the Inpatient Holding Area to work as an

overflow for PARR.

6.6.1.5(3) A large, critical volume of patients comprise the movement from the OR’s

to PARR. Therefore, the adjacency arrangement between the ORs and

PARR is very important. It is desirable to arrange PARR so that it has a

direct and close travel distance to the OR’s. It is desirable to have more

than one entrance from the OR restricted corridor into PARR.

6.6.1.6 Operating Room Layout:

6.6.1.6(1) Scrub sinks need to be adjacent to each OR restricted corridor

entrance.

6.6.1.6(2) It is desirable to split the equipment storage into spaces located

directly outside each OR. It is critical that the Cardiac, Neuro and

Ortho OR’s have access to a large amount of closely-located

equipment storage.

6.6.1.6(3) Anaesthetists need efficient and short access routes from the OR suite

to Pre-Op and PARR.

6.6.1.7 Inpatient Holding Area Layout:


22



6.6.1.7(1) This area must be adjacent to the PARR and within visual site lines of

the surgery Control Desk

6.6.1.7(2) One bay in the inpatient holding must be dedicated as a blocking room

and double as the paediatric room when needed. This will enable the

Anaesthetists to prepare a patient’s block prior to transfer into an OR

which will assist to optimize OR room efficiency.

6.7 SURGERY STANDARDIZATION:

6.7.1 Standardization can take many forms. The exact nature and degree of standardization is to

be developed through the User Group Consultation Process as described in Schedule 2. In

each department the interior finishes, heights and locations following items are to be

standardized:

6.7.1.1 Headwall - Wall protection, gases, bumper rails, fixed equipment, monitor, light

fixtures and switch quantity and location, data/power quantity and location.

6.7.1.2 PARR - Width and length of the bay, Headwalls, fixed Equipment, Monitors, light

fixture and switch quantity and location, patient orientation (head at bed), patient lift

configuration, privacy curtain, data/power quantity and location.

6.7.1.3 PARR Isolation - Headwall, light fixture and switch quantity and location, fixed

equipment, patient orientation (head at bed), patient lift configuration, privacy

curtain, data/power quantity and location.

6.7.1.4 Operation Rooms - Width and length of room, room layout, fixed equipment (where

ever possible), nurse station/PACS, light fixture and switch quantity and location,

data, power quantity and location, gases, door size, windows, and colours and

patient orientation.

6.7.1.5 Cardiac Operating Rooms - Width and length of room, room layout, fixed equipment

(where ever possible), nurse station/PACS, light fixture and switch quantity and

location, data, power quantity and location, gases, door size, windows, and colors

and patient orientation.

6.7.1.6 Pre-Op bays - Headwall, light fixture and switch quantity and location, fixed



6.7.1.7 Pre-Op Isolation - Headwall, light fixture and switch quantity and location, fixed



6.7.1.8 Stretcher Alcove and Scrub Bays - The complete configuration should be identical.

6.7.1.9 Dictation Alcoves - Configuration, counter, light fixture, switching, acoustic.

6.7.1.10 Pneumatic Tube Stations - Configuration, adjacent countertop.

6.7.1.11 Standardize millwork where appropriate.

6.7.1.12 Standardize equipment placement in patient rooms, patient bays, OR, etc.


23



6.7.2 Surgical Specialty Organization:

6.7.2.1 Each OR will be designated to serve a surgical specialty. These specialties should

be grouped together and organized within the department for specific reasons. The

groupings and location rationale are listed below:

6.7.2.1(1) GROUP 1: Cardiac OR’s, Hybrid and Vascular

6.7.2.1(1)(a) As close to CSICU as possible (direct and short route)

6.7.2.1(1)(b) Similar stent usage and anesthesia assistant coverage

6.7.2.1(1)(c) Lots of storage needs for both unsterile and sterile

times

6.7.2.1(1)(d) Hybrid OR will be shared by Cardiac, Vascular Thorasic

and Trauma so needs be located close to Group 2.

6.7.2.1(1)(e) Vascular may require use of perfusion room

6.7.2.1(2) GROUP 2: General Surgery, Thoracic, Trauma, Open Urology

6.7.2.1(2)(a) Priority to locate near the Inpatient Holding Area and

entrance for transfer to ICU.

6.7.2.1(2)(b) Similar supply usage for MIS.

6.7.2.1(2)(c) Group 2 to be directly adjacent to Group 1.

6.7.2.1(3) GROUP 3: Neuro, Ortho, Obs/Gyne, Plastics

6.7.2.1(3)(a) Low turnover but directly adjacent to PARR due to

transportation risk.

6.7.2.1(3)(b) Due to large amount of soiled goods the Ortho OR

should be located in close proximity to the Soiled Utility

Room.

6.7.2.1(4) GROUP 4: Closed Urology, ENT, Dental/Eyes

Access to both surgical restricted and by-pass corridor is

required. This will allow this OR to be used for admitted

patients and for ambulatory patients. This OR is not to act as

a pass-thru from the by-pass corridor side to the restricted

surgery side.


24



6.8 PROCESS FLOW DIAGRAMS:

6.8.1 The Authority places great value on Principles of LEAN workflow and design. To the extent

possible in pre-design, KGH has developed operational strategies with which the new IHSC

will be managed. These plans include staffing models, goals, and the processes necessary

to manage the delivery of care in the new building. As part of this development a series of

process flow maps were produced. These maps illustrate the steps, processes and policies

that are to inform the design. Not all process within the new building were mapped. The

process flow diagrams that have been provided focus on the patient and how various

resources must be made available during the delivery of care for specific patient processes.

It is expected that the design will reflect these processes. The following process flow

diagrams have been included:

6.8.1.1 Perioperative Process

6.8.1.2 Surgical Room Turn

6.8.1.3 Same Day Cardiac Surgical Patient

6.8.1.4 Cardiac Surgery to CSICU

Interior Heart and Surgical Centre – Appendix 3A

Kelowna General Hospital Interior Heart and Surgical Centre

– June 201225

PERIOPERATIVE PROCESS

1

3

4

5

6 7

11

10

89

12



– June 201226

PRE-ADMIT PROCESSThe surgeon’s office generates an OR booking form for elective patients before they

arrive at the hospital. This is the same process used for CSICU patients.

1. SCENARIO ONE• Patient goes straight to Day Care Surgery and skips the main lobby

• Their paperwork is checked and the band is put on while the patient is on the

second floor

2. SCENARIO TWO• Once the patient comes through the door, he or she goes to the main lobby and is

guided to the reception area

3. WAITING AREA/DISCHARGE LOUNGE• People waiting for surgery and those leaving are in the waiting area.

• Privacy may be required if the receptionist is asking personal questions about patient

history

4. PRE-OP BAYS• Flow of patient belongings and patient bundles for same day admits (SDA) patients

and daycare patients will be defined through the User Consultation process

5. TRANSPORT TO OR• Prior to transport, must first confirm OR is available. A new patient is not called until

a patient is out of the OR

• A 3 minute advance warning is given before bringing patient

• Patient is given choice of stretcher or wheelchair

• Note: If the room is still being prepped for surgery, the waiting patient will be taken

to the holding bay and watched by a member of the surgical team

• Note: integrated central OR desk may be beneficial

6. POST-SURGERY• If the patient is a CSICU patient, he or she is taken to the CSICU

• If a bed is not available, placement is determined based on whether the patient had

anesthesia. If no, they can go back to the patient room. If yes and no ICU bed is

available, they go to PARR

7. IS BED AVAILABLE IN PAR?• May need flex staffing as needed if there are no openings in PARR

• Use technology to notify PARR of patient – electronic smart board

8. DAY CARE OR PATIENT ROOM• Electronic communication that reports multiple patients coming out from which

rooms and serves as central communication between OR, central desk and PARR

9. INPATIENT SURGICAL PATIENT• Surgical inpatient goes to OR holding area.

• Surgical inpatient already has IV started and most checks have been completed at

this point

• Consult will determine if stable

• Porter transports patient to holding area on stretcher

PERIOPERATIVE PROCESS (CONTINUED)



– June 201227

10. HOLDING ARE• Mark site of surgery

• Surgeon and anesthesiologist visit patient as close to surgery as possible

• Chart

• Anesthesia check

• Family member may be with patient (outside of restricted area)

11. GO TO OR• Same process as same-day once in OR

12. ED PATIENTS• Consult will determine if stable enough

• If stable, go to IP holding

• For unstable ED patient, keep patient in ED until first room is available in OR and bypass

IP holding

• Afterwards, patient will be in IP ward

PEDIATRIC PATIENTS• Pediatric same-day patients go to pediatrics first and then check into OR. If in an

area with bays, parents will accompany

• Process should be both child- and family-friendly

• There is potential to have more than 1 patient on the same day unless you could

control how many to bring in on one day.

• Need resource flexibility to staff peds (census varies)

• Possibility of having group of two to three 4-sided rooms between IP holding and

PARR that could be used for peds and adults. Peds patient could use the room in

the same way as inpatient holding and would be both pre- and post- for peds

FOR PEDIATRIC SURGICAL DAY-CAREFor pediatrics patient who is not an inpatient, follow scenario 1 or 2 to reception to wait

room to inpatient holding. Very rarely will peds same-day go directly to ICU

CANCELLATIONS CAN OCCUR AT ANY POINT.Reasons include: no bed, no time, bumped in, medical conditions, patient arrives sick,

patient ate, etc. It is possible to have a cancellation after patient changes clothes and

something is detected during check-up

PERIOPERATIVE PROCESS (CONTINUED)



– June 201228

SURGICAL ROOM TURN

OR Room Cleanby Environmental

Services

Dirty Equipment toCentral Sterile

Processing

Room Prepped forNext Case

Night Before Surgery

Room Preppedand Checked Room Ready Patient In Patient OutIs Anything

Missing?

Yes

Replace MissingInstrumentation

Day of Surgery

Check case cart Room readyNotify

EnvironmentalServices

1

2

3

4

1. NIGHT BEFORE SURGERY• If something missing, call perioperative to get it

• Anesthetic assistants come in and check the machine

2. DAY OF SURGERY • Another room check

• Use checklist before, during, and after

3. INFORMED DURING PATIENT-OUT PROCESS:• Environmental services notified at patient reversal

• Central desk

• MDR

• Perioperative bay

• PARR

• Porters

4. ROOM PREP AND SET-UP FOR NEXT CASE• Aides and nurses come back in and set-up again

• Note that instrumentation sets will be downstairs

CASE-SPECIFIC PROCESSES AND SUPPLIES NOTES• Possibility 1: Dedicate an OR to certain cases, and place equipment for those cases

immediately outside the room

• Possibility 2: Leave space in OR and make it flexible so case-specific carts can be

brought in

No cleaning of instruments occur on this floor. All dirty carts go downstairs



– June 201229

INTERVENTIONAL CARDIOLOGY PATIENT PATHWAY

Patient Registersat Central

Registration

CardiologyReception

Patient greetedand placed inholding bay

Interventionalcardiologist

evaluation andconsent

Roomavailable?

Hold in prep andwait for room to

become available

No

Walk patient tocath labYes Patient to table

Patient attached tomonitor, and site

prep by scrubnurse

Drape and set upinjection

equipment

Initiate case andupdate tracking

board

Diagnostic orInterventional?Do case DiagnosticIntervention

required?Disposition? NoAdmit

Discharge to home

Patient to holdingarea

Interventional

Do the caseYes, Now

Successful?

To referral hospital

Access site?Pull sheath Femoral

Physician pullssheath in cath lab

Radial

To FailedInterventional

Cardiology PatientPathway

No

Yes, with Plavix

Outpatient

Inpatient

Porter bringspatient withappropriate

nursing support ifindicated

Patient inCritical Care?

Transport inhospital bed tocath lab room

Yes

To Holding Area(in Outpatient

process above)

No

Yes

Patient to holdingarea

Monitor (about 2hours)

ScheduledOutpatient arrives

at Admitting

Procedurecomplete Call porter Is critical care

bed available? Yes

Hold and wait forbed to become

available

No

Patient on in-patient unit

Cath lab calls floorand porter for

patient

Patient to criticalcare bed via porterand cath lab scrub

nurse

Post--Procedure Unit

1 2

3

4



– June 201230

OUTPATIENTS1. CENTRAL REGISTRATION• Use the same Central Registration area during Admitting process as the same-day

cardiac surgery patient

2. HOLDING BAY• Space requirements: Stretchers in holding bays fold up to seated position

• Patients disrobe and gown here

• Processes that take place here: IV begun, patient interview, and BC cardiology

registration form, verify pre-admission testing is complete

• If pre-admission testing is not complete, it will take place now

3. ACCESS SITE• Radial Access site: About 80% of patients

• RN pulls femoral sheath in the cath lab

• Doctor pulls radial sheath

• Femoral Access site: doctor pulls sheath if still present in the holding area, where

the patient is subsequently monitored for about 2 hours

INPATIENTS4. TRANSPORT TO CATH LAB• When the patient is transported in the hospital bed to the cath lab room, the bed

remains outside the cath lab room

• Space requirements: Respiratory and Porters must be at the cath lab when the

patient comes off of the able. Also, if the patient is interbated, respiratory will stay

INTERVENTIONAL CARDIOLOGY PATIENT PATHWAY (CONTINUED)



– June 201231

Does patientneed surgery?

Refer to CTsurgeon forconsultation

YesDoes CTsurgeonapprove?

YesCT surgeon sendsreferral form to CV

coordinator

CVCorodinatorcoordinatespre-surgicalscreening

Does patientlive nearhospital?

Clinical review byCT surgeon

Schedule surgery

Diagnosticsordered

CV Coordinatorperforms chart

audit

7-days before surgery

Arediagnostics,assessment

and dischargeplanning

complete?

Yes

Unit clerk movesmedical record to

same-dayadmission

Patient calls forarrival instructions

and pre-registration

1 day before surgery

Patient arrives athospital

Patient goes toCentralizedRegistration

Patient registersVolunteer takespatient to pre-opreception area

Gown patient Pre-op check bynurse

Patient receivesanesthesiaevaluation

Is patientcleared?

Surgical caseclosed

Inform CSICU thatpatient is coming

Surgical close andcase complete

Prep patient fortransfer

Patient clinicalintake via phone

Patient taken totreatment station

Can sugicalclearance be

resolvedquickly?

Diagnosticsordered from

another hospital

No

Conductdiagnostics at

KGHYes

Day of surgery

Tracking board isupdated

Transfer patient toCSICU

Surgeon and ORnurse make

introductions topatient

No

Yes

Surgical caseinitiated

Same Day CardiacSurgery Patient

Exit to Cardiology

No

No

Complete tests

No

Surgery is delayedor cancelled No

Who timeout process

Patient off pumpClose who process

1 2

3

76

5

4

SAME DAY CARDIAC SURGICAL PATIENT



– June 201232

WHEN SURGERY IS NEEDED1. CALL CONSULT• Refer to a CT surgeon for consult. Surgeon has to approve before case can proceed

2. PRE-SURGICAL SCREENING• Process to focus on being more patient-centered and streamlining patient care–

“bringing everything to the patient vs. sending the patient to everything”

• KGH GOAL: To reduce diagnostics cancellation rate attributable to pre-

diagnostic testing to 0%

3. PATIENT LOCATION• If patient does not live near hospital, rely on referral network. How will quality be

affected once KGH begins serving a different patient population and having different

clinicians performing diagnostics?

4. 7 DAYS BEFORE SURGERY• Pre-op education and discharge planning. How will KGH disseminate information

and when should it have been completed by?

5. 1 DAY BEFORE SURGERY• Booking instructions. What other technology solutions are available to reach patients

(text messaging, email, etc.)?

6. DAY OF SURGERY• How do they get from door to Admitting? Do patients have single or multiple access

points?

7. GOWN CHANGE• How should cubicle or station be designed?

ADDITIONAL QUESTIONS• From a nursing perspective, how does this impact the rest of the organization?

• Where is pre-op going to occur?

SAME DAY CARDIAC SURGICAL PATIENT (CONTINUED)



– June 201233

CSICU calledwhen closingstarts. RRT

notified as well

Porter takesCSICU bed to OR Case complete

Patient transfer toCSICU bed by

Anesthesia,Perfusion, or OR

Team

Bedside report

RN staff andAnesthesia

conduct patientintake

Patient in OR Critical Carebegins

1

2

CARDIAC SURGERY TO CSICU

1. CSICUSpace requirement: must be space for respiratory therapist in unit Nursing ratio is 1:1

2. CRITICAL CAREFIRST 6 HOURS:• Q 30-60 min ABG

• Admission chest x-ray

• Ionotrope management

• Vital signs q15

• Medication and sedation management

• Cardiac outputs and diagnostics

• Telemetry monitoring

• Hemodynamic monitoring, chest tubes, pacing wires. Chest tube management

• Extubation Pathway (about 12 hours)

• Maybe dialysis

• Balloon pump (IABP)

• Telemetry is wired into the rooms. Continuous monitoring.

• Hourly consultation with family in the room

• Pulmonary toilet

• Maybe ECMO

6 TO 12 HOURS:• Nurse ratio still 1:1

• Dangle legs at bedside

• Extubate

• Personal hygiene care

• ECMO

• Consultations

12+ HOURS:• Prep for transfer

• PO’s in am

• Weaning drips

• Pull arterial line

• Out of bed (ambulate in room), sitting in chair

ROOM TURN:• Patient transferred, nurse and RT clean room, housekeeping cleans, nurse re-stocks.

• CSICU nurse transfers patient out of CSICU in a wheelchair

• Space requirements: Low-air returns and positive pressure will need to be in rooms

• Private rooms needed


34



6.9 Concept Diagrams and Intra-Departmental adjacencies:

6.9.1 Concept diagrams have been included to provide a more complete picture of operational

requirements. The diagrams show concepts of adjacencies, access, and circulation. These

design concepts are intended to provide information regarding departmental needs and

operational requirements.

6.9.1.1 Surgical Suite Concept Diagram

6.9.1.2 Surgery Control Desk Concept

6.9.1.3 Team Care Station Concept Diagrams

6.9.1.4 Cardiac OR Concept Diagram

6.9.1.5 PARR & Pre-OP Concept Diagram


35




36




37




38




39




40




41



6.10 CARDIAC SURGICAL INTENSIVE CARE UNIT:

6.10.1 CSICU PROGRAM:

6.10.1.1 Future facilities on Level 2 Strathcona will be provided for the provision of cardiac

services. These include:

6.10.1.1(1)(a) Coronary Care Unit (CCU); and

6.10.1.1(1)(b) Cardiac Inpatient Unit.

6.10.1.2 The CSICU will be located in the IHSC and contains patient care, staff support,

and visitor support facilities used in the provision of “critical” care to cardiac care

adult patients. Specialized medical and nursing services are provided to patients

requiring intensive care and/or observation, monitoring and/or mechanical life

support.

6.10.1.3 Optimally, the requirement for nursing care will include one nurse for every intensive

care patient for the first 24 hours post-surgery, after which they will be transferred

to the CCU or the Cardiac Inpatient Unit.

6.10.2 ACTIVITY INDICATORS:

6.10.2.1 For various topics the activity indicators summarize the current and future state that

is to inform the design. These estimates are to be used when designing in

consultation with the Authority.

Activity 2009/10 2012/13 2030

# of CSICU beds 3 6 6 (2 beds for future)

# of CSICU patient days annually - - +2600

6.10.3 CSICU Departmental Adjacencies:


Surgery to CSICU Direct route for movement of critically ill post cardiac surgery

patients, equipment and staff convoys.

CSICU to Intensive Care Units Internal route for movement of critically ill patients.

CSICU to CCU Direct and short route.

CSICU to Cardiac Inpatient Units Internal route for movement of patients

CSICU to Inpatient Units Internal route for movement of patients

CSICU to Diagnostic Imaging Internal route for movement of patients.

CSICU to Laboratory Direct access via tube station.


42



6.10.4 DESIGN PRIORITIES:

6.10.4.1 Through a series of user group meetings, the clinicians for various departments and

specialties have produced a list of clinical design priorities. These priorities are not

exclusive of other typical design features that may be necessary and desirable..

These priories were deemed critical to the success of patient outcomes and staff

efficiency. It is expected that these priorities will be incorporated in the clinical

design.

6.10.4.2 Cardiac Surgical Intensive Care Unit Design Priorities:

6.10.4.2(1) Direct Line of Sight from Team Care Station to each Decentralized

Care Station.

6.10.4.2(2) Shortest Path of Travel from Cardiac OR’s to CSICU.

6.10.4.2(3) Sufficient Path of Travel Width from Cardiac OR’s to Each Patient

Room (Corridors, Doors, Corners, etc.)

6.10.4.2(4) Patient Room Layout.

6.10.4.2(5) Storage – Location and Configuration of , for example, equipment

alcoves, as determined through the User Consultation Process.

6.10.4.2(6) Direct Natural Daylight for each patient room.

6.10.4.2(7) Staff need to view and access multiple patients; therefore, window and

a sliding door between patient rooms with integral blinds is necessary.

6.10.5 KEY DESIGN FEATURES:

6.10.5.1 This section outlines specific design concepts related to the CSICU that have been

identified by staff as having a design requirement or specific needs associated with

operations.

6.10.5.1(1) Corridor Circulation:

6.10.5.1(1)(a) Corridor path from Cardiac OR’s to CSICU should be

as short and direct as possible.

6.10.5.1(1)(b) The corridor between the Cardiac OR’s and all CSICU

patient rooms must accommodate the patient,

equipment and staff post surgical convoy which can be

up to 7ft wide and 14’ long. Due to the high risk

patients that are being transported, it is critical that

these routes be as efficient as possible. The number of

corridor corners and turns should be minimized in the

path between cardiac OR’s and the CSICU patient

rooms.


43



6.10.5.1(2) Elevators and Stairs:

6.10.5.1(2)(a) Public elevator needs to be near the CSICU family

waiting room but should not open directly onto the

waiting room.

6.10.5.1(3) Adjacencies and Department Layout:

6.10.5.1(3)(a) It’s critical that this department be on the same floor as

the Cardiac OR’s and be close to the future CCU that

will be developed on level two of the Strathcona

building.

6.10.5.1(3)(b) It is critical that the team care station have direct line of

sight to each decentralized care station.

6.10.5.1(3)(c) The department should be designed around the “spoke

and wheel” concept with the Care Station in the middle

and the patient rooms around the perimeter.

6.10.5.1(3)(d) A Crash Cart Alcove needs to be centrally located for

quick access to staff.

6.10.5.1(3)(e) The Central Care Station needs to be located and

configured so that the unit clerk can observe people

and patients entering the unit.

6.10.5.1(3)(f) Enclosed CSICU patient rooms are required for

infection control and family privacy. Additionally, these

rooms could serve as ICU overflow if the Cardiac

census is low.

6.10.5.1(3)(g) Provide the CSICU Waiting Room with one adjacent

quiet room for personal discussions and meetings with

clinical staff. In addition, locate a second quiet room

within the department, yet away from the patient rooms

to offer staff and families a meeting area that is more

convenient to the patient rooms and can be accessed

away from the view of other visitors. This room can

serve a dual purpose and can be used for staff

meetings.

6.10.6 STANDARDIZATION:

6.10.6.1 Standardization can take many forms. The following items are to be standardized

through the User Group Consultation Process as described in Schedule 2 . In each

department the interior finishes, heights and locations following items are to be

standardized:


44



6.10.6.1(1) Headwall/Booms - Wall protection, gases, bumper rails, fixed

equipment, monitor, light fixtures and switches, data/power,.

6.10.6.1(2) Decentralized Care Stations – Case work, , light fixtures, switching,

power/data

6.10.6.1(3) CSICU/Isolation rooms – headwall/boom, gases, bumper rails, fixed

equipment. monitor, light fixtures and switches, power/data, case work.

Mirrored room layout is acceptable .

6.10.7 PROCESS FLOW DIAGRAM:

6.10.7.1 The Authority places great value on Principals of LEAN workflow and design. To the

extent possible in pre-design KGH has developed operational strategies with which

the new IHSC will be managed. These plans include staffing models, goals, and

the processes necessary to manage the delivery of care in the new building. As

part of this development a process flow map was produced. This map illustrates

the steps, processes and policies that are to inform the design. Not all process

within the new building were mapped. The process flow diagram that has been

provided focuses on the patient and how various resources must be made

available during the delivery of care for specific patient processes. It is expected

that the design will reflect these processes.



– June 201245

CARDIAC SURGERY TO CSICU

• Space requirement: must be space for respiratory therapist in unit

• Nursing ratio is 1:1

CRITICAL CARE

• First 6 Hours:

• Q 30-60 min ABG

• Admission chest x-ray

• Ionotrope management

• Vital signs q15

• Medication and sedation management

• Cardiac outputs and diagnostics

• Telemetry monitoring

• Hemodynamic monitoring, chest tubes, pacing wires. Chest tube management

• Extubation Pathway (about 12 hours)

• Maybe dialysis; maybe IABP

• Telemetry is wired into the rooms. Continuous monitoring.

• Hourly consultation with family in the room

• Pulmonary toilet

• Maybe ECMO

Space requirement: must be space for respiratory therapist in unitNursing ratio is 1:1

Critical CareFirst 6 Hours:

Q 30‐60 min ABGAdmission chest x‐rayIonotrope managementVital signs q15Medication and sedation managementCardiac outputs and diagnosticsTelemetry monitoringHemodynamic monitoring, chest tubes, pacing wires. Chest tube managementExtubation Pathway (about 12 hours)Maybe dialysis; maybe IABPTelemetry is wired into the rooms. Continuous monitoring.Hourly consultation with family in the roomPulmonary toiletMaybe ECMO

6 to 12 hours:Nurse ratio still 1:1Dangle legs at bedsideExtubatePersonal hygiene careECMOConsultations

12+ hours:Prep for transferPO’s in amWeaning dripsPull arterial lineOut of bed (ambulate in room), sitting in chair

Room turn: patient transferred, nurse and RT clean room, housekeeping cleans, nurse re‐stocks.CSICU nurse transfers patient out of CSICU in a wheelchairLow‐air returns and positive pressure will need to be in rooms. This is very important for

architectureWant to design with private rooms

PAGE TO BE REFORMATED PER GRAPHIC DESIGN


46



6.10.8 CONCEPT DIAGRAM:

6.10.8.1 Concept diagrams have been included to provide a more complete picture of

operational requirements. The diagrams show concepts of adjacencies, access,

and circulation. These design concepts are intended to provide information

regarding departmental needs and operational requirements.


47



6.11


48



MEDICAL DEVICE REPROCESSING

6.11.1 MDR PROGRAM:

6.11.1.1 Medical Device Reprocessing (MDR) will be responsible for the decontamination,

inspection, assembly, function testing and terminal sterilization of surgical packs

and procedural instruments for all hospital sterilization volumes and departments.

MDR activities include washing surgical case carts, cleaning mobile patient

equipment, flexible endoscope processing, replacing damaged procedure

instruments, and stocking case carts.

6.11.1.2 Approximately 40% of the MDR volume is non-surgical.

6.11.1.3 A portering service delivers equipment and instruments from around KGH that

require reprocessing.

6.11.1.4 The KGH MDR also reprocesses equipment and instruments from external sites. It

is important that this shipping and receiving is convenient to accommodate this

external flow.

6.11.1.5 The soiled and clean drop-off and pick-up shall be convenient relative to the MDR

work flow process.

6.11.1.6 Numerous satellite operations currently service KGH due to a lack of space in the

existing facility. Endoscopy services within the Centennial Building will process and

be responsible for their own scope inventory.

6.11.1.7 It is anticipated that the Strathcona MDR will be fully replaced and that the Centennial

MDR will relocate, except for endoscopic services, to the new IHSC MDR.

6.11.1.8 Services within the MDR will include:

6.11.1.8(1) Decontamination of surgical instruments, carts and some equipment.

6.11.1.8(2) Soiled case cart wash process.

6.11.1.8(3) Sterilization of flexible endoscopes.

6.11.1.8(4) Sterilization of heat and moisture sensitive medical devices and

surgical instruments.

6.11.1.8(5) Assembly (Prep & Pack) of surgical instruments.

6.11.1.8(6) Steam sterilization of surgical instrument trays and separately wrapped

instruments, basin sets, pre-packaged towel/gown packs.

6.11.1.8(7) Case picking for procedure sites.

6.11.1.8(8) Storage of sterile supplies and packs.


49



6.11.1.9 Porters will be responsible for the delivery and return of case carts and restocking of

sterile product in other clinical areas of the hospital.

6.11.1.10 An Information System, with applications for instrument processing, will be

implemented for MDR. It may include bar code software for instrument and bundle

tracking. All MDR products will be scanned into the System. MDR will use an

instrument tracking and management system that interfaces on some level with

existing IT systems.

6.11.2 ACTIVITY INDICATORS

6.11.2.1 For various topics the activity indicators summarize the current and future

state that is to inform the design. These estimates are to be used when

designing in consultation with the Authority.

x

Position FTE 2011/12 FTE 2016 FTE 2030

MDR Coordinator 1.0 1.0 1.0

MDR Supervisor 2.0 2.0 3.0

MDR Lead Hand 4.0 3.0 4.0

MDR Technician 29.27 35.27 47.27

FTE Note: Projections Only

MDR Volumes 2011/12 – Cases Annually 2024 – Cases Annually

All service (non-cardiac) 13,000 17,000

Cardiac services 0 1,000

6.11.3 MDR DEPARTMENTAL ADJACENCIES:


MDR to Surgery Direct access via clean and soiled elevator.

MDR to Intensive Care

Patients

Internal route for movement of sterile supplies.

MDR to Inpatient Units Internal route for movement of sterile supplies.

MDR to Diagnostic Imaging Internal route for movement of sterile supplies.

MDR to Existing Campus

(Centennial OR’s)

Internal route for movement of sterile supplies via level 1 or level 3

links from IHSC


50



6.11.4 Room Adjacencies

6.11.4.1 Ensure that the MDR clean elevator enters directly into the Sterile Core Area. It is

also required to have a stairwell connecting the Sterile Core and the Sterile Stores

within the MDR.

6.11.4.2 Ensure that the MDR soiled elevator enters directly into the Surgery Soiled Utility

room

6.11.4.3 Provide sufficient space/clearance to safely manoeuvre carts through the cart cool

down area (room 639) at the same time carts are being cooled and stored. Staff

must not be required to hoist or make several attempts to gradually turn these carts

in order to move them through this space.

6.11.4.4 The existing logistics corridor (Strathcona, level 1) should have easy and direct

access to the loaner room and the Breakout Area.

6.11.4.5 Provide ample room in front of the decontamination washers.

6.11.4.6 RESERVED

6.11.4.7 The ultrasonic machine requires adjacency to the decontamination sinks

6.11.4.8 One decontamination sink must be dedicated to flexible scope cleaning and needs

to be located in the soiled scope room. This will require a user–regulated

suction/vacuum to pull cleaning fluid through the scope.

6.11.4.9 There shall be a minimum of 4500 mm of clear space in front of the soiled and clean

elevators in the MDR and on the Surgical Floor. This space shall be clear of fixed

objects and obstacles. The intent of the clear space is to reduce traffic congestion

in front of busy soiled and clean elevators.

6.11.4.10 Each entrance into the MDR (including but not limited to all entrances into sterile

zone, clean, decontamination and breakout area) needs a “clean area” with a

clinical handwash sink, a gowning zone and a mirror, coat hooks, soap and paper

towel dispenser.

6.11.4.11 Layout of each zone should align workflow with travel distances and movement of

material.

6.11.4.12 Access to the clean elevator must be from within the MDR sterile storage area.

6.11.4.13 The Loaner Room must be adjacent and be able to access the Breakout Room.

6.11.4.14 Locate the Breakout Room next to the equipment supervisor’s office. The

supervisor’s office can be open into the sterile supplies area.

6.11.4.15 It is critical that the breakout room be directly adjacent to the sterile storage room.


51



6.11.4.16 The housekeeping room is to have access from both the decontamination area and

outside the unit. This allows access to housekeeping without going through the

decontamination side of MDR. It is critical that this access is controlled and does

not allow staff to use this as an access to MDR.

6.11.4.17 Pass-through sterilizers facilitate the creation of a clean and sterile side of the

department. The pass through should be close to the sterilizers as required to

efficiently return carts to the clean side.

6.11.4.18 Linen storage needs to be in an enclosed room and separate from sterile storage

(locate on clean side).

6.11.4.19 Dryers need to be located on clean side and not within sterile area.

6.11.4.20 Cart washer should be located to facilitate good work flow of work through

decontamination stations.

6.11.4.21 Locate open hopper sink next to the soiled elevator. The open hopper sink does not

require a separate room.

6.11.4.22 Sufficient room for carts and bins which hold soiled linen, biohazard, recycling,

garbage needs to be allocated adjacent to the soiled elevator, this area also requires

ease of access to exchange the carts/bins and remove from the department

6.11.4.23 Soiled and Clean MDR elevators must not be accessible to public.

6.11.4.24 The scope washing and disinfecting process, described in MDR pathway 1 and 2,

should be located proximal to the soiled receiving area. The soiled scope room will

provide direct access into the clean scope room. The clean scope room will house

the disinfecting equipment and will have a pass through to the packaging and

assembly area of the clean zone.

6.11.4.25 The Soiled Receiving area must be adjacent to the soiled elevator and

decontamination zone room entrance. Soiled products, garbage and biohazard

materials will be removed from the case carts in this space. It will house a hopper

and a variety of bins to hold soiled products (including laundry).

6.11.4.26 The Soiled Holding area must be located close to the sorting and washing area and

the cart washers. This space will hold materials/carts awaiting the next step of the

process flow and in particular will allow room for cart staging in front of the cart

washers. It may also house overflow bins of products to be disposed of and waiting

for removal from the department that were generated from the soiled receiving

area. It is not a requirement that this space be enclosed.

6.11.4.27 The soiled receiving and holding area may be combined with approval from the

authority if the functionality in 6.11.4.25 and 6.11.4.26 can be maintained.


52



6.11.4.28 The Linen Bundle area must be located in the clean assembly and packaging area.

It will house linen wrappers and other linens used to package devices.

6.12 DESIGN PRIORITIES:

6.12.1 Through a series of user group meetings the clinicians for various departments and

specialties have produced a list of clinical design priorities. These priorities are not

exclusive of other typical design features that may be necessary and desirable. These

priories were deemed critical to the success of patient outcomes and staff efficiency. It is

expected that these priorities will be incorporated in the clinical design.

6.12.1.1 Separate walled zones.

6.12.1.2 One way work flow incorporating LEAN work flows.

6.12.1.3 Ergonomic design of work flows and work stations.

6.12.1.4 Efficient Clean and Soiled elevator location.

6.12.1.5 Natural Daylight.

6.12.1.6 Future flexibility.

6.12.1.7 Convenient administrative area.

6.12.1.8 Staff stair from Sterile Stores to sterile core.

6.13 KEY DESIGN FEATURES:

6.13.1 This section outlines specific design concepts related to the MDR that have been identified

by staff as having a design requirement or specific needs associated with operations.

6.13.2 Corridor Circulation:

6.13.2.1 MDR entrance and access should be separated from the public lobby and

circulation.

6.13.2.2 MDR supplies from Strathcona should not cross a public corridor

6.13.2.3 Work Flow:

6.13.2.3(1) Ensure one way work flow of materials being cleaned within MDR. The

only exceptions are as follows:

a) cart washer carts pass through from clean zone back into

decontamination via a “pass through door”;

b) instrument washer rack pass through from clean zone back to

decontamination;

c) the sterilizer carts pass through from the clean zone and back

into the sterile zone.”

6.13.2.3(2) Path 4 of the MDR Instrument and equipment pathways labeled as

“Equipment” must occur after the last decontamination sink workstation

in the “Instrument” path (Equipment and Instrument Pathway, path 3).

This will enable staff to gradually unload all instruments and equipment

from the carts through the decontamination zone and then proceed


53



with the dirty carts to the cart washer. This ensures staff are not

required to off load equipment onto other carts (double handling)

during the decontamination process or that the original carts must back

track through the decontamination zone to the cart washer area.”

6.13.2.3(3) There must be a minimum 1000mm wide clear space to accommodate

the main cart circulation paths in the MDR.

6.13.2.3(4) There must be sufficient travel cart and instrument/equipment routes

from zone to zone to prevent potential bottlenecks in the main workflow

paths. Each access point (doorway) into the next zone must be

adequate in size to handle the anticipated volumes.

6.13.2.3(5) MDR Pathways 1 - 5 (including 3a, 3b, 4a, 4b) must originate from the

soiled elevator and entrance. A case cart coming into the department

may have items on it that have to follow each of these pathways.

6.13.2.4 The cart washer unloading area must not cross or be utilized by other main

workflow paths, due to slip hazards of wet carts.

6.13.2.5 Provide a floor drain on the Clean side of the Cart Washers

6.14 STANDARDIZATION:

6.14.1 Standardization can take many forms. The following items are to be standardized in

consultation with the Health Authority. The exact nature and degree of standardization is to

be developed within the through the User Consultation Process as described in Schedule 2.

6.14.1.1 Clean Area at Entrances, i.e., the organization and layout of clinical handwash sink

and equipment.

6.14.1.2 Decontamination workstations

6.14.1.3 Assembly workstations

6.15 DECONTAMINATION SINKS:

6.15.1 Decontamination Sinks & Workstations: Each height adjustable decontamination work

station is required to include the following:

6.15.1.1 Ample counter space on either side of stainless steel sinks.

6.15.1.2 Three basin stainless steel sinks 24” X 17” X 10” (sink dimensions are approximate

and will be confirmed during user consultation).

6.15.1.3 Appropriate sized stainless steel flat surface cover plate to place over sink to

transition to more counter space on demand.

6.15.1.4 Water gun that is tempered and operates independently from faucets.

6.15.1.5 Two faucets centered between the three basins

6.15.1.6 Pure water.

6.15.1.7 Instrument grade air.

6.15.1.8 User regulated suction (vacuum).


54



6.15.1.9 Task lighting

6.15.1.10 Electrical and data outlets on both sides of counter space.

6.15.1.11 Stainless steel shelving above sinks.

6.15.1.12 Right to left one way work flow.

6.15.1.13 The decontamination work sinks must not be located along walls unless approved

by the Authority. They can be placed in a back to back position with a wall

between them, in accordance to the workflow diagrams. These workstations must

allow sufficient space in front to accommodate for the staff member working at the

station (600mm minimum) as well as space for flow of materials and other staff

(900mm minimum) between the work stations.”


55



6.16 ASSEMBLY WORKSTATIONS

6.16.1 Assembly Workstions: Each heigh adjustable assembly workstation is required to include the

following:

One way flow

Medical air, vacuum, power and data

Monitor/computer

Drawers, supply baskets

Task lighting

6.17 PROCESS FLOW DIAGRAMS:

6.17.1 The Authority places great value on Principals of LEAN workflow and design. To the extent

possible in pre-design KGH has developed operational strategies with which the new IHSC

will be managed. These plans include staffing models, goals, and the processes necessary

to manage the delivery of care in the new building. As part of this development a series of

process flow maps were produced. These maps illustrate the steps, processes and policies

that are to inform the design. Not all process within the new building were mapped. The

process flow diagrams that have been provided focus on the patient and how various

resources must be made available during the delivery of care for specific patient processes.

It is expected that the design will reflect these processes.



– June 201256

NOTE: Reference Other Flow Diagrams for additional relevant clinical and MDR processes.



– June 201257

PAGE TO BE REFORMATED PER GRAPHIC DESIGN



– June 201258

NOTE: Reference Other Flow Diagrams for additional relevant clinical and MDR processes.


59



6.18 CONCEPT DIAGRAM:

6.18.1 Concept diagrams have been included to provide a more complete picture of operational

requirements. The diagrams show concepts of adjacencies, access, and circulation. These

design concepts are intended to provide information regarding departmental needs and

operational requirements.


60




61




62



6.19 STAFF & ADMINISTRATIVE SPACES:

6.19.1 Staff working in the IHSC building must utilize highly technical skills, e.g., perform surgical

procedures and assemble surgical kits, and frequently make key decisions that have a

significant impact on patient outcomes. The following design concepts are key to the

success of these areas:

6.19.2 CARE CENTERS:

6.19.2.1 Optimize site lines within PARR and Pre-Op areas from care centers to patient bays

or decentralized workstations.

6.19.2.2 Optimize site lines from OR Control Center to surgical suite pre op and inpatient

entrance and to the Inpatient Holding Area.

6.19.2.3 Provide multiple height workstations at all care station to allow staff the choice to sit

or stand to chart or access the computer. The overall concept and details of each

Care Centre will be developed with the Authority through the User Consultation

Process.

6.19.2.4 Provide direct or borrowed natural light for all care stations.

6.19.2.5 Adjacency to medication rooms in CSICU, PARR and Level II Recovery is desirable.

6.19.2.6 Adjustable lighting levels are required at all care stations so staff have the ability to

modify lighting levels to accommodate both patient and staff needs and daytime vs

night time work environments.

6.19.2.7 Provide purse lockers close to or within care centers.

6.19.3 STAFF WORKSTATIONS WITHIN THE SURGERY RACETRACK:

6.19.3.1 Staff require easy access to computer workstations throughout the surgical suite.

These workstations require space for either a mobile computer workstation along

with a drop down counter or a standing height stationary computer with additional

desk surface to accommodate a patient chart or book.

6.19.4 DICTATION ALCOVES:

6.19.4.1 Distribute OR Dictation Alcoves throughout the surgical racetrack (one booth per

two OR’s) and the four remaining together in a distraction-free area.

6.19.5 STAFF LOUNGE (ROOM 404):

6.19.5.1 Staff access from surgery areas to lounge must not cross any public circulation

flows or family waiting areas.

6.19.5.2 Direct natural light is required.


63



6.19.5.3 Direct access to an exterior healing garden is optimal.

6.19.5.4 Provide space, e.g., a smaller alcove within the Lounge, that allows some privacy

and less distraction for emotional restoration/relaxation.

6.19.5.5 Direct access to the lockers rooms without crossing a public zone.

6.19.5.6 Locate the lounge on the central courtyard, with glazing on two sides of the room

which offers views of the courtyard. Provide two access doors to the courtyard .

The area accessible to the west of the lounge will be covered to provide protection

from the elements and will be separated from the main courtyard using wooden

screening to provide privacy.

6.19.6 MDR STAFF LOUNGE / MEETING ROOM (ROOM 604):

6.19.6.1 Provide space for food preparation, socialization and relaxation.

6.19.6.2 Room will also be used as a meeting room space.

6.19.6.3 Provide daylight and views on two sides of the lounge, offer access to an outdoor

roof patio, and ensure that the roof patio has views of the central courtyard below.

6.19.6.4 Direct access to an exterior roof top garden is required.

6.19.6.5 Provide relaxing seating and convenient kitchen amenities.

6.19.7 LOCKER ROOM:

6.19.7.1 Staff Change Rooms and Washrooms shall be adjacent to the Staff Lounge (Room

404).

6.19.7.2 Provide privacy from within the change rooms to and from adjacent spaces.

6.19.7.3 Provide an area to store winter coats and boots that are too large or wet to place in

lockers

6.19.7.4 Provide duty shoe shelves in each locker room

6.19.8 ON CALL ROOMS:

6.19.8.1 Locate On-Call rooms in a quite area of the building isolated from noise and

circulation traffic. Ensure that On-Call rooms will provide a comfortable space to

relax or sleep.

6.19.9 The two Meeting Rooms in the Pre-Op/ Level II Recovery Area Room Code 124, shall be

accessed by a public corridor. The doors to the meeting rooms will require controlled

access.

6.19.10 Pneumatic Tube Stations:

6.19.10.1 The following areas shall have at least one pneumatic tube station:

• One in each Pre-Op/Level II Recovery Team Care Station

• One in the Surgery Control Center

• Two in the Sterile Core Area

• One in the OR Race Track adjacent to the Satellite Lab – Tissue Prep. Area


64



• One in the PARR Team Care Station

• One in the CSICU Team Care Station

• One in the MDR Sterile Stores area

6.19.10.2 Each Pneumatic Tube Station shall be directly visible by staff stationed within the

Team Care Station. Directly adjacent to each Pneumatic Tube Station shall be a

countertop with upper cabinets a minimum length of 1 meter.



– June 201265

Interior Heart and Surgical Centre Functional Space Requirements

Room Code Space Description Units of

Space NSM Per

Unit Total NSM Room Splitable Remarks

SURGICAL SERVICES SUITE

PRE-OP & LEVEL II RECOVERY AREA101 Receiving Desk 1 9.0 9.0

102.01 Equipment / Stretcher Alcove 1 4.0 4.0 102.02 Equipment / Stretcher Alcove 1 4.0 4.0 103.01 Patient Belongings Storage 1 9.0 9.0 yes103.02 Patient Belongings Storage 1 9.0 9.0 yes

104 Surgery Waiting Area 1 45.0 45.0 Combined with Receiving Desk105 Volunteer Desk Area 1 4.0 4.0 106 Public Washroom, Assessible 1 4.5 4.5 107 Family Quiet Room 1 10.0 10.0

108.01 Private Patient Room 1 11.0 11.0 Provide 2 Pediatric bays with large glazed break-away doors.

108.02 Private Patient Room 1 11.0 11.0 Provide 2 Pediatric bays with large glazed break-away doors.

108.03 Private Patient Room 1 11.0 11.0 108.04 Private Patient Room 1 11.0 11.0 108.05 Private Patient Room 1 11.0 11.0 108.06 Private Patient Room 1 11.0 11.0 108.07 Private Patient Room 1 11.0 11.0 108.08 Private Patient Room 1 11.0 11.0 108.09 Private Patient Room 1 11.0 11.0 108.10 Private Patient Room 1 11.0 11.0 108.11 Private Patient Room 1 11.0 11.0 108.12 Private Patient Room 1 11.0 11.0 108.13 Private Patient Room 1 11.0 11.0 108.14 Private Patient Room 1 11.0 11.0 108.15 Private Patient Room 1 11.0 11.0 108.16 Private Patient Room 1 11.0 11.0 108.17 Private Patient Room 1 11.0 11.0 108.18 Private Patient Room 1 11.0 11.0 108.19 Private Patient Room 1 11.0 11.0 108.20 Private Patient Room 1 11.0 11.0 108.21 Private Patient Room 1 11.0 11.0 108.22 Private Patient Room 1 11.0 11.0 108.23 Private Patient Room 1 11.0 11.0 108.24 Private Patient Room 1 11.0 11.0 108.25 Private Patient Room 1 11.0 11.0 108.26 Private Patient Room 1 11.0 11.0 108.27 Private Patient Room 1 11.0 11.0 108.28 Private Patient Room 1 11.0 11.0 108.29 Private Patient Room 1 11.0 11.0 108.30 Private Patient Room 1 11.0 11.0 108.31 Private Patient Room 1 11.0 11.0 108.32 Private Patient Room 1 11.0 11.0 108.33 Private Patient Room 1 11.0 11.0 108.34 Private Patient Room 1 11.0 11.0 108.35 Private Patient Room 1 11.0 11.0

June 2012 Page 1 of 11

PART 7. FUNCTIONAL SPACE REQUIREMENTS: 7.1 The Functional Space Requirements outline the spaces that are to be provided within the IHSC building.



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Space NSM Per


108.36 Private Patient Room 1 11.0 11.0 108.37 Private Patient Room 1 11.0 11.0 108.38 Private Patient Room 1 11.0 11.0 108.39 Private Patient Room 1 11.0 11.0 108.40 Private Patient Room 1 11.0 11.0 108.41 Private Patient Room 1 11.0 11.0 108.42 Private Patient Room 1 11.0 11.0

108A.01 Bariatric Private Patient Room 1 13.0 13.0 108A.02 Bariatric Private Patient Room 1 13.0 13.0

109.01 Patient Washroom, Accessible1 4.5 4.5 One washroom to service six patient

rooms. Distribute throughout patient room area.













109A Patient Washroom, Accessible, Bariatric 1 5.4 5.4 110.01 Patient Room, Airborne Isolation 1 11.0 11.0 110.02 Patient Room, Airborne Isolation 1 11.0 11.0 111.01 Patient Washroom, Assessible 1 4.5 4.5 Associated with Air Borne Isolation

Rooms111.02 Patient Washroom, Assessible 1 4.5 4.5 Associated with Air Borne Isolation

Rooms112.01 Ante Room 1 4.0 4.0 Associated with Air Borne Isolation


Rooms113.01 Team Care Station 1 10.0 10.0 Yes113.02 Team Care Station 1 8.0 8.0 Yes113.03 Team Care Station 1 10.0 10.0 Yes114.01 Medication Room 1 7.0 7.0 114.02 Medication Room 1 7.0 7.0 115.01 Cart Alcove 1 2.0 2.0 115.02 Cart Alcove 1 2.0 2.0 116.01 Clean Supply Room 1 10.0 10.0 Yes116.02 Clean Supply Room 1 10.0 10.0 Yes117.01 Soiled Utility 1 22.0 22.0




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Space NSM Per


117.02 Soiled Utility 1 22.0 22.0 118.01 Nourishment Station 1 5.0 5.0 118.02 Nourishment Station 1 5.0 5.0 119.01 Stretcher Storage 1 15.0 15.0 Yes119.02 Stretcher Storage 1 15.0 15.0 Yes120.01 Equipment Storage 1 15.0 15.0 Yes120.02 Equipment Storage 1 15.0 15.0 Yes

121 Housekeeping Closet 1 12.0 12.0 Central Housekeeping Closet122.01 Staff Washroom 1 2.5 2.5 122.02 Staff Washroom 1 2.5 2.5 123.01 Decentralized Care Stations 1 0.7 0.7 123.02 Decentralized Care Stations 1 0.7 0.7 123.03 Decentralized Care Stations 1 0.7 0.7 123.04 Decentralized Care Stations 1 0.7 0.7 123.05 Decentralized Care Stations 1 0.7 0.7 123.06 Decentralized Care Stations 1 0.7 0.7 123.07 Decentralized Care Stations 1 0.7 0.7 123.08 Decentralized Care Stations 1 0.7 0.7 123.09 Decentralized Care Stations 1 0.7 0.7 123.10 Decentralized Care Stations 1 0.7 0.7 123.11 Decentralized Care Stations 1 0.7 0.7 123.12 Decentralized Care Stations 1 0.7 0.7 123.13 Decentralized Care Stations 1 0.7 0.7 123.14 Decentralized Care Stations 1 0.7 0.7 123.15 Decentralized Care Stations 1 0.7 0.7 123.16 Decentralized Care Stations 1 0.7 0.7 123.17 Decentralized Care Stations 1 0.7 0.7 123.18 Decentralized Care Stations 1 0.7 0.7 123.19 Decentralized Care Stations 1 0.7 0.7 123.20 Decentralized Care Stations 1 0.7 0.7 123.21 Decentralized Care Stations 1 0.7 0.7 123.22 Decentralized Care Stations 1 0.7 0.7 123.23 Decentralized Care Stations 1 0.7 0.7 123.24 Decentralized Care Stations 1 0.7 0.7 123.25 Decentralized Care Stations 1 0.7 0.7 123.26 Decentralized Care Stations 1 0.7 0.7 124.01 Meeting Room 1 34.5 34.5 124.02 Meeting Room 1 34.5 34.5

Pre-Op & Level II Recovery Area Sub Total: 945.5




– June 201268



Space NSM Per


SURGICAL PROCEDURES AREA201 Patient Care Coordinator Office 1 11.2 11.15 202 Surgery Control Center 1 11.0 11.0

203.01 Patient Holding Area 1 10.0 10.0 203.02 Patient Holding Area 1 10.0 10.0 203.03 Patient Holding Area 1 10.0 10.0 203.04 Patient Holding Area 1 10.0 10.0 203.05 Patient Holding Area 1 10.0 10.0 203A Patient Holding Area - Private 1 10.0 10.0 Private room with sliding glass door

204.01 Cardiac Operating Room 1 65.0 65.0 204.02 Cardiac Operating Room 1 65.0 65.0

205 Hybrid Operating Room 1 75.0 75.0 Lead lined206 Hybrid OR Control Room 1 10.0 10.0 207 Hybrid OR Equipment Room 1 5.0 5.0

208.01 Operating Room 1 65.0 65.0 208.02 Operating Room 1 65.0 65.0 208.03 Operating Room 1 65.0 65.0 208.04 Operating Room 1 65.0 65.0 208.05 Operating Room 1 65.0 65.0 208.06 Operating Room 1 65.0 65.0 208.07 Operating Room 1 65.0 65.0 208.08 Operating Room 1 65.0 65.0 208.09 Operating Room 1 65.0 65.0 208.1 Operating Room 1 65.0 65.0 208.11 Operating Room 1 65.0 65.0 208A Operating Room - Urology 1 60.0 60.0 Lead lined with Control Room.

209.01 Scrub Bay Alcove 1 2.0 2.0 209.02 Scrub Bay Alcove 1 2.0 2.0 209.03 Scrub Bay Alcove 1 2.0 2.0 209.04 Scrub Bay Alcove 1 2.0 2.0 209.05 Scrub Bay Alcove 1 2.0 2.0 209.06 Scrub Bay Alcove 1 2.0 2.0 209.07 Scrub Bay Alcove 1 2.0 2.0 209.08 Scrub Bay Alcove 1 2.0 2.0 209.09 Scrub Bay Alcove 1 2.0 2.0 209.10 Scrub Bay Alcove 1 2.0 2.0 209.11 Scrub Bay Alcove 1 2.0 2.0 209.12 Scrub Bay Alcove 1 2.0 2.0 209.13 Scrub Bay Alcove 1 2.0 2.0 209.14 Scrub Bay Alcove 1 2.0 2.0 209.15 Scrub Bay Alcove 1 2.0 2.0 210.01 OR Strecher Alcove 1 1.0 1.0 210.02 OR Strecher Alcove 1 1.0 1.0 210.03 OR Strecher Alcove 1 1.0 1.0 210.04 OR Strecher Alcove 1 1.0 1.0 210.05 OR Strecher Alcove 1 1.0 1.0 210.06 OR Strecher Alcove 1 1.0 1.0 210.07 OR Strecher Alcove 1 1.0 1.0 210.08 OR Strecher Alcove 1 1.0 1.0 210.09 OR Strecher Alcove 1 1.0 1.0 210.10 OR Strecher Alcove 1 1.0 1.0




– June 201269



Space NSM Per


210.11 OR Strecher Alcove 1 1.0 1.0 210.12 OR Strecher Alcove 1 1.0 1.0 210.13 OR Strecher Alcove 1 1.0 1.0 210.14 OR Strecher Alcove 1 1.0 1.0 210.15 OR Strecher Alcove 1 1.0 1.0

211 Cardiac Profusion Workroom 1 23.0 23.0 212.01 Staff Washrooms 1 2.5 2.5 212.02 Staff Washrooms 1 2.5 2.5

213 Sterile Core Area 1 220.0 220.0 214.01 Equipment Storage 1 16.6 16.6 Yes214.02 Equipment Storage 1 9.4 9.4 Yes214.03 Equipment Storage 1 29.3 29.3 Yes214.04 Equipment Storage 1 19.5 19.5 Yes214.05 Equipment Storage 1 22.8 22.8 Yes214.06 Equipment Storage 1 8.7 8.7 Yes214.07 Equipment Storage 1 6.9 6.9 Yes214.08 Equipment Storage 1 7.2 7.2 Yes

215 Surgery Soiled Utility 1 24.0 24.0 216 Mobile C-Arm Equipment Storage 1 8.0 8.0 217 Satellite Laboratory - Point of Care Testing 1 6.0 6.0

217A Satellite Laboratory - Tissue Prep 1 10.0 10.0 218.01 Biomedical & Anaesthetic Storage Room 1 16.2 16.2 Yes218.02 Biomedical & Anaesthetic Storage Room 1 16.3 16.3 Yes

219 Biomedical & Anaesthetic Workroom 1 60.0 60.0 220.01 Dictation Alcoves 1 2.0 2.0 220.02 Dictation Alcoves 1 2.0 2.0 220.03 Dictation Alcoves 1 2.0 2.0 220.04 Dictation Alcoves 1 2.0 2.0 220.05 Dictation Alcoves 1 2.0 2.0 220.06 Dictation Alcoves 1 2.0 2.0 220.07 Dictation Alcoves 1 2.0 2.0 220.08 Dictation Alcoves 1 2.0 2.0 220.09 Dictation Alcoves 1 2.0 2.0 220.10 Dictation Alcoves 1 2.0 2.0 220.11 Dictation Alcoves 1 2.0 2.0

221 Radiology Technicians Workroom 1 6.0 6.0 222 IT Equipment Workroom 1 13.0 13.0 223 Housekeeping Closet 1 10.0 10.0

224.01 Patient Washroom, Accessible 1 4.5 4.5 224.02 Patient Washroom, Accessible 1 4.5 4.5

225 Surgery Medication Room 1 10.0 10.0 Surgical Procedures Area Sub Total: 1,701.1




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Space NSM Per


LEVEL 1 RECOVERY AREA (PARR)301.01 Patient Stretcher Bay 1 10.0 10.0 301.02 Patient Stretcher Bay 1 10.0 10.0 301.03 Patient Stretcher Bay 1.00 10.00 10.00301.04 Patient Stretcher Bay 1.00 10.00 10.00301.05 Patient Stretcher Bay 1.00 10.00 10.00301.06 Patient Stretcher Bay 1.00 10.00 10.00301.07 Patient Stretcher Bay 1.00 10.00 10.00301.08 Patient Stretcher Bay 1.00 10.00 10.00301.09 Patient Stretcher Bay 1.00 10.00 10.00301.10 Patient Stretcher Bay 1.00 10.00 10.00301.11 Patient Stretcher Bay 1.00 10.00 10.00301.12 Patient Stretcher Bay 1.00 10.00 10.00301.13 Patient Stretcher Bay 1.00 10.00 10.00301.14 Patient Stretcher Bay 1.00 10.00 10.00301.15 Patient Stretcher Bay 1.00 10.00 10.00301.16 Patient Stretcher Bay 1.00 10.00 10.00301.17 Patient Stretcher Bay 1.00 10.00 10.00301.18 Patient Stretcher Bay 1.00 10.00 10.00301.19 Patient Stretcher Bay 1.00 10.00 10.00301.20 Patient Stretcher Bay 1.00 10.00 10.00302.01 Patient Stretcher Room, Airborne Isolation 1 11.0 11.0 302.02 Patient Stretcher Room, Airborne Isolation 1 11.0 11.0 303.01 Patient Washroom, Accessible 1 4.5 4.5 Associated with Air Borne Isolation

Rooms303.02 Patient Washroom, Accessible 1 4.5 4.5 Associated with Air Borne Isolation



Rooms305 Team Care Station 1 12.0 12.0 306 Medication Room 1 7.0 7.0 307 Clean Supply Room 1 12.0 12.0 Yes308 Soiled Utility Room 1 18.0 18.0 309 Equipment Storage Room 1 15.0 15.0 310 Patient Washroom, Accessible 1 4.5 4.5 311 Staff Washroom 1 3.0 3.0

312.01 Equipment Alcove 1 2.5 2.5 312.02 Equipment Alcove 1 2.5 2.5

Pre-Op & Level II Recovery Area Sub Total: 315.5

ADMINISTRATIVE & STAFF FACILITIES401.01 Private Office 1 11.15 11.2 401.02 Private Office 1 11.15 11.2 401.03 Private Office 1 11.15 11.2 402.01 Shared Office 1 11.15 11.2 402.02 Shared Office 1 11.15 11.2 402.03 Shared Office 1 11.15 11.2

403 Staff Washroom 1 3.0 3.0 404 Staff Lounge 1 65.0 65.0 Yes




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Space NSM Per


405 Male Change Room 1 34.8 34.8 406.01 Male Change Room Shower Cubicles 1 4.5 4.5 406.02 Male Change Room Shower Cubicles 1 4.5 4.5

407 Male Multi Stall Washroom 1 12.0 12.0 2 Waterclosets, 2 Urinals, 2 Sinks408 Female Change Room 1 78.9 78.9

409.01 Female Change Room Shower Cubicles 1 4.5 4.5 409.02 Female Change Room Shower Cubicles 1 4.5 4.5

410 Female Multi Stall Washroom 1 25.0 25.0 411 Scrub Dispenser Alcove 1 6.0 6.0

412.01 On Call Room 1 7.5 7.5 412.02 On Call Room 1 7.5 7.5 412.03 On Call Room 1 7.5 7.5 412.04 On Call Room 1 7.5 7.5 413.01 On Call Washrooms 1 2.5 2.5 413.02 On Call Washrooms 1 2.5 2.5 413.03 On Call Washrooms 1 2.5 2.5 413.04 On Call Washrooms 1 2.5 2.5 414.01 Dictation Room 1 13.5 13.5 Yes414.02 Dictation Room 1 13.5 13.5 Yes

Administrative & Staff Facilities Sub Total: 376.6

Surgical Services Suite Grand Total: 3,338.7




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Space NSM Per


CARDIAC SURGICAL INTENSIVE CARE UNIT (CSICU)

PATIENT CARE AREA501.01 Private Patient Room 1 22.0 22.0 501.02 Private Patient Room 1 22.0 22.0 501.03 Private Patient Room 1 22.0 22.0 501.04 Private Patient Room 1 22.0 22.0 501.05 Private Patient Room 1 22.0 22.0 501.06 Private Patient Room 1 22.0 22.0 501.07 Private Patient Room 1 22.0 22.0

502 Private Patient Room, Airborne Isolation 1 24.0 24.0 Bariatric503 Patient Washroom, Accessible 1 6.5 6.5 Associated with Air Borne Isolation

Rooms504 Ante Room 1 6.5 6.5 Associated with Air Borne Isolation

Rooms505.01 Decentralized Care Stations 1 4.0 4.0 505.02 Decentralized Care Stations 1 4.0 4.0 505.03 Decentralized Care Stations 1 4.0 4.0 505.04 Decentralized Care Stations 1 4.0 4.0

Patient Care Area Sub Total: 207.0

PATIENT CARE SUPPORT AREA510 Team Care Station 1 15.0 15.0 511 Staff Work Room 1 12.5 12.5 512 Medication Room 1 7.0 7.0 513 Clean Utility Room 1 12.0 12.0 Yes514 Soiled Utility Room 1 15.0 15.0 515 Equipment Storage 1 25.0 25.0 Yes516 Linen Cart Alcove 1 1.0 1.0 517 Nourishment Center 1 5.0 5.0 518 Housekeeping Room 1 5.0 5.0 519 Staff Washroom 1 3.0 3.0 520 Patient Washroom, Accessible 1 4.5 4.5 521 RT Storage Room 1 8.85 8.85

521A PCC Office 1 11.2 11.2 Patient Care Support Area Sub Total: 125.0

VISITOR AREA525 Multi Person Handwash Bay 1 2.0 2.0 526 Waiting Area 1 12.5 12.5 527 Public Washroom, Accessible 1 4.5 4.5

528.01 Family Quiet Room 1 10.0 10.0 528.02 Family Quiet Room 1 10.0 10.0

Visitor Area Sub Total: 39.0

Cardiac Surgical Intensive Care Unit Grand Total: 371.0




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Space NSM Per


MEDICAL DEVICE REPROCESSING (MDR)

ADMINISTRATIVE AREA601.01 Office 1 11.15 11.2 601.02 Office 1 11.15 11.2

602 Shared Office 1 9.0 9.0 603 Shared Office 1 16.0 16.0 604 Meeting Room / Staff Lounge 1 33.0 33.0 Yes605 Loaner Drop-Off Room 1 4.5 4.5 606 Server Room (removed) 1 - - 607 Staff Locker Area (see 612/613) 1 22.0 - Yes608 Change Room (see 612/613) 4 2.0 - Yes609 Staff Washroom 1 2.5 2.5 610 Shower Room 1 2.0 2.0 611 Vestibule 1 7.5 7.5 612 Male Stall Locker Area 1 8.0 8.0 613 Female Staff Locker Area 1 12.0 12.0 614 Staff Washroom 1 2.5 2.5

Administrative Area Sub Total: 119.3

DECONTAMINATION AREA615 Staff Gowning Room 1 6.0 6.0

616.01 Handwashing Sink Alcove 1 2.0 2.0 617.02 Handwashing Sink Alcove 1 2.0 2.0 618.03 Handwashing Sink Alcove 1 2.0 2.0 619.04 Handwashing Sink Alcove 1 2.0 2.0

617 Soiled Receiving 1 64.0 64.0 618 Soiled Elevator 1 8.5 8.5 619 Sorting & Washing Area 1 70.0 70.0 620 Soiled Holding Room 1 20.0 20.0 621 Auto Washer / Disinfection Area 1 55.0 55.0

622.01 Cart Wash Area 1 12.0 12.0 Pass Thru Cart Washer622.02 Cart Wash Area 1 12.0 12.0 Pass Thru Cart Washer

623 Soiled Scope Room 1 12.0 12.0 624 Detergent Dispensing Room 1 5.0 5.0 625 Housekeeping Room 1 12.0 12.0 626 Staff Washroom 1 4.0 4.0

Decontamination Area Sub Total: 288.5




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Space NSM Per


ASSEMBLY & STERILIZER AREA631 Cart & Equipment Clean & Dry Area 1 25.0 25.0

632.01 Pass Thru Dryers 1 2.5 2.5 632.02 Pass Thru Dryers 1 2.5 2.5

633 Clean Cart & Equipment Holding Area 1 40.0 40.0 634 Packaging & Assembly Area 1 104.0 104.0

634A Clean Scope Room 1 16.0 16.0 635 Non-Sterile Storage 1 50.0 50.0 636 Linen Bundle Storage Area 1 10.0 10.0 637 Steam Sterilizing Area 1 38.0 38.0

638.01 Hydrogen Peroxide Sterilizing Area 1 12.0 12.0 638.02 Hydrogen Peroxide Sterilizing Area 1 12.0 12.0 638.03 Hydrogen Peroxide Sterilizing Area 1 12.0 12.0

639 Cart Cool Down Area 1 24.0 24.0 Assembly & Sterilizer Area Sub Total: 348.0

643 Sterile Stores 1 190.0 190.0 644 Breakout Area 1 25.0 25.0 645 Empty Case Cart Holding Area 1 20.0 20.0 Yes646 Full Case Cart Holding Area 1 50.0 50.0 Yes647 Clean Elevator 1 8.0 8.0 648 Distribution Area 1 15.0 15.0 649 Clean Equipment Holding Area 1 25.0 25.0

Sterile Storage & Clean Supplies Area Sub Total: 333.0

Medical Device Reprocessing Grand Total: 1,088.8

TOTAL PROGRAMMED SPACE: 4,798.5

STERILE STORAGE & CLEAN SUPPLIES




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Space NSM Per


OTHER SPACES / PUBLIC AREAS / ENTRANCES 700.01 Public Washrooms (Multi Stall) 1 17.0 17.0

700.02 Public Washrooms (Multi Stall) 1 17.0 17.0 701 Rose Ave Entrance 1 22.0 22.0 702 Discharge Seating Area 1 30.0 30.0

703.01 Vending Alcove 1 2.1 2.1 703.02 Vending Alcove 1 2.1 2.1 703.03 Vending Alcove 1 2.1 2.1

704 Wheelchair Storage 1 5.0 5.0 705 Lobby IHSC 1 140.0 140.0

706.01 Self Registration Alcove 1 1.5 1.5 706.02 Self Registration Alcove 1 1.5 1.5

707 Level 1 Lobby/Link IHSC to Centennial 1 65.0 65.0 708 Level 2 Link IHSC to Centennial 1 20.5 20.5 709 Level 3 Link IHSC to Centennial 1 57.0 57.0 710 Level 1 Link IHSC to Strathcona 1 22.0 22.0 711 Level 2 Link IHSC to Strathcona 1 39.0 39.0 712 Level 3 Link IHSC to Strathcona 1 39.0 39.0 713 Exterior Enclosed Courtyard 1 1,187.0 1,187.0 714 Data Communication Rooms 10 -



76



PART 8. REFERENCES:

8.1 Baker, R.S., Norton, P.G., et al, The Canadian Adverse Events Study: the incidence of

adverse events among hospital patients in Canada, May 2004.

8.2 Institute for Family-Centered Care, Patient and family centered hospital design: a self

assessment inventory, 2004.

8.3 Kohn, J., Corrigan, J., and Donaldson, M., , To Err is Human: Building a Safer Health

System, 2000.

8.4 Sadler, Berry, et al., Good Health Care by Design – The Hastings Centre Report, (The Fable

2 Hospital). January - February 2011.

8.5 Ulrich, R. and Zimring, C., The Role of the Physical Environment in the Hospital of the 21st

Century: A Once-in-a Lifetime Opportunity, Sept 2004.

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