Dr.Sharad H. Gajuryal

JR,MD(Hospital Administration)

BPKIHS,Dharan

INPATIENT DEPARTMENT

Basically People go to hospital for two purpose; either seek out door consultation in OPD or for admission in hospital. Inpatient ward are for those patients who need treatment under healthcare personal’s supervision.

Patient are admitted in Inpatient Ward for short and long term depending on severity of their disease.

Inpatient Department consists of a wards with Nursing Station, Beds, and all other facility & services necessary for good patient care.

It is one of the important aspects of hospital as every ratios and calculation for hospital planning and designing process is based upon the no. of bed it consists.

To provide highest possible quality of medical and nursing care.

To make a provision of essential equipment, Drugs, and other material required for patient care.

To provide comfortable and desirable environment to patient on temporary substitution of home.

To provide facilities for visitors.To provide suitable atmosphere for highest

possible degree of job satisfaction among healthcare personal and high level of patient satisfaction.

To provide opportunity for education, Training and research

Function of Inpatient Department

The IPD forms 33%-50% of the structure of hospital construction and most of the equipment and staffs are in this department with maximum amount of patient care, training, medical teaching and research concentrated in this department . IPD is the area which gives maximum output of services and name and fame to the hospital too and so maximum vigilance is required to prevent litigation and to gain patient satisfaction.

Features of IPD

There are different types of ward design;1.Open ward or Nightingale Ward2.Rig’s Pattern Ward (Unilateral or

Bilateral)3.Modified Rig’s Pattern Ward4. “T” and ‘Y” Shaped Ward5. ‘L” , ‘H’, ‘E” Shaped Ward.

Forms of Inpatient Ward:

This type of ward was designed in 1770 by Frenchman, Later it was adopted by Florence Nightingale and is known by her name. The characteristics of Nightingale ward is :

Patient Bed in two row at right angle to the longitudinal wall.

It may have side rooms for utilities and perhaps one or two side rooms, that can be used for patient occupancy when patient isolation or patient privacy is important.

Nursing Station, Doctor’s room and others facility at one end. Bathroom and WC at the other end.

Good Visibility and economical and easy to construct, plenty of fresh air & ventilation.

Nightingale Ward

Noisy and no privacy for patientRisk of cross infectionFatigue of NursesSpace between bed reduced

Disadvantage of Nightingale ward

It has got a nursing station in centre of ward, Ancillary and Auxiliary service at one end and utility service at other end. The nurse travel time has been reduced and the supervision over patients condition also improved in modified pattern of ward.

Modified Nightingale Ward

It was first made in Rigg hospital in 1910 in Copenhagen.

Ward unit is divided into small compartments separated from each other . Each compartments having 4-6 or more beds arranged parallel to the longitudinal wall. Bed may be on one side or both side of nursing station. Isolation room (1 or 2) can be kept in ward.

Advantage of RIG’s Ward /Bay Ward is there would be privacy for patient, Risk of cross infection minimized, less noisy, Isolation of infectious cases can be easier.

Rigg’s Ward

AIIMS Hospital

Disadvantage of RIG’S ward include

Communication between patient and nurse is more difficult

Direct observation of patient is difficult.More staffing requiredCostly and difficulty to maintain than Open

ward.

Abstract Changes in the design of hospital wards have usually been determined by

architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.

AuthorsPattison HM, Robertson CESourceJournal of advanced nursing 23:4 1996 Apr pg 820-6

Components of Ward Unit

Ancillary Accommodation

Primary Accommodation

Sanitary Accommodation

Auxiliary Accommodation

Primary Accommodation: It consists of single bedroom or multiple bedroom for patients and a nursing station.

Ancillary accommodation: service for direct support of treatment. Eg: portable x-ray, side lab,Pantry,Dietician service in ward, mobile pharmacy.

Auxiliary accommodation :Service in indirect support of treatment . Eg:Store, housekeeping, doctor’s room, nurse’s room, seminar –teaching room.

Sanitary accommodation : Consists of WC, Bathroom, Janitor’s room ,sluice room.

Components of ward unit

PLANNING & DESIGNING OF

WARD COMPNENTS

Hospital policy and plan Function and locationRelationship with other departmentsStaffing patternWorkflowCommunicationSafety issue Emergence of hospital infectionDignity and privacy of patient

Factors Affecting/Influcencing ward Design

Location :Away from parking and crowd area, adjacent to support and diagnostic services, should be away from mortuary.

Circulation: Vertical or horizontalVertical circulation can be arranged with less space with

central vertical spine for lifts, conveyers and stairs and pipe lines. Reduces patient errors and cross infections.

Horizontal circulation: eliminates requirement of expensive vertical transportation system. suitable for inpatient up to 300 bed strengths.

Physical Facilities

Aim of ward design: General ward :Healthy EnvironmentPediatric/ psychiatric ward- SafetyGeriatric ward- Safety/ comfortObs/Gyne ward – PrivacyICU- Nursing CareOT-Infection control

Primary accommodation:

Size of ward :depending upon type of patient , kind of nursing and manpower.

NHS,UK recommends 24 bed/wardTraditionally it’s 32(+/-)10 beds/ward

Area of ward :90 -110 sq.feet /bed (8-10 sq.meter)Distance between center of two bed -2.25 meter,not less

than 2 meter.Distance between two bed -1.25 meterWidth of corridor -2.4 meterDistance between bed end and wall-0.25mDistance between bed wall and bed nearest to side wall-

0.65 meter.

2.5 m

0.25 m

1.25 m

0.65 m Nursing Area60 sq feet/5.

5 m sq.

Modular grid-1.6 m i.e 3 grid unit for each bed space / 1.5 grid unit for toilet

Ceiling Height : at least 3 meter.,Height of suspended ceiling fan –at least 2.6 meter.

Windows: if only in one wall then it should be 20% of floor area , if multiple windows then 15% of floor area.

Corridors: the width of corridor recommended is 2.4 m to faciliate movement of trolley,bed ,stretchers

Door : should not be less than 1.2 meter wide and 2.25 m tall.

Bed side locker/cupboard-mustChair sofa/sofa cum bed- for visitorsOther facilities-depending upon

rooms(private/semiprivate/deluxe/semi deluxe)

Nurse station: should not be less than 60 sq. feet with nursing table ,sisters room and build in cup board. with provision of large glass window for observation is possible.

Doctors room :120 sq ftNurse room :120 sq feetSpace for stretcher trolley 21 sq ft Store room :200 sq ft Clean utility room -80 sq ft Sluice room -120 sq ft

Auxiliary Accomodation

Toilet with washroom/bathroom & WC-50-70 sq ft

Only WC -4-5 sq ft Only shower -6.5 sq ft Dirty utility -120 sq ft Janitors closet -7 sq ft

Recommended- urinal (1 for 16 bed ) WC- (1 for 8 bed ) bathroom (1 for 12 bed ) wash basin (1 for 10 bed )

Sanitary accomodation

Ward pantry -100 sq ft

Ancillary accommodation

Water & electricity supply :300 ltr water /bed/day round the clock supply

For electricity, Point should be carefully designed with every cubicle having switches / one industry switch for machine like portable x ray/ natural lights should be planned / provision of night light

Communication: There should be effective communication source between nurse and patient and nurse and other units.

Other Facilities

Fire safety : there must be provision for fire extinguisher ,with fire exit stairs with ramp

Ramp width-1.5 meter (1:12 feet ) ( (4.8 degree angle; 8.3% grade)

Hot and cold water supply Nurse call system ClockOxygen cylinder/suction pipe /thermometer

holder.iv stand etc.

THANK-YOU