hospital planning.pptx

ward management

1. PLANNING AND ORGANIZING: HOSPITAL, UNIT AND ANCILLARY SERVICES

2. INT R ODUCTION A hos p i t al establishment i s a r esi d e n t i a l whi c h p r o vides short-term and long-term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturients. It may or may ambulatory no t also p r ov i d e se r vices f or patients on an out- patient basis.

3. WHO e xpert c ommi t t ee, 1956 : ‘ Th e hospi t a l is an integral part of a social and medical organization, the function of which is to provide for the population complete healthcare, both curative and preventive, and whose out- patient services reach out to the family in its home environment; the hospital is also a centre for the training of health workers and for bio- social research’.

4. FEATURES OF A HOSPITAL 1 . A hospi t al i s an o p en s y st em which i n t e r acts with its environment. 2 . A hospi t al s y st em i s t o b e dyn a mic a n d i n e q ui l ibrium with wider social system. 3.A hospital system is not an end in itself, it must function as a part of the larger health care system. 4.A hospital system tends g r o w s, t o w a r d s elabo r a t i o n a nd i t need s t o be c om e mo r e di f f e r e n t i a t i o n i. e . as it specialized in its elements.

5. TYPES OF HOSPITAL 1. Based on Objective General hospitals Special hospitals Teaching cum Research Hospital Based on Administration, ownership, control or financial income Governmental or public Non-governmental or private Semi Govt Hospital Voluntary Agency Hospitals

6. Based on Length of Stay Short-term or short-stay hospitals (Stay less than 30 days) Long-term or long-stay hospitals: (Stay more than 30 days) Depending on Type of Medical Staff Closed-staff hospital Open-staff hospital Based on bed capacity (Size): Small hospital (Up to 100 beds) Medium hospital (More than 100 to less than 300 beds) Large hospital (More than 300 beds)

7. Based on type of care: Primary Care Secondary Care Tertiary Care By teaching affiliation: Teaching hospital Non-teaching hospital Based on system of medicine: Allopathic hospital Ayurvedic hospital Homeopathic hospital Unani hospital Hospitals of other system of medicine

8. Based on regionality: Regional District Upazila Health Complex Union Health and Family Welfare Centres Community Clinics 10. As per WHO Classification: Regional Hospital Intermediate/ District Hospital Rural Hospital

9. FUNCTIONS OF A HOSPITAL – Concerned w ith hea l th p r o motion – Preventive P ar t icip a t e wi t h c ommuni t y/p e ri p h e r al heal t h c a r e delivery systems Curative – Patient care – Includes health education Training – Continuing and on the job training Research – Health related researches

10. AIMS OF HOSPITAL PLANNING To increase utilization of hospital facilities. To increase population coverage. T o enla r g e t h e e xi s ti n g hos p i t al b y i n t r o ducin g n e w facilities. To increase productivity of hospital. Modernization of the already existing facilities. To reduce the cost of operations and maximize efficiency of services.

11. GUIDING PRINCIPLES IN PLANNING Patient care of high quality: Provision of appropriate technical equipment’s and supplies. An organizational structure that assigns responsibility and requires accountability for various functions within the organization. A continuous review of adequacy of care provided by physicians, nursing staffs and paramedical personnel.

12. Effective community orientation: A g o v e r nin g boa r d ma d e up of p e r son s who h a v e leadership demon s t r a t e d c on c e rns f o r c ommuni t y and ability. Policies that assure availability of services to all people. Participation of the hospital in community programmes to provide preventive care.

13. Economic viability: A corporate organization that accepts responsibility for sound financial management in keeping with desirable quality of care. A planned programme of expansion based solely on demonstrated community need. An annual budget plan that will permit the hospital to keep pace with times.

14. Orderly planning: Selection of a si t e l a r g e enough t o p r o vide f o r f u t u r e expansion and accessibility of population. R e c ogniti o n o f the ne e d o f u n c lu t t e r e d t r a f fi c p a t t e rns and visi t o r s and wi t hi n f o r m o v em e n t o f s t a f f , p a t i e n ts efficient transportation of supplies. Medical technology and planning: D e v el o pme n t in m e di c al t echnology is t aki n g plac e so sophisticated technology rapidly that now the use of determines the professional status.

15. DIVISIONS OF A HOSPITAL Administration division Outpatients’ division Outpatient clinics Pharmacy Emergency reception Diagnostic services division Laboratories Radiology (diagnostic) Therapeutic services division Physical Therapy Radiology (therapeutic)

16. Internal medical treatment division Operation Theatres Intensive Care unit Maternity section Central Sterilization Department Inpatient division Patient wards Nursing station Work area

17. General service division Kitchen Laundry Storages Workshops Mechanical services Mortuary Security Parking Landscaping

18. HOSPITAL PLANNING TEAM The hospital consultant: He should be from the medical field. He helps in locating departments, rooms, and utilities, equipment’s and service in a manner that ensures the better patient care and smooth functioning of administration. The core group: It is composed of hospital consultant, two medical administrative personnel and, financial experts who work without other member in early stage, but later the core team has to be enlarged as the project is progressed and once clinical service are taken up.

19. The architect: Architect must have enough technical knowledge about planning layout of hospital. The role of architect is site evaluation, cost estimation, drawing design, list of movable and non-movable equipment, engineering service and construction documentation. Engineers: Engineer in hospital mainly deals with electrical, mechanical and plumbing section. Engineer check the materials used in the construction and other equipment required in term of quantity and quality. They discuss with team and negotiate in the market.

20. Hospital administration: He is one of the important members of the core group to give his valuable suggestion regarding the plan. He is kept informed about the details of planning at every step. His role is to guide, give suggestions, selecting equipment and other materials, formulate policies, procedure and strategies and other matters related to development of hospital.

21. STEPS IN HOSPITAL PLANNING

22. Preliminary survey: To determine the character, needs and liability towards community to which the hospital is going to provide services. Various points in survey are : size of community economic status in general extent of availability of health service occupation and income of community need of health services transport system commonly used general attitude of people towards health and health service

23. There are certain characteristics which make people turn away from a hospital: Building not constructed as a hospital hospital not clean hospital is inaccessible or is in poor location because of security risk, nuisance or parking facilities inadequate medical care, staff and equipment limited service non availability of 24 hours service Preliminary survey is very necessary, as it gives a basic idea of what is to be done based upon the needs of the community it is going to serve.

24. Study of existing hospital: This study should be comprehensive and involve both short- and long-term needs and objectives. It should cover the following areas: bed capacity of the institute physical condition hospital occupancy bed ratio volume and kind of hospital service quality of facilities and service This study will help the core team to understand the strength and limitation of existing facilities and also facilitates the planning of the hospital.

25. Study of required staff and service: The consultant or the committee must make a study of human resources, doctors, nurses and other professional staff required for the proposed hospital. It is generally agreed that in addition to traditional service such as internal medicine, general surgery, pediatrics, obstetrics and gynecology, specialists in the discipline of eye, ENT, dermatology, radiology, pathology, urology must be provided.

26. The architect should make the estimation of the cost of the project. The area needs for financial planning are construction, equipping and furnishing the hospital. The funds should be planned in excess keeping in view that the price will hike.

27. Expens e s on funds: s a laries and w a g es, Operating ac c ou n t of repayment o f loans, p a y m e n t of i n t e r e s t and other ope r a tional and mai n t e nance e xpen s es init i al s t a g e a r e d u ring this the r e v e n u e s . Th e r e higher than shoul d be p r op e r plann i n g and di s tr i b u t i o n o f f u n d s to prevent loss to the organization.

28. Equipment and material planning: A equipment list is compiled and reviewed by administrator and departmental staff. This information also helps in financial planning. Material management should be done in a such a way that the resources are available always in a good condition and adequate quantity so as to facilitate proper care to the client.

29. Patient Bed planning: It depends on the size of the community around the hospital. In cities more bed required because of increasing urbanization. Th e bed privacy planning should provide b e t w ee n the bed s and enough space between each bed to give patient a conducive environment.

30. Site selection: Land selection: There must be enough land for constructing a hospital. Plentiful land should be available for future impor t a n t f ac t o r s in expansion of the hospital. Soi l s e lec t ion: Th e t w o soil selection is subsoil water level and structure of the soil. It will help to determine the bearing quality of the soil.

31. Public utility: Availability of public utility should be considered such as water supply, sewage disposable and electricity. Water supply: 300-400 liter /bed/day Electricity supply: 1kw/ bed/day (include every department) Sewage disposable: liquid effleurage same as water consumption per day and solid disposable 1 kg /day/bed.

32. Circulat i o n : util i ty and succes s o f the hospi t al d e p e nd s on circulation route within and outside the hospital. Internal circulation: the departments should be interrelated with in the hospital. Ex t ernal c i r c ul a tio n : onl y on e e n t r ance a n d on e e xi t f or hospital to avoid traffic. P arkin g f acilit y: a d e qu a t e par k ing f acili t y f o r p a ti e n t visi t o r s and ambulance is considered.

33. PATIENT CARE UNITS Planning a Patient Care Unit Patient care unit is defined as a part of the hospital which is designed in a specific manner to provide care to specific types of patients. e.g., General wards, Intensive Care Unit, Coronary Care Unit, Burn Unit, Paediatric Unit, Causality, Neurosciences Unit etc.

34. An ideal patient p r o vide the be s t care unit f acili t ies shall and optimal work environment which eventually will lead to high quality care provision.

35. Advantages of Proper Planning of Patient Care Unit It enhances the work efficiency of staff. It meets the basic and functional requirement of the hospital. I t in c r eases a n d f acili t a t es nu r s e p a tie n t i n t e r action a n d hel p s in standardizing the care. It gives aesthetic look to the hospital. I t help s i n me e t i n g e xpec t a t i on s of the p a t i e n ts th r oug h g ood environment during their stay. I t help s i n r educing f a t i g u e f ac t o r among the st a f f i f p r operly planned.

36. Types of Patient Care Units The designing of the units should be in such a way that it should facilitate the nurse for better observation of her patients. The design, type, location, physical facilities and layout should help in smooth running of the ward functions. The capacity of the unit i.e. bed occupancy should be based upon type of conditions of patient, requirements, availability of doctors, and staff available.

37. CIRCULAR PATTERN

38. RIGG’S PATTERN

39. CROSS PATTERN

40. Elements of Planning Patient Care Units Size and shape of the unit Patient's room: General, private or semi-private Treatment room Sluice room (store room) Nurses' station

41. Requirements in Patient Care Units Medication trolley having an ampoule cutter, syringes, needle burner, water for injection, nebulizer machine, kidney dish etc. Crash cart for the emergency management with all the articles like oxygen catheters, suction catheters, emergency drugs, laryngoscopes, endo-tracheal tubes, defibrillator along with pads, E.C.G. electrodes, water soluble jelly, ties, syringes, kidney dish etc. Various containers having different identification for proper waste segregation and disposal as per the hospital policy.

42. Spacious bathroom and toilet facility having bedpans, urinals and pint measures for the bed ridden patients and urine measurement. Visitor's room for the patients' visitors and attendants during the visiting hours. It should not be too noisy that it disturbs the other patients on the unit. Diagnostic room for urine analysis and for the other sample storage. Dietary trolley for the patient's feed, naso-gastric tubes, feeding glass, feeding syringe.

43. Ward/Unit Management Help the ward in charge to carry out her/his work or acts as ward in charge during their absence. Mai n t a in g en e r al clea n liness o f the w a r d an d the s a ni t a r y annexure. Supervise the duties of group "D" employees and guides them and report accordingly. Writes the diet register and supervise the distribution of diet and report if any, necessary. Maintain scheduled poisonous drug registers. Supervise nursing care and other tasks carried out by the students.

44. Maintain duty room trays , sterilize instruments and see that procedural trays are in readiness. Take over from duty of the previous, new and serious patients, instruments, supplies, drugs etc. and handover the same accordingly. Maintain all the records pertaining to the ward/unit. a. Maintain case papers, investigation reports etc. Mai n t ain v i t al sig n chart s , i n t a k e- outpu t ch a rts a nd special charts if necessary. Take special care of medico-legal case papers and records. Write day and night orders and maintains ward statistics. other

45. Floor plans A floor plan is a drawing to scale, showing a view from above, of the relationships between rooms, spaces, traffic patterns, and other physical features at one level of a structure.

46. Emergency department EDs need to be placed in an area of the hospital that is easily accessible to Emergency vehicles entering the site. Emergency department needs to be essentially situated on ground floor, as near as possible or in front of entrance gate of the hospital. The overall size of the ED will depend on the volume and scope of services provided.

47. Entrance and reception area: Conceptually, it is desirable to have three separate areas with separate entrance for casualty services, outpatient services and indoor services. It must have proper sign board which can be illuminated at night or can have adequate lighting for easy visibility. Not to have other human traffic. Reception need to be situated at the entrance, clearly visible & reachable without blocking human or trolley traffic. Entrance to casualty area should be broad enough to permit two ambulances.

48. Waiting Area: Adequate sitting accommodation, drinking water, toilets, telephones, public address system Space for trolleys & Wheel Chairs. When the patient is brought to casualty by an ambulance, taxi, private car, stretcher, staff at reception counter should quickly arrange for wheel chair or trolley depending on the situation. Crash cart The waiting area should measure at least 4.4 m2 / 1000 attendances per annum.

49. Triage: The minimum acceptable floor area per Triage/Assessment Cubicle is 16meter sq. Minimum combined Reception and Triage area must be 1.8-meter sq. /1000 patient attendances per annum.

50. Resuscitation Area: Area for immediate care of patients and victims in cardiac arrest, airway and breathing and circulation compromise. a r ea c onsi s ts of t w o or Th e ‘ R esu s ’ more resuscitation beds (sometimes upto 12) with all resuscitative equipment (monitors, i n tuba t i o n & d e f i brill a t o r s, surgical ai r w a y , e q uipme n t) a v ai l able a t an a rm ’ s di s t ance including pediatric resuscitation kits. All priority I patients are managed here.

51. Space for Security & Police Constable: Casualty department is likely to get victims of assaults, riots etc. As medicolegal cases need to follow prescribed procedural formalities, it is necessary to have police constable’s counter at the waiting hall entrance.

52. Space for patient brought dead: Keep the body at a place which is not visible to other incoming patients & persons waiting in the waiting hall. In the event of disaster, number of dead bodies is likely to be more. After labelling the bodies, they may be sent to mortuary & handed over relatives or police after completing procedural formalities.

53. Examination Room: Two or three examination tables separated by curtains are available. It should be possible to carry out life- saving first aid procedure like cardiopulmonary resuscitation on this table before sending the patient to observation ward. Treatment Room: Minor procedure like catheterization, suturing of small wounds, dressing, bandaging etc. can be carried out.

54. Observation Area: Depending on the patient load 4 to 8 beds may be placed in this area. Those patients may be kept in observation ward who are waiting to be evaluated by a particular speciality, waiting for emergency medical procedure etc. Storage Space: Linen, d r essing stored. c onsumabl e i t ems l i k e dr u gs, m a t e r i a l, e q u i pme n ts c an be Min i m u m f l oo r a r ea f or s t o r a g e is a t t e n dances 2.2 m e t e r s q . / 1000 p a ti e n t per annum.

55. Operation theatre An operation theatre is the "heart" of any major hospital. An operating theatre, operating room, surgery suite or a surgery centre is a room within a hospital within which surgical and other operations are carried out. The aim is to provide the maximum benefit for maximum number of patients arriving to the operation theatre. Both the present as well as future needs should be kept in mind while planning OT.

56. Central corridor plan

57. Specialty grouping plan - The "specialty grouping" plan is simply a variation of the hotel or race track plan, in which ORs are grouped by specialty (e.g., neurosurgery, general surgery), each with its own closely associated clean storage areas and, in some cases, each with its own soiled instrument work area.

58. Structure of OT OT can be divided into clearly demarcated four zones to indicate specific precautions to be practiced before crossing the border of each zone. This zone indicate: Relatively clean area Absolutely clean area Absolutely clean & aseptic area Unclean area

59. Outermost Zone: This zone is called as protective zone. This zone is clean, but not sterile area. In this area following activities are housed: Administrative area Office of operation theatre superintendent or manager Office of the anesthesia chief Space for surgeons to write or dictate operation notes Frozen section biopsy laboratory Dark room for developing X-Ray films Changing room Surgeon’s room Trolley bay Waiting area for relatives

60. Intermediate Zone: This zone is clear, but not sterile. Entry for people bringing supplies, patients etc. can be permitted after changing foot- wear. It includes following: •Storage area for equipment's & instruments Supply received from central sterilization & supply department Medicines, intravenous fluids, other consumable items and linen Post-operative recovery room having 1 to 2 beds per operating table •Preoperative waiting patients

61. Inner most zone: This area is kept absolutely clean & sterile. No one other than persons actually involved in doing surgery or assisting in surgery should be allowed to enter. In teaching hospitals 4 to 5 students are permitted after changing. This zone includes: operating room (minimum size 18ft* 20 ft) Anesthesia induction room Patient holding areas Scrub area for surgeons & nurses

62. Unclean zone for disposal: This zone is used for temporary storage of: •Used linen •Used instruments •Waste material •Cleaning gloves, instruments

63. Sub areas in OT Pre-operative check in area (reception): This is important with respect to maintaining privacy, for changing from street clothes to gown and to provide lockers and lavatories for staff. Staff room: Men and women change dress Holding area: Planned for IV-line insertion, preparation, catheter / gastric tube insertion, connection of monitors, & shall have O2 and suction lines. Facility for CPR should be available in this area.

64. Post anaesthetic care units (PACU): These should contain a medication station, hand washing station, nurse station, storage space for stretchers, supplies and monitors / equipment and gas, suction outlets and ventilator. Additionally, 80 sq. ft. (7.43 sq. m) for each patient bed, clearance of 5 ft. (1.5 m) between beds and 4 ft. (1.22m) between patient bed sides and adjacent walls should be planned. Sanitary facility for staff: One wash basin and one western closet (WC) should be provided for 8-10 persons.

65. The anesthesia gas / cylinder manifold room / storage area: It should be in a cool, clean room that is constructed of fire-resistant materials. Conductive flooring must be present but is not required if non inflammable gases are stored. Adequate ventilation to allow leaking gases to escape, safety labels and separate places for empty and full cylinders to be allocated. Rest rooms

66. Idle OT should have following characteristics: Operative room for routine work (18ft * 20 ft). Super specialty departments like neurosurgery & cardiac surgery require bigger area i.e. about 500ft to 600ft, as these theatres need to have more equipments. Effecting air conditioning should maintain the temperature as per requirement. Efficient & sincere paramedical & non-medical staff to carry out necessary instructions promptly.

67. Walls: Smooth wall which is impermeable to moisture having finish of epoxy resin or vinyl sheets type of painting. Doors: Main door to the OT complex has to be of adequate width (1.2 to 1.5 m). The doors of each OT should be spring loaded flap type, but sliding doors are preferred as no air currents are generated. Flooring: The flooring must be slip resistant, strong & impervious with minimum joints or jointless conductive tiles/ terrazzo, linoleum etc., The recommended minimum conductivity is 1m ohm and maximum 10m ohms.

68. Isolation ward An isolation facility aims to control the airflow in the room so that the number of airborne infectious particles is reduced to a level that ensures cross- infection of other people within a healthcare facility is highly unlikely.

69. Types of Isolation Rooms: Airborne infection isolation (AII)/Negative pressure isolation refers to the isolation of patients infected with organisms spread via airborne droplet nuclei <5 μm in diameter. These include patients suffering from measles, chickenpox, tuberculosis, etc. Protective environment (PE)/Positive pressure isolation is a specialized area for patients who have undergone allogeneic hematopoietic stem cell transplant (HSCT), etc.

70. Planning Premises of Isolation Rooms Location: The isolation rooms should be located at one end of ward. Isolation wards for infectious cases to be kept out of routine circulation. Number of beds for isolation beds: About 2.5% of the beds of a large hospital in a special unit would probably be adequate except during periods of unusually high demand.

71. Space: An isolation room has to provide uncluttered space around the bed for equipment and the increased number of personnel involved in emergency care. A room area of about 22 m 2 is adequate within an isolation unit. Adequate number of wash hand basins should be provided within the patient care areas and nursing stations with a view to facilitate hand washing practice. Separate arrangements for garbage and infectious waste removal from wards and departments in the form of separate staircases and lifts.

72. One to two standard isolation rooms per ward unit should be planned throughout the hospital with wash basin in room, shower, toilet and wash basin in bathroom. Door with self- closing device and a normal window AC to be provisioned for these rooms.

73. Bed Management System Bed centers should be at least 3.6 m apart. Minimum possible number of beds should be kept in a cohort as to prevent chances of cross-infection. Spacing must take account of access to equipment around the bed and access for staff to hand-wash facilities. Provision of permanent screens between bed spaces should be there as an aid to prevent frequent traffic and thus the potential for microorganism transfer.

74. Intensive care unit Intensive Care is a dedicated unit for critically ill patients who require invasive life support, high levels of medical and nursing care and complex treatment. The intensive care unit provides a concentration of clinical expertise, technological and therapeutic resources which are coordinated to care for the critically ill patient.

75. Space programme Th e g u idelines f o r ICU des i gn s hou l d b e b ased on cri t eria s e t by ISCCM, India given below. L e v e l I , si x t o eig h t bed s — smal l d i s trict hospi t al, sma l l pri v a t e nursing homes, rural centres. Level II, six to eight beds — larger general hospital Level III, 10 to 16 beds-tertiary level hospitals The new level III ICU are further planned based on type/ usage of ICU i.e. general or speciality-based like medical, cardiac, neurosurgical, transplant, paediatric. The location of ICU should be close to the operation theatre, imaging diagnostic services and laboratory.

76. The floor spaced per ICU bed can be planned 3 m X 4 m (12 sq. m) to maximum of 5 m X 5 m (25 sq. m) based on consideration of application of ICU including services and equipment positioning. The outside environment viewing window for each patient bed is strongly suggested as part of the design. A minimum of one to two metre distance should be kept between two beds as per NABH standard.

77. The height between floor and false ceiling should be three metres . The ideal single leaf door size for each ICU cubicle or separate room having clear space of 2.1 m X 1.2 m height and width with wide view panel for visual access to patient is suggestive. It is indicative to have 12-16 beds per ICU area for optimal design considering all essential support functions. The total area of ICU should be 2.5 to 3 times the total space of ICU beds which includes supply and service corridor/ passageway of 2.4 m width . At least one patient cubicle as isolation with anteroom facility having negative pressure is recommended within the ICU.

78. The overall design of the ICU should consider. The other essential areas in patients, staff and visitor movement, storage space of equipment and medicine, location of essential areas like nurse station, clean and dirty utility etc. Floor plan of ICU may contain nourishment room, stat lab, linen storage, staff lounge and utility services.

79. The civil structure The walls for separate room should be finished plaster wall of six-inch block/ brick wall. The wall finish should be durable, tough wearing and should withstand water and routine cleaning by chemicals. Two coats of anti-bacterial paint with approved shade on primer applied wall and ceiling will help to kill harmful bacteria that can cause hospital superbugs, including MRSA and E. coli.

80. Imperforated false ceiling with good acoustics and monolithic finish need to be installed in ICU area. The flooring of ICU should be smooth, seamless and durable as there will be heavy movement of patient beds and medical equipment like portable X-Ray. The flooring should be able to sustain wet things like water, chemical solutions without losing its characteristics. As per International Noise Council, the noise level in an ICU should be under 45 dB in the daytime, 40 dB in the evening and 20 dB at night .

81. Lighting The lighting distribution illumination control should be planned based on routine physical examination ( around 350 lux), during procedure of patient ( around 1000 lux ), during night time ( around 5 lux ). The emergency lighting should be connected to few light fixtures to avoid a complete black out scenario. The energy conservation aspect like LED lights and more natural daylight should also be considered.

82. Air-conditioning, heating, ventilation services Sterile air having low velocity with 21-24 C should be planned. The central air conditioning system or ICU specific air conditioning system has to be planned such that for ICU cubicle the requirement of six minimum air changes/hour with two minimum outside air changes/hour having positive pressurization. It is better to have dedicated air handling unit (AHU) having 99% efficiency down to five microns for each ICU unit. The fresh air for AHU unit must not be located near potential contaminated air like Kitchen exhaust hood, vehicle parking area or laboratory hood.

83. Water supply Water supply inside the ICU with sufficient pressure can be broadly classified into three types i.e. domestic soft water (hot and cold) for sinks and scrubs, RO water for dialysis port and for drinking purpose and treated sewage water for flushing in commodes. The provision of hand free sinks having hot and cold-water facility at major functional area like nurse station, clean and dirty utility and ICU with cubicles has to be planned.

84. Piped medical gas system Each patient should have provision for oxygen, vacuum outlet and compressed air outlet. Audible and visible low- and high-pressure alarms must be installed both in the ICU along with manual shut- off valve provision for each medical gas system.

85. Firefighting and detection system The National Building Code (NBC) has given norms on fire-related infrastructure like installation of extinguisher, sprinkler and alarm, water storage tank and pump capacity based on building height and plot area. In high rise building where ICU is located, the fire escape routes should be clearly indicated. Location of various types of fire extinguishers should be placed at prominent place. Smoke, heat sensors, sprinklers, manual call points and hydrant systems should be tested on a regular basis.

86. ANCILLARY SERVICES Hospital ancillary services are those supplemental or auxiliary services that are provided to patients in order to support the diagnosis and treatment of conditions. Ancillary services refer to health care services provided exclusive of room and board. Ancillary departments form the backbone in the functioning of a tertiary care hospital without which doctors, dentists, and nurses would not be able to function effectively.

87. Ancillary services can be divided into three categories- Diagnostic Custodial Therapeutic Dia g n o s tic hosp i t al ancill ar y se r vices m a y b e p r ov i de d i n the hos p i t al i n the c ase of r adio l og y , audiol o g y , cli n i c al lab se r vices se r vic e s . Custodial hospice, nursing and pulmonary testing home services and home health ancillary include se r vice s . Therapeutic services include physical therapy, occupational therapy, speech therapy, radiation therapy, nutrition and weight management. Many physicians provide in-office ancillary services.

88. Importance of Ancillary Healthcare Service Providers It helps clinicians organize into Integrated Practice Units. Ancillary services enable physicians or organizations to measure the outcomes. It promotes a shift towards bulk payments for care cycles. Ancillary care providers facilitate the integration of care delivery systems by defining the scope of services and concentrate volume in a few places. These services also play a vital role in expanding the geographic reach of healthcare delivery. It helps build a supporting information technology platform.

89. Advantages of Ancillary Services Ancillary care services comprise around 30% of the total medical spending, making it essential for every healthcare service provider. These services help reduce the core workload as all the secondary care is facilitated by ancillary providers. Additionally, these providers are cost-saving and prudent, making them an ideal alternative to the outpatient physician and hospital services.

90. 1. Administrative Resources Ancillary services for primary care play a vi t al r ole in c o s t s . s a ving time and T h e p r ov i d e r s, indepen d e n t l y , a n d r e c ei v e ope r a t i onal instead of work for payment operating hospitals p r oc e s s in g , collections, r esolu t i o n manageme n t, and a p peals from hospitals.

91. Increased Patient Access By connecting to a wider patient base insured under worker compensation, group health, secondary group health, auto medical, and medicare plans. Credentialing Ancillary care allows the hospital to be in a company of well-skilled experts and technicians. These services are certified in providing stringent quality and control standards. They regularly monitor the network to ensure the patients are receiving excellent-quality care.

92. 4. Education and Support Ancillary service providers are medical experts too, and readily educate the patients and payers ad v a n t a g es of on the ho w their services can bear a change in the overall clinic operation.

93. Challenges in Implementing Ancillary Technology in the Healthcare Sector Lack of Interoperability Absence of compatibility in the computers or systems utilized by ancillary care providers for coding, billing, and monitoring patient care. Patient satisfaction, utilization management, and adequate care are some of the major aspects that can affect the service, providing the ability of ancillary care providers.

94. Lack of Consumer Ability to select delivery of care The large deductible of patients is a substantial influence on their decisions on how and where to get the care and how much money do they wish to spend. From the price at which they need an x-ray to the location at which they want to receive physical therapy, consumers nowadays are more conscious and want the best options at the best price.

95. Limited Leverages If ancillary providers operate as independent businesses, they will have to face limited leverages. Healthcare providers want to pay less for materials and better business solutions, which is possible only if ancillary providers agree on sharing the same goals and increased authority.

96. Other ancillary services: Medico-legal/post mortem Ambulance services Dietary services Laundry services Security services Waste management including Biomedical Waste Ware housing/central store Maintenance and repair Electric Supply (power generation and stabilization) Water supply (plumbing)

97. Heating, ventilation and air-conditioning Transport Communication Medical Social Work Nursing Services CSSD - Sterilization and Disinfection Horticulture (Landscaping) Refrigeration Hospital Infection Control Referral Services

98. RESEARCH ARTICLE Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they? A study was conducted by Bhavya Balasubramanya, Catherin Nisha, Naveen Ramesh, and Bobby Joseph in 2016 to study the morbidity profile of the staff working at ancillary departments of a tertiary care hospital in Bengaluru, Karnataka, India. They conducted study in a 1,200-bedded tertiary care hospital in Bengaluru, Karnataka, India. Annual medical check-up (AMC) for all the staff working at the ancillary departments has been started in recent years and is provided free of cost and during working hours. A total of 150 employees from ancillary departments underwent AMC in the year 2013. The most common morbidities were diabetes mellitus (11%), hypertension (10.6%), musculoskeletal disorders (9.3%), surgical problems (8.6%, hemorrhoids, varicose veins), and dental caries (6.6%). On stool microscopy, 12% of the dietary workers showed ova/cyst. There was a significant positive correlation between age and the number of chronic morbidities (P < 0.01). The study concluded that lifestyle disorders such as diabetes mellitus and hypertension were the major morbidities among the staff in the ancillary departments of the hospital. Regular follow-up, adherence to medication, and lifestyle modifications in terms of diet and exercise were ensured.

99. SUMMARY AND CONCLUSION Although to treat the patients, hospitals need to have a team of experienced and professional doctors, but the other factor that plays a great role in treating the patients is the infrastructure of the hospital. The infrastructure design of the hospitals plays a crucial role in the safety of the patient. No matter how much money is spend on the infrastructure of the hospital because one cannot renovate the hospital so frequently. Therefore, infrastructure must be kept in mind before building a hospital. The infrastructure of the building should be designed in such a way that it looks attractive, functional and safer for the patients. This is why hospital planning and designing plays a crucial role.

100. REFERENC E S Shabnam Masih. Essentials of Nursing Management in service and education. 2017. New Delhi. LOTUS Publishers. Second edition. Pg. No. 83-94. PubMed. Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they? Available from https:/ /w w w.ncbi.nlm.nih.gov/pmc/articles/PMC4922276/ Journal ListIndian J Occup Environ Medv.20(1); Jan-Apr 2016PMC4922276 [cited 29 Aug 2020] PHYSICAL LAYOUT TH E OPER A T I N G R O O M . A v ailable f r o m https://rajnursing.blogspot.com/2018/09/physical-layout-operating-room.html [cited 9 Sep 2020] PubMed. Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they? Available from https: //w ww .ncbi.nlm.nih.gov/pmc/articles/PMC4922276/ [cited 10 Sep 2020]