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Healthcare Facility Planning Tools and Guidelines Volume 2, Number 4 |
Fall 2009
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In This Issue
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Planning an Outpatient Pharmacy: Small, Medium, or Large? Incorporating the Parking Garage Into Disaster Planning Generic Administrative Office Suites Provide Efficient Space Utilization Estimating the Space Required for Outpatient Physical and Occupational Therapy |
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Feature Print (PDF) |
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Compare the actual room-by-room space programs
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Planning an Outpatient Pharmacy: Small, Medium, or Large? BACKGROUND Most outpatient pharmacies that are located within a hospital or in an ambulatory care center (on or off-campus) fall into one of four categories ― minimal, small, medium, or large. Assuming that outpatient demand has been established based on the availability and convenience of similar services and potential competition from commercial pharmacies, the primary determinant of an outpatient pharmacy’s size is the average number of daily prescriptions (scripts) that will be filled during the busiest eight-hour shift. This generally determines the numbers and sizes of rooms or areas and overall gross square feet (GSF) as follows:
The actual room-by-room space programs can be compared by following this link.TYPE OF SPACES REQUIREDRegardless of the number of daily scripts, most outpatient pharmacies require the following spaces:
ADDITIONAL SPACE FOR LARGER OUTPATIENT PHARMACIES
An outpatient pharmacy should be located in an area with a high volume of outpatient traffic and the entrance should be convenient and highly visible from the main circulation corridor. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
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In the News |
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Incorporating the Parking Garage Into Disaster Planning OVERVIEW
In what is believed to be the first training exercise in the country, a team of healthcare professionals at Stanford (California) Hospital and Clinics turned the first floor of a parking garage into a drive-through emergency room in hopes of creating a more efficient way to treat a large number of patients during an influenza pandemic or other emergency. The hospital’s medical director for disaster planning believes that drive-through triage can serve as a blueprint for hospitals nationwide and across the globe. During the flu season, emergency departments are bursting at the seams as people with limited health insurance use the emergency department as their primary care physician. According to Dr. Eric Weiss, medical director of disaster planning at Stanford Hospital and Clinics and Lucille Packard Children’s Hospital: “We have to have a new mechanism to take care of large numbers of patients during a pandemic and I think that this is going to be it.” HOW IT WORKS Stanford physicians at first thought of creating a tent outside the emergency department but discarded that idea since it would require people to stand outdoors during the winter. Since everyone arrives by car, the drive-thru idea seemed like a great way to use the automobile as a self-contained contamination enclosure. People are comfortable in their cars and if they are not felling well, they don't have to get out and walk. The volunteer patients made their way through the drive-thru triage just as they would at the emergency department. As cars entered the parking garage, patients registered and were given paperwork. They then drove through one of two lines and stopped at the first station, triage, where nurses and emergency department technicians checked for vital signs ― temperature, heart rate, blood pressure, and respiration ― and gathered the patient's medical history. Physicians, nurses, and other staff wore gowns and gloves throughout the exercise. From there, patients drove another 10 to 15 feet for a medical screening exam where physicians reviewed the symptoms and made a diagnosis. Finally, they were discharged or admitted to the hospital. CONCLUSION During the exercise, the team observed and evaluated the process. Over the next several days, they reviewed the data to try to find ways to streamline the process. The results will likely be published in a journal and begin to spread throughout the medical community. From an article in the San Jose News by Mark Gomez on June 12, 2009. |
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Trendline Print (PDF) |
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Generic Administrative Office Suites Provide Efficient Space Utilization BACKGROUND
As many of these departments are being forced to resize their staff in response to cost containment pressures and changing skill requirements, vacant offices and workstations are often scattered throughout the organization. At times, growing departments may need to pack multiple people into a single office, while shrinking departments have surplus space. Many departments also have dedicated conference rooms which, although infrequently used and inappropriately located, were not available for use by other hospital staff. CURRENT TREND Space for administrative staff ― not involved in day-to-day patient care ― is increasingly being centralized into generic administrative office suites with a central reception area, groups of conference rooms, shared office equipment, and flexible workstations. This configuration provides the most efficient space utilization and ensures that space is equitably allocated and distributed among the departments and services that need it at any given time. The intent is to assign offices and workstations according to the immediate need allowing for the flexibility to reassign the space on a periodic basis as demand changes and staffing levels fluctuate. This prevents staff from becoming overly territorial about their space. With more sophisticated information systems, space can still be charged to department or cost center budgets based on use and conference/classrooms scheduled centrally based on daily demand. LOOKING TO THE FUTURE Imagine the scenario where every member of the healthcare administrative staff is assigned mobile computing devices such as a laptop computer, personal digital assistant (PDA), or cellular phone ― in lieu of an office, desk, file cabinets, book shelves, and hard-wired computer and desk phone. Whether the staff member is an administrator, nurse manager, financial analyst, surgery scheduler, information technology programmer, or a pre-registration clerk, he/she either works from home (when management objectives can be quantified), works in a central administrative office suite (or building) in an assigned office or cubicle, or works directly at the point-of-care, or point-of-service, to facilitate the needs of the organization’s patients and other customers. Using wireless technology, all staff can access the institution’s secure Intranet and external Internet to input, retrieve, review, analyze, and store all data and information required to fulfill the requirements of their specific role within the organization. In this paperless environment, all day-to-day communication occurs electronically via e-mail, voice mail, or video conference, and routine management reports and information ― such as time sheets, budgets, and personnel assessments ― are all created, transmitted, and stored electronically. This scenario seems somewhat futuristic when envisioned for the healthcare industry even though for many other industries this is the standard operating procedure. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
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Technology |
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OVERVIEW Pulmonary function testing measures the function of lung capacity and lung and chest wall mechanics to determine whether or not the patient has a lung problem. Pulmonary function testing is commonly referred to as "PFT" and such tests are usually performed by Certified or Registered Pulmonary Function Technologists (CPFT or RPFT) who are credentialed by the National Board for Respiratory Care (NBRC). When a patient is referred for pulmonary function testing, it means that a battery of tests may be carried-out including simple screening spirometry, static lung volume measurement, diffusing capacity for carbon monoxide, airways resistance, respiratory muscle strength, and arterial blood gases. Spirometry is the standard method for measuring most relative lung volumes; however, it is not capable of providing information about absolute volumes of air in the lung. Thus a different approach is required to measure residual volume, functional residual capacity, and total lung capacity. Two of the most common methods of obtaining information about these volumes are gas dilution tests and body plethysmography.
HOW IT WORKS The plethysmography test is done by enclosing the subject in an airtight chamber often referred to as a body box. A pneumotachometer is used to measure airflow while a mouth pressure transducer with a shutter measures the alveolar pressure. The most common measurements made using body plethysmographs are thoracic gas volume and airway resistance. Using body plethysmography, doctors can examine the lungs' resistance to airflow, distinguish between restrictive and obstructive lung diseases, determine the response to bronchodilators, and determine bronchial hyper reactivity in response to methacholine, histamine, or isocapnic hyperventilation. SPACE REQUIREMENTS The dimensions of the body box are approximately 30" by 35" by 71" high with a footprint of about 7.5 square feet. The recommended area for the body box itself and an adjacent computer console is 54 square feet (7' by 9') to allow for opening the body box door. THE GOLD STANDARD The Body Box 5500 Series (Morgan Scientific, Inc.) is the gold standard in pulmonary function testing. It is a precise, elegant pulmonary function instrument that is designed to measure all the thoracic gas volume, whether in communication with the airways or not, to provide a true assessment of absolute lung volume. Patients can easily exit the body box should they feel uncomfortable and there is easy communication between the respiratory therapist and the patient for reassurance and testing instructions. The test can be carried out quickly with the least inconvenience to the patient. The body box interior is quiet, bright and easy to decontaminate. back to top Additional information on the Body Box 5500 can be found at Morgan Scientific. |
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Rule-of-Thumb |
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Estimating the Space Required for Outpatient Physical and Occupational Therapy |
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Note: DGSF represents the "footprint" of a department or functional area and includes the net square feet of the individual rooms as well as the space occupied by internal circulation corridors, walls/partition, and minor utility shafts; DGSF excludes common areas such as shared public corridors and lobbies, elevator banks, stairwells, major mechanical spaces, and the space occupied by the building's exterior wall. Source: SpaceMed Guide (Second Edition). |
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Copyright ©2009 SpaceMed. All rights reserved. |
Larger outpatient
pharmacies ― such as those with more than 500 scripts per day ― may require
additional space such as:
The cars, minivans and sports-utility vehicles began lining up and slowly
moving forward, just as they would at a busy fast food drive-thru. But there
weren’t any burgers or fries on the menu. Instead, drivers and passengers
were examined by a team of Stanford doctors and nurses, all without getting
out of their cars.
The traditional
healthcare facility has many departments involved in the administration and
management of the organization in accordance with policies established by
the governing board. Most of these administrative services use generic
office space with a mix of private offices, open or partially-enclosed
cubicles, and open workstations to accommodate different hierarchies of
staff dictated by the organizational structure and peak-shift staffing.
Patient traffic to these areas is rare.
Body
plethysmography is a very sensitive lung measurement used to detect lung
pathology that might be missed with conventional pulmonary function tests.
This method of obtaining the absolute volume of air within one's lungs may
also be used in situations where several repeated trials are required or
where the patient is unable to perform the multibreath tests. The technique
requires moderately complex coaching and instruction for the patient.