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ARCHITECTURE
UDC 725.51
Bulakh Irina Valerievna
PhD of Architecture, Associate Professor Department of Design of the Architectural Environment,
Kiev National University of Construction and Architecture ORCID: 0000-0002-3264-2505; ResearcherID:V-4802-2018; Spin-Kod: 9274-0113
DOI: 10.24411/2520-6990-2019-10213 NEW APPROACHES TO THE FUNCTIONAL PLANNING OF HOSPITALS AND ENTRANCE
GROUPS OF MEDICAL INSTITUTIONS
The rapid development of medical technologies, methods of diagnosis and treatment, the accelerated rhythm of life of a modern person in an urbanized space, of course, requires new architectural solutions in the design of medical institutions. The need for innovative approaches begins with a viewing of the functional-planning organization of the entrance group of a medical institution. This statement is due to the fact that a shorter waiting time satisfies the patient, however, certain features of the room layout can increase the waiting time for the patient and reduce the time of admission. Speaking about the outpatient center, the increase in the duration of the intakes accordingly reduces their total number per day, limiting the workload of the center. To address this issue, it is advisable to take into account the following functional and planning features: the design of multifunctional cabinets with portable equipment; the creation of dressing rooms for patients; storage for materials in the office; centralized registration.
Multifunctional cabinets with portable equipment. In many medical institutions, doctors perform various functions in different offices. As a result, there are waves of increase and decline in patient flows, which often do not coincide for different specialized cabinets. Multifunctional cabinets with portable equipment allow you to perform any task in any room. A striking example is the department of preoperative diagnosis. Ten multifunctional cabinets with portable equipment provide greater flexibility than five rooms with ECG equipment and five laboratories. Patients do not need to wait for their turn to one office, if they can use any office.
Changing rooms. Planning a medical facility can reduce patient waiting times, including through the installation of dressing rooms at examination rooms. For example, in the tomographic center separate dressing rooms for each imaging method usually lead to their uneven use. Grouping locker rooms can compensate for waiting times and balance uneven patient flows. A group of adjacent changing rooms with lockers for patients' belongings compensate for the need to hold onto the dressing room until the patient returns.
Storage for materials in the office. Having prepared the materials at hand, the medical staff gets the opportunity to concentrate on the examination and treatment of patients. Storage of materials, instruments and even office equipment (printer) in separate and remote areas limits the time spent on their search and collection.
Centralized registration. In many outpatient centers, patients must be registered at the main registration
desk, as well as at a specialized unit of the medical institution. This procedure requires a repetition each time the patient visits the medical facility. Each registration adds 5 to 10 minutes to the patient's visit. The way out of this situation can be the implementation of all registration functions at the main rack and the transfer of patient information in electronic form to the necessary department. It should be noted that the pleasure of the patient to visit the medical institution is reduced every five minutes of waiting. Saving even one minute per visit significantly increases the time and cost savings for organizing the provision of medical services during the year. Considering what influence this may have over the year of the work of the medical institution, designing while taking into account time savings is very important.
The next functional-planning element of the medical institution, which is considered as part of this publication and requires corresponding changes, is the inpatient unit. The word "hospital" evokes the immediate and traditional image of wards, patients and nurses. The hospital is an important element of the medical complex, but recent changes in medical technology have led to the fact that most medical services are provided in other departments of the medical institution. Hospital wards and nursing posts have been the subject of many studies in the design of hospitals over the past 50 years, and new data have led to the emergence of a "scientifically based" medical design: bedridden patients recover faster and feel better if there is a family near them. more personal space and amenities, and also have a view of the nature from the windows of the chamber and access to the open air. Studies have also shown that nurses work better if they are provided with decentralized jobs near patients, which reduces the time they move; Single rooms provide greater flexibility in terms of levels of care and privacy while reducing patient movement.
The architectural form of the inpatient component should reflect the functional needs: compact blocks of hospital wards or wards with appropriate decentralization of nursing posts instead of long corridors of traditional hospitals, as well as a large building perimeter to ensure maximum window size for patients. Centralized support facilities, such as conference rooms and staff rooms, can be designed for several departments; however, each unit needs a separate space for storing medicines, food and facilities for waste disposal, organizing workplaces for doctors and nurses, and proper storage of tools and equipment. Since patient rooms are constantly occupied, the orientation of windows in the wards with respect to the sun and the environment is important. New directions in the design of patient
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rooms are determined by funding systems and cultural expectations to the same extent as medical practice. When the health care system supports more staff and more generous use of space, trends and regulatory requirements move toward larger individual premises with optimal infection control and amenities, such as a private toilet and shower, communications. Spacious single rooms have greater flexibility in reorienting and replacing equipment and furniture. The long-term plan for the operation of a medical facility is that individual units and departments will be periodically updated. In this sense, hospitals, in which chambers remain the norm for four or more places, should gradually be modified. Inpatient treatment areas are very specialized facilities that are often only cosmetically updated for many years and which are not easily converted for other purposes. The number of beds in the department is determined by the principle of the optimal number for the most effective nursing care and short movement of staff, and usually consists of 24 to 40 beds. Within the department it is necessary to separate the flow of visitors, staff and patients. The location of nursing posts should provide a clear and separate circulation of clean and polluted materials to support services such as food, materials, pharmacy and laundry. Beds for intensive care should be on the same level close to the operating room in order to ensure patient transportation as soon as possible. For maximum flexibility, it is best to place all types of intensive care units together on the same floor. Inpatient departments require direct access to diagnostic and treatment services, effective access to additional services, but they should be separated from outpatient areas and the administrative part. Of course, it is not always possible to adhere to all the above principles in the functional planning organization of the medical space, but approaching this goal affects the overall performance of the medical institution.
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