December 12, 2018

MH0052 [Hospital Organisation Operations & Planning] Set1 Q4

Q.4. Explain the various ward designs. Explain them with diagrams.

Ans:

Size: The size of the wards depends on several factors. It can vary from as low as 10 beds to as high as 90 beds in a single ward. Some of the parameters influencing the design and layout of the wards are:

1. Severity of the patient condition The more the severity, smaller the ward. E.g.: ICU, CCU, T.B Sanatorium etc.
2. Category of the ward General wards has more number of beds than special room or deluxe wards.

Location: The location of the wards depends on the activities taking place, services rendered, movement of patients, relatives of patients, doctors, nurses, paramedical staff, visitors etc.

Example: It is desirable to have the surgical wards close to operation theater and post op; ante-natal wards close to labour theater; ICU close to the Accident & Emergency centre etc.

Ward Areas: the various areas that need to be included while designing the wards are:

Patient space: it includes: Multibed bays, patient rooms/

Day space: serves as a space for reading, writing, watching TV, etc.

Patient relatives area

Visitors waiting area

Corridor space that would allow movement of man, machines and trolleys, stretchers, etc.


Ward Design
Nightingale Ward:
The nightingale ward is named after Florence Nightingale. This pattern came into existence after the Crimean war during the 19th century. Each ward has a total of 40 beds. Schematic picture of this plan is given below. This arrangement has the following advantages; 1) excellent cross-ventilation, 2) good lighting, 3) clear and unimpeded view of all patients.


Fig. 1: Nightingale Ward

The disadvantages are: 1) No privacy for the patients, 2) Lot of traffic (food cart, patient trolley, ward stock etc) moving through the patient care areas causing inconvenience and disturbance to patients admitted, 3) Nurses/ other staff fatigue factor, due to the distance to be covered for rendering services located in separate areas.

Variant Nightingale:
To overcome some of the disadvantages faced in the Nightingale pattern, a variant of the same was created. Even in this pattern there are 40 beds. The Variant Nightingale pattern is also called Cruciform Shape. The length of the ward is 26 meters. This concept gave rise to the evolution of having single bed room/double bed room wards. A sketch of this type of layout is illustrated below.

Fig. 2: Variant Nightingale Pattern

Advantages of this design is: 1) Privacy for patients 2) Reduction in noise levels 3) Reduced incidence of cross-infection 4) Attached toilets making it convenient for patient attenders/visitors 5) Flexibility in usage of wards among different departments. This pattern was not free of defects as it had a few disadvantages; 1) Reduced view from the nursing station 2) Patients found it difficult to communicate to nurses and doctors 3) Cost of construction, maintenance, overheads etc was more with high capital costs 4) Maintenance also was difficult as this pattern increased the floor area.

Rigs Design:
The Rigs pattern of ward was first designed in 1910 and implemented in Denmark. The length was reduced and width was increased as compared to the Nightingale pattern. A schematic representation of this layout is given below.

Fig. 3: Rigs Design

Some of the special features incorporated in this design are as follows:
1. There was a major shift in the earlier concept of spacing of beds.
2. Privacy in general wards was enhanced due to wall partition of 5 ft height.
3. The distance walked by the nurses for rendering service was reduced.
4. Patient beds are arranged parallel to the main corridor, in order to reduce traffic disturbances in the ward.

Some of the other patterns worth mentioning are:

Nuffields ward:
A lot of research was done on hospital design during 1950s. Nuffields study (1949-1955) deserves special mention. Based on the findings, an experimental ward was constructed. The design is represented below.

Fig. 4: Nuffields Ward

Race track design/deep plan:
This concept arose during 1950s in the United States. Also called double corridor system, this design has 36 beds with two nursing stations.

Fig. 5: Rack Track Design 

Harness type ward:
Also known as the crossed type, this design is known to have different types of rooms with single, double, four and even eight beds.

Fig. 6: Harness type Ward

Other ward types:

Courtyard ward:
This type of wards makes provisions for natural light and ventilation. This also helps in saving costs and hence contributes towards the hospitals economy.

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