DESIGN OF 300 BEDED HOSPITAL

Introduction

The hospital you have to build has to be very usable from the point of
view of your patients and staff. This part of the Clinic gives you
counseling on rooms so that you can design a better hospital. Some
rooms clearly fulfill a single function; others play a more important role
in the running of the hospital, acting as hubs about which patients
flow. It is essential to understand their operation before you go about
designing your level. The planning of the hospital depends on its
objectives/purpose. Once the objective/ purpose of the hospital have
been identified, a project coordination team is appointed. The team is
responsible for the planning and designing the hospital. The team
consists of financers, architects, engineers, medical doctors, health
planner/hospital administrator, finance manager.

Stages In Planning And Designing A Hospital.

1. Identifying available finance and other possible sources of
finance.
2. Deciding on the area/ location of the hospital.
3. Identifying the needs of the area by carrying out a survey.
4. Deciding on the present and proposed services to be offered.
5. Preparing the design.
6. Getting the design approved.
7. Starting construction.
8. Identifying and hiring the required personnel and working out a
schedule for training.
9. Working out a schedule for purchase of required equipment/
material.
10. Commissioning the hospital.

1
1. Finance:-. An assessment should be made of available
finances and possible sources of arranging finance. Bank loans
and there are also donors who give grants specifically for setting
up charitable hospital.

2. Location:- A need assessment survey of the community should

be done before deciding the location of the hospital. This helps in
deciding the location of the hospital and determines its
catchment area. According to the purpose of hospital the area
should be selected for profit select the area where people have
paying capacity and for charitable purpose decide the location
according to the need of people.

3. Preparing The Design:-

a. Site Selection:- Site selection is very important part of

the hospital planning process. At times, availability of land,
supporting services and finance become the main factors
which decide site selection.
b. Legal Requirements:- No objection certificate from local
government. There should be a proper map of the land. The
land should be in an authorized colony/market only.
c. Proper Electrical And Water Connections should
be available. For this, the electricity load required should be
worked out and doubled at the time of applying.
d. Permission for sewage connection should be obtained.
e. Size of the land:- for 100 bedded hospital 1 acre or 400
meter square per bed.
f. Plot Ratio:- in urban area a single storey hospital can have
up to 150 beds.

2
 g. Designing Consideration:- in designing a hospital two
approaches can be used- the biologic and the artistic. Both
approaches have their advantages and drawbacks.
i. Biological Approach:- in the biological approach
the hospital is designed according to its functional needs. A
balance attempted between the hospital and its
environment. In this approach, a linear spire system is
followed in which the entry to various departments is
through a central spire which may have several levels.
There is no thoroughfare through departments. This
system absorbs hospital growth easily and departments do
not strangle themselves. Also, when an obsolete
department has to be updated it is delegated to a
temporary structure in the hospital complex till it is
dismantled and an updated department erected. Since the
circulation core is independent and separate from the
departmental areas, activities within the hospital are not
disrupted. The biologic approach allows an outside view
and natural light, even when a department needs to be
expanded or changes made in it.
ii. Artistic Approach:- the artistic approach is
creative, based on focus, patterns and determined space.
These overtly monumental and systematic hospital
buildings are more admirable as pieces of large scale
sculpture than the common older hospitals and are also
much less useful.

Location And Physical Facilities

3
1. Location:- The OPD is the showcase of any hospital and reflects
its image. It should have an independent approach at the
entrance of the hospital and should be on the ground floor for
easy access. It should be segregated from IPD, so that OPD
patients need not pass through inpatient areas. Some treatment
facilities like radiology, pathology, physiotherapy and blood bank
should be interposed between the OPD and IPD so that they are
equally accessible to both.

2. Physical Facilities And Space Requirements:-

S.N Facility No. of Area in

o rooms (Msq)
1. General
a. Entrance hall with enquiry 1 98
counter, cash counter and
record area.
b. Room with toilet for officer in 1 17.5
charge
c. Room with toilet for Nurse-in- 1 17.5
charge
d. Sanitary inspector’s room 1 14
e. OPD medical record room 1 35
f. Canteen 1 28
g. Lavatories – separate for gents 2 35
and ladies (common for patients
and staff)
f. Janitor’s closet 1 7
2. Medical clinic
a. Consultation and examination 3 17.5
room
b. Cardio-graphic examination 1 14
c. Waiting room 1 49
3. Surgical clinic
a. Consultation and examination 3 17.5

4
S.N Facility No. of Area in
o rooms (Msq)
room
d. Dark room 1 14
e. Waiting room 1 49
4. Orthopedics clinic
a. Consultation and examination 1 17.5
room
b. Plaster and splint storage room 1 14
c. Fracture and treatment room 1 17.5
d. Plaster cutting room 1 14
e. Recovery room 1 14
f. Waiting room 1 35
5. Eye clinic
a. Consultation and examination 1 28
room
b. Refraction room 1 17.5
c. Minor surgery and treatment 1 17.5
room
d. Dark room 1 14
e. Waiting room 1 21
6. ENT Clinic
a. Consultation and examination 1 28
room
b. Treatment room 1 14
c. Audiometry room 1 14
d. Waiting room 1 14
7. Dental clinic
a. Consultation and examination 1 17.5
room
b. Dental hygienists room 1 14
c. Recovery room 1 14
d. Dental workshop 1 17.5
e. Waiting room 1 21
8. Obstetric and gynecological
clinic
a. Reception and registration area 1 17.5
b. Consultation and examination 2 17.5
room
c. Treatment room 1 17.5
d. Clinical laboratory 1 14
5
S.N Facility No. of Area in
o rooms (Msq)
e. Toilet cum changing 1 10.5
room(attached to treatment)
f. Waiting room 1 28
9. Family planning clinic
a. Consultation and examination 1 17.5
room
b. Treatment room 1 17.5
c. Health educator and social 1 17.5
worker’s room
d. Recovery room 1 14
e. Waiting room 1 21
10. Pediatrics clinic
a. Consultation and examination 2 17.5
room
b. Dressing treatment and 1 17.5
dispensing room
c. Immunization room 1 17.5
d. Waiting room 1 28
11. Skin and STD clinic
a. Consultation and examination 1 17.5
room
b. Treatment room 2 17.5
c. Superficial therapy room 1 14
d. Skin laboratory 1 21
e. Waiting room 1 21
12. Psychiatric clinic
a. Consultation and examination 1 17.5
room
b. ECT room 1 21
c. Psychologist’s room 1 17.5
d. Social worker room 1 17.5
e. Waiting room 1 21
13. Supporting facilities
a. Central injection room 1 14
b. Specimen collection room / 1 17.5
clinical laboratory
c. Social worker’s room 1 14
d. Waiting room 1 21

6
Planning
Allocation of area (in square feet) for various utilities.
S.N Areas 300 Bedded
o Hospital
1. Public areas 3400
2. Clinical area 14695
3. Administrative areas 5280
4. Circulation areas 6625
5. Total net area 30000
6. Wall and partition 3000
areas(10%)
Gross area for total 30000 Sq.Ft.
building

1. The Public Area Includes traffic, main entrance, reception and

information, registration and records area, non clinical areas and
entrance hall, waiting room, public toilets and washrooms,
snacks bar, consultation room, special examination room,
treatment/dressing room.

2. The Clinical Area Includes

• Clinics for various medical disciplines, medical clinics,
surgical clinics, orthopedics clinic, eye clinic, ENT clinic,
dental clinic, obstetric and gynecological clinic, family
planning clinic and pediatrics clinic.
• Ancillary facilities include injection clinic and pharmacy.
• Auxiliary facilities are laboratory, radiology, blood bank,
health education, social services, and screening clinic,
preventive and social medicine.

7
3. Administrative Area is administrator’s office, business office
and house keeping.Storage facilities are general stores, drug
stores and linen storage.

Inpatient Services

Inpatient services are the most important in the hospital based

health care delivery system. Inpatient hospital services are under
constant pressure of increasing demand and their capital and
operational costs are very high, which directly affects the hospital.
In patient care units are grouped as follows:-

• General Ward:- These wards are the traditional type and have
patients who are not critically ill but need continuous care or
observation and have to be in bed. These include wards for the
disciplines of medicine, surgery, ENT and ophthalmology.

• Specialty Ward:- These wards are for patients who need

hospitalization in particular specialties such as orthopedics,
pediatrics’, psychiatry, infectious diseases, skin, obstetrics and
gynecology and other specialized disciplines.

• Intensive Care Units:- These wards are for critically ill patients.

Planning And Organizing An Inpatient Unit

1. Physical Facilities:- The inpatient area should be located away

from main road and the OPD area.

8
 Important measurements to keep in mind while designing a
ward.
• The size of hospital bed is 6’6” x 3’3”.
• The minimum distance between the centre of two beds
should be 0.25m, space at the foot-end 0.09m, space at
the head-end 0.25m. thus the space required would be
3.15m x 2.25m =7.19m2(75 sq.ft)
• The area per bed in award is 70-90 sq.ft(7m2)
• The area per bed in the ICU is 100-120 sq. ft per bed.
• A single bedroom with an independent toilet should have a
minimum space of 125 sq. ft (14m2) and a double bedroom
21 m2.
• The space between two rows of bed is 5 ft.
• The distance between two bed should be 3 ½ to 4 ft.
• Clearance between the bed head and wall should be 1 ft
and between the side of a bed and wall about 2 ft.
• The width of the dormitory should be 20ft.
• The average size of a toilet should be 3.50 m2.
• The size of an isolation unit should be 14 m 2, and should
contain a bed, bedside locker, chair for the patient’s
attendant and a built-in-cupboard. These units should have
separate toilets.
• Width of the hospital corridor should be 3m wide to
accommodate two passing trolleys and the ceiling height
should be 7 ½ to 8 feet.

2. Size:- The size of a ward or nursing unit varies in different

hospitals. The maximum activity in a ward takes place between 8
a.m and 12 noon, less during the rest of the day and least at
night. The requirement of staff of staff in the night shift will be

9
 the same as in an average-size unit. The modern trend is to have
a head nurse for a unit of 35-35 beds.

3. Shape/design

• Open Ward:- About 30-35 patients were housed in such

wards and the length of the ward was not less than 96 feet.
Advantages are- nurses have ample visibility and can observe
patients directly, adequate cross-ventilation, natural light is
available and economical to construct and maintain.
• Rig’s Ward:- In this design, the ward unit is divided into
small compartments or cubicles separated from each other by
low partitions, each cubicle having 1,2,3,4 or 6 beds arranged
parallel to the longitudinal walls. In India it is not practical due
to shortage of finances and nursing personnel.

4. Types Of Ward Design

• Nightingale Ward:- This is an open ward with 20-30 beds.

The services are located at either end of the ward.
• L-Shaped Ward:-In this, the nursing station is placed at the
900 junction of the L. The visibility is better with less walking
distance between the nursing station and the patient.
• T-Shaped Ward:- The nursing station is at the vertical arm
and the patient’s area are located on the horizontal arm.
Serious patients are kept in section A.
• Circular Ward:- This design occupies the minimum space
and reduces the walking distance between patient and nurse
to the minimum.
5. Ancillary Accommodation

10
 • Nursing Station:- The nursing station should be 20’x20’ and
should have sister’s room with attached toilet, cupboards for
medicines, a large work table and stools, build in cupboards to
hold medicines, stationary, forms etc.
• Treatment Room:- Required for physical examination,
dressing and certain procedures which cannot be carried out
conveniently at the bedside.
• Clean Utility Room:- This room(100-200 sq.ft) is used for
clean storage, e.g drugs, intravenous sets and solutions, CSSD
articles, packing dressing.
• Bathrooms And Toilets:- Adequate bathroom and toilets
should be provided. Toilets for a individual room in a ward unit
shall be 3.5 m2 comprising a bath, wash basin.

Staffing Norms For Medical Personnel For A

General Hospital

S.N Specialty 300 bed

o strength
1. General medicine 2
2. General surgery 2
3. Gynecology and 2
Obstetrics
4. Paediatrics 2
5. Anaesthisia 4
6. Dentistry 2
7. Radiodiagnosis 2
8. Pathology 2
9. Orthopedics 2
10. Ophthalmology 2
11. ENT 2
12. Skin and STD 1
13. Psychiatry 1

11
 14. Chest disease and 1
Tuberculosis
15. Biochemistry 1
16. Microbiology 1
17. General Duty Medical 20
Officer

Staffing Norms For Nursing Staff And

Nursing Supervisors

S.N Nursing Personnel Staffing Norms

o
1. Nursing superintendent 1 per hospital
2. Dy.Nursing 1 up to 400 beds
superintendent
3. Asst. Nursing 1 for 100-150 beds or 3-4 wards
Superintendent
4. Ward sisters 1 for 25-30 beds or 1 per ward.
5. Staff nurse 1 nurse for 3 beds
For ICU/ICCU 1 nurse for 1 bed(+ 30% leave
reserve)
6. It is suggested that for each 250 beds there should be one
infection control nurse.

Norms For Class ‘D’ Employees

In 300 beded hospital we need 150 class ‘D’ employees as per the
ratio of 1employee per 2 beds.

Conclusion

12
"A hospital functional design can promote skill, economy,
conveniences, and comforts; a non-functional design can impede
activities of all types, detract from quality of care, and raise costs to
intolerable levels." ... Hardy and Lammers

Bibliography

1. Cedric B. Finch, Dr. D.K Sharma, Dr.R.C Goyal. Hospital Planning

and Management.1999. Voluntary Health Association Of India.

13