IN PATIENT DEPARTMENT

DISSERTATION REPORT

ON

IN PATIENT DEPARTMENT

Submitted in partial fulfilment of the

Requirement for the award of degree of
MASTER OF ARCHITECTURE
2016-2017

SUBMITTED BY

KUMAR AVINASH
M-Arch- 1st Sem
Health Care Architecture

GUIDED BY
Abdul Halim Babbu

DEPARTMENT OF ARCHITECTURE
FACULTY OF ARCHITECTURE AND EKISTICS
JAMIA MILLIA ISLAMIA
NEW DELHI 110025

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 IN PATIENT DEPARTMENT

DISSERTATION REPORT
On

“IN PATIENT DEPARTMENT”

Submitted in partial fulfilment of the

Requirement for the award of degree of
Master of Architecture

Submitted by
KUMAR AVINASH
M-Arch- 1st sem
Health Care Architecture

Guided by
Abdul Halim Babbu

FACULTY OF ARCHITECTURE & EKISTICS

JAMIA MILLIA ISLAMIA
NEW DELHI-110025

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Department of Architecture
Faculty of Architecture & Ekistics,
Jamia Millia Islamia, New Delhi

Certificate

In the partial fulfilment of the M-Arch degree program, this is to certify that ‘KUMAR
AVINASH’ has worked on the Dissertation project entitled “IN PATIENT
DEPARTMENT” under my guidance and supervision.

Abdul Halim Babbu Prof. S.M. Akhtar

Guide Dean

External Examiner 1 Ar. Mohammad Ziauddin

Head of Department

External Examiner 2

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Declaration

I Kumar Avinash hereby declare that the Dissertation entitled “IN-PATIENT

DEPARTMENT” submitted in the partial fulfillment of the requirements for the award of the
degree of Masters of Architecture is my original design/ research work and that the information taken
from secondary sources is given due citations and references.

[Signature]

KUMAR AVINASH

Roll.No:16MHA017

Date: M.Arch. Sem. –Ist

Place: 2016-17

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Acknowledgment

At various stages in doing of thesis, a number of people have given me invaluable support.In this
regard I owe a depth of gratitude to my inspiration & guide Abdul Halim Babbu. Who have cultivated
devotion & determination in me & have been a helping hand at every moment to support & motivate
me. I would deeply thank To the Classmates for the systematic structuring the dissertation so as to
make it an gradual process of learning and application; for his regular evoking insightful discussions.
I am Grateful to My Parents, who kept ultimate faith in me & always provided me backup with their
love & best wishes.
Above all, I am highly grateful to God, who provided me such a golden opportunity, brilliant guidance,
& kind support.
I would finally thank Ar. Vishal Chauhan for the much needed pep talks, discussions, motivation and
all those things who made this thesis and this course come alive.
At last I beg pardon from all those who helped me but, my self-centered mind escaped their names.

With Regards,
Kumar Avinash
M-Arch – Ist sem

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CONTENT

1. SUMMARY………………………………………………………………………………………………………...9-10
1.1. INTRODUCTION
1.2. NEED OF THE STUDY
1.3. AIMS AND OBJECTIVES
1.4. SCOPE OF WORK
1.5. METHODOLOGY
2. IN-PATIENT SERVICES……………………………………………………………………………………..11-15
2.1. FUNCTIONS OF IN-PATIENT DEPARTMENT
2.2. COMPONENTS OF WARD UNIT
2.3. FORMS OF IN-PATIENT WARD
2.3.1. THE NIGHTANGLE WARD
2.3.2. STRAIGHT, SINGLE CORRIDOR WARD
2.3.3. L- SHAPED WARD
2.3.4. THE RACE TRACK
2.3.5. THE CRUCIFORM PLAN
2.3.6. T- SHAPED WARD
2.4. TYPES OF IN-PATIENT WARD
3. PLANNING OF IN-PATIENT DEPARTMENT……………………………………………………….16-18
3.1. MODELS OF CARE
3.2. ;LEVELS OF CARE
3.3. PLANNING MODELS
3.3.1. BED NUMBERS AND COMPLEMENT
3.3.2. SWING BEDS
3.3.3. UNIT PLANNING OPTIONS
3.4. FUNCTIONAL AREAS
3.4.1. FUNCTIONAL RELATIONSHIPS
3.4.1.1. EXTERNAL
3.4.1.2. INTERNAL
3.5. SPACE TO TRANSFER A PATIENT TO AND FROM A BED

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4. DESIGN ………………………………………………………………………………………………………….19-21
4.1. ENVIRONMENTAL CONSIDERATIONS
4.1.1. ACOUSTICS
4.1.2. NATURAL LIGHT
4.1.3. OBSERVATION AND PRIVACY
4.2. SPACE STANDARDS AND COMPONENTS
4.2.1. ROOM CAPACITY AND DIMENSIONS
4.2.2. ROOM TYPE AND WIDTH LENGTH
4.2.3. BED SPACING AND CLEARENCES
5. ACCESS, MOBILITY AND OH&S (OCCUPATIONAL HEALTH AND SAFETY)…………22-25
5.1. INFECTION CONTROL
5.1.1. HAND BASINS
5.1.2. ISOLATION ROOMS
5.2. SAFETY AND SECURITY
5.3. DRUG STORAGE
5.4. FINISHES
5.5. FIXTURES AND FITTINGS
5.5.1. BED SCREENS
5.5.2. CURTAINS/ BLINDS
5.6. BUILDING SERVICES REQUIREMENTS
5.6.1. INFORMATION TECHNOLOGY/ COMMNUNICATIONS
5.6.2. NURSE CALL
5.7. FUNCTIONAL RELATIONSHIP
5.8. SPACE PLANNING
5.8.1. LOCATION
5.8.2. ACCESS
5.8.2.1. PALLNING STARTEGIES
6. STANDARDS FOR THE FUNCTIONAL AREAS……………………………………………………...25-27
7. CASE STUDY…………………………………………………………………………………………………….27-33
8. PREFERED LAYOUT…………………………………………………………………………………………34-36
9. CONCLUSIONS…………………………………………………………………………………………………33
BIBLIOGRAPHY………………………………………………………………………………………………..36
APPENDICES………………………………………………………………………………………………36

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1 SUMMARY

1.1 INTRODUCTION
 Basically People go to hospital for two purpose; either seek out door consultation in OPD or
for admission in hospital. Inpatient ward are for those patients who need treatment under
healthcare personal’s supervision.

 Patient are admitted in Inpatient Ward for short and long term depending on severity of their
disease.

 Inpatient Department consists of a wards with Nursing Station, Beds, and all other facility &
services necessary for good patient care.

 It is one of the important aspects of hospital as every ratios and calculation for hospital planning
and designing process is based upon the no. of bed it consists.

They can be broadly classified as:

 Wards
 Nursing Station
 Support Areas

1.1.1 FUNCTIONS
 The prime function of the Inpatient Unit is to provide appropriate accommodation for the
 delivery of health care services including diagnosis, care and treatment to inpatients.
 The Unit must also provide facilities and conditions to meet the needs of patients and visitors
 as well as the workplace requirements of staff.

1.1.2. DESCRIPTION
 The Inpatient Accommodation Unit is for general medical and surgical patients. In larger
 health facilities this Unit includes specialist medical and surgical patients, for example,
 cardiac, neurology/ neurosurgery, integrated palliative care and obstetric patients.
 Patients awaiting placement elsewhere may also be accommodated in this type of facility.

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1.2 NEED OF THE STUDY

To study the requirement, use and planning of Inpatient services in a hospital and analyze the activity
in detail and its functions.

1.3 AIMS AND OBJECTIVES

 To study and understand the components of inpatient department which are wards, nurse
stations & support areas.
 To study the design, space requirements and other considerations of inpatient department
essential for architects while designing the inpatient services in a hospital.
 To analyze the working of inpatient services department.
 To study the structural requirements while planning a inpatient department.

1.4 SCOPE OF WORK

 Understanding of basic concepts.
 Facilities and space requirements.
 Architectural design and planning.
 Case studies
 Analysis and inferences

1.5 METHODOLOGY

STUDY

EXAMPLES

ANALYSIS

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2 INPATIENT SERVICES
 The IPD forms 33%-50% of the structure of hospital construction and most of the equipment
and staffs are in this department with maximum amount of patient care, training, medical
teaching and research concentrated in this department . IPD is the area which gives maximum
output of services and name and fame to the hospital too and so maximum vigilance is required
to prevent litigation and to gain patient satisfaction.

2.1 FUNCTION OF INPATIENT DEPARTMENT

 To provide highest possible quality of medical and nursing care.

 To make a provision of essential equipment, Drugs, and other material required for patient
care.

 To provide comfortable and desirable environment to patient on temporary substitution of

home.

 To provide facilities for visitors.

 To provide suitable atmosphere for highest possible degree of job satisfaction among
healthcare personal and high level of patient satisfaction.

 To provide opportunity for education, Training and research

2.2 COMPONENTS OF WARD UNIT

 Primary Accommodation: It consists of single bedroom or multiple bedroom for patients and
a nursing station.

 Ancillary accommodation: service for direct support of treatment. Eg: portable x-ray, side
lab,Pantry,Dietician service in ward, mobile pharmacy.

 Auxiliary accommodation :Service in indirect support of treatment . Eg:Store, housekeeping,

doctor’s room, nurse’s room, seminar –teaching room.

 Sanitary accommodation : Consists of WC, Bathroom, Janitor’s room ,sluice room.

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2.3 FORMS OF INPATIENT WARD:

There are different forms of ward design;

1. Open ward or Nightingale Ward

2. Straight or Single Corridor Ward

3. L-Shaped Ward

4. Race Track Shaped Ward

5. Curciform Ward.

6. T-Shaped Ward

2.3.1 THE NIGHTINGALE WARD

This is an open-plan ward containing 25-30 beds. Services are located at either end of a long,
rectangular ward; staff supervision is in the aisle between the two rows of beds. This is the noisiest
type of ward.

Fig. 2.3.a. The Nightingale Ward

2.3.2 STRAIGHT, SINGLE-CORRIDOR WARD

This simple layout has many advantages: all of the rooms can be lit and ventilated naturally through
windows. Service rooms and the nurses' station are centrally placed, and distances are minimized. Staff
can see down the full length of the corridor, making supervision easier than in other forms. They will
know where other staff are working and can call them quickly in an emergency.

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2.3.3 L-SHAPED WARD

In this layout, the patient beds are on the two legs of the L, and the support services and staff
supervision are on the junction. Services and supervision are concentrated at the entrance, with
minimal penetration into the Patient areas.

Fig. 2.3.c. L- Shaped Plan

2.3.4 THE RACE TRACK

In this type of ward, the patient areas are laid out at the periphery of a deep rectangle, and the services
and staff areas are in the middle. Patients are given a view, but the staff has no view (and perhaps no
ventilation when the WARD central air-conditioning is not working!). Staff have long distances to
travel, and communication between them is difficult.

Fig. 2.3.d The Race Track

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2.3.5 THE CRUCIFORM PLAN

In this plan, the patient rooms comprise a peripheral arrangement, and the support and supervision
areas are laid out at the intersection of the arms. This form results in a lot of cross-traffic. It is used in
double wards, where there are two separate ward units but only one set of supervisory staff.

Fig. 2.3.e. Cruciform Plan

2.3.6 T -SHAPED WARD

The advantages of this form Are similar to those of the L- Shaped ward. Support and supervision are
concentrated on the vertical arm, and the patient areas are located on the horizontal arm.

Fig. 2.3.f. T-Shaped Plan

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2.4 TYPES OF INPATIENT WARD:

There are different Types of ward;

1. Single Ward

2. Double Bedded Ward

3. Five Bedded Ward

4. Deluxe Ward

5. VIP Ward.

6. General Ward

7. Isolation Ward

3. PLANNING OF INPATIENT DEPARTMENT:

3.1. MODELS OF CARE
Models of Care for an Inpatient Unit may vary dependent upon the patients’ acuity and
numbers of, and skill level of the nursing staff available.
Examples of the models of care that could be implemented include:
patient allocation
task assignment
team nursing
case management
primary care (comprehensive range of generalist services by multidisciplinary teams that
include not only GPs and nurses but also allied health professionals and other health
workers) or
a combination of these
The physical environment should permit of a range of models of care to be implemented,
allowing flexibility for future change.

3.2. LEVELS OF CARE

The levels of care will range from highly acute nursing and specialist care (high dependency),
with a progression to intermediate care prior to discharge of transfer (self care).

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Patients requiring 24 hour medical intervention or cover will generally not be nursed or
managed within a general inpatient unit.

3.3. PLANNING MODELS

3.3.1. BED NUMBERS AND COMPLEMENT
Each Inpatient Unit may contain up to 32 patient beds and shall have Bedroom
accommodation complying with the Standard Components.
For additional beds up to 16 as an extension of a standard 32 bed Unit, this may be permitted
with additional support facilities in proportion to the number of beds, for example 1 extra Sub
Clean Utility, Sub Dirty Utility and storage.
For additional beds of more than 16, additional support facilities for a full unit (32 beds) will be
required, located to serve the additional beds.

The preferred maximum number of beds in an acute Inpatient Unit in Maternity or Paediatric
Units is 20-25 beds.

A minimum of 10 % of the total bed complement may be provided as Single Bedrooms in an

Inpatient Unit used for overnight stay for Isolation of patients. The current trend is to provide a
greater proportion of single bed rooms largely for infection control reasons.

3.3.2. SWING BEDS

For flexibility and added options for utilisation it may be desirable to include provisions for
Swing Beds. This may be a single bed, a group of beds that may be quickly converted from
one category of use to another. An example might be long-stay beds which may be converted
to acute beds.
At any given time, swing beds are part of an Inpatient Unit in terms of the total number of beds
and the components of the unit. For example:
Ward A + Swing Beds = One Inpatient Unit as per these Guidelines.
Alternatively: Ward B + the same Swing Beds = One Inpatient Unit as per these
Guidelines.
Facility design for swing beds will often require additional corridor doors and provision for
switching patient/ nurse call operation from one Staff Station to another. Security is also an

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issue, for example, converting General/Medical beds to Paediatric beds.

3.3.3. UNIT PLANNING OPTIONS
There are a number of acceptable planning options for Inpatient Units including:
Single Corridor; Patient and support rooms are clustered along a single corridor
Double Corridor – racetrack; patient rooms are located on the external aspects of the
space and support rooms are clustered in the central areas in a racetrack configuration
Combinations: - L, T & Y shaped corridors, patient rooms are located along external
aspects, support areas may be located in a central core area
3.4. FUNCTIONAL AREAS
The Inpatient Accommodation Unit will comprise the following Functional Areas or zones:
Patient Areas - areas where patients are accommodated or facilities specifically serve
patients
Staff Areas - areas accessed by staff, including utility and storage areas
Shared Areas - areas that may be shared by two or more Inpatient Units

3.4.1 FUNCTIONAL RELATIONSHIPS

3.4.1.1. EXTERNAL
Principal relationships with other Units include:
Easy access from the Main Entrance of a facility
Inpatient Units must not be located so that access to one Unit is via another
Ready access to diagnostic facilities such as Medical Imaging and Pathology
Ready access to Emergency and Critical Care Units
Surgical Units require ready access to Operating/ Day Procedures Units
Ready access to staff amenities.
3.4.1.2. INTERNAL
Optimum internal relationships include:
Patient occupied areas as the core of the unit
The Staff Station and associated areas need direct access and observation of Patient
Areas
Utility and storage areas need ready access to both patient and staff work areas
Public Areas should be on the outer edge of the Unit
Shared Areas should be easily accessible from the Units served
3.5. SPACE TO TRANSFER A PATIENT TO AND FROM A BED

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Fig. 3.5. Patient Transfer to- from Bed

4 DESIGN
4.1 ENVIRONMENTAL CONSIDERATIONS
4.1.1. ACOUSTICS
The Inpatient Unit should be designed to minimize the ambient noise level within the unit and
Transmission of sound between patient areas, staff areas and public areas.
Consideration should be given to location of noisy areas or activity away from quiet areas
Including patient bedrooms and selection of sound absorbing materials and finishes.
Acoustic treatment will be required to the following:
patient bedrooms,
interview and meeting rooms
consult rooms
staff rooms
toilets and showers
Please refer to Part C, 9.2 “Acoustic Solutions for Healthcare Facilities”
4.1.2. NATURAL LIGHT
The use of natural light should be maximized throughout the Unit. Natural light must be
available in all bedrooms.
4.1.3. OBSERVATION AND PRIVACY

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The design of the Inpatient Unit needs to consider the contradictory requirement for staff
visibility of patients while maintaining patient privacy. Unit design and location of staff stations
will offer varying degrees of visibility and privacy. The patient acuity including high
dependency, elderly or intermediate care will be a major influence.
Factors for consideration include:
use of windows in internal walls and/or doors
location of beds that may affect direct staff visibility
provision of bed screens to ensure privacy of patients undergoing treatment;
location of sanitary facilities to provide privacy for patients while not preventing
observation by staff.
4.2. SPACE STANDARDS AND COMPONENTS
4.2.1. ROOM CAPACITY AND DIMENSIONS
Maximum room capacity shall be eight beds, although six is preferred.
Minimum dimensions, excluding such items as ensuites, built-in robes, alcoves, entrance
lobbies and floor mounted mechanical equipment shall be as follows:

4.2.2. ROOM TYPE WIDTH LENGTH

SINGLE BED ROOM :3450 mm 3600mm
TWO BED ROOM :3450 mm 5600 mm
FOUR BED ROOM :6100 mm 5600 mm
SIX BED ROOM :6500 mm 6750 mm

Minimum room dimensions are based on overall bed dimensions (buffer to buffer) of 2250 mm
long x 1050 mm wide. Minor encroachments including columns and hand basins that do not
interfere with functions may be ignored when determining space requirements

4.2.3. BED SPACING / CLEARANCES

Bed dimensions become a critical consideration in ascertaining final room sizes. The
dimensions noted in these Guidelines are intended as minimums and do not prohibit the use
of larger rooms where required.
In bed rooms there shall be a clearance of 1200 mm available at the foot of each bed to allow
for easy movement of equipment and beds.
This is represented diagrammatically below:

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Fig.
4.2.a

Typical Bed room Plan

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In multiple-bed rooms, the minimum distance between bed centre lines shall be mm.
Paediatric bedrooms that contain cots may have reduced bed centres, but consideration must
be given to the spatial needs of visiting relatives. To allow for more flexible use of the room the
2400 mm centre line is still recommended. Consider allowing additional floor area within the
room for the children to play.
The clearance required around beds in multiple-bed rooms and chair spaces is represented

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5. ACCESS, MOBILITY & OH&S (OCCUPATIONAL HEALTH &

SAFETY)
Patient wheelchair access bedrooms and ensuites should enable normalisation of activity for
wheelchair dependant patients, as opposed to patients who are in a wheelchair as a result of
their hospitalisation.

5.1 INFECTION CONTROL

5.1.1. HAND BASINS

Hand-washing facilities shall not impact on minimum clear corridor widths. At least one is to be
conveniently accessible to the Staff Station. Handbasins are to comply with Standard
Components - Bay - Hand-washing and Part D - Infection Control.

5.1.2. ISOLATION ROOMS

At least one 'Class S - Standard' Isolation Room shall be provided for each 32 bed Inpatient
Unit. At least one 'Class N - Negative Pressure' Isolation Room shall be provided for each 100
beds in facilities of level 4 and above. These beds may be used for normal acute care when
not required for isolation.

5.2. SAFETY AND SECURITY

An Inpatient Unit shall provide a safe and secure environment for patients, staff and visitors,
while remaining a non-threatening and supportive atmosphere conducive to recovery.
The facility, furniture, fittings and equipment must be designed and constructed in such a way
that all users of the facility are not exposed to avoidable risks of injury.
Security issues are important due to the increasing prevalence of violence and theft in health
care facilities.
The arrangement of spaces and zones shall offer a high standard of security through the
grouping of like functions, control over access and egress from the Unit and the provision of
optimum observation for staff. The level of observation and visibility has security implications

5.3. DRUG STORAGE

Each Inpatient Accommodation Unit shall have a lockable storage area or cupboard
containing:
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Benches and shelving

Lockable cupboards for the storage of restricted substances
A lockable steel cabinet for the storage of drugs of addiction
A refrigerator, as required; to store restricted substances, it must be lockable or housed
within a lockable storage area
Space for medication trolley
Note: Storage for dangerous drugs must be in accordance with the relevant legislation.
5.4. FINISHES
Finishes including fabrics, floor, wall and ceiling finishes, should be selected with consideration to
infection control, ease of cleaning and fire safety, while avoiding an institutional atmosphere.
In areas where clinical observation is critical such as bedrooms and treatment areas, colour selected
must not impede the accurate assessment of skin tones.
5.5. FIXTURES & FITTINGS
5.5.1. BED SCREENS
In multiple-bed rooms, visual privacy from casual observation by other patients and visitors shall be
provided for each patient. The design for privacy shall not restrict patient access to the entrance, toilet
or shower.
5.5.2. CURTAINS / BLINDS
Each room shall have partial blackout facilities (blinds or lined curtains) to allow patients to 0rest
during the daytime.
5.6. BUILDING SERVICES REQUIREMENTS
5.6.1. INFORMATION TECHNOLOGY/ COMMUNICATIONS
Unit design should address the following Information Technology/ Communications issues:
Paperless records
-held computers

-rays / Records.

5.6.2 NURSE CALL

Hospitals must provide an electronic call system that allows patients and staff to alert nurses and other
health care staff in a discreet manner at all times.
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5.7. FUNCTIONAL RELATIONSHIP DIAGRAM

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5.8. FUNCTIONAL RELATIONSHIP DIAGRAM

Fig. 6. Standards

6 INPATIENT ACCOMMODATION UNIT GENERIC SCHEDULE OF

ACCOMMODATION
Schedule of Accommodation for a 30 Bed Unit at all RDS Levels follows. Although
categorised by level of service, this does not necessarily lead to different physical
requirements.
The Schedule of Accommodation lists generic spaces that form an Inpatient Unit.
Quantities and sizes of some spaces will need to be determined in response to the
service needs of each unit on a case by case basis.

=
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7 CASE STUDY- MEDICS INTERNATIONAL HOSPITAL ,

LUCKNOW

PROJECT’S NAME: MEDICS INTERNATIONAL HOSPITAL

CLIENT’S NAME: MEDICS INTERNATIONAL LTD.

ARCHITECT: RSMS ARCHITECTS

STRUCTURAL CONSULTANT: TECHNICAL PROJECT CONSULTANTS

ELECTRICAL CONSULTANT: MILESTONE CONSULTANTS

PLUMBING CONSULTANTS: DEW POINT

LOCATION: LUCKNOW

SITE AREA: 8.22 ACRES

PLOT SIZE: 334MTX120MT

BUILT-UP AREA: 60000 SQ. MTS.

BED CAPACITY: 300

PARKING CAPACITY: 225

AGE OF THE BUILDING: 9 YRS

COST OF PROJECT: 155 CRORES

SITE The site is 334mtsX120mts.

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8. PREFERED LAYOUTS :

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9. CONCLUSION:
 INPATIENT department is one the most important and major department of any hospital.
 The location of this department should be such that it serves both the outpatient department,
Inpatient department as well as emergency department.
 It is preferably placed on the UPPER floors.
 The department should be well connected from the other departments of the hospital also.
 The placement of X-ray rooms and other examination rooms should be easy approachable for
the patients. Each room should have attached toilet as well as attached changing room for the
patient. A monitoring should also be provided.
 The floor should have a nurse room as well as doctor’s room.
 A proper study should be done for traffic movement of the patients from procedures rooms to
the outer areas. Corridors and doors leading to all patient areas and examination rooms
should allow easy and safe movement of all patients, including handicapped or injured.
 There must be adequate and pleasant waiting space. The provision of pleasant surroundings
and seats will help the anxious patient.
 Materials with better shielding control should be identified through market surveys and
should be used.
 All the structural considerations should be mentioned and should be taken care of in the
earlier stages of planning only, as it is the major component for the functioning as well safety
for the workers as well as the patient of inpatient department.

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BIBLIOGRAPHY
 Planning and Structural Shielding of Diagnostic inpatient Department, M.H.Mandour, 1999.
 NBC
 IHFC
 Standard Specifications For Basic INPATIENT Departments
 VA Design Guide Inpatient Service , April 2008 (Department Of Veterans Affairs Veterans
Health Administration Facilities Management Office)

Website:
 http://www.hospitalinfonet.com/Modules/Content/User/Article/wards.aspx
 www.archnet.com
 http://www.sciencedirect.com/science/article/pii/0010448574900013

KUMAR AVINASH /M.ARCH (MEDICAL ARCHITECTURE) /IST SEM Page 36