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Planning an Ambulatory Care Facility: The Lean Toyota or the More Generous Hummer
Prudent Health System (PHS) planned to construct a new outpatient building to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics on it main campus. Workloads were projected for a ten-year planning horizon and a room-by-room space program was prepared based on the workload and other functional planning assumptions provided by PHS ambulatory care staff. An initial schematic drawing was developed by the architect and the project cost was estimated. A business plan was then prepared along with a financial pro forma analysis. Due to the large amount of space and corresponding high project cost, and high operational costs relative to the projected incremental revenue, PHS's Chief Financial Officer asked the executive team whether they really needed a "Hummer" when a "Toyota" might suffice. The executive team agreed to evaluate the impact on overall space need (and resulting capital and operational costs) of planning a "lean" facility versus a more "generous" facility. Based on the analysis, the overall building gross square feet (BGSF) was reduced from 90,000 BGSF (requiring four floors) to 50,000 BGSF (with only two floors).
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| In the News |
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USP 797 Impacts Pharmacy Space and Design
USP 797 is a regulation that governs any pharmacy that compounds sterile preparations including centralized and satellite hospital-based pharmacies, outpatient pharmacies, and off-site pharmacies. USP 797 is designed to cut down on infections transmitted to patients through pharmaceutical products and to better protect staff working in pharmacies in the course of their exposure to pharmaceuticals. Issued by U.S. Pharmacopeia (USP), USP 797 has been endorsed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) who expects that organization will be in full compliance by January 2008.
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| Trendline |
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Rethinking the Traditional Intensive Care Unit
Many hospitals feel that they never have enough intensive care beds and are constantly pressured to expand existing units or create new units. Historically, intensive care units (ICUs) have provided intensive observation and treatment of patients in unstable condition. Because of the high-tech requirements and highly-skilled staff, these units are expensive to build and operate. However, insufficient intensive care beds can affect the ED when the ICUs are full. Healthcare organizations are redesigning ICUs to better monitor and care for patients, are improving nurse-staffing ratios, and are hiring specialists, known as intensivists. Remote patient management of critically-ill patients is being successfully implemented in a number of hospitals around the U.S. in response to shortages in nursing staff and intensivists, and the desire to improve the quality of care and patient outcomes. Remote or virtual ICU monitoring centers can monitor multiple ICUs at once from a remote location with real-time "telepresence" including the review of clinical documentation and medical images, the monitoring of vital signs, and the use of digital stethoscopes and high-quality video cameras.
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| Technology |
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RFID Gaining Momentum in Hospitals
Hospitals are increasingly using radiofrequency identification (RFID) technology to optimize equipment and supply management, improve patient flow, streamline hospital operations, and improve patient safety. RFID uses radio waves to automatically identify and track the movement of items or people. The basic hardware includes an RFID tag (consisting of a microchip with an antenna) and a reader or receiver. RFID can be either passive or active. With passive RFID, the small RFID tags must be within a one-meter range of a reader making it a good choice for inventory management. Active RFID tags transmit at higher power levels and have ranges of 30 feet with a battery life of up to ten years. Transmitting a constant signal, they can provide continuous tracking of people or items that move frequently and over large distances throughout the hospital.
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SpaceMedGuide
A Space Planning Guide For Healthcare Facilities
SECOND EDITION
Current Trends.
State-of-art planning methodologies.
Industry benchmarks and rules-of-thumb.
Quick. Efficient. Effective.
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Rule-of-Thumb |
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Emergency Department Capacity and Space Need |
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Emergency departments are complex operational models impacted by many other parts of the hospital and healthcare system. However, not all EDs are burdened with operational and customer service problems. Some are sources of pride for their communities. These peak performing EDs handle a significantly higher number of annual visits per treatment bay and use less overall square feet.
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From the Editor |
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Decisions made during predesign planning have a major impact on long-term operational costs as well as on the overall size of the facility and initial capital costs. As shown in this issue's case study, there are many factors that influence how much space is required to handle any projected workload. The rule-of-thumb in this issue compares the space required to deliver care between poor, average, and peak performing EDs. New regulations, such as USP 797, also impact the size and configuration of certain spaces. Real-time "telepresence" that allows the remote monitoring of patients presents new ways of configuring ICUs and the use of RFID in hospitals improves patient flow and streamlines hospital operations. The focus of this newsletter, like the SpaceMed Guide, is to promote operational processes that are focused around the patients, exploit new technologies, and provide efficient use of staff, equipment, and space. I welcome your comments or ideas for future issues.
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