Hospital – Life Cycle Journey & Departments (Royal Marsden Hospital Tour – UK)

This video will be about the life cycle journey of a typical hospital starting with a strategic plan and ending with the demolition In the first part, we will talk about the life cycle journey of a hospital To facilitate understanding the life cycle of a hospital, we will make an analogy with human life cycle Then, we will talk about hospital departments generally Also, we will have tours for some departments Such tours will include the following departments: Emergency (ER), Surgery (OR), Laboratory, Radiology, Obstetric (LDR), and CSD. In the last part we have a tour visit for the oncology specialty hospital “Royal Marsden Hospital” in UK, which has been built based on British Standard (BS): Health Building Notes (HBN) and Health Technical Memoranda (HTM) Now, we will start with the talk about hospital life cycle Human life cycle starts with a fetus in a womb Then, after passing childhood and adolescence, adulthood will remark the period of human usefulness After that, the usefulness in human life cycle will end being elder Finally, death will be the final stage in this cycle In the next slide, we will watch a video summarizing a life cycle of human A life cycle of hospital journey is similar to a life cycle of human It has a start known as “Strategic Planning Phase”, and ends with a “Demolition Phase” Each phase has a specific aim and role In the second figure, we see the BIM tool used in modern hospital designing school BIM is an acronym of “Building Information Modeling”, which covers all hospital life cycle Our human body system consists of number of biological systems, such as nervous system, respiratory system, circulatory system, digestive system…etc Each system is made of connected organs To achieve specific function, body systems communicate with each other to create life Similarly, hospital is made up of systems, known as “Departments”. Each department has specific function and anatomy, known as a “Functional & Space program” The functional program can be further separated into sub-programs: inter-functional and intra-functional sub-programs Hospital life cycle is made up of the following phases: pre-design, design, construction, hospital equipping, commissioning, operation and maintenance, renovation, and demolition. The pre-design phase can be further separated into other phases or sub-phases: strategic planning, master planning, and functional & space program Hospital life cycle starts with a strategic plan In the strategic planning phase, type of services, different locations, planned growth covering complete life cycle, size of investment, and other issues, will be discussed. Based on this discussion, a feasibility study will be made, and green light will be given to move on into a master plan. An update of the strategic plan will be made during a hospital operational life based on the situation Also, a strategic planner should consider operational cost “hospital annual budget expenses and revenues” to reach proper view and decision in strategic plan Based on the strategic planning phase, hospital investment

will be either made or even cancelled If the strategic planning phase reveals that a new element of clinical service is to be provided, or an existing one altered, extended or relocated, the options for housing these clinical needs must be evaluated before a specific scheme is identified This should be encapsulated in a “Master Plan (MP)”, and its associated development control plan (DCP) The main aims of these plans are to set out, and define the particular qualities and attributes of a place, and illustrate how to make the best use of them Key considerations behind the development of a master plan include: maximizing opportunities, understanding the constraints, context and physiology, flexibility and future proofing, and deliverability. The result will be a linear process Thus, the output of strategic plan will be an input into a master plan In master plan, a specific location will be selected from suggested locations Specific data will be gathered about the site Then, a master plan will be translated into a functional and space program The summary of a functional and space program will be handed to a design team: architect and other engineers (A/E team) In this slide, we can see the development of master plan This includes the study of site concerning: constraints, observations, response, opportunities, private and public realm, and functional zones. In the functional and space program, the function and required space of each department will be examined. Each department will have two functional sub-programs: intra-functional and inter-functional subprograms An intra-functional program will study the functionality inside the department itself Whereas, an inter-functional sub-program will study the functionality of department with the respect to the rest of hospital Functional programs should be made based on a national or international accreditation standard requirements One of the famous international accreditation organization is the joint commission international (JCI) Then, the functional program will be translated into a space program with an illustrative budget Concerning the design phase, there are two schools: conventional and modern In old or conventional school, an architect or architectural team will draw the hospital main maps based on the summary of the functional & space program (correction) Then, the hospital main maps will be handed into other engineers: civil, electrical, mechanical, telecommunication…etc However, each engineer will work separately Consequently, the clashing will happen during the hospital construction Modern school uses Building Information Modeling “BIM”, where all team work will be made in one model BIM will be the design topic of this lecture After the finishing of design phase, hospital drawings will be handed for a contractor The constructional work should be supervised by consultancy company Hospital equipping will include: hospital furniture and medical equipment Medical equipment planner is needed to achieve the best results Medical equipment planner is usually a “biomedical engineer” A room by room equipment list should be prepared with a bill of quantities Then, the tender documents will be developed This includes legal and general terms specification document as well as other documents It’s important that the specifications of medical equipment should be “generic” allowing most reputable suppliers to share in tender Useful resources to prepare medical equipment specifications as well as hospital furniture include: ECRI, MD Buyline, NHS, Technical Bank of Specifications…etc Finally, a comparison summary will be made to decide the “bid winner”. The usefulness phase of a hospital life cycle will start with a commissioning phase, which is essential prior to reach full operation phase

During commissioning, initialization of hospital building systems, purchasing hospital consumables, hospital staff training (equipment, HIS…etc.) as well as many tasks will take place During operational life, a master plan will be developed every 4-7 years to cover: a possible capacity expansion or a renovation of hospital part The expected period of master plan will vary based on the expected work during this plan Renovation is a demand as a result of the aging of: hospital furniture, medical equipment, and hospital infrastructure as well as increasing hospital capacity and services Finally, a demolition decision will be made either after reaching the lifespan of a hospital building or the inability to expand due to the site limitations To sum up, we will make an analogy between a human body and a hospital In such analogy, we will notice: human body systems will mean departments in hospitals, physiology will mean functional program, anatomy will mean space program, human life cycle stages will mean hospital life cycle phases, expected human lifespan is 60 to 70 year; whereas, expected hospital building life span is 30 to 40 year In this part, we will talk about hospital departments, which can be classified as: either professional health service or non-professional health service Then, we will watch tours for some hospital departments As we mentioned previously, hospital in this course could mean: a general hospital, a specialty hospital, a medical center or even a medical city Hospital departments can be classified into two major categories The first category is professional health service, such as medical, nursing (an example of nursing departments are ICU, Medical/Surgical, NICU, PICU…etc), paramedical, outpatient (OPD), Accident & Emergency (ER or A&E), Operating rooms (OR). The second category is non-professional health service, such as admission, human resources (HR), purchasing, medical records, housekeeping (domestic department), laundry, kitchen, engineering 0:12:57.360,0:13:02.399 (clinical and general), Central Sterile Supply (CSSD or CSD) Now, the department tours will include the following departments: Emergency Department (ER) – Lahey Hospital and Medical Center, Surgery Department (OR) – Methodist Hospital, Laboratory department – Renown Eegional Medical Center, Radiology Department – Unity Point Health Saint Luke’s Hospital, Obstetric (LDR) Department – Sibley Memorial Hospital CSSD Department. We will start our tour with the Emergency Department (ER), which is open 24 hours, seven days a week. ER treats various types of injuries: ranging from ankle sprain to drug overdose, severity is assessed by a process called “Triage” In ER Department, patients are: either treated completely or sent to other hospital areas In this slide, we see functional diagram for a typical emergency department Such programs are made based on accreditation standards, such as JCI Usually, accreditation standards are updated regularly based on the best healthcare practice Consequently, these functional diagrams will change. Additional to accreditation standards, the type and size of a hospital (e.g. general, specialty, medical center or city) will also lead to a change in functional diagrams. Then, functional program will be translated into a space program with room-by-room list In this slide, the first functional diagram is

an ER department inter-functional diagram, which shows the relationship between ER department and other departments The second functional diagram is an ER department intra-functional diagram, which shows the relationship between spaces inside the ER department itself In the next slide, we will watch a tour video for the emergency department (ER) at the Lahey Hospital and Medical Center “Welcome to Lahey Hospital and Medical center’s new state-of-the-art emergency department in burlington massachusetts The facility is the only level 2 trauma center in northeastern massachusetts, designed with the patient in mind. The new facility can accommodate more than 50,000 patients per year, and offers many new features that will improve the experience of those needing care Patients and their family members will enter the 45,000 square foot space into a large sun-filled reception area The triage fast track area is where patients will be evaluated upon arrival Those with minor conditions will be examined and treated here There is a dedicated radiology area conveniently located near this triage fast track area. For these minor emergency patients, there are four color-coded pods throughout the emergency department Each with a clinical team station, where staff can facilitate day-to-day operations These stations serve as the main areas, where physicians, nurses, and other members of the medical team make coordinated decisions about patient care. There are 36 private treatment rooms, large enough to accommodate the care team as well as family members. Every treatment room has a corresponding pod color and letter Each room also has a number, which appears both outside of the room and on the back wall of the room For patient safety, three rooms in the emergency department are designed to ensure the safety and comfort of patients suffering from behavioral health problems. The area includes: an office for a social worker, who can help coordinate any further treatment the patients may need upon discharge The central station is the primary communication area for charge nurses and other key staff. Charge nurses can see everything happening in the Emergency department from this vantage point The area directly behind the central station is an enclosed space, where providers can work uninterrupted on medical decision making and documentation The emergency department’s new imaging suite features: 2 CT scanners & an X-Ray unit along with a reading room for radiologists to interpret the imaging studies The new emergency department also has 4 dual trauma rooms, where patients suffering from serious injuries and illnesses will be treated by a multi-disciplinary team The trauma rooms are equipped with advanced life-saving equipment and surgical capabilities There are also separate EMS and trauma team entrances and clinical staff can go between trauma rooms Patients arriving by ambulance will enter through our covered ambulance bay vestibule. There is a large decontamination area, where patients who have been exposed to chemicals or other harmful substances can be decontaminated before being treated in the Emergency department When our new emergency department opens, our talented staff will finally have a facility that equals their expertise and commitment. And more importantly, our friends and neighbors will be able to obtain life-saving care in a state-of-the-art facility designed especially for them The second hospital department, which I will talk about, is the Surgery department. Surgery is done in the OR department In order to make a surgery, sterile environment is required Surgical team includes variety of health care workers, such as surgeons, nurses and anesthesiologists Usually, OR contain surgical instruments, monitoring equipment, and emergency equipment The room size of operating rooms (ORs) was conventionally decided based on the type of performed surgery, such as cardiac, orthopedic, gynecologic, general…etc However, recently, Universal OR with the largest operating room sign has been adopted to ease the surgery department future capacity expansion

New models of operating rooms have appeared recently, such integrated OR (iOR) and hybrid OR In this slide, we see a typical Surgery department functional diagram, which consists of: inter-functional and intra-functional diagrams integrated into one diagram instead of two separate diagrams This diagram is taken from the International Health Facilities Guidelines (iHFG) In the next slide, we will watch a tour video for the surgery department (OR) at the Methodist Hospital “The surgery project started many years ago. Our goal was to make it the most efficient operating room possible In order to do that, we looked at a concept of any room, any procedure, any time What we can do with this new operating room is improve the quality of our patient care We do a great job now in a small space And, so by opening up this space, it just makes a better work environment for everyone in the operating room, but it also creates a more inviting more healing environment for our patients when they come into a space that’s new It’s bright. It has all the things that they need to make sure that their experience here is the best. They can be patients from my point of view pretty much are all why we’re here you know we all work as a team to give them the best outcomes and the best care we can, and you know the happier they are the happier we are I think it’s going to tremendously impact patients experience all the way from the pre-operative area and the transitions into the operating room, where there’s more space and families being able to be around the patients more as they go through stressful times The surgical setting is pretty important just because it it provides us with enough equipment and tools that we can actually do our job efficiently You have an operating room where you have good flow of the entire case, which includes the team as well as the surgeon It just makes the surgery more successful. Besides, the new OR is approximately double of what our old ORs were Each room is just over 600 square feet, where our old rooms were 400 square feet So, about 150 % bigger than they were before So, that allows us to advance with the new technology Any new technology that comes in we know we have room for We know what we have capability for and we’ve developed that in our strategic plan for building these operating rooms and having them take us into the future technology used. Today is completely different from 1968, when the old ORs were conceived and developed. Some things have gotten smaller. But in the case of the hybrid room, some things have gotten larger When you incorporate imaging into the actual OR theater, it takes a lot of space So, traditionally uh vascular surgery was done with an open surgical and technique incisions on the body bypasses or a repair of an artery Now, with the advent of endovascular surgery, we can travel again within the lumen of the blood vessel. A hybrid suite allows us to do both at once Traditionally, patients had to get an open procedure, go home recover May be get an endovascular surgery later We can do all that at once now. Because the imaging technology is so good, we have more precision in what we do, where we place stents for patient. standpoint again the smaller incisions less recovery time, less pain, earlier to work better meaningful life recovery is what patients. see It’s hard for me to envision what the next breakthrough in technology will be, but we have tried to think of everything possible and incorporate it into these rooms. So, that if structure needs to change, the supports are in the ceiling IT changes. We think we have the infrastructure set to accept those types of innovations It’s really amazing how it comes together where you have the construction workers, the physicians, and the nurses, all working together to make this happen, and to make it happen with the patient focus.” In the laboratory department, clinical laboratory services include: clinical core lab (chemistry, hematology and uranalysis), microbiology, pathology, molecular testing. The clinical laboratory services will vary based on the type of hospital, such as general, specialty, medical center or medical city The new design trend in clinical laboratory is the adoption of fully automated laboratory concept The automation will include: pre-analytic, analytic, and post-analytic. This aims to minimize the number of lab staff, and consequently minimize the hospital operating expenses In this slide, we see functional diagrams for a typical laboratory department. In the next slide, we will watch a tour video for the

Laboratory department at the Renown Regional Medical Center “Most of you have seen a hospital, have been in a patient room, a waiting room, or experienced some of the technology, but what you might not know is the kind of things that happen behind the scenes that allow the hospital to provide excellent patient care to each and every one of you. In the clinical laboratory, where there’s lots of automation, it’s fairly new before we got the automation. A big day in the lab would be about 600 tests in a 24-hour period. Now, with the automation, we’re able to perform 800 to 1000 on a typical day, and doing our health fairs in high flu seasons and things like that, we go up to 1200 to 1400 tests per day and that’s 24 hours a day seven days a week. We have an automation line that we’ve had for about three years now The automation line is advantageous to the patient because we are able to provide faster turnaround times Because everything is done automatically, the specimen is put on the automation line It is actually then centrifuged on the line. And, then, based on the barcode system the line reads the barcode and can tell what tests are to be run the line. Then, takes the specimen to each individual analyzer to be tested We now can perform testing in 30 to 45 minutes versus the hour to two hours that it used to take when we would have to do things manually I understand this machine that we’re standing in front of is fairly new to the lab, and we’re doing DNA testing, the advances of molecular microbiology, we are now performing more DNA testing. The advantage of DNA testing is that instead of a test taking 3 days because you have to grow an organism or a virus. We now can get results in an hour or two. I really want to thank you for your time today, and telling us about the exciting things that are going on here in the lab that helps our patients The tests when they’re completed, the specimen goes to a place that’s called the “stockyard” If a physician needs to add a test, the system knows that it already has some blood in the refrigerator as an example, and the robot will get the specimen out of the stockyard, put it back on the line, do what is necessary to perform the additional testing. And, then, send the results out. Thank you for joining us on this behind the scenes tour We hope that we showed you some things that you wouldn’t have expected to see in a hospital, and we look forward to showing you much more in the future.” Radiology services include: radiography, fluoroscopy, mammography, ultrasonography, computer tomography (CT), magnetic resonance imaging (MRI)…etc Recently, most interventional radiology services have been transferred into surgical suite In this slide, we see inter-functional diagram and intra-functional diagram of Radiology department In the next slide, we will watch a tour video for the Radiology department at the Unity Point Health St Luke’s Hospital “Offered at sunnybrook medical plaza, Unitypoint Health St Luke’s imaging and breast screening services provides imaging for the whole family When you arrive, a friendly Saint Luke’s face will greet you. For check-in or with your physician referral, you can pre-register by going to unitypoint.org. Then, check in at a kiosk when you arrive If you’re here for a mammogram, you’ll be guided to a state-of-the-art digital mammography suite These exams last 15 to 20 minutes and take several angles of the breast to see asymmetry or masses that indicate breast cancer Rest assured the vast majority of mammograms are perfectly normal However, if a suspicious mass is found St Luke’s offers Mammotome, a less invasive procedure used to obtain tissue samples under ultrasound or mammography guidance The Mammotome allows a quicker diagnosis of abnormalities while cutting down on patient discomfort and healing time Another popular service is a bone density scan used to detect “osteoporosis”. This procedure takes 20 minutes, and scans your lower back and head For other imaging needs, St. Luke’s offers state-of-the-art diagnostic services including: the latest technology for digital x-ray and ultrasound Ultrasound procedures use sound waves to visualize internal organs, muscles. And, more advanced detailed imaging is also available in the new CT suite, using 3D images, CT scans visualize nearly every part of the body to detect internal injuries,

diseases, masses and more In St. Luje’s, low-dose radiation is offered, exclusively, at St Luke’s. So, patients can be assured, they’re receiving the lowest radiation necessary to achieve a quality image. Finally, St Luke’s offers MRI services to show even more detailed images inside the body, including breast MRI. In a comfortable prep area, patients receive contrast material through an IV (Intra Venous) During the exam, patients lay flat for 10 to 35 minutes in a short bore MRI, which is about half the length of a traditional MRI This option is more open for those, who are uncomfortable in small spaces But still allows for very detailed images and accurate results Patients can focus on the scenic mural in the ceiling, and listen to music of their choice for greater comfort during the exam For all your imaging needs, ask your doctor to refer you to Unitypoint Health St Luke’s imaging and breast screening services In this slide, we see inter-functional diagram and intra-functional diagram of Obstetric department In the next slide, we will watch a tour video for the Obstetric department at the Sibley Memorial Hospital “Welcome to the University of Maryland Obstetric Care Unit. This state-of-the-art labor floor individualizes every delivery. We will go behind the scenes to give you a tour of our labor rooms, so that you know what to expect when having a baby here This is the waiting room. You and your family will come in this entrance, meet with our admitting specialist. A triage nurse will come out and decide which zone you need to go to. There’s: a labor zone, a prep and recovery, and triage. Let’s go to triage So, this is one of our triage rooms. There are five of them If you’re not sure if you’re in labor, you will come here first A nurse will put you on the fetal monitor. We’ll do your vital signs. We’ll do a brief assessment And, then, shortly thereafter a doctor or a midwife will come and examine you This is our fetal monitor. You’ll be put on the fetal monitor to see if you’re contracting and seeing how the fetal the baby’s doing You’ll be in this room a minimum of probably an hour maybe a few more. If you’re in labor, this is our labor zone, come on in You will labor, deliver and recover (LDR) in this bed Your family has a zone over here for themselves with a recliner and a couch And, this is the baby zone. If you notice, our artwork it’s designed to have a focus, when you’re in labor lots of tranquility All of our rooms have a shower. And, four of our rooms have tubs, in case you need them for hydrotherapy, which is water for pain relief If you are scheduled for a C-Section, this is our prep and recovery zone We would prep you in here. We would do your vital signs, and prepare you for your C-Section. Once prepared, you’ll go to the OR You’ll come back to this room for recovery. We promote bonding with the baby The baby will be here with you. And, if you are breastfeeding, we would love for you to breastfeed. You’ll be in this room a couple of hours, and then go to the Mother/Baby Unit This is one of our three operating room (OR) suites. This is where your C-Section will take place Most of the time, your support person can come in here with you We take care of all types of pregnant patients, and it will be our privilege to take care of you As you can see, the University of Maryland offers a comfortable experience for your birth. The only thing better than our facilities is our medical team At the University of Maryland Obstetric Care Unit, we can make every delivery a personalized individualized experience, whether you’re low risk and having an uncomplicated delivery or the ultimate high risk with the most danger to mother or baby. Our team has the expertise and services to satisfy your delivery needs.” Central Sterile Department (CSD) is made

of three areas: dirty, clean and sterile. Firstly, soiled items will be firstly received at the dirty area Then, they will be washed and dried Then, the clean items will be wrapped in the clean area, and entered into a double door sterilizer Finally, sterile items will be received in the sterile area through the double door sterilized In this slide, we see inter-functional diagram and intra-functional diagram of CSD department. In the next slide, we will watch a tour video for the CSD department [Applause] [Applause] In this part, we will have video for the “Royal Marsden Hospital”, which is an oncology specialty hospital dedicated for the treatment of cancer patients in united kingdom (UK). In the next slide, we will watch an overview video for the Royal Marsden Hospital, which is an oncology specialty hospital dedicated for the treatment of cancer patients in united kingdom (UK). The video demonstrates the medical equipment of such hospital The Royal Marsden Hospital is built on the UK Health Building Notes (HBNs) and Health Technical Memoranda (HTM) “My name’s kelly palmer, and i’m the chief executive of the Royal Marston Hospital The Royal Marsden was the first hospital in the world to be dedicated solely to the treatment of cancer. We work closely with the institute of cancer research as one of the largest cancer centres in the world. Patients can come to the Royal Marsden with a diagnosed cancer, or they can be diagnosed in one of our rapid diagnostic and assessment centres The purpose of a rapid diagnostic center is to detect tumors early on in their progress in order to give patients the best chance of cure and survival We run a number of early diagnosis clinics. Each week tumors that are diagnosed here include head and neck, urology, breast, sarcoma, and skin patients, will get their result And, if they need more complex imaging they can get state-of-the-art CT, MRI, intervention and PET/CT if required The care we offer is founded on the principle of a multi-disciplinary approach This team will recommend the best care at each stage of treatment. As a world leading and specialist cancer centre, we attract leaders in our field I’m Nick Finess. I’m a consultant clinical oncologist, and i lead the cyberknife program The cyberknife is a unique piece of radiotherapy equipment. It’s mounted on a robotic arm, which means that it can move in almost limitless planes around a patient

This allows us to give very highly conformal dose to a specific targeted area We have a 25 million pound radiotherapy development at sutton And, in total, we have 11 linear accelerators. We have a long and established history of running clinical trials and plan to be at the forefront of cyberknife research I’m Chris Ogden, and I head up the robotic program here at the Royal Marsden. I put together the first team in the UK to be recognized internationally as being able to perform the radical robotic prostatectomy. And, I’ve now passed over a thousand procedures, and still lead with the most radical robotic prostatectomies performed by any single surgeon in the UK. At the Royal Marsden Hospital, we do everything we can to provide patients with the reassurance advice psychological support and ongoing rehabilitation that patients need to adapt to life after cancer. I’m Jarv Sandrev I’m a consultant gastroenterologist in pelvic radiation disease Over the last 30 years or so, there’s been a revolution in the treatment for cancer with far more people being cured and far more people living for very much longer But an inevitable consequence of this dramatic, and it has been a truly dramatic increase in survival, are the physical side effects, which people develop after cancer treatment I run a completely unique service in the UK and probably in the world to try and help people, who have developed these side effects of cancer treatments The Royal Marsden will continue to build on its heritage of innovation and its ability to offer the very latest in cancer diagnostics treatment and care.” In this slide, we see the website for the British Guidelines “Health Building Notes (HBNs) and Health Technical Memoranda (HTM)” Kindly visit their website to get familiar with their guidelines and standards Finally, thank you for watching