A Presentation on Specialty & Super

Specialty Services

Presented By : Dr.Devendra Kumar

MHA Final YearAcharya College Of Hospital Administration,

BangaloreDate Sep. 1st 2009

Contents

1. Cardiology. 2. Cardio thoracic Surgery.3. OBG.4. ENT.5. Other Specialty Services.

CARDIOLOGY DEPARTMENT

Cardiology (Super Specialty)

• Introduction:- Once the patient has suffered from any cardiac ailment, he suffers from physical and psychological disorders and is not able to lead a normal life. It is for these patients that this OPD has been established. It helps to consul the patient and helps to bring him back to normal routine of life. It provides Diagnostic, Therapeutic, Preventive, Curative, support to the cardiac patients. Cardiology Super Specialty hospital which is tertiary care or Quaternary Heart care Hospitals where all Primary, Secondary, Tertiary, and Quaternary services are available in the supervision of specialist Cardiologists or cardiothoracic surgeons who must be DM (Cardiac), Mch. (Cardiac Surgery) deals with advance cardiac cases like.

•

Location and layout of OPD

It should be at the grand floor of the main hospital complex and easily accessible to staff and cardiac patients.

Specialized OPD Services may include the following. • Separate entry.• Easily accessible.• Near to all Investigation Lab. ( ECG, ECHO, TMT, Holter

Monitoring, Pathology Lab,.Staff Zone – The following should be planned: Staff clock rooms and toilets. Seminar room.Parking and Entrance:• Main entrance to the OPD should have gentle sloping ramps to

facilitate movement of patients on wheel chairs and those carried on stretchers. The surface should be slip/ skid free.

Continue…

• Entrance should have a double door with a width of 1500mm to facilitate passage of stretcher and wheel chairs.

• Wheelchairs should be readily available at the entrance.

• Staff and patient entrance should be separate, with each entrance providing access to the respective zone.

Enquiry Desk, Reception station • The height of counter should be adapted to

the need of wheelchair patients.• To ensure privacy of discussion between

patient and reception staff, Reception should have counters.

Waiting Area• The waiting area should be planned more than the

number of people expected during peak hours.• Sub waiting area may be shared between the

various consultation room. To facilitate movement of patients, call system should be provided, which direct the patient to the appropriate consultation room.

• The distance from the waiting area to the consultation room should be short and clearly marked.

• Patients on wheelchairs require extra space for movement.

• Toilets should we close to the waiting area. Male and Female toilets should be separate. Toilets for staff should also separate from those for the patients.

Waiting area

Spatial needs for a basic consultation unit.

Schedule of Accommodation

Room /Space Area in m2

Enquiry and reception 7

Waiting area* 45-60

Trolley and wheelchair bay 7

Room of OPD in-charge 15

Consultation and examination room**

12

Treatment room 15

Specialty clinic*** 12

Injection room 10

Room for nursing incharge 10

Room for minor surgery 20

ECG Room 10

Instrument and trolley room 7

Flash autoclave 7

Continue….Wash-up room ( sluice) 7

Fracture and plaster room 15

Audiometery room 12

Eye-slit lamp room 12

Playroom (pediatric) 10

Pharmacy 20

Drug store 15

Equipment, plaster store 15

Counseling room 15

Toilets 12

Circulation space 30%

The schedule of accommodation is for general OPD, howver, for specialty OPD, area will vary as per equipment and patient load.

* as per patient load. ** A Number of consultation room may be required. *** for each specialty.

Investigation laboratories.

Catheterization Laboratory & CCU• CCU is the short form Coronary care unit. It is a

highly sophisticated equipped cardiac ward where patient is under observation 24 X 7.

• Location near to Cath. Lab, C.O.T. There is no clear cut role for location of CCU but it should be traffic free place, Easily accessible, it can be any floor ( Manipal 4th Floor)

• Layout CCU layout similar to other ICU ward but basic difference is CCU connected with cath. Lab in most of the hospitals.

• Other physical facilities and lighting, fixtures same as ICUs.

• It is also divided into Zones Protective zone and clean zone.

Catheterization Laboratory• Cardiac catheterization- A highly specialized

procedure- is the insertion of a catheter through a vessel into the heart, which makes it possible for the cardiologist to explore the heart to see how well the heart and coronary arteries are functioning. Cardiac catheterization is relatively painless non-surgical procedure that is performed in a specially equipped hospital laboratory.

• the procedure performed in the cardiac catheterization laboratory can be classified as diagnostic and therapeutic.

• Diagnostic procedures: Coronary angiogram Rt. And Lt. heart catheterization

Continue…

Electrophysiological studies Intravascular ultrasoundTherapeutic Procedures Coronary angioplasty with stent

implantation Rotablator, Atherectomy Percutaneous transliminal valvulopalsty pacemaker implantation Laser angioplasty Implantation of cardioverter defirillator Etc.

Location and layout

• Traditionally, cath. labs were located within the diagnostic radiology suite. The tend, particularly in specialty high-tech hospital, is towards setting them as independent units. Since asepsis condition is a critical factor, the same general conditions that apply to surgical suites hold with regard to location, circulation and infection control. For this reason, some hospitals located their cath. Labs close to but separate from the surgical suite – for example, on an exclusive, on surgical floor. There should no cross traffic though the cath. Lab and no interference from the activities of other departments.

Layout of Cath. Lab.

Manipal Hospital Cardiac Cath. labs

Ward

Manipal Hospital Cardiac Cath. labs

Equipments

Equipments

Equipments

Equipments

Design ElementsThe following facilities are needed:• Catheterization procedure room• Control/console room• Patient holding room, preferably equipped

with ECG monitors• Patient recovery room• Technicians work room• Dark room for 35 mm film, if necessary• Equipment storage room• Film view area for cardiologists• Desirable- a small chemistry lab ( ABGA )

Continue..

• Scrub facilities• Storage space for crush carts• Alcove for wheelchairs and stretchers• Clean and soiled utility rooms• ToiletsSpace RequiredThe space requirement is around 700 square

feet which includes: 500 square feet for procedure room 100 square feet for control room 100 square feet for clean / storeThe procedure room size and the size of door

should

Continue… depend not only on the type and extend of

equipments and staff but allow for patients delivered by coronary unit bed instead of stretcher, attached to respiratory at head, a balloon pump at the feet, attended by extra staff to service these supports, and physicians, residents in the laboratory as observers.

Power • 3000 KVA generators to allow adequate

penetration and resolution at cine film exposure of 80-150 frames per second or high speed cut film the laboratory should be powered individually from a separate main feeder line with backup connections.

• Ventilation Air –conditioned and zoned. ( Protective, clean, scrub )

Continue….Air flow Sterile Zone Clean zone protective zone

out with pressure. (HEPA Filters)Air circulation Laminar (vertical Flow) 10 -15 Circulation per

hour.Humidity 55% +_ 2 %Temperature Inside 220 C (+_ 20 C)Lighting General 150 lux to 300 lux, medication room

500 lux, procedure room 100000- 120000 lux on table must be shadow less .

Continue….

• Ceiling may be needed to support heavy equipments.

• Gases, suction piped in facilities with wall outlet.• X-Ray protection measures during construction.Equipments:• Radiographic system.• Power injector • Physiological Data monitoring and acquisition

instrumentation • Cinematographic film • Film processor • Viewing equipments• Other CCU equipments etc.

Organization

• Staffing in the cardiac catheterization lab. include

• Chief of Services• Cardiologists• Nursing in-charge• Radiological technologist• Staff nurses.• Nursing aid• ClerkAll member should be trained in

cardiopulmonary resuscitation and advance cardiac life support.

Cardio-thoracic Surgery.• Cardio-thoracic surgery is branch of cardiology

which deals with cardiac surgery like Balloon Mitral, Aortic and Pulmonary Valvuloplasty

• Balloon valvuloplasty or percutaneous balloon valvuloplasty,

• Rotational and Directional Atherectomy• IVUS is an invasive procedure, performed along with

cardiac catheterisation.• The surgical removal of a blood clot (thrombus) from

a blood vessel is called thrombectomy.• Aortic Aneurysm & Dissection with Endovascular

Stent Graft• Non-surgical Coil/Device Closure of ASD, VSD, PDA,

AV Fistula

Location and LayoutDefinition: An COT is that specialized facility of

hospital where life saving or life improving processors are carried out on the human body by intensive method s under strict aseptic conditions in a controlled environment by specially trained personnel to promoting healing and cure with maximum safety, comfort and economy.

Objectives of Planning:The main objective of planning in an OT should be to:• Promote high standards of asepsis.• Ensure maximum standard of safety.• Optimize utilization of OT and staff time.• Optimize working conditions. • Patient and staff comfort in terms of thermal,

acoustic and lighting requirements.

Continue….

• Allow flexibility.

• Facilitate coordinated services.• Minimize maintenance.• Ensure functional separation of spaces.• Provide a smoothing environment.• Regulate the flow of traffic.Principles of Designing:• The essential principles that should be

followed while planning the physical layout of an operating room suite are the exclusion of contamination from out side the suite, with proper traffic pattern within the suite and separation of the clean areas from contaminated areas within the suite.

Manipal cardiac OT Complex Layout

Continue…

Design Parameters:• Preparative Patient Holding Area 802 feet • Post –anesthetic Care Units 802 feet• Service Area Hand wash area, Sub sterile

area, Sterile supply storage etc.• Staff Amenities separate room for male/female

staff with locker, shower, Toilets etc.• Medical Gases .• Anesthetic Work Room.• Blood Storage.• Set-up Room.• Laboratory.• Storage.

Zoning

Protective Zone Reception Waiting area Trolley bay and Changing room. Clean Zone Preoperative room Recovery room Staff room and Store.

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Sterile Zone Operating suite Scrub room Anesthesia induction

room and Set-up room. Disposal Zone Dirty utility and Disposal corridor.Engineering Parameter

as other OTs

Modern OT (O T WITH MEDIA BRIDGE)

Schedule of Accommodation

Room/Space Area in m2

Reception 10

Anesthetic induction room* 15

Operating room (major) 36-48

Scrub-up / gowning 6

Support Areas

Anesthetic room* 10-15

Mobile equipment bay* 4

Linen bay* 3

Janitor cupboard* 2

Clean-up room* 12

Disposal room* 10

Flash sterilizing room* 5-6

Laboratory / frozen section ( Opt’nal)

4-12

Set-up room* 20

Store anesthesia* 20-40

Continue…

Store equipment 20-40

Store sterile 20-40

Store non sterile 20-30

Blood store 4

Recovery Area

Patient bay* 9

Linen bay 3

Resuscitation trolley bay* 2

Hand washing bay* 1

Clean utility* 12

Dirty utility* 10

Staff station 6-14

Continue…

Administrative Staff Area

Change room* 10-130

Office (single person)* 9

Store* 10

Toilet Staff* 4

Shower staff* 4

Staff lunge 10-30

Shared Areas

Meeting room 20-30

Store general 9

Waiting 4

Circulation areas 30%

* Many may be required

OBSTRATIC & GYANAECOLOGY Specialized team consisting

of gynecologists, embryologist, sonologists, radiologists, andrologists, psychological counselors and biomedical team, ensure complete support for expectant mothers right through pregnancy and post pregnancy period, in addition to providing advanced fertility solutions to couples struggling to achieve pregnancy.

Obstetrics and Gynaecology

 • We provide excellent healthcare services for expectant mothers in need of special care during and post pregnancy. Our skilled and experienced medical staff offers the highest standard of educative and supportive services including all required clinical facilities for maternity and reproductive healthcare, child birth and postnatal care.

Continue…• Reproductive Medicine and

Assisted Conception Department of Reproductive

Medicine and Assisted Conception is a super-specialty one stop single window centre for couples desirous of having children and require help with conception. At Max we offer a wide range of infertility treatment, IVF treatment and other assisted reproductive services. We have internationally trained and experienced fertility specialists, skilled and experienced embryologists, gynaecologists, andrologists and other qualified technical staff to assist fertilization.

Location and layout

This should preferably be located on the same floor and in close proximity to the labour delivery units. It should have an ultrasound scanning room. A day room also be provided.

Layout

Bed

LDRP Suite

Spatial Requirements1. Family waiting room. In the attractively furnished and decorated

( Telephone, reading materials should be available )

2. Diagnostic - admitting room. easily accessible , patient prepare for labor

room, there should be examination table , stationary, an adjustable ceiling light fixture, a small laboratory for blood and urine analysis and washbasin.

Size 17m2 Wheelchair .3. Observation room.4. Labor room . Size 12m2

Continue… Equipped with labor delivery bed. Oxygen supply Suction point. Mobile Anesthesia machine. Crush cart. Stretcher. Washbasin.Labor room should have Temperature and humidity

control.6. Delivery room. Delivery room should have a floor area of about

30 m2

for Obstetrical or surgical lamp a ceiling height of at least 2.8 m is required , door width of 1.3 m allow the patient to be moved to the delivery room on a labour bed.

Continue…7. Operating room. For caesarian section , same as OT.8. Anesthetic work room. All anesthetic equipments and gases.9 Recovery room For rest, observation, an care 12m2

recovery room are need. Oxygen and suction should be available. 10. Nursery for newborn (Temp. 25-270 C)11. Procedure room for newborn. A 12 m2 procedure room

12. Special Examination room ( About 12 m 2)

Continue………….13. Nursing Unit14 Obstetrician office15 Change room for staff16 On- Call room17 Nourishment area, 18 Cleaners Room19 Utility room Placenta Disposal20 Storage Facilities21 Area for Relatives.Equipments Required Shadow less theater lamp Outlet; Medical gases, Ceiling mounted, O2, N2

O, Vac, Medical Air,

Continue…. Table Delivery ,Anesthetic machine, Stand

Drip, Trolley instrumentFetal Monitor, USG Machine,Warmer, Syringe pump, Pusle Oxi.Pocket Doppler. Temp 180 C , Humidity 55%, Light 480b luxStaff: 1 Obstetrician, 1 pediatrician, 1Nursing

Incharge, 4 Staff Nurses , Other Aid and support staff.

???........

Next Department is……..?

ENT

Introduction

• Services ensure comprehensive care for all ear, nose and throat (ENT) related diseases and disorders.

• Programmes are designed to provide total care and preventive options for various ear, nose and throat (ENT) infections and disorders.

• List of services that ensure comprehensive treatment facilities and total care for all ear, nose and throat (ENT) related diseases and disorders.

• Adenoidectomy• Treatment for Sinusitis.• Functional Endoscopic Sinus Surgery.• Mastoidectomy.

Continue…

• Microlaryngoscopy – MLS.• Myringoplasty.• Pediatric Sinusitis Treatment• Septoplasty• Stapedectomy• Tonsillectomy• Tympanoplasty

Location & Layout

Location any floor for the hospital but area should be Noise and Dust free.

The layout of an ENT hospital too should be divided into three zones:

• Nursing zone• Clinical zone • Support zoneNursing zone that the patients are admitted

and cared for throughout their stay in the hospital. The clinical zone consists of the diagnostic and treatment areas while the support zone comprises of all the support services required for running the hospital.

Clinical zone• The clinical zone requires lavish waiting

areas and appropriate functional areas since the trickle of patients, from cold admissions from wards and hot admissions from trauma, may flood any facility. The healthy as well as the sick normally frequent these areas.

• Thus, for the Oto-Rhino-Laryngology or more commonly known as the ENT speciality, the checklist for the clinical zone would read as detailed below.

1.Emergency unit2.Out-patient unit3.Diagnostic unit

Continue…4.The clinical skills and research

laboratory5.Audiology and speech department6.OT complex7.Common areas

• In the current scenario, good diagnostic services are essential for good medical and surgical care. This is essentially an area for the doctors and the medical students where they perform various procedures and dissections on the dead body to perfect their surgical skills.

Continue…The temporal bone laboratory for performing

dissections of the temporal bone and body laboratory for performing head, neck and body dissections and dummy endoscopies are the important activity areas of this unit. Alongwith the above mentioned laboratories, space should also be provided for refrigerated body storage cabinets, faculty room, lecture hall, library and storage.

Continue..• The audiology and speech unit of rehabilitative

medicine and is concerned with the diagnosis and treatment of speech and hearing disorders. Traditionally, this unit has been a part of the ENT department. However, with advancements in medical science, this department has developed an independent identity.

• The facilities required in the department are: • a large waiting room• a history room where a patient’s medical history

would be recorded to decide the course of treatment

• sound treated rooms for hearing test• impedance room• BERA room

Continue..• cochlear implant room• speech therapy roomThe speech therapy room should be very well lit

and ventilated, advanced therapy rooms and paediatric areas should also be provided. Space for audiologist and faculty alongwith equipment storage and clinical demonstration room and conference room would make a self sufficient audiology and speech department.

Operation theatres equipped with latest microscopes, endoscopes, alongwith facilities for TV monitoring and video recording of surgical procedures in a well laid-out physical environment can be the talking point of any ENT hospital.

ENT Operation Theater• The plan of the operation theatre department is guided

by the demand to combat infection. The air conditioning system should be so designed through a range of pressures which would permit air movement from clean to dirty areas and not the reverse and an ultra clean air should be formed around the operating table.

• In the operating unit in an ENT hospital, separate scopy theatres alongwith the major theatre must be provided. The space in the operating theatre department is generally classified into three main areas ie. operating/scopy suites; the second area consists of scrub-up, sterilising unit, sterile store, post-operative suites and lastly, the third area consists of reception, transfer, pre-operative, staff/doctor change, staff rest rooms, administrative area. These three areas are linked to evolve a efficient operation theatre unit.

Equipments Required

• Audio meter• Impedance Audio meter• Otto scope• Microscope• Inter vision Camera• Light Source• ENT work stationStaff requiredENT Surgeon,Assist. SurgeonNurses

Layout of ENT Hospital

Now…..Your Hospital is ready to inaugurate

Have a Look of Super Specialty Hospital

THANK YOU