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Lloydminster Hospital

Functional Program & Master Plan

Submitted by RMC Resources Management Consultants (Alberta) Ltd.

& IBI Group

Final

June 2007

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN TABLE OF CONTENTS

Final 2007-06-30

TTAABBLLEE OOFF CCOONNTTEENNTTSS

EEXXEECCUUTTIIVVEE SSUUMMMMAARRYY II 11.. IINNTTRROODDUUCCTTIIOONN 11

1.1 Purpose 1 1.2 Background & Context 1 1.3 Project Scope 3 1.4 Planning Process & Acknowledgments 4 1.5 Document Organization 5 1.6 Glossary of Terms 5

22.. PPRROOJJEECCTT PPAARRAAMMEETTEERRSS 88

2.1 Overview 8 2.2 PNHR Guiding Statements 8 2.3 Catchment Area Review & Population & Bed Projections 10 2.4 Planning Parameters 19

2.4.1 Program & Service Parameters 19 2.4.2 Physical Parameters 23 2.4.3 Functional Parameters 24

33.. FFUUNNCCTTIIOONNAALL PPRROOGGRRAAMM SSUUMMMMAARRIIEESS 2277

3.1 Overview 27 3.2 Functional Evaluation Summary 27 3.3 Potential Bed Capacity of the Existing Hospital 33 3.4 Space Requirements Summary 36

44.. SSIITTEE && BBUUIILLDDIINNGG RREEVVIIEEWW 4400

4.1 Existing Site Conditions 40 4.2 Future Development 42 4.3 Building Condition Overview 44

4.3.1 Summary 44 4.3.2 Architectural & Building Enclosure 44 4.3.3 Structural 48 4.3.4 Mechanical & Electrical 49

55.. MMAASSTTEERR PPLLAANN 5511

5.1 Summary of Evaluation Findings 51 5.2 Development Options 51 5.3 Recommended Master Plan 54

5.3.1 Schematic Layouts 56 5.3.2 Project Cost Estimate 61

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN TABLE OF CONTENTS

Final 2007-06-30

66.. FFUUNNCCTTIIOONNAALL PPRROOGGRRAAMM CCOOMMPPOONNEENNTTSS 6.1 Administration 6-1 6.2 Admitting, incl Public Facilities 6-5 6.3. Ambulatory Services 6-9 6.4 Diagnostic Imaging 6-19 6.5 Emergency 6-23 6.6 Facilities & Maintenance 6-29 6.7 Finance, incl Payroll and Scheduling 6-31 6.8 Food & Nutrition Services 6-36 6.9 Foundation 6-40 6.10 Health Information Services 6-43 6.11 Housekeeping & Laundry 6-49 6.12 Human Resources & Labour Relations 6-53 6.13 Information Technology Services 6-57 6.14 Laboratory 6-62 6.15 Materials Management 6-66 6.16 Medical/Transition Inpatient Services 6-72 6.17 Obstetrical & Surgical Inpatient Services 6-78 6.18 Operating Rooms 6-83 6.19 Pharmacy 6-91 6.20 Therapies 6-94 6.21 Volunteers & Ladies Auxiliary 6-97

AAPPPPEENNDDIICCEESS

A. Lloydminster Hospital Building Enclosure Review A-1 B. Lloydminster Hospital Structural Review B-1 C. Lloydminster Hospital Mechanical & Electrical Review C-1

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN EXECUTIVE SUMMARY

Final i 2007-06-30

EEXXEECCUUTTIIVVEE SSUUMMMMAARRYY OOVVEERRVVIIEEWW

This document constitutes the Functional Program & Master Plan for the Lloydminster Hospital. Its primary purpose is to provide a planning strategy and framework together with recommendations for the redevelopment of the Hospital facilities, to address both immediate and short term priority needs as well as longer range growth needs. Important goals of the Functional Program & Master Plan are to: Address critical service needs. Improve facilities for service delivery now and in the future. Make optimum use of the facilities.

The Functional Program & Master Plan will serve as a ‘living document’, reviewed and updated on a regular basis, so that it reflects changing conditions, new directions in its guiding parameters and assumptions, and future initiatives.

BBAACCKKGGRROOUUNNDD The Lloydminster Hospital is now a 20-year old facility. Its operation is the responsibility of the Prairie North Health Region (PNHR) under a joint agreement with East Central Health (ECH) for the delivery of health services in the Lloydminster region. Hospital funding, both operating and capital, is provided by the Alberta and Saskatchewan Departments of Health through the PNHR and ECH. The Hospital was designed in the early 1980’s to serve the needs of approximately 15,500 residents in the City of Lloydminster and its immediate surrounding area. The Hospital reflects the model of health care delivery at that time. Since then there have been a number of major changes that are driving the need to re-examine the Hospital and its current and future development requirements, such as: The restructuring of health services in the 1990’s in both Alberta and

Saskatchewan leading to the closure of smaller hospitals in surrounding communities and the consolidation of services in larger centres such as Lloydminster.

The significant growth in the economy and population of the Lloydminster region, making it the fastest growing area in Saskatchewan and one of the fastest in Alberta, i.e.: - The City of Lloydminster population surpassed 25,500 persons in

2007. - As a regional economic centre, the City of Lloydminster serves a

market area as large as 120,000 people; for health services, it serves a catchment area of 65,000 to 90,000 people.

- The Lloydminster area population growth encompasses young families including a local ‘baby boom’, a young industrial-based age group, a growing senior’s population choosing Lloydminster for their remaining years, and a high proportion of Aboriginal population.

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Extensive changes in the delivery of health care services over the past two decades, placing different demands on the Hospital.

The aging of the 20-year old Hospital building and the quality of its original construction have led to ongoing building performance and maintenance issues, e.g. water infiltration, the deterioration of materials and the inability to humidify the interior. The building and some of its major systems have reached a point where major upgrading and/or replacement are required if the building is to serve as a hospital for the next 10 to 20 years and beyond, i.e. building envelope, mechanical systems.

PPLLAANNNNIINNGG PPAARRAAMMEETTEERRSS The following Program/Service Parameters provide the framework for identifying the future requirements of the Lloydminster Hospital. The Hospital is expected to serve a regional population of 75,000 to

105,000 in the next 10-15 years. The Hospital requires 81 to 87 beds to meet the current demand. The future Acute Care bed needs in Lloydminster are:

Year Bed Needs 2011 - 90 to 99 2016 - 96 to 107

2021 - 102 to 116 Plan Lloydminster Hospital as a Level 1 Regional Referral Centre. Expand services such as Mental Health/Psychiatry; Intensive Care;

Surgery including Orthopedics, Urology and ENT; Medical beds; Obstetrical LDR’s.

Plan for significant growth in Ambulatory Care, i.e.: - Expand from 6 to 12 Day Surgery beds. - Expand from 5 to 12 Dialysis stations. - Provide additional facilities for chemotherapy, endoscopy and

specialty clinics. Add MRI services (initially a mobile unit). Plan to accommodate at least 50,000 Emergency visits, including a

‘fast track’ area for more effective service delivery. Expand to 4 OR’s, with potential for further growth.

Other Key Planning Parameters include: Locate services on-site if it makes the most sense for services

delivery and enhances patient/client access. The future is uncertain, therefore:

- Plan open-ended, flexible and adaptable space. - Provide options for future expansion. - Consider expanding the site.

Integrate and locate high volume / ambulatory services at ground level and at the same time reclaim Inpatient space.

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Increase the ratio of single bedrooms to plan for trends such as family centred care and infectious diseases.

Ensure short-term expansion and renovations fit into a comprehensive, long-term redevelopment strategy.

EEVVAALLUUAATTIIOONN FFIINNDDIINNGGSS The High Priority Hospital services / departments that should be located in new construction include: Ambulatory Care - Chemotherapy, Day Surgery, Dialysis,

Endoscopy, Clinics, etc. Emergency. Future Inpatient Beds. Operating Rooms. Therapies.

In addition, a number of other Hospital clinical and logistical support services require significant expansion to address existing deficiencies and to serve current and future growth needs. The key findings of the Architectural and Engineering Evaluation of the existing building are: Confirmation that the building mechanical and electrical systems

do not have capacity to serve future expansion. Confirmation that the structure can support a new 4th floor

inpatient unit. Must address the following building issues to operate as acute care

facility for the next 10 to 20+ years: - Replace building envelope to provide environmental control

and humidification - may change appearance. - Upgrade elevators - also add in new. - Replace/upgrade mechanical and electrical systems - near end

of life cycle.

The key findings of the Site Evaluation are: There is significant expansion capacity on the existing 6.3 hectare

site, including parking, i.e.50-60% of site area still available. Will likely need to consider future access from 36th Street. Recommend acquiring land across 43rd Avenue for long term

future growth needs.

RREECCOOMMMMEENNDDEEDD MMAASSTTEERR PPLLAANN The Recommended Master Plan proposes to expand the Hospital to the east and southeast, i.e. towards the ‘rear’ of the site where the majority of open space is available. The initial Stage 1 expansion would be at least two floors, with the optional capability to add one or two additional floors of inpatient units in the future.

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The existing space vacated by services such as Emergency, Ambulatory Care, OR’s, Therapies and Special Care would be renovated to accommodate the required expansion of other clinical and logistical support services, e.g. Admitting, Cafeteria, CSR, DI, Health Information Systems, Information Technology, Materiel Management, Telehealth and Conference facilities, etc. The proposed Stage 1 Development addresses the anticipated growth needs of the Hospital over the next 10+ years, including approximately 110 inpatient beds, a significantly higher proportion of single bedrooms, and expansion of key services such as Ambulatory Care, Emergency, Surgery, Obstetrics and Special Care. There are at least three potential options for the Stage 2 Development, depending upon how future needs evolve: Option 1: Construct the new 4th floor inpatient unit to the existing

building, which adds another 30-40 beds. Option 2: Construct a new 3rd floor inpatient unit to the Stage 1

expansion, which adds another 60-70 beds. Option 3: Construct a new Inpatient Tower attached to the Stage

1 building containing approximately 110-120 beds. The Main Benefits of the Recommended Master Plan are that it: Addresses highest priority needs first. Provides the maximum range of future options for subsequent

phases of expansion, including the potential replacement of the existing building.

Can be implemented without major disruption to the provision of existing services.

Begins the process of ‘uncongesting’ the front of the site. Allows a number of options for either bundling or phasing capital

projects. Makes good use of existing vacated space for ‘lower serviced’

functions. Maintains and makes best use of a building that is ‘only’ 20 years

old. Provides excellent potential for significant future growth in key areas

such as Inpatient Beds, Emergency, Ambulatory Services, Operating Rooms/Surgery, and Obstetrics, if and when required.

Schematic Layouts and the Project Cost Estimate for the Recommended Master Plan are presented on the following pages.

v

RREECCOOMMMMEENNDDEEDD MMAASSTTEERR PPLLAANN -- SSCCHHEEMMAATTIICC LLAAYYOOUUTTSS

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Final x 2007-06-30

PPRROOJJEECCTT CCOOSSTT EESSTTIIMMAATTEE

Recommended Master Plan - Stage 1

Component Area m2 Unit Rate Estimated Cost

New ConstructionGround Level:

Ambulatory Care 984.0 4,680.00 4,605,120Home Care 300.0 3,470.00 1,041,000Information Technology or Scheduling/Finance/Payroll 280.0 3,820.00 1,069,600Emergency 900.0 4,680.00 4,212,000Ambulance Bay 110.0 2,740.00 301,400Therapies 323.0 3,830.00 1,237,090

Second Level:Operating Rooms 760.0 6,900.00 5,244,000Day Surgery 220.0 5,150.00 1,133,000Special Care Unit 600.0 4,680.00 2,808,000New Inpatient Beds (30-32 beds) 1,300.0 4,250.00 5,525,000

Sub-Total 5,777.0 $ 27,176,210

300.0 4,700.00 1,410,000Circulation and Building Gross Areas (30%) 1,820.0 4,470.00 8,135,400

Sub-Total New Construction 7,897.0 $ 36,721,610

Functional RenovationsGround Level:

Admitting 90.0 3,060.00 275,400Health Information Services 311.0 3,060.00 951,660Meeting/Conference Space 220.0 2,780.00 611,600Cafeteria Expansion ~ 3,120.00 ~CSR 277.0 3,750.00 1,038,750Diagnostic Imaging 75.0 3,750.00 281,250Foundation and Gift Shop 140.0 2,780.00 389,200Materials Management ~ 2,500.00 ~Staff Facilities ~ 3,150.00 ~

Second Level:Obstetrics 200.0 3,400.00 680,000Inpatient Unit (50% of area) 420.0 1,275.00 535,500

Third Level:Inpatient Unit (50% of area) 805.0 1,275.00 1,026,375

Sub-Total Renovations 2,538.0 $ 5,789,735

Space Planning Contingency (5%)

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Recommended Master Plan - Stage 1 (continued)


Building UpgradingUpgrade Other Key Areas of Building 2,500.0 650.00 1,625,000Replace Building Envelope allow sum 5,150,000Upgrade Mechanical Systems allow sum 3,862,000Upgrade Electrical Systems allow sum 1,931,000

Sub-Total Building Upgrading $ 12,568,000

Site WorkAdditional and Replaced Parking allow sum 500,000Roadways allow sum 450,000Landscaping allow sum 250,000

Sub-Total Site Work $ 1,200,000

Sub-Total 12,935.0 $ 56,279,345

Scope/Pricing Contingency (10%) 5,628,000Construction Contingency (5%) 3,095,000

Total Construction Cost $ 65,002,345

Design Fees and Administration Costs (20%) 13,000,000

Equipment and Furnishings (15%) 9,750,000

Total Estimated Cost (April 2007) $ 87,752,345

Escalation Allowance (to construction mid-point September 2010) 49,785,000

TOTAL ESTIMATED COST $ 137,537,345

Assumed Escalation Rates

2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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Final xii 2007-06-30

Recommended Master Plan - Stage 2 Options

Option 1 - Add New 4th Floor to Existing Building


New Construction - 4th FloorNew Inpatient Unit (~40 beds) 1,600.0 4,250.00 6,800,000

Sub-Total 1,600.0 $ 6,800,000

Circulation and Building Gross Areas (30%) 480.0 4,040.00 1,939,200

Sub-Total Stage 2 - Option 1 2,080.0 $ 8,739,200

Scope/Pricing Contingency (10%) 874,000Construction Contingency (5%) 44,000





Escalation Allowance (to construction mid-point April 2011) 8,369,000



2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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Option 2 - Add New 3rd Floor to the Stage 1 Expansion


New Construction - 3rd FloorNew Inpatient Units (~60-70 beds) 3,000.0 4,250.00 12,750,000

Sub-Total 3,000.0 $ 12,750,000



Scope/Pricing Contingency (10%) 1,639,000Construction Contingency (5%) 82,000








2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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Option 3 - Construct New Inpatient Tower


New ConstructionNew Inpatient Units (~100-120 beds) 5,000.0 4,250.00 21,250,000New Diagnostic Imaging 600.0 4,680.00 2,808,000Public and General Support to theInpatient Units 400.0 3,860.00 1,544,000

Sub-Total 6,000.0 $ 25,602,000

Circulation and Building Gross Areas (30%) 1,800.0 4,050.00 7,290,000


RenovationsExisting Space Re-assignment andReconfiguration 3,200.0 650.00 2,080,000




Sub-Total 11,000.0 $ 36,147,000








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Final xv 2007-06-30


Option 3 - Construct New Inpatient Tower (continued)


2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 1. INTRODUCTION

Final 1 2007-06-30

11.. IINNTTRROODDUUCCTTIIOONN

11..11 PPUURRPPOOSSEE This document constitutes the Functional Program & Master Plan for the Lloydminster Hospital. Its primary purpose is to provide a planning strategy and framework together with recommendations for the redevelopment of the Hospital facilities, to address both immediate and short term priority needs as well as longer range growth needs. The Functional Program & Master Plan is intended to guide capital investments in the Hospital over the next 10 or more years and to provide a foundation for the subsequent steps of project approval and implementation, including detailed planning and design. Important goals of the Functional Program & Master Plan are to address critical service needs, to improve facilities for service delivery now and in the future, and to make optimum use of the facilities. The Functional Program & Master Plan is expected to serve as a ‘living document’, reviewed and updated on a regular basis, so that it reflects changing conditions, new directions in its guiding parameters and assumptions, and future initiatives.

11..22 BBAACCKKGGRROOUUNNDD && CCOONNTTEEXXTT The Lloydminster Hospital, located in the Saskatchewan portion of the City of Lloydminster, is now a 20-year old facility having opened in 1987. Operation of the Hospital is the responsibility of the Prairie North Health Region (PNHR) under a joint agreement with East Central Health (ECH) for the delivery of health services in the Lloydminster region. Funding for the Hospital, both operating and capital, is provided by the Alberta and Saskatchewan Departments of Health through the two Health Regions, PNHR and ECH. The existing Hospital was planned and designed in the early 1980’s to serve the needs of approximately 15,500 residents in the City of Lloydminster and its immediate surrounding area. The Hospital reflects the model of health care delivery at that time. Since then there have been a number of major changes that are driving the need to re-examine the Hospital and its current and future development requirements, such as: The restructuring of health services in the 1990’s in both Alberta

and Saskatchewan and the formation of health regions, leading to the closure of smaller hospitals in surrounding ‘rural’ communities and the consolidation of services in larger communities such as Lloydminster.

The significant growth in the economy and population of the Lloydminster region, making it the fastest growing area in Saskatchewan and one of the fastest in Alberta. Such growth is reflected in:

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- The City of Lloydminster population reached 25,523 persons in 2007 according to the Municipal census, plus an estimated ‘shadow’ population of approximately 1,500 persons. It has grown by 7.95% since the 2005 Municipal census, and has averaged about 3% growth a year over the past 30 years. The City is poised to continue growing to a forecast population of about 37,000 by 2021 (including the availability of land and infrastructure).

- As a regional economic centre, the City of Lloydminster now serves a market area as large as 120,000 to 130,000 people.

- For health services, it serves a catchment area as large as 65,000 to 90,000 people.

- The Lloydminster area population growth encompasses young families including a local ‘baby boom’, a young industrial-based age group, a growing senior’s population choosing Lloydminster for their remaining years, and a high proportion of Aboriginal population.

- Major increases in the demands being placed on Hospital-based services such as emergency, acute care beds, surgery, ambulatory clinics, and diagnostic services.

- The increasing demand in obstetrical services to meet the needs of the young community and surrounding First Nations.

Extensive changes in the delivery of health care services over the past two decades, placing new and different demands on the 20-year old Hospital, e.g.: - Decreasing lengths of stay along with increasing levels of

acuity and higher intensities of care for inpatients. - Increasing prevalence of infectious diseases. - Major advances in technologies and their impact on the

increased scope of ambulatory procedures and diagnostic services.

- Creating better social and physical environments to improve the quality and safety of the hospital setting for patients and staff.

- Facilitating increased patient and family involvement in acute health care delivery.

- Responding to the inevitability of change by providing facilities that are more adaptable and flexible.

- The ongoing need to optimize space utilization and enhance the efficiency of operations.

The aging of the 20-year old Hospital building and the quality of its original construction have led to ongoing building performance and maintenance issues, e.g. water infiltration, the deterioration of materials and the inability to humidify the interior. The building and some of its major systems have reached a point where major upgrading and/or replacement are required if the building is to serve as a hospital for the next 10 to 20 years and beyond, i.e. building envelope, mechanical systems.

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The Lloydminster Hospital began a process of redevelopment in 2003 with the decision by PNHR and ECH to add CT Scanning services to the Hospital. This led to a more in depth look at other priority needs in the facility and the preparation of a preliminary plan that focused on the phased redevelopment of Diagnostic Imaging including CT Scanning, Pharmacy, Foundation offices, Ambulatory Care Services and Emergency. Initial renovations were completed in 2005/06 for Diagnostic Imaging, Pharmacy and the Foundation offices. At that time the PNHR and ECH decided that a more comprehensive review of all Hospital services and facility needs was required to ensure future needs could be met. To this end, the PNHR and ECH initiated the Lloydminster Hospital Functional Program & Master Plan project and the joint team of RMC Resources Management Consultants (Alberta) Ltd. and IBI Group was commissioned to undertake the work.

11..33 PPRROOJJEECCTT SSCCOOPPEE The Terms of Reference for preparing the Functional Program & Master Plan outlined the following scope of work for the Lloydminster Hospital: Assess hospital service needs - both clinical and ancillary/support -

over the next 20 to 25 years to develop the agreed-upon parameters for planning the programs, operations and space.

Reflect current and emerging trends in health care services delivery in the hospital setting including, for example, the growth in ambulatory/outpatient services.

Reflect the vision and philosophy of PNHR in consultation with key stakeholders, service leaders and staff of the PNHR and the Lloydminster Hospital, relative to the planning, design, staffing and operation of the hospital.

Focus on innovation, flexibility and operational efficiency in program delivery, facility planning and design.

Provide direction to the architect for the overall planning concepts and development strategy for the redeveloped facility, including future expansion options.

Establish and document the space requirements for the redeveloped facility identifying all existing and proposed net and gross areas.

Establish the project budget and evaluate the operational cost impact for the regeneration and expansion project.

The scope of work was expanded in March 2007 to incorporate Engineering Evaluations of the Hospital building that included: Structural Review - Aedis Consulting Ltd. of Edmonton (Chell Yee). Building Enclosure Review - Building Science Engineering Ltd. (BSE)

of Edmonton (Chris Makepeace).

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Mechanical & Electrical Review - FSC Consulting of Edmonton (Ross Abdurahman, Mechanical and Neal Bourassa, Electrical).

11..44 PPLLAANNNNIINNGG PPRROOCCEESSSS && AACCKKNNOOWWLLEEDDGGEEMMEENNTTSS

The planning work for the Lloydminster Hospital Functional Program & Master Plan project included a comprehensive consultation process comprising: A Steering Committee that provided oversight, guidance and

hands-on input throughout the project and served as the primary link between the consultants and the PNHR and ECH.

Meetings with approximately 25 User Groups representing the various services and departments at the Hospital and Community Health Services, including also a Functional Gaming session.

Meetings with the Medical Staff. Meetings with representatives of the City of Lloydminster, i.e.

Mayor, City Manager, Chamber of Commerce. Meetings with representatives of the Metis and Aboriginal

communities, including a visit to Onion Lake and its Health Centre. Meetings with representatives of local interest groups such as the

Concerned Citizens for Seniors Care. The receipt of other input such as correspondence from the

School Board and the Lloydminster and Area Drug Strategy. The consultants began work in November 2006 with target completion by early April 2007. The schedule was extended to early June 2007 to accommodate the work and implications of the Engineering Evaluations. The consultants would like to acknowledge and thank the members of the Steering Committee including: Sissel Bray, ECH Dr. T.L. Cavanagh, Medical Staff Lionel Chabot, PNHR, Committee Chair Dr. Mark Chapelski, Medical Staff Don Duncan, PNHR, Board member David Fan, PNHR Brian Harasymuk, ECH Barbara Jiricka, PNHR Jerry Keller, PNHR

Bonnie O’Grady, PNHR, Board Chairperson Terry Setter, ECH Morris Smith, Community Advisory Committee Lois Sonnega, PNHR Brian Stevenson, ECH Glennys Uzelman, PNHR Joan Zimmer, PNHR

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The prime consultants involved in the project and responsible for the contents of the report are Peter Milne and Debi Dancey-Dallaire of RMC, David Kraatz of IBI, and the aforementioned Engineers.

11..55 DDOOCCUUMMEENNTT OORRGGAANNIIZZAATTIIOONN The Lloydminster Hospital Functional Program & Master Plan document is organized as follows: 1. Introduction, summarizes the purpose, background, process and

study document. 2. Project Parameters, set out the framework and the key planning

parameters and assumptions for the future development of the Lloydminster Hospital, including the review of population projections and bed requirements.

3. Functional Program Summaries, including the functional evaluation summary, review of existing bed capacity and future space requirements summary.

4. Site & Building Review, provides an overview and summary evaluation of the existing Hospital site and building, including its condition, constraints and opportunities.

5. Master Plan, presents the recommended redevelopment plan for the Hospital and discusses options that were also considered. It includes the project cost estimate for the recommended master plan.

6. Functional Program Components, present the more detailed information on projected programs and services and their space requirements, organized according to the various program/ service components that are potentially accommodated in the Lloydminster Hospital.

The Engineering Evaluation reports are provided in the Appendix.

11..66 GGLLOOSSSSAARRYY OOFF TTEERRMMSS Following are explanations of some common terms frequently used in the Lloydminster Hospital Functional Program & Master Plan. Ambulatory Care - Health care services provided by medical and/or other health care professionals to ambulant patients. While this term usually applies to outpatient services, it may include services provided jointly to ambulant inpatients and outpatients.

Building Gross Square Metres or Building Gross Area (BGSM) - The sum of all building floor areas measured to the outside face of exterior walls for all stories or areas having floor surfaces. Building gross area includes component gross areas, general circulation, mechanical and electrical space, exterior walls and structure.

Circulation - The movement of patents, staff, public and materials within the building and site, typically categorized as follows:

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Dedicated Circulation: Circulation for specified people or material, which may or may not require a control point.

Internal Circulation: The system of connecting links (corridors, stairs, etc.) within components, connecting rooms of a component or directly connecting contiguous components.

General Circulation: Public connecting links (corridors, stairs, elevators, entrances, etc.) between components and serving the building as a whole.

Restricted Circulation: Internal circulation for specified people, which can be entered only by passing a control point.

Component or Functional Component - A cohesive grouping of activities or spaces related by service or physical arrangement, according to which the Functional Program is organized. A component may or may not be a department since the term ‘department’ refers to an administrative organization rather than a functional organization of space and activities.

Component Gross Square Metres (CGSM) - The portion of a building assigned to a specific component (department), including net areas, internal circulation, partitions and small mechanical shafts. For programming purposes, the CGSM is often determined by multiplying the total net square metres by a component gross-up factor.

DCECC - Dr. Cooke Extended Care Centre.

ECH - East Central Health.

External Relationships - The prioritized functional relationships and proximities of one component to another.

FTE - Full Time Equivalent - A term used to express the conversion of a number of annual paid hours into the number of individuals who, if they were working a complete shift on a regular schedule basis, would be required to accommodate that number of hours.

Functional Program / Master Program - An assessment and description of the proposed services, activities, workload and staffing of a facility’s components, together with an allocation of the facility resources (space) required to support them. For this document, the Functional Program in fact reflects more of a Master Program level of information. For each component it outlines the scope of existing and projected services, regional context, future trends, projected workload and staffing assumptions, assessment of the current situation, functional requirements, relationships, and a summary of projected space requirements in CGSM.

Functional Gaming / Modelling - Refers to a planning technique that focuses on establishing and testing functional relationships. It typically utilizes a two or three-dimension model of the buildings and/or site to enable a variety of participants to become involved in the determination of optimal facility layouts.

Headcount - The number of people actually working in a component or area at peak utilization, which includes full time, part time and

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casual employees. The headcount is often a key parameter in determining facility requirements.

Internal Relationships - The prioritised functional relationships and proximities between rooms/areas within a component.

Master Plan - A document which utilizes text and drawings to outline how development/construction could occur on a site to meet future needs. More specifically, it is a framework to guide the orderly development of a site and facilities to meet future service needs over an anticipated time period.

Net Square Metres (NSM) - The horizontal area of space assignable to a specific function. The net area of a room is measured to the inside face of wall surfaces.

PNHR - Prairie North Health Region.

Project Parameters - Establishes the key planning and programming parameters and assumptions for the project, including the strategic vision, the scope of programs and services (clinical, education and research), functional components, the operational framework, physical/site parameters, and financial parameters and/or project schedule if known.

User Group - Service providers and stakeholders representing one or more components, who will provide input and feedback in the development of the Functional Program.

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 2. PROJECT PARAMETERS

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22.. PPRROOJJEECCTT PPAARRAAMMEETTEERRSS

22..11 OOVVEERRVVIIEEWW One of the key activities of the project was the development of strategic planning parameters and assumptions. They provide a framework for establishing future development needs at the Lloydminster Hospital and form the foundation for the Functional Program & Master Plan. The parameters are grouped into three categories: Program/Service Parameters, establish the future role of the

Lloydminster Hospital, including its scope of programs and services and projected bed requirements. Important inputs into these parameters are the review of population projections (presented in Section 2.3 of this chapter), the PNHR Strategic Plan 2005/06 - 2009/2010, the East Central Health Plan 2006 - 2009, and recommendations on future program needs and trends from key service providers including the medical staff.

Physical Parameters, provide the physical development framework and assumptions for the Hospital building and its site. The review of the existing Hospital facilities, including the Engineering evaluations, guided the formulation of these parameters.

Functional Parameters, address key functional needs and priorities such as space planning concepts and functional relationship priorities.

PNHR is the organization responsible for the delivery of health care services in Lloydminster and at the Lloydminster Hospital, in partnership with ECH. As a lead-in to the Parameters, the Chapter first provides an overview of the PNHR’s guiding statements, including its Vision, Mission, Values and Goals and Objectives. This is followed by the review of population projections for the Lloydminster Hospital catchment area.

22..22 PPNNHHRR GGUUIIDDIINNGG SSTTAATTEEMMEENNTTSS The PNHR Vision, Mission, Value statements are examined and re-confirmed annually by the Board. An outcome of the 2005/06 PNHR Strategic Plan was the recommendation to refine the Mission and Value statements to reflect Prairie North’s maturation as a Region. The updates are anticipated to occur in 2006/07. PNHR Vision “Healthy People in Healthy Communities.” PNHR Mission “Working together to promote and support healthy living in healthy communities.”

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PNHR Values Accountability and Responsibility to sustain the future of our health

care resources. Respect, Compassion, and Dignity for all people, regardless of

cultural, social and economic factors. Trust and Integrity in everything we do. Appropriate Access to Quality health services: the right service at

the right time in the right place. Creativity and Innovation that support learning, partnerships, and

an ongoing commitment to progress. Safe and supportive environment for all.

Goals and Objectives The following PNHR Goals and Objectives, reaffirmed by the Board for 2005/06, mirror those established by Saskatchewan Health for the Province’s health system.

Goal - Improved Access to Quality Health Services Objectives: Responsive, coordinated primary health care. Reduce waiting times for surgical procedures. Improve emergency medical care. Improved hospital, specialized services and long-term

care.

Goal - Effective Health Promotion and Disease Prevention Objectives: Better promotion of health and disease prevention. Improve the health of northern and Aboriginal

communities.

Goal - Retain, Recruit and Train Health Providers Objectives: Improve utilization and availability of health human

resources. Develop representative work places. Create healthier more effective work places.

Goal - A Sustainable, Efficient, Accountable and Quality Health System

Objectives: Ensure quality, effective health care. Appropriate governance, accountability and

management for the health sector. Sustain publicly funded and publicly administered

Medicare.

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22..33 CCAATTCCHHMMEENNTT AARREEAA RREEVVIIEEWW && PPOOPPUULLAATTIIOONN && BBEEDD PPRROOJJEECCTTIIOONNSS The primary purpose of reviewing the Lloydminster Hospital’s service or catchment area and the correlative population numbers is to identify their impact on inpatient bed requirements at the Hospital. The analysis looks at population growth up to 2021. Data was obtained from various sources, i.e. Statistics Canada, Alberta Health & Wellness, Saskatchewan Health and the City of Lloydminster. Option A looks at a catchment area of persons living within a relatively close proximity to Lloydminster. It contains a regional population of approximately 60,700 persons including the City of Lloydminster (2006 data). Options B through D then expand the catchment area further and further out from Lloydminster on both the Alberta and Saskatchewan sides. Option D, which contains a regional population of approximately 119,500 persons, includes all of Alberta Census Division 10, i.e. it includes communities such as Camrose, Tofield and Lamont. While Option D may reflect the potential market/trade area of Lloydminster, it likely extends beyond what would be considered the catchment area for most services provided at the Lloydminster Hospital and most services provided by the local physicians. The accompanying analysis was reviewed, amended and accepted by the Steering Committee. For the Lloydminster Hospital Functional Program & Master Plan, the Steering Committee agreed that a combination of Options B and C best reflect the most likely scenario as a basis for projecting future needs. Considering the strong potential for continued growth in the region and the desire to plan for flexibility, it is recommended that the future Hospital space and expansion needs be based on the upper end of the range, i.e. the Option C bed projection numbers. In summary, the future Acute Care bed needs at the Lloydminster Hospital are estimated to be:

Year Bed Needs 2011 - 90 to 99 2016 - 96 to 107

2021 - 102 to 116

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TABLE 2-1 LLOYDMINSTER HOSPITAL INPATIENT BED PROJECTIONS FINAL REVISION

Option A - Bed Projections based on the City of Lloydminster Population Projections, Alberta Region population defined as the County of Vermilion River and 50% of the County of Minburn, and a Portion of the Saskatchewan Region population (Census Division #17) 2006 2011 2016 2021 City of Lloydminster Population 1 A 23,643 2 25,345 26,485 27,676 Alberta Region 3 B 18,583 19,921 20,817 21,754 Saskatchewan Region 4 C 18,492 19,823 20,715 21,647 Lloydminster Regional Population (A+B+C) D 60,718 65,089 68,017 71,077 Current Acute Care Bed Supply 5 E 58 58 58 58 Actual Beds / 1000 Beds per 1000 population (E/(D/1000) F 0.96 0.89 0.85 0.82 Target Beds / 1000 6 Recommended beds per 1000 population 7 G 1.9 1.9 1.9 1.9 Bed Need ((D/1000) x G) H 115 124 129 135 Other Acute Beds in AB Service Area 8 I 25 25 25 25 Other Acute Beds in SK Service Area 9 J 17 17 17 17 Surplus / Deficit 10 K -15 -24 -29 -35

Lloydminster Hospital Bed Projection 73 82 87 93 Notes: 1. Source: City of Lloydminster Population Projections, as of March 2007; includes Lloydminster, AB and

Lloydminster, SK population; excludes ‘shadow’ population estimated to be 1,500 persons. 2. The April 2007 Municipal census reports the City population to be 25,523. However, the City’s projections for

2011 to 2021 remain, to date, unchanged. 3. Alberta Region includes the County of Vermilion River (13,590) and 50% of the County of Minburn (4,993). 4. Saskatchewan Region includes a portion of Census Division #17 which includes RM of Britannia 502, RM of

Eldon 471 (Town of Maidstone, Village of Waseca), RM of Frenchman Butte 501 (Onion Lake First Nations, Village of Paradise Hill, Town of St. Walburg), RM of Hillsdale 440 (Village of Neilburg), RM of Wilton 472 (Town of Lashburn, Village of Marshall). Note that the Lloydminster, SK population is included in line A in the table.

5. The 58 beds include 6 transition beds. 6. Alberta Health and Wellness bed planning guideline. 7. Estimated population growth rate of 7.2% for the period 2006 to 2011 (based on the City of Lloydminster

projections), 4.5% growth rate for the period 2011 to 2016, and 4.5% for the period or the period 2016 to 2021 (growth rates for 2011 and beyond based on Alberta Health and Wellness Population Projections for Health Regions 2004-2033).

8. Acute beds counted in Line I include Vermilion (25). 9. Acute beds counted in Line J include Maidstone (10) and Turtleford (7) for a total of 17. 10.Surplus / Deficit calculation arrived at by discounting the Bed Need (Line H) by the current acute care bed

supply in Lloydminster (Line E) and by the Other Acute Beds in AB Service Area (Line I) and SK (Line J).

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Option B - Bed Projections based on the City of Lloydminster Population Projections, Alberta Region population defined as the County of Vermilion River and 50% of the County of Minburn, and the Saskatchewan Region population (Census Division #17) 2006 2011 2016 2021 City of Lloydminster Population 1 A 23,643 2 25,345 26,485 27,676 Alberta Region 3 B 18,583 19,921 20,817 21,754 Saskatchewan Region 4 C 22,596 24,223 25,313 26,452 Lloydminster Regional Population (A+B+C) D 64,822 69,489 72,615 75,882 Current Acute Care Bed Supply 5 E 58 58 58 58 Actual Beds / 1000 Beds per 1000 population (E/(D/1000) F 0.89 0.83 0.80 0.76 Target Beds / 1000 6 Recommended beds per 1000 population 7 G 1.9 1.9 1.9 1.9 Bed Need ((D/1000) x G) H 123 132 138 144 Other Acute Beds in AB Service Area 8 I 25 25 25 25 Other Acute Beds in SK Service Area 9 J 17 17 17 17 Surplus / Deficit 10 K -23 -32 -38 -44



2011 to 2021 remain, to date, unchanged. 3. Alberta Region includes the County of Vermilion River (13,590) and 50% of the County of Minburn (4,993). 4. Saskatchewan Region includes Saskatchewan Census Division #17 ( RM of Britannia 502, RM of Eldon 471

(Town of Maidstone, Village of Waseca), RM of Frenchman Butte 501 (Onion Lake First Nations, Village of Paradise Hill, Town of St. Walburg), RM of Hillsdale 440 (Village of Neilburg), RM of Wilton 472 (Town of Lashburn, Village of Marshall), RM of Parkdale 496, RM of Paynton 470, RM of Loon Lake 561, RM of Turtle River 469, RM of Meota 468, RM of Mervin 499 (excludes RM of Meadow Lake 588). Note that the Lloydminster, SK population is included in line A in the table.



8. Acute beds counted in Line J include Vermilion (25). 9. Acute beds counted in Line J include Maidstone (10) and Turtleford (7) for a total of 17. 10.Surplus / Deficit calculation arrived at by discounting the Bed Need (Line H) by the current acute care bed


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Option C - Bed Projections based on the City of Lloydminster Population Projections, 50% of the Alberta Region Population for Census Division #10 and the Saskatchewan Region Population for Census Division #17 2006 2011 2016 2021 City of Lloydminster Population 1 A 23,643 2 25,345 26,485 27,676 Alberta Region 3 B 42,574 45,640 47,694 49,840 Saskatchewan Region 4 C 22,596 24,223 25,313 26,452 Lloydminster Regional Population (A+B+C) D 88,813 95,208 99,492 103,968 Current Acute Care Bed Supply 5 E 58 58 58 58 Actual Beds / 1000 Beds per 1000 population (E/(D/1000) F 0.65 0.61 0.58 0.56 Target Beds / 1000 6 Recommended beds per 1000 population 7 G 1.9 1.9 1.9 1.9 Bed Need ((D/1000) x G) H 169 181 189 198 Other Acute Beds in AB Service Area 8 I 65 65 65 65 Other Acute Beds in SK Service Area 9 J 17 17 17 17 Surplus / Deficit 10 K -29 -41 -49 -58



2011 to 2021 remain, to date, unchanged. 3. Alberta Region includes 50% of the Alberta Census Division #10 (i.e. 50% of the population for Division #10 in

2006). 4. Saskatchewan Region includes Saskatchewan Census Division #17 ( RM of Britannia 502, RM of Eldon 471




8. Acute beds counted in Line J include Vermilion (25), Vegreville (25), and Two Hills (15) for a total of 65 beds. All are located in Census Division #10.

9. Acute beds counted in Line J include Maidstone (10) and Turtleford (7) for a total of 17. 10.Surplus / Deficit calculation arrived at by discounting the Bed Need (Line H) by the current acute care bed


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Option D - Bed Projections Based on the Estimated City of Lloydminster Regional Market/ Trade Population

Note: The bed projections in Option D below are calculated based on the estimated trade area population for the City of Lloydminster. However, not all acute care beds in the assumed trade area are included in the calculation of the surplus/deficit, e.g. Camrose.

2006 2011 2016 2021 City of Lloydminster Population 1 A 23,643 2 25,345 26,485 27,676 Alberta Region 3 B 73,216 78,488 82,020 85,711 Saskatchewan Region 4 C 22,596 24,223 25,313 26,452 Lloydminster Regional Population (A+B+C) 5 D 119,455 128,056 133,818 139,839 Current Acute Care Bed Supply 6 E 58 58 58 58 Actual Beds / 1000 Beds per 1000 population (E/(D/1000) F 0.49 0.45 0.43 0.41 Target Beds / 1000 7 Recommended beds per 1000 population 8 G 1.9 1.9 1.9 1.9 Bed Need ((D/1000) x G) H 227 243 254 266 Other Acute Beds in AB Service Area 9 I 65 65 65 65 Other Acute Beds in SK Service Area 10 J 17 17 17 17 Surplus / Deficit 11 K -87 -103 -114 -126 Lloydminster Hospital Bed Projection 145 161 172 184 Notes: 1. Source: City of Lloydminster Population Projections, as of March 2007; includes Lloydminster, AB and


2011 to 2021 remain, to date, unchanged. 3. Alberta Region includes Alberta Census Division #10 (Camrose County No. 22, Beaver County, Minburn

County No. 27, Vermilion River County No. 24, Two Hills County No. 21, Lamont County). 4. Saskatchewan Region includes Saskatchewan Census Division #17 ( RM of Britannia 502, RM of Eldon 471


5. Additional source: City of Lloydminster Regional Population Information. 6. The 58 beds include 6 transition beds. 7. Alberta Health and Wellness bed planning guideline. 8. Estimated population growth rate of 7.2% for the period 2006 to 2011 (based on the City of Lloydminster


9. Acute beds counted in Line J include Vermilion (25), Vegreville (25), and Two Hills (15) for a total of 65 beds. All are located in Census Division #10.

10.Acute beds counted in Line J include Maidstone (10) and Turtleford (7) for a total of 17. 11.Surplus / Deficit calculation arrived at by discounting the Bed Need (Line H) by the current acute care bed


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CENSUS DIVISION 10: CAMROSE - LLOYDMINSTER, ALBERTA

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TABLE 2-2 ACUTE CARE BED COMPARISON - SELECTED SASKATCHEWAN FACILITIES

Measure Battlefords Prince Albert Swift Current Yorkton Lloydminster Acute Care Beds 75 2 100 3 94 4 87 5 58 6

Population 1 18,849 40,140 15,903 17,006 23,643 Beds/1000 Population 4.0 2.5 5.9 5.1 2.5

Notes: 1. Population source: Saskatchewan Health Covered Population 2006 for the specified cities. 2. Battlefords Union Hospital includes 22 psychiatry beds. 3. Prince Albert (Victoria Hospital) includes 8 ICU beds. 4. Swift Current (Cypress Regional Hospital) includes 4 ICU beds, 20 medical beds, 20 surgical beds, 19

obstetrics/gynecology bed, 14 psychiatry beds and 17 pediatric beds. 5. Yorkton Regional Health Centre includes 33 medical beds, 6 ICU beds, 12 pediatric beds, 15 maternity beds

and 21 surgical beds. 6. Lloydminster Hospital includes 12 obstetrical beds, 7 surgical beds, 30 medical beds, 3 special care beds and

6 transition beds. Hospital Categories (as defined by Saskatchewan Health): Level 1 Regional Centre: Services communities between 30,000 and 40,000 population. Level 2 Regional Centre: Services communities between 15,000 and 30,000 population.

Services provided by a Regional Hospital (as per The Facility Designation Regulations – Chapter R-8.2 Reg 6 (effective December 16, 2005): 8. If a facility or part of a facility is designated as a regional: (a) It must provide to inpatients and outpatients:

i. Medical services; ii. Basic radiology and laboratory services; iii. Fluoroscopy and computerized tomography diagnostic services; iv. Emergency stabilization services; v. Observation and assessment services; vi. Convalescent and palliative care; vii. Surgical services; viii. Obstetrical services; ix. Intensive care services; x. Special medical services in the areas of internal medicine, general surgery, obstetrics and

gynecology; and (b) It may provide any of the following

i. Specialty medical services in areas including, but not limited to, orthopedics, ophthalmology, urology and otolaryngology;

ii. Rehabilitation services Services mentioned in clauses 5(f) to (o) (long term care, health assessment and screening services, counselling services, therapy services, referral services, health education services, health promotion services, disease and injury prevention services, chronic disease management services, and disability management services.

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TABLE 2-3 ACUTE CARE BED COMPARISON - SELECTED (ECH) ALBERTA FACILITIES Measure Camrose Vegreville Vermilion Wainwright Lloydminster

Acute Care Beds 76 2 25 3 25 25 58 4

Population 1 15,850 5,520 4,435 5,365 23,643 Beds/1000 Population 4.8 4.5 5.6 4.7 2.5 Notes: 1. Population source: 2006 Official Population List, Alberta Municipal Affairs for the specified cities/towns. 2. Bed count for St. Mary’s Camrose includes a 10 bed psychiatry unit. 3. Bed count includes 3 Coronary beds. 4. Lloydminster Hospital includes 12 obstetrical beds, 7 surgical beds, 30 medical beds, 3 special care beds and

6 transition beds.

TABLE 2-4 POPULATION PROFILES Age Characteristics – Lloydminster (AB/SK) Population 2001

Lloydminster, SK Lloydminster, AB Age

Group Male Female Total Male Female Total Total

Pop % of Pop

0 to 4 335 300 655 455 465 920 1,575 7.5 5 to 14 665 595 1,260 1,035 1,000 2,035 3,295 15.7

15 to 19 375 330 710 490 505 990 1,700 8.1 20 to 24 495 460 955 525 515 1,040 1,995 9.5 25 to 44 1,335 1,265 2,605 2,915 2,105 4,305 6,910 32.9 45 to 54 365 330 700 835 835 1,670 2,370 11.3 55 to 64 175 190 360 425 425 845 1,205 5.7 65 to 74 140 140 285 315 345 660 945 4.5 75 to 84 75 130 205 160 300 460 665 3.2

85 & over 40 65 105 70 150 220 325 1.5 Total 4,025 3,810 7,840 6,510 6,640 13,150 20,990

Median age 26.2 27.7 26.8 31.9 33.7 32.7 % of pop 15 & over 74.7 76.4 75.6 77.1 78.0 77.6

Source: Statistics Canada, Census 2001

Age Characteristics - Lloydminster SK and Onion Lake Population 2006

Lloydminster, SK Onion Lake First Nation, SK Age

Group Male Female Total % of

Pop Age

Group Male Female Total % of

Pop 0 to 4 393 370 763 8.3 0 to 4 195 196 391 13.4

5 to 14 745 664 1,409 15.4 5 to 14 382 376 758 26.1 15 to 19 371 352 723 7.9 15 to 19 184 172 356 12.2 20 to 24 563 502 1,065 11.6 20 to 24 139 125 264 9.1 25 to 44 1,590 1,481 3,071 33.5 25 to 44 367 370 737 25.3 45 to 54 563 479 1,042 11.5 45 to 54 107 98 205 7.0 55 to 64 266 236 502 5.5 55 to 64 54 54 108 3.7 65 to 74 158 158 316 3.4 65 to 74 27 37 64 2.2 75 to 84 84 102 186 2.0 75 to 84 8 12 20 0.7

85 plus 21 65 86 0.9 85 plus 1 5 6 0.2 Total 4,754 4,409 9,163

Total 1,464 1,445 2,909 Source: Saskatchewan Health

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22..44 PPLLAANNNNIINNGG PPAARRAAMMEETTEERRSS 2.4.1 Program & Service Parameters

Scope of Services Within the context of the Saskatchewan Health hospital

categories, plan for the Lloydminster Hospital to become a Level 1 Regional Centre serving the eastern portion of PNHR and the western portion of ECH. A Level 1 facility is defined as serving a community population of 30,000 to 40,000 (other examples include Prince Albert and Moose Jaw). As a Regional (Referral) Centre, it must provide the following services to inpatients and outpatients: - Medical services - Basic radiology and laboratory services - Fluoroscopy and computerized tomography diagnostic

services - Emergency stabilization services - Observation and assessment services - Convalescent and palliative care - Surgical services - Obstetrical and gynecological services - Intensive care services

For certain services, the Lloydminster Hospital is serving a catchment area as large as approximately 90,000 persons. The rapid growth in the City of Lloydminster and its demographic profile are also generating a demand for additional health services, e.g. it surpassed 870 births last year. Accordingly, in addition to the basic specialties of Internal Medicine, General Surgery, Obstetrics and Gynecology, the Lloydminster Hospital will plan to provide a wider range of services including Psychiatry, Orthopedics, Urology, ENT and Ophthalmology, as well as the infrastructure required to support these services. Some of these secondary specialty services are currently provided on a partial basis, e.g. visiting clinics.

Further to the previous point, in planning for the future services of the Lloydminster Hospital, the Master Plan will consider the impact of a ‘primary’ catchment area as large as 65,000 - 90,000 (current population) and a ‘broader’ service area as large as 120,000 (current population), including as well the projected growth of this population over the next 10 to 20 years.

In planning for the future services of the Lloydminster Hospital, the Master Plan should address the high pressure needs in the community, such as: - A young, industrial-based population, both resident and

‘shadow’. - A high proportion of Aboriginal population. - A growing senior’s population choosing to spend their

remaining years in the community.

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Administrative Services The longer term plan needs to accommodate administrative

services on the Hospital campus. However, in the short term there may be no other option than to

temporarily relocate off campus those functions that do not directly support the acute care services, in order to address priority acute care service needs such as more inpatient beds and related growth space.

Admitting Consider providing a satellite Admitting/Registration function in

the new Ambulatory Services component.

Ambulatory Services Plan to co-locate Ambulatory Services such as: Chemotherapy,

Day Surgery, Endoscopy, Outpatient Services, Pre-Admission Clinic, Renal Dialysis, and Specialist Clinics so that facilities such as reception, admitting/registration, patient waiting and amenities, exam rooms, staff amenities, and other supports can be shared.

Plan space that is appropriately and efficiently designed and located to accommodate Ambulatory Services, including the capability for future expansion.

Diagnostic Imaging Plan to include a MRI docking station in the immediate future

(2007) and the addition of a permanent MRI in the longer term. Determine the impact of adding Mammography services on

existing available space.

Emergency Emergency reached almost 40,000 visits in the past two years. The

time frame for implementing alternative Primary Health Care services in the community for the lower acuity Level’s 4 and 5 (CTAS) patients to access (as proposed in the PNHR Strategic Plan 2005/06 - 2009/10) is likely longer than anticipated.

Within the initial 5 - 10 year time frame of the Master Plan, it is assumed that Emergency will continue to be the primary point of entry and that a fast track area should be planned to assist in handling the workload growth.

It is recommended that the Master Plan consider a potential target of up to 50,000 Emergency visits, which will require approximately 30 patient spaces, including the provision of a fast track area.

Food and Nutrition Services Plan to expand the servery and cafeteria seating to

accommodate the projected increase in staff and visitors.

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Health Information Services (HIS) Plan to change processes and procedures within HIS with the

introduction of the electronic health record.

Home Care Plan to accommodate Home Care services within an expanded

Lloydminster Hospital. Consider the need for direct access from an outside entrance

and from parking, as well as the potential to share clinical facilities with Ambulatory Services, when determining the preferred location for Home Care.

Housekeeping/Laundry Determine the impact of contracting the Laundry service to an

external provider. The space required to support a contracted services will be significantly less, i.e. space within the Hospital for clean and soiled linen holding and distribution.

Information Technology (IT) The recommended space requirement for IT includes a data

centre that must be designed to mitigate against fire and water damage, and be in a well ventilated and cool/dry environment.

Inpatient Services The recommended inpatient bed projections identify a potential

need to accommodate approximately 110 -125 beds at the Lloydminster Hospital in the 10-15 year time frame. Mental Health (Psychiatry) - Plan for the addition of psychiatric inpatient beds in the future,

i.e. approximately 8-10 beds. Medicine Services - Plan for a significant increase in medical beds, i.e.

approximately 56-60 beds, which will require the eventual development of a second medical inpatient unit, i.e. two units of approximately 30 beds each.

Obstetrical Services - Plan to provide a separate obstetric unit incorporating the

concept of LDR’s, together with an antenatal area and post-partum beds, i.e. approximately 15 antenatal and post-partum beds and 4-5 LDR’s, recognizing that the workload volume surpassed 870 births in the past year.

Special Care / Intensive Care Services - Plan to provide Intensive Care level services with a range of 4

to 6 beds. Surgical Services - Plan to provide a separate surgical inpatient unit with the

potential for a significant increase in beds, i.e. approximately 21-25 beds. In addition, plan to expand the Day Surgery service to 10-12 stretchers/beds.

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Transition Beds - Assume the Transition beds will remain located in the acute

care Hospital, with a projected range of approximately 6-10 beds.

Children’s Health - Plan to include ‘assigned’ paediatric beds within the Medical

Inpatient Unit(s) that have the flexibility to properly accommodate the child and family support but also have the flexibility to be used as swing beds for adults.

Laboratory Plan for the potential addition of Microbiology services (within

existing space) and Pathology services (will require additional space) in the Master Plan time frame.

Materials Management Consider the option of locating Materials Management services in

an alternative location on campus, recognizing that while it serves facilities in the surrounding region its primary day-to-day user will continue to be the Hospital.

Pharmacy Plan to include an IV Additive Program as a future regional

service.

Surgical Suite Plan for a capacity of 4 OR’s to support the anticipated increase

in workload volume due to population growth and the development of services such as orthopedics, as well as the assumption that C-sections will be done in the Surgical Suite in the future.

Provide the planning capability to expand by 1 or 2 additional OR’s in the longer term future.

Therapies The satellite rehabilitation space will continue to be required and

is best located proximal to the Transition unit and Medical unit(s). It is a preferred direction to locate the main Therapies department

with other Ambulatory Services.

Volunteers and Ladies Auxiliary In the future, volunteers will be increasing support to Ambulatory

Services. There is an opportunity to build a closer working relationship

between Volunteers and the Ladies Auxiliary.

Foundation Plan to locate the Foundation in a more accessible and visible

location within the Hospital, also allowing for its anticipated growth.

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2.4.2 Physical Parameters

1. The Master Plan assumes that the Lloydminster Hospital will remain the only acute care hospital in the City of Lloydminster within the planning time frame, i.e. at least over the next 10 to 20 years and most likely beyond. Therefore, projected growth requirements in hospital-based acute care services in the City of Lloydminster will need to be accommodated on the Lloydminster Hospital site.

2. The Master Plan is reviewing whether the existing Lloydminster Hospital building has at least another 20 to 30 years of useful life and at what cost. If the cost of renovating and upgrading the existing building

exceeds about 75% of the cost of replacing it, then potential replacement may need to be considered in the Master Plan options. The Master Plan needs to review the capacity of the existing site to accommodate the eventual replacement of the existing Hospital building.

Assuming the existing building is to be retained, the Master Plan must include the costs for renovating and upgrading it to an acceptable current standard, including rectifying any deterioration that may have occurred due to deficiencies in the building envelope (e.g. leaking roof and windows).

3. The Master Plan will acknowledge the degree of uncertainty in defining the future scope of acute care and regional services that will be provided in the Lloydminster Hospital, including the potential extent of the geographical catchment area it serves. The Master Plan will address this uncertainty through strategies

such as creating flexible and adaptable space, providing options for additional expansion in acute care areas (including both inpatient and ambulatory services), providing open-ended development zones, and earmarking areas on the site for future expansion.

The Master Plan will identify potential opportunities to expand the Hospital site through acquisition of adjacent property as an additional means of planning and preparing for future growth.

4. The Master Plan will consider both short-term and longer term redevelopment strategies for the expansion and renovation of the Lloydminster Hospital, so that the higher priority needs can be addressed as quickly as possible. While such strategies may include the temporary relocation off campus of selected functions that do not directly support the acute care services, e.g. administrative services, the longer term strategy will be to locate these services on campus, as long as it makes sense from a service delivery perspective.

5. A key direction of the Master Plan is to locate health services in proximity to one another to promote coordination and integration of services and to facilitate user access, i.e. users should be able

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Final 24 2007-06-30

to come to one location in the community to access as many of the health services as possible delivered by the PNHR.

6. The Master Plan recognizes that there are recurrent costs (e.g. leasing) associated with moving services off campus and that the preferred solution is to obtain one-time capital funds to build the space that is required to deliver the programs and services.

7. The Master Plan will integrate short-term expansion and renovation projects into a comprehensive facility redevelopment plan that considers the implications of longer range growth needs, i.e. 10 to 20 years and beyond.

8. If the decision is to renovate, upgrade and expand the existing Hospital building, the redevelopment of the Lloydminster Hospital might need to be phased. If phasing is required: The recommended strategy must ensure that the Hospital

remains a fully functional and operational facility at the conclusion of each phase.

The recommended strategy must minimize the number of internal moves and renovations required to accommodate the functional reorganization, appreciating the operational impacts and disruption to existing services.

While there may be no other option than to move selected functions off campus to create short term growth and/or decant space within the Hospital, these will be treated as temporary solutions if it makes sense form a service delivery perspective to move them back on site.

9. If the decision is to renovate, upgrade and expand the existing Hospital building, the Master Plan will address the existing physical building deficiencies in concert with functional upgrading and space re-purposing, to minimize both the cost and disruption of renovations.

10. The Master Plan recognizes the need to plan existing and new Hospital facilities to accommodate the integration of information technology (including Telehealth) in virtually all health care activities and based on the assumption that it will utilize wireless technology.

11. The Master Plan will earmark a site location for the Mobile MRI (in 2007) and the potential inclusion of a helicopter landing pad sometime in the future.

12. The Master Plan will identify the potential increase in on-site parking required over the development time frame.

2.4.3 Functional Parameters

1. The Master Plan will optimize the use of highly serviced, expensive hospital space for acute care/clinical services as well as functions that directly support those services.

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Inpatient space will be reclaimed to accommodate acute care beds and related services, assuming the space can be upgraded to acceptable current standards and at an acceptable cost.

To the extent possible, other less intensive clinical functions and non-clinical functions will be located in less costly space designed for those purposes, e.g. ambulatory services, administrative and logistical support services.

2. A priority is to increase the percentage of single bedrooms from the current level of 27% on the existing Inpatient Units. The ideal target is eventually to achieve 80 to 100% single bedrooms. However, it is recognized that this may not be functionally or operationally feasible within the limitations of the existing inpatient facilities and that interim options of increasing the percentage to a target range of 50% to 60% might have to be considered.

3. Plan any new Inpatient Units with a recommended target of 80 to 100% single bedrooms. Services such as Obstetrics, Special Care and Psychiatry should in fact have 100% single bedrooms.

4. Plan Ambulatory Services as an integrated component to maximize functional and operational efficiencies and to share resources, i.e. Chemotherapy, Endoscopy, Outpatient Services, Pre-Admission Clinic, Renal Dialysis, Specialist Clinics, and possibly Day Surgery.

5. If the decision is to renovate, upgrade and expand the existing Hospital building, locate Ambulatory Services to: Move them out of the existing inpatient facilities. Provide direct outpatient access, e.g. ground level, with its

own ‘defined’ entrance (including a satellite registration/ admitting if necessary), and the availability of parking proximal to the entrance.

Provide convenient access from the existing main (front) entrance with minimal intrusion to other services, e.g. Emergency.

Reflect the strong functional affinity of Ambulatory Services with Diagnostic Services, e.g. Laboratory, Diagnostic Imaging and with Emergency, e.g. cast room.

Provide future expansion capability (horizontal and/or vertical), e.g. locate on an outside wall next to available site area.

6. Plan Emergency Services to: Optimize space utilization, e.g. ‘universally sized’ rooms. Efficiently handle both high and low workload periods. Address issues such as: the high volume of level 4 and 5 visits

(i.e. ‘fast track’ area) and the increasing number of patients waiting in Emergency for an inpatient bed.

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Provide future expansion capability, e.g. locate on an outside wall next to available site area.

7. Wherever possible and functionally feasible, share the following resources: Patient reception, waiting and washrooms. Exam rooms. Med-surg supply areas (clean and soiled). ‘Hoteling’ workstations. Meeting space. Staff amenities. Administrative work areas including multi-function equipment.

8. Plan existing and/or new space to support a family-centred care model and to respect patient privacy.

9. Plan for restricted public access in clinical/treatment and staff areas.

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 3. FUNCTIONAL PROGRAM SUMMARIES

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33.. FFUUNNCCTTIIOONNAALL PPRROOGGRRAAMM SSUUMMMMAARRIIEESS

33..11 OOVVEERRVVIIEEWW Another key activity of the project was the functional evaluation of the Hospital programs and services and their current space. This chapter presents a comprehensive summary of the evaluation, including its findings and recommendations - see Section 3.2. As a follow-up task to the evaluation, the potential bed capacity of the existing Hospital inpatient units was examined according to different scenarios, the primary intent being to understand the implications of trying to increase the bed complement and at the same time meet current inpatient accommodation benchmarks such as a higher ratio of single bedrooms - see Section 3.3. Section 3.4 contains a summary of the Functional Program space projections that form a key input into the Master Plan options.

33..22 FFUUNNCCTTIIOONNAALL EEVVAALLUUAATTIIOONN SSUUMMMMAARRYY The Functional Evaluation Summary is presented in Table 3-1 on the following pages. The first set of columns provides a breakdown of the key findings for each program/component of the Hospital with regard to: its location (e.g. relative to other components, main entrance, ground floor, etc.), the overall layout (i.e. functionality), the room sizes, and whether it meets benchmarks. The legend of shaded circles is intended to provide a visual message, i.e. black circles represent components that are in the worst condition. The next set of columns in the Summary identifies, for each component, the current amount of space (in component gross square metres, i.e. CGSM), the projected space requirements in 5-10 years, and whether the component is likely to require future growth beyond the 5-10 year time frame (e.g. may indicate that it should be located where future growth can occur such as on an exterior wall). The remainder of the Summary identifies the relative priority of each component for redevelopment, to help guide the Master Plan, and provides comments that highlight the key findings and recommendations. The recommended distribution of projected inpatient beds is provided on the final page of the table.

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LLOYDMINSTER HOSPITAL - FUNCTIONAL PROGRAM & MASTER PLAN TABLE 3-1 FUNCTIONAL EVALUATION SUMMARY

Legend: Good Fair Poor

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Functional/Space Evaluation Space Requirements

Component Location Overall Layout Room Sizes

Meets Benchmks

Current CGSM

Proj CGSM 5-10 Yrs

Future Growth

Master Plan

Priority Comments

4.1 Administration N/A 170.2 200.0 Low to Medium

Office sizes generally adequate; staff workstations, reception & meeting space are undersized

4.1.1 Telehealth, Meeting & Education Facilities

No 126.2 220.0 Yes High Have 3 rooms ranging from 32 to 54 sqm that are undersized w/ poor acoustics; require more & larger rooms plus storage

4.1.2 Hospital Staff Facilities N/A 152.0 200.0 Possible Low Potential need for a central staff lounge

4.1.3 Medical Staff Facilities N/A 30.0 80.0 Possible Medium Require expanded facilities incl lounge, computer stns, lockers, on-call space

4.2 Admitting No 67.3 90.0 Possible High Lost space in the DI expansion resulting in significant overcrowding & privacy issues; adjacency to Emergency is good; distance from Health Records is an issue; assume satellite Admitting in Ambul Serv

4.2.1 Public Facilities No 100.0 Yes Medium to High

Existing lobby has reached capacity as patient volume continues to grow

4.3 Ambulatory Care / Outpatient Services

No 0.0 100.0 Yes High Have no dedicated Ambulatory Care space; outpatient services currently utilize Emergency & Inpatient spaces

4.3.1 Chemotherapy No 61.1 80.0 Possible High Inappropriately located on 3rd Floor Inpatient Unit occupying bed space; poor outpatient access; can share support spaces w/ other Ambul Services

4.3.2 Day Surgery & Pre-Admission Clinic (PAC)

No 175.0 280.0 Possible High Inappropriately located on 2nd Floor Inpatient Unit occupying bed space; poor outpatient access; forecast 12 patient spaces (6 currently); can share support spaces w/ other Ambul Services including PAC clinic space

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Meets Benchmks

Current CGSM

Proj CGSM 5-10 Yrs

Future Growth

Master Plan

Priority Comments

4.3.3 Dialysis No 92.3 450.0 +104 sqm

of support for offices, clinic, etc.

Possible High Inappropriately located on 3rd Floor Inpatient Unit occupying bed space; poor outpatient access; forecast 12 dialysis stations (5 currently) + potential for expansion to 18; can share support spaces w/ other Ambulatory Services

4.3.4 Endoscopy Yes 99.6 100.0 Yes High Inappropriately located on 2nd Floor Inpatient Unit occupying bed space; poor outpatient access; potential to add 2nd procedure room in future; can locate recovery beds w/ Day Surgery & share support spaces w/ other Ambul Serv

4.3.5 Specialist Clinics N/A 78.2 90.0 Yes High Inappropriately located on 2nd Floor Inpatient Unit occupying bed space; poor outpatient access; can share support spaces w/ other Ambul Services; space projection includes Cast Clinic

4.4 CSR N/A 187.3 277.0 Medium Will need expansion to support increase to 4 OR’s; should maintain adjacency to OR’s for functional & staffing efficiencies

4.5 Diagnostic Imaging Yes 445.4 595.0 Yes Low Recently renovated (April 06) w/ internal capacity for growth; addition of Mammography may impact on space needs; recommend planning for a permanent MRI in the longer term plus additional support/storage

4.5.1 Mobile MRI N/A 100.0 Incl above

High Require 60’ x 18’ pad adjacent to building w/ tractor trailer access (minimum 50’ turning radius); locate in proximity to patient support facilities within the Hospital such as washrooms

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Meets Benchmks

Current CGSM

Proj CGSM 5-10 Yrs

Future Growth

Master Plan

Priority Comments

4.6 Emergency No 413.8 900.0 +110 sqm

for new ambul bay

Possible High Projected 50,000 visits (higher acuity) require approx 30 patient spaces; should maintain adjacency to DI & Admitting

4.7 Facilities & Maintenance No 124.6 210.0 Medium Current area excludes basement space & outdoor storage; require expansion of shops, equip maintenance & storage

4.8 Finance N/A 54.5 80.0 Possible Medium Current space is separated & lacks storage; projected space includes growth of 1- 2 staff

4.8.1 Payroll N/A 39.0 65.0 High Inappropriately located on 2nd Floor Inpatient Unit occupying bed space, therefore rated high priority; should be located w/ Finance

4.8.2 Scheduling N/A 28.0 52.0 High Inappropriately located on 2nd Floor Inpatient Unit occupying bed space, therefore rated high priority; should be located w/ Payroll (share information)

4.8.3 Human Resources Yes 39.8 52.0 Possible Low Current space & location function well incl shared support w/ Administration; projected space incl growth of 1 staff

4.9 Food & Nutrition Services N/A 412.3 512.0 Medium Kitchen originally designed to support 115 beds; cafeteria/servery under-sized

4.10 Foundation N/A 70.8 90.0 Possible Medium Location needs to be more accessible & visible; require addn’l space for recep, meetings, storage, potential staff growth

4.10.1 Gift Shop N/A 30.0 50.0 Low Current space includes gift shop @ 20 sqm & office @ 10 sqm; gift shop needs to at least double in size w/ office adjac

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Meets Benchmks

Current CGSM

Proj CGSM 5-10 Yrs

Future Growth

Master Plan

Priority Comments

4.11 Health Information Services

N/A 181.0 311.0 Medium Require additional staff workstations & file storage (incl replacement of temporary file room); also prefer closer proximity to Admitting & Emergency for after hours access to records

4.12 Home Care No TBD 300.0 Medium to High

Plan to relocate from CHS building to the Hospital; share space w/ Ambul Services

4.13 Housekeeping & Laundry N/A 392.1 462.0 Medium Require housekeeping storage and additional shower/change facilities

4.14 Information Technology No 85.0 280.0 Possible High Inappropriately located on 2nd Floor occupying bed space, therefore rated high priority; relocation of IT equipment/ data centre also a high & urgent priority

4.15 Laboratory Yes 291.2 291.2 +80 sqm

for Pathol

Yes Low Existing space adequate to add microbiology services; need to earmark future growth space for Pathology

4.15.1 Morgue N/A 34.0 TBD Low Morgue space is being used primarily as storage; future space need TBD

4.16 Materials Management No 273.0 450.0 Possible Medium Current area excludes basement space & outdoor storage; MM lacks space in areas such as loading dock, receiving/ staging, cart marshalling, equipment & archival storage, dialysis supplies; this is a regional MM site supporting other PNHR facilities; potential to locate MM off-site is under consideration

4.17 Medical / Special Care/ Transition / Psychiatry Inpatient Services

No 1609.6 3,560.0 Yes High Current guidelines suggest a higher ratio of single rooms; 30 medical, 3 special care & 6 transition beds in operation; medical beds will increase substantially

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Meets Benchmks

Current CGSM

Proj CGSM 5-10 Yrs

Future Growth

Master Plan

Priority Comments

4.18 Obstetrical & Surgical Inpatient Services

No 1040.6 1,670.0 Yes High Currently a combined unit w/ 19 beds; recommend separating Obstetrical & Surgical Units; propose future LDR model; surgical beds will increase substantially; require a higher ratio of single rooms

4.19 Operating Rooms & Recovery (Surgical Suite)

No 340.0 760.0 Possible Medium ORs under-sized; require additional 1-2 ORs to support projected population/ volume increase, incl orthopedics; require additional recovery spaces; assumes C-sections done in OR in future

4.20 Pharmacy Yes 207.5 207.5 Low Current space adequate to support projected volume

4.21 Therapies (incl satellite space on Inpatient Unit)

227.5 322.7 Medium Additional space req’d for private assessment, waiting & storage

4.22 Volunteers & Ladies Auxiliary

N/A N/A 5.0 50.0 Medium Require volunteer workroom, locker area & storage (currently share w/ Gift Shop)

Proposed Bed Projection & Distribution Projected CGSM, 5-10 Yrs Comments

Medical Inpatients ± 56 - 60 beds 2 units @ 1,080.0 = 2,160.0

Ideally, 2 units of 28-30 beds w/ approx 16 private rooms (2 rooms w/ isolation ante rooms) and 6-7 semi-private rooms plus public and staff support space; includes Paediatric beds

Surgical Inpatients ± 21 - 25 beds 940.0 Includes approx 12 private rooms (2 rooms w/ isolation ante rooms) and 6 semi-private rooms plus public and staff support space

Special Care Unit ± 4 - 6 beds 600.0 Based on 6 beds at an ICU space standard, e.g. all single rooms

Transition Unit ± 6 - 10 beds 400.0 Based on 10 beds

Obstetrical Inpatients ± 15 pp/ap beds + 4-5 LDR’s

730.0 Ideally, all should be private rooms; includes antenatal patient space

Psychiatry Inpatients ± 8 - 10 beds 400.0 Based on 10 beds w/ all single rooms

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33..33 PPOOTTEENNTTIIAALL BBEEDD CCAAPPAACCIITTYY OOFF TTHHEE EEXXIISSTTIINNGG HHOOSSPPIITTAALL One of the emerging and important factors in the programming and design of acute care hospitals is the trend to a higher percentage of single private bedrooms. As is the case in many health facility trends, new hospitals in the USA are setting the benchmark at 100% single bedrooms. Hospital projects in Alberta that are in the design phase are expecting to achieve about 80% of the beds in single bedrooms. Key drivers of this trend include: Shorter lengths of stay along with increasing levels of acuity and

higher intensities of care for inpatients. The ability to maximize utilization of the beds. The increasing prevalence of infectious diseases. The need to create better social and physical environments to

improve the quality and safety of the hospital setting for patients and staff.

The need to facilitate increased patient and family involvement in acute health care delivery.

Table 3-2 examines three scenarios for the future use of the inpatient beds in the Lloydminster Hospital. Note: all of the options assume that the space currently occupied on levels 2 and 3 by administrative offices and ambulatory services (i.e. Chemotherapy, Day Surgery, Dialysis, Endoscopy, Specialty Clinics) is reclaimed for inpatient services, but that the relocated Pharmacy remains on level 2 and the Special Care Unit remains in its current under-sized space. Scenario 1 - Maximum Beds / Not-to-Standards Scenario This option accommodates a total of 98-101 beds on the existing

two floors, but with only 28% single beds. It also retains the 3-4 bed rooms and does not increase the number of LDR’s as proposed. Scenario 1 is not appropriate as a basis for future planning.

Scenario 2 - Mid-Range Scenario This option accommodates a total of 75-77 beds on the existing

two floors, with 51% single beds. It accommodates 2 patients in the 3-4 bed rooms and 1 patient in the undersized 2-bed rooms and increases the number of LDR’s as proposed. The reclaiming of Pharmacy space would add another 8 beds. With the potential expansion of a new 4th floor inpatient unit, the number of beds increases to 116-124 with approx 65% as single beds.

Scenario 3 - Ideal / Closest-to-Standards Scenario This option accommodates a total of 59-61 beds on the existing

two floors, with 78% single beds. It also accommodates 2 patients in the 3-4 bed rooms and 1 patient in the undersized 2-bed rooms and increases the number of LDR’s as proposed. The reclaiming of Pharmacy space would add another 6 beds. With the potential expansion of a new 4th floor inpatient unit, the number of beds increases to approximately 106 with 80-85% as single beds.

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LLOYDMINSTER HOSPITAL - FUNCTIONAL PROGRAM & MASTER PLAN TABLE 3-2 EXISTING BED CAPACITY

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TABLE 3-2 POTENTIAL BED CAPACITY - EXISTING 2ND AND 3RD FLOORS 1. Maximum Beds / Not-to-Standards Scenario Floor & Bed Distribution No. Beds Total No. Beds % of Total Beds Assumptions / Comments 2nd Floor 15 x 1-bedroom 15 beds 35% 14 x 2-bedrooms 28 beds 65% Subtotal 2nd Floor 43 beds

Reclaims Day Surgery, Endoscopy, Specialty Clinics & non-inpatient office space

Pharmacy remains on 2nd floor Additional LDR’s not developed

3rd Floor 13 x 1-bedroom 13 beds 23% 15 x 2-bedrooms 30 beds 53% 4 x 3-4 bedrooms 12-15 beds 24% Subtotal 3rd Floor 55-58 beds

Reclaims Chemotherapy & Dialysis space Provides space for patient dining, lounge & therapies, i.e. Transition unit Accommodates 3-4 patients in the existing 4-bedrooms Maintains the Special Care Unit w/ 3-4 beds within its existing space

Totals 28 x 1 bedroom 28 beds 28% Number of single bedrooms is well below current standards 29 x 2-bedrooms 58 beds 58% 4 x 3-4 bedrooms 12-15 beds 14% Total 2nd & 3rd Floors 98-101 beds 2. Mid-Range Scenario Floor & Bed Distribution No. Beds Total No. Beds % of Total Beds Assumptions / Comments 2nd Floor 18-20 x 1-bedroom 18-20 beds 61% 5-7 x 2-bedrooms 10-14 beds 39% Subtotal 2nd Floor 30-32 beds


Pharmacy remains on 2nd floor 2 additional LDR’s & ante-natal space are developed

3rd Floor 20 x 1-bedroom 20 beds 44% 11 x 2-bedrooms 22 beds 49% 1 x 3 bedroom 3 beds 6% Subtotal 3rd Floor 45 beds

Reclaims Chemotherapy & Dialysis space Provides space for patient dining, lounge & therapies, i.e. Transition unit Accommodates 2 patients in the existing 4-bedrooms & 1 patient in the

smaller 2-bedrooms Maintains the Special Care Unit w/ 3 beds within its existing space

Totals 38-40 x 1 bedroom 38-40 beds 51% 16-18 x 2-bedrooms 32-36 beds 45% 1 x 3 bedroom 3 beds 4% Total 2nd & 3rd Floors 75-77 beds Reclaiming Pharmacy space adds ~8 more beds, 4 singles & 2 doubles

Add New 4th Floor ~40 beds Provides a total of 116-124 beds with approx 65% single bedrooms

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LLOYDMINSTER HOSPITAL - FUNCTIONAL PROGRAM & MASTER PLAN TABLE 3-2 EXISTING BED CAPACITY

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3. Ideal / Closest-to-Standards Scenario Floor & Bed Distribution No. Beds Total No. Beds % of Total Beds Assumptions / Comments 2nd Floor 23 x 1-bedroom 21-23 beds 84% 2 x 2-bedrooms 4 beds 16% Subtotal 2nd Floor 25-27 beds


Pharmacy remains on 2nd floor 2 additional LDR’s & ante-natal space are developed

3rd Floor 25 x 1-bedroom 25 beds 74% 3 x 2-bedrooms 6 beds 18% 1 x 3 bedroom (ICU) 3 beds 9% Subtotal 3rd Floor 34 beds

Reclaims Chemotherapy & Dialysis space Provides space for patient dining, lounge & therapies, i.e. Transition unit Accommodates 2 patients in the existing 4-bedrooms & 1 patient in the

smaller 2-bedrooms Maintains the Special Care Unit w/ 3 beds within its existing space

Totals 38-40 x 1 bedroom 46-48 beds 78% 16-18 x 2-bedrooms 10 beds 17% 1 x 3 bedroom (ICU) 3 beds 5% Total 2nd & 3rd Floors 59-61 beds Reclaiming Pharmacy space adds ~6 more beds, 6 singles

Add New 4th Floor ~40 beds Provides a total of 105-108 beds, but with 80-85% single bedrooms

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It is recommended that the Lloydminster Hospital consider targeting as close as possible to the Scenario 3 Bed Capacity for the mid to longer range planning. In the short to mid term, it is acknowledged that the Hospital will most likely need to accept the Scenario 2 Bed Capacity as a reasonable interim target in order to meet service demands and in recognition of the constraints imposed by the current facilities as well as operational and budget realities.

33..44 SSPPAACCEE RREEQQUUIIRREEMMEENNTTSS SSUUMMMMAARRYY The following tables present the projected 5-10 year space requirements and other project elements that will need to be accommodated in the Master Plan options.

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SCENARIO A - EXPAND & RENOVATE THE HOSPITAL Option / Component Existing Use Proj CGSM Comments New Construction / Expansion Ground Level: Ambulatory Care 984.0 Incl Chemotherapy, Dialysis, Endoscopy,

Outpatient & Specialty Clinics Home Care 300.0 Primarily office space Information Technology 280.0 Emergency 900.0 Incl new elevator to floors above Ambulance Bay 110.0 Therapies 323.0 PT, OT, Speech Language CSR 277.0 Include new lift to OR’s above

Second Level: Operating Rooms 760.0 4 OR’s Day Surgery 220.0 12 stretcher/beds

Third Level: Special Care Unit 600.0 6 beds

Fourth Level: New Inpatient Unit - Approx 40 beds 1,600.0 Vertical expansion of inpatient tower Circulation & Building Gross Areas 2,050.0 At all levels; assume 30-35% of CGSM Subtotal New Construction 8,404.0 Represents BGSM Functional Renovations Ground Level: Admitting Emergency 90.0 Health Information Services Emergency 311.0 Meeting/Conference Space Therapies 220.0 Incl Telehealth Cafeteria Expansion Meeting Rms 100.0 Diagnostic Imaging Emergency 75.0 Foundation & Gift Shop Office Space 140.0 I.e. Admitting & Finance Materials Management Laundry 150.0 Incl expans of loading dock into new sp Staff Facilities Health Rec 100.0

Second Level: Obstetrics Inpatient Unit 200.0 Development of more 2 LDR’s &

Antenatal area in existing space Inpatient Unit Inpatient Unit 840.0 Minor renovations to reclaim inpatient

bed space; minimal wall reconfiguration

Third Level: Inpatient Unit Inpatient Unit 1,610.0 Minor renovations to reclaim inpatient

bed space; minimal wall reconfiguration Subtotal Renovations 3,836.0 Building Upgrading Upgrade Remainder of Building ~2,500.0 Minor renovations Replace Building Envelope Net area of brick walls is ~2,930 sqm Upgrade Mechanical Systems Assume ‘typical’ medium level upgrade

to 20-year old systems Upgrade Electrical Systems Assume ‘typical’ medium level upgrade

to 20-year old systems Site Work Additional & Replaced Parking Assume 150 stalls Roadways New on-site access to Ambulatory Care Landscaping

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SCENARIO B - EXPAND & RENOVATE/REPLACE HOSPITAL (PHASED REPLACEMENT) Option / Component Existing Use Proj CGSM Comments

Stage 1 - New Construction / Expansion

Ground Level: Ambulatory Care 984.0 Incl Chemotherapy, Dialysis, Endoscopy,

Outpatient & Specialty Clinics Home Care 300.0 Primarily office space Information Technology 280.0 Emergency 900.0 Incl new elevator to floors above Ambulance Bay 110.0 Therapies 323.0 PT, OT, Speech Language CSR 277.0 Include lift to OR’s above

Second Level: Operating Rooms 760.0 4 OR’s Day Surgery 220.0 12 stretcher/beds

Third Level: Special Care Unit 600.0 6 beds

Circulation & Building Gross Areas 1,550.0 At all levels; assume 30-35% of CGSM Subtotal Phase 1 New Construction 6,304.0 Represents BGSM

Phase 1 - Functional Renovations

Ground Level: Admitting Emergency 90.0 Health Information Services Emergency 311.0 Meeting/Conference Space Therapies 220.0 Incl Telehealth Cafeteria Expansion Meeting Rms 100.0 Diagnostic Imaging Emergency 75.0 Foundation & Gift Shop Office Space 140.0 I.e. Admitting & Finance Materials Management Laundry 150.0 Incl expans of loading dock into new sp Staff Facilities Health Rec 100.0

Second Level: Inpatient Unit Inpatient Unit 1,040.0 Reclaim inpatient bed space w/ the

minimal renovations possible

Third Level: Inpatient Unit Inpatient Unit 1,610.0 Reclaim inpatient bed space w/ the

minimal renovations possible Subtotal Phase 1 Renovations 3,836.0

Building Upgrading

Upgrade Remainder of Building ~2,500.0 Minor renovations Upgrade Mechanical Systems Assume low level upgrade to 20-year old

systems, to serve lower level functions Upgrade Electrical Systems Assume low level upgrade to 20-year old

systems, to serve lower level functions

Site Work

Additional & Replaced Parking Assume 150 stalls Roadways New on-site access to Ambulatory Care Landscaping

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Option / Component Existing Use Proj CGSM Comments

Stage 2 - New Construction

New Inpatient Units 5,000.0 Assume 110 beds @ ~45 CGSM/bed New Diagnostic Imaging 600.0 Public & General Support to the

Inpatient Units 400.0

Circulation & Building Gross Areas 1,800.0 At all levels Subtotal Stage 2 New Construction 7,800.0 Represents BGSM

Stage 2 - Renovations

Existing Space Re-assignment & Reconfiguration

3,200.0 Assume approx 1/2 of the existing area will require minor to medium renovations to accomm lower level functions such as admin, offices, support spaces, etc. as well as tying into the new Inpatient Building

Subtotal Phase 2 Renovations 3,200.0

Site Work

Additional & Replaced Parking Assume 75 stalls Roadways New on-site access to Inpatient Bldg Landscaping

SCENARIO C - FULL REPLACEMENT OF THE HOSPITAL Option / Component Existing Use Proj BGSM Comments

New Construction

New Hospital on Existing Site ~21,000.0 Assume 130-140 beds @ ~150 BGSM/bed (incl Home Care)

Subtotal New Construction ~21,000.0

Site Work - New Site

Parking Assume 400 stalls Roadways New on-site access to main entrance &

to emergency Provision of new site services Landscaping

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 4. SITE & BUILDING REVIEW

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44.. SSIITTEE && BBUUIILLDDIINNGG RREEVVIIEEWW

44..11 EEXXIISSTTIINNGG SSIITTEE CCOONNDDIITTIIOONNSS The Hospital is located on a 6.3 hectare (15.6 acres) site situated on the Saskatchewan side of the City of Lloydminster. The existing Hospital building is at the north end of the site, next to 43rd Avenue, with visitor, staff and service parking located directly adjacent to the building. The Community Health Unit is located just to the west of the Hospital on 43rd Avenue. The Hospital building and parking occupy approximately the north 40% of the site. The remainder, located to the south adjoining 36th Street, is currently used as playing fields. Adjacent development includes, to the east along 43rd Avenue, housing; and to the west the Health Unit and housing. Across 43rd Avenue, the land (owned by Husky Oil) is un-developed and could provide future expansion opportunities for the Hospital or related services/functions. The Hospital is zoned I-Institutional. Extended medical treatment services and protective and emergency services are permitted uses under this zoning. The portion of the site occupied by the Health Unit (also owned by PNHR) is zoned C3-Neighbourhood Commercial. The adjacent land use zone is residential uses - R1, R3, and R4. Across 43rd Avenue, the un-developed land is zoned RR - Residential Reserve. The site has two access points, both from 43rd Avenue. The westerly access is the primary visitor and emergency vehicle entrance. It also provides access for service vehicles to the rear (south side) of the hospital. The second site access primarily serves the staff parking. The site is developed with three parking areas, two for staff and one for the public, with a drop-off road providing access to the front entry. Generally, the parking and roadways are in fair physical condition, as are the majority of the walkways. The front portion of the Hospital, which incorporates Emergency and drop-off plus visitor parking, is relatively constrained and at times congested. To the south of the Hospital are two free-standing out-buildings: one a garage and the second a maintenance shop, which also houses the emergency generators. The 02 storage tank, cooling tower and transformer are located between these outbuildings and the Hospital. The gross floor areas of the existing Hospital are: Main floor - 5,065 sqm 2nd floor - 2,700 3rd floor - 2,115 Boiler plant - 590

Total 10,470 sqm Additional areas include the penthouse, crawl space and outbuilding. Exhibit 4.1.1 illustrates the current site development.

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44..22 FFUUTTUURREE DDEEVVEELLOOPPMMEENNTT The size of the site is sufficient to accommodate significant growth of the Hospital, including even its potential replacement. One of the development options considered expanding Emergency directly to the northwest from its current location, in part to remain adjacent to Diagnostic Imaging. However, growth in this direction is relatively constrained by the access road and Community Health building. By comparison expansion to the southwest or southeast into the playing fields is relatively unencumbered. If expansion occurs in this direction, the cooling tower and O2 storage tank may need relocation. Expansion towards 43rd Avenue is limited by the change in elevation, although it is possible towards the southeast. The Recommended Master Plan is based on the intention to remain and redevelop the Hospital on its existing site. Therefore it is recommended that the PNHR give serious consideration to acquiring a portion of the undeveloped (Husky Oil) land across 43rd Avenue. While not required for short to mid-term development, it would be prudent as a longer term strategy. The potential and anticipated growth of the community and region and the impact of this growth on the future role and size of the Lloydminster Hospital could result in the existing site becoming fully utilized. Additional land may be required to accommodate Hospital-related functions such as Materials Management, Administration, medical/outpatient clinics, parking, other levels of health care services, etc. Exhibit 4.2.1 illustrates the growth potential on the existing site.

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Final 44 2007-06-30

44..33 BBUUIILLDDIINNGG CCOONNDDIITTIIOONN RREEVVIIEEWW IBI Group, as part of the Master Plan & Functional Program team, assessed the physical condition of the Lloydminster Hospital. IBI was responsible for the architectural review. The scope of work was expanded in March 2007 to incorporate Engineering Evaluations of the Hospital building that included: Structural Review - Aedis Consulting Ltd. of Edmonton. Building Enclosure Review - Building Science Engineering Ltd. (BSE)

of Edmonton. Mechanical & Electrical Review - FSC Consulting of Edmonton.

During the review of the building, the Facilities and Maintenance staff at the hospital were available and led walk-throughs of the facility. Drawings were also made available to the team, including as-built and the construction drawings. Based on these reviews and observations, there are a number of issues regarding the physical condition that should be addressed - the primary concern being the status of the building envelope. 4.3.1 Summary

The Lloydminster Hospital, opened in the late 1980’s, has a number of issues that should be addressed if the Hospital continues to operate as an acute care facility. A number of other upgrades will be required if a significant expansion is proposed. Highlights from the Building Condition Review include: Building envelope and roofing enclosure to be replaced (if

continues to operate as an acute care facility). Structure can accommodate development of a new 4th floor for

inpatient purposes. However, elevators will need to be upgraded to machine room-less geared elevators if new 4th Floor added.

Mechanical / Electrical systems near end of life cycle. Significant upgrades of equipment will be required.

Basic systems (i.e. boilers) do not have capacity to accommodate a significant expansion (+ 50%).

Site services (sanitary, storm, power) are currently adequate. If a significant expansion is undertaken upgrades will be required.

4.3.2 Architectural & Building Enclosure

The Lloydminster Hospital was constructed in the late 1980’s and opened in 1987. The design architects were Holliday-Scott Paine Rusik Architects. The Hospital is designed as a three-storey building over a crawl space/ basement. The main floor of the Hospital houses the majority of the diagnostic and treatment areas. The two upper floors were designed as in-patient units, though with down-grading on the number of beds,

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Final 45 2007-06-30

some of these have been converted to other uses, including offices, ambulatory care and pharmacy. A sub-basement, located at the south corner of the Hospital houses the boiler plant. The crawl space / basement is under the main floor. This is currently used for storage, shops and also houses a number of the mechanical air systems. A penthouse, located on top of the in-patient tower houses air-handling units. Construction of the Hospital is concrete, incorporating concrete waffle slabs, for both floor and the roof structure. Portions of the Hospital that are single-storey incorporate a steel structure for the roof. The use of the waffle slab, often left exposed, within the corridor restricts the ability to accommodate possible renovations, as the planning of openings through the slab is restricted by the waffle ribs. This constraint is particular critical when relocating and/or installing new plumbing services such as toilets and showers. The exterior walls of the building include a masonry rain screen with insulated, steel stud back-up wall. Air-barrier is provided by a vapour barrier installed on the interior of the studs. The majority of the windows are punched, incorporating an interior glazed insulated system. The windows have proved to be a continuing concern with numerous leaks. The Hospital is currently re-installing the existing windows to attempt to correct the leaks. This is proceeding on a phased basis. The design of the roof includes a mansard-type design with cold attics above the concrete roof deck of the tower. This roof deck has been designed as level. The roofing includes low sloped roof areas over the attics with sloped metal standing seam mansard at the edges. The roof and mansard is constructed on steel stud framing with loose fill insulation on the concrete deck. The steel joist framed roofs is bottom-bearing joists. These roofs also have a mansard design. Extensive roof repair and re-roofing has recently been completed. An enclosed courtyard is located on the second level. A barrel vault aluminium and glass skylight is located over the main entrance. This vault is showing signs of failure of the lites through loss of seals. Building Enclosure In light of some of the concerns with the building enclosure, a separate study was carried out by Building Science Engineering (BSE) which is attached to this report as Appendix A. BSE identified a number of concerns with the design and construction of the windows, air barrier and how the various elements tie together. There are several issues with respect to the operation of the building envelope, which have plagued the Lloydminster Hospital since it was opened in 1986. Had the building mechanical system been operated to the Standards for Hospitals with humidity levels of 30 - 60%, there would have been serious condensation problems in colder weather.

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As it now stands most of the problems relating to water are from the ingress of exterior water through the roofing, around windows, at the barrel vault, and curved glazing of the main floor, and in some cases through the walls. Each individual item could be addressed individually, for instance: While the re-roofing has been recently done there is a concern

with the tie-in of the roofing to walls. The brick veneer could be removed in 3 to 4 ft. sections allowing for a new structural support system from the back-up structure. Then the roofing termination could be done to prevent water from entering behind the roofing.

In the area of the Second Floor Courtyard, the area could be roofed over and provided with either artificial light or clerestory glazing.

The windows could be replaced with a pressure equalized and drained curtain wall system of glazing with more efficient units but without the blinds between the glazing. While this would improve the performance of the glazing and frame, it would not eliminate water from entering the wall from around the windows in the long-term.

The barrel vault glazing and curved residential sunroom glazing could be replace by a clerestory (vertical glass and frame system) with a flat roof.

Unfortunately, there is little that could be done to effectively improve the water-resistance, energy efficiency and condensation resistance of the general building envelope without removal of the brick veneer. The exterior could be rebuilt with a Pressure Equalized Rain Screen Insulated Structure Technique (PERSIST) approach to a new cladding system. After removal of the masonry veneer, existing exterior sheathing and batt insulation a new construction revised construction could be built. The new walls would consist of the existing studs, which would need to be checked for corrosion and structural attachment to the concrete structure that surrounds the infill panels, and new mould resistant sheathing attached to the exterior. An SBS membrane would be adhered to the exterior primed surface of the sheathing. This system would provide the air-barrier function of the assembly; as well, the SBS membrane would waterproof the wall. Roofing, windows, louvers and penetrations for mechanical and electrical would be sealed to the membrane to ensure continuity of the system. Insulation would be mechanically fastened to the exterior of the SBS membrane to ensure the tight contact of the insulation to the membrane. Structural requirements for new cladding would be required to not compromise the continuity of the air seal system and would be designed to minimize thermal bridging. Cladding could be re-installed as brick masonry or lighter claddings like metals could be an option, with perhaps brick on just the lower floor. Most of this work could be undertaken from the exterior in the warmer summer months with

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Final 47 2007-06-30

scaffolds setup to protect the new construction process from inclement weather. At the same time, new pressure equalized and drained windows could be installed and tied into the SBS membrane of the wall. The use of internal louver blinds within the glazing would have to be changed. It would be our opinion that while individual item changes could improve some of the problems of water leakage, the more complex issues of environmental requirements need to be addressed as a complete package for the long term performance of the facility. Interior Finishes & Fittings The floor finishes within the hospital are generally sheet vinyl products on the floor (except within service areas, which incorporate concrete). Where sheet vinyl is used cove bases are provided. Quarry tile flooring is used at the main entry lobby to the Hospital. Both visitor and patient washroom include ceramic tile on the floor and walls. Within the offices and meeting rooms carpet is provided. The carpet is starting to show its age and should be replaced shortly. Otherwise, the flooring finishes are in fair condition and should continue to show good wear potential for the short to medium term (ten-plus years). The walls are generally drywall on steel studs. Wall protection is provided, including corner guards and wall protection in the corridors. A number of the corridor walls are showing scarring, where not protected, although for the most part the damage is aesthetic only. The ceilings are generally in good condition. Finishes include suspended acoustic tile, drywall and in the in-patient tower, corridors exposed waffle slab. Within the in-patient units the Hospital is in the process of installing tile drop ceilings throughout the corridor area. This installation should improve the acoustics within the corridors. Doors are generally solid core wood in hollow metal frames. Doors into service areas, such as Material Management, are rated as all are stair doors. Hardware is barrier-free lever handles. Where there is cart access, door protection is provided. Certain clinical areas include breakaway sliding glass doors such as in Special Care. Generally, the doors are in good condition. Vertical Circulation Vertical circulation includes four stairwells that provide access from the sub-basement through to the third floor of the IPU. Three of the stairs are located at the ends of the in-patient units. The central stair also extends to the penthouse. A fifth stair provides access to the power plant located in the sub-basement from the maintenance area.

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Four elevators are provided: one provides access to the sub-basement from the main floor; and three that provide access to the in-patient tower (one of these also provide access to the crawl-space). Two of the in-patient elevators are located centrally for use both by patients and staff. The third in-patient elevator, located adjacent to the Laboratory and DI, is intended to transport patients to the OR’s. The elevators have required a significant amount of maintenance, though they continue to operate at an acceptable level. As one of the considerations of the master plan is to potentially add a fourth floor to the hospital it is expected at that time that significant upgrades will be required to the three elevators permitting access to the in-patient units. It may be appropriate at that time to consider replacing the elevators with a machine room-less geared elevator. These would provide better service and use significantly less energy than the current elevators. At the very least, consideration should be given to upgrading the controllers of the existing elevators. Summary As noted in the BSE report, the present enclosure design problems are significant and should be addressed as soon as possible. If not addressed the water leakage and he eventual health and safety issues will continue and may impact the ability of the facility to meet the functional requirements under the standards for a health facility. Generally, the other architectural finishes are acceptable. 4.3.3 Structural

The Structural Drawings were prepared by MacPherson & Robb Engineering Ltd. in 1985. The drawings provide design information of the concrete and steel superstructure, although notes or specifications with regard to material strengths are not available. Geotechnical information was not available. It is understood (and subsequently confirmed) that the structure was originally designed for future additional floors. However, the drawings do not include any notes, or make any reference to future floors, or include any details that indicate provision for more floors. The existing drawings show that the concrete structure for the roof slab is identical in details and reinforcing to the structure for the third floor. A general review of the roof slab design shows that it will safely carry a superimposed dead load of 1.3 kilopascals (27 psf) and a live load of 2.4 kilopascals (50 psf). A live load of 3.6 kilopascals (75 psf) over the entire slab will exceed the capacity of the slab. The live loads specified in the Building Code are 1.9 kPa for patient rooms, 3.6 kPa for operating rooms and laboratories, and 4.8 kPa for corridors. Therefore, depending on the intended use of the future floor (existing roof), the slab may or may not have the capacity. If it is only for patient rooms, it appears that the existing slab is sound enough to carry the loads.

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The existing concrete columns below the existing roof slab were reviewed to determine their capacity to carry additional loads. It was assumed that the new floor above the existing concrete roof slab would be a steel structure with concrete on metal floor decking. The new roof above this floor will also be a steel structure. Using these dead loads and a live load on the future floors of 2.4 kPA, we found that the existing concrete columns do have the capacity to carry the additional loads. It should be noted that only a select number of columns were reviewed, however it does appear that the columns were designed for future floors. The foundations and piles were also reviewed, using a uniform live load of 2.4 kPa for the upper floors and 4.8 for the main floor. The existing pile loadings for four “typical” interior belled piles were calculated then added loads for proposed additional floors and/or or a roof. Several piles appear to have a lot of additional capacity. However, we did find that the central pile in each wing does have limited spare load carrying ability. According to our preliminary numbers, these piles could carry a fourth floor (the existing roof) with a uniform live load of 2.4 kPa, plus a new steel framed roof. The limited review of the existing Lloydminster Hospital structure and foundations has shown that they have the capacity to carry one additional inpatient floor - the report is included as Appendix B. The existing concrete roof slab would be the new fourth floor and a new structural steel frame would provide a roof over this floor. The steel roof over Diagnostic Imaging and Emergency does not have the capacity to carry an additional floor. 4.3.4 Mechanical & Electrical

FSC Consulting carried out the Mechanical and Electrical systems assessment. Their review included a site review and review of drawings; the report is included as Appendix C. Overall the majority of the mechanical and electrical systems and equipment are in the final quarter of their current life cycle. This is to be expected, as the building has been in continuous operation for the past 22 years, which is near the median life of most mechanical equipment. The original systems as selected were of good to high-end institutional quality and suitable to provide a reasonable level of staff and patient comfort, health and safety at the time of their original selection. These systems are with a few exceptions still suitable today and are still selected as baseline systems for acute care occupancies. Equipment is still generally in fair condition but at approximately 22 years age retains little life expectancy when compared to the median predicted service life of 20-30 years as listed by ASHRAE TC 1.8. The current fair condition of many of the systems and equipment can be attributed to the maintenance and operations program provided the

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high quality of the original equipment and the availability of systems redundancy that has allowed shorter operating run times on primary equipment such as boilers and fans. To maintain operations for the next 5-10 years equipment replacement and system upgrades will be necessary to both maintain functionality and to meet new program and code requirements, regardless of the current condition of the equipment and systems. To extend operations greater than 5-10 years for a full additional life cycle of 20-30 years will require complete major upgrade and retrofit, or modernization, of all systems at considerable cost and impact on building use. For all systems the necessary upgrades would require complete refit of systems effectively shutting down the areas served. This type of upgrade would entail complete system modernization that is only warranted if the intent is to use the health centre for a new 20 to 30 year life cycle. Costs to complete this modernization will be essentially equal to those for a new health care facility mechanical system. While there will be certain savings associated with reuse of some equipment and distribution these savings will be offset by additional costs for working within an operating health care facility. As a key element of the mechanical system assessment the systems have been evaluated with regards to their suitability for an increase in approximately 50% of gross building area plus significant program upgrades through a large portion of the existing hospital. These increases will impact on the existing systems and their ability to meet the building requirements. For the sanitary and fire protection systems only nominal upgrades will be necessary to the existing systems that would not be warranted by extending their life cycle. For the HVAC systems, however, not only would modernization of the existing systems be required but due to limited additional capacity in the existing systems all new HVAC systems will be required for any major increase in building program requirements. Complete discussions on the recommended upgrades and suitability of each of the mechanical and electrical systems are provided in the report included in the Appendix.

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 5. MASTER PLAN

Final 51 2007-06-30

55.. MMAASSTTEERR PPLLAANN

55..11 SSUUMMMMAARRYY OOFF EEVVAALLUUAATTIIOONN FFIINNDDIINNGGSS The high priority Hospital services / departments that should be located in new construction include: Ambulatory Care - Chemotherapy, Day Surgery, Dialysis,

Endoscopy, Clinics, etc. Emergency. Future Inpatient Beds. Operating Rooms. Therapies.

In addition, a number of other Hospital clinical and logistical support services require significant expansion to address existing deficiencies and to serve current and future growth needs. The key findings of the Architectural and Engineering Evaluation of the existing building are: Confirmation that the building mechanical and electrical systems

do not have capacity to serve future expansion. Confirmation that the structure can support a new 4th floor

inpatient unit. Must address the following building issues to operate as acute

care facility for the next 10 to 20+ years: - Replace building envelope to provide environmental control

and humidification - may change appearance. - Upgrade elevators - also add in new. - Replace/upgrade mechanical and electrical systems - near

end of life cycle.

The key findings of the Site Evaluation are: There is significant expansion capacity on the existing 6.3 hectare

site, including parking, i.e.50-60% of site area still available. Will likely need to consider future access from 36th Street. Recommend acquiring land across 43rd Avenue for long term

future growth needs. 55..22 DDEEVVEELLOOPPMMEENNTT OOPPTTIIOONNSS

The Project Parameters identify a significant enhancement of Hospital programs and services to address current needs as well as to respond to the continuing growth in the region. This results in the need for a relatively major expansion and redevelopment of the Hospital facilities and infrastructure to accommodate the present and future space needs of the growing programs and services. The building condition study identifies a number of concerns including the requirement for

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replacement of the building enclosure, if the existing facility is going to continue to be operated as an acute care hospital. In light of these factors, it is prudent to examine a broad range of Hospital redevelopment scenarios, including potentially the full replacement of the building. Scenario A - Expand & Renovate the Hospital This scenario looks at retaining the existing Hospital and continuing to operate it as an acute care facility, using as much as the existing infrastructure as possible. It would include the construction of a new Emergency and Ambulatory Services wing to the south and west of the existing Operating Rooms and Health Records, i.e. at the southwest corner of the existing building. Above the new Emergency and Ambulatory Services one to two additional floors would be proposed to house the new OR’s, Day Surgery, Special Care Unit and possibly new Inpatient beds. New Inpatient beds would also be provided in the development of a new 4th floor on the roof of the existing inpatient tower. This new wing would be tied back into the existing in-patient units at both the 2nd and 3rd levels. The existing elevator at the north end of the in-patient town would continue to be used for patient movement, or a new elevator provided in the addition to link the three floors. The spaces vacated by the relocation of departments would be back-filled to accommodate growth of adjacent departments and the relocation of displaced departments such as Health Records. This scenario would most likely need to be a phased approach with the new wing being developed, commissioned and occupied prior to the renovations occurring in the existing Hospital facilities. In developing this scenario, the consultants, Gaming Session participants and Steering Committee reviewed various locations for the new Emergency and Ambulatory Services expansion, including building out directly to the northwest from the existing Emergency, as well as expanding the existing building towards the southeast and/or the southwest. One of the objectives was to try and retain high priority functional relationships between service components such as Emergency and Diagnostic Imaging. The concluding consensus was that while expansion to the northwest directly adjacent to the existing Emergency and diagnostic services and close to the main entrance appears to make the most sense to address short term priorities, it does not represent good long term thinking. It further constricts the front area of the site and access to the building entrances and tends to close off subsequent stages of expansion. Locating this first stage of expansion more towards the rear of the building provides far more flexibility and opportunities for the continuing redevelopment/expansion of the Hospital and furthermore, will be far less disruptive to ongoing operations while the construction occurs.

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Scenario B - Expand & Renovate/Replace the Hospital, i.e. Phased Replacement Due to concerns over the existing building infrastructure and envelope, this scenario examined developing (on a phased basis) a new hospital on the existing site - linked to the existing facility. Under this approach, the first stage would be to proceed with the new Emergency department located to the southwest of the existing OR’s and Health Records, with the Ambulatory Services wing adjacent. A second storey would be developed to accommodate, similar to Scenario A, new OR’s and a Special Care Unit. The space vacated by these new additions would be backfilled, similar to Scenario A, with other departments. The Emergency / Ambulatory Services wing would be designed as a start of a new chassis for a new Inpatient building. By developing to the south, the Hospital “address” would change to 36th Street, however, ambulance services to Emergency could still be provided from 43rd Avenue. Upon completion of the new Inpatient building, the existing Hospital would be used primarily for administrative, office and support functions, including potential Community Health Services and medical/outpatient clinics. It is expected that these uses would not require a significant upgrade to the building envelope, as nominal humidity levels would only need to be accommodated. This scenario would need to be phased similar to Scenario A. The concluding consensus was that Scenarios A and B are very similar, with basically the same stage 1 expansion and then variations coming into play for the later stages of development. The Steering Committee recommended that the preferred approach would be to use a combination of these two scenarios that fully addresses the identified 5-10+ year needs in a stage 1 expansion and leaves open as many options as possible for subsequent stages of redevelopment/ expansion. Scenario C - Full Replacement of the Existing Hospital In consideration of the potential costs entailed in upgrading/replacing the existing building infrastructure and envelope, it is appropriate to examine the option of fully replacing the existing Hospital. It is assumed this would occur on the existing site and would entail a facility sized to meet the needs of at least the next 15 to 20 years (with potential for future expansion beyond those needs). The existing Hospital could either be demolished or converted to other uses. It is anticipated that Scenario C would comprise a new hospital of approximately 21,000 gross square metres (i.e. 130-140 beds). The estimated cost of this scenario would be in the order of magnitude of

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$150 to $170 million in today’s dollars (April 2007) or with assumed escalation, an end cost in the range of $240 to $275 million.

55..33 RREECCOOMMMMEENNDDEEDD MMAASSTTEERR PPLLAANN The Recommended Master Plan endorsed by the Steering Committee proposes to expand the Hospital to the east and southeast, i.e. towards the ‘rear’ of the site where the majority of open space is available. The initial Stage 1 expansion would be a minimum of two floors, with the optional capability to add one or two additional floors of inpatient units in the future. The ground level of the Stage 1 expansion would accommodate a new Emergency (including ambulance bays), Ambulatory Services (i.e. Chemotherapy, Day Surgery, Dialysis, Endoscopy, Specialty Clinics), the relocation of Therapies, and possibly one or more support components that is currently occupying inpatient space (e.g. Information Technology). The new Operating Rooms, Day Surgery and Special Care Unit would be on the second floor, together with a new Inpatient Unit of 30-32 beds. The existing space vacated by services such as Emergency, Ambulatory Care, OR’s, Therapies and Special Care would be renovated to accommodate the required expansion of other clinical and logistical support services, e.g. Admitting, Cafeteria, CSR, DI, Health Information Systems, Administrative functions, Materiel Management, Telehealth and Conference facilities, etc. The proposed Stage 1 development addresses the anticipated growth needs of the Hospital over the next 10+ years, including approximately 110 inpatient beds, a significantly higher proportion of single bedrooms, and expansion of key services such as Ambulatory Care, Emergency, Surgery, Obstetrics and Special Care. There are at least three potential options for the subsequent Stage 2 development, depending upon how future needs evolve: Option 1: Construct the new 4th floor inpatient unit to the existing

building, which would add another 30-40 beds. Option 2: Construct a new 3rd floor inpatient unit to the Stage 1

expansion, which would add another 60-70 beds. Option 3: Construct a new Inpatient Tower attached to the

Stage 1 building containing approximately 110-120 beds.

The main benefits of the Recommended Master Plan are that it: Addresses highest priority needs first, i.e. Emergency, Ambulatory

Services, OR’s, additional Inpatient Beds, etc. Provides the maximum range of future options for subsequent

phases of expansion, including the potential replacement of the

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existing building if, for example, its upgrading costs are excessively high.

Can be implemented without major disruption to the provision of existing ongoing services, e.g. areas such as Emergency are unaffected.

Begins the process of ‘uncongesting’ the front of the site, e.g. emergency vehicles, outpatient parking.

Facilitates the installation of the mobile MRI in a readily accessible location in proximity to Diagnostic Imaging.

Allows a number of options for either bundling or phasing capital projects depending upon need and availability of capital funding support.

Makes good use of existing vacated space for ‘lower serviced’ functions.

Maintains and makes best use of a building that is ‘only’ 20 years old and that would be difficult to justify its full replacement.

Provides excellent potential for significant future growth in key areas such as Inpatient Beds, Emergency, Ambulatory Services, Operating Rooms/Surgery, and Obstetrics, if and when required.

Schematic Layouts for the Recommended Master Plan are presented on the following pages.

56

55..33..11 RREECCOOMMMMEENNDDEEDD MMAASSTTEERR PPLLAANN -- SSCCHHEEMMAATTIICC LLAAYYOOUUTTSS

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55..33..22 RREECCOOMMMMEENNDDEEDD MMAASSTTEERR PPLLAANN -- PPRROOJJEECCTT CCOOSSTT EESSTTIIMMAATTEE

Recommended Master Plan - Stage 1


New ConstructionGround Level:

Ambulatory Care 984.0 4,680.00 4,605,120Home Care 300.0 3,470.00 1,041,000Information Technology or Scheduling/Finance/Payroll 280.0 3,820.00 1,069,600Emergency 900.0 4,680.00 4,212,000Ambulance Bay 110.0 2,740.00 301,400Therapies 323.0 3,830.00 1,237,090

Second Level:Operating Rooms 760.0 6,900.00 5,244,000Day Surgery 220.0 5,150.00 1,133,000Special Care Unit 600.0 4,680.00 2,808,000New Inpatient Beds (30-32 beds) 1,300.0 4,250.00 5,525,000

Sub-Total 5,777.0 $ 27,176,210

300.0 4,700.00 1,410,000Circulation and Building Gross Areas (30%) 1,820.0 4,470.00 8,135,400


Functional RenovationsGround Level:

Admitting 90.0 3,060.00 275,400Health Information Services 311.0 3,060.00 951,660Meeting/Conference Space 220.0 2,780.00 611,600Cafeteria Expansion ~ 3,120.00 ~CSR 277.0 3,750.00 1,038,750Diagnostic Imaging 75.0 3,750.00 281,250Foundation and Gift Shop 140.0 2,780.00 389,200Materials Management ~ 2,500.00 ~Staff Facilities ~ 3,150.00 ~

Second Level:Obstetrics 200.0 3,400.00 680,000Inpatient Unit (50% of area) 420.0 1,275.00 535,500

Third Level:Inpatient Unit (50% of area) 805.0 1,275.00 1,026,375


Space Planning Contingency (5%)

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Recommended Master Plan - Stage 1 (continued)


Building UpgradingUpgrade Other Key Areas of Building 2,500.0 650.00 1,625,000Replace Building Envelope allow sum 5,150,000Upgrade Mechanical Systems allow sum 3,862,000Upgrade Electrical Systems allow sum 1,931,000

Sub-Total Building Upgrading $ 12,568,000



Sub-Total 12,935.0 $ 56,279,345

Scope/Pricing Contingency (10%) 5,628,000Construction Contingency (5%) 3,095,000





Escalation Allowance (to construction mid-point September 2010) 49,785,000



2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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Option 1 - Add New 4th Floor to Existing Building


New Construction - 4th FloorNew Inpatient Unit (~40 beds) 1,600.0 4,250.00 6,800,000

Sub-Total 1,600.0 $ 6,800,000



Scope/Pricing Contingency (10%) 874,000Construction Contingency (5%) 44,000








2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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Option 2 - Add New 3rd Floor to the Stage 1 Expansion


New Construction - 3rd FloorNew Inpatient Units (~60-70 beds) 3,000.0 4,250.00 12,750,000

Sub-Total 3,000.0 $ 12,750,000











2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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Option 3 - Construct New Inpatient Tower


New ConstructionNew Inpatient Units (~100-120 beds) 5,000.0 4,250.00 21,250,000New Diagnostic Imaging 600.0 4,680.00 2,808,000Public and General Support to theInpatient Units 400.0 3,860.00 1,544,000

Sub-Total 6,000.0 $ 25,602,000

Circulation and Building Gross Areas (30%) 1,800.0 4,050.00 7,290,000


RenovationsExisting Space Re-assignment andReconfiguration 3,200.0 650.00 2,080,000




Sub-Total 11,000.0 $ 36,147,000








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Final 66 2007-06-30


Option 3 - Construct New Inpatient Tower (continued)


2007/08 - 18%2008/09 - 15% 2009/10 - 10% 2010/11 - 10%

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.1 ADMINISTRATION

Final 6 - 1 June 2007

6.1 ADMINISTRATION (INCLUDES CORPORATE EXECUTIVE OFFICE)

Scope of Service Present Services

The PNHR has three Corporate Administration Offices. The Lloydminster Hospital houses the Lloydminster Administration Office which currently includes: Executive suite which has the Corporate Office of the CEO (who

comes to Lloydminster on the average two days per week); a small meeting room (accommodates 6-10 people); office for Executive Assistant to CEO; and a lavatory and small kitchen area with sink.

Office of VP Finance/Information Technologies. Offices of 3 Directors: Acute Care, Continuing Care, Labour Relations. Office being shared by 1 HR Consultant and the Chief of Staff and

visiting VPs. Reception office for 1 Executive Secretary, who is also the Telehealth

Coordinator for Lloydminster. Office being shared by 2 Executive Secretaries. Large room housing 2 track filing units, multi-function machine (printer,

copier, fax, scanner), shredding machine, other small office equipment, coffee machine, small fridge and shelving/cupboards for supplies.

The Administrative offices are staffed from 0800-1700 hours Monday-Friday, with the main door to the Administrative offices usually being locked over the lunch hour, even though there are staff in the office over lunch hour to accommodate the one-hour time differential with the rest of the Region in Saskatchewan. Job duties of the Executive Secretary working at the reception desk include provision of mail service for all PNHR Lloydminster facilities by posting/sorting/distributing mail on a daily basis of Canada Post mail as well as the Inter-Office mail. Job duties of one of the Executive Secretaries working in the shared office includes providing confidential clerical, administrative and organizational support to the Labour Relations/Human Resource team. The other Executive Secretary in the same office provides confidential clerical, administrative and organizational support to the Acute Care Services team and Site Chief of Staff. The Executive support staff are responsible for bookings in the two conference rooms on the main floor of the Hospital, and the conference room and computer lab on the second floor. For overflow, bookings are also made at the conference rooms in the Community Health Services building and Dr. Cooke Extended Care Centre. The three conference rooms in the hospital are all wired for Telehealth (video conferencing) communications. There are specific requirements and preferences for room lighting and color of walls to accommodate proper viewing with the Telehealth

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equipment. There are 2 sets of Telehealth equipment - one owned by East Central Health for AB program use, and one owned by PNHR for Telehealth Sask operations. Telehealth services in Lloydminster are unique for PNHR as the Lloydminster program serves two provinces. Regional Context

The Executive Assistant in the Lloydminster Admin Office currently provides administrative and organizational assistance to the CEO and PNRHA Board of Directors. The current 3 Executive Secretaries in Lloydminster report to this Executive Assistant. The CEO’s other Executive Assistant works in the North Battleford Administration office with 3 Executive Secretaries under her responsibility as well. Ease of communication and sharing of information between the Lloydminster, North Battleford and Meadow Lake Admin offices, as well as the Communications Officer, is important to smooth operation of the Region. Projected Services

This group envisions one all encompassing office area for all administration, finance, HR and payroll staff with one central reception, with branching sub-reception areas specific to each departments’ offices.

There is the need for one large conference area that can be sub-divided into smaller conference rooms as required by each department.

Administration needs a larger file and office equipment room accessible by all these departments.

Future Trends

Impact of Technology Computer workstations with ability to burn CDs. New technology allowing secretaries to send faxes directly from

individual work stations rather than using the multi-function machine. Laptops with a wireless network connection.

Current Staffing & Projections

Table 2: Current Staffing Position

2006 FTE

2006 Headct

2011 FTE

2011 Headct

2016 FTE

2016 Headct

Exec. Assistant 1 1.0 1 1.0 1 1.0 Exec. Secretaries 3 2.8 3 3.0 4 4.0 Total FTE = Fulltime Equivalent

Assessment of Current Situation New regional management personnel have been forced to locate offices elsewhere in the building as Region management responsibilities have far outgrown the current office availability in the Admin area.

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The small reception area is over-crowded with one wall covered with mail folders for all departments in the hospital. The postage machine is located in the Admin filing area. The counter and working area of the reception desk is normally piled up with incoming and outgoing mail from both mail services. The reception desk area is very crowded attempting to accommodate the mail, secretary's computer, telephone and many files for a busy reception area, as well as accommodate files and a working area for the secretary's second job responsibilities of Telehealth Coordinator. The desk area was not built for today's technology and is not conducive to appropriate ergonomics for the secretary working at her computer. The mail folders and postage machine located in the Admin reception office make for a high volume of traffic for an area that works with confidential matters. A separate mail room is needed that is available to managerial staff 24/7. Depending on the staffing responsibilities for a mail room will affect the decision of where the best location for a separate mail room would be – closer to Admin or Materials Management. The shared working area of the executive secretaries is cramped with 2 desks. The shared office is not conducive to providing privacy for each secretary concentrating on work to be done or when making phone calls or meeting with staff and physicians. In order to cover the reception desk when that secretary is away from her desk, the other 2 Executive Secretaries need to retain their close proximity to the reception desk and preferably have a visual to the reception area and yet be able to have private office space. This could be accommodated with a two-way mirror. Current office set up has a mirror installed in the hallway to provide this viewing accessibility. A dedicated conference room with appropriate lighting and painting, with sinks (for clinical use) and cupboard/storage for Telehealth usage is needed. With the existing number of conference rooms, it is difficult to accommodate the increasing number of meeting requests. More conference/meeting rooms are needed to accommodate expansion of programs. Having the conference rooms not far from the Admin office is helpful to the Executive Secretaries as they are continually setting up and dismantling Telehealth and other office equipment used in the conference rooms, as well as arranging the tables and chairs according to the different bookings. The current size of the executive suite is adequate in conjunction with

increased offices and work area for other Admin personnel. As described above, additional other office space and associated

amenities (such as conference rooms, file room, coffee room and washrooms) are desired for an all encompassing business suite to enhance efficiencies.

Functional Requirements

The current system for accessing office supplies from MM is working fine for the Administrative Office.

Duties and responsibility for sorting and distribution of mail should be a function under Materials Management, rather than the Administration Office. A mail room accessible to all department heads outside of

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normal office hours is needed. Wireless headsets to provide hands-free and private answering of telephone. For example, this would allow typing on computers while taking dictation of a letter on the phone.

In the conference rooms: DVD recorder. Updated teleconference equipment. A storage area/room for various office equipment constantly used in

the conference rooms is needed. Currently, equipment is either left in the conference rooms or stored in the Admin Office or downstairs in the “crawl space” of the hospital.

Space Summary

Space Summary Existing (CGSM)

Additional (CGSM)

Total (CGSM) Comments

Administration 170.2 30.0 200.0 Telehealth, Meeting & Education Facilities

126.2 94.0 220.0

Total 296.4 124.0 420.0

Functional Relationships

External Relationships

Administration 1. Finance & HR

2. Main Entrance

3. Meeting Rooms

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.2 ADMITTING


6.2 ADMITTING Scope of Service

Present Services

Admitting operates 24 hours 365 days providing the following services: Reception and information services for patients, public and visitors

entering the Hospital’s main entrance. Main Hospital switchboard, which handles calls from throughout the

community and surrounding areas. Processing of inpatient admissions including newborns (newborns are

also registered with the Saskatchewan Newborn Registry System). Registering of most patients that come through the Hospital, i.e.:

- All Outpatient Service/Ambulatory Care visits including: Cast Clinic, Cardiac Stress Tests, Chemotherapy, Dialysis, Dressing Changes, Emergency Referrals, IV Therapy, Minor Operative Procedures, Obstetrical Assessments, Obstetrical NST’s, Nebs, Pre Admission Clinics, Telehealth Sessions.

- Other registrations including: Day Surgery, Diagnostic Imaging incl. CT Scan, Emergency, Endoscopy, Holter Monitor, Laboratory, Respiratory Therapy, Community Dietetic Counselling, Diabetes Nurse Educator, Dietetic Consultations.

- Visiting Specialist Clinics including: Dermatology, ENT, Podiatry and Ophthalmology.

Processing of billings including: for private rooms and equipment, Alberta Blue Cross, Alternate Level of Care, Self, RCMP, Dept. of National Defence, Dept. of Veterans Affairs, Dept. of Indian Affairs, SHSP Billings, WCB Alberta, WCB Sask, WCB Other, Unpaid Accounts.

Pulling patient files from Health Records after hours (creates the problem of Admitting being left un-staffed).

Emergency patients are sent to Admitting for registration, unless their condition is too acute. Therapies’ patients are not registered by Admitting. Admitting has a multi-function machine that is shared with Therapies, Emergency and EMS. Regional Context

The Lloydminster Hospital Admitting Department is one of two regional sites using the WinCIS Patient Registration Program, North Battleford being the other. The Meadow Lake Facility is being brought on to the WinCIS Regional Program in March of 2007. Projected Services

Admitting will continue to provide the same services with the following anticipated changes: Potential provision of a ‘satellite’ Admitting function in Ambulatory

Care. Improved workflow and functional efficiency of the department and

improved patient confidentiality.

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The addition and/or growth of programs and services will potentially reflect on staffing and day to day activities in Admitting.

Electronic Health Records, will impact Admitting directly in terms of activities and staffing.

Future Trends

As the population increases in the City of Lloydminster and surrounding areas, Admitting will increase in workload accordingly, which could also mean an increase in staffing. New technology for the Admitting Department would mean a change in the procedures of registering patients and other processes that it undertakes.

Current Workload & Projections Table 1: Historical & Projected Workload

Measure 2006/07 Projected 2011 Projected 2016 Inpatient Separations 4,236 Emergency Visits 37,048 Ambulatory Visits 8,150 Total

Current Staffing & Projections Table 2: Current Staffing Position

2006 FTE

2006 Headct

2011 FTE

2011 Headct

2016 FTE

2016 Headct

Office Coord. 1 1 Patient Registration Clerks

4 3.64

Patient Reg.Cler 8 4.05 Total 13 8.69 FTE = Fulltime Equivalent 1 – 8 hour Day (0800-1630) (M-F) Office Coordinator 1 – 12 hour Day Employee (7 days a week) 1 – 8 hour Day (8-4:30)(M-F) 1 – 8 hour Day (0700-1530) (M-F) 1 – 8 hour Evening (1430-2300) (M-F) 1 – 12 hour Night (1917-2300) (7 days a week) 1 – 8 hour Day (0900-1730) (Weekends Only) Admitting has 1 Office Coordinator, 4 Full-time Employees, 7 Part-time Employees and 6 Relief Staff.

Assessment of Current Situation Due to the renovations in December, 2005 Admitting lost a significant percentage of its space and is currently working in limited and relatively confined area.

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Patient confidentiality is not available as there are no personal work areas for staff to register patients. Admitting also provides the billing and receipting of payments from patients and this is also not a confidential service that should be provided. The Admitting Office Coordinator is also a part of this office, and is not able to provide any confidentiality to any staff regarding issues. It is also a difficult office to work in when patients are being registered, the main hospital switchboard is located in this office, and there is constant traffic from other departments using the multi-function unit. Other concerns and deficiencies with the current Admitting facilities include: Staff are tripping over each other to process paperwork for patients. Small storage area for paperwork. Lack of ventilation (as a result of the 2005 renovations). A fan is

running constantly. Flooring - no carpet, cement only. Multi-function machine - creates a high flow of users. The layout of the front work area at the Admitting Desk allows for

patients to stand behind the staff and watch what is happening in the office or while staff are processing patients at the desk.

One of the positive aspects of the existing space and locations is the windows along the outside of the front of the Hospital, and the main mall area, as it has the open windows on top. This is a great feature to work in this area with the openness of it.

Functional Requirements In addition to the lack of staff workspace, limited confidentiality and other issues highlighted above, key functional requirements include: Due to the renovations to X-ray and the back hallway behind,

Admitting lost space as the back wall was moved in further, thus removing the Tube System. This provided access to transport papers from department to department. Now this involves staff to transport to these areas to deliver patient charts.

Admitting also lost the cupboards used for paper storage, filing, and other documents. They now use a small area for this on the other side of the Admitting Office.

In Admitting there is a requirement for the following equipment: ‐ Work stations for privacy also. ‐ Storage Area for files, billing, and patient information. ‐ Office Coordinator should have a privacy area. ‐ Office equipment and programs to be able to handle the

programs needed to process patients.

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Space Summary Space Summary Existing

(CGSM) Additional

(CGSM) Total

(CGSM) Comments

Main Admitting 67.3 23.0 90.0 The 90.0 sqm does not include additional space required for satellite Admitting in Ambulatory Care or elsewhere

Public Facilities N/A 100.0 100.0 Require major improvements in the public circulation & waiting space around Admitting

Total 67.3 123.0 190.0


External Relationships 1. Provide close access by general or internal circulation to

Emergency to facilitate the movement of patients and staff.

2. Provide close access by general circulation to Health Records to facilitate the movement of staff and records.

3. Provide close access by general circulation to Main Elevators & Public Facilities to facilitate the movement of patients and visitors.

Admitting 1. Emergency

2. Health Records

3. Main Elevators &

Public Facilities

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.3 AMBULATORY SERVICES


6.3 AMBULATORY SERVICES Scope of Service

Present Services: This component of the Functional Program includes the following programs and services that should be co-located in the new Ambulatory Services area of the Hospital: • Community Chemotherapy Centre (Chemotherapy) • Chronic Disease Management (CDM) • Clinical Nutrition • Dialysis • Endoscopy • Outpatient Services/Specialty Clinics, including day medicine

services. Note: the Day Surgery and Pre-Admission Clinic (PAC) programs are included in Component 6.18 Operating Room, Day Surgery/PAC & Central Supply. Chemotherapy • Initiated in 1998 in Lloydminster, the Chemotherapy program has

expanded to 5 days per week. In 2006, the average number of patients per month on active treatment was approximately 40 with an average of 5 new patients per month. The average number of monthly patient visits totalled approximately 100, including visits for chemo treatment, procedures, exams, consultations, etc. The number of visits per patient can be as high as 5 per month.

• The patient workload grew by over 40% between 2005 and 2006. Of particular note was the growth in advanced chemotherapy treatments (Chemo 5) that tend to be more intensive with a higher risk of reaction and higher nursing care requirements.

• The workload includes chemotherapy for non-cancer patients, e.g. MS and a significant percentage of younger patients.

• The program currently uses two inpatient bedrooms on Level 3 and some adjacent support spaces, i.e. office across the hall.

Chronic Disease Management • The CDM program provides inpatient and outpatient services, with a

focus to date on diabetes education. CDM typically serves patients who are elderly, of whom many may have respiratory problems and/or may be disabled, amputees, wheelchair-bound, use walkers, obese, etc. Therefore, location/ access for many of these clients can be an issue if it is not close to an entrance and drop-off.

• CDM works closely with Clinical Nutrition/Dietitians and would benefit from being co-located with these (and other outpatient) services, which would also improve access to administrative support services (i.e. currently based in DCECC which is not convenient).

Clinical Nutrition • The Clinical Nutrition Dietitians provide inpatient and outpatient

assessment, counselling and education.

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• In addition to supporting the inpatient services, they work closely with the Diabetes Education program and with services such as Dialysis and Therapies.

• One Dietitian is located at the DCECC (although she does not provide services to the CDCECC); the other shares an office with the Dietary Supervisor at the Hospital.

Dialysis • The Northern Alberta Renal Program (NARP) will continue to provide a

satellite dialysis service on site at the Lloydminster Hospital. This is an outpatient service.

• The dialysis unit has 5 dialysis (chair) stations. One station supports 4 patients. The nursing ratio is 3 patients to 1 nurse, which will continue.

• Hours of operation area 0700 to 1900 Monday to Saturday. The prime time for dialysis is 1300 hours. Because Lloydminster services a more rural population, residents prefer to be treated during the day rather than during evening hours because of the distance some are required to travel.

• The service technician from Edmonton visits the unit for ongoing preventative maintenance and repair of the equipment. The visiting technician service is likely to continue over the next 5 to 7 years.

Endoscopy • Endoscopy provides an invaluable service to the Lloydminster area.

The majority of patients are outpatients, but inpatients are also done. The following procedures are performed: screenings, biopsies, polyp removals, cauterizations, dilations, and haemorrhoid banding.

• Occasional scopes are done on an emergent basis (mainly foreign bodies and GI bleeds), but this is strictly on an informal basis as there isn’t an on-call rotation setup.

• Endoscopy is located on the 2nd floor in inpatient space and consists of 1 procedure room, 1 prep room, 3 recovery beds (semi-private and private) and the clean-up room which contains 2 Steris washers as well as their sinks and storage shelving. The supply room is shared with Day Surgery.

• Endoscopy uses the Laboratory for specimens and Health Records for reports. CSR does some sterilising. Occasional assistance is required from Day Surgery, the FIN or manager whenever RN skills are required. Access to a Booking Clerk is required.

• Endoscopy operates Tuesday and Thursday 0730 - 1530; Friday 0730 - 1330.

• Colposcopy - is operated by the Endoscopy staff and located adjacent to the endoscopy prep room. Staff are able to utilize the Steris washers to clean the instruments being used for the colposcopy procedures. It is strictly an outpatient procedure which could be done in a clinic as well as in Hospital if the gynaecologist had his office so equipped. Lab and Health Records are used to track specimens and results. Also CSR does end-cleaning of equipment. Appointments are made through the Booking Clerk. Colposcopy uses a private room on the 2nd floor that used to be office. Its hours of operation are: every other Monday 0730 - 1230.

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Outpatient / Specialty Clinics • Visiting specialist clinics presently include Dermatology, ENT,

Ophthalmology and Podiatry. These clinics are currently inappropriately housed on the 2nd floor inpatient unit.

• Other types of outpatient services (mostly accommodated in Emergency at this time) include blood transfusions, biopsies (liver, muscle, etc.), dressing changes, Holter monitoring, IV therapy, other minor procedures, stress testing, etc.

Regional Context: Chemotherapy • The Chemotherapy program at Lloydminster Hospital is part of the

Community Cancer Centre Program of the Alberta Cancer Board and the Community Oncology Program of the Saskatchewan Cancer Agency. It covers a large geographic area centred in Lloydminster; the closest centres are in Bonnyville, Camrose, North Battleford and Meadow Lake.

Chronic Disease Management • Diabetes education is provided across a large geographic area to

PNHR people from Maidstone, Neilburg, Lashburn, Paradise Hill, Paradise Valley, Onion Lake, Turtleford and Lloydminster.

Dialysis • NARP operates dialysis services for residents of Northern Alberta. The

NARP administrative office is located in Edmonton. • In addition to the dialysis unit in Lloydminster, there other satellite

dialysis units in the area are located in St. Paul (6 dialysis stations) and Vegreville (6 dialysis stations).

• The dialysis unit provides services for residents in the Lloydminster area (in both Saskatchewan and Alberta), with some referrals as far away as Cold Lake.

Endoscopy • These services have a large catchment area and often see patients

from great distances whether it be for endoscopy or colposcopy. Outpatient / Specialty Clinics • These services also tend to have a large catchment area and will see

patients from throughout the regional ‘service/trading’ area of Lloydminster.

Projected Services: Chemotherapy • The current space can accommodate 6-7 patients per day; this is

expected to grow to at least 10-12 patients per day. • Anticipated service trends include: further growth in patients receiving

advanced chemotherapy, more children (mainly blood transfusion vs. chemo treatment), more MS patients receiving chemo).

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Chronic Disease Management • The service vision is to expand into cardiac/stroke, respiratory and

arthritis education. Clinical Nutrition • The Clinical Nutrition staff and services will benefit greatly by being co-

located with other outpatient services as part of the new Ambulatory Services area at the Hospital.

• Growth in activities associated with the CDM programs in particular is anticipated.

Dialysis • The number of patients requiring dialysis grows approximately 10% per

year. This growth rate in dialysis cases of 10% per year is expected to continue over the next decade.

• The Lloydminster Hospital services a significant Aboriginal population (e.g. Onion Lake) and this group has a higher incidence of renal failure resulting from diabetes.

Endoscopy • Endoscopy and colposcopy should be co-located with the other

ambulatory services on the ground floor. There are opportunities for sharing facilities such as reception, waiting, and other support areas.

Outpatient / Specialty Clinics • Growth in the workload volume and/or frequency of the current

specialist services is projected, as well as additional services such as Orthopedics and Urology.

• The co-location and consolidation of various outpatient and day activities will improve both patient access and service delivery, including the opportunity to share staff and space.

Future Trends: Chemotherapy • The demand for locally-based chemotherapy services is expected to

increase, including the ability to provide more advanced treatments as the urban (tertiary) cancer centres transfer more patients to the community facilities.

Chronic Disease Management & Clinical Nutrition • CDM programs will need to grow and expand to meet the needs of

the aging population, including the need for more clinical nutrition support.

Dialysis • The demand for dialysis is expected to increase as the population

grows and ages. Other trends include the growth in the home dialysis program, the opportunity to develop Peritoneal Dialysis (PD) and prevention clinics (i.e. Early Intervention Clinics, Renal Insufficiency Clinics, etc.).

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• Telehealth consultation with specialists in Edmonton will be developed to allow patients to access services remotely rather than having to travel 3 hours to Edmonton. Therefore, clinic space with Telehealth capability will be required.

Endoscopy • Endoscopy Room - with the trend to more screening, there is the

advantage of two scope suites. The technology is growing by leaps and bounds in this area and the current systems will have to be continually upgraded to keep pace. Also see the need for an RN in here rather than the strictly LPN staffing that is traditionally used.

Outpatient / Specialty Clinics • Increased demand to provide additional day medicine and minor

procedures in an outpatient setting.


Measure Current Projected 2011 Projected 2016 Chemotherapy New & Follow-up Visits

1,000a 1,500b 2,000b

Dialysis Stations 5 12 12 Outpatient Clinic Visits N/A 150 200

Endoscopy Visits 1,397c TBD TBD Endoscopy Procedures 1,685c TBD TBD

Other Ambulatory Visits 8,150 TBD TBD Notes: a. Estimate based on 6 months data for 2006. b. Assumes workload will double in 10 years. c. 2006/07 data; visits grew by 40% from previous year; procedures grew by

78% from previous year.

Current Staffing & Projections Table 2: Current & Projected Staffing Position 2006

FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Chemotherapy Prog:

CDM: Diabetes Nurse Educ 0.64 1 1 1 1 1 Cardiac Nurse Educ - - 0.5 1 1 1 Respiratory Nurse Educ - - 0.5 1 1 1

Clinical Nutrition: Dietitians 2

Dialysisa: Nurse Manager 1.0 1 1.0 1 1.0 1 Clinical Nurse Educ 1.0 1 1.0 1 1.0 1 Registered Nurse 4.6 2 9.2 4 9.2 4

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Position 2006 FTE

2006 Headct

2011 FTE

2011 Headct

2016 FTE

2016 Headct

Nurse Aide 1 1 2.5 2 2.5 2 Unit Clerk 1.0 1 1.5 1 1.5 1

Endoscopy:

Outpatient / Specialty Clinics:

Total 8.6 6 15.2 9 15.2 9 FTE = Fulltime Equivalent a. 2011 and 2016 staffing based on 12 stations in operation

Assessment of Current Situation Chemotherapy • Current location on the third floor of the Hospital is inappropriate and

a makeshift solution that involved minimal renovations. • Accessibility for outpatients and their family members is poor. • Space deficiencies include: adequate separate bed space for

advanced chemo treatments, patient and family support amenities, staff work space, access to an exam room, supplies storage (located in rooms), nutrition stations, child-friendly space.

Chronic Disease Management & Clinical Nutrition • Staff are currently located on various sites in three different buildings;

consolidation is required. • Some staff are in shared office space, which makes it difficult to do

patient/family counselling. • Lack of storage for educational aids and materials is seriously lacking,

especially storage space adjacent to the classrooms. • Require teaching space for up to 30 persons with adequate area to

create a functional set up. • Require access to exam/consultation room(s) for one-on-one and

family sessions. Dialysis • The dialysis unit is located on the third floor of the Hospital in partially

renovated inpatient space. The area was not purpose built for an outpatient dialysis unit and therefore there are deficiencies with the current space, e.g. insufficient storage space, inadequately sized patient treatment spaces (see next bullet point), in adequate supply storage space, inadequate family and staff support space, etc.

• The unit has 5 dialysis stations that accommodate chairs. The space planning guidelines indicated that “there should be adequate space for each patient dialysis station with its attendant equipment, and there should be sufficient separation of space from neighbouring stations. The space should be adequate for movement of staff around the patient in order to provide proper patient care and cleaning without encroaching on neighbouring stations (Reference: Centers for

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Disease Control and Prevention, Hospital Infections Program. Control measures for hepatitis B in dialysis centers. Viral Hepatitis Investigations and Control Series). This is certainly not the case in Lloydminster. The current dialysis stations have insufficient patient, staff and family support space.

• There are 6 parking stalls assigned for dialysis patients. The number of parking spaces will need to increase to support up to12 dialysis stations.

Endoscopy • While the existing space is generally adequate for the functions and

workload volume (with capacity to expand services to 5 days a week) the current location on the second floor in inpatient space is very inappropriate.

Outpatient / Specialty Clinics • Specialty Clinics operate in inpatient space on the 2nd floor, using two

bedrooms and the corridor as a waiting area. The location and space are very inappropriate for this type of outpatient activity.

• Most other outpatient activities are accommodated in the Emergency department, which tends to put even greater pressure on an area that is severely cramped and undersized.

• Co-locating outpatient and clinic activities in a purpose-designed Ambulatory Services area will improve workflow and functionality, create a much improved patient/family centred environment, and facilitate significant sharing of staff and facilities. It will also accommodate the anticipated growth in services which is not possible in the current spaces.

Functional Requirements All of the Ambulatory Services components need to be relocated into new purpose-built space that meets the needs of: • Sharing facilities such as reception/registration, patient and family

waiting, child waiting/play space, other patient amenities such as washrooms and a nutrition station, ‘universal’ exam rooms, procedure rooms, clean and soiled utilities, staff workstations including touch down workstations for visiting staff, staff amenities, etc.

• The ability to share patient exam and recovery spaces. • The ability to provide spaces that afford the degree of privacy

appropriate for certain types of activities such as physician exams, consultations, advanced chemotherapy treatments, etc.

• Flexibility for multiple use and changing needs. • Direct patient/family access, i.e. ground level location in proximity to

designated outpatient parking. • Capability for facilities expansion to respond to future service growth. • Convenient access to diagnostic support services such as DI and

Laboratory. • Very close access (adjacent if possible) to Emergency in order to

share facilities such as the cast room, minor procedure rooms, EENT room, etc.

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• Some of the components such as Chemotherapy, Dialysis and Endoscopy will have specific room planning and design requirements that will be developed in the next stage of programming and design. For example, requirements related to Dialysis facilities are outlined below.

Dialysis Facilities Dialysis units have specific functional requirements. The key requirements are highlighted below. The reception / nursing station needs to be located in such a way as

to support the needs of the clinical area and waiting / reception. The dialysis stations should allow for easy visual access to all stations

by care providers. It is imperative that the facility design be barrier free, as up to 50% of

the clients require the use of wheelchairs. Stretchers and beds need to be able to move in and out of the unit.

The water treatment system needs to be established on the lowest level of the facility or on a floor that is structurally able to hold the weight of the system (300 – 500 gallon holding tank). With the risk of water leaks and flooding in this area, externalized plumbing and floor drains are required. This room also requires sound proofing as the water treatment system is very loud.

The HVAC (Heating, Ventilation and Air Conditioning) system requirements are significant. Each dialysis machine puts out the heat of approximately 10 persons. An interruption of the HVAC system for more than 20 minutes will result in the dialysis treatments being discontinued (also require a telephone).

Doors, doorways, hallways and elevators within the facility need to be sized to suit safe cart passage.

Within each hemodialysis station there is the following: ‐ Reclining Chair (large – may go flat) or a bed ‐ Dialysis machine (includes blood pressure cuff) ‐ Dialysis hook-up for RO water, 120 volt electricity, drain, data

connection to PC PARIS system ‐ Electrical outlets (110V) for IV pumps and other equipment ‐ IT networked connection for hemo machine & computers (1 pc

between every 2 stations) ‐ Overbed Table ‐ Bedside Table (may be shared 1:2 stations) ‐ Stool/visitors chair ‐ Individual lighting ‐ Client call bell ‐ Sharps container ‐ Hand sanitizer (between every 2 stations) ‐ Hand-free sinks – at every 4 stations minimum (IP&C standards) ‐ Individual TV on wall-mounted arm ‐ Space for carts and providers for assessment and provision of

treatments (such as wound care) ‐ External Internet connection for client use ‐ Privacy curtains ‐ Wall mounted TV’s for patient use (only in client care area)

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One dialysis station should be an enclosed space for isolation purposes.

A waiting room will space to accommodate a hand wash sink, a nourishment station, ice machine, seating for (patients and family) waiting room, a workstation with Internet access, and wheelchairs and mobility aide storage required.

A reception desk should have room to support the needs of the clinical area as well (i.e. nursing station). The nursing / reception desk shall be room for 2 computers, 1 printer, 1 fax machine, 1 scanner, 1 photocopier (may be combined with fax machine) stationary and charts having orders processed.

A chart room is required to secure charts. The chart room need to be locked and secure.

Space for stock medications, 2 fridges, locked storage and non-locked storage are required. A lockable metal narcotics cabinet needs to be secured within a pantry style locked cupboard with retractable hinged doors. This area needs to be placed in an observable area, ideally near the nursing station and must have a counter and sink.

A confidential area is required for nurses to report on client status at the start and end of every shift. This conference room can also be used for report, meetings with client families, and presentations. At other community dialysis units this room is also used for staff breaks (which is advantageous to the unit if staff call-back is required).

A room to support repairs and maintenance of dialysis machines needs to be provided.

A secure workstation or office is required for the unit manager. Space for a copier, fax and 2 computers required. A space for the clinical educator is also required with a hemodialysis hook-up for training.

A soiled utility room is required with a sink, garbage and storage for sharps containers and biohazard buckets. Need stainless steel counter workspace (due to chemicals) and a dilution tank. Exhaust hood over a deep sink is required for solution disposal (due to chemicals). A second double sink is required for cleaning of equipment and hand washing. Vestibule required at entry. Provide FRP panels to walls – full height. A Tornado ARJO system required for bedpan and urinal disposal would eliminate the need for a hopper.

Clean supply storage is required for IV pumps to be stored and charged – 5 - 6 required. Electrical to be placed at 44”. Room required for 6-7 supply utility carts, oxygen concentrator and 6-8 cylinders. Counter space and storage cupboard approx. 5’ adequate. Provide FRP panels to walls – full height. Northwest Clinic supply room is not large enough.

The dialysis treatment area needs to support numerous carts used for supplies and equipment (i.e. portable lifts). Some of these are located permanently on shelves or carts and others are mobile.

Clinic room space is required for the outpatient clinic activities (could be shared with other ambulatory care programs). Each clinic room needs to have a sink, cupboard for clinic supplies, computer, charting space, BP machine (stand alone or wall mount), otoscope, ophthalmoscope, stool, chair, step stool, at least 2 chairs per room for

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the patient and family, a lab/soiled are for PET tests/fluid disposal, and examination table. The consultation room requires a sink, computer and charting space, but otherwise is set up as an educational room with table and chairs.



4. Provide direct access to the unit from an Outpatient/Public

entrance for ease of drop-off and outpatient and family parking.

5. Provide close access by general circulation to Therapies

facilitate the movement of patients and staff. 6. Provide close access by general circulation to Emergency

facilitate sharing of facilities.

7. Provide convenient access by general circulation to Diagnostic Services (i.e. DI and Laboratory) for the movement of patients and staff.

8. Provide convenient access by general circulation to Day

Surgery for the movement of patients.

Space Summary

Space Existing (GSM)

Additional (GSM)

Total (GSM) Comments

Chemotherapy Area 61.1 80.0 80.0 Assumes shared support areas Dialysis Unit 92.3 357.7 450.0 Required space based on 37.5 GSM

per station; 12 stations with one room used for isolation

Dialysis Clinic, Office & Staff Support Space

0.0 104.0 104.0 2 clinic rooms, support space, Manager and Educator offices

Endoscopy Area 99.6 100.0 100.0 Specialist Clinics 78.1 90.0 90.0 Ambulatory Care / Outpatient Services

0.0 100.0 100.0

Other Support 0.0 60.0 60.0 Also includes space for CDM & Nutrition staff

Total 331.1 891.7 984.0

Ambulatory Services

1. Outpt/Public Entrance

2. Therapies

3. Diagnostic Services

5. Day Surgery

4. Emergency

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.4 DIAGNOSTIC IMAGING


6.4 DIAGNOSTIC IMAGING

Scope of Service Present Services: Diagnostic Services includes general radiology, fluoroscopy,

ultrasound and CT. Computed radiography (CR) has been in operation in the

department since October 2006. The film quality (detail) has improved with this technology.

Department hours of operation: 0800-2300hrs Monday - Sunday with an on call Technician from 2300-0800 hours - CT and Ultrasound hours of operation: 0800-1630 Mon-Fri

(Radiologist performs emergent ultrasounds after hours) - Provide services for Emergency patients, inpatients, outpatients

(1100-1700 hours Mon-Fri non-urgent general radiography) - The department has a full time Radiologist Monday - Friday from

0800-1630 hours Regional Context: Fluoroscopy provides a service for the Wainwright/Vermilion area

(ECH closest fluoroscopy service is Vegreville) 5 days/week as well as patients within PNRH (Battleford has the closest fluoroscopy service).

The 16 slice CT service was implemented January 2006 and provides a service for patients transported by ambulance from Wainwright, Provost and Vermilion Hospitals in ECH. (Battleford Union Hospital provides CT service for the other side of PNHR)

Ultrasound services are accessible on an emergent/urgent basis, as well as the elective booking slots.

The full time radiologist provides physicians with access to emergent fluoroscopy and ultrasound procedures and interpretation.

An off-site Radiologist provides access to CT services Monday - Friday 0800-1630. Plans are underway to recruit a second on-site Radiologist.

Projected Services: A future mammography service is projected. A (lead lined) room

within the department is ready to receive the mammography equipment once program approval is received.

A third general radiography room is ready to be equipped to respond to anticipated volume increase.

The CT hours will need to be expanded to provide Stroke Protocol service.

Expansion of the ultrasound program is anticipated. The provincial RIS/PACS will be implemented commencing late

2007(which will decrease need for film storage over a 5 year period). In the short to intermediate term, a mobile MRI service will be

implemented. The projected implementation date is the fall 2007. A docking station will be required. In the longer term (5-10 yrs), a stationary MRI unit is anticipated (not a mobile service).

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The third general radiography room needs to be equipped as an Emergency trauma room ( ED can handle with multiple trauma)

The future emergency department should have a trauma room equipped with stationary x-ray equipment.

Because Lloydminster has a large number of young active residents, this demographic will impact the level of orthopaedic services in the area resulting in the need for a C-arm in the OR.

Future Trends: RIS/PACS will require increased PCs and paper scanners in D.I. work

areas. As well, the Emergency Dept, OR, ICU, inpatient units and visiting specialists will need access to PACS.

RIS/PACS will require staff and physician training. RIS will require more user training than PACS.

CT and Ultrasound services will need to be expanded and Human Resources increased (recruitment and retention is an ongoing issue). Experienced aging staff will require replacement.

Current Workload & Projections

Table 1: Historical & Projected Workload

Measure Current Projected 2011

Projected 2016

X-ray workload units 57,800 110,000 140,000 Ultrasound workload units 35,800 52,500 80,000 CT Exams 2,937 5,000 6,000


FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Radiologist 1 1.0 2 2.0 2.5 3.0 Coordinator 1 1.0 1 1.0 1 1.0 CT MRT 2 3.0 3 3.0 3 6.0 MRT 4 6.0 8 10.0 10 14.0 CLXT 0.5 5.0 1 4.0 2 5.0 U/S 1.5 2.0 2.5 3 3 4.0 Support staff 3 4.0 5 8.0 6 9.0 Total 13 22.0 22.5 31.0 27.5 42.0 FTE = Fulltime Equivalent

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Assessment of Current Situation Renovations to the department were completed in April 2006. The area includes 1 general radiography room, 1 digital fluoroscopy,

a CT and 2 ultrasound rooms. The area has 2 empty rooms that are lead lined. One room is slated for a second general radiography room (and should include standing limb imaging equipment to support an orthopedic service) and another room for ultrasound room to support a mammography service once approved.

The CT Room is adequately sized includes cupboard storage and a wheelchair accessible patient bathroom.

The proximity of DI to the Emergency Department and Surgical Suite is ideal.

The X-ray reception desk is separate from Lab desk and is quite functional.

Current space concerns include: Radiologist offices are small in size. The department lack sufficient storage areas for supplies, soiled linen,

the mobile x-ray unit and mechanical lift. The area requires an inpatient waiting area and a holding area for

out of town ambulance patients. The CT prep area is tight space. Only one of the ultrasound rooms is accessible for beds or stretchers. The area requires additional outpatient washrooms. With the anticipated mammography service, designated change

areas are required that are located proximal to the designated mammography room.


External Relationships 9. Provide direct access by internal circulation to Emergency to

facilitate the movement of patients and staff. 10. Provide direct access by internal circulation to the Surgical

Suite to facilitate the movement of patients and staff.

11. Provide convenient access by general circulation to Ambulatory Care for the movement of patients and staff.

Diagnostic Imaging

1. Emergency

2. Surgical Suite

3. Ambulatory Services

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Internal Relationships

Generally, the overall lay-out and space relationships are quite good within the department.

The mammography change and waiting area should be located proximal to the mammography ultrasound room.

The reception area works well in its current location at the front end of the department proximal to the patient waiting area.

The docking station for the mobile MRI should be proximal to the department in particular a patient change area and washroom.

Space Summary

Space Summary Existing (GSM)

Additional (GSM)


Diagnostic Imaging 445.4 150.0 595.4 Additional space to accommodate mammography waiting, improved office space, storage space and a permanent MRI

Mobile MRI 0.0 100.0 100.0 Require 60’ x 18’ pad adjacent to building with tractor trailer access (minimum50’ turning radius); locate in proximity to patient support facilities within the hospital such as washrooms

TOTAL 445.4 250.0 695.4

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.5 EMERGENCY


6.5 EMERGENCY SERVICES

Scope of Service Present Services:

Emergency Services provides 24-hour 365-day access to hospital-based emergency care. It is the first point of entry to the Lloydminster Hospital for persons seeking unscheduled medical attention. It serves patients of all ages experiencing an emergency episode that require critical to non-urgent medical attention, including those patients that cannot or will not obtain basic medical care at other sources of health care in the community. It handles any situation through either service delivery on site or stabilization and transfer to the appropriate referral facility. Emergency Services at the Lloydminster Hospital include: 24-hour physician coverage with normally 1 present in the

department at any time (occasionally 2 may overlap or an additional physician may be called in to assist in providing surgical treatment, trauma, etc.).

Triage, assessment, diagnosis, stabilization and to the extent possible, treatment of the patient’s health condition.

Observation (including overnight) and admission to an inpatient bed in the Lloydminster Hospital if required (and when available).

Resuscitation and stabilization of patients and preparation for transport to a higher level of care if necessary.

Minor surgical procedures such as suturing, cauterizations, biopsies, circumcisions, setting closed fractures, application and removal of casts, etc. (excludes any procedures under general anaesthetic).

Medical treatments such as IV therapy (potential to shift to Ambulatory Care).

Emergency Services tends to act as the ‘buffer’ for all other services within the Hospital and to other service throughout the community and region. At this time, it is a combined department of outpatient/ ambulatory and general emergency services. Patients may be sent to Emergency to access the Hospital-based diagnostic services such as DI and CT and/or for a specialist consultation such as Internist and Surgeon. To the extent that the City of Lloydminster does not have a true walk-in clinic or medi-centre, Emergency Services tends to be used as one. Emergency also receives patients with acute mental health conditions, including patients at risk of injuring themselves or others. One of the more critical problems facing the Lloydminster Hospital is the volume of ‘admitted’ inpatients waiting in Emergency for an inpatient bed, reflecting both an overall shortage of inpatient beds in the Hospital as well as the growth pressures being experienced in the community. Regional Context:

The Lloydminster Hospital Emergency serves a large catchment area and often sees patients from great distances, including access to specialists and services such as CT scanning.

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Projected Services:

The planning of Emergency Services needs to consider: Optimizing space utilization, e.g. ‘universal’ rooms. The ability to efficiently handle both high and low workload periods. The ability to provide extended/overnight observation of patients,

many of whom go home in the morning. The flexible use of Emergency beds/spaces in lieu of an ‘Observation Unit’ is likely the preferred approach.

The ability to address issues such as: the high volume of level 4 and 5 visits (‘Fast Track’ area) and the increasing number of patients waiting in Emergency for an inpatient bed.

Providing future expansion capability. Emergency and Ambulatory/Outpatient services need to be separated. For example, all booked outpatient procedures including lumps and bumps, biopsies, infusions, physician rechecks and referrals should be relocated to Ambulatory Care. Cast clinic could also be Other projected patient services needs include: Separate/private triage area. Additional exam/treatment rooms. Dedicated trauma room. Proper quiet room. Expanded cast room. EENT room. Nutrition room. Expanded and improved patient/family waiting and adequate

patient washrooms. Double ambulance bay. Separate isolation room with shower. EMS work space. Improved security. Improved staff work areas for physicians and nurses.

Future Trends:

Lloydminster has a large young population, i.e. over 30% of patients in Emergency are 16 or younger. Significantly, there is also a large older population and that will only increase with the advent of more assisted living facilities in Lloydminster. As long as the oil patch remains buoyant, there will be young nursing staff moving to the community with their significant others. Even with these nurses, the department is still short. The availability of nursing students certainly helps with recruitment. Other important service trends to consider in the planning of Emergency Services and its facilities include:

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Emergency utilization varies greatly throughout the 24-hour period, often peaking in evening hours, and potentially to overload situations in the event that no beds are available for admitted inpatients.

Increasing volumes of patients with more complex health needs are being managed in the community (including factors such as early discharge and waiting lists) resulting in an emergency population that is increasingly acute.

The aging population also impacts on Emergency Services due to its higher level of acuity, longer stay for investigation and management, requirement for additional staff resources, and the need to accommodate family.

The increasing incidence of cancer and problems associated with obesity will impact on Emergency Services, e.g. more cardiac episodes, diabetes and crisis management.

The increasing risk and concern over emergency patients that may have a highly infectious disease such as SARS.

The ability to do more sophisticated treatments within the Emergency setting, including procedures under conscious sedation and the safe and effective use of short acting drugs. At the same time there is increasing demand for rapid access to diagnostic tests and their results to assist in diagnosing and treating emergency patients as quickly as possible. The impact of these trends may be reduced inpatient admissions but at the same time longer stays in Emergency.

Other trends to be considered in Emergency Services include: increasing need for monitored beds, methods for diverting/handling ‘fast track’ patients, use of point-of-care testing, other technology changes such as the use of RISPAC, EHR and Telehealth/telestroke.



Unit / Measure 2003/04 2004/05 2005/06 2006/07 2011 Projection

2016 Projection Comments

Emergency/Outpatients Emergency Visits 34,928 35,963 35,409 37,048 45,000 50,000

Triage Code 1 44 33 49 Triage Code 2 654 260 552 Triage Code 3 4,404 3,687 5,040 Triage Code 4 19,013 20,675 17,593 Triage Code 5 11,848 10,754 10,372

# of ER Calls # of Kms traveled

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Current Staffing & Projections Table 2: Current Staffing Position 2006

FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Total FTE = Fulltime Equivalent

Assessment of Current Situation With the renovations to Diagnostic Imaging, Emergency lost a patient bed, the quiet room, the physician on-call room, some storage and a staff room. The manager’s office had to be relocated and it now too far away to be as effective as the previous location. Emergency has since started sharing Diagnostic Imaging’s conference room as a meeting room, staff debriefing room and a quiet room; and took an office from Diagnostic Imaging and gave it a dual purpose for the Chief of Staff’s office and the sleep room for physician on call. Emergency Services presently has 12 patient spaces described as follows: 1 Minor Operating Room with an older OR table and overhead

surgical light used for suturing minor trauma, various biopsies of lesions, bone marrow, thyroid, etc.; other minor surgeries as required, e.g. circumcisions.; a slit lamp for eye exams; a cautery machine for bigger bleeders. This room shares a reach through cabinet with the Trauma room next door. (Very important that this cabinet be transferred to new trauma area). The cabinet is home to all sterile supplies, syringes, local anaesthetics eye tray, some linen, suture materials, and some specialized trays.

1 Trauma Room with an overhead surgical light and a stretcher that is x-ray capable. Room is equipped for resuscitation of a critical trauma patient with various monitors, a defibrillator, a bear hugger warmer and a blanket warmer. This room tends to get non-trauma patients – usually those requiring closer observation.

1 Resuscitation Room with an overhead surgical light and a stretcher. Room is used for critical patients, for all chest pains needing investigation and patients requiring close observation. It has a storage cabinet for the ventilator, intubation supplies and various required items, monitors and a blanket warmer. Both the trauma and resuscitation rooms have wall-mounted cardiac monitors which are hard-wired through out the department.

6 Exam/Treatment Bays (also known as the Daybed Area) that is a catchall area for many types of patients. One bed is in a glassed-in room and there are only curtains separating the remaining 5 beds, which doesn’t allow for much privacy or confidentiality. The area has a counter with cupboards and each bed has its own little closet (the area was originally designed as a Day Surgery unit). Each bed is hard wired for the portable cardiac monitors to be plugged into allowing the vitals to be sent to the monitor screen at the nurses’ desk. There is also a small storage closet home to many paper supplies that Materiel

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Management no longer seems to have room for, different linens, and other supplies.

Exam Room 1 that serves primarily as a private gynecology exam room (used to be an office). Room has an exam table, cart, scale, built-in cupboard, portable oxygen, suction and light. Room is also used for overnight patient holding by moving the table flush against the wall and squeezing a stretcher in. This room as well as the other exam room is hard wired for the cardiac monitor system.

Exam Room 2 that serves primarily for extended patient observation, treatments, e.g. blood transfusion and a patient awaiting admission (also used to be an office). Room has the same portable services as Exam Room 1 and a regular patient bed into (that has to be turned on its side to get in and out as the door is too narrow). This room is next to the only patient washroom in the department.

1 Cast Room that also has to be used for patients other than those with bone or muscle injuries (used to be a tub room). In addition to the patient stretcher, this small room houses the department’s whole supply of crutches, casting materials and equipment, splints, linens and special plaster disposal sink. It is difficult to move patients in and out of here on stretchers.

In support of the 12 patient spaces, Emergency Services has the following other facilities:

Patient Waiting Area - relocated across from Admitting in an effort to provide privacy for the Exam rooms and the triaging areas

1 Patient Washroom - all urine collection and testing equipment is kept in here.

Nursing Station - very crowded with no separate triage area; has cardiac monitor and printer, computer screen, lab printer, charts and requisitions. Triaging of patients occurs here. The nurses and doctors spend a lot of time in and around the desk. The medication cart is tucked in behind as well as a locked medication room which contains a fridge. Across from the desk is another locked room which has more medications and various high-end cost supplies in it. It also has the back-up power panel for the hospital.

Clean Utility Room - with 2 supply carts, some shelving and a cupboard unit with sink; also has IT and other panels on the wall and is therefore unable to accommodate more shelving.

Soiled Utility Room - has housekeeping supplies, the pharmacy bucket as well as counters, cupboards and hopper sink.

Security Desk and Ambulance Communication Systems - located near the ambulance doors. The ice machine is in behind this desk. Additional patient triaging occurs here. Ambulance supplies are in a locked cupboard in the foyer between the ambulance doors. Extra boards and equipment from other services are stored in the corner.

Ambulance Bay - a single (large) bay for ambulances as well as private vehicles. However, need to accommodate a minimum of 2 vehicles at this time. There are numerous problems with the overhead doors. Fire panel is located on the wall.

1 Staff Washroom - located directly across from the Security Desk.

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One of the advantages of the existing layout is the good visibility from the nursing station to most areas within the department and the short travel distances between all work spaces.


As a general parameter, it is recommended that Emergency be completely replaced rather then trying to renovate and expand the existing department. With a projected volume of approximately 50,000 annual visits, it will require a total of about 25 to 30 patient spaces. The concept of highly flexible, ‘universal’ exam/treatment spaces should be employed in the planning.


(GSM) Additional

(GSM) Total

(GSM) Comments

Emergency 413.8 486.0 900.0

Ambulance Bay 70.0 40.0 110.0


External Relationships 12. Provide direct access by internal circulation to Diagnostic

Imaging to facilitate the movement of patients and staff.

13. If possible, provide direct access by internal circulation to Ambulatory Care to facilitate the movement of patients and staff and sharing facilities.

14. Provide direct access by general circulation to Admitting to facilitate the movement of patients, staff and records.

15. Provide direct access by general circulation to Laboratory to facilitate the movement of patients.

Emergency 1. Diagnostic Imaging

2. Ambulatory Care

3. Admitting

4. Laboratory

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.6 FACILITIES & MAINTENANCE


6.6 FACILITIES & MAINTENANCE


Facilities & Maintenance provides the following major services at the Lloydminster Hospital: Boiler room equipment maintenance such as servicing and repairing

boilers, pumps, heat exchangers, zone valves, compressors, vacuum pumps, etc.

Hospital grounds maintenance such as planting and caring for flowers, cutting grass, sweeping sidewalks, snow and ice removal, etc.

General maintenance within the Hospital including plumbing, electrical, welding and pipefitting repairs.

Providing carpentry, plastering and painting. Maintaining and repairing all equipment. The performance of security duties such as locking and unlocking

doors, making security rounds, helping with disorderly people, etc. The provision of assistance to the Nursing department (and others) by

delivering necessary patient equipment, setting up traction, moving furniture, responding to emergency calls, etc.

Other duties as assigned. Regional Context

There is a Director of Facilities/Projects based in North Battlefords. The department is broken down into three areas. Meadow Lake, North Battleford and Lloydminster. A Site Manager is based at the Lloydminster Hospital responsible for: Lloydminster Hospital, Dr. Cooke Extended Care, Jubilee Home, Home Care Building, and Paradise Hill Health Center. There are two regional carpenters, one electrician, one Bio-med, and one painter - all based out of North Battleford. Projected Services

It is anticipated that the following will be added to the Lloydminster Hospital: 1 regional electrician, 1 Bio-med, painter, 1carpenter. Future Trends

Impact of Technology Preventive Maintenance Program Keeping track of PM done on all equipment. Equipment maintenance PM done on manufacturers’

recommendations Cost and repair tracking More bio-med equipment to maintain

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.6 FACILITIES & MAINTENANCE



Measure Current Projected 2011 Projected 2016 Existing Building Area ~10,500 sqm 16,000 - 20,000 sqm


FTE 2006

Headct 2011 FTE 2011

Headct 2016 FTE

2016 Headct

Maintenance operator 7 7.3 Maintenance service worker

1

Maintenance manager 1 1 Total 9 8.3 FTE = Fulltime Equivalent

Assessment of Current Situation The carpentry and pipefitting areas are inappropriately located in a

cramped area in the crawlspace, where it is difficult to build items and take them to the departments.


Future areas that are required include a carpentry shop, electronic shop and a paint shop. There is the need for an expanded maintenance shop to repair all equipment. Currently, beds brought down for repair work have to be repaired in hallway.

Responsibility for bariatric equipment needs to be clarified.


(CGSM) Additional

(CGSM) Total

(CGSM) Comments

Facilities & Maintenance 124.6 85.4 210.0

124.6 85.4 210.0



Facilities & Maintenance

1. Mechanical Rooms

2. Materials Management

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.7 FINANCE


6.7 FINANCE (INCLUDING PAYROLL, BENEFITS & SCHEDULING)


This component encompasses the services of Finance, Payroll, Benefits and Scheduling, including regional and local services that are based in Lloydminster. Note: during the latter stages of the Functional Program & Master Plan project, the PNHR was planning for the potential relocation of certain Finance functions to off-site space, at least for an interim period to free up space in the Hospital for acute care functions. Finance Finance processes financial information for the PNHR and provides independent services. Finance has no direct client interaction. The VP Finance & Information Management (Jerry Keller) is presently based at the Lloydminster Hospital and is part of the PNHR Senior Management Team. The Finance Manager, Lloydminster Area (Trent Wobeser) is also located in the Hospital. Finance operates Monday to Friday, 0730-1630. Payroll Payroll does the entire payroll and benefit functions for approximately 690 staff in the Lloydminster Area. It runs two payroll systems - one for each province. Because the cut-off dates are one week apart, a payroll run needs to be done every week. There are two sets of benefits - one for each province. There is a need to understand six collective agreements - 3 Saskatchewan and 3 Alberta Unions. The department currently operates with 3.8 FTE staff. Office hours are Monday to Friday, 0800-1700. Scheduling Scheduling currently handles all the scheduling for approximately 284 staff in the Lloydminster Hospital and 77 staff at the Jubilee Home. It utilizes a scheduling program known as ESP - Kronos, based in Kelowna, BC. The scheduling staff follow two sets of rules for two collective agreements (CUPE and SUN). Scheduling currently operates with 3.64 FTE. Office hours are Monday to Friday 0600-1700 and Saturday/Sunday 0600-1430. Regional Context

Finance Services are coordinated regionally and specific to Lloydminster in Finance, Payroll, Benefits, Scheduling and IT services. This includes regular reporting to ECH on program statistics and costs of services. Payroll Payroll looks after all payroll and benefit functions for PNRH - Lloydminster Area, which includes the Dr. Cooke Extended Care Centre. Scheduling Scheduling currently looks after the Lloydminster Hospital and Jubilee Home staff. It services are expected to expand to eventually encompass the whole Lloydminster Area.

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Projected Services

Finance Changes will be driven by volumes and added services, as well as new technologies. Finance may take on further duties from other department thus requiring more staff. Payroll There have been some discussions about the DCECC Payroll system, currently running on Phoenix Payroll out of Edmonton, changing over to the Saskatchewan Association of Health Organization out of Saskatoon. This would mean running only one payroll system. There would be no change in the benefits. Depending on what happens in the Lloydminster area, more services provided means more staff and that would have a direct impact on the Payroll department for both Payroll and benefits. Scheduling This department was expecting to bring on the rest of the staff at the Lloydminster Hospital (70 +) prior to March 31, 2007. It also anticipates that the DCECC facility will be added to the ESP system within the next two years if not sooner. When this happens it may be necessary to set up a Scheduling department at the DCECC facility as the DCECC is an Alberta Union and therefore this position would belong to that union and be on the DCECC Payroll and Benefits. Future Trends

As a support services, any changes will be driven by existing and new service demands. For example, as client-based services become busier, staff duties and activities will increase due to increased workload. There are no foreseeable issues with HR as skilled employees are available. For Payroll new technology means that all benefits would be on-line (already have some DCECC benefits on line as well as WCB for both Alberta and Saskatchewan). Any new technology may result in staff increases which in turn has an impact on the whole Payroll department. Payroll works closely with the HR unit for any union issues related to payroll and benefits. Scheduling relies on the HR department on an ongoing basis. The two work hand and hand to resolve any issues relating to shifts and any changes within the Unions means changes within the rules of scheduling. HR plays a big role in the functioning of the Scheduling Department. If new technology results in an increase in staff then this would have an impact on Scheduling. Impact of Technology The majority of workload is already electronic; further advances will cut down on storage needs.

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Measure Current Projected 2011 Projected 2016 Not applicable Total

Current Staffing & Projections Table 2: Current Staffing Position 2006 FTE 2006

Headct 2011 FTE 2011

Headct 2016 FTE

2016 Headct

Finance 6.0 6 6.0-7.0 6-7 7.0-8.0 7-8 Payroll 3.80 5 4.0 5-6 TBD TBD Scheduling 3.84 6 6.0 7-9 TBD TBD Total 13.64 17 16.0-17.0 18-22 TBD TBD FTE = Fulltime Equivalent

Assessment of Current Situation General Comments These functions are currently separated into four different locations in

the Hospital (Note: may change with pending relocation off site). As a generally comment, office/workstation space is tight and

somewhat makeshift and adequate storage is unavailable. Services such as Payroll require access to private interview/meeting

space for confidential discussions with staff. Finance, Payroll, Benefits and Scheduling ideally should be in proximity

to the majority of service delivery, e.g. for cashing, credit services as well as payroll and scheduling services.

Space is required for the Auditors when on site; currently use the executive conference room.

Finance Current location is central but separated, e.g. Manager’s office is

down the hall and their office space is poorly configured. The Special Projects staff requires a separate office.

Payroll Currently Payroll has 4 desks in a small area, which disrupts the

productivity of work, e.g. 4 telephones ringing and many interruptions. The majority of the interruptions can’t be reduced but with a better office setup this would mean that only one staff being interrupted instead of all four. The noise level of one person on a phone within a small confined area means that all four staff have their work interrupted.

Payroll ideally should have an open area that all Payroll staff could access for Payroll or Benefit records, forms etc. with four enclosed workstations surrounding this area for privacy and better work

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productivity. For staff signing up for benefits, terminating employment or retiring, there needs to be a separate room within the department that staff will feel comfortable discussing retirement issue, etc. or even just filling out the benefit enrolment information. For staff that are retiring and want to go through their pension options, etc, they currently go to a conference room although there may not always be one available so they have to use the chapel or even an empty patient room. Not very professional but this can’t always be helped as space is very limited.

Scheduling Scheduling has the same issues as Payroll, a 3 desk setup in a small

confided space. They also need to be close together but separate workstations with an area open to all would be ideal.

As Payroll and Scheduling work close together on most things they need to be in the same area as they share information. Example: There is one Hire Form completed and once Scheduling has hired this employee into the ESP system then this information is given to Payroll so that they can look after the payroll and benefit side of things. They need to have a close relationship so that both departments can run and therefore they need to be close if not within the same area.


General Comments Specific equipment needs: office furniture, computers, fire proof safe. Information sharing between Payroll and Admitting - either paper

hardcopy or sent via email. All PNHR/Lloydminster Hospital/DCECC services will potentially have

an impact on Payroll/Benefits and Scheduling if they result in an increase of staff within the Lloydminster Area.

Need adequate and accessible storage space as paper records continue to increase for the foreseeable future.

All records that need to be obtained for Payroll and Scheduling are currently held in the Crawl space. Due to shortage of space in both departments, information is relocated to the Crawl space even though it may still be ‘active’, e.g. less than 1 year old. This is not an ideal situation as it results in wasted time running back and forth between the two areas. The adjacent file storage area was lost to when Pharmacy was redeveloped.


(GSM) Additional

(GSM) Total

(GSM) Comments

Finance 54.5 25.5 80.0

Payroll 39.0 26.0 65.0

Scheduling 28.0 24.0 52.0

Total 121.5 75.5 197.0

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Functional Relationships As Payroll has a partnership with the Finance area it would be idea for

these departments to be within the same area. There are many things that Finance needs from Payroll and therefore there is a lot of back and forth between the two departments.

Payroll and Scheduling also have a functional relationship with one another that involves day to day interaction, as well as with HR, e.g. shared files.

Finance needs to be in proximity to the mail room (in Administration) for functions such as cheque distribution.

Finance has a day to day interaction with Admitting regarding cash accounting.


Finance, Payroll & Scheduling

Human Resources

Administration

Admitting

IT

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.8 FOOD & NUTRITION SERVICES


6.8 FOOD & NUTRITION SERVICES

Scope of Service Present Services: Food and Nutrition Services (FNS) provides meals to inpatients and the Transition Unit totalling 58 beds. In addition, an average of 60 meal days per month (or 180 meals) is provided to Emergency and Day Surgery patients. Nourishments are delivered to special diets twice a day and evening nourishments are delivered to all patients.

The department orders and distributes cases of disposable items such as Styrofoam cups to the Nursing Units. Some supplies are ordered through Material Management.

Food and Nutrition Services operates a cafeteria service for staff and visitors and is open from 0900 to 1330. A vending machine service is available to provide food for all shifts.

Food is prepared on-site using traditional cooking methods. Baking is done on–site and supplemented with the use of some frozen products.

Food is delivered using a Client Focused Food Delivery System. A cart containing a refrigerated and a heated unit goes to each station and food is served at that point. At present, there is one wagon per floor. A cook and 2 Aides go to each floor to deliver the food.

Nutrition Services is responsible for washing all dishware in a central dish room.

The Lloydminster Hospital has students throughout the year which adds to the overall activity in Food Services.

Regional Context: The Lloydminster Hospital is a hub for Regional Meetings, Workshops and Telehealth. This will continue to have an impact on Food Services. Food and Nutrition Services provide a catering service for meetings and workshops. Projected Services: The cafeteria will need to be expanded to accommodate the increase in staff and visitors as the number of inpatient beds and ambulatory services increase. Any changes in services to outpatients or inpatients can affect the department, e.g. the addition of an 8 bed Transition Unit in January 2006. Future Trends: Future trends are anticipated to be: Many activities in Acute Care affect Nutrition Services. Keeping out-

patients in Emergency for longer periods of time to avoid unnecessary admissions has resulted in essentially another unit which requires our services.

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An increase in cafeteria patronage due to increases in visitors, and outpatient services, i.e. CAT scans, scopes, dialysis, cataract surgery, chemotherapy and general population increase.

Increase in vending machines including coffee vending, Increase in Meal Days due to increase in patient count. The Head Cook position will eventually be replaced with a Full Time

Food Service Supervisor; a graduate from a two year Technical program.

Computerized Purchasing is a function of the department but not part of the Materials Management Program. There is potential for centralized Purchasing for Food Services in Lloydminster.

Food Delivery Systems change as technology changes. A new Food Delivery system using new technology might have to be considered as the Hospital grows. Space planning should include room for a conveyor belt system and food wagons.

Food is delivered using a Client Focused Food Delivery System. At present, there is one wagon per floor and consideration should be given to increasing to 2 wagons on each inpatient floor (2nd and 3rd floors). As the number of inpatient beds expand, a review of the food distribution system will be required and consideration given to a future tray line in the kitchen.



Measure Current Projected 2011 Projected 2016 Meal Days Inpatient/yr 720 Meals Days Outpatients Other – Staff & Visitors Total


Table 2: Current & Projected Staffing Position 2006

FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Manager (Dietitian)

1.0 1 1.0 1 1.0 1

Head Cook (Supervisor)

1.0 1 1.0 1 1.0 1

Cook 3.27 5 5.0 8 5.0 8 Food Services Workers

7.38 16 9.0 20 9.0 20

Total 12.65 23 16.0 30 16.0 30 FTE = Fulltime Equivalent

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Assessment of Current Situation The Main Kitchen is spacious, large window to see outside and has a

good layout. It was originally designed to support 115 beds (which is the likely future number of beds).

The dry storage area is adequate and if the disposable products were kept in Material Management general stores area, there is sufficient storage space for future service requirements.

The cafeteria will need to be expanded to accommodate the increase in staff and visitors. The seating space at times is limited and tends to be cramped because extra tables and chairs have been added to meet the growing demands. (Expansion of the Cafeteria was included in the earlier version of the Functional Plan completed in 2005.)

The cafeteria serving line is no longer adequate. There is not enough space for hot food items. More refrigerated display cases are needed. Staff members are subjected to long line-ups, especially when noon hour meetings are held. A new design for cafeteria service is needed.

The existing patio off the cafeteria is considered beneficial to staff and visitors.

Meeting Rooms off the cafeteria works very well. Meals are picked up in the cafeteria and taken to the meeting. Those attending the meeting can choose their meal.

The courtyard off the cafeteria is used a lot by staff and visitors, especially in nice weather. Staff Barbeques are held in courtyard.

The Food and Nutrition Services Regional Manager (Administrative Dietitian) has an office in the Main Kitchen which is no longer appropriate as the position has a more regional focus and is not involved in the daily operations. The office should be relocated.

Currently, the Head Cook and Clinical Dietitian share an office. An office for the Clinical Dietitian has been included within the Ambulatory Care component thereby rectifying this issue.


A client-focused Food delivery system is used using a “Burlodge” cart which is half refrigerated and half oven. The cart is taken to the Nursing Unit, plugged in and food is plated and delivered to the patient’s room.

Additional steamer required for increased food production. The department is already supplied with computers. Equipment for Cafeteria should be considered as part of an over-all

renovation plan

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16. Provide convenient access by internal circulation to facilitate

the movement of FNS staff to the inpatient units (for meal distribution).

17. Provide convenient access by internal circulation to facilitate

the movement of FNS staff for meal distribution.

18. Provide convenient access by general circulation to the cafeteria for the movement of staff and visitors.


Generally, the overall lay-out and space relationships are quite good

within the department. The office area for the Regional Manager does not need to be

located within the kitchen area; the Head Cook should be located there.


(GSM) Additional

(GSM) Total

(GSM) Comments

Cafeteria/Servery 171.9 99.7 271.6 Additional space for cafeteria/servery and office space

Dishwashing Area 49.1 0.0 49.1 Kitchen Area 191.3 0.0 191.3 Kitchen originally sized to support 115

inpatient beds Total 412.3 99.7 512.0

Food & Nutrition Serv.

1. Inpatient Units

2. Ambulatory Care

3. Staff and Visitors

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.9 FOUNDATION


6.9 FOUNDATION


The Lloydminster Region Health Foundation (LRHF), formed in 1983, is a non-profit charitable organization, running separately from the PNHR administration. LRHF has a 14-member volunteer Board, which operates with the assistance of an Executive Director and professional development staff. The Mission of the LRHF is… “To enhance public healthcare in our community by generating and receiving donations”. The LRHF has grown significantly in recent years in its number of programs, number of staff and success in fundraising. It now totals 6 staff. Key services/functions include: Fundraising activities, including Events such as the Health First

Campaign, Health Home Lottery, Annual Gala, Meet and Greet, One Hour Club, and third party events.

Operational support to the Gift Shop in the Lloydminster Hospital. Supporting and accepting donations, including conducting donor

tours. Selling Lottery and Gala tickets (peak activity times when additional

volunteer staff are brought into the Foundation office). Conducting campaign mail outs (approx 14,000 letters). Administration of the Foundation.

The LRHF receives daily support form the Administration Office with respect to administrative support, mail, photocopying, etc. In addition to selling a broad range of sundry items, the Gift Shop manages the vending machines and flowers and supplies telephones and TV’s for patient rooms. It includes 1 full-time and 2 part-time staff and approx 14 volunteers. Regional Context

The LRHF supports the facilities and services of the Lloydminster Hospital, Jubilee Home, Dr. Cooke Extended Care Centre, Homecare Community and Mental Health Services. Projected Services

The overall scope of services and functions is not expected to change in a significant way, other than continued growth, which may generate the need for additional staff and volunteers working in the Foundation office. One of the goals of the LRHF is to develop an improved donor recognition display/system at the Hospital.

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Future Trends

Even with the operational and capital funding support of provincial governments, there is continuing need to fundraise to support local health care delivery. It is assumed that the LRHF will continue to explore new and innovative approaches to fundraising and generating support.


Measure 2006/07 Projected 2011 Projected 2016 Not Applicable Total

Current Staffing & Projections Table 2: Current & Projected Staffing Position

2006 FTE 2006 Headct

2011 FTE 2011 Headct

2016 FTE

2016 Headct

Executive Director 1 1 1 1 1 1 Professional Development Staff

5 5 TBD TBD TBD TBD

Volunteers - var TBD TBD TBD TBD Gift Shop Staff 3 TBD TBD TBD TBD Gift Shop Volunteers var TBD TBD TBD TBD Total 9 TBD TBD TBD TBD FTE = Fulltime Equivalent

Assessment of Current Situation The LRHF recently relocated to renovated space that was vacated by Pharmacy (when it moved to the 2nd floor). While the location is at ground floor and relatively central, it lacks public visibility. Visitors often need to ask directions to find the Foundation office, which creates an unnecessary burden on other services such as Admitting and DI. This is particularly an issue when traffic is heavy, e.g. buying Lottery tickets. Other concerns and issues with the current Foundation facilities include: It lacks a proper reception counter and visitor waiting area. Its

entrance needs to be much more open, inviting and welcoming to visitors.

It requires an ‘open’ work area for functions such as mail outs, visiting volunteers, job sharing, etc.

The internal meeting space had to be converted to another staff office. Access to a meeting room for 4-10 persons is required.

Closer access to a mail/photocopy/work space is required; the space in Administration works well but ideally should be closer.

Access to additional office/workstation space will be required if the LRHF continues to increase in number of staff.

Adequate and proper storage space is required - presently utilizing the Crawl space for some items.

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While the current location of the Gift Shop is quite central and close to the elevators, closer proximity to the main entrance and public waiting areas would be more beneficial.

Functional Requirements The Foundation office occupies approximately 71 sqm. A target area of approximately 90 sqm (i.e. 25% growth) is recommended, with the additional proviso that it be located adjacent to ‘soft’ space (e.g. meeting room) into which it could expand if further growth is necessary. The Gift Shop is approximately 20 sqm and needs to double its size. The office should be located adjacent.


(CGSM) Additional

(CGSM) Total

(CGSM) Comments

Foundation Office 70.8 19.2 90.0 The 90.0 sqm does not include the space required to replace storage located in the Crawl space

Gift Shop 30.0 20.0 50.0 Includes Gift Shop @ 40 sqm and office @ 10 sqm

Total 100.8 39.2 140.0

Functional Relationships External Relationships

19. Provide close access by general circulation to the Main

Entrance to increase visibility and access.

20. Provide close access by general circulation to the Main Elevators and Public Facilities such as waiting areas to increase visibility and access.

21. Provide convenient access by general circulation to the Gift Shop.

1. Provide close access by general circulation to the Main

Entrance to increase visibility and access.

2. Provide close access by general circulation to the Main Elevators and Public Facilities such as waiting areas to increase visibility and access.

3. Provide convenient access by general circulation to Ambulatory Services and Emergency.

Foundation 1. Main Public Entrance

2. Main Elevators & Public Facilities

3. Gift Shop

Gift Shop 1. Main Public Entrance

2. Main Elevators & Public Facilities

3. Ambulatory Services & Emergency

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.10 HEALTH INFORMATION SERVICES


6.10 HEALTH INFORMATION SERVICES

Scope of Service Present Services: Health Information Services at the Lloydminster Hospital includes two functions: 1. The office of the regional manager of Health Information Services

(HIS) for the entire region which involves overseeing health records management for all Prairie North health facilities; and

2. Health Records for the Lloydminster Hospital. The Health Records department is responsible for the following: Processing and assembly of inpatient charts, outpatient charts and

day surgery charts Transcription of dictated reports by physicians including discharge

summaries, operative reports, histories, consults, correspondence and diagnostic imaging reports

Release of information in accordance to regional policies and provincial legislation

Coding and abstracting inpatient and day surgery charts in accordance with CIHI Coding Standards and CIHI DAD Abstracting standards, Saskatchewan Health QA Audits and internal guidelines

Retrieval of charts for a variety of purposes Filing all permanent charts Analysis of health information for various internal and external requests Provide statistical information (EG: Month end activity statistics,

residence code statistics) Provide consultative services for various stakeholders Assisting in clinical research and study projects requested by various

stakeholders Quantitative and qualitative analysis of chart deficiencies Processing birth registrations

Hours of Operation: Monday through Friday 0800-1630 Regional Context: Regionally, Health Information Services in Lloydminster represent one of the two regional hospitals in the Prairie North Health Region and fall under the portfolio of the Director, Strategic Health Information Services. Because this is now a regional portfolio, it is expected that Lloydminster HIS will play a key role in the bigger picture of regional standardization of a variety of processes (including coding standards, chart processing standards, release of information and retention/disposal procedures). Lloydminster is also has an affiliate relationship with East Central Health and the Manager, HIS is an ex-officio member of the East Central Health Information Management Committee which meets monthly. This allows Lloydminster to be aware of new initiatives in Alberta and how they impact the HIM service. In this way, we are able to adapt some of our

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data collection processes so as to meet both Saskatchewan’s and Alberta’s needs. Projected Services: In the future, the Health Records department will begin coding and abstracting Ambulatory Care information. This is not currently mandated in Saskatchewan, although it is in Alberta. Further involvement in data analysis with a more extensive and broader delivery of services is a key direction, as well as the anticipated introduction of the Electronic Health Record (EHR). There will also be further development of data quality standards both within the facility and regionally. Future Trends: As technology evolves, Health Information Services are brought closer and closer to the Electronic Health Record. As technology changes, processes and procedures will change including processing of charts, chart storage and the ability to deliver information. As technology changes and becomes more advanced, processes change in order to accommodate these particular changes even if the changes are not initiated in our department. For example, the procedures for Pathology Reports and Filing Lab reports have changed because of the Laboratory’s move to a Lab Information System (TriWin). The move towards an EHR will have a direct impact on storage and retention of records, allowing for scanning of documents and online storage. Lloydminster is also positioned to take a lead role regionally processes are standardized and streamlined in the smaller centres. With limited skilled professionals in the rural settings, the potential exists for expansion of services electronically to serve these settings (scanning of documents, etc.) Various changes to processes as linked with new technology will also likely result in changes to the staffing mixture.


Measure Current 2006/07

Projected 2011 Projected 2016

Beds in Operation 58 Average Daily Census 47.9 Inpatient Bed Days 17,492 Occupancy Rate 82.6% Inpatient Separations 4,236 OR Cases 1,763 Emergency Visits 37,048 Other Ambulatory Visits 8,150 Notes: As the population of the service area increases, this will impact workload.

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Headct 2006 FTE

2011 Headct

2011 FTE

2016 Headct

2016 FTE

Health Record Clerks

4 3.5 5 4.5 6 5.5

Analyst 1 1 1 1 2 2 HIM Practitioner 2 1.87 4 3.87 5 4.87 Transcriptionist 2 2 3 3 4 4 Manager 1 1 1 1 1 1 Total 10 9.37 14 13.37 18 17.37 FTE = Fulltime Equivalent

Assessment of Current Situation HIS Regional Manager The HIS regional manager’s office is located on the second floor

adjacent to OH&S and a Finance office. The space is located in a (former) inpatient area. The office lacks file storage space. This function does not need to be located in a patient care area and would be better situated in an administrative office area. The HIS regional manager does not need to be located with the Lloydminster Hospital Health Records Department because it is a regional function and the Lloydminster Hospital Health Records Department has its own manager.

Health Records Department The Health Records Department is located on the main level near the

physician’s lounge and the Surgical Suite. The area includes a general workroom with three staff workstations

and active file storage, an enclosed area with 2 workstations (was the former manager’s office), the manager’s office (a former workroom) and the transcription area located across the corridor from the general workroom.

There are windows along the outside wall of the department providing natural light and a comfortable work environment.

The department lacks sufficient staff workstation space. The manager cannot accommodate all the employees, i.e. two positions are vacant because there is no space. There are also equipment issues, such as not having enough desks or computers which slows down the productivity of the department. As each position requires use of a computer, it is difficult to have shared workstations.

The filing space is maxed out and with the current mobile filing system breaking down, there is concern for employee safety issues or not being able to access charts in certain rows. There is 2205 linear feet of shelving storage.

The location of the department is not optimal. It is removed from Admitting. It would be preferred for the department to be centrally located in the building proximal to Admitting.

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There are several plans and proposals that have been submitted to the PRHR senior management group as described below. a) A proposal is under review for the Health Records department to take

over the Library space adjacent to the department for space for the two positions to be filled.

b) A proposal is under review to replace the current workstations with smaller ones in order to better accommodate current employees.

c) A proposal is under review to acquire 3 additional workstations for 1 current employee and two vacant positions.

d) The department is in the process of transferring the responsibility for transcription of diagnostic imaging reports to the Diagnostic Imaging department, to be in line with the rest of the region.

There have been no timelines delivered for any of the above proposals as they are currently in the review stage. At this time, there has been no feedback. The reasoning behind these proposals is to improve work flow, efficiency and address the space issues as the department cannot accommodate the current employees, never mind any additional increase in the next few years.

Functional Requirements HIS Regional Manager The HIS Regional Manager requires an office space with sufficient file

storage within the office (2 lateral filing cabinets). A workstation for an administrative support staff will be required.

Health Records Charts must be accessible after-hours by Admitting Staff and, on

occasion, Emergency Department staff. Physicians have access to the dictation area 24/7.

Health Information Services require the following equipment: ‐ Workstations for each permanent employee ‐ Computers for each permanent employee ‐ Adequate file storage system or alternate form of storage

(currently out of physical space) ‐ Computer Programs consisting of (currently), WinCIS, Excel, Word,

Powerpoint, Folio ICD-10 and CCI, WinRecs (Med2020), Dictaphone, Crystal Reports.

‐ Need to ensure that as technology evolves, computers are up to date and able to handle the various computer programs that are added to the department each year.

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1. Provide direct access by internal circulation to Admitting for the ongoing flow of patient-related information, e.g. charts.

2. Provide convenient access by general circulation to

Medical Staff from the Physicians Lounge. Facilities for chart completion dictation, signatures, research and review.


patient care areas for the transportation of health records.

1. Provide direct access by internal circulation to the Administrative office area to support the ongoing flow of patient-related information.


Health Records to promote exchange of information.

Internal Relationships The following describes preferred internal relationships/concepts: Privacy Provide acoustic and visual privacy in offices and clerical work areas. Staff work areas should be visually separated from the public reception/waiting area for confidentiality reasons. Acoustics All work spaces should be acoustically designed in order to maintain confidentiality of conversations. Security Provide for security of confidential documents by locating in lockable file cabinets, which can be visually observed from secretarial/clerical areas. Private offices should be provided with lockable doors, individually keyed. Access/Control Provide control of access to staff offices and work areas from the public reception/waiting areas.

HIS Reg. Manager

1. Admin. Office

2. Health Records

Health Records

1. Admitting

2. Physicians Lounge

3. Patient Care Area

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Natural Light

Allow for adequate natural light and exterior views within offices and staff work areas to maintain psychological well being of staff.

Open Office Concepts Provide for clustering of functional areas within open office concepts, e.g. transcriptionists located together, coding staff together and proximal to the health record files, etc.

Space Summary Space Existing

(GSM) Additional

(GSM) Total

(GSM) Comments

HIS Regional Manager 10.0 30.0 40.0 Add’l space for an administrative workstation and file storage

Health Records Department 171.0 100.0 271.0 Require additional file storage and 8 staff workstations

Total 181.0 130.0 311.0

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.11 HOUSEKEEPING & LAUNDRY


6.11 HOUSEKEEPING & LAUNDRY

Scope of Service Present Services: Laundry The hospital has an in-house laundry facility. The laundry does all linen

for the hospital, the Thorpe Recovery Centre, Home Care and a local funeral home.

Currently, soiled linen is collected from all areas within the hospital (5 times daily Monday-Friday). Laundry staff deliver clean linen to all areas (X-ray, Emergency, Transition Unit, Speciality Services, Dialysis, 3rd floor, 2nd floor, Physiotherapy, the OR and Dietary).

Hours of operation: Monday to Friday, 0600 -1530. Housekeeping Provide Housekeeping service to all areas of the facility 7days a week

0600 - 2230. Pick up garbage which includes handling of biomedical waste, clean

and disinfect patient rooms, bathrooms, carbolize beds and remake as patients are discharged.

Clean the OR, CSR, Health Records, Laundry Department, Materials Management, Shipping and Receiving, Maintenance, Housekeeping, Dietary, Cafeteria, Conference Rooms, Administration ,Human Resources, Finance Department, Physio department, Health Foundation, Gift Shop, X-Ray Department, Emergency, Payroll, IT Program, OHS, Speciality Areas, 2ndFloor, Day Surgery, Maternity, Labour and Delivery Rooms, Scopes, Disposal Areas, Pharmacy Department, Transition Unit and all areas of third Floor including the Chemotherapy Unit.

Regional Context: Laundry and housekeeping services are specific to the Lloydminster Hospital. Projected Services: As the facility grows in size, Housekeeping staff and the related

equipment will increase. As the laundry equipment ages, the potential to contract the service

will be considered within the next 3-5 years. Future Trends: Additional cleaning time for more complex equipment will be

required, e.g. an airflow mattress that requires 2 staff 1 hour to clean. Recruiting staff is becoming increasingly difficult. With the oil industry

in Lloydminster hiring employees, it is difficult to compete to hire for entry level positions. The Region will need to look at recruiting incentives.

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Measure Current Projected 2011 Projected 2016 Linen weight 868,136 Facility size (square meters)

7,341.3


FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Manager 1.0 1 Laundry Staff 6.2 Housekeeping Staff 14.2 Total FTE = Fulltime Equivalent

Assessment of Current Situation The Laundry facilities have the following challenges: ‐ Lack of storage space for linen. ‐ The dirty laundry holding area is located in the same side as CSR;

there should be a physical barrier between these two areas. ‐ The laundry work area has ventilation issues (dust and heat) with

high static level. ‐ In regards to Housekeeping, the following applies: ‐ Lack of space in the current housekeeping rooms. These rooms

require supply storage and need to be well ventilated. ‐ Although there are staff changes areas located near

Administration, the space is remote from the support service departments who are heavy users of this space.

‐ The staff computer area (used for scheduling) and staff room spaces are tight spaces.

‐ The central equipment storage area is under-sized. Functional Requirements

If a decision is taken to contract the laundry service, the facility will still require a receiving area for the clean linen with a work area to load the linen carts, and a separate soiled linen holding area proximal to the loading dock.

As the facility expands, additional housekeeping rooms will be required. Each housekeeping room requires a sink, floor storage for larger items, shelving storage for supplies, and the room must be well ventilated.

The central housekeeping area requires a large equipment storage area with power outlets to charge the scrubbers. Also required is a soiled area to empty the scrubber tanks.

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Laundry and housekeeping staff members require a locker/change area with a shower facility for both males and females. This space can be shared with other support departments, e.g. facility maintenance.

A waste area with a compactor is required located proximal to the loading dock. Currently, bio-hazardous waste is storage in the basement. There should be an outside (secured) cold storage area for this waste.


External Relationships - Laundry

22. Provide direct access to the loading dock for pick-up of

clean linen and holding for soiled linen. 23. Provide convenient access by general circulation to all

Patient Care Area to facilitate the movement of linen (both clean and soiled).

24. Provide convenient access by general circulation to other

areas in the hospital to facilitate movement of linen and staff.

External Relationships - Housekeeping 1. Provide direct access to the loading dock and for ease of

waste drop-off and pick-up of cleaning supplies from stores. 2. Provide convenient access by general circulation to all areas

of the hospital to facilitate the movement of staff. 3. Provide convenient access by general circulation to Day

Procedures for the movement of patients and staff. 4. Provide convenient access by general circulation to Inpatient

Units for the movement of patients.

Internal Relationships – Laundry If the decision is made to continue with an on-site laundry, the area

requires a separate linen holding area that is located proximal to area that holds the cleaning and drying equipment. A folding area a cart assembly area is required next to the laundry equipment.

Internal Relationships - Housekeeping As mentioned above, the housekeeping rooms are located

throughout the facility. As the facility expands, additional rooms will be required that are strategically located to facilitate an efficient service.

Laundry 1. Loading Dock

Housekp’g 1. Loading Dock


3. Other areas

2. All Hospital Areas

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The central equipment storage area should be located proximal to the manager’s office and central staff facilities i.e. change facilities, staff scheduling area, etc.

Space Summary


Additional (GSM)


Laundry 205.1 0.0 205.1 The area requires reorganization but not additional space

Housekeeping 35.0 30.0 65.0 This is the central Housekeeping area and does not include the closets in the program areas; additional storage space required

Staff Change/Locker Facilities 152.0 40.0 192.0 Should be located near the support areas; additional space for shower/washroom facilities

Total 392.1 70.0 462.1 Notes: (1) The housekeeping rooms located throughout the facility are included in the program area space calculation where the room is located. As the facility expands, additional housekeeping rooms will be added. The Housekeeping space above is the central work/office and storage area only. (2) If a decision is made to contract the laundry service, a portion of the 205.1m2 will be required for a clean linen holding / storage area and a separate soiled linen holding / storage area located proximal to the loading dock.

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.12 HUMAN RESOURCES & LABOUR RELATIONS


6.12 HUMAN RESOURCES & LABOUR RELATIONS

Scope of Service Present Services: Human Resources/Labour Relations in the Lloydminster office consists of the Director Labour Relations, and two Human Resources Consultants. The service also shares clerical with the Administration office, utilizing about 50% or more of Denise Wild’s time. The HR staff also perform other clerical functions themselves since they do not have dedicated clerical support. The Director of Labour Relations is responsible for Out-of-Scope (OOS) advertising, OOS compensation, and overall direction to the Human Resources Consultants who are responsible for Labour Relations, Recruitment and Attendance Management; the Representative Workforce staff and program; as well as shared responsibility for the OH&S Consultant in Lloydminster office and the Return to Work Facilitator in the North Battleford office for the part of their portfolio that is return to work. The one Human Resources Consultant is responsible for: Geographic: Lloydminster and Meadow Lake SUN & CUPE Lloydminster UNA, AUPE

and HSAA. Recruitment for this portfolio.

Jurisdictional: UNA, AUPE and HSAA. PNRHA CUPE.

The other Human Resources Consultant is responsible for: Geographic: Rural SUN & CUPE (Edam, Goodsoil, Cutknife, St. Walburg, Loon Lake,

Paradise Hill, Turtleford, Neilburg, and Maidstone). Recruitment for this portfolio.

Regional Context: Due to the Region having two large centres it makes sense to have HR staffing in two locations in order to support the managers. The majority of the managers and the region’s staff are in these two large centres so it makes sense to have support in both centres. Labour Relations and Recruitment as well as Representative Workforce and Return to Work or Attendance Management are high in priority in the Regional plans due to staffing vacancies and high sick time costs. The one Human Resources Consultant provides services to the Dr. Cooke Extended Care Centre as part of her portfolio and has to maintain knowledge of the three Alberta Collective Agreements. Projected Services: Services should remain the same in the future with increased focus on recruitment efforts. HR sees a need for additional space within the next 5 to 10 years due to increased number of staff. The HR Consultant staffing

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could increase by one. HR also requires dedicated clerical staffing in the future due to increased needs to standardize across the region and due to increased workload, i.e. advertising. This would mean additional office space for up to two persons over time. Additional staffing may also be required in the return to work function in order to better deal with quicker returns when off sick and more ability to make accommodations for those staff returning so they can return to work earlier. Future Trends: A Human Resources data program or ability to track more information in the new payroll or scheduling systems would provide better information for planning without having to spend human resources time on putting the information together. Impact of Technology Technology will not have any impact on HR needs. The number of staff, number of vacancies, recruitment needs, representative workforce program needs will have an impact on needs for services over time. Technology could have an impact on data available for HR planning as indicated above.



Measure Current Projected 2011 Projected 2016 Not Applicable Total


Table 2: Current Staffing Position 2006

Headct 2006 FTE

2011 Headct

2011 FTE

2016 Headct

2016 FTE

HR Consultants – Lloyd office

2 2 3 3 3 3

Clerical - Lloyd Shared 0.50 1 1 1 1 Director LR 1 1 1 1 1 1

HR Consultants – NB office

2 2 2 2 3 3

Clerical - NB 2 2 3 2.5 3 3 HR Consultant – Attendance NB

1 1 1 1 1 1

HR Consultant – recruitment NB

1 1 1 1 1 1

Representative Workforce Coordinator

1 1 1 1 1 1

Return to Work 2 1 3 2 3 2

Total 12 11.5 16 14.5 17 17.0

FTE = Fulltime Equivalent

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Assessment of Current Situation Being located in the Hospital is beneficial for Human Resources &

Labour Relations as it is the largest site with the most management staff in the Lloydminster area and HR can provide better support being on the same site.

The Director has been in the same office for 12 years now and has noted that the location works well. The size of the office is conducive to having a few people to meet with if required without needing a conference room.

The sizes of the HR Consultants office are also conducive to conduct small labour management meetings when required in their offices.

The proximity of the Director to the two HR Consultants is a must and works well in the current set up.

The location within the Administration office allows the HR staff to share the reception, clerical and provide coverage to one another. The personnel files are also in the admin area which is a plus, as well as the proximity to the multi-function machine.

Much of the work of HR staff involves small group and one-on-one meetings. Having offices of adequate size to accommodate this is very beneficial.

Occasional access to a small conference room for interviews is required, although HR staff are able to use the executive conference room at times which is beneficial.


Depending on location, the HR staff need access to printer, photocopier, and fax machine. No other equipment needs other than office equipment for new positions.

It is recommended that the Human Resources & Labour Relations component be located adjacent to ‘soft’ space to allow future growth if necessary.


(GSM) Additional

(GSM) Total

(GSM) Comments

Human Resources & Labour Relations

39.8 12.2 52.0 Additional future growth space may be required depending upon staff growth

Total 39.8 12.2 52.0

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Human Resources & Labour Relations

Administration

Main Entrance

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.13 INFORMATION TECHNOLOGY


6.13 INFORMATION TECHNOLOGY (IT)

Scope of Service Present Services: PNHR IT is based upon an accepted set of business needs: the motivation factors and case for action. The following planning principles and objectives have been defined for Prairie North’s Technical Architecture: Appropriate health information and services will be accessible

regardless of location, time, method of access, and group. Access to health information and services will be authenticated to the

degree required by specific information and services. Information will be protected to the level required both internally and externally.

Coherent and navigable access will be provided across multiple points of interaction for health information and services spanning regional jurisdictions.

Prairie North’s information and services will quickly respond to the client’s changing expectations

Prairie North’s service levels and functionality, focused on citizen value, that are provided via technology improvements will be pursued providing there is no proportional impact relative to costs. Costs and quality will be considered as ‘tradeoffs’ to the citizen value equation.

PNRHA will reduce the total cost of ownership of IT investments through the elimination of duplicate infrastructures or support services and the leveraging of economies of scale.

PNHR IT provides a wide variety of IT services to the health region as well as local service support to the Lloydminster Hospital as defined below: Ensure security and privacy - PNRHA is committed to protecting the

confidentiality, integrity, availability and privacy of its information and assets.

A Corporate Perspective - PNRHA will undertake business management that views architecture from a corporate perspective, with individual facilities operating in consideration of the corporate view. Information and information technology are corporate resources. Information systems will be aligned with business needs and corporate funding priorities. Components will be developed and deployed in alignment with this Enterprise architecture.

Stable Technology - PNRHA will only purchase platforms and operating systems that are tested and generally accepted by the IT industry and will avoid the absolute and newest technologies for implementations where support risk cannot be justified.

Weighs Total Cost of Ownership –achieve the lowest aggregate cost and evaluate all technology in the context of the existing IT/IM architecture. This approach analyzes the full cost of purchasing, implementing and supporting technology over its ‘life-cycle’.

Use of Industry Best Practices – instead of reinventing processes, PNRHA will leverage proven industry standards.

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Reuse before Buying, Buy and Integrate before Building – look at reusing components and applications before investing in new; as last resort, build

Subject Matter Experts – Resources will be properly skilled, trained for their role, and managed with appropriate guidance so they can operate to the best of their abilities

PNHR IT works closely with all departments from an IT support to project management and implementations. The standard hours of operations are 8 a.m. to 5 p.m. Monday to Friday. The on-call service is from 5 p.m. to 11 p.m. Monday to Friday and 8 a.m. to 11 p.m. on Saturday and Sunday. Regional Context: The Information Technology department utilizes a set of principles and standards that provide a blueprint for the deployment of the technology and information infrastructures in alignment with our regions business goals. It consists of strategies, policies, standards and best practices relating to the creation of, access to and protection of information used in the provision of health services; and the development and deployment of hardware and software technology in support of regional, provincial and national Electronic Health Record priorities. The staff members at the Lloydminster Hospital site have regional responsibilities. Projected Services: The Information Technology department is working on multiple regional and provincial projects that require high availability of network and data centre services. The need for enhanced physical security is also a requirement as well as a staging location for computing service. With over 55 existing regional and provincial IT projects, two major projects are currently driving the need for a real data centre for delivery of data, network and computing services within the next year. Having the IT department attached to the Data Centre is a must for physical security as well as workflow needs. It currently makes upwards to 30 trips a day to the existing data centre (wiring closet) when working on support or projects. Future Trends: IT’s involvement and support requirements will continue to increase as the implementation of and advancements of technologies are introduced into PNHR. IT will continue to evolve with role additions/changes to respond to immediate shortages or currently non-existing roles. This will prove to be an increase in local IT support and project staffing requirements. PNHR is the IT Enabler and this will be a positive impact on the overall team. The largest impact will be the requirement for subject matter expertise and the human resource issues of hiring, staffing and placement. With the existing shortage today, we currently have three IT professionals (two Managers and one Senior Analyst) occupying one room. IT is now included in all communication systems, i.e. I.P. phones, nurse call systems, etc. because there is a significant IT component with these communications systems, as well as in the assessment of clinical technology. These trends are likely to continue.

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Other future directions include the availability of computer kiosks for staff, patient access to the Internet, proactive monitoring of the network to avert system problems, and IT support 24/7.



Measure Current Projected 2011 Projected 2016 Projects 55 IT Projects

50% increase - 80 projects

50% increase from 2011 projection – 120 projects

Computers 700 Desktops Server Room 1 Server room # of Facilities Serviced 26 Facilities



FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Director of IT 1 1 1 Manager of Ops 1 1 1 Manager Integrations 1 1 1 Senior Analysts 1 1 2 Analysts 0 3 3 Admin Support 0 1 2 Total 4 8 10 FTE = Fulltime Equivalent

Assessment of Current Situation Although the IT staff are located on site close to the delivery of the

technology services and close to the majority of users for desktop support, the office accommodation is inadequate. The IT offices are located on the second floor in (former) inpatient rooms. Room 222 (former semi-private room) accommodates 3 staff workstations, with manager’s sharing the space. The director’s office (Room 223) which is an inpatient room is also used for storage of IT related equipment. There is no expansion space to accommodate the projected staff increase of 3 by 2011 and an additional 3 by 2016.

The computer training room (Room 7.1.1.) on the second floor has 6 computer workstations and additional training space is required (at least another 6 workstations).

The existing server room (data centre) is located in a closet on the main level. The server room is under-sized for the type of mission critical services it provides. The existing server room is nothing more than a wiring closet with some air-conditioning. It needs to have the power, air conditioning, wiring and security upgraded to industry standard specifications of a hospital data centre.


PNHR IT currently deploys all hardware and software regionally from two major locations - North Battleford and Lloydminster. All hardware

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is ordered in larger quantities and stored locally on site in the Lloydminster Hospital. Since most of the user base is located in the hospital it is preferred for IT to keep the hardware local and close to the office for hardware staging and deploying.

At any time, IT has up to 75 computers, 75 monitors, networking switches, department specific hardware and spare parts like hard drives, keyboards and mice in stock.

There are two mission critical applications that will require an immediate upgrade in space and infrastructure of the existing server room to a data hosting. The term Data Centre is used to reflect the future specification and build of a true Hospital Data Centre to meet the service level expectations of mission critical hospital systems.



4. Provide convenient access by general circulation to the IT area for staff training and ongoing IT support.

5. Provide convenient access by general circulation to the

Administrative Office at the hospital to promote ongoing communication and facilitate IT project planning.

Internal Relationships The following describes preferred internal relationships/concepts: Acoustics All work spaces should be acoustically designed in order to maintain confidentiality of conversations. Security Provide for security of all IT equipment by providing secure lockable space (could have keypad access). The data centre (server room) must have enhanced security. Confidential documents by locating in lockable file cabinets, which can be visually observed from secretarial/clerical areas. Private offices should be provided with lockable doors, individually keyed. Access/Control Provide control of access to staff offices and work areas. Data Centre Requirements The server room must be designed to mitigate against fire and water damage. It needs a well ventilated, cool / dry environment. Also required is an IT Testing/Staging area with the same requirements as the server room. Consideration should be given for an external back-up site.

Information Technology

1. Hospital Staff

2. Admin. Office

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Training Space Computer training space is required that is easily and readily accessible by all staff. Training courses are offered at night and secure and safe access for staff and trainer is a must. Office Concepts IT managers require enclosed offices. Clerical and technical support staff can be accommodated in open concept workstations. Provide for clustering of functional areas within the open office concept, e.g. locate technical staff together.


(GSM) Additional

(GSM) Total

(GSM) Comments

IT Office / Work Area 48.5 100.0 148.5 Require space for 10 staff and storage Data Centre 5.0 55.0 60.0 Require a staging area, a fish

bowl/control centre and server room IT Training Room 31.5 40.0 71.5 Require a training room to

accommodate 12 computer workstations plus demonstration space

Total 85.0 195.0 280.0

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.14 LABORATORY


6.14 LABORATORY

Scope of Service Present Services:

Laboratory services at Lloydminster Hospital include: phlebotomy, specimen procurement, electrocardiograms (ECG), Hematology, Chemistry, Transfusion Medicine, Microbiology and referral Histology. Services are provided for the following Hospital-based programs/units: Inpatient Units - 3rd floor medical unit, transition unit, special care unit,

2nd floor maternity and surgical units. Emergency Services. Surgical Suite. Community Chemotherapy Centre (3rd floor). Pre-operative Assessment Clinic (PAC). Referral specimen testing from the Renal Dialysis Unit 3rd floor). BHCG, pregnancy testing, urea, creatinine urgent and non urgent for

Diagnostic Imaging. Other Ambulatory Care services such as Day Surgery and Endoscopy. Referral specimen testing from on-site Specialists Clinics, e.g. ENT,

Ophthalmology, Dermatology. Services are provided for the following off-site programs/clients: Jubilee Nursing Home and North Wing of DCECC. Some Home Care clients. Referral specimens from Onion Lake. Community clients (outpatients) referred from local and out-of-town

physicians, i.e. approximately 20 per month. Urgent or Stat testing of referral specimens from local the DKML clinics. Periodic requests to test urgent referral specimens from Maidstone

and other PNHR facilities. Hours of operation are as follows: Routine lab services are provided for Inpatients and Emergency

patients Monday to Friday from 7:00 to 17:00. Urgent lab services are provided for Inpatients and Emergency patients evenings and weekends. A tech is on call during the night to provide urgent lab services for Inpatients and Emergency patients.

Routine lab services are provided for community patients (outpatients) Monday to Friday from 8:00 to 16:30.

Regional Context:

The Laboratory is part of the Diagnostic Services for the PNHR; its primary function is to provide services to Lloydminster Hospital Inpatients and Ambulatory Care patients. It also serves community patients (outpatients) from PNHR and ECH, although the large majority of these utilize the two community-based DKML laboratories collection sites in Lloydminster.

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DKML has the contract to provide services to community patients in Lloydminster. Histology testing, autopsies and other non-routine tests are referred typically to Edmonton. Projected Services:

The projected Laboratory services are, to a large extent, dependant upon the future scope and volume of activity at the Hospital. An increase or change in any of the clients or programs that the lab services impacts on its workload in various ways. Any time there is a new specialist that utilizes laboratory diagnostics services, there is an increase in workload. New tests that are brought on board require research, set up, and continued monitoring of use and quality, all which increase our workload and impact staffing.

It is assumed that the current scope of Laboratory services will continue, with the following potential changes and/or service enhancements (including those recommendations arising out of the Diagnostics services review completed in 2006): More specimen processing/accessioning/data entry. Enhancement of on-site Microbiology services. Potential addition of Pathology services in the future.

Determining services to community clients depends on agreements with DKML. Increases or decreases in testing menus will be determined by a regional lab advisory committee. There is a proposal to bring fibrinecton testing on board, a point of care test. Future Trends: An aging population will increase the workload of the Laboratory, as the elderly tend to need more diagnostics services. More acute care patients with a higher level of acuity are expected, increasing the demand for STAT testing. Available human resources is a concern for the lab and creative plans will be needed to decrease workload and/or improve efficiency. Electronic records will help the transfer of information to be more efficient. Impact of Technology: Implementation of the Triwin lab system has improved some areas of the workflow and improved record retention for the lab disciplines utilizing the LIS. There are still some workflow issues, which may be improved with a different staff mix. Impact to the patient has been that all patients need to register in Wincis, before entering the LIS to ensure that the lab visit is tied to the correct visit in Wincis. POC testing needs to be monitored by the lab. Telehealth saves enormous travel time and is a very useful tool.

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Measure Current 2006/07

Projected 2011 Projected 2016

Lab Tests/Procedures 204,435a Lab Workload Units 938,173 Total Note: a. Number of tests/procedures grew by 32% between 2005/06 and 2006/07 and 21% between 2004/05 and 2005/06; i.e. 61% total growth in the past two years.


FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Total FTE = Fulltime Equivalent

Assessment of Current Situation The open design of the lab is a positive feature, providing flexibility

and relatively functional work space. The current location close to Emergency and the Operating Rooms is

good for the collection of urgent blood work. Similarly, Emergency and the Operating Rooms have easy access to blood products.

The microbiology department is small, and if the workload were to increase it could become crowded. A separate area could be looked at, but removal from the general lab would make it difficult for micro to help with coverage in the main lab.

Transfusion Medicine Department is also a little cramped. Reorganization of the lab could help the space restrictions in this area.

There are pockets of under used space in the lab that could be better utilized if the space was reorganized.


The main change to the lab at this time is the area of the outpatient reception. Other more specific functional and equipment needs in the near future include:

Chemistry systems are due for replacement. Coagulation instruments need upgrading. Vitek is due to be replaced. Serofuge is needed for Transfusion Medicine. Blood bank fridge for Transfusion Medicine is due to be replaced.

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New blood gas instrumentation is required for fetal scalp pH, (ionized calcium too)

Blood culture reader has been experiencing capacity problems. Telephone head set, and telephones are in poor shape and due for

replacement. For the Master Plan, it is recommended that future lab growth space

be earmarked for the addition of on-site Pathology.


(GSM) Additional

(GSM) Total

(GSM) Comments

Laboratory 291.2 80.0 371.2 Proposed additional space to add Pathology services; could be separate form the main lab if necessary.

Morgue 34.0 0.0 34.0

Total 325.2 80.0 405.2


External Relationships 25. Provide direct access by internal circulation to Diagnostic

Imaging to facilitate the movement of patients and to share facilities.

26. Provide direct access by general or internal circulation to

Emergency to facilitate the movement of patients and staff. 27. Provide direct access by general or internal circulation to

Ambulatory Care to facilitate the movement of patients.

Laboratory 1. Diagnostic Imaging

2. Emergency

3. Ambulatory Care

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.15 MATERIALS MANAGEMENT


6.15 MATERIALS MANAGEMENT


Materials Management procures medical supplies, office supplies, medical equipment and services for: Lloydminster Hospital: Third Floor (Acute Care)

- Replenish shelves and exchange ICU cart twice weekly - Fill IV orders twice weekly and office supplies once a week

Dialysis Unit - Receive and store dialysis supplies (bi-weekly) and replenish

exchange carts three times weekly Chemotherapy

- Fill medical & office supply orders once weekly Day Surgery & Endoscopy

- Replenish carts twice weekly - Fill IV orders twice weekly and office supplies once weekly

Obstetrics - Replenish shelves twice weekly (medical supplies & IV solutions 4

times weekly) - Fill order for office supplies once weekly

Emergency - Exchange and replenish supply carts twice weekly - Fill orders twice weekly for IV solutions and once weekly for office

supplies Operating Rooms

- Fill medical supply and office supply order once weekly Diagnostic Imaging

- Replenish supply carts once weekly - Fill CT order once weekly

Laboratory - Replenish supply cart once weekly

CSR - Fill order once weekly - Submit order for all wraps, custom packs for OR weekly as non-

stock All above departments (with the exception of Dialysis) also submit non-stock orders on as needed basis. Other departments such as Registration, Administration, Health Records, Pharmacy, Gift Shop, Finance, etc order on as needed basis for non-stock supplies. Inventoried office supply orders are filled once weekly. Dietary

- Submits non-stock order for dietary disposables on as needed basis (weekly)

Housekeeping - Order filled once weekly for paper towels, garbage bags, toilet

tissue, etc. Laundry

- Orders chemicals on as needed basis (non-stock)

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- Orders linen when needed (space concern) {kept in stock at Dr. Cooke Extended Care Centre}

Materials Management, in cooperation with Maintenance, picks up supplies in Lloydminster (local vendors) and deliver to Battlefords & rural facilities. This also includes repaired equipment or equipment sent to Battlefords to the Biomedical Engineer for assessment.

Dr. Cooke Extended Care Centre (LTC) - 12 hours per week Materials Management position - Stores person orders medical supplies, briefs, nutritional

supplements and stocks carts, transfers pharmaceutical supplies - Picks & packs linen order for region - Supplies delivered from Materials Management once a week - Supply of briefs stored in stores area and distributed to wards

Jubilee Home (LTC)

- Approx 2 hours per week Materials Management position - Stores person orders medical supplies including briefs, Jevity

(nutritional supplements) and stocks shelves in central locations - Supplies delivered from Materials Management once a week

Community Services Building

- Orders are submitted weekly (stock & non-stock) and delivered once a week

Rural Facilities served include:

- Cut Knife Health Complex - Manitou Health Centre (Neilburg) - Maidstone Union Hospital - Pine Island Lodge (Maidstone) - Maidstone Community/Public Health Services

All sites above submit orders to Materials Management twice weekly (stock & non-stock) departments include nursing, housekeeping, dietary (disposables) and laundry (chemicals)

- Riverside Health Complex (Turtleford) - Lady Mints Health Care Centre (Edam) - St. Walburg Health Complex - Paradise Hill Health Centre

Above sites submit orders to Materials Management twice weekly (stock & non-stock) departments include same as above rural facilities

- Orders for all rural facilities are delivered twice a week - Biohazard waste is collected from the rural facilities and brought

to the Lloydminster Hospital for storage until picked up ( once every two weeks) {chilled storage space}

Materials Management reconciles invoices for purchases of supplies for Lloydminster and its rural facilities. As well as medical supplies and office supplies, invoicing is done for maintenance purchases, and all other purchases for all departments in Lloydminster and area including rural facilities.

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Hours of operation in the Lloydminster Hospital Materials Management department are 0700 - 1530 Monday to Friday. Staffing is as follows: 1 – OOS Purchasing Manager 1 – (FT) Stores person/Purchasing Clerk 4 – (FT) Stores person/Vehicle Operators Materials Management also purchases products for outside facilities such as Pharmacies, Vet Clinics, Fort Pitt, clients/residents, ambulances and first responders, etc on a cost recovery basis. Regional Context

Materials Management provides services to the rural facilities throughout the region include: Pricking and packing of supplies for all departments and loading onto

platform trucks in receiving, delivering supplies twice weekly, returning second platform truck to Lloydminster Hospital receiving for stocking with supplies

Delivery of drugs from Lloydminster Hospital Pharmacy to rurals Pick up of lab supplies (for rurals) and vaccines from Battlefords and

distributed throughout rural facilities and Lloydminster facilities Pickup and delivery of mail from & to Battlefords Hospital and inter-

office mail distributed to rural facilities. Transfer needed equipment throughout region Delivery of medals on wheels occasionally Pick up biohazard waste for transfer to Lloydminster Hospital Communicate with staff at rural sites with questions or concerns

regarding supplies, equipment & service Management of Capital plan:

Materials Management adheres to and supports the capital planning process, regionally, as determined by Finance.

Management of Preventative Maintenance contracts:

Lloydminster Materials Management houses the Regional Director position so an additional office near MM is required

Pandemic Planning Surplus equipment available throughout region need space also for

certain amount of supplies Projected Services

With the projected expansion/regeneration of the Dr. Cooke Extended Care Centre, Materials Management would need to be involved insofar as having space to house supplies and an area for receiving fright. One rebuild/expansion must coordinate with the other. It is expected that the Dialysis Unit will expand from 5 to as many as 12 stations which will mean more than a 100% increase in supplies kept in the stores area. More space will be required for dedicated cart storage. Other service increases could include:

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Home Care office relocation to the Hospital site. More computerization, bar coding proposed. Wound and skin care service supplies.

Future Trends

The impact of technology and medical advances in the Materials Management department are very challenging insofar as keeping up with the needs of medical professionals. Advances are very evident on a daily basis, i.e.: Equipment Dressings Technology incorporated into our Materials Management E-system

would simplify some processes, however, controls must be in place. With the population growth and resultant services, Materials

Management requires consideration as we grow relative to program expansions, i.e.: Dialysis Program - each chair relates to 15-20% increase in volume with a program already short by 400-500 square feet of shelving.

Recruitment and retention of well qualified people is also an ongoing challenge for the department as it is such a “workers” market environment. Impact of Technology Bar coding is a big issue - the old technology not yet in place; it would

bring about more accuracy. Some procedure changes result in more product handling (i.e.

disposable drapes as opposed to reusable). Computer awareness and program understanding make retention of

staff a priority.


Measure Current Projected 2011 Projected 2016 Incoming # of pieces 490 700 1,000 Outgoing # of pieces 140 280 450 Total

Weekly Average


FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Manager 1 1 1 1 1 1 Purchasing Clerk 1 1 1 1 1 1 Stores person/Driver 7 4.5 7 5 8 6 Skin/Wound Care Ns 1 1 1 1 2 1.5 Total FTE = Fulltime Equivalent Staffing - unless full-time positions, it is difficult to retain staff, thus many growing paints

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Have very good staff now – all working at maximum efforts. OH&S could become a concern if workload continues to increase.

Assessment of Current Situation

Best: We are situated in the hospital; in close proximity to other support services.

Worst: growth is magnified; space may be as much as 50% low. Exterior space/access is only about 60% effective; also need better access to waste recycle areas. Lack of space in stores area is an ongoing issue.


All other systems/programs/services have an impact on Materials Management. This is evident in the expansion of existing services such as Dialysis, Radiology/CT. It will also become evident in the addition of new services such as gaining a new surgeon in the near future, expansion of facilities (Dr. Cooke), and implementation of SIS program for surgical bookings.

Processes throughout the week: ‐ Monday – fright received from various vendors & sources; fright

delivered to Pharmacy, Lab, etc. All fright, with the exception of pharmaceuticals checked, received into system, delivered to appropriate department or put on rural platform trucks, stocked on shelves, received into system. Local purchasing done (Wal-Mart, Home Hardware, etc.) for non-stock items. Third Floor and Day Surgery/Scopes carts & shelves replenished. Dialysis carts stocked. Dialysis supplies received, checked and stored every second week. Stock orders for rural deliveries on Tuesday pricked & packed. Dr. Cooke stores person replenishes carts and distributes briefs. Issuing of supplies entered on system. Phone calls and drop-ins regarding supplies & services dealt with. Repairs and returns to vendors packaged.

‐ Tuesday – Delivery driver loads van with supply carts, delivers to rurals (also takes mail and drugs) picks up mail from rurals as well as Battlefords Union Hospital. (Delivery route includes BUH, Maidstone, Cut Knife and Neilburg.) Shelves/carts are stocked for Maternity and emergency. IV orders are filled for all floors. Dr. Cooke supplies are delivered. Jubilee supplies are delivered. Materials Management at Dr. Cooke delivers supplies and replenishes carts. Materials Management puts supplies away at Jubilee Home. Received fright in materials Management, puts away or distributes to appropriate departments, receives into system. Enters issues into system. Start filling orders for rurals for Wednesday.

‐ Wednesday – Delivery driver loads platform trucks full of supplies onto truck, delivers to rurals (route includes Turtleford, St. Walburg, Edam and Paradise Hill), also takes mail & drugs; picks up mail from rurals to be distributed throughout the region. Office supply orders are filled for Lloydminster Hospital (all departments). Lab X-ray and CT supply carts replenished. Freight received as on Monday, Tuesday. Computer work completed. Fill orders for

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Thursday deliveries. Dr. Cooke stores person replenishes carts and delivers briefs.

‐ Thursday – Same as Monday for supplying Lloydminster Hospital; same as Tuesday for rural facilities.

‐ Friday – Same as Tuesday for supplying Lloydminster Hospital; same as Wednesday for rural facilities.

In addition, all invoice reconciliations are done daily, purchasing is done daily and stocking of shelves in Materials Management is done daily. This in addition to phone calls, drop-ins and last minute order. Cardboard boxes are broken down daily and all pallets are stored outside.

Materials Management currently has stationery shelving on Third Floor (2 supply rooms) as well as Maternity (1 supply room, IV room and LDR). Other departments have exchange carts (Emergency, ICU). Shelving was installed in preparation for bar coding, but not yet in place. Current shelving system is not user friendly vs carts. Equipment needed in Materials Management: ‐ Electric fork lift (better usage of higher shelving ‐ Shelving to complete bar coding ‐ Digital camera (to record damages, etc.) ‐ Bar coding hardware – scanners

Space Summary


Additional (CGSM)


Materials Management 273.0 177.0 450.0

Total 273.0 177.0 450.0



Materials Management

1. Laundry

2. Food Services

3. Dialysis

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.16 MEDICAL / TRANSITION INPATIENT SERVICES


6.16 MEDICAL UNIT/SPECIAL CARE UNIT/TRANSITION UNIT (Includes future psychiatric beds)

Scope of Service Present Services: Medical Unit The Medical Unit consists of 28 acute medical/paediatric beds and 2 palliative care beds for a total of 30 inpatient beds operating 24 hour with professional nursing service. Special Care Unit The Special Care Unit has 3 beds in operation (with a capacity of 4 beds) with 1 space considered an isolation area. The unit has one nursing staff assigned at all times. It operates as a sub-unit of the medical unit. The unit provides 24 hour professional nursing care for up to three non-ventilated patients who are critically ill. Transition Unit The Transition Unit is a relatively new service that opened approximately one year ago. The unit is a 6-bed service that provides sub-acute and active rehabilitation. The average length of stay is approximately 2 weeks, with a maximum length of stay of 60 days. The patients tend to be older individuals who require active rehabilitation post surgery, post stroke, etc. Regional Context: Existing programs and services offered fit within the plan to deliver acute care to ill patients to the City of Lloydminster and surrounding areas. Under the Saskatchewan Health guidelines for hospitals, the Lloydminster Hospital is considered a regional centre. Services provided by a Regional Hospital (as per The Facility Designation Regulations – Chapter R-8.2 Reg 6 (effective December 16, 2005) are as stipulated below: 8. If a facility or part of a facility is designated as a regional:

(a) It must provide to inpatients and outpatients: i. Medical services; ii. Basic radiology and laboratory services; iii. Fluoroscopy and computerized tomography diagnostic

services; iv. Emergency stabilization services; v. Observation and assessment services; vi. Convalescent and palliative care; vii. Surgical services; viii. Obstetrical services; ix. Intensive care services; x. Special medical services in the areas of internal medicine,

general surgery, obstetrics and gynecology; and

(b) It may provide any of the following: i. Specialty medical services in areas including, but not limited

to, orthopedics, ophthalmology, urology and otolaryngology; ii. Rehabilitation services

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iii. Services mentioned in clauses 5(f) to (o) (long term care, health assessment and screening services, counselling services, therapy services, referral services, health education services, health promotion services, disease and injury prevention services, chronic disease management services, and disability management services.

Projected Services:

The medical, special care and transition beds support a city population of over 25,000 and an area population of approximately 90,000 and this population is expected to increase to over 100,000 within the next decade. The number of beds will need to increase to support the projected population and to fulfil the regional centre role. It is anticipated that the Special Care Unit will eventually function as an Intensive care unit. It is also expected that inpatient acute psychiatry beds will be required. Based on the projected population and scope of services, the following bed requirements have been identified:

Program Projected Bed Range Comments Medical Unit 56 to 60 beds 2 units of 28-30 beds with approximately

16 private rooms (2 rooms with isolation ante rooms) and 6-7 semi-private rooms; includes pediatric beds

Special Care Unit 4 to 6 beds Should be built to support an ICU level of care

Transition Unit

6 to 10 beds All private rooms with dining and rehabilitation space

Psychiatry Unit

8 to 10 beds All should be private rooms; will require common dining area

TOTAL 74 to 86 beds An evaluation of the transition unit found that this program is an effective approach to transitioning patient from acute care back to the community. Another finding was that the program is appropriately situated within an acute care setting because of the acute care supports required to support the patient, e.g. specialty physician services, acute rehabilitation services, etc. Future Trends: New technology will mean more time for patient care and patient teaching. Medical advances will have an impact on length of stay, which will decrease, and acuity of care, which will increase. Nurses will require more training as they become more specialized and knowledgeable technologically. The aging population will have an impact on numbers of elderly patients in acute care compared to the younger population, therefore a greater need for training in geriatric care. The numbers of nursing professionals that are retiring coupled with the fact that it is a challenge to the RN positions will likely mean more LPN’s will

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need intensive training and/or the ability to complete RN training in a more reasonable time frame. Impact of Technology Technology will have an impact on sending patients to tertiary centres for diagnostic tests, specialist consultation. Diagnosis and treatment will be affected. The use of the electronic record will increase communication flow and follow up.



Measure Current Projected 2011 Projected 2016 Average Length of Stay (Acute Care) Days

3.9 3.6 3.6

Occupancy Rate 81% 80% 80% Average Length of Stay (Transition Unit) Days

17.8 14.0 10.0

% Discharged Home from Transition Unit

75% 85% 85%


Table 2: Current Staffing – Medical Unit & Special Care Unit – 33 beds Position Day Shift Night Shift Manager (1) 1 0 Registered Nurse (2) (3) 4 3 Licensed Practice Nurse 4 2 Ward Clerk 1 0 Total 10 5 FTE = Fulltime Equivalent Notes:

(1) Manager works days Monday to Friday (2) One RN works an 8-hour shift on days; all other staff work a 12-hour shift (3) One RN is assigned to the Special Care Unit

It is anticipated that the staffing for a 30-bed medical unit will be similar to the above staffing. The current staffing for the Special Care Unit, i.e. 1 RN per shift will increase as the number of beds increase and the level of acuity increase. The nurse to patient ratio for intensive care patients ranges from 2:1 to 1:1 depending on the level of acuity. Table 3: Current Staffing – Transition Unit – 6 beds Position Day Shift Evg Shift Night Shift Licensed Practice Nurse (2) 1 1 0 Special Care Aide (3) 1 1 1 Total 2 2 1 FTE = Fulltime Equivalent Notes:

1. The Medical Unit Manager oversees the Transition Unit. 2. The LPN works an 8-hour shift. 3. The Special Care Aide works a 12-hour shift.

It is anticipated that the staffing will increase with a projected 10 beds in operation.

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Table 4: Projected Staffing – Psychiatry Unit – 8 to 10 beds Position Day Shift Night Shift Manager (1) 1 0 Registered Nurse 2 1 Licensed Practice Nurse 2 1 Ward Clerk 1 0 Total 6 2 FTE = Fulltime Equivalent Notes:

(1) Manager will work days Monday to Friday (2) One RN works an 8-hour shift on days; all other staff work a 12-hour shift (3) One RN is assigned to the Special Care Unit

It is anticipated that the unit will also have access to other Mental Health professional, e.g. psychiatrist, psychology, social work, etc.

Assessment of Current Situation The 30-bed medical unit, the 3-bed special care unit and the 6-bed

transition unit are located on the 3rd floor of the hospital. Of the 30 medical beds, eight (8) private rooms are available with 2

rooms used for palliative care patients. There are 2 rooms with 3 beds in each in use (which were originally used as 4-bed rooms) and the remainder are semi-private rooms.

When there is pediatric admission, the child is most often admitted to a semi-private room and the other bed is closed during that admission allowing space for the parent(s) within the room. Pediatric admissions increase during the flu/respiratory infection season. A pediatric lounge area has been created in Room #3.1.18.

The Special Care Unit is rated as a 4-bed unit with 3 beds in operation. One space is considered an isolation area. The unit is an open bay concept. These rooms should be single patient rooms given the acuity of the patients.

The Transition Unit uses 4 private rooms and 1 semi-private room. A dining area has been created (in a semi-private room) in Room #310 as part of the rehabilitative program approach, i.e. patients are encouraged to have their meals in a common dining area. As well, a satellite rehabilitation room has been created using a 4-bed patient room (Room #316).

The 3rd floor is designed with all service rooms located in the middle of the wings while the patient rooms are on the outside.

Space deficiencies include: ‐ Insufficient number of single patient rooms ‐ Inadequate space for equipment (recliner chairs for immobile

patients, patient lift equipment, wheelchairs, walkers, commodes) ‐ Congested nursing desk area when doctors do their a.m. rounds ‐ Inadequate space for nurses to meet with their team members to

discuss care issues and do their charting ‐ Patient lounge area used for equipment storage


The majority of patient rooms should be single room accommodation. This is a best practice direction that promotes infection control, patient privacy and confidentiality. At a minimum, 50 percent of the

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medical unit rooms should be private, all special care rooms’ private, and all psychiatry rooms private.

A medication room is required on each unit. Medications are dispensed by a unit dose system. Each patient has a drawer labelled with their name containing their medications in the medication cart. The RN prepares the IV medications by a minibag system administered by a secondary IV line. Supplies are stored in the Supply Room delivered by the Stores staff on a regular basis.

The Special Care Unit should be designed as an intensive care unit. Therefore, all patient rooms must be single rooms and include a patient zone (with overhead lift), a family zone and a staff zone. In most cases, there are large pieces of equipment that must be in the room, e.g. a ventilator.

The Transition Unit requires rehabilitation space and common dining room space.

This Psychiatry Unit will require a common dining / recreation area.


6. Provide direct access by internal circulation to the special care unit to promote sharing of common space and staff resources.

7. Provide convenient access by internal circulation to

facilitate the movement of staff and patients between the inpatient unit and diagnostics (i.e. diagnostic imaging).

3. Provide direct access by internal circulation to the medical unit to promote sharing of common space and staff resources.


facilitate the movement of staff and patients between the inpatient unit and diagnostics (i.e. diagnostic imaging).

a. Provide convenient access by internal circulation to facilitate the movement of staff and patients between the medical inpatient unit and the transition unit.

b. Provide convenient access by general circulation to the

central rehabilitation service.

Special Care Unit

1. Medical Unit


Medical Unit 1. Special Care Unit


Transition Unit

1. Medical Unit

2. Rehabilitation Services

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Internal Relationships The following describes preferred internal relationships/concepts: Nursing Desk The nursing desk should be located proximal to the patient rooms. For the psychiatric and the special care units, the patient rooms should be observable from a central nursing desk. Support Space The support space, e.g. medication room, clean supply room, etc. should be located in the core of the inpatient unit for ease of access by staff members. Transition Unit The patient rooms should be located proximal to the satellite rehabilitation space and the common dining room. Pediatric Requirements Some of the patient rooms should b earmarked for pediatric inpatients. These room should be single room accommodate with space for the parent to room in. A pediatric lounge space should be located nearby.

Space Summary


Additional (GSM)


Medical Unit 1,266.8 893.2 2160.0 Bases on 60 beds @1,080 CGSM per 30-bed unit

Special Care Unit (1) 84.3 515.7 600.0 Based on 10 beds ICU @ 60 CGSM per bed

Transition Unit (2) 258.5 141.5 400.0 Based on 10 beds @ 40 CGSM per bed Psychiatric Unit (2) 0.0 400.0 400.0 Based on 10 beds @ 40 CGSM per bed Total 1,609.6 1,950.4 3,560.0

Notes: (1) Space projection based on the assumption that the Special Care Unit will

be an intensive care unit as per the definition of services for a regional centre.

(2) CGSM for the transition and psychiatry units slightly higher than the allocation for a medical inpatient bed because of the need for common dining and rehabilitation space that is not necessarily required on a medical inpatient unit.

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.17 OBSTETRICAL / SURGICAL INPATIENT SERVICES


6.17 OBSTETRICAL / SURGICAL INPATIENT SERVICES


Obstetrical and Surgical Inpatient Services are currently provided on a combined unit comprising 19 inpatient beds, i.e. 12 maternity beds (antenatal, labour and delivery, postpartum) and 7 inpatient surgery beds. Some of the 19 beds swing between obstetrics and surgery as necessary to meet day-to-day workload fluctuations. Observations regarding the present services: The growing (and unpredictable) obstetrical patient volume is having

an impact on the availability of surgical beds, which results in elective surgical admissions being delayed or cancelled. Depending upon availability, these same beds are also utilized for those Day Surgery patients, who by 1900 hours are not ready for discharge and need to be admitted, as well as for overflow medical patients.

Surgical procedures are booked 5 days a week; the current scope of procedures encompasses general surgery and gynecology, but no orthopedics, which are referred to Camrose, Edmonton and Saskatoon.

C-Sections and twin deliveries are done in the OR’s located on Level 1; there is a room intended to serve as a C-Section OR located on the 2nd level obstetrical unit that is used as a back-up 3rd delivery room.

Most newborns room-in with the mother; the Nursery is used primarily for sick babies and babies of recovering mothers who are unable to care for their newborn, e.g. some C-Section moms.

NST’s and labour assessments are done on the inpatient unit - could become part of Ambulatory Services in the future.

There are 2 General Surgeons; a 3rd has been recruited and is expected to arrive by mid 2007; an Orthopedic Surgeon is also being recruited and expected to begin performing surgical procedures at the Hospital within the short term.

There are 2 Obstetricians/Gynecologists; obstetrical services, including deliveries, are also provided by general practitioners.

Regional Context

The role of the Lloydminster Hospital as a regional referral centre for both obstetrics and surgery has grown in recent years and is expected to increase further. Key factors include: Access to specialist Obstetricians/Gynecologists based in Lloydminster

and the availability of procedures such as epidurals. The increase in General Surgeons including the expected addition of

orthopedic surgery. Access to other services that can have an impact on surgical

volumes, e.g. Endoscopy, CT, Dialysis. There are no obstetrical or surgical services in the surrounding rural

area in PNHR.

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There are limited obstetrical and surgical services in the surrounding area in ECH, resulting in referrals to Lloydminster Hospital from communities such as Vermilion, Wainwright and Provost.

The City of Lloydminster is growing in its role as a regional market/ service centre for residents living within a radius of up to 50 to 100 kilometres.

Projected Services

The planning of Obstetrical and Surgical Inpatient Services needs to consider: Accommodating potentially significant increases in both the

obstetrical and surgical workload volumes in response to: projected population growth, a high percentage of young population, the regional referral role, increases in staff resources.

Separating obstetrics and surgery into two inpatient units; the current mix has a number of drawbacks and with the anticipated increase in beds, separate units should be planned.

Obstetrics would prefer to move to a LDR service model that has labour and delivery occurring in the same room, after which the mother is moved to a post-partum bed. The LDR rooms and post-partum rooms should be grouped into two separate but adjoining clusters.

Implementing Family Centred Maternity Care, a PNHR initiative. This includes the capability for fathers to room-in, which is difficult in the current facilities due to double rooms, lack of space, etc.

The pre-admission of maternity patients. The addition of orthopedic surgery. A future increase in the number of Pediatricians in Lloydminster.

Future Trends

The following service directions and trends are expected to influence obstetrical and surgical inpatient services at the Lloydminster Hospital. The increasing acuity and complexity of patients, e.g. more complex

surgery, more acute post-surgical care, higher risk maternity patients and potentially less stable newborns, increased numbers of inductions and epidurals. Trends such as these are already having a significant impact on staffing resources, particularly nursing.

The increase in infectious, transmittable and resistant diseases, resulting in a greater need to adequately screen and isolate patients.

A growing regional population that has a relatively high ratio of persons in the young child-bearing age (i.e. the annual number of births continue to rise), as well as growth in the over-65 age group.

Shorter length of stay increases the demand for information, patient education and support to be provided in a condensed period of time, as well as the need for increased liaison/follow-up with Home Care and Community Health Services. Patients from the rural areas don’t always have the necessary supports available upon discharge.

The number of nursing professionals that are retiring coupled with the challenge in filling all of the RN positions means more LPN’s will need

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intensive training and/or the ability to complete RN training in a reasonable time frame. Also, new staff need training time and mentoring.

Impact of Technology The use of the electronic record will increase communication flow

and follow up. Implementation of the Lab Information System and RIS-PACS. Specialists eager to have technology similar to tertiary care.


Table 1: Historical & Projected Workloads

Measure 2006/07 Projected 2011 Projected 2016 Surgical Inpatient Services - Beds in Operation 7 21-25 - Separations 416 - Patient Days 1,158 - Average Length of Stay 2.8 - Average Daily Census 3.2

Obstetrical Inpatient Services

- Beds in Operation 12 12 + 3 ante

partum + 4-5 LDR’s

- Separationsa 1,362 - Patient Daysa 3,178 - Average Length of Stay 2.3 - Average Daily Census 8.7

- Live Births 874 - Newborn Patient Days 1,536 - Average Length of Stay 1.8 - C-Section Rate 13.3%

Notes: a. Includes gynecology patients

Current Staffing & Projections Current staffing includes: Day Shift Night Shift RNs 3 x 12 hrs RNs 3 x 12 hrs LPN 1 x 12 hrs + 1 x 8 hrs LPN 1 x 12 hrs + 1 x 8 hrs Ward Clerk 1 x 8 hrs ‘Desk’ RN 1 x 8 hrs With the increasing workload and level of acuity and complexity of patients in obstetrics and surgery, the current level of staffing is stressed, resulting at times in less than optimum care. There is inadequate time for activities such as patient teaching. Because Housekeeping staff are available only between 06:00 and 22:00, nursing staff are required to perform housekeeping duties between 22:00 and 06:00, e.g. cleaning delivery rooms.

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The Hospital has been unsuccessful in securing a nurse manager for this area.

Assessment of Current Situation

The combined Obstetrical and Surgical Inpatient Unit, located on the 2nd floor, has a number of space issues as noted in the following points. The use of semi-private rooms is not conducive to Family Centered

Care and limits the ability to increase the utilization of the surgical beds. Also, the semi-private rooms are too small for stretcher access.

The nursing station is distant from the majority of the obstetrical area and lacks privacy.

The medication room is undersized. Access to a night cupboard is on the 3rd Floor for orders after 16:30 and on weekends.

There is no staff conference and report room (use the Nursery). The Nursery is likely oversized at this time given that most newborns are

rooming-in. However, space in the Nursery for activities such as circumcisions, etc. is not very functional.

There are inadequate facilities to support Family Centred Care, e.g. family lounge, nutrition station.

A number of the patient showers are non-functional. Finishes such as floors, ceilings and walls are in need of upgrading;

issues regarding mould have also been reported. Space for equipment and supplies needs to be better planned. Staff noted issues regarding the functioning of equipment such as

monitors, IV pumps, thermometers, BP monitors, as well as the need for a microscope.

Require access to a staff on-call room located in proximity to the unit.

Functional Requirements For purposes of the Master Plan, the following functional requirements of the Obstetrical and Surgical Inpatient Services will need to be addressed. Providing separate inpatient units for Obstetrics and Surgery.

However, the units should be located on the same floor and adjacent to allow the sharing of resources where appropriate and when necessary.

Increase in numbers of beds, i.e. consider the potential of increasing the number of surgical beds by a factor of two to three.

Moving to a higher percentage of single bedrooms – suggest a target of 100% in Obstetrics and an initial target of 50% in Surgery. Over the longer term, surgical beds should also move as close as possible to 100% singles.

Converting the Obstetrics unit to an LDR model – estimate a need for 4 to 5 LDR’s at the outset with the capability to add more.

Improving the facility/space deficiencies identified under the Assessment of Current Situation.

Space Summary


Additional (CGSM)


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Additional (CGSM)


Combined Obstetrical & Surgical Inpatient Unit

1,041

Obstetrical Inpatient Unit - separate 730.0 Assume 12 pp beds + 3 ante partum beds + 4-5 LDR’s

Surgical Inpatient Unit - separate 940.0 Assume 21-25 surgical beds

Total 1,041 629.0 1,670.0 Notes: Existing Delivery Rooms are 29.7 sqm and 25.3 sqm., which are close to

current guidelines. Existing Case Room is 36.8 sqm., but lacks the appropriate support

areas such as sterile supply, recovery room, etc. if it was to be used as an OR.

Existing Nursery is 50.0 sqm.


Surgical Inpatient Unit

1. Obstetrical Inpatient Unit

2. Surgical Suite


Obstetrical Inpatient Unit

1. Surgical Inpatient Unit

2. Surgical Suite


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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.18 OPERATING ROOMS


6.18 OPERATING ROOM/DAY SURGERY& PAC/CENTRAL SUPPLY

Scope of Service Present Services: This component covers the operating room, central supply, day surgery and Pre-Admission Clinic (PAC) functions. The scope of services is described below. At present, there are two operating room theatres along with an

adjacent recovery room that holds two stretchers. The holding area can also accommodate two stretchers.

The theatres are booked Monday to Friday to run approximately 8 hours. Only one theatre is operated at a time. This is being evaluated at present to find ways to operate both theaters at the same time as needs are changing.

Staffing at present is usually five staff persons. One registered nurse covers the recovery room. The staff comes in on staggered hours in order to cover for lunches and late theatre cases. Once the regular shift is over, the on call staff comprised of two individuals remains to finish the outstanding slate and or emergencies that have arisen.

There are six day surgery beds available for use on a given day. The staffing is generally one registered nurse and one licensed practical nurse. On select days an additional staff is brought in to assist. The staff of this department does all the PAC for the surgical department. The area operates 12 hours per day during the week.

There is one booking clerk along with an assistant who is available to do some of the paper work for day surgery. This includes the work done for the Saskatchewan Registry program.

Central Supply is operated by two staff persons, one of which is fulltime and the other part time. They are scheduled to work Monday to Friday only. They do the processing for the entire hospital as well as the necessary supplies for the operating room. The area has recently converted to disposable packs which have eased some of the work load. However, there continues to be days when the reprocessing is not done by the end of the CSR staff shift resulting in the operating room staff having to clean up the case carts.

Regional Context: Lloydminster Hospital is one of two regional hospitals in PNHR with a surgical service. Projected Services: The surgical services are provided by two general surgeons, two

gynecologist/obstetricians, local dentists and visiting ophthalmologist, and EENT. Another general surgeon will be arriving by the summer of 2007.

Discussions are underway for a visiting orthopedic specialist to perform day surgical procedures. These additional physicians will impact the operating room OR time available, the day surgery area, the

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available surgical beds and central processing volumes. A future direction could be the recruitment of an urologist.

At present, the feasibility of operating the two theatres at least twice a week to allow for additional time for the anticipated general surgeon and orthopedic specialist is under review. There is consideration required not only in the supplies required but also the availability of inpatient beds (plans are underway to see if discharges can be better facilitated in this area to accommodate more surgery until more beds and staff become available) and day surgery beds.

The other consideration that needs to be reviewed is how best to offer the Pre-Admission Clinic (PAC) to pre-operative patients. An evaluation on the PAC program is in process (with the thought of having one person assigned to this function).

Future Trends: With advances in medical technology, more surgical procedures are

being done on a day surgery basis. As well, less invasive surgical procedures (e.g. using scopes) are another trend.

With more procedures being done on an outpatient basis, additional day surgical spaces coupled with longer hours of operation (up to 23 hours stay) is a key trend.

New technology and equipment require larger operating theatres. New wireless technology will improve communication.



Measure Current Projected 2011 Projected 2016 Surgical Services OR Cases 1,664 3,200 6,400 OR Procedures 2,041 4,000 8,000 Day Surgery Visits 2,164 3,400 4,300 Total Notes: Projections for 2011 based on 2 ORs in operation Projections for 2016 based on 4 ORs in operation

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FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

OR Nursing Staff 7.0 5 14.0 10 28.0 20 Recovery Room Nurse

1.4 1 2.8 2 5.6 4

Day Surgery RN 1.4 1 2.8 2 2.8 2 Day Surgery LPN 1.4 1 2.8 2 2.8 2 CSR Staff 2.8 2 5.6 4 6.0 4 Booking Clerk 2.8 2 3.0 3 3.0 3 Total 16.8 12 31.0 23 48.2 35 FTE = Fulltime Equivalent Notes: OR staffing for 2011 based on 2 ORs in operation; 5 days per week; 2016 staffing based on 4 ORs in operation; 5 days per week Projected Day Surgery staffing based on 12 patient spaces

Assessment of Current Situation The two operating room theatres are sized within the suggested

space guideline of a general OR suite (40-60 m2). OR#1 is 60.3 m2 and OR #2 is 51.6 m2.

There is a case room on the second floor that was originally designed to perform caesarian sections. Because of physician and staff coverage, this space has not been used for this purpose and is used as a back-up LDR/case room.

The Surgical Suite lacks a proper patient entry and holding area. The circulation space within the Surgical Suite is quite tight.

The Surgical Suite lacks sufficient space for case carts, clean supplies and soiled items.

There are two recovery beds to support the 2 ORs. The space is very tight and lacks a staff workstation and storage area for supplies / stretchers. There should be 2 recovery beds per OR.

In regards to the Pre-Admission Clinic (PAC) to pre-operative patients, there is no assigned space for surgical consults at present. Open bed space is being used when available but if the department there is no available space other than the hallways.

The day surgery spaces (6 spaces) are located on the second floor in former inpatient space. With the plan to repatriate inpatient beds, the day surgery area will need to be located elsewhere preferably in outpatient/ambulatory care space on the main level (the same level as the Surgical Suite).

Operational and related space concerns identified by staff are listed below: There is no available staff to cover late shifts in central supply and on

weekend. The workload on Monday can be overwhelming. The space is limited with no room for expansion. As well, the layout adjacent to the laundry is unacceptable in today's standard. The workflow is less than ideal and needs to be changed with renovations. This is exactly the same in the operating room where the flow of contaminated items crosses over the main area of the theatre.

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The operating room runs late on many days. Consideration must be looked at in the future to changing hours of work to cover for the late and emergencies on the slate. At present, there is planned proposal for an operating room/ central supply aide to do some of the non nursing duties to free up time to assist in operating a second theater. It is becoming apparent due to the nursing shortage that nursing not be responsible for non nursing duties. Skilled personnel should be used for the job they are trained to do.

When the theatres run late, there are issues regarding the adequacy of recovery room staff coverage.

Day surgery spaces operate at capacity and there are not enough inpatient surgical beds for the types of procedures and number of admissions. This is always a consideration for bookings. More surgical beds are a necessity in this growing community. An option is to have day surgery spaces used for overnight stays Monday to Friday to accommodate some of the surgery patients requiring a longer recovery period. This will become more apparent once a second theatre is in operation.

The issue of caesarian sections is an ongoing one. Emergencies must be available to be done on the unit without expecting the staff to move the patient and all the necessary equipment and supplies down the elevator to the operating room. The unit itself should be able to accommodate the emergencies with staff being available to go upstairs to assist. The timeframe and energy expended in moving the patient at this stressful time must be eliminated. It is expected that this will be an issue if a second theatre becomes operational and the need for an emergency or urgent c-section arises when both theatres are in use.


With the projected population growth for Lloydminster coupled with the planned increase in the number of surgeons coming to the area, it is anticipated that additional operating room theatres and recovery spaces (2 recovery spaces per OR) will be required along with additional support space, i.e. supply storage, additional circulation space, etc.

The number of day surgery spaces will need to grow from the current 6 spaces up to 12 beds.

The PAC requires assigned space (i.e. an office and a clinic examination room) preferably located with other ambulatory care services and located in proximity to the day surgery area.

Depending on the decision about contracting Laundry services, Central Supply could expand into a portion of the Laundry space. Additional processing space will be required with an expanded OR program.

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1. Provide convenient access by general circulation from Emergency for the ease of patient transfers.

2. Provide convenient access by general circulation for the

transfer of patents to the Surgical Inpatient Units.

3. Provide convenient access by general circulation to Day Surgery and PAC for the ease of patent movement to the Surgical Suite.

4. Provide direct access by general circulation for the

transfer of patients from the LDR.

5. Provide direct access to Central Processing for the delivery / pick up of case carts.

Internal Relationships Surgical Suite

Spatial Organization for Surgical Suite The organization of the Surgical Suite should be based on the following major principles:

The maintenance of aseptic control in operative and associated areas.

The efficient movement of patients, staff and supplies according to preoperative, operative and postoperative procedures.

The efficient and effective communication throughout the department.

Surgical Suite/ Recovery 1. Emergency

2. Surgical Inpatient Units

3. Day Surgery /PAC

4. LDR

5. CSR

OR OR

Sterile Core

OR OR

Support Space Recovery

Control

Pre-Op Holding

Staff Support

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Restricted and Semi-Restricted Areas. The Surgical Suite will be divided into unrestricted, restricted and semi-restricted areas. Restricted areas are designed to higher infection control standards, have more stringent access and clothing restrictions. ORs have the most stringent infection control restrictions. Core and corridors are semi-restricted. Non-sterile areas have more relaxed access and clothing restrictions. Non-Restricted spaces ‐ Pre-Op holding (and Day Surgery Unit) ‐ Staff Locker Rooms / Lounge ‐ O.R. Admin and Educational support ‐ Peripheral housekeeping rooms Semi-Restricted ‐ OR support spaces ‐ Central sterile core ‐ Recovery ‐ Diagnostic Imaging equipment ‐ Internal Housekeeping Rooms Restricted ‐ Within the OR’s

Special Requirements for Surgical Suite

Infection Control Infection control is achieved through:

Zoning the Surgical Suite into restricted, semi-restricted and non-restricted zones

The use of impervious, durable, easily cleaned surfaces Easily cleaned equipment that tolerates hospital approved

disinfectants. Specially designed HVAC systems in conformance with the CSA

standard for Health facilities. This includes special provisions for OR’s, clean corridors, and PARR such as HEPA filtered air. Some of the special provisions for OR’s include: ‐ HEPA filtered supply air system distributed through laminar flow

diffusers and ducted ground level return air. ‐ Hand wash sinks in conformance with CSA and CHR standards. ‐ Maintain separation between hoppers and flash sterilizers. ‐ Hand washing facilities throughout

Security Public access to the Surgical Suite is limited to the suite entrance

adjacent to the reception desk/ nursing station. Other access points are controlled with electronic door hardware incorporating a pass code or security card system.

Recovery Area Recovery accommodates a minimum 1.5 to 2 recovery

stretchers/beds for each OR.

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Each stretcher position is provided with a telephone, intercom/nurse call, emergency call button (code blue), electrical and medical gas outlets, a computer charting station with integrated monitoring, physiological monitoring and storage for beside supplies. The stretchers are sufficiently spaced to accommodate portable IV poles a ventilator and a recovery team.

Internal Relationships Day Surgery Area / PAC The spatial organization of this component should be generally as shown in the functional diagram below.

Internal Relationships Central Supply

NURSES STATION

CONF. /

MEDICATION

SUPPORT SPACE

WAITING ROOM

Reception shared with

PAC

PATIENT SPACES (UP TO 12)

PAC Clinic

Space

DAY SURGERY/ PAC

Decontamination

Equipment Processing

Cart Washing

Washers/ Sterilizers

Equipment Holding

Cart Holding & Assembly

Processing, Packaging & Holding

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General Requirements The primary design consideration for sterile processing is the

unidirectional flow of instruments and equipment from the soiled to the clean/sterile areas, as indicated in the diagram above.


(GSM) Additional

(GSM) Total

(GSM) Comments

Surgical Suite Existing Space OR#1 – 60.3 sq.m. OR #2 – 51.6 sq.m. Recovery – 41.2 m2 Other - 186.9 sq. m. (incl. locker/ change rooms)

340.0 420.0 760.0 Additional space includes the addition of 2 ORs, support space, additional 6 recovery beds and enhanced storage, case cart area and locker/change room space

Central Supply 187.3 90.0 277.3 Additional space required to support expanded ORs

Day Surgery Area 127.2 112.8 240.0 Day surgery spaces expanded to 12; space calculated @ 20GSM per space

PAC 0.0 40.0 40.0 Require an office, clinic examination room and support space

Total 654.5 662.8 1317.3

Notes: Assumes caesarean sections will be performed in the Surgical Suite.

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.19 PHARMACY


6.19 PHARMACY

Scope of Service Present Services: The pharmacy program provides pharmacy services to the hospital and to the Dr. Cooke Extended Care Centre, providing medications and working medication administration records for patient care. The department also provides services to rural facilities, i.e. Edam, Turtleford, Cutknife, St. Walburg, Neilburg and Paradise Hill and Material Management delivers the supplies. The Emergency department and Operating Rooms have stock supplies and access to night cupboards. Pharmacy technicians fill ward stock orders for all patient areas of the hospital. They also regularly check for expired product in all areas. Pharmacists answer medication questions from physicians, nurses, and other health care providers. They also participate in multi-disciplinary groups. If fully staffed, clinical pharmacy services will become more available to the ward areas and to patient individual programs (e.g. basic anticoagulation teaching). The department is currently in a one year old renovated area on the second floor of the hospital. Hours of operation are Monday-Friday from 0800 -1630 hours. There is no structured call back. Phone calls and rare call-backs do happen. Regional Context: Pharmacy fills supply (medication) orders for 7 rural facilities. Projected Services: When fully staffed, the department should investigate implementing an IV add program (currently recruiting a 0.8 pharmacist position and a 0.6 technician position). The hours of operation will likely be extended as the volume of patients and required pharmacy services increase. Because of insufficient staff, participation at DCECC has declined and would be resumed in ideal conditions. Involvement in chronic disease management clinics (e.g. diabetes, COPD, etc.) from a clinical pharmacy services perspective is likely. Future Trends: Changes in the scope of pharmacy services will be aligned with changes that happen in acute care. Use of technology will support the provision of safer and better services to the patients, such as computerized physician orders and bar coded medication check processes. Computer physician ordering will be coming in the near future, which will change the scope of part of services. Information links, e.g. lab work values etc. will also improve service coordination and delivery.

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FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

Manager 1.0 1 1.0 1 1.0 1 Pharmacist 1.1 3 3.0 5 3.0 5 Technician 3.0 3 5.0 5 5.0 5 Total 5.1 7 9.0 11 9.0 11 FTE = Fulltime Equivalent Notes: Projected staff based on the following assumptions: - Supporting 100-115 acute care beds - Supporting expanded ambulatory care programs

Assessment of Current Situation Pharmacy was recently renovated in 2005. The space is adequate for

future growth requirements. The location is quite good - second floor (near the acute care areas).

There will probably be a few functional requests through time but a lot of them have been dealt with during the renovation, e.g. equipment requirements for an IV add service, i.e. a second freezer, and a second hood installed in the clean room.

In the current location, the department no longer has access to the pneumatic tube system.

The chemotherapy anteroom has cupboard storage. The cupboards should be removed and shelving installed. The sink in the clean room should be removed.


Pharmacists will require access to patient consultation space in the ambulatory care area and inpatient areas for counselling purposes.

Pharmacy currently provides medications via unit dose, ward stock and night cupboard. An automatic night cupboard has been on the wish list for a few budgets. This tool would be easier for nursing to use and would better control inventory for pharmacy.

Pharmacy fills patient specific carts with unit dose meds on a bi-weekly program. New admissions or changes to medications are filled as orders come in. A “tub deliver system” was not included in the renovation so there are many trips made around the facility in one day.

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Ambulatory to facilitate the movement of staff. 2. Provide convenient access by internal circulation to the

inpatient and transition units to facilitate the movement of staff.

3. Provide convenient access by internal circulation for the

movement of supplies. Internal Relationships

Generally, the overall lay-out and space relationships of the pharmacy are quite good within the department. There is sufficient space for future growth.

Space Summary


Additional (GSM)


Pharmacy 207.5 0.0 207.5

Notes: It is assumed that clinical pharmacy support space (i.e. assessment rooms and medication space) will be included in the inpatient and ambulatory care areas for use by pharmacy staff.

Pharmacy 1. Ambulatory Care

2. Inpatient & Transition Units

3. Material Management

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.20 THERAPIES


6.20 THERAPIES

Scope of Service Present Services: The Therapies Department provides rehabilitation services for both inpatients and outpatients (adults and pediatrics), which includes physiotherapy and occupational therapy. The department works in conjunction with Nursing, Speech Language Pathology, Physicians, Social Work, Home Care and Pharmacy to deliver comprehensive rehabilitation services within an acute care setting. A physician referral is not required to access the department. The department has both a centralized and decentralized approach to service delivery. The main department is located on the main floor of the hospital and there is a satellite rehabilitation space on the 3rd floor. Hours of operation: 0700 – 1630 hours Regional Context: The Therapies Department works in partnership with all patient care programs to ensure a regional integrated service delivery approach. Projected Services: A new pediatric program called TIPS – Therapeutic Integrated Pediatric Services, began in 2006. Because a larger pediatric assessment and treatment area was required to support this program and no additional space was available within the department, the program was located off-site in the Co-Op building downtown, a less than ideal location. Therapies are to play a role in the Chronic Disease Management strategy. Space to accommodate a group education/exercise session may be required. A stroke strategy will be part of this initiative. Future Trends: New technology: will increase the budget and additional space will be required for new equipment. The aging population coupled with the projected population growth of the Lloydminster area will increase the workload both in inpatients and outpatients. Currently, support staff time is required to manually collect health records and x-ray reports. The electronic health record would enable therapists to access reports independently without having support staff to leave the dept. to manually collect them. The Therapies department will require updated and appropriate equipment to perform electronic records and access electronic records.

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Measure Current Projected 2011

Projected 2016

Visits 8563 10,000-12,000 12,000-14,000


FTE 2006

Headct 2011 FTE

2011 Headct

2016 FTE

2016 Headct

PT 4.2 5 6.0 6 6.0 6 OT 0.6 1 3.0 3 3.0 3 PTA 1.8 2 3.0 3 3.0 3 Ward Clerk 1.0 1 1.0 1 1.0 1 Total 7.6 9 13.0 13 13.0 13 FTE = Fulltime Equivalent

Assessment of Current Situation The Therapies department is located on the main floor of the hospital,

which is an accessible location. There is a large, open gym concept within the department. As well as an open gym area, the treatment area also includes 2 hi-lo mat areas, 3 treatment cubicles, and 1 pediatric room and a private assessment room.

There is a satellite treatment room on the 3rd floor to support inpatients.

Space issues within the department include: - Insufficient equipment storage space (including locked storage

space) - Insufficient space within the staff charting area - No outside light into the department - Pediatric therapy room is too small with poor storage - Only one private assessment room and 2 are required - Senior therapist’s office doubles as an assessment room which

should not be a duel function space - No open floor/gym space to assess patients walking/ running

ability - Inadequate waiting area – require at least 3 waiting spaces - Administrative area lacks file storage space

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28. Provide direct access by internal circulation to Ambulatory to

facilitate the movement of patients and staff and share administrative support space.

29. Provide convenient access by internal circulation to the

inpatient and transition units to facilitate the movement of patients and staff.


Generally, the overall lay-out and space relationships of the main department are quite good within the department. The space deficiencies are noted above.

The staff charting area looks into the main gym area and this functional relationship should be maintained. The private assessment/treatment spaces should be located way from the main gym area.

The administrative workstation which provides the reception function should be located proximal to the patient waiting area.

Space Summary


Additional (GSM)


Main Therapy Department 180.0 100.0 280.0 Additional space required for storage, treatment and staff support space

Satellite Therapy Space 42.7 0.0 42.7 A 4-bed patient room being used on the 3rd floor

Total 222.7 100.0 322.7

Notes: It would be a preferred direction to locate the main department with other ambulatory care services. A satellite space to support inpatient rehabilitation activities should remain.

Therapies 1. Ambulatory Care

2. Inpatient & Transition Units

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LLOYDMINSTER HOSPITAL FUNCTIONAL PROGRAM & MASTER PLAN 6.21 VOLUNTEERS & LADIES AUXILIARY


6.21 VOLUNTEERS & LADIES AUXILIARY

Scope of Service Present Services: Volunteers Services include the gift shop administration and patient visiting/support. The Volunteer Coordinator’s office is located in the Community Services building. The coordinator is responsible for volunteer services at the hospital, DCECC, Jubilee Home and Pioneer Lodge. The coordinator is the liaison with the Ladies Auxiliary. There are 15 active volunteers at the hospital.

The Ladies Auxiliary is a specific volunteer program that focuses on fund-raising to support patient care activities and comforts. Over $39,000 was raised last year. This group also coordinates the activities of 16 community knitters and these products are sold in the gift shop and at local farmer’s markets. Each spring, a tea and bake sale is held in the cafeteria and the adjoining 2 meeting rooms. There are 21 active members and several honorary members.

Regional Context: As mentioned above the Volunteer Coordinator oversees volunteer services at a number of sites in Lloydminster. The Ladies Auxiliary is specific to the Lloydminster Hospital. Projected Services: In the future, Volunteers will be increasing support in ambulatory care, e.g. portering activities for people coming for a day procedure/surgery. As well, the Volunteer Coordinator is looking to increase the number of 1:1 visits with patients, assist with meal delivery, and assist patients during meal times. In regards to the Ladies Auxiliary, the members are aging and it is increasingly difficult to recruit new members. The group is looking at other strategies to engage the community such as expanding community group activities beyond the knitters. Future Trends: Most volunteer services are facing challenging times when recruiting new volunteers. Tapping into to high school and college students who require a community placement as part of their curriculum is a strategy being undertaken, as well as targeting volunteers for time limited projects. Offering more flexibility in the hours of operation for volunteers is another strategy.

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Headct 2006 FTE

2011 Headct

2011 FTE

2016 Headct

2016 FTE

Volunteer Coordinator

1 0.3 1 0.5 1 0.5

Hospital Volunteers

15 N/A 20 N/A 25 N/A

Ladies Auxiliary 21 N/A 20 N/A 25 N/A Total 37 0.3 41 0.5 51 0.5 FTE = Fulltime Equivalent Notes: On average, up to 10 volunteers will be at the hospital at any given time.

Assessment of Current Situation Volunteers Services As mentioned earlier, the Coordinator’s office is location in the

Community Services building located next to the hospital. The location does not pose an issue.

The program has a closet in the administrative area where volunteers go to sign in. They do not have a locker or lounge area to stow personal items or to check their assignment.

Ladies Auxiliary The Ladies Auxiliary does not have any dedicated space at the

hospital. The group holds monthly meetings (the first Monday of each month at

2:00 pm) in Conference Room #1 which works well. The group lacks storage space to store their products, wool, etc. They

store some products in the gift shop office which is less than ideal. Some files are stored in the basement of the hospital.


Volunteers Services The program should have a volunteer lounge area with lockers. In future, card swipe access to a volunteer space should be

implemented. The volunteer lounge and lockers should be located in an accessible,

welcoming location. Ladies Auxiliary The Ladies Auxiliary should be encouraged to access the volunteer

lounge space. A dedicated storage area should be assigned to the group to store

their products, wool, etc. The group can continue to book meeting space for their monthly

meetings or use the volunteer lounge area for small meetings.

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8. Provide convenient access by general circulation to Ambulatory Care to facilitate patient portering by volunteers.


patient care areas to facilitate the volunteer patient visiting service.

5. Provide convenient access by general circulation to the volunteer lounge to promote sharing of this space with the Ladies Auxiliary.


general bookable meeting space at the hospital.

Internal Relationships The following describes preferred internal relationships/concepts: Access/Control Provide control of access to the lounge/work area from the public reception/waiting areas. The storage space must be lockable space.


(GSM) Additional

(GSM) Total

(GSM) Comments

Volunteers 5.0 35.0 40.0 Additional space for a volunteer lounge/work area and lockers; current space is a closet in the Admin suite

Ladies Auxiliary 0.0 10.0 10.0 Additional space assigned for storage Total 5.0 45.0 50.0

Ladies Auxiliary

1. Volunteer Lounge/Work Area

2. Meeting Room Space

Volunteers 1. Ambulatory Care


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