CIRCULATION SYSTEM IN A HOSPITAL

SUBMITTED BY:
MARC- 136 ATAULLA KHAN
DISSERTATION- I M. ARCH. (HEALTHCARE ARCHITECTURE)
1ST SEMESTER, SESSION- 2016-17
JAMIA MILLIA ISLAMIA, New Delhi-25
ABSTRACT:
Circulation in
Architecture is defined
as the way people move
through and interact
with a building.
Hospital planning starts
with Circulation
The purpose of studying the circulation system in building is to
lead to a smooth flow of people traversing the building and
hence the smooth flow of activities in a building.
The basic objective of an efficient circulation system is to
minimize travel time of the users of the hospital.
So that the activities can be fast, efficient, comfortable and
utilize the least amount of energy in moving from one place to
another.
DEFINING CIRCULATION:
Circulation in Architecture is defined as the way people move
through and interact with the building.
Structures such as elevators, escalators and staircases are often
referred to as circulation element, as they are positioned and
designed to optimize the flow of people through a building.
Circulation is also defined as the orderly movement through a
circuit. The word ORDERLY implies PURPOSE, and PURPOSE
implies DESIGN.
Departments in a
Hospital

Functional
linkages between
Departments

Vertical Activity Horizontal

Flow Activity Flow
OVERVIEW OF HOSPITAL
A hospital is a health care institution providing
patient treatment with specialized staff and
equipment.
The best-known type of hospital is the general
hospital, which has an emergency department. o During peacetime,
A district hospital typically is the major health hospitals can be
care facility in its region, with large numbers of indicated by a variety of
symbols. For example, a
beds for intensive care and long-term care. white 'H' on a blue
Specialised hospitals include trauma background is often
used in the United
centres, rehabilitation hospitals, childrens States.
hospital, seniors' (geriatric) hospitals, and o During times of armed
conflict, a hospital may
hospitals for dealing with specific medical be marked with the
needs such as psychiatric problems and certain emblem of the red
disease categories. cross, red crescent or
red crystal in
Specialised hospitals can help reduce health accordance with the
care costs compared to general hospitals. Geneva Conventions.
A GENERAL HOSPITAL CONSISTS OF THE FOLLOWING DEPARTMENTS
DEPARTMENTS OUTPATIENT DEPATMENT
ACCIDENT & EMERGENCY SERVICES
DAY CARE SERVICES
INPATIENT SERVICES
OPERATING UNIT
INTENSIVE CARE UNIT
LABORATORY SERVICES
MEDICAL IMAGING SERVICES
BLOOD TRANSFUSION SERVICES
MORTUARY SERVICES
MEDICAL RECORD SERVICES
ADMINISTRATIVE UNIT
LAUNDRY SERVICES
CENTRAL STERILE SUPPLY DEPARTMENT
CATERING SERVICES
EXTERNAL CIRCULATION IN A HOSPITAL

Patients, attendants and visitors

Vehicular
staff

Movement
Ambulances
Pedestrian

Service vehicles for mortuary, kitchen, laundry

Fire vehicles as per fire norms

Patients, attendants and visitors

staff
MAIN ENTRANCE AND LOBBY AREA OF HOSPITAL
SYNTHESIS: USER ACTIVITY FLOW
The users in a hospital can be divided into the following two categories:

OUTSIDE USERS

These include: Patients. attendants, relatives, friends, visitors.

- The patients are the prime users in a hospital.

- The attendants are those who accompany the patients in various
activities checkups, surgery, or staying with the patient in IPD.
- Relatives and friends are those who visit the patient in IPD or ICU
- Visitors those who come for donation of blood in blood bank, include
volunteers, students etc.

It is understood that the outside users are not acquainted with the
system in a hospital. the location of various departments and how to
reach them. Hence, way finding is an important aspect in a hospital
INSIDE (IN-HOUSE) USERS

These include: Doctors, nurses, administrative and other staff

These users can be divided into 6 categories:

1. Medical Staff

2. Nursing Staff

3. Para Medical and others

4. General Administrative Staff

5. Fire and Security

6. Engineering services
Generally, the OPD departments in a hospital include:
1. General Medicine
2. General Surgery
3. Obs & Gynae.
4. Pediatrics
5. Orthopaedics
6. Otorhinolaryngology (ENT)
7. Opthalmology
8. Burns & Plastic surgery
9. Psychiatry
10. Dental Surgery
11. Dermatology
Apart from the above, Doctors specialists are required in Emergency
Services. Anesthesia, Radiology, Pathology, Forensic Medicine &
Community Medicine and Blood Bank
SEQUENCE OF ACTIVITIES
PATIENT AS *A1: Patients first visit to a hospital
A USER
*A2: Patient takes reports from laboratory and imaging services

*A3: Patient brought in IPD

*A4: Patient brought into ICU

*A5: Patient brought to OPERATION THEATRE

*A6: Patient brought into EMERGENCY

*A7: Patient goes to/ taken to IMAGING SERVICES

*A8: Patient goes to DAYCARE

*A9: Patient dies and is taken to MORTUARY

PATIENTS FIRST VISIT TO A HOSPITAL
Inquiry/ Registration
Waiting Area
Reception Desk Counter

Exam/ Treat OPD Respective

End ment/minor OT consultation Deptt. In OPD-
etc. room sub waiting area

Sample
Imaging
collection (sent
Department *A7
to lab)

Wait for reports/

come later- *A2
SEQUENCE OF ACTIVITIES
PATIENT *B1: Patient attendant accompanies the patient in OPD
ATTENDANT
AS A USER *B2: Patient attendant takes reports from laboratory or imaging
services
*B3: Patient attendant stays with the patient in IPD

*B4: Patient attendant accompanies patient in ICU

*B5: Patient attendant accompanies the patient to OT

*B6: Patient attendant brings in the patient to emergency

*B7: Patient attendant accompanies the patient to imaging services

*B8: Patient attendant accompanies to day care

SEQUENCE OF ACTIVITIES
RELATIVES/ *C1: Patient relatives visit patient in IPD
FRIENDS
AS A USER
*C2: Patient relatives visit patient in ICU

*C3: Patient relatives go to Mortuary

*C4: Visitors go to Blood Transfusion

Services
KEY FLOW CHART OF A GENERAL HOSPITAL

Source: Hospitals Facilities planning and management, GD Kunders

FLOW CHART OF NURSING DEPARTMENT

Source: Hospitals Facilities planning and management, GD Kunders

FLOW CHART OF A SURGICAL SUITE

Source: Hospitals Facilities planning and management, GD Kunders

FLOW CHART OF OBSTETRICS DEPARTMENT

Source: Hospitals
Facilities planning and management, GD Kunders
FLOW CHART OF OUTPATIENT DEPARTMENT

Source: Hospitals Facilities planning and management, GD Kunders

FLOW CHART OF ADMINISTRATIVE DEPARTMENT

Source: Hospitals Facilities planning and management, GD Kunders

NBC 2005

Corridors and Passageways:

4.8.1 Exit corridors and passageways shall be of width not less than
the aggregate required width of exit doorways leading from them
in the direction of travel to the exterior.
4.8.2 Where stairways discharge through corridors and
passageways, the height of corridors and passageways shall be
not less than 2.4 m.
4.8.3 All means of exit including staircases lifts lobbies and corridors
shall be adequately ventilated.
Internal Staircases:

4.9.1 Internal stairs shall be constructed of non-combustible materials

throughout.
4.9.2 Internal stairs shall be constructed as a self-contained unit with
an external wall of the building constituting at least one of its sides
and shall be completely enclosed.
4.9.3 A staircase shall not be arranged round a lift shaft.
4.9.4 Hollow combustible construction shall not be permitted.
4.9.5 No gas piping or electrical panels shall be allowed in the
stairway. Ducting in stairway may be permitted if it is of 1 h fire
resistance rating.
CASE STUDIES:
CONTEMPORARY RESEARCH PAPERS:

Wayfinding is more than signs.

A stronger management concern for the patient experience, as
part of a market share focus,
means that old systems such as endless standard signs (and even
worse, colored stripes on the floor) are being replaced by more
information,
More interactive systems. Electronic kiosks, computerized direction
systems, and planning that is clear and modular,
Even without signs, are the new tools in helping patients and
families navigate the hospital and to make it more accessible to
them.
Modular Planning:
Recent experience in medical planning by large healthcare
organizations has shown the value of working within a standardized
typical planning module to organize a flexible structure that can
adapt to future needs.
Hospitals of 50 years ago reflected the planning assumptions of the
times, that narrow wings of patient rooms were desirable to allow for
natural ventilation, and that once planned the hospitals diagnostic,
treatment, and support areas were relatively static.
Current thinking is quite the opposite; while patient units take a form
specific to their function, and are seldom modified for other functions
later, the rest of the hospital needs to be easily adaptable and
expandable without disruption to ongoing operations.
The discipline of an overall planning module encourages these kinds
of alternatives.
Worldwide, the trend is toward an overall hospital planning module
that can accommodate either a large ward or pairs of patient
rooms, groups of typical exam rooms, one large special purpose
room such as an operating room, or groups of structured parking
bays.
The future hospital: A Logical Planning Approach
Because a hospital is by definition all about people and movement,
planning has to start with circulation systems as a basic framework
for any concept:
l The main public entrance needs high visibility and easy access,
leading to the main public space
An outpatient entrance, also visible but separate from inpatient
and visitor traffic, leads to ambulatory care clinics
Emergency Medicine needs a separate away from public traffic,
but convenient to outside access
The service entrance and loading bays need to be easily
accessible but out of public view
Drop off and parking needs to be conveniently provided for all
types of traffic
Hospital staff parking, separate from patients, needs to be close to
a 24 hour entry
How it works
Circulation starts with secure login and automatic verification of
customer health
insurance and ride eligibility.
Patient contact and health information is auto-populated into the
system from health
system records.
Circulation enables hospitals to schedule and manage
transportation around patients
needs and preferences. Scheduling can be done as far in advance
as needed and
reoccurring appointments can be booked with a simple click to
eliminate task duplication.
 The platform asks if patients require wheelchair assistance or help getting
in/out of a vehicle; if they are hearing/vision impaired; travel with a caregiver;
and other important factors to determine the best vehicle selection.
A growing number of vehicle types are available through Circulation,
including uberX and uberXL, and in some cities other options are available,
such as UberACCESS.
Ride reminders and real-time notifications can also be automatically sent to
both patients and their caregivers via phone, text or email to enhance
communication.
All billing and payment reconciliation with Uber and healthcare
organizations is seamlessly handled on the backend of Circulations system.
To help mitigate fraud and abuse, Circulations utilization performance
tracking functionality gives administrators the ability to set triggers and detect
suspicious activity.
 BIBLIOGRAPHY:

Hospitals Facilities planning and management, GD Kunders

Modern trends in Planning and Designing of Hospitals, Shakti Kumar
Gupta, Sunil Kant, R Chandrashekhar, Sidhartha Satpathy
Hospital Information system in Medicare an experience at Tata main
hospital, Jamshedpur, Mohanty Rajesh, Rana Sarosh D, Kolay Saroj K
Assessing User Satisfaction of using Hospital information System (HIS) in
Malaysia, 2011 International Conference on Social Science and
Humanity, Singapore.
Evaluation of hospital information system in the Northern Province in South
Africa, report prepared for the Health Systems Trust, by the Medical
Research Council of South Africa.
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