Professional Documents
Culture Documents
Outpatients Gazetted
Outpatients Gazetted
FACILITY GUIDES
Outpatient
Facilities
Gazetted
8 May 2015
Task Team: B:03
Supported by:
Document tracking
Version Date Name
Date Version Name
06/02/2013 Discussion Draft 1 E Fleming
19/12/2013 Discussion Draft 1 E Fleming/M Coetzer
03/2014 Proposal V.1 E Fleming/M Coetzer
31/03/2014 Proposal V.1 E.Fleming/CduTrevou
20/06/2014 Proposal V.1 E Fleming/M Coetzer
27/7/2014 Proposal V.1 E Fleming/Meirovich
28/11/2014 Proposal V.2 G Abbott
8 May 2015 Gazetted National Health Act,2003(Act
no.61 of 2003)
INFORMATION NOTES
Abbreviations
CHC - Community Health Centre
CR - Computer Radiography
DICOM - Digital Communication System
DR - Digital Radiography
EC - Emergency Centre
ENT Ear-nose-throat
GIT - Gastro-intestinal Therapy
HIS - Hospital Information System
HPCSA - Health Professionals Council of South Africa
IHPF - Integrated Health Planning Framework
IUSS - Infrastructure Unit Support Systems
NDoH National Department of Health
OoM Order of Magnitude
OPD - Outpatients Department
PHC - Primary healthcare
PACS - Picture Archiving Communication System
POPD - Paediatric Outpatient Department
RIS - Radiology Information System
STP - Service Transformation Plan
PART G - ........................................................................................................................... 83
1. Applicable legislation ............................................................................................................ 83
Recommended
Recommended
Recommended
Recommended
CROSS-CUTTING
ISSUES
Essential
Essential
Essential
Essential
Adult inpatient Admission, x Generic room x Integrated
services administration requirements infrastructure
and related planning
services
Clinical and General x Hospital design x Briefing manual x
specialised hospital principles
diagnostic support
laboratory services
guidelines
Mental health x Catering x Building engineering x Space guidelines X
services for services
hospitals
Adult critical Laundry and x Environment and x Cost guidelines x
care linen sustainability
department
Emergency x Hospital Materials and x Procurement
centres mortuary finishes
services
Maternity care x Nursing Future healthcare x Commissioning
facilities education environments health facilities
institutions
Adult oncology x Health facility Healthcare x Maintenance x
facilities residential technology
Outpatient Central sterile x Inclusive x Decommissioning
facilities service environments
department
Paediatrics and x Training and Infection prevention x Capacity
neonatal resource and control development
facilities centre
Pharmacy x Waste disposal x Information x
technology and
infrastructure
Primary Regulations x
healthcare
facilities
Diagnostic x
radiology
Adult physical x
rehabilitation
Adult post-
acute services
Facilities for
surgical
procedures
TB services x
Colours legend
Planners and Consultants
Procurement Administrators
Related documents
1. Policy context
The Outpatients Department (OPD) is Outpatient care covers clinical care or treatment administered in
the ‘shop window’ of the healthcare a medical office, clinic, community health centre or hospital that
facility. It is one of the departments does not require an overnight stay in a hospital or medical
everyone is likely to visit at least once, facility. Such treatment is also referred to as ambulatory care and
and the initial impression of the
includes preventive, promotive, curative and rehabilitative
service, building and its organisation is
services.
likely to remain.
This document addresses the planning and design of
accommodation for outpatient departments that are attached to,
or part of, an acute hospital that offers either district, regional or
tertiary services.
Hospital based outpatient services may include:
Outpatient department which may include general services or specialist clinics in
family medicine, internal medicine, surgery, orthopaedics, paediatrics, obstetrics,
gynaecology, cardiology, gastroenterology, endocrinology, ophthalmology, dentistry
and dermatology – depending on the level of services provided by the hospital
Day care facilities where patients have surgery that is “same-day”1 i.e. The surgery is
performed on the patient as an out-patient service and the patient goes home the
same day. Day surgery procedures do not require hospitalisation of the patient
Rehabilitative outpatient services which may include physiotherapy, occupational
therapy, speech therapy, audiology, and
Hospital emergency centre (EC): Most visits to hospital emergency departments do
not require hospital admission and can include walk in patients (ambulatory).
Although generally classified as outpatient services, this document does not include the
following:
Emergency care covered in the IUSS document “Emergency Centres”
Rehabilitative care covered in the IUSS document “Adult Rehabilitative Facilities”
Clinic and Community Health Centre outpatient services covered in the IUSS
document “Primary Healthcare”
Maternity outpatient care covered in the IUSS document “Maternity Care Facilities”
and
Paediatric outpatient care covered in the IUSS document “Paediatric Facilities”
District hospital Regional hospital Tertiary hospital Central hospital Specialist hospitals
50–600 beds 200–800 beds 400–800 beds Max 1 200 beds Max 600 beds
Family medicine Internal medicine Internal medicine Super specialties TB
and sub-specialities in the disciplines
of internal medicine listed for tertiary
Including Gastro- care and including
Intestinal Therapy oncology and
(GIT) nuclear medicine
General surgery Surgery and sub- Mental health
specialities of
surgery
Specialities: Specialities and
- Obstetrics and sub-specialities:
Gynaecology - Obstetrics and
- Orthopaedics Gynaecology
- Ophthalmology - Orthopaedics
- Ophthalmology
- Neurology
- Urology
HIV/Aids Paediatric Paediatric Paediatric
Rehabilitation Rehabilitation Rehabilitation Rehabilitation
Infectious Infectious diseases Infectious diseases Infectious diseases
diseases including TB including TB
including TB
Mental health Mental health Mental health Mental health
Optometry Optometry Opthalmology
Dentistry Dentistry Orthodontics
Initial determinants
Consulting and treatment rooms are together seen as the planning units (PU’s) for the OPD
and are used as the basis for determining the size of the OPD. In the OPD the PU’s can also be
seen as patient contact spaces. Each planning unit is then supported by a range of other spaces
required to enable the primary service. PU’s should be provided for the population served at a
rate in accordance with its projected needs as described in strategic planning.2
This strategic planning should be done by the provincial Department of Health planners.
In assessing the service and calculating the size and number of PU’s for the OPD the strategic
planner will source and determine:
population density, age distribution and economic profile
geographical and other factors impacting transport and access time to the facility and
to adjacent and/or referral facilities
the scope of services required (service package)
the range of hospital services to be delivered
anticipated activity levels for each out-patient service
the types of patient contact space required for each service
operational assumptions
the calculated number of patient contact spaces required for each service, and
2Adapted from: Department of Health (DoH). 2011. Facilities for primary and community care services: Policy and service
context manual. (2685:1.6). London, UK: DH.
Operational assumptions
To enable patient contact spaces to be quantified, assumptions about the following operational
factors will be required:
opening hours per week (eg. 8hr day for 5 days a week; or 24hr service for 365 days a
year)
average duration of each appointment by service and room type (high, acute care, or
low preventive health and chronic care, turnover), and
average room utilisation rate.
The room utilisation rate allows for non-attendees, unplanned activity and the complexity of
scheduling a variety of staff. As a rough guideline utilisation rate of at least 60% should be
achieved during normal operating hours, and probably not more than 80% at which point
workflow is adversely affected. However, the impact on room requirements of using a higher
utilisation rate to test other operational scenarios should be investigated.
Calculate the number of patient contact spaces required for each service
The examples below illustrate the calculation for consulting and treatment rooms for general
clinical services at district level using the steps outlined above. This would apply to both
existing and new facilities. Requirements for specialist patient contact spaces such as for
rehabilitation therapy should be determined in a similar way.
In busier facilities generic patient contact spaces may be shared on a sessional basis to
maximise their use unless required on a dedicated basis for full-time use.
Obviously, where a higher percentage of people utilise the treatment room (eg. surgical OPD
and orthopaedic OPD) and for a longer period, then the factors in the calculation need to be
adjusted accordingly which will result in the number of treatment rooms being increased.
These calculations are by way of example only and are to be adjusted to suit local circumstances.
Support space
In order to function efficiently, the patient contact spaces (planning units) require access to a
range of support spaces (for example utility rooms, storage spaces, etc.). The number and mix
of support spaces required should be identified from an analysis of the number and mix of
patient contact spaces....
Staff spaces
The staff spaces that are needed can be quantified by referencing the staff organogram and the
staff structure in the department....
Public spaces
Requirements for waiting spaces and public toilets (except independent wheelchair toilets)
may be based on the number of patient contact spaces in the hospital. ...
Independent wheelchair toilets should be quantified according to the size of the building and
number of patients anticipated...
As a general assumption most patients attending an outpatient service will be accompanied by
a family member or carer. The waiting areas need to be sized accordingly. The number of
reception stations is determined by the peak load of patients attending, arrivals management
and the ratio between appointments and non-appointment patients.
3. Patient profile
The profile of patients presenting at an OPD could be one or more of the following:
New patients requiring assessment or consultation with a health practitioner
New patients referred for specialist intervention from another facility or a
practitioner
Patients with booked specialist appointments
Patients who require specialised investigations to confirm diagnosis or evaluate
progress
Patients requiring repeat prescriptions
1. Overview
The service and policy context Part B includes general planning principles and design
should be the basic determinant of considerations for the Outpatient Department and includes
planning and design principles of the general OPD planning and design considerations, describes
Outpatient Department design primary activities within the OPD, locates the OPD within the
hospital and defines the relationship of the OPD to other units
within the hospital.
OPD related intra-departmental relationships and workflow diagrams are provided to explain
the flow of patients, clinical staff, support goods and services, maintenance staff as well as the
flow of the public through the facility. Workflow diagrams within the department are provided
to assist in understanding the intra-departmental relationships in support of functional flow to
ensure productive service delivery.
Communications
A patient communication or call system must be provided. It is suggested that an electronic
communications board that will flash the patient’s service number be used instead of an
intercom to reduce noise and to allow for flexibility of waiting space.
Inclusive environments
A healthcare facility will have a high proportion of occupants, patients and visitors who are
unable to function without some form of assistance. To ensure minimum patient dependence
on staff and others, consideration should be given to designing for optimum patient
independence and enhanced staff productivity (Australasian Health Facilities Guidelines,
2010).
A ‘person with a disability’ is defined by national legislation as a person that is ‘limited in one
or more functional activities’. This includes communication, hearing, and seeing, learning,
moving, intellectual and emotional disabilities. The impairment may be permanent, recurring
or transitory. While 5% of the population has some form of recognised disability 3 this
proportion will be far higher amongst those using healthcare facilities.
Disability may be sensory, physical, cognitive or psychological. Consideration should be given
to the wide range of disabilities, including the following:
mobility impairment
visual impairment
hearing impairment
cognitive impairment, e.g. patients with brain injury or dementia, and
mental illness.
In addition, cultural and literacy issues should be considered as they can impact on access and
safety (Australasian Health Facilities Guidelines, 2010).
Further detail is provided in the IUSS Inclusive Environments in Healthcare guide.
Horizontal circulation
The width of corridors is generally determined by the traffic carried. For pedestrian and
wheelchair access, corridors should be a minimum of 1 500 mm wide, and 1 800 mm wide in
passing places. Where trolleys need to be maneuvered, this should increase to 2 600 mm. Main
corridors designated as ‘hospital streets’ in firecode-compliant buildings, need to be a
minimum of 3 000 mm wide, especially where pedestrian traffic is high.
3 StatsSA 2007 Community Survey – as quoted in IUSS Inclusive Environments, section 1.4
4 Growth Solutions Group: Specialist clinics wayfinding guidelines: The outpatient journey: August 2008 www.gsg.com.au
Signposting shall clearly identify staff, patient and visitor areas, and draw attention to
restricted areas.
Way-finding and signage must be considered from the inception of the design process when it
is possible to ensure that pathways can be designed to be logical, simple and easy to follow.
Way-finding maps should be located at strategic points throughout the site and allow visitors
to orientate themselves. The maps should be consistent with the signage and the typology
needs to be clear and concise. Guidance for and examples of way-finding maps and signage are
included in the IUSS Hospital Design Principles guide.
Artwork 5
Viewing nature scenes plays a key role in creating a healing environment which can improve
patient outcome. Research suggests that nature art can:
reduce stress and anxiety
lower blood pressure
reduce the need for pain medication
increase patients’ trust and confidence, and
be a positive distraction for patients, visitors and staff.
Other research6 has indicated that the art preferred by patients, in order of preference is as
follows:
55 http://healingphotoart.org/
Photograph 1: Courtesy of Mitchells Plain Hospital, Cape Town: Outside waiting area
“The research findings of Roger Ulrich, PhD, indicate that psychologically appropriate art can
substantially affect outcomes such as blood pressure, anxiety, intake of pain medication, and
length of hospital stay. In particular, representational nature art is shown to have a beneficial
7
effect on patients experiencing stress and anxiety.”
Cultural elements and age group have a strong influence on the reaction to various artworks,
therefore it is essential that the architects and health planners consult with people (of all ages)
from the surrounding communities that will attend the clinic to establish preferences.
6 Study: “Beyond traditional treatment… establishing art as therapy,” was conducted by the Foundation for Photo/Art
in Hospitals in collaboration with the Italian Oncology Group of Clinical Research (GOIRC), coordinated by Prof.
Francesco Di Costanzo, director of the Oncology Department of Careggi Hospital in Florence, Italy. Three cancer
centres in Italy – Ancona, Perugia, and Messina – participated in the research. 345 patients from these centres were
tested on their perception of the hospital environment before and after the display of nature photos in the treatment
rooms of their Cancer Centres.
7 Friedrich, MJ. 1999. The arts of healing. Journal of the American Medical Association (JAMA), 281(19)
The OPD is a busy area with patients, escorts, staff and service staff constantly moving to and
from the consulting rooms, to treatment rooms, service points as well as to and from other
departments. As it is important to create a calm welcoming environment methods to reduce
noise levels should be employed. This can be done through positioning specific rooms
appropriately (noisy areas away from those areas requiring quiet) and applying materials that
have better soundproof qualities. Information on material selection is contained in the set of
IUSS Internal Finishes in Healthcare Facilities guides.
Ergonomics
Ergonomics is the scientific discipline concerned with designing according to the human
needs, and the profession that applies theory, principles, data and methods to design in order
to optimise human wellbeing and overall system performance. (Wikipedia)
Badly designed recurring elements such as workstations and the layout of critical rooms have
a great impact on the Occupational Health and Safety (OHS) of staff and the welfare of patients.
There are five principles to consider when designing ergonomic spaces:
safety
comfort
ease of use
productivity/ performance, and
aesthetics
All workspaces should be adaptable to the users occupying that space. Therefore it should be
capable of adjustment or modification to suit that user. For instance, conventional work
surface heights for seated users are not suitable for people who use wheelchairs and in this
case dual-height surfaces should be provided. Worktop heights and widths in work areas
should be designed taking into account the type of work to be performed in this space and
users..
Ventilation
The air management in the waiting areas should be designed to reduce the spread of airborne
pathogens such as tuberculosis. At least 12 air changes per hour should be achieved.
It is recommended that UVGI lamps be appropriately fitted in all large waiting spaces.
While natural ventilation with good cross ventilation provides higher air changes per hour and
is more cost effective, it can be adversely affected by weather conditions and the need to close
windows and openings, especially in winter, heavy rainfalls etc. Hybrid systems that use both
natural and artificial systems of ventilation should be investigated.
Further information on ventilation and airborne IPC risk is contained in the IUSS documents
Building Engineering Services, and TB Services.
4. OPD location
OPD’s attract the highest volume of patients attending the hospital. Many of these may be in
wheelchairs or have mobility problems. The OPD should therefore be located directly off
hospital admissions and must be on the ground floor. If, in extreme cases where it is not
possible to locate the OPD on the ground floor, lifts must be provided.
The out-patient travel route needs to be as short and direct as possible from the main hospital
arrival point through admissions to the OPD for all patients and their escorts but particularly
so for the infirm and for those with disabilities. Approprite signposting is essential. All
patients should pass the security checkpoint at the entrance. Dedicated porters situated in
OPD will assist patients requiring wheelchair or trolley assistance. A wheelchair and trolley
parking space should be provided at the OPD entrance.
The OPD must be separate from the inpatient areas. Patients should be able to move into and
out of the OPD without entering other parts of the hospital.
5. Interdepartmental relationships
In order to create a coherent, user-friendly building it is essential to achieve the correct
adjacencies for the different functional zones, departments and spaces. Key considerations
with regards to outpatients and other departments within the hospital include the following:
a single main entrance to the health facility, which should be overseen by a main
security/information/help desk
from here, patients and visitors should be directed to either the inpatient areas or the
records and admissions area prior to attending outpatients
depending on the size of the facility, central OPD records and day patient admissions
desks should be at the entrance to the OPD. This area may be part of the main records
and admissions area upon entry into the hospital and should be adjacent to the OPD.
the admission and discharge area for inpatients should be separate to the records
waiting area, but should connect to the records area. It is from this point that inpatient
and outpatient flow paths should not cross and the two areas should be separate
the Medical Records Department need to be readily accessible due to the constant
movement of health records between OPD and Medical Records. Therefore, this
department must be placed immediately adjacent to, or below the admissions floor on
the lower level, to assist file retrieval and to reduce waiting times for patients at
service points
there should be easy access to the rehabilitation unit from the outpatient and the
inpatient accommodation. After consultation, patients may be referred to the
Rehabilitation Department, Dietetics and Social Work
most administration spaces are located separate from both the inpatient and
outpatient areas
should the health facility have a cafeteria, this should be close to the outpatients’ area
and accessible from the inpatient areas
OUTPATIENTS REHABILITATION
UNIT
INPATIENTS
EMERGENCY
THEATRES
SERVICES
6. Intradepartmental relationships
Key considerations with regards to the layout within the OPD include the following:
in the outpatients, there should be a centrally-placed general waiting area adjacent to
the records counter where patients register and collect their records/file before
proceeding to the cashier or the clinical areas within outpatients
adjacent to a waiting area is the preparation or vitals room where patients’ vitals and
data are recorded by a nurse before the patient is directed to one of the consulting
suites’ sub-waiting areas. Depending on the size of the clinic and services offered, this
may be only one suite or could be several different suites (e.g. orthopaedic, medical.
ophthalmology and separate surgical suite)
access to some suites may be controlled from local staff communications bases or
secondary reception desks
OPD staff rest areas are located separate, but close to the consulting suites
utility spaces are distributed close to the consulting and treatment areas, but central
stores, decontamination areas, disposal holds and maintenance accommodation are
located in a separate non-patient services area, with discrete access. Vehicular access
serving this entrance is separated from public vehicular and pedestrian routes, and
Ablutions CONSULTING
STAFF
MAIN AREAS
MAIN OPD
WAITING TREATMENT
ENTRANCE
AREA
COUNSELLING Storage &
RECEPTION Utilities
EMERGENCY
Figure 5: Rooms relationships that promote the principal of ‘clean to dirty’ flow
It is important that key room relationships are maintained such as illustrated in Figure 5 in
order to allow principles of a one directional flow from clean to dirty to be enforced.
8. Flow Patterns
The design of the OPD must facilitate efficient patient and staff movement both linking into
and from the OPD to other areas in the hospital as well as between and within the zones and
groups of spaces within the OPD. Consider:
patient routes
staff routes
routes for the collection and removal of waste
routes for the delivery and distribution of supplies
routes for emergency evacuation, and the
design and layout of circulation spaces.
At the information desk, fast-track patients that require admission to the day ward or for
special investigations will be directed to the point of service.
A district hospital will, depending on its size, consist mainly of a family medicine suite only.
OPD’s in larger district, regional and tertiary hospitals are usually arranged into individual
specialist “suites” with support rooms and dedicated sub-waiting areas. For example an
orthopaedic clinic suite may consist of a sub-waiting area, consulting room, procedure room,
POP room and support rooms (stores, utilities etc). These areas may or may not share support
services. The orthopaedic suite may also share the sub-wait and support rooms, including a
procedure room, with the surgical suite.
Each suite functions according to the clinical requirements of the particular suite. An
orthopaedic suite will be configured differently to a medical suite as it will have a procedure
room and POP room with additional storage. Consultation with the project user group prior
to planning is essential to establish the number and type of rooms per “suite”.
The size of each suite is determined by need and the number of patient contact rooms that can
be effectively managed by a team of available practitioners. Each suite should be large enough
to maximise work efficiency but not so large that it becomes impersonal or difficult to
navigate. These suites may host a range of different specialty clinics throughout the week or
month, on a timetabled basis.
It is important to establish which services will share the suite on a timetabled basis as this has
a bearing on the provision of space.
A regional OPD will be configured differently to a tertiary facility OPD as patients will enter the
hospital, obtain their records from the main admission records area and may wait in a
common waiting area to have their vitals taken before they are directed to the appropriate
suite. However, some suites may have their own record storage which means patients may go
straight to the sub-wait area dedicated to the suite concerned. These operational issues must
be decided and discussed with the user departments prior to design to determine the flow of
patients through the system and to determine those areas that will be shared and those that
will not.
Figure 10: Tertiary Hospital Outpatients – Intra-relationships, clusters and patient flow
1. Overview
This section provides room information, requirements and diagrams for all general out-patient
department rooms and spaces. Additional more specific room requirement specifications and
layouts of rooms that are generally common to more than one department, such as consulting,
treatment, counselling rooms, offices, utility rooms and ablutions, are covered briefly in this
section and cross referenced to the separate set of IUSS Generic Room Data Sheets (currently
under development). These contain room design issues, finishes, fittings, fixtures with
associated services, services, loose equipment and room plans, elevations and isometric
drawings.
Details of the requirements for specialist out-patient services and suites will be found in Part D
following.
The design of any space in a healthcare environment must be based on:
the intended function of the space
the activities required to enable that function to be accommodated including
frequency and duration of activities
the people who will perform or be involved in the activities
the equipment and stock required to enable the activities
the environment necessary to enable the activities (lighting, ventilation...) and to
ensure occupant safety, and
the engineering services necessary for equipment, for environmental control and
general operational needs.
The focus of this section will be on providing general information that has primary functional,
spatial and service implications for the designer. Once approved the data in the generic room
data sheets will provide more comprehensive information on each of the points above and will
take precedence over general information in this guide.
Refer also to the IUSS Building Engineering Services guideline for service design principles and
detail requirements.
Lists of standard room requirement schedules for different levels of out-patient services with
cross referencing to the Generic Room Data Sheets are included in Part F.
2. Public zone
As indicated in section B:4 above patients coming to the OPD will have first gone through an
admission process through the main hospital admissions department where they will have
been received, registered, collected their files or cards, paid if required to do so and directed to
the OPD. The admissions department manages primary access to the whole hospital and is
covered in the IUSS Admission, Administration and Related Services Guide.
The public zone spaces shown here are within the OPD and presume that the general
admissions process has been fully covered in the admissions department.
2.4. Ablutions
Public ablutions and baby change areas need to be provided so as to be readily accessible to
those waiting in the out-patients unit. General requirements are covered under the hospital
admissions unit.
3. Patient zone
Public access to the various suites within the outpatients unit needs to be controlled, and to be
as direct as possible, from the admissions unit and public waiting areas. In small buildings this
control may be provided by the main reception desk. In larger buildings, with more suites, a
number of additional control points (staff communication bases) may be required.
Suturing of wounds
Male circumcision
Insertion of IUCDs, PAP smears
Termination of pregnancies (see ToP suite D6)
Refer to IUSS Generic Room Data sheet AK for detailed room data, layouts and equipment list.
Location: accessible from the waiting and consulting areas and close to the sluice room
Space: each room should have a floor space of 25 - 30 m² and a minimum wall length of
4.3 m
People: professional nurse;
(Refer to the IUSS Generic Room Data sheets for detailed information.)
5. Staff zone
The following standard rooms are required:
Staff room
Staff ablutions
6. Support zone
The support zone should be located away from the admission and patient circulation zone
close to the link to hospital circulation but still be accessible to procedure and treatment areas
and consulting rooms.
The following standard rooms are required:
Sluice room
Clean utility
Dirty utility
Store – medicine?
Store - linen
Store- equipment
Store - medical and surgical sundries
Cleaners room
The briefing schedule will identify the number of utility spaces and cleaners’ rooms required
to satisfy clinical functionality. Additional rooms may be required, however, because of the
layout of the building or based on facilities management operational policies. The numbers of
such rooms may consequently be adjusted in the project accommodation schedule. Additional
rooms may be located within suites or between them or adjacent to lift and stair cores.
cleaning and disinfecting of bowls and other receptacles used in treatment as well as if
required the normal decontamination, sluicing, cleaning and disinfecting and storage
of bed pans, urinals, sputum mugs and wash basins
cleaning and temporary holding of used medical instruments for collection and
sterilisation at CSSD
testing and disposing of patient specimens as well as temporary storage of laboratory
samples, and
hand washing by staff before leaving the room.
At the Sluice room soiled linen may be rinsed and bio-hazardous waste such bodily fluids disposed
of . The first point of washing of soiled linen is the sluice room, after which the dirty linen and items
are bagged and transferred to the dirty utility.
Refer to IUSS Generic Room Data sheet BMF for detailed room data, layout and equipment list.
9National Health Service Scotland. 2002. Scottish Health Planning Note (SHPN52): Accommodation for day care part 1- day
surgery unit. (Version 1). Scotland: Borders General Hospital NHS Trust.
1. Dental suite
It is important before commencing design of the dental suite that the design team consult the
user department and suppliers of the dental chairs to ensure that not only is the space
provision appropriate but that the electrical and mechanical services are correctly planned for
the safe provision of all services.
1.1. Overview
People attend oral dentistry departments as out-patients for specialist consultation,
examination and treatment. Out-patients attending oral surgery, orthodontic and restorative
dentistry departments
are mainly ambulant
are often accompanied by an escort, and
many of the patients are children and , as such, waiting areas should include a play
area.
Treatment carried out differs according to the level of speciality in different facilities:
Primary Health care Facilities which include clinics, community health centres and
district hospitals
Services: general dental practitioners perform general dental examinations and
treatment
Regional Hospital
Services: general dental practitioners perform general dental examinations and
treatment
Tertiary Hospital
Services:
o treatment of referred cases beyond the skill of a general dental practitioner
o orthodontics
o trauma work
o dental treatment required because of general medical conditions, such as
AIDS, hepatitis, severe heart disease and haemophilia, and
o oral and maxilla-facial surgery.
This guide covers dental services at clinic, CHC, district and regional hospital levels. Specialist
dental facilities will be addressed in a separate document.
Location
The dental suite is part of the general out-patient service and should be located next to the
OPD of the hospital or Community Health Centre both for general patient accessibility by
patients and other medical professionals as well as ready access in case of medical emergency.
Entrance
RECEPTION &
WAITING
RECORDS
OFFICES DENTAL
SURGERY 1
LAB
STAFF
FACILITIE
DENTAL
S
SURGERY 2
offices
small laboratory / utility room set between two consulting rooms
dirty utility
sluice – access?
A lab area set off from the main dental room (this could be a clean utility room)
compressor room.
Activities 10
The OHP will work seated on a stool from the patients’ right or left-hand side behind his head
and will be assisted by a dental assistant seated or standing on the patient’s left or right side.
The instrument trolley, dental cabinet, refuse bin and wash-hand basin should be within easy
reach of the OHP. An exception to this could be the wash-hand basin fixed to the opposite
window wall.
Dental X-rays would be taken using mobile equipment or equipment fixed permanently in the
surgery.
Dental instruments, drugs, medicines and materials are stored in drawers or cabinets with
doors out of sight of the patient, and only the essential supplies and instruments are on the
instrument trolley during procedures.
The OHP would normally wear surgical gloves, protective glasses and a mask during
procedures and these must be readily available in the surgery.
A sink and draining board to be provided if the used instruments are washed and disinfected
within the surgery. This function, however, is better centralized where the instruments can be
sterilized using a small autoclave
A clinical wash hand basin is to be provided in the room and must have elbow action taps or
hands free action taps.
Room requirements
Refer to IUSS Generic Room Data sheet AKA for detailed room data, layouts and equipment list.
Key factors which affect the space requirements include:
the size and shape of the room
the types and positions of fixtures, specialist built-in units and fittings
the types and position(s) of the dental chair(s) and associated equipment
space to allow for optimal working positions around the patient seated in the dental
chair
space to accommodate any required mobile equipment that may be required, and
the position of the dental chair in the consulting/treatment room should be such that
access to the chair is both easy and obvious to a patient.
The dental treatment room will contain specialist built-in cabinetry, a reclining chair, ceiling-
mounted lamp, wall-mounted inter-oral periapical X-ray machine and a console adjacent to the
chair supplying dental gases.
Specialist advice should be sought on the need for X-ray protection.
A resuscitation trolley should also be provided nearby.
10NHS Estates: 1992: Health Building Note 12: Supplement 2: Oral surgery, Orthodontics, Restorative dentistry,
London : HMSO
Mechanical requirements
low voltage wire, 20mm water supply, 12mm air supply, 220V electrical supply,
40mm PVC vacuum to be supplied in position indicated on the drawings. These points
are to be supplied where chair mounted equipment is required
a dental vacuum system must be provided to serve the dental aspiration equipment at
each chair. This removes from the patient’s mouth saliva and water used to flush away
debris arising from treatment, or to cool high speed dental tools. This dental vacuum
system is entirely separate from the medical vacuum system
medical oxygen and medical vacuum should be piped to wall-mounted outlets close to
the dental chair;
plumbing must be done by an experienced plumber and be according to dental
plumbing specifications;
service duct: Provision must be made for leading an under-floor electric cable, a
20mm water supply pipe, a 40mm PVC vacuum pipe and 12mm compressed air
supply pipe to a point in front of the base of the dental chair in the room. Reference is
to be made to the dental chair supplier to obtain the necessary details for the duct and
the service inlets and outlets.
compressed air: Compressed air should be provided in each consulting/treatment
room to supply the dental unit and a wall-mounted outlet for the use of portable tools.
The piped medical compressed air system may be used where convenient, otherwise a
small compressor set to serve the department will be necessary. The compressor and
its associated air receiver, driers, separators and other accessions should be located in
a separate plant area externally (with external access for cleaning and maintenance)
to minimise noise in the department. This area must be caged for security purposes,
well ventilated, tamper and vandal proof. The air intake should be sited in a dry
position outside the plantroom and be fitted with a silencer and filter as appropriate
This room requires ventilation and acoustic treatment. Amalgam from waste water
will be captured and stored here.
Dental gases may be piped from a central manifold or provided from bottles. If a bottle
store is provided, it should be located on an outside wall with good ventilation. When
nitrous oxide is used, a gas scavenging system must be fitted.
2. Stoma therapy
The service will provide both in- and outpatient support for new patients and for patients with
stomas or incontinence. The service is managed by a trained stoma therapist. The unit
requires a small waiting area, consulting rooms, and a procedure room that could double-up
for patient teaching and a large store room for outpatient stoma issue. The support rooms
required will be shared with the main OPD.
3. Rehabilitation Unit
Hospitals should have a rehabilitation area where professionals can provide physical therapy
and work with groups such as occupational therapy, physiotherapy, basic rehabilitation
support, speech therapy and audiology, as well as issue- and fit-assistive devices. The unit will
serve both in- and out-patients and should be located close to the OPD to facilitate out-patient
access and limit the flow of out-patients into the main hospital. There should also be easy
access by rehabilitation unit staff to in-patient wards. The unit will also support outreach
services by rehabilitation workers to the communities and clinics.
Full details of the rehabilitation unit are covered in the IUSS Rehabilitation Facilities Guide.
Speech therapy
Audiology
Consulting room with audiology booth in room
Sound booths
Tymp Room
Hearing Aid Testing Room
11 CSIR and Andrew Wade, Sound Research Laboratories South Africa (Pty) Ltd .
5. Ophthalmology outpatients
The main functions of an ophthalmology out-patients department include specialist
consultation, examination and treatment in respect of eye disorders and diseases that do not
require either day-case or in-patient activity. Accommodation must be suitable for the
examination, treatment and care of ophthalmic out-patients.
The paramedical services related to ophthalmology are:
orthoptics
optometry
Optometry services
Optometry is a healthcare profession that is autonomous, educated, and regulated
(licensed/registered) where optometrists are the primary healthcare practitioners of the eye
and visual system who provide comprehensive eye and vision care, which includes refraction
and dispensing, detection/diagnosis and management of disease in the eye, and the
rehabilitation of conditions of the visual system. An optometrist is not a medical doctor and
they are not trained or licensed to perform surgery in an operating room.
Ophthalmology services
Ophthalmology services are delivered as a regional (or tertiary) service by an ophthalmologist
who is a medical or osteopathic doctor and who specializes in eye and vision care. As a medical
doctor, an ophthalmologist is licensed to practice medicine and surgery. An ophthalmologist
diagnoses and treats all eye diseases, performs eye surgery and prescribes and fits eyeglasses
and contact lenses to correct vision problems. Ophthalmology can be divided into the
following clinical specialties:
cataract
glaucoma
medical retinal
cornea/external diseases
oculoplastics
paediatrics
ocular motility
vitreo retinal
strabismus
lacrimal, and
orbital.
Orthoptics services
Within ophthalmology, orthoptics is a diagnostic, assessment, therapeutic and monitoring
service for children and adults with eye muscle abnormalities and visual function problems.
This service is usually a separate facility (or a dedicated room within ophthalmology) close to
the ophthalmology clinic.
12 NHS Estates: 1996. Ophthalmology: Health Building Note 12: Supplement 4: London: HMSO
ADMINISTRATION &
STAFF
Return visits Reception ORTHOPTICS
Play
Area
MAIN
WAITING Ablutions
Pharmacy
AREA
Interview
OPTOMETRY
Refraction/contact
New referrals
lens room
Psycho-physical and
electrophysiology
tests
Patient flow
13 Adapted from the NHS Estates: 1996. Ophthalmology: Health Building Note 12:Supplement 4:London: HMSO
Haemodialysis
Haemodialysis is a type of dialysis that uses a special filter to cleanse the blood. During
haemodialysis treatment, blood is passed from the body through a set of tubes to a filter. The
cleansed blood is then returned to the body through another set of tubes. On average,
haemodialysis treatments are typically administered three times per week and last two and a
half to four hours.
Haemodialysis treatments are typically performed in an outpatient dialysis centre.
Peritoneal Dialysis
Peritoneal dialysis (PD) is a process in which blood is artificially cleansed using a man-made
solution that is delivered into and removed from the abdominal cavity.
In PD, the peritoneal cavity in the abdomen is used as a reservoir for the dialysis solution. The
thin membrane lining of this cavity provides a suitable barrier through which blood can be
filtered. A tube or catheter is surgically placed in the abdomen to create an access for
peritoneal dialysis. PD can be undertaken through the CAPD process (Continuous Ambulatory
Peritoneal Dialysis) or using a cycling machine using the CCPD (Continuous Cycling Peritoneal
Dialysis).
In Peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube
into the peritoneal cavity, where the peritoneal membrane acts as a semipermeable
membrane. The dialysate is left in the peritoneal cavity for a period of time to absorb waste
products, and then it is drained out through the tube and discarded. This cycle is repeated 4-5
times during the day.
14 http://www.emoryhealthcare.org/dialysis/treatments.html
7.4. Interrelationships
The layout of the unit must take into account the functional relationships between three zones
– patient treatment stations, service support facilities, and staff areas. Staff must be able to see
patients in the dialysis area; balancing adequate observation with patient privacy. Utility
areas, equipment storage and maintenance areas should be located to enable ease of access
from patient treatment stations, and the layout of the multi-station dialysis area should enable
patients to talk to each other and for nurses to be able to call for assistance from one station to
another15
Phleboto Consultatio
my Room n/Counselli
Shared
Haemodialysi support
Renal s Rooms
Waitin facilities
Entrance &
g area Staff station
Reception
Peritoneal Shared
Patient
Patient Dialysis Staff
Change
ablution Facilities
& Rooms
16 NHS, UK 2011. Main renal unit - Main renal unit: Planning and design manual 6381:0.4:England
Dialysis
Machine
Treatment
chair
17 Raising of all edges of the floor to create a pond sufficient to retain any liquid spills within the room.
Priorities
When caring for victims of sexual violence, the overriding priority must always be the health
and welfare of the patient. The provision of medico-legal services thus assumes secondary
importance to that of general health care services (i.e. the treatment of injuries, assessment
and management of pregnancy and sexually transmitted infections (STIs), performing a
forensic examination- medical and forensic services.
The setting
Appropriate, good quality care should be available to all individuals who have been victims of
sexual assault. Consultations should take place at a site where there is optimal access to the
full range of services and facilities that may be required by the patient, for example, within a
hospital or a clinic. Individuals should be able to access services 24-hours a day.
Regardless of the setting (i.e. hospital-based or community-based) and location (i.e. urban,
suburban or rural area), care should be ethical, compassionate, objective and above all,
patient-centred.
Safety, security and privacy are important aspects of service provision.
The ideal is that the medico-legal and the health services are provided simultaneously; that is
to say, at the same time, in the same location and preferably by the same health practitioner.
Policy-makers and health workers are encouraged to develop this model of service provision.
In practice, victims of sexual violence present at any point or sector of the health care system.
Therefore, all health care facilities should be in a position to recognize sexual abuse and
provide services to victims of sexual violence (or at least refer patients to appropriate services
and care), irrespective of whether a forensic examination is required. If not already in place,
health care facilities need to develop specific policies and procedures for dealing with victims
of sexual violence.
Multiple services
Provision of comprehensive services to victims of sexual violence requires a team approach in
order to provide a coordinated range of services to victims.
Apart from a healthcare worker, other members of the interdisciplinary team may include:
Facilities
High quality facilities for providing medical services to sexual assault victims are characterized
by a number of key features, namely, they are accessible, secure, clean and private. All of these
features should be incorporated when planning a new facility or modifying an existing facility.
8.3. Location
The ideal location for a health care facility for sexual violence victims is either within a
hospital or a medical clinic, or somewhere where there is immediate access to medical
expertise. For instance, a patient may present with acute health problems (e.g. head injury,
intoxication) that require urgent medical intervention and treatment. Similarly, there should
be ready access to a range of laboratory (e.g. haematology, microbiology) and counselling
services.
Minimum accommodation:
waiting room/reception area
separate consulting/examination room with access to a dedicated toilet and waiting
facilities.
Additional room(s) for others (e.g.family, friends, police) may be required.
Where services are provided to children, the physical surroundings should be child-friendly.
Special equipment for interviewing the child (e.g. two-way mirrors or video recording
facilities) may be required.
Consultation/examination room(s)
The room must contain an examination couch positioned so that the health worker
can approach the patient from the right-hand side; the couch must allow examination
with the legs flopped apart (i.e. in the lithotomy position)
The temperature in the room must be thermally neutral (i.e. not too cold or too hot);
Auditory and visual privacy (particularly for undressing) is essential
Clean bed-linen and a gown for each patient must be provided for
Lighting provision should be sufficient to perform a genito-anal examination
Clinical hand-washing facilities (with soap and running water) with hands free taps
(IUSS generic set BEI)
Provision for the storing of forensic supplies is required
A table or desk for documenting and labelling specimens is required
The door into the room must be lockable to prevent entry during the examination
Provision for a telephone, computers and data is required
Where possible, this should be a separate facility for child victims and may require a
two way mirror with an adjacent observation room
Minimum 25m²
Refrigerator and cupboard for the storage of specimens, preferably lockable.
Counselling room
A separate room containing a table and chairs where a support person could talk with the
patient.
Waiting area
A dedicated waiting area within the Victims of Violence unit is critical:
Reception area
A reception area that could also be used as a room for waiting family and friends.
Record room
To store examination records;
Consideration must also be given to matters of confidentiality; completed records
must be stored securely and accessed only by authorized staff.
Storage
Storage should be provided for:
Linen
Sterile packs
Consumables
Stationery, and
Medicines.
Laboratory services
Specimens collected from victims can be broadly divided into two categories, those used for
diagnostic health purposes and those used for criminal investigation.
18National Health Service Scotland. 2002. Scottish Health Planning Note (SHPN52): Accommodation for day care part 1- day
surgery unit. (Version 1). Scotland: Borders General Hospital NHS Trust.
1. Worcester Hospital
1. Applicable legislation 19
Basic Condition of Employment Act Amendment (Act 10 of 2002). Cape Town South Africa:
Government Gazette.
Child Care Act Amendment (Act 74 of 1983). Cape Town South Africa: Government Gazette.
Child Justice Bill 2003
Criminal Procedure Act 1977 (Act 51 of 1977). Cape Town South Africa: Government Gazette.
Correctional Service Act Amendment (Act 122 of 1992). Cape Town South Africa: Government
Gazette.
Domestic Violence Act 1998 (Act 116 of 1998). Cape Town South Africa: Government Gazette.
Drug Trafficking Act 1992 (Act 140 of 1992). Cape Town South Africa: Government Gazette.
Employment Equity Act 1998 (Act 55 of 1998). Cape Town South Africa: Government Gazette.
Heath Act 1977 (Act 63 of 1977). Cape Town South Africa: Government Gazette.
Health Professional Act 1974 (Act 56 of 1974). Cape Town South Africa: Government Gazette.
Labour Relations Act 1995 (Act 66 of 1995). Cape Town South Africa: Government Gazette.
Medicine and Related Substance Control Act Amendment (Act 59 of 2002). Cape Town South
Africa: Government Gazette.
Mental Healthcare Act 2002 (Act 17 of 2002). Cape Town South Africa: Government Gazette.
Non-Profit Organizations Act 1997 (Act 71 of 1997). Cape Town South Africa: Government
Gazette.
Nursing Act 1978 (Act 50 of 1978). Cape Town South Africa: Government Gazette.
Occupancy Health and Safety Act 1993 (Act 85 of 1993). Cape Town South Africa: Government
Gazette.
Pharmacy Act 1974 (Act 53 of 1974). Cape Town South Africa: Government Gazette.
Prevention and Treatment of Drug Dependency Act 1992 (Act 20 of 1992). Cape Town South
Africa: Government Gazette.
Probation Services Act 1991 (Act 116 of 1991). Cape Town South Africa: Government Gazette.
Promotion of Equality and Prevention of Unfair Discrimination Act 2002 (Act 52 of 2002).
Cape Town South Africa: Government Gazette.
Public Management Act 1999 (Act 1 of 1999). Cape Town South Africa: Government Gazette.
South African Constitution Act 1996 (Act 108 of 1996). Cape Town South Africa: Government
Gazette.
South African School Act 1996 (Act 84 of 1996). Cape Town South Africa: Government Gazette.
Social Work Act Amendment (Act 110 of 1978). Cape Town South Africa: Government Gazette.
19 National Department of Social Development (NDSD). n.d. Minimum norms and standards for out-patient treatment
centers. (A manual developed with the support of the United Nations office on drugs and crime). Pretoria South Africa:
NDSD.
2. Glossary of terms
Accreditation: The official authorisation of a service by the public body legally entitled to
confer that authorisation by the laws of the country, based on a prescribed
set of quality standards (WHO, 2003).
Consulting: The taking and writing up of the clinical history from the patient.
Clinics: A clinic refers to a health care facility designated for the purpose of
providing outpatient care on a regular basis. Clinics can range in size from
very small to large, with a wide range of clinical services and are confined
to outpatient care usually for at least 8 hours a day, five days a week.
Clinics are the main sites for ambulatory care in rural areas. This is the first point of care for
patients as it is usually the closest point of care for the patient.
Hospitals: A hospital refers to a facility designated for the purpose of providing both
outpatient and inpatient care on a regular basis. Hospitals provide
Rehabilitative centres:
A facility designated for the purpose of providing rehabilitative care. This
may include physiotherapy, occupational therapy, speech therapy, and
audiology.
3. References
Australasian Health Facility Guidelines and Australasian health infrastructure alliance, n.d.
Guidelines. [Online] Available at: http://www.healthfacilityguidelines.com.au/guidelines.aspx
[Accessed 22 February 2014].
Bending M, Lowson, K, Saxby, R and Whitehead S. 2009. Cost-effectiveness of hospital design:
options to improve patient safety and wellbeing systematic literature review of single rooms.
YHEC, University of York.
NHS Estates, 2004. Health Building Note (HBN) 12: Out-patients. Norwich England: TSO (The
Stationery Office).
NHS, UK 2011. Main renal unit - Main renal unit: Planning and design manual 6381:0.4:
England
NHS Estates: 1996. Ophthalmology: Health Building Note 12: Supplement 4: London: HMSO
Artwork
20
Suggested reading :
“Art in Healthcare” In: HEALTHCARE DESIGN MAGAZINE, December 2011.
Domke, H. “Picture of Health – Handbook for Healthcare Art”.
“Putting Patients First – the essential healthcare art book” February 2009.
Available: WWW.HEALTHCAREFINEART.COM.
“Beyond traditional treatment: Establishing art as therapy” by Elaine Poggi.
In: healthcare design magazine, november 2006.
Hathorn, K. “Current Research in Evidence-Based Art Programs” November 2006.
American Art Resources.
“The Arts of Healing” In: Journal of The American Medical Association, 281:9.
20 http://healingphotoart.org/