INPATIENT

DEPARTME
T

JAINA JOSE
MHA 1ST YEAR
2021-2023
 CONTENTS
 INTRODUCTION  TYPES OF WARD
 FUNCTIONS OF IPD  COMPONENTS OF A NURSING UNIT
 PROGRESSIVE PATIENT CARE  SPECIAL WARDS
 PLANNING AND DESIGNING OF  STAFFING
WARD  MANAGEMENT IN THE WARD
 FEATURES OF IPD  PERSONNEL MANAGEMENT IN THE
 LOCATION WARD
 INTERDEPARTMENTAL RELATIONSHIP
 CIRCULATION OF IPD
 INTRODUCTION
 For most of the people, hospital means the ward. It is in reality also. Basically people go
to hospital for two purposes; either to seek out door consultation in the OPD of the
hospital or for admission to hospital and get treatment as inpatient. The consultation
can be done in the consulting chambers outside the normal OPD of a hospital also. For
hospitalization we necessarily require an Inpatient Department (IPD).

The IPD consists of the following components:

a) Nursing Station
b) The beds
c) Necessary services, storage work
d) Public areas, needed to carry out the nursing care
 FEATURES OF IPD
 The IPD forms 33% to 55% of the structure of the hospital construction and
most of the equipments and staff are housed in this department or area.

 Maximum amount of medical care, medical teaching, training and research is

concentrated in this department.

 This is the hospital area, which gives maximum output of services, name and
fame to the hospital.

 Maximum amount of stress is given on nursing services for maximum vigilance

so as to prevent litigation and patient’s dissatisfaction.
COMPONENTS OF IPD
Nursing
Station

IPD

Public area
Services

Beds
 FUNTIONS OF IPD
 To provide highest possible quality of medical and nursing care.

 To provide essential equipments, drugs and other materials required for patient care.

 To provide comfortable environment, substituting temporary home for patients

designed to accommodate all their basic needs(eating, sleeping and toilet).

 To provide facilities for visitors.

 To provide highest possible degree of job satisfaction.

 To provide opportunity for education, training and research in the field of medicine,
nursing and hospital administration.
 PLANNING AND DESIGNING OF WARD
Factors taken into consideration for planning of Nursing
Unit:

 Hospital policy  Interdepartmental relationship

 Space requirement  Traffic flow
 Function  Staffing of IPD
 Work plan  Communication
 Location  Utilization of Service
 Work flow
LOCATION

It should be situated away from the main roads and from OPD to avoid disturbances
and potential source of cross infection. It should be approachable for supportive
services. The intramural transportation should be well planned for effective and
efficient transportation of the staff, patients and supplies, within the hospital.
 OT

Laundry Radiology

Logistics WARD Lab

Dietary Physio
OPD

INTERDEPARTMENTAL RELATIONSHI
P
 CIRCULATION OF IPD

 Arrangement of wards for vertical  Arrangement of wards for horizontal

circulation circulation
 TYPES OF WARD
 Nightingale ward
 Rig’s pattern ward
 Modified Rig’s pattern ward
 Racing track ward
 “T” and “Y” shaped ward
 Single straight corridor ward
 “L” shaped plan
 Cruciform plan
 “H” shaped plan
 “E” shaped plan
 Box planS
 Central corridor multiple rib pattern
 NIGHTINGALE WARD
The rectangular pavilion type of ward was designed in the year 1770 by
Frenchman, later it was adopted by Florence Nightingale and is known by her
name. The characteristics of the Nightingale ward are:
 Patient’s beds in two rows at right angle to the longitudinal walls.

 Bathroom and WC at one end.

 Nursing station, doctor’s room, and other facilities at other end.

 The length of the ward is about 96 feet to home 30-35 patient.

 This type of the ward continued till 1925.

 Bathrooms and isolation rooms were added to it.

 Subsequently the Nurse’s table shifted to the centre, because the nurse had to

walk long distance to attend patients.

 In tropical countries wide corridors were placed on either side of the
ward to protect it from direct sun light.

DISADVANTAGES OF NIGHTINGALE WARD

• No privacy for patients
• Noise pollution
• Risk of cross infection
• Constant glare to patient

Modified Nightingale Ward

The modified nightingale ward has got the nursing station in the centre of
the ward, the ancillary, auxillary services are provided at one end and the
utility services at other end. The nurse’s travel time has been reduced and
the supervision over the patient’s condition also improved in the modified
pattern.
 RIG'S WARD

 The ward unit is divided into small compartments or cubicles

separated from each other by low partitions. Each cubicle having l, 2, 4
or 6 beds arranged parallel to the longitudinal walls. In developing
countries due to resource crunch, it may not be possible to maintain
the wards entirely on Rig's pattern. However, the Committee on Plan
Project (COPP) has recommended two single bed rooms in every ward
of 20-30 beds, for the patients who require special nursing care. There
are certain advantages and disadvantages.
 The Advantages are :
i. There is privacy for patient
ii. Risk of cross infection minimized
iii. Isolation of infection cases easier
iv. Enhancing flexibility of utilization. There is possibility of accommodating
both the sexes of patient in one ward.

 The disadvantages are:

i. Communication between patient and nurse is more difficult.
ii. The direct observation of patient is difficult.
iii. The nurse has to walk more, due to complexity of ward.
iv. More nursing personnel are required for nursing care.
v. It s costly to build and maintain.
 COMPONENTS OF A NURSING UNIT
 There are four important components of the nursing unit of the
hospital:
 Primary Accommodation
 Ancillary Accommodation
 Auxiliary Accommodation
 Sanitary Accommodation.
PRIMARY ACCOMODATION
It consists of single bed rooms. The size of room required for various
types is given as under:

NO. OF BEDS RECOMMENDED SPACE

1 BED 14 sq. meter
2 BED 21 sq. meter
4 BEDS 28 sq. meter
6 BEDS 42 sq. meter
 SIZE, SPACE AND FACILITIES
The distance between the bed end and the wall is 025 and distance between the two
beds is 1.25 m. The distance between the beds should permit hassle free movement of
nurse and staff. Distance between the wall and the bed nearest to Side wall should not be
less than 065 m.
a) Ceiling height: The floor to ceiling height of the ward should not be less than 3.00 m.
The minimum space between the floor and beams should not be less than 2.6 m.
b) Windows: If windows are located only on one wall it should be 20 % of the floor area.
If windows are on opposite walls at the same level it should be 15 % of the floor area.
c) Corridors: The width of the corridor is recommended as 2.40 m. to facilitate
movement of beds, stretchers, trolleys etc.
d) Doors: The width of the doors should not be less than1.20 m, to facilitate movement
of the bed.
e) Dedoing: It should be up to the height of 1.20 m. for maintaining cleanliness.
f) Bedside lockers and cupboard: A bedside locker for safe custody of the
patient's belonging should be provided. In cubicles the rooms can have
cupboard for hanging of clothes.

g) Chairs/sofa/sofa cum bed: Usually in patient's bed rooms these facilities are
required for accompanying patient's relatives or attendants/ visitors.

h) Other facilities: In modern hospital all such facilities are being provided as
per the categorization of the suits, e.g. private/semiprivate/deluxe/super
deluxe rooms. These rooms are having all the basic amenities like, AC, fridge,
TV, PC, Telephone, kitchen, attached bath rooms, the list can be endless.
Ancillary Accommodation
It consists of the following facilities:
i. Nursing Station
ii. MOs Room
iii. Clean Utility Room (100-120 sq. ft)
iv. Treatment Room
v. Kitchen/ Pantry (100 sq. ft)
vi. Daycare room
vii Stores.
Nursing Station
This is the nerve centre of the ward unit and should be so located that the
nurses can keep a watch over as many patients as possible. The distance
to the farthest patient should not be too much. In the Rig’s pattern the
acute patient are housed on either sides of the nursing station with
provision of large glass window for direct observation. The size of nursing
station is about 20' x 20' with sister’s room, large work table and build in
cup board.
Sanitary Accommodation
It will have following areas:
i. Dirty Utility room
ii. Bathroom and WC: a) Urinal (1 for 16 beds) b) WC (1 for 8 beds).
c)Bath room (1 for 12 beds) d)Wash basin (One for 10 beds)
iii. Janitor Room.
Water and Electricity Supply
1. Water approximately 300 liters./bed/day round the clock supply.

2. Light:
a) Point should be carefully designed

b) Glare free

c) Natural light should planned

d) One industry switch for machines like portable X-ray.

e) One 15 Amp and one 5 Amp switch in each cubicle

f) Night lamps.
 Communication: There should be an effective two-way communication, paging system and mobile or cell
phone system is the need of the hours. One broad band connection is desirable in each nursing station/ ward
for easy access of the medical library.

Air-conditioning: Centralized air conditioning of nursing units helps in patients comfort and reduces hospital
acquired infections.

Auxiliary Accommodation : it is normally common between 2-3 wards or for each floor. It will include:
a. Ward laboratory
b. Seminar Room
c. Employee's rest room and changing room
d. Nurse's rest rooms
e. Visitor's room
f. Duty Medical Officer's room, Sister's room may be provided at the scale of one per floor or for 2 to 3 wards.
g. Trolley bay on floor basis of 400 beds or above
h. other facilities like : i. Cold and Hot Water supply
ii. Piped gas for heating purpose
iii. Clerical outlets
iv. Nurse call system, telephone, clocks, etc.
 SPECIAL WARDS : In addition to the wards discussed above there are some special
types of ward with specific requirement like:

 Children’s Ward
Special consideration for planning for children’s ward include the provision of a large
proportion of isolation rooms and facilities for mother to come into the hospital with
their children. There is a also need of play room

Children’s Ward
 Maternity Ward
The maternity ward of the general hospital needs to be
linked very closely with clinics or health centers established
in the community near the homes The of a district hospital
should have a separate entrance, as child birth is a
physiological and not pathological process, and it is
undesirable that a woman should associate a normal
function with the care of the sick. The provisions in the
maternity wards will depend upon:

a. The number of women who would desire a hospital bed

b. The number of women who ought on medical grounds to
have a hospital delivery
c. The average length of stay in normal case
d. If a policy of "rooming in" the babies with their mothers
is adopted, the rooms or bays in the nursing unit should
be made a little wider, to allow space for the cot beside
the mother's bed.
Psychiatric Ward: the psychiatric ward if possible should be located on the ground
floor. It is desirable to treat the psychiatric department as a separate wing of the
hospital, physically linked to it. Many small one bed rooms are desirable; larger bed
rooms should be subdivided by means of curtains to give the patients privacy. One or
two isolation rooms are adequate for a unit of 24 beds. If possible a hair dressers and
small beauty parlor should be included in the hospital ward design
 Isolation wards :are used to isolate patients who pose a risk of passing a potentially harmful
infection on to others. Such infections can range in severity widely, from diseases such as 
influenza to ebola, covid19 etc. Although more precautions are generally taken with diseases of a
higher mortality rate. 

 In an isolation unit, several measures must be implemented in order to reduce the spread of
infection. The units are generally placed away from the main hospital, and staff often only work in
that unit. In some hospitals, the unit is placed in a separate building.

 Ventilation is important to reduce the transmission of airborne spores, and the most severely
affected patients are placed in separate wards. However, in some circumstances, especially in
areas experiencing a major epidemic, makeshift isolation wards can be constructed.
STAFFING
 MO 1 MO/ 12-15 BEDS
Gen. Medicine 1 specialist/ 100 beds+ 1 additional/ 50 beds
Gen. Surgery STAFFING 1 specialist/ 100 beds+ 1 additional/ 50 beds

Gynae and Obstetrics 1 specialist/ 100 beds+ 1 additional/ 40 beds

A. MEDICAL
Paediatrician 1 specialist/ 100 beds+ 1 additional/ 150 beds

Anesthesia, Dentistry, Radiodiagnosis, 1 specialist/ 200 beds+ 1 additional/ 150 beds

Pathology, Orthopaedics, Ophthalmology, ENT,
Skin and VD

Psychiatric, Biochemistry, Microbiology 1 / hospital above 200 beds

Chest Disease and TB 1 / hospital above 200 bed + 1 for additional

200 bed

Forensic Medicine 1 / 1500 bed

B. NURSING

Nursing Personnel Staffing Nurse

Nursing Superintendent 1/ hospital
Dy. Nursing Superintendent 1 up to 400 beds + 1 additional/ 200 beds
Asst. Nursing Supdt. 1 for 100-150 beds or 3-4 wards
Ward Sister 1 for 25-30 beds or 1/ ward
Teaching Hospital 1 Nurse for 3 beds
Non teaching hospital 1 Nurse for 5 beds
ICU/CCU 1 Nurse for 1 bed(+30% on leave reserve)
Infection Control Nurse 1 Nurse/ 250 beds
The nurse patient ratio depends upon the :
1. Size and layout of the ward
2. Type of cases, acute , chronic, mental, children
3. Type of hospital- teaching, non teaching or research
4. Number of important patients(VIPs)
5. Types of equipments
6. Average length of stay of patient
7. Availability of student nurses
 WARD MANAGEMENT
Management of
personnel

Policy and
Management
procedures of
of patient care
IPD

MANAGEMENT
OF WARD

Management
Management of
and control of
supplies and
environment of
equipments
IPD