Lecture 9: Facilities Planning

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Outline Introduction to facilities Planning

Considerations in Determining Facilities Requirements

Work Simplification to Material Flow

Flow Planning Hierarchy Activity Relationship Analysis Systematic Layout Planning

Facilities Analysis Components of Facilities

Analysis Facilities Consideration in

Clinical Engineering

Functions of Facilities Management Engineering

Life Safety Hospital Safety Program Security and Resource Protection Professional Environment Medical Functionality

Facilities Design Design Issues Design/Development Process Clinical Areas

Intensive-Care Areas (ICU) General Patient-Care Areas

(GCU) Surgical Suites Obstetrical Facilities Imaging Suites

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Introduction to Facilities PlanningConsiderations in Determining Facilities

Requirements Flow

1. lot sizes

2. material handling equipment and strategies

3. layout arrangement

4. building configuration

471

Considerations in Determining Facilities Requirements Space

1. lot sizes

2. storage system

3. production equipment type and size

4. layout arrangement

5. building configuration

6. housekeeping and organization

472

Considerations in Determining Facilities Requirements Activity Requirements

1. material or personnel flow

2. environmental considerations

3. organizational structure

4. continuous improvement methodology

5. control issues

6. process requirements

473

Work Simplification to Material Flow Eliminate flow by planning the delivery of

materials to the point of ultimate use

Minimize flow between to points by planning it to take place in few movements

Combine flows and operations

474

Flow Planning Hierarchy

1. Effective flow between departments

2. Effective flow within departments

3. Effective flow within workstations

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Activity Relationship Analysis

Considers qualitative factors in plant layout

Relationships are evaluated and closeness rating is assigned to each pair of relationship (A,E,I,O,U, and X)

Closeness ratings represent an ordered preference for closeness

476

Rules of Thumb in Activity Relationship Analysis (ARA) No more than 5% of the closeness ratings to

be an A or C

No more than 10% to be an E

No more than 15% to be an I

No more than 20% to be an O

At least 50% to be U

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Relationship Chart

1 PresidentO

2 Costing UA A

3 Engineering IO

4 President’s Secretary

1122

33

Ordinary Ordinary closeness: closeness: President (1) & President (1) & Costing (2)Costing (2)

Absolutely necessary: Absolutely necessary: President (1) & Secretary President (1) & Secretary

(4)(4)

44

I = Important

U = Unimportant

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Development of Layout Using ARA List all departments or activities to be

included

Obtain closeness ratings by interviewing or surveying persons involved in the activity

Determine reasons for closeness ratings and record in the REL chart

Assign a closeness rating for each pair wise combination of activities

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Systematic Layout Planning

Goal Locate two areas with high frequency and logical

relationships close to one another using a straight-forward six-step procedure

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Steps in SLP

1. Chart Relationship the relationships between two different areas are

established and then charted on a special form called the relationship chart.Value

A

E

I

O

U

X

Closeness Line code Value

Absolutely necessary

Especially important

Important

Ordinary closeness OK

Unimportant

Undesirable

4

3

2

1

0

-1

Relationship Ratings

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Relationship Chart

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

Admissions

Medical Records

Control Desk

Waiting Room

FSR Room

Bone Marrow Room

Lumber Puncture Room

Nursing Functions Area

Examining Rooms

IV Therapy/Recovery Rooms

X-Ray, Diagnostic

EKG

ENT

Hematology Lab

Pathology Lab

Pharmacy

Utility/Linen Room

Ladies’ Room

Men’s Room

Local Transport Office

Play Room

Computer Input/Output

X-ray, Therapy

o o oo

o

oo

o

o

o

o

ooo

o o

A A A

AA A

AA

A

A AA

E E EE

E

E

EE

EE

III II I

OI

III

I

I

IIIII

I

I

IX

XXX

X X

Code Closeness

A Absolutely Necessary

E Especially Important

I Important

O Ordinarily close

U Unimportant

X Undesirable

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Steps in SLP

2. Establish Space Requirements Square Footage

calculated based on production requirements extrapolated from existing areas projected for future expansion or fixed by legal standards, such as the ADA or

architectural standards

Kind and shape of area

Location w/ respect to utilities

483

Steps in SLP

3. Diagram Activity Relationship A visual representation of the different activities

are drawn.

Activity Relationship Diagram

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Steps in SLP

4. Space Relationship Layout A spatial representation is created by scaling

the areas in terms of relative size.

Modifications may be made to layout based on several reasons (ex. storage facilities, personnel requirements, bldg. features, utilities)

485

Space Relationship Layout

486

Steps in SLP5. Evaluate Alternative Arrangements

Need to evaluate the different alternatives to determine the best solution

The steps: Identify factors

deemed important. Add weights. Rate for satisfying the

factor Each rating is then

multiplied by the weight.

Sum, compare, high

487

Steps in SLP

6. Detail Selected Layout and Install handling methods, storage facilities, personnel required, building features, utilities

488

Facilities Analysis

Directed to the primary purpose of engineering and maintenance in the hospital and includes The physical plant Utilities system Major non-movable equipment items Fire protection Safety systems Electronic communication systems

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Components of Facilities Analysis1. Functional Analysis

Flow of people and materials are analyzed and evaluated

2. Analysis by Layout Determine affinity relationships among various

locations involved

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Components of Facilities Analysis3. Support System Analysis

Includes heating, ventilation, air conditioning, electrical system, suction system, compressed air and compressed gas system Fire safety system Plumbing system Steam system Building structure others

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Components of Facilities Analysis4. Analysis by Relationship

Concerned with the relationship of the first three components

The patient is the center of the analysis

The Patient

Temperature Humidity

Air Volumes

Electrical Systems

Sound LevelsLighting

Suction systems

Compressed gases

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Facilities Consideration in Clinical Engineering Operating Rooms

Considered a controlled environment, where control relates to all aspects of the environment including: Cleanliness Lighting Temperature and humidity control Electrical environment Support systems Ventilation Building structural features

493

Facilities Consideration in Clinical Engineering Radiology

Begin with the structure of the radiology department itself

Controlled temperature and humidity environment must be known for the number of computer interface in the radiology department

Electrical requirements should also be known like the proper voltage and current required

Consideration of growing numbers of special procedure rooms present in the department

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Facilities Consideration in Clinical Engineering Clinical Laboratory

Fastest growing department in terms of instrumentation

Need stabilized line voltages to operate computer-interfaced diagnostic systems

Primary electrical consideration should be that all equipment is grounded

Should safety programs for highly toxic and dangerous liquids

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Facilities Consideration in Clinical Engineering Special-Care Units (SCU)

May be an intensive-care unit (ICU), an coronary –care unit (CCU or variations of this

In considering SCU, address the overall environment such as noise levels, light intensity, location of central nursing station and other practicalities

SCU should be supplied by emergency electrical generation system

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Facilities Consideration in Clinical Engineering Other services

Emergency room Has the utility needs similar to operating rooms and SCU Requires special planning and analysis that must be

undertaken when considering layout and design of functional services

Nursery Has controlled environment with access limited to

nursery personnel to minimize outside environmental effects to protect vulnerable infants

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Facilities Consideration in Clinical Engineering

Respiratory Therapy Departments Consideration should be given to the provision of

oxygen and compressed air to provide outpatient treatment in the future

Physical Therapy Departments Installation of ground fault interrupters (GFIs) is

recommended to protect patients if a fault occurs in electrical equipments that has direct contact to patients

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Functions of Facilities Management Engineering

Ensure maintenance of the physical plant Minimize consumption of resources Prevent contamination of the surrounding environment

Life Safety Ensure reliability and safety of building systems Ensure that codes and standards are met to protect

patients, staff and visitors against undue risk of fire or other hazards

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Functions of Facilities Management Hospital Safety

Protect facilities personnel, patients and visitors from physical and biological hazards

Security and Resource Protection Ensure maintenance of facilities to provide secure

environment Make adequate provisions for protection of

facilities, property and personnel

500

Functions of Facilities Management Professional environment

Ensure conduciveness to the delivery of high-quality medical care of the interior and exterior appearance of facilities

Medical Functionality Provide adequate space to accommodate people

and equipment with physical access for all patients

501

Engineering systems that must be controlled Medical Air

Air intended for human respiration Significant in dealing with neonates in respirators

Medical/Surgical Vacuum Systems Are required to provide vacuum pressure for drainage,

aspiration and suction during medical procedures Centrally piped and consist of two or more vacuum pumps,

operating alternately or simultaneously Each pump should be capable of maintaining a minimum

required vacuum equal to 75% of peak calculated demand

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Engineering systems that must be controlled Piped Medical Gas Systems

Provide oxygen and nitrous oxide, nitrogen, carbon dioxide, helium and air to specifically identified outlets within procedural rooms throughout the facility

Heating, Ventilation and Air Conditioning Maintain the ambient hospital environment

503

Engineering systems that must be controlled Electrical Systems

Hospitals are dependent on electrical power

Lighting Illumination is the essential part of the medical

facility Emergency lighting system must be properly

designed to ensure health-care delivery can continue even if there is a power outage

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Engineering systems that must be controlled Communication Systems

Essential to the safe and efficient operation of any medical facility

Fire Protection Systems Fire emergencies must be quickly contained or

controlled to avoid necessity of evacuating the entire facility

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Life Safety Objective

Reduce the probability of injury and loss of life from the effects of fire and other emergencies or hazards

Appropriate provisions of life safety code Comprehensive statement of construction Effective inspection process Drawings Installation, testing and maintenance Annual inspection and testing Program to manage portable fire extinguishers Written fire plan Strict smoking policy Policy statements

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Hospital Safety Program Goals

Ensure a safe environment Reduce the risk of human injury in the facility

Responsibilities of facility manager Oversee the development, implementation and

monitoring of the hospital safety management program

Manage ongoing process of collection and evaluation of hazard and safety practice information

507

Security and Resource Protection Objectives

Minimize loss, theft and damage of hospital resources

Maintain order during emergencies

Responsibility of facility manager Coordinate building security plans with local police Request police assistance in determining

appropriate security measures

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Professional Environment

Responsibility of Facility Manager Develop a long-term plan for maintaining and

improving the appearance of the facility

Housekeeping functions should be performed in an effective and timely manner Important in maintaining the aesthetics of the

hospital Essential to provide an aseptic environment which

facilitates medical treatment

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Medical Functionality

To efficiently allocate adequate space to accommodate both people and equipment it is necessary to Develop a facilities master plan that provides

overall view of the activities planned for the facility Establish guidelines for space utilization

Facilities master plan long range planning tool that can be used to prioritize

minor or major construction projects necessary for the operation, maintenance and future developments

510

Facilities Design Issues

Cost “What is the total cost of the project?” Includes:

architect and engineer fees cost estimating construction management Asbestos abatement (in existing spaces) Building permits Insurance Change orders Contingencies

511

Facilities Design

Not normally associated with the “traditional” duties of the practicing clinical engineer.

Usually other engineers are hires to do the job: civil, mechanical, industrial, licensed architect.

These environments range from the relatively simple surroundings of patients rooms to complex surroundings of surgery, imaging and critical care.

512

Work Flow Model of a Facilities MgmtVerbal or Written communication

1New Additions

Conducts Safety and Performance Tests

Identifies Environmental Units and Exceptional Equipment

Prepares Maintenance

Schedules Maintenance

Prepares Equipment file Worksheet

Prepares Instruction File Worksheet

Distribute Reports

3. Corrective Maintenance

Performs Maintenance

Prepares Corrective Maintenance Worksheet

Engineering Department Files

Reports Jobs OutWork Order

Jobs OutWork Order

3. Preventive Maintenance

Performs Maintenance

Records results in Work Orders

OR Records Reason Mait. Not Perf. On Jobs –Out Report

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Facilities Design Issues

New Construction versus new renovation Factors that affect the decision to build a new facility or to

renovate an existing space include a comparison of relative costs for new versus old construction

Space “How much space is actually needed?” Published guidelines, standards or equipment

manufacturers’ recommendation have a well-established minimum space requirements

To what extent a given design goes beyond minimum requirements

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Facilities Design Issues

Adjacencies “How does this project affect other services?” Critical factor to consider in design projects (e.g. the

proximity of medical services that interact directly) Efficiency and quality of patient care is improved as access

to adjacencies is optimized

Handicap access Design attention paid not only for physically challenged

patient but also for staff members and visitors who may be handicapped

515

Facilities Design Issues

Utility systems “What are the utility requirements of the project?” Utility services in clinical services area is

substantial Design process must be carefully evaluate the

demand level to avoid overthrow existing service capacities or provide for the expansion

516

Facilities Design/Development Process Determination of and contractual

arrangements with the appropriate planning of architectural and

engineering services

Establishment of schedule Deadlines should be establish to prevent from

taking unacceptable long period of time

517

Facilities Design/Development Process Identification of the space “footprint”

Area must conform to minimum space requirement for the function

Must satisfy requirements of adjacencies

Development of a floor plan block diagram based on function Define the functional space and quantity of individual space Produce a functional block diagram that meets appropriate

design criteria

518

Facilities Design/Development Process Development of functionality layouts

Consider specific details of equipment layouts, utility outlet quantities, styles and locations, interior finishes and any other requirements

Construction of models (prototypes) Mock-up with exact dimensions, draw-in utilities,

and moveable equipment should be made to correct both discrepancies between design drawings and anticipated final product

519

Facilities Design/Development Process Termination of design process

Desirable to obtain agreement, in writing, for user groups involved

End the possibility of further discussion Recognize that the design represents the best

efforts of the entire design team to accomplish specific goals within limitations of available space and resources

Limits the duration of the design process Prevents the likelihood of change orders that

could occur during the actual construction

520

Facilities Design/Development Process Construction documents

Detailed design information are transformed to specification books and blueprints

Used by local building authorities to issue building permits Used by hospital design team for cost estimating and

competitive building purposes Used by construction contractors to build the facility Should be reviewed to ensure correct and accurate

information are translated into the final specification and prints

521

Clinical Areas

Intensive-Care Areas (ICU)

General Patient-Care Areas (GCU)

Surgical Suites

Obstetrical Facilities

Imaging Suites

522

Intensive-Care Areas

Concentrated care are rendered to seriously ill patients under where more continuous monitoring and intensive treatment could be offered

Common needs in ICUs Bed space Support Functions Medication Preparation Utility Services

523

Bed Space Space allocation are based on

Open area Has the advantage of greatest visibility Least amount of space required per bed Other considerations (e.g. ventilation control, privacy and

equipment maneuverability) makes it less than ideal for most modern applications

Cubicle Provides for solid partitions with viewing panels between beds, a

solid headwall and open space in the direction of nursing station Offers greater degree of privacy while maintaining substantial

visibility and accessibility Control for ventilation and noise abatement may be problematic

524

Bed Space

Individual room Maximizes privacy and ventilation control Requires the most space, the greatest investment in

floor space and highest construction cost Often impedes visibility Space required for each bed is directly related to the

severity of the patient’s illness or injury

525

Support Functions

Nursing Station Command post of the ICU Must be sized, configured, equipped and located

to accommodate all the activities situated and come from this station

Activities in nursing station Communications

Space for telephones, nurse call consoles, intercoms, data terminals, printers and also verbal communication with nurses, physicians, visitors and ancillary support staff

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Support Functions Clerical

Adequate space for the record-keeping requirements of the nursing unit staff

Includes open writing space for forms, records and references

Central Monitoring Monitoring systems incorporate central station displays and

recorders normally located at the nursing station Position should allow for ready access and proper visibility

Visual access to patients Nursing station should be located in a way that could provide

visual access to all patients within the unit and equidistant from all beds

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Support Functions

Charting Activities Maintenance of patient charts and medical

records performed by nurses, physicians and allied health personnel

Separate charting area should be considered not too far from nursing station since most of the charting are made in the nursing station

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Support Functions Medical Preparation

A separate area for the stocking and preparation of necessary medications

Areas for medical preparation Clean utility activities

Storage space for sterile medical and surgical supplies, additional intravenous (I.V.) solutions and other “clean” items

Should include a sink and adequate counter space as well as storage cabinets and shelves

Soiled utility activities Separate, compartmentalized space for holding normal trash,

biomedical waste, reusable items and bagged soiled linen Should include a utility sink, a clinical sink and bedpan sanitizer

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Support Functions Nourishment Station

Small pantry for special needs (e.g. reheating food) Provision should be made for refrigerator, a small heating or

microwave oven, an ice machine, a hand washing sink and minimal storage cabinets

Linen Storage Space for storage of clean linen

Equipment Storage Storage for equipment needed for the unit Space is determined by the amount and type of equipment stored

Staff Lounge/Lockers Space for staffs to take breaks, write shift change reports and

conduct in-service education sessions Changing areas , lockers and lavatory facilities

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Support Functions

Visitor Waiting Space Space for the visitors to wait since visiting times are

restricted Head Nurse’s and Assistant Head Nurse’s Offices

Office space for the head nurse to do administrative task that requires privacy or isolation

Housekeeping Functions Space for the equipment and supplies required by

housekeeping personnel to keep the unit clean Should include janitorial closet large enough to keep all

appropriate supplies

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Support Functions

Utility Services Electrical power

Receptacles It is important to provide adequate number of receptacles It is critical to analyze probable locations of devices and

distribute receptacles accordingly

Circuits Analysis of total loads should be made Circuits should have a rated capacity and protection of 20

amps or more Use of emergency power and the consequences of circuit

failure should be determine

532

Support Functions

Emergency Power Should be considered in the basis of

Capacity of the alternate power source Likelihood of a total external power outage versus

internal distribution failure

Equipotential grounding Needed to protect patient from micro shock hazard

533

Support Functions Lighting (For specific values look at Ergonomic standards

table) General Illumination

Various level of lighting are required in ICU that depends on Flexibility in lighting could be achieved with multi-switched bulbs

or fluorescent dimmers Color spectrum of room lighting should be considered

Task illumination Performance of visual task of low contrast over prolonged period

of time may require increased luminance Night lighting

Provide an area of high-contrast task lighting for nurse charting off to the side of the room

Natural lighting Design should incorporate exterior windows in proximity to patient

spaces

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Support Functions

Plumbing fixtures Hand washing sinks

Should be installed in each patient room and at every major functional space

Toilets Space provided for early ambulation or providing staff with

convenient waste disposal

Heating, Ventilation and air conditioning Design to supply air or to remove air from ICU must

meet common and specialized criteria Should provide air movement from “clean” to “less clean”

areas

535

Support Functions

Piped Medical Gases Significant consideration to the overall design, is the

availability of a continuous supply of oxygen, medical vacuum and other piped gases

Quantity and location of appropriate piped gas outlets should be determined in relation to the patient and the number and types of devices that will require the simultaneous supply of these gases

Outlets should be configured in a way that it could prevent unintended connection to the incorrect gas

536

Support Functions

Communications Provisions should be incorporated into the design for a

number of definite or possible communication lines Communication system includes

Nurse call Telephones Bedside monitors Entertainment/education Other data transmission Paging systems

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General Patient-Care Areas

Design Criteria Size

Total space for each patient bed in GCU is smaller than in ICU

Total number of patients are larger than in ICU Density of utility services

Utility services smaller than in ICU since there is less equipment and fewer and less complicated procedures

Increased patient awareness Less acutely ill or recuperating patients are much more

aware of their surroundings

538

Surgical Suites

Design for operating rooms are the most complex since medical standards associated with surgical procedures are carried over to room design specifications

Design must accommodate four distinct user groups: Patients Surgeons Anesthesiologists Surgical nurses and technicians

539

Surgical Suites Design Factors

Size Standard minimum size is 400 sq. feet Room dimensions are determined by equipment and

personnel access factors Utility services

Requires high-density utility services such as: Electrical power

Almost all of the equipment used needs electrical power Number of receptacles are determined by the equipment

load Electrical outlets are often suspended from the ceiling to

avoid tripping from power cables Abundant number of circuits should be available throughout

the room

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Surgical Suites

Lighting High level of general illumination is required for

visual tasks of low contrast and are of very small size

Plumbing Need for fixtures for specialized applications

and for significant plumbing requirements (such as scrub and utility sinks and instrument processing systems)

541

Surgical Suites

Medical gases Greatest concentration of the medical gas

outlets in the hospital occurs in the operating room

Most gas supplies are suspended from the ceiling

Communications Data terminals and telephones should be

provided but should not be within the operating room

542

Surgical Suites

Heating, ventilation and air conditioning Specifications include

1. positive pressure in relation to adjacent room and corridors

2. Minimum of three room changes per hour of fresh air and a minimum of 15 room changes per hour of total air with high filtration

3. No recirculation by room units

4. Relative humidity of 50 to 60 percent

5. Temperature control of 70 to 75 oF

543

Surgical Suites

Finish Materials Walls should be hard, relatively seamless,

nonporous and easy to clean Floors should be hard, seamless, nonporous

and easy to clean Finish ceilings should be washable and

prevent debris from the utilities or slab above from filtering into the operating rooms

Cabinets for storage should not interfere on available floor space

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Obstetrical Facilities Design criteria required are similar to the operating room, but the

primary difference in design criteria is in the current attitudes toward childbirth process

Design is based on the notion of permitting the mother to progress through the first three major steps of childbirth in the same room and the same bed

Needs to accommodate first and foremost the mother and her spouse Obstetrical nurse Obstetrician Baby Equipment used for child birth

Number, location and style of utility service outlets are determined by personnel and equipment used

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Imaging Suites

Design features for imaging rooms are determined primarily by the specific imaging technologies involved

Designed around equipment that is big, heavy and expensive

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Mini-Case

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Mini-Case: get a host hospital and do the following Choose a specific department in the hospital Document the current layout and get the

information/ material flow of the current layout using SLP

Make a recommended layout to increase the efficiency and productivity of the department

Create an analysis by relationship with the patient as the center: with the new layout and incorporate the support system analysis

548

References

Bronzino, J.D. (Ed.). (1992). Management of medical technology: a primer for clinical engineers. Boston: Butterworth-Heinemann

Webster, J.G. & Cook, A.M. (Ed.). (1979). Clinical engineering: principles and practices. Englewood Cliffs, N.J..: Prentice-Hall, Inc.

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