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Home My WebLink About650230.tiffI I S a Weld County Medical Center Greeley MASTER RAN Rodney S. Davis Associates Archtecls 821 11th ys0007 6,50330 Ir. Cheyenne Greeley Colorado Springs CONTENTS Page PART I PURPOSE AND INTENT 1 PART II MEDICAL STAFF AND HOSPITAL PERSONNEL 7 PART III BUILDING CONSIDERATIONS General 8 Satellite Concept 10 PART IV DISCUSSION OF DIAGRAMMATIC MASTER PLAN - GENERAL A. Material Handling Systems B. Basic Relationships of Departments C. Entrances Site Plan PART V FIRST FLOOR A. Use of Space in Existing Building B. Outpatient - Emergency C. Radiology, Surgery and Pathology D. Auditorium (Exhibit Room Below Ground Floor) E. Parking Structure (First and Ground Floor) F. Long Term Expansion G. Acute Hospital (New West Wing and Central Core -First) H. Chapel Facilities First Floor Plan PART VI GROUND FLOOR PART VII PART VIII 13 16 17 19 20 20 21 22 22 23 23 24 25 A. Present Building - Use Of 26 B. Kitchen and Cafeteria - Second Floor 26 C. Supply Coordination 28 D. Central Supply 28 E. Future Computer 29 F. Pharmacy 29 G. Physical Therapy and Occupational Therapy 29 Ground Floor Plan 31 SUB -BASEMENT 32 Sub -Basement Plan 33 BOILER HOUSE -LAUNDRY -ENGINEERING SHOP COMPLEX 34 CONTENTS Page PART IX SECOND FLOOR A. Acute Beds B. Isolation C. Pediatrics D. Cafeteria E. Coronary Care and Intensive Care Units F. Location of Intensive Care Unit G. Present Patient Room Modifications (All Floors) H. Educational Facilities I. General Comments Second Floor Plan PART X THIRD FLOOR A. Obstetrics Department B. Extended Care -Long Term Care Units C. Definition of Extended Care Unit D. Common Rooms for Patients E. Educational Department F. Expansion Possibilities for Obstetrics Department G. Definition of Long Term Care H. Long Term Care Area Third Floor Plan PART XI FOURTH FLOOR A. Acute Beds (New West Wing) B. Nursing Home C. Nursing Home Garden D. Barber and Beauty Shops E. Self -Care Unit Fourth Floor Plan PART XII FIFTH FLOOR AND UPPER FLOORS A. Acute Beds B. Psychiatric Wing C. Sleeping Quarters Fifth Floor Plan Sixth Floor Plan 36 37 37 37 38 39 40 40 42 43 44 45 45 46 47 47 47 48 49 50 50 51 51 52 53 54 54 55 57 58 CONTENTS Page PART XIII AUXILIARY STRUCTURES CONNECTED TO THE HOSPITAL A. Plot Plan B. Staff Housing C. Cancer Clinic D. Public Health Offices and Laboratory E. Medical Office Building PART XIV SUMMARY APPENDIX "A" Nursing Pathology Laboratory Technician Radiology Radiology Technician Medical Staff Dietary Physical Therapy & Occupational Therapy William M. Mangum, M.D., Director of Medical Education and Chief of Surgery Maintenance Department Central Supply Laundry Manager Housekeeping Purchasing Department Comptroller and Personnel Director Inhalation Therapy Medical Records Pharmacy Operating Room and Recovery Room Recovery Emergency Department Obstetrics Department Accounting Credit Manager Admitting Medical Staff Meeting APPENDIX "B" Floor Plans of Existing Building 59 59 59 61 61 63 64 67 69 70 72 73 74 76 76 78 79 80 81 82 83 84 85 86 87 89 90 91 94 94 95 96 A LONG RANGE PLAN FOR WELD COUNTY MEDICAL CENTER GREELEY, COLORADO PART I PURPOSE AND INTENT This report, part of the Long Range Plan which was instituted by the present Board of the Weld County General Hospital and by the Administration headed by Mr. Richard H. Stenner, Administrator of the hosnital, is an attempt to completely reevaluate the present hospital building and its function in light of anoroxi- matel • twenty-five years of development in the medical field since the last report was made for the then forward looking Board. It is commendable in looking back and seeing how correct that Board was in their farsightedness twenty-five years ago and to realize that the present Board is enually farsichted and recognizes that though Weld County has one of the outstanding hospitals, both from a physical and operation standnoint, they cannot afford to stand still in the rapidly developing field of medicine. °articularly this report is basically interested in the physical facilities, and will evaluate them from the current and future aspects. lhile it has truly been said that a hospital is not made of brick and stone but of people, it certainly hen doves all concerned to provide the best possible workinc con- ditions and physical facilities in order that these people may do their job in the most efficient and expe- ditious manner possible, and with the greatest potential benefit to the patient and community. The fact that the present hospital is in excellent physi- cal shape, is well maintained and well operated, gives the casual observer a sense of .,ell -being and a false impression of a greater ability than actually exists to meet future needs. Hospital buildings and their uses have changed more in the last decade than in the previous fifty years. It can be said changes have occurred more ranidly since this hospital opened its doors than they had in the previous hundred years. So, while this building does not seem to be old, the basis upon welch it was originally conceived has been drastically outmoded. Pape 1 Tremendous upheaval in the methods and hardware of medical care is also apparent in the administration, payment, con- trol and regulations of today's hospital. This is caused by such items as Medicare, Medicaid and third -party pay- ments which represent the major portion of the hospital income and thus exerts considerable influence on the operational aspect of the institution in order to comply with their regulations and criteria. The high salaries necessary to attract trained personnel are causing a revolution in the manner of medical practice, hospital operation, hospital planning and related fields that has yet to become apparent to the general public. In a Long Range Plan it would be tragic for this hospital to continue to think in the now generally accepted manner of operation and to do future planning upon that basis. The r.cent statements by the President of the United States, which were preceded by many similar statements from other distinguished people concerned with the medical field and its every increasing costs, are but one indication that there are going to be major changes made that will affect the entire medical care field. While no one can tell exactly what direction the changes may take and no one building can be a panacea for all the problems inherent in the health field, still the relationship of the hospital to the doctor, medical practice, the administration of health care, the coming total community concept of medical care and the concept of preventative medicine, is already visibly changing to those who are closely watching the field. The problem is not to be considered as merely one of re- placing an older piece of equipment with a newer and larger one or the expanding of certain facilities, but rather it must be viewed in a much broader aspect, and that is what has and is happening to the practice of medicine and health care in general and what is the coming trend. There will be even more rapid changes as time progresses, and every attempt should be made to keep the planning of the hospital on a flexible basis rather than a rigid basis. The fine distinction to be drawn here is between the extent to which maintenance of the building and its durability must be considered, and the extent to which costly items should be included that will allow great flexibility of arrangement in the future. Already under construction in California and in two other locations are more costly hospitals that have no columns Page 2 whatsoever on the interior of the building, in other words, being built like bridges spanning the full width of the building. Also, they have provided large spaces between each floor in which heating, ventilating nines, ducts and electrical services can be routed with maximum accessibility for installation, servicing and revision. All such services are necessary to the operation of any modern building, but are renuired to a far greater degree in a hospital. While such an approach will cost very heavily initially, it is expected to return the investment by the great flexibility and future economics that it does allow in the rearrangement of the building for medical services. Though such an approach is not specifically recommended at this time, these facts, in addition to many other factors that will be discussed individually in the body of the report, did contribute to the final conclusion that the acute bed portion of the hospital should be totally housed in a new connected building. This does leave the opportunity to further evaluate such an approach and to then study prototypes now under con- struction, including a study now in process at Stanford (under a large foundation grant) to evaluate the problem of construction methods to achieve physical flexibility of arranaement and services in hospital buildings. Building expansion, such as larger mental health facil- ities than those incorporated in this plan, are possible and their growth areas are indicated on site studies. The growth of Long Term Care Units, Extended Care Units and Rehabilitation Units and their future use pattern cannot be clearly defined at this time because of an insufficient history of use. These factors may require relocation of nursing home beds out of the present exist- ing structure (as now projected in this Master Plan). If this relocation is necessary, a new building to the east would be the logical answer with mental health facilities sharing the building and all connected to tne main structure by a tunnel and material -handling system (this will be discussed later in this report). This report will not contain charts showing past growth of patient care, what the future growth of patient care will be or any of the usual charts that are ordinarily contained in a report of this nature. These projecting charts are quickly rendered meaningless because of changes in medical practice, changes in the third -party payment programs, abrupt changes in population, either accelerating or deaccelerating, all of which are occurring frequently. cage 3 No one has any real knowledge that can successfully predict what the population of the area will be that Greeley will serve, let alone the utilization of the hospital and its various facilities. These charts are at best of little use because it only takes one event such as the Kodak plant in Windsor to completely forestall any predictions made. We also see that even where there is not as dramatic a change that these charts often are in error because due to some extraneous circumstances completely unpredictable, the use of medical facilities will change drastically leaving the charts little more than an exercise in drafting. It has been Mr. Stenner's thinking all along that parameters of the maximum growth this facility should achieve on its present site and possible expanded site be studied; that we not establish any particular time schedule predictions. Therefore, this whole program is based on a growth to a central hospital unit of from 550 to 600 acute beds and the contributory facilities to make a true Medical Center. Augmenting this is the concept of satellite units, which are discussed herein, being placed throughout the service community as needed. This report is an attempt to show the possible course of action that the hospital should take, and growth would be achieved by segmenting the plans in the light of then current conditions and as the need is apparent. No particular priority as to any phase of the work is in- tended to be implied in this report, rather the project in its ultimate form is conceived with the segmenting to be done in final analysis and as expedient at the time of fruition of need and means of accomplishment. A Master Plan is only a point of departure, a guideline from which decisions can be made. It does discipline sub- sequent concepts and other considerations for additions, alterations or acquisitions of land. These can then be evaluated in the light of the total concept. It is a handbook, so -to -speak, for future development and a basis on which to implement later facts, later knowledge and later requirements and the proper timing for same. An important consideration is that a large industrial complex like Kodak will attract other medical service in- stitutions such as a hospital, albeit a proprietary type hospital, perhaps even an organization that would provide total medical care, hospitalization, including medical personnel. Page 4 All of this makes it imperative that the Weld County community act expeditiously in showing their intention to serve the expanding community with the necessary modern facilities. Failing in this, Weld County General Hospital could be reduced to a hospital pri- marily handling county indigents, migrants and other types of non- or low -paying patients. This ultimately would place by far a greater burden on the taxpayer than a balanced institution that treats all types of patients with adequate ancillary facilities, that need not be duplicated a few miles away, but rather augmented by use of satellites We are purposely omitting here the phrase as "money allows" because we feel this program should be predicated on the services that the hospital extends to the community and will make it the leading hospital in the area and a true Medical Center These services must then be pro- vided in the most economical way practicable. The manner in which this can be done will be, undoubtedly, debated, but the fact that the hospital board and adminis- tration has implemented this study illustrates an interest and intention on their part that Weld County General Hospital keep the preeminence that it achieved in its community service some two decades ago and has main- tained. It would be tragic if it did not continue to lead the way by becoming the dominant Medical Center in northern Colorado A study has been conducted in this state that was aimed at trying to achieve cooperation and utilization of hospital facilities to the greatest extent. This study, centering around Denver because of budget limitations, did not extend into the Weld County area, but is still indicative of the concept that hospital and medical - oriented people have come to realize is essential to con- trol rapidly rising medical care costs. If this central- ization and utilization is not done voluntarily, it will be done by Federal Government regulation with more red tape and more taxes as the result. A well-intentioned program in New York State has greatly stultified hospital building and services in that state by having become a political football and bureaucratic struggle for power and control within the state organi- zations.. It is with these facts in mind that this report has been prepared Though subject to questioning, debate and to alteration before its acceptance as even a preliminary plan, the most important tact still remains that the Page 5 community must take steps now to show its interest and will- ingness before the initiative is taken by other groups. A forward looking program can be presented for financial assistance to foundations, local and national; research foundations; health organizations, as well as to the govern- ment for grants for the different facets of medical care and research. By having a comprehensive plan and mustering the forces necessary to achieve same, the County and its health insti- tutions can greatly benefit. All these opportunities will be lost should another institution be built in the area first that combines the latest techniques and medical hardware, thus attracting staff, personnel and patients to a greater competitive degree than the Weld County General Hospital. The physical location of Greeley, some 70 miles north of Denver, but surrounded by considerable agrarian areas, as well as other small communities who do not have the facilities that Weld County even now offers, does give Weld County General Hospital a head start towards becoming the major Medical Center for the whole area. Certain long-range projections by the governmental agencies have discussed locations such as Sterling, Colorado, and other areas as possible sites for such a Medical Center. However, there is no doubt that should Weld County make definite aggressive steps towards maintaining its preeminence, full cooperation of these agencies would be extended. With modern roads and modern technology being developed for transportation facilities, such as helicopter ambulances, Weld County General Hospital becomes a logical selection as a site for such a development. However, it must be borne in mind that it is not the only site. A facility of this sort, while requiring a large initial investment, could not only make a fair return on such an investment, but could become a large factor in the expansion of Weld County itself. There is no doubt that the selection of the area by Kodak was immea- surably aided by the present hospital's excellent reputation. A progressive county attracts progressive institutions and industry. With the pollution and inherent transportation problems of larger long-time established communities, this gives a newer, younger and smaller community a chance to avoid these growth problems while building and thus create a more desirable living environment than other larger metropolitan areas. Page 6 PART II MEDICAL STAFF AND HOSPITAL PERSONNEL With the foregoing thoughts as a basis for the consider- ation of expanding Weld County General Hospital, we arranged to meet with the heads of all departments and chiefs of staff, services and other medical personnel closely involved with the operation of the hospital, also the medical staff, during which no firm proposals were made by either the administration or the Architect, but rather a general dis- cussion of where the medical profession saw the hospital going and its future role in the community. In so doing, every person in the hospital was given an opportunity, either directly or indirectly through their immediate superiors, to put forth any idea they had as to the expan- sion, operation or future of the hospital. They were encouraged to do this without regard to how "far out" some of the suggestions might be. Actually, we were looking for mind -stretching thoughts, and for any concepts that anyone had seen developing in their particular discipline. It was interesting to note how many of these various items and suggestions coincided with similar ideas or suggestions made by others at separate meetings. This basically then made such suggestions of considerable importance, inasmuch as people with disciplines of quite different natures within the hospital came to the same related conclusions. These meetings are briefly summarized in Appendix "A" of this report, but the main thoughts expressed therein have been embodied in this Long Range Plan as far as practicable and where applicable at this stage of the planning. Some of the discussions centered around details in planning of departments that at this time are not apropos to a long- range broad area study. However, discussions of this sort with personnel were encouraged in that they often give an insight into a department that would help the Architect to evaluate whether space allocated for these departments was indeed of a valid amount. They are, however, omitted from this report as not being pertinent to the reader who is more concerned with the future direction and extent of the hospital than with the smaller details of its function. Nevertheless, the Architect has considered these details and does have records of them in his files. Page 7 PART III BUILDING CONSIDERATIONS - GENERAL This report is based not on projected patient loads or hospi- tal use as was aforementioned, since all such statistics that are available from governmental and health organizations run some two years behind the current times, and as previously noted in the introductions, such figures have been rendered useless by recent industrial developments in the Weld County area; therefore, it is based on what is thought by the administration, medical staff, hospital personnel and the Architect to be the trend and the direction that hospital planning and building are going. It is an attempt to be as forward -thinking and yet flexible, recognizing the constant changes taking place in building and medical techniques. Thus, it was with this thinking in the background, that the conclusion was reached that the present building was too in- flexible for the incorporation of the major facilities needed for a modern-day acute hospital. As departments will be discussed individually later in this report, let me generalize to say that the major departments such as Surgery, Pathology, Radiology and Emergency are now physically unrelated in the present building and located in such a manner that their mandatory expansion cannot be achieved without major struc- tural change or expansion, which would in most cases predicate relocation even within the present building or an adjacent expansion thereto. In the past decade many departments requiring a high amount of sophisticated electrical and mechanical installations and extensive built-in facilities have either greatly expanded their needs or are totally new services with totally new space requirements. They are all still basic to the needs of an acute hospital. This remodeling has often been done at costs considerably more than new construction would have come to in order to provide these necessary departments with expansion and to locate them in a somewhat feasible relationship to each other. These expenditures, that are actually uneconomical, have had to be made utilizing existing portions of the building. Examples of these are the Intensive Care Unit, Coronary Care Unit, Recovery Rooms and the greatly enlarged Pathology and Radiology Departments. Weld County General Hospital has been more fortunate than most existing facil- ities in being able to accommodate these major demands with alterations and expansion, but with some compromises. However, the limit of reasonable accommodation has been reached, plus the fact that locations and relationships are Page 8 far from ideal an future expansion is virtue y impossible from a feasibility viewpoint. The higher utilization of the other ancillary facilities, such as Physical Therapy, Inhalation Therapy, Emergency areas, and the need to accommodate all other related functions such as Outpatients to established departments must be considered. To summarize it, there will be very little of the pres- ent departments that would not need extensive expansion and alterations, and in some instances, the building would almost have to be taken down to its bare frame and rebuilt. Cost of doing this in an existing hospital and continuing to keep the hospital in operation very often brings the cost to within a very close proximity, or even exceeding new construction costs in some instances. The operating dollar loss, the inefficiency and the high increase in other every -day operating costs, plus the factor that the contractor will protect himself against unknowns in bidding such a construction program, all make for a totally impractical procedure. Coupled with this is the loss of flexibility in obtaining the most efficient of layouts within the department itself, as well as for operational relationships because of the existing structure, mechanical and electrical services and similar items, and the need to retain the existing not being the least of all these. This then leads to compromises that do not necessarily result in decisions that are to the best interests of the hospital medically, efficiently and on a long-term operational consideration basis. The Architect has had personal experience with using existing areas, which in some instances were essential because of the location of the hospital, site restric- tions or other factors. In all cases, considerable cost and compromise of operational efficiency was involved. The original concept of the Weld County General Hospital was to such a degree of enlightenment that acquisition of considerable land at that time makes it now, despite the much greater needs, not beyond the realm of reason to attach to the present structure ultimately, a new acute hospital wing, while at the same time utilizing that which exists to its greatest degree, but in another context and other related usages. This will be illus- trated in some detail during the text covering the plans, but the new structure and use of the old building is a basic assumption of this plan with none of the present structure being removed, merely encompassed and altered. Page 9 It might be p ited out at this juncture at the concept of new construction allows the minimum interference during con- struction periods to the present operation in that the major medical services could be constructed as needed, and moved into a new portion of the building before any extensive alterations or reduction of services need be done in the present building. This will achieve many obvious economies, as well as maintain the best possible service to the patient at all times. In the final concept, the use of the present building would then be to augment the acute hospital. While the complete Master Plan cannot be devised around periods of construction, even if individually a year or two in length, at the same time that facet of the problem cannot be utterly ignored as it has direct bearing on feasibility, costs and operations. Satellite Concept As previously discussed, the conclusion had been reached to take this hospital to a five to six hundred acute bed hospital with the necessary ancillary supports and related services as an arbitrary goal. The decision for this goal was made based primarily on the growing concept of satellite units. With the more complex facilities that it is necessary for an acute hospital to maintain in order to serve its patients with the ultimate in medical care, which will be desired as well as used by medical staff, it has become impossible for every hospital to offer all these complex services and equipment, along with the properly trained personnel to provide the whole gamut of modern medical care. Therefore, it has become apparent to many that we must establish Medical Centers in strategic locations for the more sophisticated and ultimate type of medical care, but at the same time provide in stra- tegic population centers the facilities for the more routine services. With the greatly increased facility for movement from one location to another of not only the outpatient type of person but of patients in general, it is becoming less and less feasible and practical to give anything but the most routine medical services outside the shelter of the hospital. Nevertheless, there is still a strong desire for treatment in the near proximity of that which is the most convenient. At the present time there is a shortage of medical doctors and trained personnel. There is every indication that this trend will continue, or indeed become worse. At the present time the University of Colorado is planning for para- medical training in the future to help overcome some of these problems, Therefore, our facilities should also Page 10 recognize these problems and build satellites in the service community that Weld County General Hospital encompasses which would be staffed by medical doctors, paramedical personnel and other trained people. The treatment and diagnosis would be confined to the more routine functions. These staff people would have the ability to recognize the need of other more advanced treatment and diagnosis, and would see that the patient was so directed to the centralized Medical Center with a capability of taking care of more serious types of problems by being staffed with the proper personnel and having the equipment capability. Here, too, would be the capability of doing the even more exotic medical procedures, such as heart transplants, kidney trans- plants and many other medical procedures that can be done only with teamwork of a large group of trained doctors and medical personnel, plus facilities and equipment not available in the average hospital. These satellites would be equipped to handle emer- gencies, so that with modern day transportation coupled with communications, these satellites could then be adequate to handle such emergencies that may arise. A perfect example of this is the great use that the helicopter ambulance has been put to in the Viet Nam War, This can be applied to civilian uses and undoubtedly will at the conclusion of the war when many of these ambulance planes will become avail- able for civilian use. Hence, heliports at satellites and the Medical Center will form a quick link with a community in order that there will not be a feeling of isolation because it does not have its own hospital. There is a certain amount of education of the public that will have to be done, as the current trend is "we must have a hospital so that if Junior falls out of the tree and breaks his arm, I can quickly get him medical attention." With the superiority of the attention he can get at the Medical Center if there are complications, plus the capability of the satel- lite to take care of him routinely and on an emer- gency basis (this will also have to be stressed) and the nearness of the Medical Center measured not in miles but in minutes, a strong argument can be made for this procedure. When the community comes to realize that just as the one -room schoolhouse is a thing of the past, so will be the little community hospital which cannot, no matter how well run, begin to compete with the large Medical Center in proper care of patients. When people realize this, then will they give up the provincialism of "our own Page 11 hospital in our own backyard" and accept the satellite con- cept which will have the emergency facilities, and which is basically what they are concerned about. These satellites can be placed more flexibly than a hospital, thus can follow current population trends, growth and needs. Their initial investment in capital funds would be far less, so as needs change in a period of years their growth or size can be more sensitive to demands. At the same time, the routine services such as shots, blood samples, other routine tests and treatments can be conveniently available in a given area. The headstart that the Weld County General Hospital has in its present location has already been expressed as the opportunity for Weld County General Hospital to become this Medical Center. Less opposition from surrounding communities will be forthcoming when the concept of the satellite hospital with the central core Medical Center is fully explained as to reasons for same and the benefit to all is set forth and fully documented. When communities realize that the satellite can be made to serve them even more fully and to the most flexible extent, then will there be general acceptance and backing for the expansion of Weld County General Hospital as a Medical Center. The discussion of these satellites, while not on the plans specifically, are as much a part of the Master Plans as are any of the other facilities. Without the satellite concept to aid in handling future patient loads and outpatient needs, this hospital would have to be planned to a much larger size than is now envisioned. Rather we feel the hospital is planned to a practical as well as a manageable size, but virtually any growth to whatever foreseeable extent can be accommodated by the satellites plus this Medical Center core. Page 12 PART IV DISCUSSION OF DIAGRAMMATIC MASTER PLAN - GENERAL It is hoped that this translation from general concepts to a diagrammatic plan will be the implementation of all the varying ideas, disciplines and experience into a workable Master Plan, thus a sizeable aid in directing future growth. A. Material -Handling Systems: A concept which is basic to the plan and which needs to be accepted in evaluating same, is the totally new concept of material -handling. In the past we have relied heavily on dumbwaiters, trayveyors, conveyors and elevators for handling food and materials in hospitals. As the need for more and more ancillary services related to one floor has brought a larger and larger base to the hospital, it has become more difficult to relate these departments and their highly ur- gent and sophisticated material -handling requirements to a basically vertical transportation system. With the advent of higher and higher wages, the cost of transporting material throughout a hospital has been a growing concern to many people in the hospital field for quite some time. While some attempts at mechanization have almost been self- defeating in that they have been more complicated, more costly and in many instances saved little time or labor, there nevertheless has out of this type of thinking grown two (at the present time) major new material -handling systems. It is a certainty that others coming on the mar- ket will soon be operational. These systems are devised to be able to handle material automatically, rapidly and obviate the necessity of cer- tain plan relationships that in the past were considered good merely from the material -handling standpoint. This allows the Architect to have a greater range of orienting departments in the best possible manner from a structural standpoint, as well as from a medical and operational standpoint and still have the departments in contact with each other from a material supply standpoint as if they were closely physically allied. These systems are actually the spine of the building, and must be accepted as such. They are capable of moving material horizontally and vertically with great expediency without immediate man control, but by remote control from a dispatching center. These systems thus approach the industrialization and production line techniques that have long been known in industrial plants. While such Page 13 impersonal techniques are not wanted for patient care, they certainly can be used for the expediting, accounting and handling of the bulk of material moved through a hospital, including dietary and virtually all items except the patient and staff itself. Even in the latter context they free the elevators for passenger and patient use, and so indirectly become an important part of that function. The two major types are Cyberail marketed by the Castle Automated Systems Division of the Ritter-Pfaudler Corporation and Amsco, a system being developed and marketed by the American Sterilizer Company. It is not the purpose of this report to judge or select, but merely to point out that such systems already exist that make many current planning re- strictions modern day anachronisms. Briefly, Cyberail consists of a container carried on a monorail with its own power source. It can move both ver- tically and horizontally with containers added or subtracted automatically from the system. Standard sized storage units are carried which will fit into modular storage rooms, utility and service areas. The containers are electronically con- trolled with requests or transmissions made at individual stations located throughout the hospital. For safety, the pathways for this system are physically separated from normal hospital circulation. The Amsco system is a self-propelled, battery -operated cart (a "glorified" golf cart) that follows an electric control tape imbedded in the floor. This cart will proceed to its own elevator, summon it, enter, ride to the appropriate floor and leave the elevator. From this ooint, it can be led by a handle which activates its motive power to any location desired. Here again the use of standard storage units would facilitate the handling of material. For largely psychological reasons the Amsco Systems Company does not recommend that the cart be dispatched automatically down public corridors. Although the cart will stop immediately upon contact with any object, it is still agreed that it would not be to the best interest of the hospital to have such carts moving about unattended in patient and public occupied areas. However, lower floors used only by hospital personnel can be used for dispatching corridors since hospital employees can easily be instructed and become accustomed to the movements of these carts. Both systems have computerized central control, can bring food, laundry and other supplies from remote areas on schedule, make emergency deliveries, and move items of less critical nature at off -hours (all night long), thus supplying the hospital totally on a twenty-four hour basis with a minimum of cost. Page 14 In the Weld County Plan, materials arriving at the ground floor receiving area are introduced into the transport system at a vertical station which lowers containers to the sub -basement horizontal network for transport to appropriate storage areas or for direct transmission to the requesting departments or even to separate buildings, as the case may be. System containers are largely quartered in one designated area of the sub -basement. When a supply request is received, a container moves first to the appropriate stor- age area for pickup and then proceeds to the requesting station. Since the hospital building is housing two complete circu- lation systems, i.e., a transportation network as well as a normal hospital circulation pattern, the required hori- zontal transport arteries are confined to the sub -basement. Vertical shafts are then positioned strategically to enter the departments of the Central Core, Surgery, Radiology, etc. For service to the existing building, one shaft rises alongside the existing southwest wing near its juncture with the center of the existing hospital. This places a transport station in the existing wing which remains an important bedroom area, yet positions the station centrally for maximum access to the remainder of the floor. Soiled linen, trash, etc. from throughout the hospital com- plex will be picked up in containers and brought to special assembly -sorting rooms. From these areas the materials will move via a tunnel to the laundry for processing or to a disposal point. Clean laundry returns by the same route to the hospital clean linen storage for future distribution. The entire hospital complex is thus tied together by a virtually invisible supply network quite independent of normal circulation spaces. Transport systems are not a new "futuristic" concept, but have been under discussion for several years.* The Archi- tect is currently in the process of planning such a system with the Lutheran Hospital and Medical Center in Denver. By the time specific detailed planning for Weld County General Hospital would be under way, there will be many installations that will have been in operation for some *William B. Foxwell, "Hospital Automation," Architectural Record, March 1969, pp. 149-164. Page 15 time. Therefore, it is felt that such a system is a perfectly logical choice to use as a basis for this Master Plan. B. Basic Relationships of Departments: Having accepted the conclusion that the new building concept for the acute hospital and the material -handling system are pertinent and proper, then it becomes a matter of orientation of the various departments, facilities and services for the best and most efficient utilization of the site, the present building, and the incorporation of the newest in medical functions and building techniques. These then become matters of judgment, but such decisions have been heavily influenced by the many aforementioned conferences with medical staff, hospital personnel and administration, as well as past ex- perience, planning institutes attended, other facilities visited and current publications. After having fully examined the present hospital and drawn composite plans that bring all the past changes, alterations and additions onto one set of drawings (small reproductions of which are reproduced herein for the reference background they provide) the conclusion was reached that it was physi- cally as well as financially infeasible to incorporate into the present building the needed expansions for Surgery, Radiology and Pathology. This, because there was no reason- able place where they could grow in relation to where they now exist, and in turn the departments are not properly related locationwise to each other for the most efficient operation. Ideally they should be contiguous one to the other, as there is considerable daily inter -function, and in case of emergency proximity is of extreme importance. The conservation of highly skilled and trained personnel's time is also of primary importance. At the same time, the very large increase in outpatient and emergency services, which should also be backed up by the Surgery, Radiology and Pathology as there is a great deal of interrelation and emergency relations here, mean that these facilities, too, should be located in proximity to the others. There was only one reasonable place for this to occur and that was on the first floor. These departments are discussed more fully later, but their relationship to each other must be understood. It has also been determined that the patient bedrooms now existing on the first floor were undesirably located for control and expansion of the hospital. The fact they were not a primary first floor occupancy requirement, i.e., their easy accessibility was not of that great an importance, became apparent and that such functions on the first floor Page 16 should be moved elsewhere, and the second and third floor existing departments would be better located on the first floor. With this conclusion, the obvious area of expan- sion was to the west and hence, the Surgery, Radiology and Pathology were placed in the core that would occur between the present building and a new acute wing which would be located even farther west.. Thus, this makes the central- ized services available to the occupants of the existing building, which will ultimately be long term care, extended care, self -care, psychiatric and nursing home patients. These departments will be discussed in detail later, but their occupants will have need from time to time for the services offered in these areas. At the same time, Emergency and Outpatient, which consists basically of smaller rooms, will be located on the first floor of the existing building at the south end, and will thus have close proximity to the Surgery, Radiology and Pathology complex. The placing of the new acute beds to the west of the service ancillary core will achieve an automatic separation that is highly desirable between acute patients and the other class of patients to be accommodated.. We will have, in effect, two institutions connected by an ancillary service core so that both have the convenient use of same, but there is no great cross flow of traffic, thus creating confusion, difficulty of control, operation, etc. C. Entrances: Outpatients would be received in what is now the Public Health Department entrance, whereas the extended care, long term care and nursing home type of patient would be received in what is now the main entrance and lobby. At the same time, a new entrance and lobby would be created to the west at the base of the new acute hospital when it is constructed and new administration quarters for a larger facility would also be housed there. There would be direct connections, of course, between the new and existing, as there will still be some necessary interrelation so that should patients or visitors enter one or the other end of the building by mis- take, they can be quickly directed to the proper facility they are seeking, However, exterior signs would try to minimize this by directing people as to which portion of the institution they are seeking. There would also be an Emergency entrance directly off of Sixteenth Street with Emergency patient parking adjacent; see plot plan and discussion of parking structure below. Page 17 The auditorium with exhibit space below will have its own exterior entrances to facilitate separate use without dis- turbing hospital related functions, but will have direct access to the main building when such use is required. A separate exterior entrance to the motel outpatient facilities is also being provided to facilitate ingress - egress without confusion, but still providing direct con- nections to the main facility. The Emergency entrance at ground floor level and its usage are discussed in detail in connection with those departments, as well as relationship to the Cancer and Deep Therapy facilities. Service functions will still have their separate entrances as required. All of these facilities are discussed in more detail in the following text, but are mentioned here to aid in an over- all concept of relationships and flow. Page 18 PART V FIRST FLOOR A. Use of Space in Existing Building: (1) Motel: The patient rooms that now occur in the northwest wing on the first floor could most easily be converted to motel type rooms, a need for which has been mentioned. This would accommo- date the person who wishes to stay in very close proximity to their relatives who are patients, or to the outpatient who has to come in for treatment but does not need hospitalization, yet perhaps has no personal transportation or is not capable of driving to a motel. This type of need could be met within the confines of the hospital itself, and by being so located is convenient to the Outpatient Department, to meal service and to the other patient facilities of the hospital, yet is isolated enough not to be in the main stream and flow of the oper- ational functions of the hospital. It would have its own entrance and a little garden court to the north. (2) Offices and Lobby (existing): The present busi- ness office would become the admitting area for the Nursing Home, Extended Care, Long Term Care and Outpatient facilities. It could thus serve the Outpatient Department which will have a very heavy admitting and record load. The present lobbies, snack bar, etc., would remain virtually intact. (3) Outpatient -Inpatient Adjuncts: Related to the above area would be the pulmonary function and inhalation therapy function which are both out- patient and inpatient oriented. That location could serve both functions readily as would the EEG and EKG and heart station, which are also lo- cated in that proximity. See plan. B. Outpatient -Emergency: In order to provide adequate space and proper relationship for the Emergency and Outpatient Department, the southern half of the area between the two south wings of the present building would be enclosed, leaving a patio court which will also be utilized at the ground floor elevation. This court is a cushion for expansion should it be needed at a later date, yet serves a function while maintaining portions of the building virtually unchanged at the present time. Page 20 The interrelationship of these facilities .with Radiology, Pathology and Surgery has been previously discussed above. The growing need and use of these facilities have also been emphasized, and the diagrammatic plans recognize all these requirements and provide adequate facilities under now understood usage. In case of a major disaster, such as was experienced in the school bus tragedy in the community, these enlarged related departments could function with greater efficiency and with less medical doctor personnel in the building (than fortu- nately was present at the time of the bus disaster). Correspondingly, during peak loads of outpatient usage, the overflow can be accommodated in the Emergency area, thus utilizing expensive facilities to the utmost. These facilities would be comprised of examination rooms, minor operating areas, cast removal, even some recovery areas for minor techniques and the complete facilities of a modern Outpatient -Emergency Department. Audio and speech testing facilities along with a blood bank complete with blood taking facilities would be part of this area. C. Radiology, Surgery and Pathology: The relationship of these three departments as the central core of the hospital has already been discussed, as has some of their functions, in general discussion items; hence, a detailed discussion of the areas at this point would be redundant. Needless to say, they would be laid out in detail, and space allocations allotted here include handling without cross flow of inpatients and outpatients, even provisions for one -day outpatient procedures in surgery and flexibility to handle the ever changing techniques inherent throughout this study. These three departments, the hub of the ancillary facilities, will be provided with adequate space for modern day depart- ments of their type with growth room, and were established on a virtually ideal related department basis. In the consideration of Surgery where no specific use of areas is designated on the plans, items such as double operating rooms that are needed for transplants, the possibility of full oxidation rooms, the use of hyper- baric chambers, or even the hyper-baric operating room, Page 21 are not completely ignored. Space allocations superficially may seem rather large, but it is because of these and many other yet unknown demands in these areas that large space allocations were made to recognize such developments. De- tail planning to specifics of need at the time of construc- tion would develop modifications to these area requirements as dictated by requirements at that time. Suffice it to say that in space allocations of these three major areas, careful consideration of all requests, dis- cussions and present day knowledge, as well as the unknown future, contributed to the final decisions. Future items that would affect the areas to a degree and as yet unknown, are greater use of isotopes, disposable operating rooms (of plastic -like tents within rooms) and even disposable operating area caosules. D. Auditorium (Exhibit Room Below Ground Floor): Another requirement that is needed by an institution of this size and was mentioned by many in preliminary dis- cussions, was the need for a large auditorium of the theater type. In other words, it would have a stage, sloped floor, theater type fixed seats with a capacity of 600 approxi- mately, and with facilities for showing both closed circuit and educational television broadcasts, educational movies and the whole range of educational techniques that are used in modern day educational institutions. This would be located to the north of the present administration wing, with its own outside entrance, and yet be connected directly to the hospital so that while it can be used for community functions unrelated directly to the hospital, it will by being directly connected still be readily available for the medical teaching functions that are envisioned. It would be immediately related to the educational facilities that are being planned to be incorporated on upper floors (this will be discussed later when those areas are explained in detail). This facility, also located close to parking, will be of considerable benefit to the entire community, educationally and activitywise, yet the flow to and from would in no way interfere with patient care. Below the auditorium would be a large open area that could be used for exhibits in connection with the Auditorium usage. E. Parking Structure (First and Ground Floor): A two-story parking structure that will abut the center core on the south in order that it may serve not only the Emer- gency entrance but also serve the acute hospital is pictured. This structure is envisioned as primarily for doctors and Page 22 hospital personnel, thus leaving the large parking area to the east and the large parking area to the west for visitor parking. Doctors would then have covered parking directly accessible to the hospital as would the majority of the in- house personnel. F. Long Term Expansion: Radiology and Pathology, should these departments grow beyond our current anticipations, have been provided with first floor expansion areas and are not "locked in". It might also be mentioned that Surgery with Central Supply below, two departments that have also seen tremendous growth, could expand into the adjacent parking structure should it become expedient at a later date, and these departments grow beyond our very generous allowances for growth. The parking structure could then be replaced by its reconstruction to the west. It would also follow that in planning the parking structure initially that it would be built in such a way that it would recognize this possible use in the future. Another interior court occurs adjacent to the new administration between the new west wing and the central core. This, too, actually is a buffer for future expansion and services of a smaller nature than the foregoing major expansion provisions. We find these safety valves negligible in cost, but invalu- able in cost savings for badly needed space requirements at a future indeterminate date. G. Acute Hospital (New West Wing) and Central Core - First Floor: Provision is made at the base of the acute hospital for it to have its own entrance, own admitting and the main hospital administration adjacent thereto with an adequate lobby adjacent. While the Master Plan cannot and should not show details of every sort, items such as a children's waiting room with toys and other facilities where the mother may leave the child, gift shops, flower shops, magazine stands, ladies auxiliary office, all of which are not specifically medical requirements yet are very important to the overall operation of the hospi- tal, its smooth flow as well as the public relation aspects, are allowed for in the areas designated. Family counseling rooms where clergy and other representatives of Churches and similar organizations can meet will be pro- vided readily available to the lobby. These rooms will be furnished as comfortable sitting rooms with privacy and quiet as an inherent part of same. A coffee shop for public service of food and beverages will also be located in this area. Page 23 The doctors' entrance would be convenient from their desig- nated area in the parking structure, would have adjacent to it a lounge and be adjacent to Medical Records for their convenience, quick use and consultation. While it is not readily apparent on the plans, such items as the flow of outpatients and visitors as separated from inpatients, have been carefully considered. The proximity of surgery to inpatient and to elevator service, yet at the same time not taking the patient out into the public area after he leaves his floor to be seen by the public is important. The transportation of material, patients and medical staff (all of these items not readily discernible as problems unless you are "living" with the institution) have been considered in this diagrammatic plan, Control of flow, both at peak periods and at off hours, separation and closing off of areas are all integrated into the plan. While departments themselves have not been specifically designed in detail, their size, relationship and general configuration was determined by consideration of these details which would have to be more finely polished and honed in an ultimate plan. However, if the basics were not there, then the plan would be more of a hindrance than an aid, and be only a superficial solution. H. Chapel Facilities: The present Chapel would remain in its present location as it would thus continue to serve both the new acute hospital and the Nursing Home -Long Term Care Unit, as well as be reasonably convenient to outside visitors. Page 24 CalrolC uuiiiuiuuiuiuuuiwest Alton, ,rIiuiuuuuii FIRST HIM al Ali PART VI GROUND FLOOR The ground floor is being discussed at this juncture as it also houses basic ancillary services, and is perhaps more closely allied to the first floor than even the upper floors. The display area and parking structure located at this level are included in first floor discussions because of their immediate relation thereto. A. Present Building - Use of: It must be remembered that the ground floor of the present hospital is below grade on the south portion of the building, but at grade on the north portion of the building. This topography was, therefore, used to the most advantage in that we intend to create the garden court entrance for the motel rooms (discussed previously) at approximately what is now the doctors' entrance to the hospital. Some of the park- ing in that area would be removed and a landscaped court, plus drive-in facilities would be created. The removal of service facilities from that area will be discussed later. This will create a more pleasant outlook for the cafeteria and motel rooms, yet isolate this related yet separate function from the daily operation and overall flow of the hospital. The proximity to existing elevators, which will be relieved of many of their present loads, makes this feasible without the expense of an additional elevator. The present ambulance entrance, storage areas and garage could be utilized for less active storage, for garden and grounds equipment, storage for snow plows, service trucks, etc. The ambulances would be housed in the basement of the parking structure on the south. In addition, the present laundry and receiving areas could be converted into little -used storage, into furniture repair areas, even have access to the outside at grade level, and would be very handy for these functions. They might well serve in these capacities for the satellite operations where practicable. These items need not be in the main stream of the quick turnover items such as food, medical supplies, linen, etc. Yet with the modern material -handling facilities that are a basis for this whole plan, they too are not iso- lated to the degree that they would be otherwise. B. Kitchen and Cafeteria - Second Floor: While the function of a kitchen for an institution is under- going tremendous changes and revolution with the advent of prepared foods of many different varieties, it is felt that a kitchen per se need not necessarily increase so greatly in size, but the need for storage, freezing capacity, dishwashing Page 26 capacity, etc., still present. Since the location of the present kitchen is also in what becomes the center ancillary core (see plan) and thus easily serves the new proposed acute hospital to the west as well as the existing building, it was felt expedient to retain the kitchen in its present location with expanded facilities and related items such as freezer, refrigerators, culinary storage, occupying some of the ground floor area of the new center core. In this way, complete flexibility for future planning of the kitchen is achieved inasmuch as it is virtually surrounded by what are now designated as storage areas, thus providing flexibility in ultimate planning to accommodate rapidly changing techniques in this field also. The use of floor kitchens to reconstitute food is also a consideration. The use of this kitchen to supply satellite hospitals is not beyond the realm of possibility. While dishwashing was mentioned above, there is under de- velopment disposable dishes of the plastic nature that are acceptable to the patient, even disposable utensils, trays and glassware, but at the moment they are still not feasible from a cost standpoint. However, developments may render them the way to go in the future. Some hospitals in Cali- fornia have tried this route, but have not been able to justify the costs, and in many instances have reverted to the more standard procedures. At the present time the air- lines, who are constantly looking for ways of serving their meals with disposable items for obvious reasons, have them- selves been unable to arrive at a satisfactory disposable solution. In fact, they are currently investing hundreds of thousands of dollars into central dishwashing units that are extremely automated; hence, they are betting heavily that a breakthrough in cost with public acceptable items will not be forthcoming in the near future. At this point, we are not by the Master Plan committing the hospital to any specific direction or solution in the handling of food ser- vices for the hospital, and feel that this must stay a completely flexible item for future evaluation and detail planning time. We have, however, assumed that with the large increase in the size of the hospital, the transportation of food by rapid material -handling equipment, which has been previously discussed, that a separated cafeteria is highly practical from a convenience to the personnel and to the ambulatory patient standpoint. We have so indicated this on our Master Plan. This is the only firm commitment in area location we have made as to the food serving provisions. Page 27 C. Supply Cooruinationc Material -handling in a hospital is of major importance due to the tremendous amount of supplies that must be furnished to all departments. The problems of furnishing Surgery and Obstetrical Departments with highly sterile supplies, the problem of furnishing linens, medicines, and goods to the patient floors be they acute or long-term, have made some consultants design a hospital as if it were strictly for material -handling purposes only, with medical functions and patient care being rather secondary. While the proverbial tail cannot wag the dog, there is, of course, a very grave and inherent problem here which will be greatly alleviated .by the modern material -handling equipment previously dis- cussed. See plans and Part IV. Nevertheless, this function must have a center of operation, a place of storage, and dispatch; hence, a good portion of the ground floor is des- ignated as storage, which being adjacent to the kitchen, Central Supply, vertical service, etc., allows complete flexibility of detailed planning in the future. Neverthe- less, these areas are somewhat centralized for control and receiving for the complete utilization of the transport system, for minimum personnel to operate same, and are related to the Central Supply Area. D. Central Supply: The Central Supply area is related to Surgery by being immediately below so that it can serve as a true Central Supply, handling all the services for that facility and in this one instance, there would be one or two dumb- waiters at strategic spots for emergency service in a manner of seconds. While this is a detail at this time, it is also a detail that had to be considered in the lo- cation of Central Supply. There will be a strong connecting link between Surgery and Central Supply that cannot under any circumstances be interrupted, and in this one instance the Architect still feels that close proximity is an absolute necessity for modern day medical techniques. The use of highly trained people (this training can be in-house) to handle all portions of sterilization in Central Supply and not utilize highly trained nursing personnel to do subsidiary jobs, allows their full utilization for a full operating day schedule and the full utilization of the Surgery area for just that and patient care purposes. The Central Supply being located in the center of the primary storage area also allows the employment of a control technique that handles all medical supplies per se, and the inter- relationship here with the Pharmacy is also apparent. Page 28 The issuance of medical supplies to outpatients is rendered convenient by its location. E. Future Computer: At this level of the new west tower, provision for a future computer center can well be made.. Space is being allocated because the extent and use of a computer in a modern medical facility is on the threshold, be it in-house or centralized. All functions of record keeping, medical and supply will ultimately be computer controlled, administered, central- ized and coordinated with like facilities. How, when and where is still to be determined, but be this a sending station or a center, with all the satellites interrelated, space allocation is recognized.. F. Pharmacy: Pharmacy in turn is located where it can be readily accessible to outpatients from the floor above and still convenient for servicing the acute hospital, as well as the ancillary core. Its relation to Central Supply has already been noted. G. Physical Therapy and Occupational Therapy: The decision to locate Physical Theraphy and Occupational Therapy on the ground floor of the present building was because in this manner a relationship with the Outpatient Department above could be maintained. Often patients in the area are repeat outpatients who come back many times for the services offered in these departments (they may well be some of the occupants of the motel). At the same time, the department has a very heavy load from inpatients, but usually these are inpatients who are in the Extended Care, Long Term Care, Rehabilitation areas or possibly the Nursing Home. The patients are not of the emergency nature type of operation; hence, their need to be located on the first floor is indeed questionable, if not undesir- able, for they bring a type of traffic, slow moving, etc., into an area of heavy traffic and this is in general undesirable. Due to the physical layout of the building, it is feasible to bring a ramp down to this ground level that will serve as an entrance and exit to the parking structure, but can also serve as a drive -up entrance to the Physical Therapy and Occupational Therapy Departments. In this way, it is not necessary for a patient on crutches to enter the build- ing at one level and then have to take an elevator down to the lower level, It is immaterial, of course, to the inpatient as he will be coming down from the upper floors Page 29 by elevator and with assistance.. Likewise the newly ad- mitted will also have assistance. The court which was created between the two south wings as discussed on the first floor area, allows the Occupational Therapy Department to have natural light by opening on what can be a very pleasant court landscaped, yet sheltered so that during many times of the year patients can enjoy this area as a sun trap where they would not be able to enjoy it were the court at first floor level surrounded by parking lots, cars, etc. Also, their privacy is not particularly violated and they need not feel they are on some sort of a public display.. At the same time, certain portions of the Physical Therapy Department, primarily the exercise rooms, are also desirous of having a pleasant outlook and a court was created that these patients could enjoy. Since they are often in various states of undress, they too need privacy and protection from the elements, but the visual connection with the outdoors is of psychological impor- tance even though many treatments do involve undressing to an extent that the privacy of the patient must be respected. The patient that comes for physical therapy and occupa- tional therapy will, of course, be admitted at the first floor level because he would have to be seen and evaluated and records established at that time. For all future trips he would know where the lower lobby was, and could be received directly into the department, again saving need- less duplication and confusion at the first floor level. Page 30 fit Wieg I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I ICeetral = iiuiuuu mirmi West Wit. GROUND FLOOR PLAN PART VII SUB -BASEMENT Because of the interrelationship of functions between the ground floor and the sub -basement, the latter will be dis- cussed briefly at this point. The material -handling systems do require some lower floor areas, and it would be located ideally in the sub -basement. This becomes the central point at which all dispatching is done and is ideally located at this level in order to eliminate any conflict of circulation of personnel, This area would also be connected by tunnels with the boiler room, linen and laundry service across the street, the mechanical shops, engineering shops, offices and everything that would be housed in the new boiler house. A tunnel to staff facilities in Mead Hall is feasible, From this central control point the subterranean areas would feed like fingers to all portions of the hospital and allow the the most direct access to the varying departments, and thus supply their needs without conflict with others.: It would also allow expansion of more immediate hospital related functions into Mead Hall when required in the future, as staff quarters will ultimately be located across the street (see below). In this manner, complete control, physical and dispatchwise, can be maintained with minimum personnel. Such a sub- basement would also allow ample space for housing mechani- cal equipment that would of necessity need to be in the main building, such as air handling fans and air-conditioning equipment that it is more economical and logical to have in here than in the remote boiler house.. Also, additional storage and virtually any other service not needed in the more active mainstream of events. Specifically there are such additional items as storage of older medical records and X-ray films which must be maintained indefinitely and yet are very infrequently used, Here, too, records from all the satellites that are inactive could be centralized, thus reducing the need for storage in these active units and again following the centralized con- cept that we are advocating throughout this program, It is also reasonable at this juncture to point out that many of the service facilities performed by the hospital personnel, such as repair of equipment, furniture, and re- finishing of furniture, would be able to be done in the central unit, minimizing the necessity for local maintenance shops since these would be of adequate size to handle such loads. Page 32 I a C I a 7 r C U C C C PART VIII BOILER HOUSE -LAUNDRY -ENGINEERING SHOP COMPLEX The basic plans for the service areas are based upon a remote boiler house, located across the street from the hospital, in an area not specifically designated, and not at the present time a part of the land under hospital control. It is antici- pated that it would be to the north of the hospital connected by a personnel tunnel in which also the material -handling system would move supplies between the two facilities. Also conceivable is vacant land to the west of the present hospital site which is not currently owned by the hospital, but the needs of the community could perhaps be impressed upon the present owners. A remote boiler house allows complete freedom of movement and planning within the main site, allows for expansion of boiler house without interference with the main building and other services, and vice versa. This is also true in re- lation to contributory buildings that are anticipated in this program, examples being the cancer clinic, medical office building and additional staff housing facilities, plus items of other similar nature. A centralized plant like this has proven to be a real economy when you consider the large campuses that are heated and cooled from a cental source, as well as serviced mechanically and electrically. All of downtown Denver, virtually, is now heated by one central Public Service Co. plant. This plant has made it uneconomical for a person to operate his own boiler plant for one building. This limits the number of personnel required to operate these plants. With modern con- trol panels that indicate functional operations throughout a series of buildings, a minimum of personnel could maintain a large complex at much less cost than by diversified operations. The connection of these facilities by tunnel and with the material -handling system, makes their exact location immaterial. The location of the laundry and engineering shops, as a part of the boiler house, leads to a logical and economical re- lationship and combines functions that can be virtually divorced from the hospital into a separate entity. There may initially be some objection of the thought of a boiler house being located in what is now a predominantly residential area, but a modern boiler house can be as attractive and un- objectionable as a large apartment house complex. With modern equipment there would be no air pollution or obnoxious odors Page 34 or any of the other undesirable items commonly associated with boiler houses. The new Samsonite boiler house in Montebello (a Denver suburb) is a case in point with no emissions whatsoever. In addition, incinerators as we know them have been out- lawed with the exception of pathological incinerators that can be obtained with burners and recombustion chambers that absolutely eliminate any type of discharge into the atmosphere that is in the slightest degree polluted. The Architect is currently installing such a pathological incinerator in a Colorado Springs hospital, so this is not an item of the future. At the same time, consideration must be given to the dis- posal of waste, and this will be done by water systems, can crushers, waste pulverizers, compactors and many other methods that result in waste that would be hauled out of the boiler house, packaged and baled. This would be less disruptive than the normal garbage and waste taken from an apartment house. There would be less traffic and less confusion generated by this boiler house than by an apart- ment complex with many families living therein. The great ponderous of goods would be received at the main building receiving area, so even this function would be divorced from the boiler house. It is also anticipated that the hospital in providing staff housing and other related facilities for a large Medical Center would also acquire some of the adjacent land to the boiler house for its own housing, apartments and such facilities as the need indicated at the time. The remote location also gives the laundry adequate room for growth because here, too, the use of disposable linens, sheets and many other items currently now being laundered and sterilized may come into the disposable realm or may not, so the future size of the laundry is indeterminate plus the obvious effect of new laundry machinery on build- ing size. The use of laundry to service the satellites would also have an influence on final sizing. Therefore, perhaps waste disposal will require more space than laundry, but since they are considered to be con- tiguous to each other and in the same building, this should pose no real proble, and again allows planning for the changing techniques and facilities that must be in- herent throughout this program. Page 35 PART IX SECOND FLOOR A. Acute Beds: At this point in planning, with the availability of large ancillary areas in the present building and of similar areas over the projected center ancillary core, there is very little possibility that the second floor of the new acute hospital would need to be used for other purposes than pa- tient care, so the first of whatwill be repetitive floors of acute beds is programmed. This allows flexibility in construction phasing, to needs, etc. This facility will constitute 40 to 48 patient beds, all of which will be private bedrooms with private toilet facilities and showers. They are conceived at the present time on a double corridor center core basis; that is, all facilities such as utility rooms, nurse stations, linen rooms, medical rooms, offices, conference rooms, floor classrooms and the full service facilities that are nec- essary for a modern nursing unit would be located in this center core surrounded by bedrooms. This center core in turn would be serviced by the material -handling system that would place food and floor supplies in the most con- venient locations for the nursing personnel on that floor. While there are varying opinions on various studies, the general consensus of opinion of most studies is that this arrangement is the most efficient from a nursing care standpoint that can be devised. The purpose of this Master Plan is not to go into details to too great an extent, but it needs to be mentioned here that it was on this basis that space and shape assignments for the Master Plan were conceived. The modern concept for acute nursing care is certainly the private bed. This eliminates the assignment of rooms, the annoyance of incompatible patients and achieves some iso- lation techniques by its very nature, and then is con- sidered as just that, an acute patient bed area, and what truly sick person wants to share a room with another sick patient? Psychologically as well as medically, this is an antiquated concept which the health field has been re- luctant to give up just as they were general wards for a number of years. Studies have revealed that while the initial cost of the facility may be somewhat greater, operation costs plus better medical care, greater utili- zation of the facilities, less movement of patients, fewer complaints, chance of cross infection and higher Page 36 occupancy all lead up to an operational cost that in the long run is very advantageous. This study does not intend to invoke a large debate about the design of patient rooms, which is a study in itself, but is merely mentioning briefly on what basis this diagrammatic Master Plan was made. It is not, of course, inviolate, and the very fact that the nursing unit is in the west wing by itself, it could take many configurations and is, of course, subject to review and reconsideration at a future date. It is our firm belief, however, that this concept of a nursing unit, which also obviated the retainage of the present wings as nursing units, is of a very solid nature and foundation. This has been based on past experience and studies of units constructed and in operation by both this organization and others. B. Isolation: Isolation has not been spelled out specifically as a de- partment in these diagrammatic plans. The need for iso- lation is greatly reduced with the use of all private beds, but for highly contagious facilities, burn cases, etc., certain specific areas would be designated as isolated areas and specific care given to ventilation, sub -utility rooms, etc. These could also be used for the treatment of respiratory, allergies and other illnesses that require complete ecologi- cal control of the environment. These again are details, but must be recorded as having been considered as a part of the plan, and would be housed in the new acute bed tower unit. C. Pediatrics: A Pediatrics Unit would also be housed in the ultimate new west wing because of the wide variety of patient and ill- ness in such an area, and makes its relationship to acute care more logical than any other bed patient areas of the hospital. D. Cafeteria: The Cafeteria is primarily related to the kitchen function Previously discussed, and with material -handling its lo- cation on the second floor, with or without the use of such devices as radar ovens, makes for a complete yet efficient freedom of location. It is so located for convenience of personnel, yet can ex- clude visitors without embarrassment by its somewhat se- cluded location. Page 37 E. Coronary Care and Intensive Care Units: Of increased importance to hospital care has been the Coronary Care and Intensive Care Units. Functions of these depart- ments are also being expanded at the present time to give special attention to respiratory care and other related items that need special attention 24 hours a day. At the same time that these units have become more and more used and expanded, especially with the advent of more refined and operational monitoring equipment, there has come the realization that the patient is moved out of these units onto the floor where he then receives the more traditional nursing attention, Perhaps since he is not exceptionally ill, par- ticularly post -coronaries once they are released, he receives less attention than a more seriously ill patient on the floor who still has not needed the Intensive Care or Coronary Care services. As a result, many medically oriented people have expressed the thought that there should be an in-between facility for post -coronary and post -intensive care units ne related to the departments and yet at the same time a step upwards in that the patient does have a private facility not quite as closely observed, thus giving him the feeling that he has progressed, He is still, however, in the same general area and not "lost" among the patients in the acute hospital. There has also been pointed out the advantage that many of these patients that have been seriously ill form a feeling of deep confidence in the nurses and hospital personnel who have worked with them through this crisis in their lives. Suddenly they are cut off from all contact with these people in whom they have great confidence, and there is somewhat of a psychological adjustment here also, This, of course, is more intense in some people than in others, With this concept in mind, we have allowed for what we term "gray rooms", in other words they are patients that do not need the maximum coronary services nor the maximum intensive services, but still require a little more than the average nursing care, These patients will be housed in what are now the patient rooms in the north wing and south wing of the present building (see discussion below), This puts them adjacent to the planned new Coronary Care and new Intensive Care Units (see diagrammatic plans), Continued relationships with the personnel would be maintained, the nurses being well aware of the patients that require their attention the most. The rooms would still be monitored, not only to their own nursing station, but to a central point in the related units, and when peak census comes the least suspect patient could be moved without danger into a still monitored room rather than Page 38 taking the calculated risk of moving him out of the area entirely to accommodate a more critically ill patient. In this way, high peak load and low patient loads could be readily accommodated with the minimum of personnel problems in staffing these units. F. Location of Intensive Care Unit: Another aspect of the location of this department is that it is still on the same floor and somewhat contiguous to a nursing unit so that in case of an undue number of crises the unit is not isolated from other nursing personnel. The location of the Intensive Care Unit immediately above Surgery allows the minimal time from the Recovery Room to the Intensive Care Unit. Also it allows ready access for the surgeon and anesthetist to see the patient if necessary even post -recovery room time. Some schools of thought have advocated that an Intensive Care Unit should become part of the Surgery, but this makes for grave problems in the flow in the surgical department; it isolates the area from a visitor's standpoint or causes bad cross flow of traffic., Extraneous items such as food and other service items not normally brought into Surgery or not provided on the surgical floor, must be provided. Most of all, it leaves an isolated unit down in an area that is virtually deserted during the late shifts making staffing more difficult, and when the patient does leave the Intensive Care Unit as aforementioned, he goes to a completely different environment. It is strongly felt that if good access is given the doctor to the Intensive Care Unit, that the immediate adjacent proximity of the Intensive Care Unit to Surgery is not required. A recent study by this organization with and for another hospital could not find, after considerable correspondence and investigation, any incidents in any medical journal where a patient expired or was detrimentally affected by trans- portation from a Recovery Room to an Intensive Care Unit. Here the care of the patient and the operation of the hospital must take a slight precedence over the convenience of the medical man. This plan has attempted to accommodate the latter, but does not recognize the Intensive Care Unit necessarily as an extension of the Recovery Room of Sur- gery, nor does it recognize the operation of two Intensive Care Units, one in Surgery and one elsewhere, which from a fluctuating census is financially and operationally impractical. Page 39 G, Present Patient Room Modifications (All Floors): While all concerned are well aware of the heating and cooling problems of the patient rooms in the present facility, it is felt that these rooms could be remodeled by modifications of the windows. Frankly their reduction in size with the use of decorative panels adjacent could be handled architecturally; with the introduction of some heating and cooling at the ex- terior walls to overcome the heat loss and gain of the windows, the present ceiling heating system being used to augment this only; plus the addition of toilets so that all of these rooms would primarily have private toilets in lieu of sharing toilets (a practice now considered highly undesirable from a noise, privacy and room assignment standpoint); these modifications would allow a series of private rooms for assignment of various non -acute and post -care patients at a minimum cost. In some instances where desirable for types of patients being cared for, some bedrooms might keep a double bed configuration. This is discussed where those specific facilities are reviewed H. Educational Facilities: Another item greatly stressed is the need for educational facilities within the building proper, especially as it becomes a Medical Center. Here, too, the satellites would use these facilities rather than attempting to provide any of their own, other than the most routine conference and classrooms that would be virtually of the type that are included in patient - nursing units. Since all the ancillary functions on the second floor of the building in the northeast and southeast wings will be relo- cated and many of these areas are now offices, laboratories, radiology, treatment rooms, public health laboratories and offices, it was felt these areas were well suited for use as educational facilities, In some Instances they are merely large rooms that could be readily adapted into classrooms; in other instances they are laboratories that could be used for instructional purposes and in still other instances they would be offices reused as offices This leads to the belief that this area can be reutilized at a minimum of cost. Page 40 As an integral part of the educational function and the offices provided for same, it is anticipated that the Chiefs of Services who would be full-time would have their offices in this area. In that way they would be available for not only consulation, but be in a central location for super- vision of their particular specialties and still be closely connected to the educational facilities of the institution. In this way they would serve their full function as Chiefs of Service and educators in the Medical Center, All of this, of course, ultimately aimed at the ultimate in patient care. In setting up this educational department, we are not think- ing merely of educating the hospital personnel or the medical staff within the hospital itself, but rather we are thinking in the broad scope of medical education at large,. In particular, we are thinking of continuing education in medi- cal terms, the continuing education of doctors in private practice, the continuing education of nurses and technicians and of all aspects of the medical field. Also the education of the public at large in preventative medicine, self post - care and related items should be considered,. Recently, as was pointed out in some of the meetings, the general practioner has set up standards for his own association, and one of the main requirements is continuing education, This is the first indication that doctors them- selves are realizing that to maintain their specialties, continuing education is an absolute must, and they will then want this education as convenient and comprehensive as possible, The Medical Center will thus furnish the facili- ties, and here again, doctors not only from the hospital but from the area and the satellites can come at given periods and still not be completely away from their practices. The proper facilities will attract the proper people, the proper personnel, educators and those seeking the education. This will be a community service that should greatly enhance medical care, both giving and receiving.. It also puts the educational wing in touch with the auditorium as discussed on the first floor It is anticipated upper levels could be reached from the second floor, be they either balcony or stair, This also puts the educational facilities near the Intensive Care and Coronary Care Units where much teaching might well be done, and also in convenient proximity to the outpatient and ancillary facilities, which could also represent a good portion of the source of their activities. Hospital personnel would frequent the educational area, the center of things so -to -speak; for this reason it was also decided that the Library could occupy what is now basically the film storage viewing and radiographic offices, This Page 41 would be a central location and it could be subdivided as necessary into a nursing library and doctors' library, but under the supervision of one librarian and under one cen- tral control, details of which would be worked out at a future date. The light court would also continue to give natural light into this area, and since the enclosure of the space between the southern wing extends only to the first floor, the outlook from this area will be primarily of little difference than it is now, except with a land- scaped court below. I. General Comments: Since the basic center core was required to be all on one floor and in the center, there is considerable roof area at the second floor level, but this allows for consider- able expansion of all types of facilities in this area that are perhaps not currently known or anticipated. This does give growth for related ancillary facilities without major structural changes in those facilities now being constructed or remodeled. At the same time, the new elevator services serving the acute hospital would be connected in a manner that will allow them to serve the Intensive Care -Coronary Care and the educational wing readily. Material -handling equip- ment would, of course, service these areas making them more closely connected by service facilities if not by distance. Page 42 f 9 4 SECOND FLOOR PLAN PART X THIRD FLOOR A. Obstetrics Department: Although there has been some talk of the interrelation of the Surgery and Obstetrics Departments and some hospitals are currently experimenting with combined Obstetric and Surgical Departments and admittedly there are inherent advantages, this program at the present time is not based on such a concept. Since it is currently restricted by State Health Regulations, it was not anticipated that a large undertaking such as reversing such a major regulation could be undertaken by one institution. The thinking con- tained in this diagrammatic Master Plan followed the more accepted conceptions of separated departments until more research and investigation has determined feasibility. However, it must be pointed out as it has been mentioned before, this plan is not inviolate and the Architect, while having some reservations about such a program, also sees advantages therein and before any final conclusions were to be made in detailed plans would certainly investi- gate this concept further. The expansion of the Surgical Department beyond that indicated on the diagrammatic plans has already been mentioned in this text, and could well accommodate such a change in planning. The trend is more and more for allowing fathers into delivery rooms, which though resisted on many rightful reasons, is also gaining some headway and cannot be ig- nored in a future planning program. This, plus size of departments, made the decision of separate areas more justifiable. Spacewise we are providing labor rooms that are accessible to the father without gowning and entered outside the department; at the same time the mother can be taken by private corridor to the delivery area. The department is planned so that the baby is transferred from the delivery room directly to the nursery (we cannot see how this could be accomplished if combined with Surgery), and then can be transported from the nursery directly into the post-oartum bed areas. In this way when babies are being transported to the mothers, the whole department can become inviolate as it is done in most maternity departments today. At the same time the use of the vertical elevators adjacent is not eliminated for other functions, since they are in the nursing unit area which can be closed off for this period of time, and there is no cross flow of extraneous traffic with nurse - baby traffic. Page 44 The labor rooms would be made from the present patient rooms that exist in the west wing, and could be done with a minimum of remodeling. These rooms would be very excellent labor rooms as they now stand, and since the windows to the north would be eliminated by the construction of the delivery suite adjacent (see plan), that problem would be alleviated. The rooms across the hall to the south side could serve as father's waiting rooms, reading rooms, decontamination rooms, doctors' sleeping rooms and many other contributory facilities. The complete third floor of the new hospital would be devoted in this one instance not to acute beds but to post-partum beds and the nursing unit would be basically of the same configu- ration as other floors in the west wing. B. Extended Care -Long Term Care Units: The patient rooms contained in the northwest wing and the southwest wing would be reutilized for extended care patients. These rooms in many instances, especially the north wing could be left exactly in the manner they are, and it would be assignment of patients only that would change their usage. The bedrooms in the southwest wing, having been constructed with the original building, would need some modifications for the aforementioned treatment of the window problems, heating and cooling problem and share -toilet problem (see discussion of present rooms and second floor). However, in some instances these could be left as double rooms with share -toilet as there is not the rapid turnover of patients in these areas that there is in the acute hospital bed assignment. Additional showers and bathing facilities would be furnished. Such rooms could thereby be lower cost rooms. In viewing the plan, the relationship of the Extended Care and Obstetrics area might be questioned. This would be handled by the fact that there is no need for any traffic between the two departments, and by the simple expedient of having a closed door with emergency exiting only the two departments would then be as separated as if they were in two separate locations, and be totally unrelated as to each others presence in actuality.. This is an excellent floor for Extended Care in that there will not be any need for traffic from the Obstetrics Department to the Extended Care Department. They will have their own elevator avail- able in the center of their department for visitors and for their transportation to therapy and other similar activities. C. Definition of Extended Care Unit: At this juncture it may be well to define the concept of what is intended in an Extended Care Unit on this dia- grammatic Master Plan in order to justify the use of other facilities as planned on the floor. The intention here is Page 45 that the Extended Care Unit is just what the name implies, although there are as many definitions and uses construed as there are different hospitals in the country. The in- tent is to handle the patient that is no longer in need of the more concentrated nursing care of an acute unit, has perhaps finished his time allotted in that area, yet is not quite ready to return home and take care of himself, or perhaps there are home conditions that obviate his return- ing there. Perhaps there is no one to stay with him, to prepare his meals, to look after him in any sense of the word, or perhaps there are working wives, parents, or children that also would leave him virtually isolated. These patients may be of an orthopedic nature, mild mental nature, general rehabilitation, or what have you, but should not be occupying acute beds that are needed more urgently by others. Therefore, he is transferred to this unit. The Medicare and Medicaid programs have recognized this need, and are in effect demanding such facilities as a part of a hospital facility (again illustrating how the third -party payment does influence the design of the hospital). In here he is prepared to become self-suffi- cient, and at the end of his stay here should be dismissed and able to again cope with his living conditions with perhaps an outpatient type of care. He might even go to the motel unit or the self -care unit. In this sense, some of these patients might be classed as rehabilitation, though not be the severe rehabilitation type, i.e., the severe brain damage or the quadriplegics or patients of that sort. These patients would still require a certain amount of rehabilitation and treatment. It incidentally is not felt that the severe rehabilitation type of case should be a part of a Medical Center inasmuch as there are centers that specialize in this and nothing else, and who have patients received from thousands of miles away. Because of this they can, therefore, concentrate on what is really a specialty to a greater degree than any Medical Center. D. Common Rooms for Patients: On this floor, in what is now the center connection between the existing east and west wings, would be provided lounges which would also have eating areas at meal time, TV rooms and other central facilities for patient comfort. It was felt these portions of the existing Surgery Depart- ment, being large rooms by nature, could be used since these areas are also used as part of the education process of the patient and, hence, are related to the Educational Department at the same time. Page 46 E. Educational Department: Educational facilities that would be remodeled into the existing Surgery rooms would be primarily assigned to classes connected more directly with extended care, minor rehabilitation, long term care, nursing home care and that type of function, and they are so related by being kept in that area. In other words, if these functions were in a separate unit as is often the case and this was what was partially conceived in preliminary discussions, they would then have to have their own educational facilities. While it appeared expedient to incorporate this type of patient bed into the building because of the logical reuse of present facilities, it was still felt necessary to retain some educational facilities that would be more directly related to this type of patient. However, the relationship of the major educational facilities and these education facilities one floor above does allow an inter -use and an inter -locking that makes for a more functional as well as a more economical use. F. Expansion Possibilities for Obstetrics Department: Here again, the roof over the floor below (see dia- grammatic plans) allows the immediate expansion of the Obstetrics Department with the minimal operational bother, an expansion that could virtually double its facilities with the now proposed Extended Care facilities becoming Obstetric beds. Such a need is practically beyond pre- sent conception, but nevertheless is mentioned as a possibility should the population growth continue to increase beyond the wildest imagination and the area become another Los Angeles. This is further not felt likely since the satellites because of convenience to home could become Obstetric Delivery Departments with post-partum beds and could handle all the routine deliveries. This is a debatable item that would need further study at a later date. Only suspected problems, cesarean or other abnormal deliveries would be made in the Medical Center itself under this concept. G. Definition of Long Term Care: Another term often used in hospitals is "Long Term Care" which is difficult to define to everyone's satisfaction, but for the purpose of this program includes patients who are for either physical or personal reasons expected to be in the facility tor an indefinite length of time, yet do not come under the definition of "Extended Care - Rehabilitation Patient" (See Part X, Pa'agraph C) because Page 47 it is not expected they can soon be rehabilitated to a degree that they would be able to return to society or because their case is such that they will be unable to leave their beds or their rooms, are perhaps more seriously ill than the normal nursing home patient, and, therefore, do not fall into the latter category of patient. All of these terms need to be defined more accurately by those using them in the medical field rather loosely. Since this has not been done, they are here set forth for their use in this context. H. Long Term Care Area: Since "Long Term Care", no matter what specific definition you put on it, does require beds, nursing care and perhaps service facilities of varying degrees, i.e., private toilets which are of little use to a permanently bedridden patient, also because some of these patients are indigent or because of the long length of their illness, costs are of an extreme factor. All these make the use of the present patient rooms on this floor similar to the treat- ment of the areas as described for Extended Care. Vari- ations in detail provisions and utilization of existing would follow later criteria to be established at that time. This applies to the number of private and double rooms, toilets, showers, etc. Therefore, in this diagrammatic program, no particular distinction has been made between the physical assignments of patient rooms for Long Term and Extended Care. Rather it is felt that it might be advantageous to all if these beds were even intermingled, from a patient's standpoint psychologically, from a nursing standpoint and from an operation standpoint. This tends to distribute the type of patient and load over a broader base and a broader assignment and care factor. Should administration, medical staff, nursing, or anyone else concerned object to this, it is merely an arbitrary assignment of names or nomenclature to a patient area. It is to be emphasized that the only type of patient for which it would not be practicable would be for modern day acute patient care. In addition to this concept of intermingling Extended Care and Long Term Care, no attempt has been made to differ- entiate between ambulatory and non -ambulatory patients, because again the thought is to distribute both categories through the areas to equalize the care, type of patient, etc. This would be a matter of assignment by the hospital admitting procedures and would not affect physical facil- ities inasmuch as they would also be varied as has pre- viously been mentioned. Page 48 iminimilliiiiiiimiiiwet Nir PART XI FOURTH FLOOR A. Acute Beds (New West Wing): The fourth floor would follow the same pattern of having 40 to 48 acute beds in the new west tower building, and would be connected but yet separated from the present building by the vertical transportation tower and service area with no cross flow of traffic necessary, each being units unto themselves. B, Nursing Home: The present beds in the north wing, as has been noted on the third floor, would need minor modifications for their use as patient care areas, and on the diagrammatic plans have arbitrarily been assigned to nursing home use and function. The southwest wing with modifications, as noted previously on the second and third floor, of heating, cooling, windows, toilets and showers, would augment the above mentioned nursing home beds, giving different type facilities for varying daily costs, assignment and other criteria, all as needed, Should the demand for Extended Care and Long Term Care grow beyond the concept of this Master Plan, the nursing home could be relocated on the hospital grounds to the east (see plot plan), Connected by a tunnel and material -handling systems, it could still retain its advantages of proximity and yet allow for expansion as needed, This again is mentioned with the ever present thought of flexibility in growth to achieve that which is needed at the time it is needed. Previous discussion of the long term care patient also brings to mind the fact that many so-called long term care patients are in nursing homes and in many instances are given merely custodial care. The fact this nursing home unit is closely and directly connected to the hospital and is part of a Medical Center, these patients could be given far better care and attention, would receive more visitors, and more visits from medical personnel because of their close proximity, Rather than being put "out to pasture" as they are in some unfortunate instances, they would be under con- siderably better surveillance for possible changes in their conditions. Many conscientious doctors have protested the care that some nursing home patients receive, particularly Page 50 t I_ am a 0. im m J Mm i. Yo• Is. u i misst wiuumum i u uuumi mu W anC INC ram a S rr idnoa anuahe nuaams :i4 _J sixteenth street I O CO mmEN eta Ca Cv C_ Ca W CO dgi S CA L Y L IMP i cv CL7 C- Cv 70 ...r MS = CU CR 4—. ea CC .�. a i ..... W = C,, 10 a o r... C 10= O t, }0 �. a ea eaa ma. L G.] — .—. ea CU O = = O = O F• 10 L7 O O PART XII FIFTH FLOOR AND UPPER FLOORS A. Acute Beds: The fifth floor, west wing is, of course, the repetitive floor to floor wing that will occur vertically to the extent that the hospital deems it necessary to grow in acute beds and this, of course, will be as has been mentioned herein many times controlled by the need for such acute beds, the type of patient care, the satellites, etc. Foundations could be laid for a tower of some con- siderable height in order to always allow expansion up- wards to provide necessary beds. We have tried in the discussion of the floors below to show the horizontal expansion for ancillary facilities that would be needed to adequately service such beds. It is also anticipated that on top of the new acute bed wing tower would be a roof heliport such as they have at the New York Pan Am Building, at a hotel in Los Angeles and many other places. While it is true that helicopters stir up the wind and make considerable noise, in an all air-conditioned and modern sealed building many floors above ground, this becomes a minimal consideration and is also of short duration. Since jet airplanes, heli- copters and items of that sort are part of every day life and fly constantly over hospitals, it is felt the life-saving function of a heliport ambulance landing directly on top of the facility and thus able to dis- patch the patient immediately to Surgery, Emergency or whatever department would be deemed necessary, would offset by far the need for a intermediate transfer to an ambulance some few blocks away to overcome this dis- advantage of noise. B. Psychiatric Wing: The remainder of the present building, fifth floor, which is primarily composed of patient rooms on the fifth floor, north wing, has arbitrarily in the Master Plan beerr assigned to psychiatric patient care. This is not thought of in the terms of patients that are ex- tremely disturbed and need maximum security, but as the emotionally disturbed or slightly disturbed who need a quiet environment to enable them to again venture out into the world.. There are slight modifications that need to be made. Perhaps one or two rooms would be treated with a more security minded concept. Modern day psychiatric care does not look with favor on the austere Page 54 stripped down type of room that only emphasizes to the patient his problem. Rather, they are looking for rooms that are of a deluxe, motel type of nature. Windows can be unobtrusively glazed with safety glass and other modi- fications of the nature done without detriment to appearance. Also, with the modern day drugs, the conjur- ing up of a steel barred jail -like wing that has in the past been associated in the public's mind with a so-called mental wing, is obsolete. Further emphasized is the fact that this proposed assignment is as arbitrary as the other room assignments of the present building, and since it constitutes no major physical changes, would be reviewed for need and feasibility before implementation. The assignments of the area could be altered at any time that was expedient, even after actual usage for this purpose. Another facet of the problem to be considered is that there is a school of thought that recommends the dis- bursement of this type of patient throughout an insti- tution rather than segregating them. This does not in any way "mark" the patient, but only places him in the hospital as a sick person. He feels no stigma and this aids in his recovery. The somewhat isolation of this unit, it being connected to the new proposed west wing only by a covered walkway which could be controlled, suggested the peac and quiet that a facility of this sort is generally considered to need. Here, too, elevated above the hustle and bustle with a magnificent view of the city and the mountains, we find the capability of creating an environment that would be conducive to the treatment of psychiatric problems if the medical staff choose this route at the time in the master program for execution. C. Sleeping Quarters: It is envisioned there would be intern's quarters that would allow for married interns, families, etc., in the staff housing facilities that are shown on the diagram- matic master plot plan. The present intern's quarters would probably not need to be utilized for that purpose to a very great extent. Since they are somewhat minimal in nature, it was felt their best use could be as so-called "sleep -in quarters". Perhaps they would not be adequate for that purpose either, but this would be determined by the amount of staff housing connected directly to the hospital at the time of usage. The facilities could, of course, be expanded if and when the need exists. In a larger Medical Center there will need to be more staff personnel, either on duty or at best on call, and it Page 55 may well be expedient to have areas of this tyre for per- sonnel of all types, medical doctors, technicians and others that are readily available within the facility itself for certain emergency procedures. Even ambulance drivers, helicopter pilots and others could come under this category. Page 56 PART XIII AUXILIARY STRUCTURES CONNECTED TO THE HOSPITAL A. Plot Plan: The plot plan for this diagrammatic Master Plan indicates usages adjacent to the main facility, but located off pre- sently owned property. Primarily they are projected to be a boiler house connected by a tunnel and through which the material -handling system would work and staff housing facilities possibly adjacent. The boiler house has pre- viously been discussed in some detail with its laundry, engineering shop, waste disposal, etc., Alternate locations have also been discussed. Connection of existing staff housing to the main complex by tunnel is also anticipated. B. Staff Housing.: The housing has been referred to in this report with the need not detailed other than to say here that it should be of a varied type providing for the staff with families, including apartments, individual units, and multi -units for flexibility. By providing playgrounds, play yards and some common areas, it can become a "living complex". Per- haps even some of the smaller homes in the area could be retained in their present relationship. In this way the boiler house, which would be providing all utilities, heat, cooling, etc., to the center would include housing also. This would be done unobtrusively as was previously indi- cated in the discussion of the utility facility. Colorado General Hospital has found it absolutely mandatory that they furnish housing for their personnel. They have attracted to the immediate neighborhood so many hospital related facilities that housing in effect has become some- what of a problem in the immediate proximity of the hospital. It is, therefore, considered highly desirous this housing requirement be considered a part of the Master Plan. C. Cancer Clinic: To the south of the present structure is envisioned a Cancer Clinic, which would be housed in a subterranean type struc- ture. By its very nature it needs to be below grade for radioactive protection and minimum structure. It would be connected to the main hospital by a tunnel at the ground floor level, thus allowing outpatient, inpatients and other traffic flow to take place with the least possible intrusion in operations. Page 59 By its very nature, its repetitive treatment and non - emergency like operation, it is expedient to have a facility of this sort dispersed away from the hospital. It is of very large bulk because of the three and four foot walls that must be built around equipment. Because of the depth requirements for large concrete protection overhead, the height of equipment used and all the other complexities of this type of operation, this means that it is an item that could virtually never with any reasonable feasibility be altered, removed or relocated. Hence, it is strongly felt that it should have its own environment so that it may grow independently and without hindrance to or from the main hospital facility. This is a radically changing field and needs tremendous flexibility in growth patterns since it cannot possibly allow for any flexibility in its own structure. Housed in this structure would be cobalt units, high volt- age machines, linear accelerators, betatrons and whatever is deemed at the time of construction by medical personnel to be the best type of medical hardware available. There is currently considerable differences of opinion as to the merits of many of these different types of equipment, many of which are still in the prototype stage. Time will solidify some of the directions to be taken by the time of construction. It is also assumed that a Chemo-Therapy Department would be built in conjunction with this clinic with a cancer registry and other related facilities also a portion thereof. In addition, growth area for the future must be provided adjacent so that additional concrete box rooms can be located for future machines as yet undreamed of, plus the related offices and treatment room spaces. Cancer patients are most often repeat ambulatory patients. Outpatients can go and even the inpatients can be trans- ported without difficulty to this facility so there is no need that it be immediately contiguous to other ancillary facilities. In fact, it is generally felt to be somewhat advantageous to have it have its own identity and general traffic separate from the main structure. Here, too, the transport system would serve the Cancer Clinic with supplies, linens, etc., through the tunnel connection, as well as all utilities being piped over also in the tunnel. Page 60 D. Public Health Offices and Laboratory: Since the Public Health Office is being displaced in the diagrammatic Master Plan, its facilities would be replaced as the first floor above the Cancer Clinic. There is a relation- ship here of the aforementioned cancer registry and other Public Health problems. The relationship to the proposed Outpatient Department is also reasonable. The department could retain its own identity, but still would be connected to the main Medical Center for easy access, records, consultations, etc. With communications and other facili- ties that are available today, this department does not need to be physically adjacent to the major facility. The material -handling system would serve what material and facilities this unit might need from the main supply source. The entire building would, of course, be heated and cooled from the central boiler plant as mentioned in the discussion of that unit. This facility would be designed to accommodate the agencies requirements at the time such a relocation takes place. E. Medical Office Building: Most Medical Centers are now providing medical office build- ings for the practioners who constitute their medical staff. This is of great convenience to those doctors, and also makes available to their patients the full facilities of the hospital, particularly the Outpatient Department where they can get quick diagnostic and radiographic work. The patient can still be "under cover" at all times when sent to the hospital for certain diagnostic work and other services, and even return to the doctor's office in a relative short space of time: This saves the doctor the problem of maintaining complex facilities himself and maintaining the trained personnel to operate them when perhaps such facilities are actually used a comparatively small portion of the time. As such facilities have become more and more complicated and expensive, it has proven expedient for the doctor to rely upon the complete facilities of the hospital. It also enables him to park his car in one place, make his in-house calls and return to his office. It makes him a part of the whole medical complex and also gives him a greater say about its operation, since his complete medi- cal life is virtually involved with the institution. This type of program has been demonstrated to be of practical value to both the hospital and the medical staff by making them a closer knit operating organization. It is with this background and knowledge and the extent to which other hospitals are already contemplating this, that this was Page 61 considered an integral part of the program. The Medical Office Building facility would be built to as many floors as the demand decreed, with rapid elevator service to the lower level, to a common first floor lobby and to a tunnel to the main facility. Only a matter of a very few minutes would be involved between the doctor's office, outpatient services, ancillary services or the patient's bedside. Page 62 PART XIV SUMMARY The foregoing is a basis for considering future growth potential of the present hospital into a full-fledged Medical Center. It is in no way to be considered as a detailed program upon which final plans for any given area could be undertaken. This latter would have to come at a given time when approach- ing actual construction with detailed analysis and study. As stated originally, the Master Plan only attempts to es- tablish parameters of thought for orderly consideration of each facet of the broad scope goal. Page 63 APPENDIX A NURSING Mrs. Geneva Woods, Director of Nursing The Director of Nursing, Mrs. Geneva Woods, representing the nursing staff mentioned the importance of the school in keeping a good supply of nurses for the hospital. There was discussion held as to the relationship that the colleges are playing in conjunction with the hospitals in the training of Registered Nurses. While all recognize this increasing trend and were in complete agreement with it, it was also felt that it made even more important the need for classroom space, and particularly classroom space on each floor where ten to twelve students could be taken for teaching purposes, and yet still be immediately adjacent to the patients and practicing nurses themselves. It was also noted that a large auditorium for use by many different departments in the hospital was a must. The desire for a theater type, i.e., sloped floor and stage, auditorium was mentioned. Additional central classrooms with office space adjacent was also felt to be a very real need in this teaching program. A hospital, by its very nature, must be a laboratory for medical training. With the rapid changes in medical practices, as previously mentioned, education becomes also a continuing thing and not only for the student. Therefore, these facilities are of a much greater need and necessity than they were origi- nally, when most teaching of any consequence was done and envisioned to be at the medical schools. Now a large medical center is required to have about the same amount of teaching facilities that previously many medical schools provided. While at the present time, the Licensed Practi- cal Nurse (LPN) is not an active program in the present Weld County Hospital, as the need for more and more RN's arises, certain work requirements can be met by the LPN's and it is, therefore, envisioned that such a program should be considered a part of the program for the future development of the hospital. It is very conceivable that this could even be done in conjunction with one of the universities on a perhaps non-credit basis as far as a college degree is concerned, but leading to a person's achievement of the LPN status. With the segregation of certain types of patients into different areas as is the coming trend, this will certainly lead to further utilization of the LPN's. Page 64 At the same me, as more physical faci ;ies for routine work are provided and the better utilization of LPN's is achieved, we may actually see less Nurses Aids being used, but rather more trained personnel with the routine work being assigned to housekeeping type personnel. The implication of mental health on the hospital facili- ties was discussed, and is certainly something that cannot be completely overlooked. There are varying contentions as to how mental health patients should be handled within a facility, but it is a field that is being recognized as being of greater and greater importance and certainly would have a bearing on the design of the facility. The necessity of maintaining the identity of each nursing unit and the philosophy of nursing care was discussed, and its effect upon physical layout of the building was recog- nized by the Architect. The growing importance of the Intensive Care Unit, Coronary Care Unit and even of the present Pulmonary and Respiratory Units was discussed. It was also discussed that by proper planning many patients could be accommodated in an Extended Care Unit who are now in the Basic Hospital Acute Care Units. This again is being given further impetus by the present handling of this type of patient under government regulations for payment, etc. Similar discussions were held concerning the Long Term Care Units, their use to what degree was somewhat of a question, but it seems that particularly for a county hospital this is a facility that should be provided because the indication is that this type of facility will be utilized more and more in the future. It was discussed further that outpatient work, which is currently not covered by many third -party payers, will in the very near future be brought under some sort of payment conditions. Doctors are currently admitting patients to the hospital for overnight stays needlessly in order that the patient will be quali- fied for these health care payments. This causes additional expense to all concerned, including the third -party payers, and tends to over utilize the hospital acute bed facilities, making additional patient beds necessary that would not otherwise need to be provided. All concerned with the health field have come to recognize this, and adjustments along this line are imminent. This fact alone will make the Outpatient Department of the hospital of much greater importance and much larger size. Many more facilities will have to be provided than in the past. This will, in effect, be an economy as it will Page 65 transfer out of the hospital certain patients who are not in need of a hospital bed per se, but rather in need of hospital -type care which can be provided adequately on an outpatient basis. Many of these patients are ambulatory and could well come in for procedures in the morning and depart in the late afternoon. The need for motel -type units for relatives of patients, and even patients themselves who are connected with the hospital on a daily treatment or frequent treatment basis and could utilize these areas at considerable savings to themselves in both time and money and still produce revenue for the hospital was mentioned. A complete facility such as a Medical Center would also provide a rehabilitation unit, perhaps not to the extent that certain specialized units such as Spalding Reha- bilitation Center and Craig Rehabilitation Hospital in Denver provide for patients from all over the country, but certainly one which would keep the patient within reasonable proximity of his family and would be well utilized and certainly a part of a progressive Medical Center. The need for handling of supply material, the disposal of material waste was, of course, discussed. Use of some of the new cleaning and disposal procedure units was described by the Architect. Also the new concept in automated material -handling units was mentioned, with the Architect assuring nursing this would be given the greatest of consideration in the ultimate solution for the ultimate hospital. One major request made was that if at all possible all major ancillary facilities, such as Radiology, Pathology and Surgery be located on one floor, and possibly a good relationship between Outpatient, Emergency and Central Supply be maintained. It was also felt that the removal of patients from the first floor area would be highly desirable because of noise, confusion, high priority need for first floor areas, etc. Minor items were discussed that affect ultimate physical layouts, but would not necessarily appear on the Master Plan. These were rooming -in for Pediatrics and other areas, even the possible provision of facilities to allow mother to have the newborn in her room if she so desired was mentioned. All of these do affect space and were, therefore, given consideration in that conjunction, Page 66 PATHOLOGY Dr. Lewis Kidder, Chief Pathologist A separate Blood Bank waiting room, yet keeping the bank related to the lab should be provided. This facility should be near the outpatient or convenient thereto. Outpatient waiting should be provided to a much greater extent than it is at the present, and the department should be arranged so that outpatients and inpatients are not waiting in the same area. Ideally the outpatient should more or less be received at one end of the depart- ment and the inpatient at another, at least physically separated so that the inpatient is not embarrassed by the waiting in hospital garb with outpatient people who are dressed for the street. This is essential in any hospital of size. Also, the Pathology Department should provide at least five pathologist offices, including one for a resident. Offices should also be provided for two head technicians and an instructor who would aid in the continuing edu- cation of not only laboratory personnel, but the facets of Pathology that nurses and other medical personnel should know to properly attend patients. Contained within a department should be provisions for a full-scale classroom which could also be a multi -use room for many pathology -related activities, particularly in connection with instruction and continuing medical edu- cation. It was felt that such a room should be large enough to seat 40 with some instruction facilities, i.e., sinks, counters, blackboards, etc., in the room and should be a part of the department. While auto -analyzers and other hardware of this nature are being more widely used in laboratories and are considered to be labor-saving, at the same time they increase the number of tests that are given even routinely, and do occupy considerable space. So they do not particularly lead to any thought that the size of laboratories will not continue to grow even if not perhaps at the rate they have in the past. The Architect felt that the advent of these electronic devices has, in effect, in most laboratories created or at least contributed to a need for additional space. He has not seen where it has actually relieved the demand for counter space or increased working areas. Page 67 Another item that is always requested is storage and more storage and a stock area convenient to the laboratory that is not in some remote location, This is a standard request, and no matter how much is provided, it seems never to be enough. A heart station next to the laboratory is foreseen by the doctors as a part of any new modern facility of this sort for preventative type medicine which is coming ever more to the forefront. Along with this would be facilities for EKG machine, treadmills, and in effect the usual heart station requirements,. Everyone visualized that the computer will become a tool of the Pathology Department, and that findings, tests, etc., can and will be transmitted to a center receiving and analyzing area, even on a national scale. The medi- cal staff cautioned that though this would be a tremen- dous aid in some extremely complicated diagnoses, this still does not relieve the hospital laboratory of making routine checks and confirming that information sent and received is correct, In other words, some secondary double checking is envisioned which would still impose considerable need for laboratory usage directly in the hospital and would not in the future, as some space-age writers have indicated, eliminate the need for a labora- tory in the hospital whatsoever, The Architect feels that any such extensive extraneous activity or any such total elimination program would be far enough in the future that it need not be seriously considered at this time in a Master Plan, At the same time, electron -microscopes are being used more and more in hospitals, and it is not at all beyond the realm of possibility that the new laboratory in this facility should make provisions for an electron -microscope room. The artificial kidney program which, of course, is impossible in the present hospital facility, would increase laboratory work. Procedures of this sort and others will become routine in a Medical Center -type hospital and re- quire considerable additional laboratory work. Even though the medical staff did not see any tremendous surge of Pathology work per patient load, they still see a very steady and gradual growth, and assume that the labora- tory will be designed to accommodate future medical tech- niques and growth, Page 68 They, too, mentioned the medical center satellite hospital concepts which were discussed virtually with all depart- ment heads. (These are discussed more fully in the basic report and recommendations.) Here we are more concerned with particular department requirements that were spelled out, and not at this juncture the overall policy concepts that were discussed. In addition, it was mentioned that the office spaces have been inadequate for some time, particularly file space and just plain working room. As the department grows, the use of secretaries and typists for receptionists will become more and more undesirable, and such personnel should be segregated from the active area, especially with the advent of greatly increased out- patient loads. Special general public services and analyses, such as pesticide testing and other such items such as air pollu- tion, contributing allergy studies, water and land pollu- tion effects, contributory matter to our whole ecology and other similar studies that might be done on the public service basis for the community and general welfare of all citizens, could well become a part of the laboratory and not specifically a general hospital demand. A large autopsy room for better medical education, pre- ventative medicine, etc,,, with adequate storage and facilities for photography, including darkroom adjacent, are seen as necessary to the expanding welfare of the community medically speaking. LABORATORY TECHNICIAN Mr. Jerry Ham, Chief Technician Mr. Ham envisions a central computer with station in the laboratory and the extensive use of auto -analyzers. With considerable more use anticipated, the outpatient - oriented services where the laboratory was involved were felt to be several rooms such as blood drawing areas, vena puncture, BMR, EKG file room, etc. Requested also was adequate storage space. An estimate of future office needs was also stated. Five offices for the pathologists, plus a technician's office was requested„ Because of a high amount of cultures, Page 69 requested also was a walk-in blood refrigerator and walk- in incubator. The latter is a very unusual requirement, but at this juncture would not constitute a space re- quirement of such major proportion that it needs to be greatly investigated. Again, the need for adequate reception and waiting area, space for the teaching program and classroom space were all reiterated. The coming trend is toward respiratory care. The re- lationship to the department and the tie-in with Inhalation Therapy was reiterated. The EKG, heart station, storage, charts, and microfilming were also renoted. Other functions of the lab and their potential were discussed, but were of the general nature that an adequate laboratory would accommodate same RADIOLOGY Dr. Phillip Weaver Dr. Weaver stated immediately that his department should be two to two and one-half times its present size He noted that isotopes are increasing gradually in use. He also stated that therapy has dropped off at the moment. Dr. Weaver felt that two or three scanners in one room could be utilized This would, of course, mean that all treatment and diagnostic rooms in the department should be considerably larger in size than were originally en- visioned in the original construction of the basic exist- ing hospital. With a more active department, office space for six to seven people, plus the head technician, should be provided. With a concept of continuing education, which was discussed, the training of technicians was not felt to take too much more space. There should be provided, however, some area with desk -type counter where the technicians could either study, write notes, or in general, have as an operative base. Dr. Weaver felt that two treatment rooms and eight diag- nostic rooms, one of them being in Surgery for certain medical procedures, would be adequate for the size hospital that could be foreseen in the future, The storage of films, microfilming for additional file space, or other types of cage 70 files, Conserv-a-Files, automated or not, all of which is a part of the department was discussed. General agreement was that at least two years of film should be immediately adjacent with additional storage beyond that time, to be not too remote or inaccessible from the department. In response to the question about a special procedure room, he stated that his concept of this was the type of room he had requested and envisioned for Surgery. He also stated it was extremely difficult to adequately re- quest specific room facilities for the somewhat indefinite future, inasmuch as he had been informed that the whole x-ray technique and set-up is very much in a state of flux, as a total new concept of radiology machines may be known to us in the next few months, operating on completely different principles. Dr. Weaver requested a classroom for ten students within the department as necessary for proper training and education techniques. He did not feel that the computer would be used for diag- nostic purposes, and the discussion of centralized computers, even on a national scale, was a fact recognized by himself. He further stated that some X-rays would be read by elec- tronic means, and even the feasibility of these being read and discussed by telephone at participating satellites by one or more doctors was not too far out in his consideration. Dr. Weaver noted the fact that the general practioner in the forming of his new association or society with its require- ments for membership and conditions, has made a strong point of continuing education and the training of people both in and out of the hospital. He, therefore, felt that all specialties and all medically oriented personnel would in the not too distant future be involved, if not required, to participate in continuing education programs. He felt that the hospital would have to be the mecca, school, teacher and examiner, or at least the base of such operations. This should then be considered in space requirement needs in the future of the hospital This being in complete accord with some of the preliminary thoughtsof the Architect is noted here again for repetition to illustrate the concurrence in thinking by many persons which gives greater strength to the conclusions. He touched also on the paramedical program discussed more fully in the basic recommendations. Page 71 Dr. Weaver mentioned the need for adequate patient wait- ing space and for the separation of in and outpatient waiting, as the Pathology Department had also requested, all for the same reasons, He also does not wish to share his waiting space with the Pathology waiting spaces as he is required to do now, RADIOLOGY TECHNICIAN Mr. Kenneth Nickerson, Chief Technician Comments from the technician in Radiology were that film storage is of extreme importance. Visualized also is the expansion of the Isotope Department, Other items that should be accommodated are a scanning machine, one room, simulator room which should be shared with the laboratory Also a classroom for 20 people should be provided. His suggestion was for four fluoroscopes, four treatment rooms, one special procedures type room (in Surgery), one smaller room that could be used for chest work, plus a workroom, five radiologist's offices, secretary's office, film library and chief technician's office, A lounge that might be sized so that it could be a future room and one special studies room was mentioned, Also mentioned was a toilet for female and male techni- cians with many dressing booths for the department. The storage of a portable X-ray on the floors or near the facilities where it might be used was mentioned. It was noted that the machine weighs about 2500 pounds, and the problems of it being moved about were noted, Questions concerning the darkroom in Surgery were raised. However, it was pointed out that undoubtedly in connection with the special procedure rooms would be an X-ray pro- cessor which practically obviates a darkroom, Exactly what rooms would be equipped permanently with radiology equipment would have to be reviewed at a greater depth at a later time, with the exception of the special procedures room consideration which will be given when assigning Surgery space. The need for a total Therapy Department with linear accelerator, cobalt, etc,, was discussed. It was pointed out that this would be a completely separate department with its own department head, technician and radiologist. This is the experience of the Architect in other insti- tutions which have gone into full-scale departments, The relationship of the basic Radiology Department, Emergency Page 72 and Outpatient was mentioned„ Also mentioned was the need for inpatient -outpatient separation, but still provisions for adequate waiting room nevertheless, In relation to film storage, it was pointed out there is stored in the department at the present time three years of film history which should be extended to five years. Again, it was mentioned that remote film storage should not be too inaccessible and could carry on the film history up to seven years in an easily accessible area, or even longer since it is the habit of the Radiologist in this institution to go into back files. For that reason, microfilming was not looked upon in a great favor, but automatic film files, electronic retrieval and that type of thing was considered to be much more acceptable, The video tape of the exam is coming into this field, and has considerable advantages since it can be used for the classroom and other phases of diagnostic use, There is a need for a small room for head and skull examination prior to Neuro-Surgery. The main comment was, of course, just overall general storage in the department and to be certain that adequate amounts were supplied. MEDICAL STAFF Dr. Donald Allely, representing the Medical Staff Dr. Allely, representative of the Medical Staff, primarily mentioned that the core of the hospital should be the acute care core, He also felt the need for more outpatient services, He envisioned a full-time staff of medical doctors, employed by the hospital as Chief of Services, i,e., Surgery, Ob- stetrics, Medical Directors, Pediatrics, Outpatient Depart- ment and other major subdivisions of patient care. He also mentioned the general practioner who would serve more as a family practioner, and yet to maintain his certi- fication in his academy will have to have continuing edu- cation (150 hours every three years), This was previously mentioned by Dr. Weaver, He felt that better educational facilities would have to be provided in the hospital in order to implement continuing Page 73 education. These programs will be anywhere from half - day to full -day programs on a post -graduate basis, and should be conducted in the hospital in order to be close to home so that the doctor may attend without being absent from his practice for several days. The need for larger and more active Physical Therapy and Occupational Therapy staffed with trained personnel was mentioned. Also the need for a larger laboratory and the need for Extended Care was stated. Dr. Allely mentioned that with more industry and the growing college, a 24 -hour patient service is going to be a necessity. He stated the college would even now like to use the hospital and do away with their infirmary or any medical facilities for the student completely. A growth in the residency personnel is a possibility. The intern training program must definitely grow, and the hospital should provide the best possible facilities for their training so as to attract good students to the area. He feels facilities for 15 to 18 interns would not be unrealistic. He also mentioned the need for training of ancillary per- sonnel and of the central role of the hospital in service for the total community. He felt that twenty years was the life expectancy of a hospital before it is totally inadequate and would need major, if not total overhaul and reorganization. He, too, mentioned the possibility of the satellite hospital which would serve communities such as Windsor and other areas beyond the immediate confines of Greeley. DIETARY Mrs. Pauline Swanson The area of Dietary was discussed with the possible thought of the central kitchen of a core hospital even serving its satellite with ready-made meals. The greater utilization of frozen foods, which was virtually unknown when the hospital was originally built, was discussed. Also, other pre-packaged and prepared food and services was mentioned. The use of computers for planning of diets, etc., was also mentioned. Even the eventuality of a computer controlled assembly line accommodating diets, choices, all automatically, was discussed. Page 74 Mrs. Swanson did mention the fact that at the present time fifty percent of the diets in the hospital are special diets. The need for facilities for teaching in the dietary field, as well as for the patient being discharged, was mentioned. The need is for the extension of education concerning diets to be used in the home, at least on a consulting outpatient basis as a part of the modern health facility. Consultation on diets is a service that should be offered to the community on a preventative medicine basis. Community education in the dietary field is needed, and the hospital could well be a center for this. It was also mentioned that many doctors could benefit from continuing education in this field, as they often prescribe diets for their patients without having the most current information available in this field. For such education programs, it was felt that multi -use classroom space could be used, but a conveniently located office for the dietitian to consult with doctors and patients should be part of the modern kitchen. An office set-up of one office for the Chief Dietitian, another for four assistants and space for a secretary was indicated. The short order kitchen for off-houn feeding and emer- gencies should be provided. Meeting rooms adjacent to the Cafeteria where food service could readily be supplied were requested. There is a con- stant demand for luncheon meetings and other educational programs to be conducted at meal time in order to conserve medical staff's time, etc. Adequate dietitian office space, a personnel lounge for slack periods adjacent to the kitchen, a dietary library and the maximum amount of storage space was mentioned. Large freezer and refrigerated areas are essential to the modern kitchens. The serving of special meals coming almost to a gourmet type to appeal to certain patients, especially long-term patients during their recovery, building up their strength, even in- cluding wine and liquor if prescribed by the doctor, is becoming a part of the modern hospital facility and will require some extra attention, control, billing and space. Some discussion of the newer type of equipment available was held, but is not apropos to this report at the present time and falls into the category of details which influence space but are not of particular current interest Page 75 PHYSICAL THERAPY AND OCCUPATIONAL THERAPY Mrs. Imogene Doughty The inpatient and outpatient separation and handling was again discussed in therapy as in other departments, as was the mention of considerable more outpatient load in the future. The Extended Care Unit that is envisioned would increase the use of these departments, Training mats, plus adequate gym space, tilt tables, treatment baths, walking tank, hubbard tank, arm and leg whirlpool baths, stairs, parallel bars and other accou- terments of modern Physical Therapy Departments were discussed, The Occupational Therapy Department with its lathe, working tools, looms, art equipment and other such facilities were also discussed as an integral part of such a department. These two departments are generally accepted in hospital practice as being contiguous to each other. The need for an orthopedic brace shop was mentioned. It was also mentioned there was a need for rehabilitation type training toilets and special lavatories to accommo- date wheelchairs. The need for separate dining areas was requested in order to help patients who have difficulty feeding them- selves or have other difficulties to avoid the embarrass- ment of eating in larger rooms, while at the same time not discouraging them by confining them to their own bedrooms. The use of carpet in the area was discussed, and it was stated that the pile should not be too deep for use by wheelchair and crutch type patients. A small office for consultation, but with the use of central dictating and the central pool type of secretary, was mentioned. It was then felt that a minimum of office space would be required in the area. WILLIAM M. MANGUM, M.D., DIRECTOR OF MEDICAL EDUCATION AND CHIEF OF SURGERY During this meeting was discussed the need of consider- able more outpatient service, including the concept of Page 76 outpatient surgery with outpatient recovery, i.e., the minor surgeries with recoveries that could be accomplished in a day, thus eliminating the necessity of tying up one acute bed for overnight use by patients who really do not need such services, This has also been discussed in the basic recommendations. The need to increase the permanent house staff, and the need for provision of offices for them within the building at con- venient locations for access of personnel in relation to departments, was mentioned.. The need for a classroom on the acute patient floors with audio-visual instruction in all classrooms was discussed. Also the use of more closed circuit TV in teaching, and specifically in relationship to Surgery with what will surely be faithful color reproduction in the very near future was mentioned. The need of a central library was emphasized along with the need for a full-time director of medical education with staff offices, secretarial facili- ties, etc, Also mentioned was full-time heads of major departments and the affiliation with professional staffs from the medical school. Many items now performed in medical doctor's offices would move to a hospital if they were better staffed and equipped with a better Outpatient Department. Most doctors would be glad to phase out the furnishing and operating of medi- cal hardware which is becoming more costly to buy and maintain, as well as the personnel to operate same, and the use of which is limited compared to the more completely equipped hospital Outpatient Department. It is not unforeseen to believe that physicians will grad- ually move their offices to hospital operated and directly connected medical office buildings. It is a trend already started in many communities, including Denver where several are proposed. It was mentioned that direct connection of these office buildings makes the continuing education program even more convenient and related. It was reiterated that motel accommodations for visitors, relatives, even outpatients who require daily treatment should be provided, being of the multi -use type that could provide housing for staff, some university related housing, as well as direct hospital needs, The satellite hospital was mentioned, but it was felt it should have provisions for overnight stay as a part of the concept. Page 77 Maximum size of the hospital was not specifically agreed upon, but with the advent of many satellite hospitals it was felt that the center core hospital would grow accord- ing to need, and this would include acute beds as well as ancillary facilities. The possibility of a dental outpatient and inpatient oriented facility, plus a dental medical staff was men- tioned in a larger facility of this type, and some con- sideration should be given for the housing of this medical discipline in the total concept and organization, especially in relation to oral surgery which cannot be overlooked. MAINTENANCE DEPARTMENT Mr. Pat Barnett The need for a separate boiler house and laundry away from the main building was emphasized. This would also allow expansion of this area without interference with the main hospital. The need of a total maintenance shop and paint shop in conjunction with this facility, as well as the waste dis- posal system and the pathological incinerator, trash baler, and crusher, was discussed and all should be a part of this complex. It was also mentioned that intern quarters on the grounds with playgrounds for children should be considered as a part of the complex. The housing of hospital ambulances and the heliport should also be a part of the total concept. The need for newer type equipment in both the boiler house and laundry to serve a complex of this size in the future, particularly automatic and remote control systems, was discussed. The paging set-up needs updating and needs to be tied together, including any new construction. Some discussion was held as to use of the present boiler room and shops after the move to the new boiler house. The Architect mentioned that mechanical and storage spaces in a hospital is like digging along the edge of a lake, water rushes in to fill any void, so will hospital usages. Page 78 Mr. Barnett wanted to be certain of color coding of pipes, their identity and all other mechanical items for ease of maintenance. He mentioned garden areas for Extended Care and the need for a parking structure, rather than extending asphalt paving farther and farther out. The question of acquiring property around the hospital and the possibility of where to acquire it, were conjected. Thought should also be given to a better security system, including the use of closed circuit TV, Mr. Barnett sees great growth from all local indications during the next ten years. CENTRAL SUPPLY Mrs. Norma Dyer More room for storage of disposables with their growing use was indicated in this department.. It was also felt the department does need certain subdivisions for various facets of their work. This would be a true Central Supply, in that all sterilization, handling of surgical and ob- stetrical instruments, and in effect everything that needed sterilization and processing in the whole hospital, would be processed through this department. The question was raised, however, of a Central Supply room on each floor and even a substock room. With the use of the material -handling system that is anticipated here, it was felt this would not be desirable or even compatible with this type of system.. It was pointed out that at the present time the department is badly in need of air-conditioning, not for the comfort of the personnel, but for storing of certain supplies which are adversely affected by the heat generated by the sterilizers and not properly exhausted. It was felt a glove processing room is no longer required as everything will be, and virtually is already, a disposable type. The relation between Central Supply and Pharmacy was related. With the growing Outpatient Department facilities, additional use of Central Supply was foreseen for the dispensing of crutches, certain surgical apparatus, etc.. Page 79 The need for a gas sterilizer of considerable size was also mentioned. There was some discussion of sterili- zation by radiation, which may well be a coming thing, though is not at the marketable stage at the present time. It was also felt that there should be an automatic stock rotation system, and any new department should be planned around such a setup with central dispatching, etc, Also, the computer control of needs, even its control of dis- pensing and its relationship to the material -handling system, which would make all this possible, was among the items that were considered. LAUNDRY MANAGER Mr. Jacob Stoll, Laundry Manager Some discussion of the newer type of washing machines and improvements that are foreseen in the laundry areas was held, and mentioned were the washer and extractor now com- bined in one machine. It was felt that other major im- provements were on the brink of bringing the laundry into a more automatic operative field. The need to maintain strict separation of the sorting of soiled linen from the operation, and the need to maintain a stricly clean area for the separating and sorting of clean linen was discussed. It was generally agreed that the best way to achieve this was a two -level laundry with the soiled being chuted down into the machines from above and a clean area below; the linen sorting and sewing area being a third part but separated from the major laundry itself. The use of conveyors in this operation was also. discussed. The going to all permapress uniforms has already made changes in the laundry, but new equipment that will precondition in the tumbler and that sort of thing will have to be considered. This also brings on more demands for the use of the tumbler and less for the ironer, thus showing how trends and changes can cause a whole new set of criteria. Also discussed was to what extent disposables could change the whole laundry picture, even the matter of paper sheets and other bed linen was mentioned. It was considered very important that the laundry be tied into the automatic material -handling system, as there is considerable exchange of materials between the basic hospital and the laundry at all times A computer could even program this operation for oft -hours Page 80 HOUSEKEEPING Mrs. Elsie Turner, Executive Housekeeper A central Housekeeping Department with more storage is the basic need, Larger janitor closets on the floors will be essential with centralized wet and dry vacuum systems, Extensive use of carpet in modern hospitals also requires similar care systems. An elevator for equipment was discussed, but central material - handling system would eliminate the need for this requirement. Request was made that all plumbing fixtures be wall -hung, particularly water closets, Ways of eliminating some maintenance problems, such as open top shower to allow the steam to escape, etc., was discussed, Central check -in and check-out for employees with a time clock was mentioned. Reduction in size and not as many windows in patient rooms was requested. This is a problem that the Architect is well aware of, The disposable mop with perhaps a vacuum system in the janitor's closets to dispose of this mop directly was dis- cussed. Attention to wall surfaces for cleaning purposes was emphasized, and the absorption of materials used in the building should be considered. The Architect also mentioned that a need to watch wall sur- faces for their fire safety and hazard standpoint, i.e., noxious gases when reaching a certain degree of temperature is generally ignored, but is a part of fire safety planning, Some materials have been discovered, even though they have otherwise been perfect for maintenance, longevity, etc., to be hazardous in that respect: Data concerning this is very difficult to obtain as most material specifications do not cover this characteristic, nor are they required to. Discussed was the use of inflatable rooms for isolation and even of disposable beds and mattresses after cases of ex- tremely contagious disease, the whole item being deflated and disposed of, Although not currently available, it is in the development stage. Page 81 PURCHASING DEPARTMENT Mr. David Warner The need for remote paging system of the selective type, i.e., perhaps the Bell Boy type to save personnel time, was emphasized. The discussion of some of the more com- plex monitoring systems that are on the market was held, particularly because equipment of this sort is processed by the Purchasing Department, though medical oriented. Looking to the future of the hospital triggered the discussion that in the future a patient may well be moni- tored for about every physiological fact there is. Under development, the Architect pointed out; is monitoring equip- ment that would be done without even the need of direct wire connections. The use of individual bed -mounted TV's was discussed and agreed upon in solving many problems. These are cur- rently on the market, though not color at the moment, but undoubtedly soon will be. Piped gas to Surgery is, of course, standard in modern hospitals, but the extent and need of it and some of the special facilities for handling it were reviewed. The need of special isolation rooms was also discussed at this meeting, as well as the use of hyper-baric chamber operating rooms and other now considered exotic equip- ment and facilities that may well become standard in the next decade. Included would be such rooms as saturated air, oxidation rooms, 100% humidity rooms, especially controlled and filtered pure air areas. Particularly, the problem of receiving shipments, storage and delivery to departments is the major item facing purchasing. A discussion of automated material -handling systems was given by the Architect at this point, since he is currently in the process of investigating two of the major systems on the market for another hospital con- currently being planned. It was agreed that it was essential that any plan should include this type of thinking in future equipment provisions. The need for office space and office interview rooms, as well as secretary and waiting areas, was mentioned as a space requirement, and is required in the comprehensive department of the type we are talking about developing here. The need for centralization of all storage and handling facilities and administration of it from a central lo- cations was noted, rather than having widely separated storage areas. Page 82 It was estimated that at least six times the amount of storage space was required for proper handling, purchasing, receiving, etc. Also mentioned is the need for conveyors in the hand- ling of some shipments within the department itself. The use of air curtains such as are used in some stores and hotels for entrances, was discussed with the idea that certain hospital areas that must be separated from others could have this type of separation without the problem of actual doors. The varying methods of waste disposal and packaging of waste materials, such as baling, crushers and water operated items were discussed. All have advantages and disadvantages, and no specific recommendations were made by anyone. The need for docks at trailer height was also mentioned, and the current disadvantage of having truck exhaust and noise in the space between wings was further emphasized. The wider general use of carpet was also discussed again at this meeting. Requests that all insulation be paper covered and not of the glass fiber type was made.The lighting of storerooms will be at least 40 -foot candles with 75 -foot candles in the offices. The need for more elevator service in the building was also mentioned, as well as the need for more refrigerator space throughout, since this is an item that has caused trouble in the past. COMPTROLLER AND PERSONNEL DIRECTOR Mr. Dale Weyerts and Mr. Roy Renfrow The need for training space for the personnel was mentioned for testing and screening which can be done in cubicles, and a conference room that could also be used for group -testing was requested. The possibility of an in-house computer was discussed with the feasibility of a central computer for the City of Greeley. The potential use of a large computer center even on a national scale was reviewed. The requirement for an internal data collection within the hospital itself was raised, thus the in-house computer appeared to have many advantages. Rapidity of retrieval from a major computer center was also a factor, however. Page 83 The need for more vault storage was also pointed out. The microfilming of X-rays, medical records, etc., was discussed at some length, both advantages and disad- vantages. The necessity of this in some cases was reluctantly admitted, but there are problems in so doing. Storage space, of course, is greatly minimized by the use of these items even with their disadvantages. It was felt that miniaturizing records is of necessity coming more to the forefront, and some of the disadvantages would be overcome as the systems were improved, Approximate personnel requirements were seven to eight in Accounting; nine to ten in Business; approximate total of 20 people. With the use of computers and other facilities, even centralized data outside the building, this number could be reduced even with a larger growing hospital. This again somewhat depends on the in-house or centralized computer facility. All business functions might be handled remotely with the exception of Admitting, which is handled separately from these functions now. INHALATION THERAPY Mr. Jerry Speyer While comparatively new to hospitals of this size, this was recognized by all persons as a fast-growing depart- ment, and will continue as such, much on the rapid growth basis that it is at the present time. This was a depart- ment that was unknown at the time the present hospital was planned. With the great advance in incidence and handling of respiratory and inhalation problems, this could combine many different disciplines into one department. This is so being recognized by many hospitals, particularly in the planning of new facilities. The thought of small cubicles for treatment with four to nine people per therapist was reviewed. Here again the question and need of keeping inpatients and outpatients separate was reviewed. It was pointed out that they could either be scheduled separately, or perhaps have separated egress. No firm commitment was made. The necessity of adequate storage, clean-up areas, clean storage and of a modified assembly line type of approach to the department functions was explored. Page 84 Hot and cold humidity areas were suggested. The high humidity rooms or 100% humidity rooms and their relationship to medical treatment, along with the concentrated use of oxygen in some areas, were further discussed. The treatment of some patients in various positions to drain mucus from lungs, which thus requires some space where beds and stretchers of rotating type could be used, became a space requirement,. The need for a classroom in this area where nurses could be trained, as well as doctors, and where they could be shown new training and patient treatment techniques, was discussed (this in addition to the training of therapists in the de- partment); also some area where outpatients could even be trained for self -care upon their total release from the hospi- tal, or as preventative care to avoid hospital confinement, in other words, community services, was discussed. Office space of a minimal nature, but still deemed necessary for a small personnel conference area and for record keeping, was mentioned. The thought was exressed for an education building for class- rooms where classes could be held, outpatients, community affairs, doctors' meetings and continuing education could be accommodated. This has been previously mentioned by several other hospital personnel, The use of compressed air and oxygen by piping to all rooms (the same as oxygen is now) was put forth, along with the greater use of compressed air in medical care, particularly compressed air in nurseries which is becoming more and more in demand. In the past, it has been used primarily for powering of some tools. MEDICAL RECORDS Ms. Virginia Van Owen The fact that the Medical Records Department is now divided was mentioned as not being good. Medical Records are always short on space it appears_. The use of typing cubicles, properly designed was discussed, and it was agreed as a good functional way of operating and at the same time saving some space requirements. The use of special underfloor duct systems for the bringing of electrical, telephone, central dictating, intercommunications, etc., to desks was depicted as being highly desirable. This does give great flexibility over a period of years and should be given serious consideration, though more costly initially Page 85 It was mentioned that they were intending to microfilm, except for the last five years since Medical Records must be kept for long periods of time, virtually indefinitely. The open -shelf type storage of medical records was considered adequate for the initial five years of records. The Architect did mention some of the highly sophisti- cated new storage facilities that are electrical, and merely by the push of a button certain drawers can be brought forward immediately in front of the operator in order that he may retrieve the information he wants. This minimizes the amount of space between shelves, etc., and allows a great deal of concentrated storage in a comparatively small area, yet gives it complete avail- ability without the use of microfilm. This might well be considered for the five-year records, the Architect pointed out. Heavy use of outpatient facilities as anticipated will, of course, increase the record load, Again, the computer was considered as a source of storing medical records and information. Although the communication problems have not completely been solved at this juncture, it is not inconceivable that medical records will be stored in computers in the not too distant future, though not without problems, Storage of more current records might still be considered a necessity. Discussion on the in-house computer and of the centralized, even national- ized data center, created some thought -provoking ideas. The present complement of the department is four full- time and two part-time typists. If the operation should continue in its present general mode of operation, this would have to be increased to six people other than the typists, plus a record librarian. The need to have the Medical Records near doctors' entrance and lounge, even with remote dictating, in order that Medical Record's personnel can discuss directly with the doctors and aid in helping keep their records up-to-date, was stressed. PHARMACY Mr. Boyd Starkey The question of outpatients' prescriptions was raised, specifically in conjunction with Medicaid and Medicare. The question of supplying drugs to nursing homes was also Page 86 an element that would greatly influence the workload of the Pharmacy., The public relation aspect, the community value, and the competition with the private pharmacies was not overlooked. Nothing was resolved at the present time, it being the consensus that many of these problems are still in the infant stage and more definite patterns will be developed in the future that will control final planning. The welfare patient and the neighborhood health center cannot be ignored in this connection either. The need for more space was emphasized, as well as the growing use of more disposable items, which requires in many instances more storage space_ The locating of a Pharmacy on an acute patient floor, as well as some other key areas where drugs would be dispensed, such as the aforementioned nursing home, possibly the Long Term Care Unit, etc., was also mentioned, but no particular conclusion was reached. The Architect felt, however, that a good distribution system would save these floor areas expensive stocking and control problems. With proper write - out systems, computer control, etc., the floor Pharmacy would become an anachronism. At the present time there are those who would not agree with this statement. The use of an automatic tube system was discussed at this point, but there are conflicting opinions as to the practicality of it for the dispensing of pharmacy items, since narcotics cannot be legally sent through it and because the size system that would accommodate larger items such as the newer disposable packaged articles would be prohibitive in cost. With the automatic fast distribution system, a tube system would tend to be a duplication. The need of the separate dumbwaiter for Pharmacy and Central Supply might not be necessary under a new fast distribution system, but it was emphasized that communication and delivery systems must be closely coordinated in operation. Center aisle type of arrangement for the Pharmacy could be considered, with again the discussion of more prepackaging considered an important part in the space planning and sizing of the Pharmacy, OPERATING ROOM AND RECOVERY ROOM Mrs. Helen Bolognesi, Surgery Supervisor Mrs. Lorraine Hendrickson, Recovery Room The need for two Central Supply Systems was discussed, also the fast distribution system was mentioned in conjunction Page 87 with this by the Architect. The use of TV for obser- vation, especially with the projected refinement of natural colored TV, would be even better -,than the gallery was generally agreed upon. The use of laser beams and other exotic items could become standard in Surgery. The need of_special procedure rooms, orthopedic rooms, cystoscopy rooms of adequate and proper equipment was outlined, The use of beds in Surgery, while controversial, does affect some aseptic standards ad- versely, and it was generally agreed that it was not a good practice and should not continue in a new facility. The more extensive use of monitoring throughout Surgery, Recovery Rooms and other locations was noted in the pro- vision that certain surgeries have monitoring anterooms which do have space size requirements. The use of a preparation room in the department allows greater utilization of the Operating Room facilities, and should be given consideration. The use of a computer for recording record material and minimizing the paper work, giving perhaps even quick decisions, was discussed in connection with this depart- ment, as it has been throughout. the hospital - The fact that open heart surgery, transplants, blood loss detection equipment, special scanning equipment and other items, some of which require double rooms, working in conjunction with each other could easily cause some of the Surgery requirements for areas to be doubled.. The need for certain basic facilities, piped and built-in, were discussed as they have been previously, including nitrous oxide, suction compressed air for air powered equipment, choice of certain anesthetic gases, etc, A clean-up system where the room is sprayed and then vacuumed, which is apparently on the market and has been used in some kitchens and surgeries, was discussed and also ties into the thought about centralized vacuum ex- pressed elsewhere. Interest was expressed in a central core sterile supply area immediately adjacent to the surgeries, in accordance with the Architect's current thinking of the outer perim- eter corridor opening to the surgeries, where the patient is then brought in while the doctors scrub, nurse supply and sterile a'ea cone fr T the %eter" cute, Page 88 The technicalities of the type of equipment to be used in the Surgery, both lighting, gas, location, overhead tracks, etc., was discussed, but it is not apropos to this discussion at the moment, though it was beneficial to all concerned for the knowledge exchanges and thinking provided,. RECOVERY The need for recovery control of contaminated cases in con- junction with the Recovery Room was specified; also the re- lationship of the outpatient to the Recovery Room, whether there would be an outpatient recovery room and how that would be handled since it is known that the idea of a one -day outpatient surgical case is growing in most hospitals and certainly should be considered a part of this one. The plan- ning layout consideration is, of course, having the Recovery Room available to the doctor in street clothes so that he may make any last minute check on his patient before departing. The question of having a small laboratory in Surgery was raised. This is a somewhat controversial item preferred by some pathologists and abhorred by others,. The relationship to Pathology and Radiology was again mentioned and emphasized. The Architect mentioned there is some discussion that no more explosive gases for anesthesia would be used in the future, and could eliminate the need for highly expensive and compli- cated floor grounding, explosion proof outlets, etc., particularly in light of the fact that many electrical items brought into Surgery now, for use during operations, are not non -explosion proof, and it would be impossible to make them so. Examples of this are portable X-ray machines, certain electronic monitoring, cutting tools and other medical items. He further mentioned that right now two hospitals are running test cases actually combining Surgery and the Obstetrical Delivery Department for further utilization of the basically similar rooms by being able to combine them in one locale. This is not condoned by health authorities at the moment, but gives considerable room for thought and the possibility of more utilization of facilities. The location of Intensive Care next to, but not necessarily as a secondary recovery room, was mentioned. These are pros and cons on this as was pointed out, and depends a great deal on physical layout. Page 89 EMERGENCY DEPARTMENT Mrs. Helen Schump Concern was expressed about keeping the emergency entrance totally separate from the main hospital and the need to also keep it as an isolated entrance for emergency only. Also, a separate area for people being transported and waiting that are not emergency cases was emphasized. This, of course, is part of the flow problem of Outpatient and Emergency which should be kept separate. At the same time there should be a place for relatives accompanying an in- jured person to be shuttled off so they won't follow them into the emergency room, and in general, interfere with nursing and medical treatment area flow. Emergency Departments should contain at least one, possibly two minor surgeries and some larger treatment rooms, as well as a series of small treatment rooms. There is a need to be able to clean down the rooms after certain cases where danger of contamination has existed. The need for a decontamination room was also pointed out. The use of mace in breaking up riots has been pointed out as a problem and one which can be brought in on clothes into the emergency room. Also, the need to perhaps have slightly separated patient waiting rooms where people, brought into the hospital from opposing sides of a physi- cal confrontation, can be separated. Such things as keeping the police separate from trouble makers is an illustration, perhaps a folding dividing wall; a need for a separated press room, complete with phone so as not to further complicate problems by the overhearing of their press reports; the need for a family waiting room for bereaved or highly emotional relatives was pointed out. The thought of a two-sided unit with the staff going down the back corridor to the treatment rooms and away from any contact with the patient or public before they enter the actual treatment rooms, was thought to be highly desirable. Since this is space consideration, it was very apropos. Crowds of people are a problem around an Emergency De- partment at certain times, and control of them should be given some serious consideration. The complementary use of the Emergency Department and Outpatient Department so that they are able to expand one into the other for heavy outpatient days and that can be used for extreme emergencies was discussed and considered a must. Page 90 Current Emergency -Outpatient Departments are being done in this manner by the Architect. The outpatient should have a central control for admitting which should not be related to the inpatient admitting; this was generally agreed. It was also thought that a full-time doctor for the Emergency -Outpatient Department was a necessity and should be more than an intern. Parking for the Outpatient -Emergency and the control of the ambulance entrance was touched upon.. The ambulance entrance off Sixteenth Street was mentioned as being desirable because it seemed to be the most direct route into the hospital and would not require any extra turns.. This would depend a good deal on the physical layout of the hospital and many other considerations, but should be given consideration. The Emergency and Outpatient Department should have their own clerical staff. Again, the thought of being able to dispatch patients to Surgery, X-ray, etc., in case of multiple emergencies, away from the public, makes the re- lationship between these departments and Surgery of con- siderable importance. Other items discussed were control centers for relating information to doctors, signal systems, extra help alarm and other details that must be eventually solved, but were not particularly related to space requirements at the moment„ As previously mentioned these items are recorded here on a check -list basis and in more detail in the Architect's office for future consideration. The problem of the ambulance, its cost, u d its personnel utilization was discussed. It was generally conceded this will have to become a hospital function and, therefore, ambulance vehicle housing and crew housing should be pro- vided. The use of helicopters as ambulances to augment motor vehicles for longer distances will be considered. OBSTETRICS DEPARTMENT Mrs. Evelyn Knaub There is expected to be an increase in Obstetrics in the hospital with the new industries bringing more families into the area, and will undoubtedly attract many young families. Page 9G The monitoring of mothers in labor was mentioned as being highly desirable. The use of induced labor, perhaps even by a mechanical stimulator or the slowing of labor by mechanical means until the doctor arrives, is a distinct possibility. There has been discussion of a complete electronic labor bed that will be marketed in the future. A rather marked increase in Ces4 eaw tetttons has been noted, and a tendency to use them more frequently electively. Only emergency "C" sections are done in Obstetrics. Double hall labor rooms, father enters on one side, nursing and doctors enter delivery enter from the other through which the mother goes, were discussed. The tendency in some locations to allow the father in the delivery rooms with'the mother was not looked upon with favor here. It was felt they only increase the chance of contamination, and often are a severe problem and potential danger. Legalized abortions will also be performed in Surgery. Close relationship to a central sterile supply system as well as a center core sterile supply as was discussed for Surgery, was generally agreed to be acceptable. It was stated that special training for people in Central Supply in the handling of packs, instruments, etc., for the department would be necessary. A type of progressive care for the Obstetrics Department was discussed, along with the thought that some minimal type of Recovery Room is being planned in the more modern departments where the mother is kept under close obser- vation for a few hours and then transferred to another room near the nursing station, and then moved on down to almost a self -care type of arrangement progressively farther away from the nursing station. The Architect mentioned that some are being planned in this manner at the present time. There has been no specific studies of expenses and record keeping problems involved in this movement of patients to ascertain results, but is an interesting concept to be reviewed from time to time. However, there is good reason for the recovery aspect of it at least, the rest being administrative, and could be successful and unsuccessful depending upon the record keeping and public relation aspects. Page 92 There was a general feeling no great advantage was gained by the newborn baby with the mother in her room. This question was raised by the Architect since there are advocates for it, although he is not one. This would take additional space and is a concept that exists and cannot be totally ignored in any proper planning process. The continuing education being considered here as elsewhere throughout the study, as well as the training of nurses and staff, a classroom in the department was requested. Also an area for nursing mothers that would be private was mentioned. A small classroom with an automatic push-button type of training film permanently set up and available both to the fathers and the mothers, which they could use at their con- venience and as often as they desired, would illustrate the points that the hospital would like to emphasize to the parents before the baby is released from the hospital. It was mentioned that it could also be in Spanish to completely reach the community in its entirety. A program for prenatal care amongst the underprivileged should be instituted. This would perhaps be done in the outpatient area or perhaps they should be brought into the classroom in this department in order to see in advance nurseries and other facilities with which they might not otherwise be familiar.. It was requested there be music in the nursery and labor rooms, and also TV in the labor rooms. They could be of the same type as contemplated in the rooms, i.e,, the individual bed -mounted, so as to minimize noise transference from one room to the other. The rooms should be sound -insulated anyway. The preparation room and a decontamination room should be provided in the labor area. It was suggested that a pre-packaged type of kit for the baby that would serve the five to eight -day duration of the stay might well be developed, and disposed of upon dismissal. The need for handling of waste might be increased, but would obviously reduce demands on sterilization. Touched upon were the premature nurseries, isolettes, suspect nurseries and other nursery requirements, some of which are required under health regulations. The use of computer and electronic charting and other aids to minimize the paper work was•also mentioned in this department. Page 93 ACCOUNTING Miss Phyllis Borg Accounting felt they needed several small offices, a walk- in vault with roll -out carts. They also felt they needed the underfloor duct system so as to have flexible locations for electrical, telephone and dictating outlets. Offices are needed for quiet conversations of a private nature, so glass partitions to ceiling around offices were requested. Such offices could be used for money -counting and other requirements where quiet is required. Noisy electronic machinery might be located in such areas to prevent the proliferation of noise. The need of an employees' lounge and selective paging was mentioned. The side opening letter files and electronically operated controls were discussed, as was the use of microfilming and other types of information, recording and retrieval, as they have been in other similar departments. Use of the computer here is an obvious consideration since certain hospitals are already on a central computer for accounting operations. Complete retrieval and printing out of bills in a matter of minutes after the patient has been given dismissal privileges is the ultimate goal and aim. There is a greater likelihood in this department of computer use than in any other department. CREDIT MANAGER Mrs. Helen Nicholson At the present time the Credit Department was described as a split department with the patient going there before being processed by Admitting, perhaps because of the in- adequacy of the Admitting Department. All agreed a more ideal way would be a major Admitting Department backed up by an adequate Credit Department. Here again the computer can enter into the processing of the patient's records, making the process considerably faster. The greater use of pre -admitting, perhaps almost entirely except for Emergency, might well be the ultimate goal. The fact that the vast majority of payments for hospital care are coming from third -party payers, there is a need for flexible wall and floor arrangements in the offices, with underfloor duct systems as requested in other areas such as Accounting and Business Offices. The whole office setup can change drastically with only a few changes in Page 94 regulations, ,pes of payment and other igctors. This area will probably have its greatest impact from use of the computer and its functions. Private offices for Credit Manager, interview rooms for Medicare and Medicaid and other related functions should be planned. Filing space, of course is always at a pre- mium. Insurance offices should be located near the cashier windows with the cashier being located away from the lobby and with provisions for wheelchairs at one of the windows. Also, rooms to complete a credit application could be adjacent. Special problems of this department are with the migrant laborers of the area. ADMITTING Mrs. Doris Deffke It was agreed that the Outpatient Admitting area should be divorced from the general admitting area. A case for some sort of a private entrance for admitting of the emergency patient was also made. A comment was made that electric beds are important to the patient; any new facilities should be 100% electric beds and should thereby not be of any consideration in admitting. The simplification of admitting and assignment of rooms where private rooms are concerned, was mentioned and dis- cussed. Where double occupancy rooms are concerned, it was felt essential that a lounge be provided on that floor. Of course, it was noted that not all patients can go to the lounges with their relatives. The problems of shared toilets between rooms was reviewed. The experience of Admitting was that a smaller room, be it private, would be more desirable than a larger double occupancy room. There is very little demand for bath tubs in any department, but there is a demand for showers. It was noted that provisions for wheelchair showers in the core was something that should be in the new facility. This is standard in any facility currently being planned by the Architect. It was also noted that if anything, showers are more needed in the Extended Care than in the Acute Care because of the high percentage of ambulatory patients in the former. Page 95 Admitting has noted that despite complaints about high costs of hospital care, everyone wants to go first class. The nearer that all facilities are equal in their accommodations, the easier for Admitting with fewer complaints and relocation of patients. Admitting cubicles to process the patient affords privacy and helps in the expeditious handling of the patient in the most practical manner. MEDICAL STAFF MEETING General discussion was held at a Medical Staff Meeting in order that Medical Staff members who had not per- sonally been interviewed would have an opportunity to note any thoughts about the operation of the hospital, its future, etc., that they might have Random comments were made, some of them reiterating what had been ex- pressed by others at previous meetings with individual staff people. Some of the comments in general were that the emergency service has grown and is completely in- adequately housed, mislocated and will continue to grow even more, particularly in view of industrial growth in the area. Better admission procedures for emergency were requested, but this, of course, would be accommodated by previously discussed separate admitting procedures, new facilities and other remedies for the whole operation. The necessity to retain the old building was discussed, and the suggestion made that an all new hospital be built, perhaps at a site closer to the Windsor area. The question was then asked which would be the acute hospital. The general feeling was that the abandonment of this hospital in this area would not be desirable, but the expansion of it to a Medical Center was the general aim of the adminis- tration and was concurred with by the majority of the Medical Staff and the Architect. The raising of this question was an interesting facet of the whole problem. Some discussion of the concept of the centralized Medical Center with outlying satellites was made by the Architect, but was not intended to be made as a firm statement, but rather as a point of discussion. The need for a heliport for the coming use of helicopter ambulances for emergency service was explored. Page 96 Continuing education with a possible resident program, plus intern program was discussed. Use of closed circuit TV for education and an amphitheater type auditorium, size of which was left indeterminate, could be used, Extended Care facilities would free some of the demand for acute beds. Architect also pointed out that the outpatient not being required to be admitted to the hospital for par- ticipation in third -party payments would also further eliminate the use of some acute beds, this specifically in relation to the one -day minor surgery and other treatments that doctors in the past have been in the habit of admitting patients for overnight stays in order for them to qualify for third -party payments, when hospitalization is not really required for the benefit of the patient. Consideration of breaking the hospital down into units of care required by the specific patients (in other words a form of progressive care) and a study of the utilization of exotic equipment needs to be made to really analyze the use and specifics of bed requirements for different departments. What do we need now was also asked. Million volt therapy machines are needed now along with either a linear accelerator, cobalt or similar. This was expressed from the floor. In returning to the discussion of a new hospital in the Windsor area, the statement was voiced from the floor that Greeley must be the center and Windsor provided with a small acute facility. The statement was made that Weld County General Hospital has always been progressive and a leader in its field and area, and will continue to progress, given the opportunity. Discussion of patient data storage by computer and better communications specifically in relation to retrieval of data was mentioned. Also held was some discussion of whether medical records could be computerized or not, with no definite conclusions reached. There was discussion of what the population was going to be in twenty years. One estimate, with no great disagreement, was one hundred thousand by 1990,. The possibility of five hundred thousand by 2000 A.D. was also mentioned. The need to tie all medical ancillary facilities together and concentrate them in one unit in the community with satellites at various locations would make possible neuro-surgery, open heart surgery, transplants, etc. Page 97 A Cancer Clinic goes hand in hand with the linear accelerator and other therapy machines previously men- tioned, and its need was another observation.. The need of a total community plan was discussed, and also where does it originate? Mention was made of some of the state studies for total utilization of facilities and to obviate duplication and competitiveness of facilities, but which has not extended as far north as Greeley. An item mentioned for Surgery which had not previously been mentioned was eye work and eye patient care. This has been incorporated by the Architect in one operating room in Denver. It can become a specific room in Surgery, but does not need to limit the use of that facility to this special purpose The need for special procedure rooms in Surgery was also again stated. The monitoring of the fetus during labor was mentioned at the meeting as it had been in the discussion of the Obstetrics Department In that connection a metabolic hospital was mentioned, one that would be concerned with genetic heredity and related items, Architect's Note: At this point this is virtually the only indication in any of the discussions that gave rise to any thought of extensive research in the hospital. It is the Architect's opinion that work of this sort should be done in a large teaching hospital of the type such as the University of Colorado runs in Denver, and it is not too logical to expect even a large Medical Center of this sort to be able to support and become heavily engaged in research work. Rather it should be more interested in community education, continuing medical education and research in the sense of improving their own operations and capabilities rather than diversifying objectives too greatly. One of the floor comments was that a more central location for a new hospital in the county was needed, since Greeley was not necessarily the center, The whole hospital service area should be served by a central hospital in order to eliminate the duplication of special equipment and the more exotic hardware and facilities that are being provided in the larger hospitals. There was asc some discussion of prepaid medical care and of panel practice, which is different from Kaiser's Page 98 setup of having permanent paid staff with offices in the Outpatient and other departments. The main Medical Center area needs more definition and more specifics it was felt. The general discussion was that all these latter ideas are basically up to the doctors to decide, as they are the controlling factors in medical practice. Page 99 11 BA,LMCNT CLOOR PLAN,- :o L. . cl,cr • 1 •Lr.: •1':'T iI .. E y, L. • G, :. } ..wr S,f ,r- - ".l_. 3 T:...9 w.;. T f or'� l ;E ; IAMB 11:!'A^ F:OCA :'LAN-5ouTN COYMIY fUl[YL NOiR�- W 1°. HI 1110,-11. r r Hello