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The Huron Expositor, 1961-05-25, Page 6gor° 1F,.�, HURON EXPOSITOR, SEAFORTH, ONT., MAY 25, 1961 Disclose A pin to provide for hospital facilities to serve the Seaforth area for at least 15 years, was Unveiled at the meeting of Scott Memorial Hospital Board Friday evening. The plan and recommendations were presented by Agnew, Peck- ham and Associates, of Tpronto. Widely known as consultants in the planning and determining hos- pital requirements, the firm was retained by the Scott Memorial Board last summer. Since that tune an intensive study of the use being made of the existing hospi- tal, the demand that exists for ac- commodation, and the potential re- quirements has been carried out. A preliminary report, presented to the board two months ago, sug- gested the trend of the recommen- dations being contained in the for- mal report now received. The report recommends construc- tion of a hospital of 45 beds, with basic services sufficient to provide for expansion to 65 beds. Estimat- ed project cost on the basis of unit costs from $18 to $21, ranged from $750,680 to $862,400. This includ- ed construction, furnishings, roads, landscaping, professional fees and contingency. This total estimate would be reduced by the cost ex- isting furnishings and equipment, which would be used in the new building. Provincial and' federal grants were estimated at $283,000. Decision to build a new hospital in order to meet the demand for improved accommodation in the Seaforth area was taken when the Ontario Hospital Services Commis- sion refused approval for improve- menthpand additions to the existing 80 -year-old building. Subsequently the board purchased a site on 'Goderich Street East, adjacent to Seaforth. In, a covering letter accompany- ing the report. the consultants commend the decisions to erect a new building, and also the site which hast been chosen. "We lieve your decision to construct an entirely new building rather than attempt to 'renovate la and expand the present structure is a sound one: We also commend you on the choice of site for the new hospital, not only for its loca- tionsize, but also for the topo- grap y�v hich will permit an in- teresting very n a ndfunctional build- ing to be erected." Th'e report discusses in detail the requirements of the area and recommends the number of beds and• degree of services required under various headings. It reviews the information on which recom- mendations have been based. The Area and Pop- ulation Served By the Hospital Seaforth itself and the neighbor- ing Townships of McKillop and Tuckersmith provide over 60 per cent of the patronage to the hos- pital. The future growth and de- velopment of these areas is of vital"' -importance in estimating the fu°t`tihre needs for hospital facili- ties. There are many features of the area which make it attractive as a location for industry. The Cana- dian National Railways offers a freight and passenger service; there is a good highway route through the town to Stratford and further connections to the east and Goderich on the west with docking and customs facilities to the Great Lakes. It seems prob- able that a new highway will soon be approved from London, north to Walkerton and going through this area. There is an ample supply for the future of first class water from local artesian wells and part of the town is serviced by sewers which lead to a treatment and dis- posal plant. Seaforth is known as a good shopping town and does serve as such to. a population within a ra- dius of 10 to 15 miles. The large district high school tends to en- courage greater commercial activ- ity and a number of the RCAF station personnel from nearby Clin- ton make their homes in the town or neighboring townships. In fact, however, . the total population has grown very slowly in the town, and in some years only holds its own. The growth to the west and south of the town. has tended to keep the population of McKillop and Tuckersmith stable, particularly in the bordering communities of Eg- mondville (approximately 500) and Harpurhey (approximately 300). Despite the encouragement of new industries and the many inviting featu "res of the area, it seems un- wise to plan for hospital services to meet the needs of a much larg- er population in the next 10 years than at present. A growth of ap- proximately 40 persons per year in the town, and a slow natural in- crease from the surrounding area, is not a significant figure when re- lated to hospital requirements. One new Industry seems possible at the moment, such to employ approxi- mately 70 people, but most of these workers would be the people already in the area. The picture can change rapidly, of course, through the location of a large in- dustry • or the expansion of ones ;already there. In the light of past liistory,lliillvd'er, the slbW increase for - the area of less than 100 peo- ple" a year is. all that should be anticipated. aster Plan For Area Hospital Service The "estimated" .pppulatjon is based on logical divisions of the 1959 figures, depending upon the geographical distribution of gen- eral hospitals in relation to the population of each township. The "actual" population is based on a compilation of actual admissions to the hospital in 1959 from the various townships, related to the overall experience of the Province of Ontario in that year (139 ad- missions per 1,000 population). Since neither method provides an entirely accurate picture of the hospital patronage, it is suggested that an average figure is the clos- est to reality, approximately 8,800 people. It is our prediction that the hos- pital should anticipate a need to serve the following population for active treatment purposes, and also to serve the chronically ill: 1961 9,000 1966 9,600 1971 10,300 It is of interest to note that In 1959, 15.4% of the population of Seaforth represented people of 65 years of age or older, whereas Mc- Killop Township had only 7.7% in this age group and Tuckersmith Township, only 9.7%. The average for the Province of Ontario in the 1951 census, for 65 years and old- er, was 8.7% of the total popula- Tion, and for Canada it was 7.75%. he rather high percentage of old- er people in Seaforth itself is cer- tain to have some effect on hospi- tal usage, since the 65 and over age group have an almost 20% greater hospital utilization rate than that of the total population (Health Information Foundation Bulletin, April 1959, p. 4). Other Hospitals Serving the Area This part of Ontario is well serv- ed with general hospital facilities. Each community, with the excep- tion of Mitchell, has a hospital of its own. Within a radius of 30 miles, there are facilities in Exe- ter (new 39 -bed South Huron Hos- pital of which eight beds are list- ed for the care of the chronically ill); Clinton (51 -bed Public Hospi- tal); Goderich (71 active beds and 24 for the chronically ill at the Alexandria Marine & General Hos- pital); Wingham (81 active beds and 48 for the chronically ill); and the Stratford General Hospital, which has an expansion program underway for active treatment beds to bring the total to approxi- mately 200 such beds, plus the 109 -bed Avon Chest Hospital for long term care. Although all of these hospitals do a certain amount of specialized work, particularly in surgery, more complicated cases and procedures are usually refer- red to the district hospital centre in Stratford or to the regional cen- tre of London. $eafortli • %WOO 'township Tueltersmtth Township Iibbbrt TdiVfiship and Dublin 1/fortis Township areY' Township ,Township 1440 l,,o il0 $"eWttlliig ' Although there are no beds in Seaforth approved for the care of chronically ill patients, the hospi- tal does always have a number of long -stay patients. In addition, there are two local nursing homes (Thamer's of 18 beds and Muir's of approximately 12 beds), both of which have graduate nurses in at- tendance and are considered by the local medical staff to provide a satisfactory standard of care. There are no specific facilities in Seaforth for the isolation of pa- tients with communicable diseas- es, but this is not a serious lack; if. such hospital care is required, it can be given in the special units in Stratford or London. Facilities for isolation care at the Scott Memorial Hospital are not satis- factory. Patients needing treatment of mental illness are usually referred to London (48 miles distant) for short term treatment and to Oril- lia for. long term care. This situa- tion will be greatly improved when the Ontario Hospital near Gode- rich is built and ready for use. Welfare services for long term bed care are not readily available. The County Home near Clinton is to be expanded, however, and will provide some, facilities for such care. This will be an improvement in the overall pattern of services required to meet the needs of that segment of the population. It is apparent that, with the ex- ception of an adequate number of beds in Seaforth for long term care and for isolation, the avail- ability of general and special hos- pital facilities in the general area assures the residents of a range of services which can meet almost any need within a reasonable dis- tance of Seaforth. atively constant. The overall occupancy of the hospital has remained steady at ap- proximately 80 % in the past two years, despite the addition of four more beds in December, 1959, through relocation of the Nursery. A hospital of this size and physi- cal plant usually operates most satisfactorily at approximately 75'i occupancy over the year; this meets the fluctuating demands and the changing needs between Medi- cine, Surgery, Obstetrics and Chil- dren and between accommodation for men and for women: An occu- pancy of 80% for the year is high for a small hospital, and any over 85cl makes it almost impossible to meet peak needs. More important than the overall occupancy, however, is the use which each part of the hospital're- ceives, since the standards vary with the particular services, This hospital is divided, with a separ- ate section of seven beds for ma- ternity patients, reserved for them alone, with a four -cot unit for chil- dren and with 26 beds for other patients (22 until December 1959). Beds Greatly Overused • This latter group experienced an occupancy of 95% in each of the last two years, an overwhelming situation in an active treatment unit. Because of the need to have beds available for emergency ad- missions, and to meet the dhang- ing requirements of the commun- ity (demands are usually most heavy in winter months), the medi- cal and surgical units of a small general hospital should never ex- ceed an average of 80% fqr the year. It is obvious that these 26 beds are being greatly over -used. One needs only to visit the hospi- tal any day between October and May to see the visual evidence, with beds along the corridors to accommodate the most recent ad- missions. This is a most unsatis- factory state of affairs; it is un- comfortable, undignified, unsani- tary, presents a danger from cross - infection, and makes it impossible to provide really adequate nursing or medical care, or to clean and maintain the hospital in a satis- factory manner. The Obstetrical Service of seven beds has not had a higher occu- pancy than 46%..,,,in either of the two years for' which this break- down of statistics is available. This is not so law as it might appear to those unfamiliar .,with the ex- treme fluctuations in demand for. beds in this service. Even with only 46% average occupancy over the year, there have been times when all _beds were filled. We re- commend an average occupancy of 65% as the ideal level for this ser- vice over the year. On this basis, seven beds is ample for the ma- ternity needs of the community: The four -bed children's unit has also proved to be of a satisfactory size for most times of the year. The occupancy has not exceeded 60% as an average for the past two years and, as with Obstetrics, we find an average occupancy of 65% to be the ideal for this ser- vice. Other than for tonsillectom- ies, most, hospitalization of chil- dren results from accidents and from outbreaks of upper respira- tory infection. These are unpre- dictable, which means the unit can be empty one day and crowded the next. The level of 65% average occupancy is as high as a small un- it can reach and still provide ade- quate service to the community. The average length of stay matches that of the total for all general hospitals in Ontario, but is a full day longer than the aver- age for hospitals of less than 100 beds. The reason is apparent when one looks at the statistics of long stay patients as compared to most general hospitals. On the date of one visit (17 November, 1960), 31% of the patients (10 of 32) had been in the hospital for more than 30 days. Of these 10, five had been there for more than four months. Once a general hospital has more than 10% to 12% of the patients there for longer than 30 days, it is providing long, term convalescent and chronic care; this situation should be met either by creating a specific unit for such care in the hospital, or by having suck patients transferred elsewhere to such a unit. Analysis of Utiliza- tion of Beds It is noteworthy that the hospi- tal has been used to a much great- er extent since the introduction of provincial hospital insurance. This is due, in part, to the greater num- ber of long stay patients and the increase in the average length of stay, but the medical staff also ad- mit patients to the hospital with less reluctance than in the past, being familiar with the financial status of their patients. The pa- tient census has increased in the past four years, from a daily aver- age of 22.2 to 29.7 in i960, a sig- nificant change in an area where the population has remained rel- • 1959 Hospital (Esti- Population Serves mate) 2,228 100%--2,228 1,684 100%=1,684 1,005 90%-1,715 1,611 70%-= '-1,128 1,637 20%= 327 1,94 30%= 582 1,961 40%= 784 2,198 20%= 7440 50 9,638 Actual 100% =2,228 86%=1,448 59% =1,124 66%=1,063 18%=1,392 750 8,005 Anticipated Bed Need a 75% overall occupancy; - only population of the hospital district; five for Obstetrics and three for we would agree with this figure as Children would have given the a minimal requirement. Therefore, recommended 65% average occu- on the "ratio" basis, there is a pancy. This suggests that a total need (1966 population) of 38.4 plus of 33+5+3. 41 beds in 1960 would eight or 10, which equals 46 to have provided adequate service to 48 beds. the patients who were actually treated in the hospital. It must be Suminary and Recommendation appreciated that this calculation does not include those patients who could not be admitted be- cause of lack of beds, but it does include a number of long stay patients who should really be as- signed to other than space for active treatment. It was predicted that the popula- tion of the area served will grow from 8,800 in 1960 to 9,600 in 1966, an increase of 9%. Since it is im- portant to build hospital facilities which will., suffice for the needs of at least a few years in advance, any planning done now should be based at least on the needs for 1966. A need of 41 beds at present, plus 9%, suggests a requirement by this method of 46 beds by 1966 if the current number of long stay patients is still to be treated in the hospital itself. Ratio Method The Ontario Hospital Services Commission has been using, in the past two years, a ratio of 4.0 active treatment beds per 1,000 popula- tion for community hospitals simi- lar to the Scott Memorial. On this basis, using our population predic- tion of 9,600 population to be serv- ed by 1966, a need of 9,6 x beds is indicated, and for 1971, an additional three beds will be needed. In fact, the Ontario Hos- pital Services Commission have al- ready approved 40 beds for the construction program envisaged. This does not include provision for the long stay chronically ill pa- tients of the community. Long Stay Patients The number of long stay patients to be cared for does affect the re- quirement. Some distinction should ,be made between the various groups of patients often consider- ed within this term. Those patients considered within the term "con- valescent" may often be in the general hospital for a long period of time, but only for the recovery stages of an acute illness or in- jury. When they no longer need frequent medical attention, plus the type of nursing care and avail- ability of diagnostic services as of- fered by the hospital, such, pa- tients should be discharged to their own homes or to a nursing home. The term "chronically ill" should be reservedfor those with long standing illness and who may have either continuing ill health or whose recurring attacks of ill- ness severely limit their activities in the short intervening periods of relatively better health. Such pa- tients may be in need of hospital care for a matter only of weeks (during an exacerbation), or it may be for a period of months or of years. Some long stay patients require little medical oversight and nurs- ing care, while others require as much care as short stay acutely ill patients. Patients with a chronic illness cannot be considered as a single group, but within approxi- mately five categories: The Scott Memorial Hospital now has a rated capacity of 37 beds and seven bassinets. For a period of time following 1948, when one-half of a former RCAF Hospital was moved to Seaforth and attached to the building, it had a rated capacity of 39 beds and 12 bassinets. When the beds on the second floor of the old build- ing were condemned for use, how- ever, the capacity became 33 beds set up. In December 1959, a reloca- tion of the newborn nursery was effected, thus making provision for four additional adult beds. Capacity -Rated and Beds Set Up Beds Total 1 2 3 4 5 6 -Medicine & surgery Obstetrics Children 1. Those who require frequent medical consultation and skilled nursing services; 2. Those who require special treatment and extensive diagnos- Medicine and Surgery tic study; This allocation of 28 beds re - 3. Those who need only occa- presents only a two -bed increase sional medical oversight, but do over the extremely crowded condi- need skilled nursing care; tions at present, but the relief 4. Those who require medical should be felt through the provi- oversight and the type of nursing sion of a separate allocation for care which could be provided by a the chronically ill (or alternatively, practical nurse; - transfer to an approved local nurs- 5. Those who may only be aged ing home). and senile and require mainly It is advisable in a hospital of varying degrees of custodial care. this size to provide as many one Patients may move from one and two -bed rooms as possible, category to another over a period -rather than larger wards, in order of time. to provide flexibility in use be - Many patients who are chronic- tween types of illnesses and be - ally ill, particularly those in groups tween men and women. However, 1 and 2 above, and some in group it is necessary in Ontario to pro - 3, should be cared for in a gen vide a minimum of 50% of the eral hospital, an adjacent unit of beds in ward -priced accommoda- the general hospital, or in a hos- tion; three of the two -bed rooms pital specifically devoted to such should be considered as such to care. Patients in groups 4 and 5, provide the balance required. To and some in group 3, may be re- differentiate the two -bed standard ferred with safety, as a general accommodation from the two -bed rule, to their own hotites.:or to one semi -private room, there would be of the better eqpipped and staffed location, size, noise or disturbance, nursing homes or homes for the addition of a toilet, et cetera. agdd. It would seem inevitable that the Scott Memorial Hospital will al- ways have a number of long stay patients, some of whom could prob- ably be discharged to a nursing home, of which there are two re- putable ones in the town. It seems almost certain that more of such transferring would be done at the present time if either one or both of these homes were approved as participating members of the in- surance plan. The Ontario Hospi- tal Services Commission has been It would be better if these facili- hesitant to 'approve hospitals or ties had a greater division of homes which do not come under rooms in order to separate infants the Public Hospitals Act with its from older chilc`ren and to separ- extensive controls. ate the very sick from those at a On this basis, eight to 10 beds convalescent stage. The size of the would be required to serve the unit, however, does not justify Based on the experience of the past two years of operation in relation to ideal levels of occu- pancy and the population predic- tions for the area, a minimum of 46 beds should be supplied to serve the short term acutely ill and the long term patients similar in type to those now in the hospital. Bas- ed on the ratio method approved by the Ontario Hospital Services Commissiong4there is an indicated need of 38 beds for the short term acutely ill and 8-10 beds for the long term chronically ill patients. Both calculations are based on an- ticipated needs in 1966. It is recommended that the new Scott Memorial Hospital provide 46 beds, of which eight should be considered for the exclusive use of chronically ill patients. An alternative to theprovision of a specific bed assignment for long term patients would be to seek, or support the application for, approval by the Ontario Hos- pital Services Commission of one or both of the local nursing homes. From all reports, these homes offer good care under the supervision of a graduate nurse. Sinc-e, the hosji- tal does not offer either the ser- vices of a physical medicine de- partment or expensive laboratory tests, the main reason for °provid- ing care for_these patients at this size of hospital in comparison with one of the nursing homes is to concentrate patients needing hos- pital facilities under one roof. However, if these long term pa- tients were transferred to a good home, it would permit the hospital to concentrate its few professional staff 'on the care of the acutely ill. It would certainly be less expen- sive for the hospital to construct and to staff a new building with a smaller number of beds. If approval should be given by the Ontario Hospital Services Com- mission to the use of the nursing homes, however, it will be neces- sary for the hospital to provide a slightly greater number of beds than in the program already re- commended, since there will often be a longer stay required at the hospital before transfer to a home than if the long stay facilities were in the same building. It is recommended that, as a possible alternatice to the 46 -bed program, the Ontario Hospital Ser- vices Commission be approached to give approval for long stay care to one or both of the nursing homes in Seaforth. Should this be gained, a 40 -bed general hospital for short term care should meet the community needs of the next 10 years. It is emphasized very strongly that some consideration must be made to the provision of accom- modation for long term patients in this community. If this is not done, and a 40 -bed general hospi- tal is constructed, the situation will be little better than at present - with 37 beds and the solaria and the 'corridors in constant use for patients. If such use is made of an old building, with .somewhat primitive facilities, one ` can im- agine the use which an attractive new hospital would receive. 3 8 - 4 5 6 26 2 2 3 - - - 7 - - - 4 - - 4 37 Newborn Nursery -7 bassinets This breakdown includes the beds set up routinely in the two solaria, but does not include those which are always set up in the main corridor of the one -storey. wing. Occupcany Method The ideal occupancy percentages of the various services disclosed that the beds for Medicine and Sur- gery were highly over -utilized, whereas those for Obstetrics and for Children were under the re- cognized annual occupancy levels. In 1980 it would have been nec- essary to have 33 beds for Medi- cine and Surgery in order to give more than one separation room for isolation purposes. Multi -Purpose Rooms The medical and surgical nurs- ing unit should have at least one single room for patients who need to be isolated for one -of several reasons; for example, they may be emotionally disturbed, have a com- municable disease or an infection, may be particularly noisy, or may be in a terminal stage of an ill- ness. Intensive Care In recent years there has been a great deal of publicity in regard to the concept of "progressive pa- tient care" which refers to the es- tablishment of facilities specifical- ly designed and staffed to meet the particular needs of •.the patient at each stage of his or her illness. A complete program of progressive patient care would include facili- ties for intnesive nursing care, in- termediate or ordinary -"nursing care, self-care or convalescence, long term care and a home care program. The complete program is more theoretical than practical for most hospitals and certainly in a small hospital. Because of the recommended size of your hospital, however, we do not feel that a completely segregat- ed allocation of beds for such a service can be justified; it would only be used to capacity intermit- tently and would be quite too ex- pensive to operate with justififica- tion. A more practical arrangement would be to place the moat ill patients in rooms near the nurses' station, a time honored system which is still the best for hospitals under 100-150 beds. "Chassis" Size It would be wise to . create the hospital departments;' in the pro- posed new hospital to a size large enough to serve the additional beds which will probably be . needed at a later date. It costs little more to provide some extra space in the present program. It would cost much more later on and particu- larly so if some of the services would have to be relocated in or- der to be enlarged. Any provision which can be made at the present time to avoid the expense. and an- noyance of extensive enlargement at a later date is time and money well spent. It is recommended that admini- strative, clinical and domestic ser- vices be planned to serve a 55 to 65 -bed capacity, thus making any future expansion following the cur- rent program comparatively inex- pensive. Recommended Departmental Areas The departmental areas which follow are based on minimum net square foot standards for a hos- pital which will serve 50 to 60 pa- tients. These recommendations are made in the light of current prac- tices at the Scott Memorial Hos- pital which differ from hospitals of equivalent size elsewhere. Administration Main lobby 500 Gift Shop 80 Public toilets and telephones 50 Admitting office 50 Business office (cashier, in- formation) 300 Medical records 200 Administrator's office 180 Toilet -, 25 Secretary's office 120 Director or nursing office . 130 Staff lounge, board room 250 Janitor's closet . 25 Retiring room 100 Required area, between 2,000- 2,500 net square feet. Emergency Department: between 550-70q net square feet. Ther is an average of one em- erfenc* each day which suggests that the suite need not be large, yet it should be planned to serve a 60 -bed hospital. The emergency entrance should have direct access from the out- side and be closely related to the admitting department and to the main entrance. With these rela- tionships night coverage of both entrances by one person is pos- sible. Obstetrics The emergency suite is best lo- cated near the X-ray department and as close to the surgical suite as is possible in order to direct a serious accident case which can- not be cared for in emergency to the surgical suite. An out-patient department, in the usual sense, is not required for this hospital since most of the doctors handle this type of case in their own offices. Radiology: between 750-900 net square feet. The hospital has a new .200MA machine which will be re -used in the new hospital. The radiologist from Stratford vis- its at least once a week. It can be anticipated that outpatient work will thcrease in volume: The loca- 250 net square feet (including. body refrigerator). At the present time it is not possible to perform autopsies in the hospital due to the lack of facilities. Although it seems unlikely that many will be done in the new hospital, it is advisable to plan for an autopsy room which would be reasonably equipped, primarily to encourage the medical staff to use such facili- ties and also because it is extreme- ly helpful in acquiring accredita- tion for the hospital. Pharmacy Dispensing a n d prescription room: required area, 200 net square feet. Physical Therapy There Is no physical therapy ser vice in the entire district and it would be desirable that this hos- pital employ a physical therapist who would be part time at the hos- pital and also would work in at least one other nearby institution. The value of a physical therapy unit has been proven over the years, not only for the rehabilita- tion of patients who have suffered injury or who have undergone sur- gery, but also for the rehabilita- tion of the chronically ill. For your hospital, one area would be needed where limited exercise functions could be under- taken as well as one or two cub- icles for massage and heat -ther- apy. Surgical Suite: between 1,600-1,- 700 net square feet. For a 60 -bed hospital two operating theatres are necessary. Also basic to the small hospital is the planning of the cen- tral sterilizing and supply depart- ment near the surgical suite, thereby reducing the required space .in the surgical workroom and it also permits the surgical staff to assist in the operation of the central sterilizing and supply department. A recovery room is not recom- mended for this hospital since there will seldom be the number of operations a day to justify a full time graduate nurse to care for patients following an operation in a separate room. Delivery Suite: between 1,000-1,- 200 net square feet. The delivery suite, naturally, should be locat- ed adjacent to the maternity beds and nurseries. The suite should be planned, as other departments, to. permit future expansion should the. hospital enlarge beyond the anticipated 60 -bed chassis. If pos- sible, a fathers' room could be just- ified; however, in hospitals of this size, the main lobby and waiting room is used for this purpose. With the central sterilizing and supply department processing all items in the hospital, it is not nec- essary to plan for a workroom in the delivery suite and, therefore, only a sterile storage area is re- commended. Central Sterilizing and Supply Department: required area, 470 net square feet. One area divided into sections for receiving and clean-up, for a workroom which would include *glove processing and topical solution preparation, a sterilizing area, and a sterile sup- ply and issuing room are the re- quired elements to serve this size of hospital. ` Nursing Uits Although the occupancy record of the past few years indicates that five beds would be adequate to maintain a 65% occupancy, there have been times when all seven beds were required. A com- promise of six beds should meet the needs at all but these very few occasions. Children tion of this department should be close to the emergency suite and Utilization of Present Hospital Beds the surgical suite. It is also advis- able to have it located as part of Statistics of Utilization an adjunct facility area which 1960 1959 1958 1957 would also include the laboratory and the pharmacy. 1,003 986 901 890 General Laboratory: between 10,869 9,686 • 8,497 8,117 290-325 net square feet. The hos- 29.9 26.5 23.3 22.2 pital has not had a laboratory as such and only routine urinalyses 80.3% - - - have been performed on patients - 80.4% 70.5% 67.4% by the nursing staff. While the service from the Stratford Gen - 94.8% - eral Hospital has been satisfac- - 95.0% tory, it is important that this hos- pital be able to perform at least 42.8% 46.39 the more basic routine tests in the hospital. Although a fully glual- 51.6% 60.1% - - ified laboratory technician may 10,8 9.9 9.2 9,0 not be obtained, it is important that someone, with partial train - 150 166 158 157 ing at least, be available. 1,189 1,229 991 988 AutopsyRoom: required area, Adults and Children: Number of admissions Number of patient days Average patient census Average Occupancy based on 37 beds based on 33 beds Medicine and Surgery based on 26 beds based on 22 beds Obstetrics based on 7 beds Children based on 4 beds Average length of stay (days) Newborn Number of admissions Number of patient days Since the total bed capacity of this hospital will approximate 45 to 46 beds, there is a debatable point in providing two nursing un- its -one for medical, surgical and long stay patients, and one for maternity. Certainly, it will be dif- ficult and uneconomical to staff a six -bed obstertical unit. There- fore, the planning of patient areas should, from the point of view of staffing and operational economy, be in one nursing unit, providing there is some physical separation between these various categories of patients. Each patient's room should have a toilet and hand basin; two bath- tubs and one shower for the medi- cal -surgical patients, children and long stay patients, and one shower and one sitz bath for the matern- ity section. A shortage of toilet and bath facilities in the present hospital has proved to be a ser- ious inconvenience. ment is desirable. However, it is essential that all general and food stores be centralized, possibly in- cluding pharmaceutical stores. There will not be a full time employee assigned to this depart- ment so it is important to pro- vide a signal system between the receiving entrance and a central location where someone would be available to receive the goods and supplies upon delivery. Employees' Facilities: between 750-850 net square feet. Small restrooms for each of these areas is particularly important in a hos- pital of this size where some of the emplpyees live in rural areas and may have to wait for their transportation home. It is unlikely that there will be more than three to four male employees who need locker space. Laundry and Housekeeping: be- tween 1,300-1,400 net square feet. The laundry, in the present build- ing, is the only adequate depart- ment in the hospital with respect to square footage and equipment. The two new 50 -pound washers, the new extractor, the new two -roll ironer, and the tumbler will serve the new hospital. A system utilizing soiled dinen chutes has been discouraged re- cently because of the danger of possible cro -infection. If linen chutes are t be installed in the building,all ne d n should be bag- ged a - ged for use. g Mechanical Facilities: between 950-1,000 net square feet. Iii- de- signing the boiler plant, it is im- portant that a reserve boiler be installed in order to be certain of continuing coverage at times of possible disaster or extreme bad weather. Thought should be given to providing one boiler which. could handle the entire hospital, plus two smaller boilers which would act as alternates for the en- tire plant; one of the latter would handle hot a water requirements in the summer months. Package -type boilers appear to be efficient for this size of hospital. An auxiliary power generator should be install- ed in order to maintain service to essential lighting to oxygen tents, to the power plant and, if neces- sary, to the elevator in case of a power failure. Parking Parking should be ample and should provide for approximately 60 to 70 cars. A reserved parking area for the medical staff should be located close to their entrance to the hospital. Nurses' Residence A decision must be made whe- ther to keep the present residence or provide another one in proxim- ity to the new hospital. Although many hospitals throughout the con- tinent are no longer„ providing residence accommodation for gra- duate nurses, it is our impression that a certain number of rooms should be provided in a commun- ity of this size without many apart- ment buildings available. The pre- sent residence is perfectly satis- factory, being a handsome house with five bedrooms on the second floor ,another one on the main floor and a private apartment with a separate entrance. There are ample lounge rooms and other fa - P g fa- cilities. The problem, of course, is transportation. It is suggested that, for the pres- ent, the present residence be re- tained unless a satisfactory finan- cial offer can be found for its sale. The nursing staff may have some available transportation or could use taxi service. The apartment at the rear could be provided rent free in exchange for maintenance services and supervision - of the heating system. If transportation proves too difficult or too expen- sive, xpensive, the purchase of a nearby 'house or the erection of a resi- dence could be considered. Nurseries One room for the recommended seven well baby bassinets, separat- ed by a nurses' work area and doc- tors' examination room, is requir- ed, plus a separate nursery for suspect infants, The latter requires an ante -room in keeping with pro- vincial government regulations. Dietary Department: between 2,- 300-2,500 net square feet. The type of food service adopted will affect the general planning of this department and the space requir- ed. It is recommended that a completely centralized food sys- tem be established, plus an ac- ceptable method for keeping food hot until it is served to patients; either one of the airline type of food trucks or the heated pellet (dri-heat system) is suggested. Central dishwashing for the hos- pital is essential for a modern dietary service. The system of, charging for staff and employee meals will have some bearing on the layout of the dining and cafeteria area. Al- though the trend in recent years has been toward providing one large dining room for all the staff, there is some merit in having a separate dining. area for the grad- uate nursing staff and one for oth- er employees. This arrangement can be accomplished and still es- tablish a pay cafeteria system. Receiving and Central Stores: between 1,500-1,800 net square feet. For this department a re- ceiving dock related to the cen- tral storage department is essen- tial. Space should be planned for general stores, commissary stores and separate areas for oxygen and anaesthesia gas storage and for medical records, X-ray records and business records, Ideally, an area set aside for 'fttrfllttire and equip. Expansion Program In planning your new hospital on the selected site, the first im- portant consideration is the site itself. Thought must be given to topography, access from the main highway, orientation, prevailing winds, future possible growth and similar controlling design factors, A decision is necessary with re- spect to the desirability of plan- ning a completely horizontal hos- pital or a two-level plan; should the building take advantage of the natural slope near the main high- way, or should it be located to the rear of the property which is rel- atively level? The site 'itself is excellent, not only in size but in its natural pos- sibilities for economical planning. The actual location of the hospital, ideally, should be fairly, close (but not too close) to the main highway for the obvious reason of accessi- bility and also to permit the hos- pital to be seen as a community building. By this reasoning one reaches the conclusion that a hos- pital entirely on one storey would not be practical in view of the topography in the area seen from the highway. It is frequently said that a two- storey hospital is more costly to construct than a one -storey lay- out. This can be true if the struc- ture is wall bearing, including in- terior partitions. For a hospital, such inflexibility is not desirable for its limits the internal planning of departments- and does not per- mit economical changes, should the hospital require enlargement in the future. Expansion is sure to come sooner or later. Also, there are advantages in constructing a two-storey building. There is less periphery; therefore, less foundation; there is less roof area, less heat loss compared to that of a slab on grade, and the inter -relation of departments and services is more compact. Natural- ly, an elevator and stairs are re - (Continued tn Pae 10 e