A CLINICAL RESEARCH CENTER
An Architectural Thesis presented to the College of Design and Planning, University of Colorado at Denver in partial fulfillment of the requirements for the Degree of Master of Architecture
The Thesis of Gayle Mylander is approved
University of Colorado at Denve
TABLE OF CONTENTS
The Project... ... 1
Background... ... 2
Thesis Proposal... ... 3
Operation... ... 5
Location... ... 9
UCHSC History... ... 15
Site Analysis... ... 17
Surrounding Buildings... ...19
Neighborhood Land Use... ...21
Traffic Patterns and Parking... ...23
Nursing Unit... ...47
Out-Patient Clinic... ...51
Program Proposal... ...62
Faci1i ty Notes... ... 64
DESIGN & CONCLUSION
Building Code Checklist... ...Al
University Hospital Plans... ...Bl
The proposed project discussed in the booklet is a 74 bed, 56,500 square foot medical research facility for the study and treatment of human disease. Included in the facility will be out-patient clinics and in-patient services. The Clinical Research Center is to be sited on the north end of the University of Colorado Health Sciences Center in the east central area of Denver, Colorado.
Throughout the history of the National Institute of Health's funding of the Clinical Research Center Program, the research center has been closely associated with a teaching hospital This association between teaching and research has developed from funding, available facilities and the nature of the investigative endeavor and the communication of its results. In addition, because duplication of many services currently provided at University Hospital would prove costly and inefficient, the Clinical Research Center is to be sited adjacent to University Hospital.
Devoted to the study of human disease and treatment, the Clinical Research Center in many aspects is quite similar to a hospital, and is currently within the geographic boundaries of University Hospital. The Clinical Research Center is, however, financially independent of the university. Although many of the patients served are treated by generally established procedures, the main orientation of the research center is toward the study of disease and the development of new treatment procedures. The differentiation then, between the familiar hospital setting and the research center, is the broader range of patient clientele, the type of
patient monitoring activities, the extent of monitoring, and the transformation of data into usable information for the medical community.
To clarify the differences, patients may range from the usual hospital variety of ill but ambulatory and able to go about their normal life yet undergoing study, or treatment to terminally ill, bed-ridden and dying. However, also included in the patients at the research center are normal and healthy individuals used as normal controls. The type of patient monitoring can include activities such as timed blood draws while patients are continuously infused with substrates, entailing bulky machinery, to very precise dietary intake over extended periods of time, to elaborate and specialized specimen collection, storage, and testing. To make this research worthwhile, it must be shared and made available for greater understanding and use in advancement in general knowledge and as improved disease treatment. This also requires facilities not generally found in a hospital.
The Clinical Research Center is a hospital and more. It is a place where a person may come to seek medical attention, a place where medical advances are made, and to some patients a home away from home.
Anyone who has had, is related to, or had association with a person with a debilitating or degenerative disease, is aware of the frustrations involved, including medicine's lack of answers and cures for many diseases. Most people in that situation welcome the chance to contribute in their own way to making their disease more understood and want to do whatever they can toward instituting their own cure or alleviating their symptoms. Prolonging one's life or increasing its quality can be a great motivation. Providing a resource facility for disease study is the aim of this thesis. Keep in mind, the goals of providing the best possible situation for all concerned is the major objective of this project.
Individuals entering a hospital situation expect in the very least, comfort, consideration, and efficiency. Stresses encountered by a patient include financial problems, lack of information, threat of severe illness or death, separation from, family or friends, and problems with medication and pain. For the most part, these stresses must be addressed by counseling, kindness, and the provision of information, usually things that only other people can provide.
Some of the stresses encountered by the patient can, however, be addressed by the environ-
ment of the Clinical Research Center. Comfort can be architecturally provided in its design. Loss of independence of the patient can be countered through design considerations encouraging the patients to function within the facility to their fullest possible extent. Additionally, promotion of research aims can be encouraged by providing an atmosphere in which the patient's compliance is fostered.
It is the contention of this thesis that through careful design and planning, some patient stresses can be addressed and minimized and patient compliance can be encouraged. These issues are discussed below.
Loss of Independence
To a great extent a patient's loss of independence is a given fact when he is no longer in his own home and no longer the master of his own schedule. It is not necessary, or good, however, to then lie in bed and await one's fate. Encouragement of a patient's mobility and functioning to the fullest possible extent will foster his own well being. A reason to get dressed, a place to go, a scene for social interaction, and amenities for ambulation will give a patient a greater feeling of his independence. It is the contention of this thesis that patient independence can be encouraged through careful planning and design of
the research center
A patient usually enters a hospital situation seeking comfort in the form of disease treatment. New stresses beyond those the patient entered with must also be provided for. As discussed earlier, much comfort must be delivered through personal encounters. In addition, the environment of the research center can provide comfort through its architectural atmosphere. Places where the patient can feel more at home with his visiting family and friends must be provided. A patient is entitled to comfort in his own peace of mind, the best as can be offered. Connections to .nature can be a source of comfort. A patient's visitors, who are, perhaps, in a position of extended visitation, and perhaps, under great stress themselves, are also entitled to a facility that has provided for their needs. It is a second contention of this thesis that comfort can be architecturally provided in the Clinical Research Center.
In the study of well patients voluntarily housed for periods of up to six weeks, their compliance is of utmost importance. An example may be an obese patient on a carefully balanced dietary intake. They are at times free to leave the research facility during working hours, perhaps
to work at a job or just for an outing. Although their compliance is encouraged through careful counseling, their motivation may not be as strong as someone in a life and death situation. Their continuation of a perhaps tedious study once underway will allow for interpretation and use of data in which much time and effort has been invested. Their adherence to attending scheduled events and the maintanence of protocol guidelines in dietary intake and specimen collection area also necessary to make the research meaningful. To encourage compliance, the environment of the research center must give more than just a hospital room to these people. Something closer to a home environment would be more enticing than a bed in a room. It is the third contention of this thesis that compliance can be encouraged through carefully designed facilities.
NATIONAL INSTITUTE OF HOSPITALS
CLINICAL RESEARCH CENTER________ ADVISORY
ADM INISTRATION/ORGANIZATIONAL OPERATION
The General Clinical Research Centers Program is an endeavor to make the resources necessary for the conduct of clinical research available to medical scientists. Set up by the National Institute of Health, the Clinical Research Center is a medical facility for the study of human diseases.
Included in the research center are patient walk-in clinics, in-patient wards, research laboratories, a metabolic kitchen, and offices.
The goals of the General Clinical Research Centers Program are:
to provide an optimal setting for controlled investigation by clinical scientists supported through the National Institute of Health and other organizations
to encourage increased collaboration between investigations in the basic and clinical sciences
to encourage, develop, and maintain a national corps of expert clinical investigators
to provide a resource where advances in basic scientific knowledge may be translated into methods for improved patient care'
Administration is primarily the responsibility of the Director of the Clinical Research Center (CRC). This is the person with whom the National Institute of Health (NIH) communicates.
The CRC Director selects an Institutional Advisory Committee which is charged with the overall development of the CRC as a resource. Also assisting in the administration of the CRC are the Director of the Core Laboratory, nursing administrators, a Research Dietitian and an Administrative Coordinator. These individuals are responsible for coordinating the patient care, research, dietary and nursing avtivities so that the CRC functions as an integrated unit.
The CRC itself is primarily devoted to research efforts but also supports patient care activities. Currently the CRC is located in two general areas of the hospital of the University of Colorado Health Sciences Center (UCHSC). Pediatric in-patients are housed on the third floor of the UCHSC hospital and the pediatric laboratories are on the third floor bridge over Ninth Avenue. The adult CRC is on the west wing of the UCHSC hospital inclusive of an out-patient clinic, a ward housing in-patients, adult laboratories, the metabolic diet kitchen,
CLINFO computer facilities, and administrative offices.
As of December 1, 1984, the CRC has been in
existence for 24 consecutive years and is one of the largest and best equipped of the 72 NIH sponsored units in existence nationally. The types of clinical investigation performed on the CRC involve a wide spectrum of pharmalogical, physiological and disease-oriented research, Types of studies include endocrine-related disorders, oncology, renal and hepatic disease, diseases of the immune system, rheumatological, dermatological and neurological disorders, and cardiac diseases. This wide range of investigative efforts results in many publications annually in national and international journals. In addition, this information is presented throughout the year at many different national and international conferences.
There are currently 57 active investigators who use 158 different protocols. Research protocols are discussed monthly at CRC Grand Rounds during which the principle investigator, nursing staff, laboratory personnel, and dietary personnel present points of view and experience with a given protocol.
Residents participate in research activities on the CRC throughout the year during which they actively collaborate with principle investigators.
The in-patient unit currently consists of seven semi-private rooms allowing a maximun of fourteen patients at one time. The nurse : patient ratio
varies depending on the requirements of each research protocol and/or patient.
Before a patient takes part in a clinical research study, the physician must fully explain the study, outlining potential risks and benefits. An informed consent must be signed by the patient, indicating an understanding of and agreement to pat-ticipate in the study. The Advisory Committee reviews the scientific merit of each project and insures its safety. The identity of patients is kept confidential (in subsequent investigative documentation and medical lectures) and the patient has the right to withdraw from a study at any time.
The nursing staff functions under the concept of primary care. Each nurse is responsible for coordinating her patients' care with the other health care professionals. She also Is the primary protocol coordinator for specific research studies. The nurse works closely with the investigator and facilitates the smooth functioning of the studies.
The out-patient department is comprised of four exam rooms, one treatment room, and a staff conference room. Approximately 6,000 patients are seen annually and this figure continues to grow. Regular clinic hours are scheduled Monday through Friday. Arrangements can be made for appointments in the evening and/or weekends without nursing support
Nurses from the in-patient unit also staff the out-patient clinic, which provides continuity of care. Patients range from ambulatory volunteers to chronically ill, wheelchair bound individuals.
All have differing needs.
Many tests and procedures are performed in the clinic: oral glucose tolerance tests, bone marrow biopsies, and excisional biopsies, to name a few. Patient/family teaching is provided on an on-going basis and includes self administration of injections, dietary compliance, and emotional support.
The metabolic kitchen is directed by a research dietitian and is designed to provide careful calculated diets for designated research studies.
Diets are calculated to meet requirements specified by the investigator. One diet presently being used is a preparation which contains specific levels of carbohydrate, protein, and fat developed for use in an endocrine protocol. Daily consistency provided continuity, which allows data interpretation at a more detailed level. All in-house patients are served by the metabolic kitchen, including those only requiring everyday balanced meals. The research dietitian counsels special diet patients in her office or in their room, adjusting a difficult diet
to their tastes as much as possible. At times outpatients receive boxed meals prepared by the metabolic kitchen for consumption at the patients' homes. Visits are made following each meal to each in-patient by the Research Dietitian or another dietary staff member to discuss meals. In-patients dine in their rooms as no dining room is provided.
The kitchen is staffed daily from 6 a.m. to about 6 p.m. throughout the week.
The CORE Laboratory for the Clinical Research Center consists of Hematology, Chemistry and Special Assay Sections. A pediatric microchemistry laboratory is necessary to deal with the smaller quantity of blood taken from children for testing. Although many of the tests performed in the chemistry and hematology sections are not unique to the Core laboratory, the laboratory's special function is to provide an arena for direct interactions between laboratory technical personnel and the investigators who are conducting research studies on the unit. In addition, the special assay section is able to respond to the needs of investigators by developing new techniques that compliment the research proposals.
CLINFO is a data management and retrieval system specially designed for clinical investi-
gators and is under the control of the CRC. Currently being set up, the system will be directed by a systems manager. It will consist of a central processing unit and terminals.
The proposed site for the expanded Clinical Research Center is located on the campus of the University of Colorado Health Sciences Center (UCHSC). UCHSC is located within the Rocky Mountain Region, in the East Central Denver area. See Figures 1-5. A little southeast of the downtown area, the UCHSC campus is divided at its west side by Colorado Boulevard, a major north-south artery connecting to the area's interstate routes. The proposed site of the Clinical Research Center is an 50,400 square foot area at the extreme north side of the UCHSC campus on 11th Avenue, directly north of the UCHSC hospital between the Colorado Department of Health to the east and the School of Eentistry to the north. The proposed building site is currently grade parking. To replace this parking an enlargement of the parking facilities directly west of the Dental School is proposed. This auxiliary site is 42,000 square feet.
The legal description of the site within which the CRC is to be located is: PT NyiWLjSW',
SEC 6 4 67 LYING U OF WLI BELLAIRE ST EXTD AS IN PLAT OF BELLEVUE PARK EXC PTNS FOR COLORADO BLVD ON U & 9th AV ON S & EXC N 30 FT OF E 870 FT OF
W 920 FT
UCHSC Campus Map
CONTOUR INTERVAL I FOOT SCALE I INCH -80 FELT
In 1924 the School of Medicine and the University Hospitals moved from the Boulder campus to the present campus which was then a treeless plain at the eastern edge of Denver's suburban development. The new campus consisted of one five-story building that included the School of Medicine at one end and Colorado General Hospital at the other. A separate three-story facility for Colorado Psychiatric Hospital, a three-story nurses' residence, and a power house with an attached laundry completed the campus. The surrounding area was unoccupied except for a few one-story residences scattered throughout the platted fields. All campus buildings were similar in design and detail and were constructed with a concrete frame faced with red brick and concrete so that a visually cohesive campus unit was established. The campus buildings were designed around two major axes in the tradition of college campuses of the day.
By 1965 a steady flow of additions and modifications during the previous 40 years and the recent construction of a new Colorado General Hospital had transformed the campus into a group of buildings that appeared different from the original concept. The postwar expansion, particularly in research and educational programs, led to the need for greatly expanded
facilities and the modernization and remodeling of existing facilities. Between 1925 and 1960 major projects included the expansion of what are now the School of Medicine and the Office Annex, and the construction of the library, the out-patient wing of Colorado Psychiatric Hospital, and the Belle Bonfils Memorial Blood Center. Construction of a new 431-bed Colorado Genreal Hospital began in 1961 and was completed in 1965. The library, power plant, and laundry were also expanded in the early 1960's.
The many buildings and additions logically expanded the educational, health care, and research functions, but considerable visual changes were made. Although the theme of the original red brick was continued in many of the buildings and additions, building clustering and details changed so that the campus lost some of its design integrity. With the conduction of the new Colorado General Hospital, an entirely new campus area was begun north of Ninth Avenue. Fortunately, the Research Bridge over Ninth Avenue made a strong visual tie between the two campus areas despite their many architectural differences.
During the ten years that followed the completion of the University of Colorado Medical Center's major campus expansion in 1965, several construction projects were undertaken with the framework of extensive ap-provel mechanisms and careful architectural control so that greater visual unity was developed. The major
projects completed during the ten-year period were the JFK Child Development Center, remodeling of the Schools of Medicine and Nursing, an addition to the Webb-Waring Lung Institute, construction of the parking garage, and an addition to the Arthritis Laboratory.
In 1981 the name of University of Colorado Medical Center was changed to its present title of University of Colorado Health Sciences Center.
More recent additions include an addition to the School of Nursing and Barbara Davis Center for the study of Childhood Diabetes addition to the hospital .
The land contours and surrounding buildings of the site for the Clinical Research Center are shown in Figure 6. Currently an asphalt parking lot, the grade slopes gently downward from the south to the north at about 4.32, allowing for drainage to the north.
A distant westerly view to the mountains exists, partially blocked by the two-story Dental School. Other views are mainly short distance views to nearby buildings.
Traffic noises are towards 11th Avenue to the north, and University Hospital emergency drive to the east.
No vegetation exists on the site.
Solar access is available, with the site shaded only very early in the morning and partially during the winter from the south.
School of Dentistry
Extending about 2/3 the west length of the site is the School of Dentistry, which is attached to the north side of the University Hospital. The two-story structure is designed to support one additional floor, with no immediate plans for expansion. The basement and first floor of the building have the same white brick as the University Hospital to which it is attached. Window arrangements are different than those of the University Hospital but compatible with the hospital's two-story clinic base.
Extending the full length of the south side of the site is the east wing of University Hospital. A two-story white brick and grey granite platform supports the six-story tower faced in dark glass with moveable vertical alluminum louvers.
Directly to the east of the site is a ramp leading to the emergency entrance of Universtiy Hospital. Further to the east is a parking area servicing the Colorado Department of Public Health, which is then directly to the east and extending the full length of the east side of the site. The Colorado Department of Public Health is a four-story red brick building with stone inlay and blue trim. Its entrance faces the site.
To the north of the site are the Cadillac
Colorado Department of Public Health
Condominiums, an eight story beige, brick structure with brown trim facing Ash Street.
To the southeast of the site is a privately owned grade level parking lot, covering a half city block.
NEIGHBORHOOD LAND USE
The land to the north of the UCHSC campus is predominately multi-family housing of medium to high density, but the north-eastern portion is gradually changing to health-related institutional use. See Figure 7. The streets are partially shaded by trees, with well maintained grassed areas between the buildings and the street.
Property east of the campus and north of Ninth Avenue is completely occupied by health institutions. It is well maintained but is busy with traffic and pedestrians. Property to the east of the campus and south of Ninth Avenue is a mixture of medium to high density, multi-family housing and health-oriented commercial space. Within four blocks east of the campus, housing shifts from medium or high-rise, multi-family housing to low-rise, multi-family and eventually single-family dwellings. All of the newer facilities are well maintained, but the area is transitional. The older age of some of the buildings is evident.
South of the campus, the area along Eight Avenue is a commercial strip that caters to UCHSC's and the neighborhood's needs for goods and services. The strip creates a great amount of vehicular traffic and a moderate amount of pedestrian traffic. This commercial strip is backed by low-density, multi-
family housing. The property beyond the commercial strip is generally well maintained and streets from Seventh Avenue south are tree shaded. Parking restrictions limit the long-term parking of cars in parts of the area. Eighth Avenue and Sixth Avenue carry heavy amounts of vehicular traffic, but most of the other streets in this residential area carry mostly light neighborhood traffic. The apartments and residences close to Ninth Avenue are mostly rental properties. Farther south the character quickly changes into a stable area that is one of the city's fine residential neighborhoods.
The southern portion of the area west of the campus begins as a commercial strip along Colorado Boulevard and changes west of the alley into single family housing. This type of housing continues north to become the land use directly west of the campus on Harrison Street between Ninth and Tenth Avenues. The northern portion is changing from single-family dwellings to medium and high-rise, multi-family housing. The rest of the area, which is generally 50 to 75 years old, is changing too. Older owners are being replaced by new young families who find the area to be a good inner city neighborhood. Property generally is well maintained with lawns and tree-shaded streets.^
TRAFFIC PATTERNS AND PARKING
Vehicular and pedestrian traffic create several major patterns in and around the campus. See Figure 8. One of the major streets dividing the UCHSC campus is Colorado Boulevard, a major north-south arterial road that separates the western portions of the campus from the main campus. Eighth Avenue is a major artery bordering the southern edge of the campus. Clermont Street at the eastern edge, Eleventh Avenue at the northern edge, Harrison -Street at the western edge beyond Colorado Boulevard, and Ninth Avenue which penetrates the campus, complete the street system. The Regional Transportation District's buses travel on Colorado Boulevard and on Ninth Avenue. They stop at UCHSC and connect to most portions of the metropolitan area.
Parking lots are scattered throughout the campus. See Figure 9. The parking garage at Ninth Avenue and Clermont Street creates heavy traffic patterns during arrival and departure hours. The visitors' parking lot east of University Hospital cannot accomodate all who would like to use it, and traffic congestion develops during the day at its Ninth Avenue entrance. Additional parking spaces to accomodate hospital patients and visitors are available in the parking garage.
UCHSC is located within a larger "East Denver
Health Complex" that includes the Veterans Administration Hospital, Rose Medical Center, Rocky Mountain Hospital, and the Colorado Department of Health. The complex covers approximately twenty square blocks. UCHSC's parking situation is interrelated with the parking requirements and the availability of parking spaces within and surrounding the complex. Consequently, two distinct categories of off-campus parking areas exist near the UCHSC campusthe parking lots and on-street parking within the complex but not part of the UCHSC campus, and the on-street parking in the neighborhoods surrounding the complex. The location of the off-campus parking areas within the complex are shown in Figure 10.
OFF-CAMPUS PARKING AREAS WITHIN THE EAST DENVER HEALTH COMPLEX
naoiaa Shortterm Restricted
of Health E-4 iiiiiiiiiiinu Unrestricted
ON-CAMPUS PARKING AREAS
Public Parking, Inc. Commercial Lot
LOCATIONS, SIZES, AND CAPACITIES OF UCMC ON-CAMPUS PARKING AREAS AND OFF-CAMPUS PARKING AREAS WITHIN THE EAST DENVER HEALTH COMPLEX
Osteopathic Hosp. K-L, 5-6
Rose Medical Center I-J. 3-4-5
--------------- -------------------2------------- Figure 9
The "Denver Formation" of blue shale and clay, considered to be the best available base, is found between 25 and 30 feet below the surface. The blue shale base, although expansive, is more than adequate to support any size and type of facility.
The high water table, however, generally makes habitable space very costly more than one level below finished grade. Two university buildings adjacent to the site have Type I Foundations with caissons, suggesting the same foundation structure for this site. The allowable point bearing of 15,000 psi will be used, with 1,500 psi of side shear.
The next four site plans, Figures 11 to 14, show campus utilities. While distribution systems meet existing requirements, future developments may require increases in capacity and line extensions. Capacity and use of some of UCHSC's physical resources are listed in Table 4.
Steam and Chilled Water
Steam and chilled water originate in the power plant where steam is generated with gas or oil-fired boilers. The five steam boilers are normally gas-fired but are on an interruptible basis to take advantage of lower gas rates. During cold weather the Public Service Company of Colorado shuts the gas off, so the boilers are switched to oil. Both high and low-pressure steam are distributed throughout the campus by mains in utility tunnels and branches to all heating units, kitchens, autoclaves, the laundry, and to minor users. The steam lines are currently adequate to supply the campus needs, but the condensate-return lines are inadequate to accommodate the demand during cold weather. Condensate is now dumped into the sewer, a waste of water and heat.
Steam is passed through centrifugal chillers to make chilled water. Condensate is then returned to the power plant through a parallel system. Fifty-
five-degree chilled water is distributed to all air handling units through pipes that are either in utility tunnels or buried. At the air handling units the chilled water is converted to chilled air and distributed to building spaces. The air temperature is modified within the air distribution systems.
Fire Lines, Gas, and Water Figure 12 shows the mains for natural gas and for water to extinguish fires and for general use. While the potable water used on campus is furnished by the Denver Water Board system, a large well with safe water exists on campus. It is sometimes used during breakdowns in the Denver system and is always used for the laundry and power plant.
Utilities Gas, Water, Fire Line
Storm Sewer and Sanitary Sewer UCHSC disposes of its wastes in five different ways. Surface water from roofs, grounds, drives, and other areas is deposited in the city storm sewers which conducts it to rivers and streams. Waste water from ail interior drains other than basement floor drains and sumps is directed into city sanitary sewers. Dilution of chemicals and filtering of some solids, such as plaster from Dentistry, are accomplished before waste water is discharged into the city sewer lines. These sanitary sewer lines go to the metropolitan area treatment plant, and then the sewage is discharged into the river. Medical waste is collected and transported to the medical waste incinerator adjacent to the power plant where it is incinerated at the proper high temperature. General burnable waste is transported to the regular UCHSC incinerator south of the power plant and incinerated. All other solid waste is either transported to the city dump by university vehicle or by private contractor.
Electrical Distribution and Telephone Most of the electricity for UCHSC is purchased from the Public Service Company of Colorado, but some is generated by steam turbines in the power plant. Telephone service is provided by the Mountain Bell Telephone Company. Although a central switchboard is used, all phones can be reached by direct dial through the "Centrex System". The main switch gear room is in the basement of the School of Medicine. Although this room is currently full
of telephone equipment, new minaturized equipment
will increase the room's capacity.
LOCATION OF STRUCTURE
5 accessory 20
side setback 7'6"
all other structures
5' if facing side
10' if facing front
ZONING PERMITTED STRUCTURES
The site is zoned R-3 with hospitals as a permitted use. Zoning restrictions are described below.
The zone lot shall not be less than 50 feet wide at front setback and shall contain not less than 6,000 square feet.
LOCATION OF STRUCTURE
Except as otherwise hereinafter provided, the space resulting from the following setbacks shall be open and unobstructed.
The Front Setback shall be not less than ten feet from front line or five feet for structures which face on either longer dimension detached accessory structure (except garages) must be on rear k of interior zone lot. Resulting space shall be used for landscaping and access ways but not parking of vehicles.
If no ally abuts the rear line of zone lot, all detatched accessory structures and fixtures shall be set in a distance of not less than five feet and all other structures
48 inches in height may be erected on any part of the zone lot between the front line of the zone lot and the front setback line for structures and on any other part of the zone lot may be erected to a height of not to exceed 72 inches. Retaining walls abutting public rights-of-way may be built to any height.
MAXIMUM GROSS FLOOR AREA IN STRUCTURE
The maximum gross f^oor area shall not be greater than three times the area of the zone lot on which the structures are located.
Sited on university land, the properyt line of interest is that facing 11th Avenue. Setbacks and other measurements will be taken from 11th Avenue property lines.
DENVER, COLORADO LATTITUDE: 39 45N ELEVATION: 5283 FT.
The climate of the Denver metropolitan area is characterized by low relative humidity, light to moderate winds, mild temperatures, and light precipitation. The average monthly temperature varies from 39.9F in January to 73.0 in July. Occasional Chinook winds help to moderate winter temperatures. Annual snowfall avarages 62 inches but persistent snow-cover is unusual. March is typically the snowiest month. Precipitation averages about 15.5 inches per year. Little precipitation falls during the winter. More than 50 percent of the annual precipitation occurs from April through July. Climate characteristics are tabulated in Table 2.
J F M A M J J A S 0 N D Y
AIR TEMPERATURE F
Monthly Mean Max 43.5 46.2 50.1 61.0 70.3 80.1 87.4 85.8 77.7 66.8 53.3 46.2 64.0
Monthly Mean Min 16.2 19.4 23.8 33.9 43.6 51.9 58.6 57.4 47.8 37.2 25.4 18.9 36.2
Monthly Mean 29.9 32.8 37.0 47.5 57.0 66.0 73.0 71.6 62.8 52.0 39.4 32.6 50.1
RELATIVE HUMIDITY %
Monthly Mean Max a.m. 63 65 67 67 70 69 68 68 68 64 68 64 66.8
Monthly Mean Min p.m. 45 42 40 34 38 35 34 35 34 35 44 44 38.3
Average 54.0 53.5 53.5 50.5 54.0 52.0 51.0 51.5 51.0 49.5 56.0 54.0 52.5
Monthly Max 1.44 1.66 2.89 4.17 7.31 4.69 6.41 4.47 4.67 4.17 2.97 2.84 7.31
Monthly Min 0.01 0.01 0.13 0.03 0.06 0.10 0.17 0.06 T 0.05 0.01 0.04 T
Normal 0.61 0.67 1.21 1.93 2.64 1.93 1.78 1.29 1.13 1.13 0.76 0.43
Mean Wind Speed mph 9.2 9.4 10.1 10.4 9.6 9.2 8.5 8.2 8.2 8.2 8.7 9.0 9.1
Prevailing Direction S S S S S S S S S S S S S
Max Wind Speed Recorded 53 49 53 56 43 47 56 42 47 45 48 51 56
Direction Assoc With Max N NW NW NW SW S SW SW NW NW W NE NW
PLAN AND VOLUME CHARACTERISTICS
Climatic design considerations should include the following:
EARLY BUILDING RESPONSES
Buildings should have flexible perimeter spaces, such as porches screened in summer, glazed in winter. Some underground space should be included for winter food storage, summer escape from heat.
DESIRABLE SITE CHARACTERISTICS
Protect from winter storm winds, but retain access to both summer breeze and winter sun. Shading in summer both to east and west, with deciduous trees over roofs. Climate is dry enough for underground spaces but is also able to support summer plants. BUILDING LOCATION ON SITE
Use outdoor space to south and north for control of winter access to sun and facilitate summer passage of breezes. Use a variety of outdoor space orientations for seasonal outdoor activities. Make use of underground space. Locate to provide summer shade east, west, and above.
Summer solar gain is more than twice that of east or west wall. Winter solar grain is about half that of south wall. Attics are helpful in winter, but must be well ventilated in summer to lose heat in high humidity areas. Use a moderately steep pitch
to south for optimum winter solar gain.
Skylights should be insulated at night in winter and shaded against direct summer sun. Avoid snow accumulations. Skylights that can open can aid summer ventilation.
Summer: Shading of east and west walls is critical. (South walls gain about two-thirds that of east and west walls.)
Winter: South wall is clearly best for solar gain, with east or west wall gain about one-third that of south wall. Potential freeze-thaw and glare problems exist on south walls, though less severe than in cool regions.
Wall openings should be medium in size and be about 25-40% of wall area.
Prevailing Winds, Sun
Facility Adjacency Study
ADJACENCY STUDY ADMISSIONS
ENTRIES AND LOBBIES
ENTRY LOBBIES 1792
ABOVE GROUND LOBBIES 2048
The admission procedure to the Clinical Research Center is as follows: 1) Patients present themselves to the Admissions Office, as records for CRC patients are held in the main records of the University Hospital. The Admissions Office calls the CRC ward for a room assignment. This takes about a half hour. 2) The patient arrives at the CRC and presents his/her admissions materials to the ward clerk. 3) Upon checkout the patient is electronically checked out by the ward clerk.
Patient admission would be facilitated by storing CRC patient records within the CRC. This would require a file room located near the reception area for the CRC.
Currently no reception area exists at the CRC.
A reception area, located near the main entry to the CRC should be immediately apparent and welcoming. Patients should arrive as relaxed as possible. At the reception area confidential conversations may take place between patients and the receptionist. This should be provided for.
A waiting area should be provided for the lobby area of the main entry of the CRC. This space needs to provide for people awaiting admissions, people waiting for patients and friends visiting patients
AOJACENCY STUDY NURSING UNIT
In this case, the nursing unit is inclusive of patient rooms, the nursing station, the doctors' station, clean and dirty utility rooms, medication room, offices and storage.
The current ward layout is a singly loaded corridor with doctors' and nurses' stations and offices located at one end. Auxiliary functions are dispersed. Because the nursing station is located at one end of the row of patient rooms, it is common practice to put patients requiring maximum care in the rooms nearest the nursing station. The size and shape of the nursing unit should depend on 1) the type of patient population to be served 2) the system used to deliver nursing care and 3) the concept of care.10 At the present CRC the type of patient population varies from healthy and ambulatory requiring minimal care, to bed-ridden and requiring extensive care. The system currently used is of primary care where each nurse is responsible for a select patient or patients and coordinating the patients' care with the other health care professionals. Additional guidelines for ward design say that the entrance to every ward should be capable of strict control. When evening and night staffing is at a minimum, this has been found to be a must. No ward should be used as a principle means of access to
NURSING UNITS PATIENT ROOMS
10 0 307 5526
2 0 400 800
2 0 304 768
18 0 307 5526
2 384 768
1 0 195 195
2 0 96 192
I 0 90 90
2 0 96 192
1 0 60 60
2 0 320 640
1 0 112 112
2 0 320 640
1 0 112 112
2 0 154 308
1 0 143 143
2 0 130 260
1 0 96 96
OFFICES HEAD NURSE
2 0 104 208
1 0 88 88
ASST. HEAD NURSE
1 0 104 104
PATIENT LOUNGE 2 0 307 614
EXERCISE ROOM 307
GAME ROOM 307
' 2 0 216 432
1 0 317 317
another. It is felt by the staff that a clustered ward would save legwork.
The commonly used facilities located elsewhere in the hospital requiring patients to leave the ward include X-ray (located on the second floor), Nuclear Medicine (located in the basement), and Pulmonary Function (located on the sixth floor). Arrangements need to be made to transport patients to these locations as duplication of these facilities would prove costly and inefficient. The use of these facilities requires a link to University Hospital.
Activities taking place in the nursing station include, reviewing charts and procedures, making notes, making phone calls, taking phone calls, and writing in patient charts. Many of the same things take place in the doctors' station with the addition of reading x-rays. It is found, however, that the doctors prefer the nursing station over their own. Because of this, the current nursing station of 100 square feet is too small. Current staffing, for the care of seven double rooms, can include four to five nurses per shift.
Currently two offices are available for the nursing unit. One is used by the ward clerk and one by the head nurse. At current staffing, an additional office is needed for the assistant head nurse.
Currently most patient rooms are twelve feet by 22 feet and 164 square feet in area. They each have a toilet room with a sink and toilet and a closet covering eight square feet of floor space.
One shower and one bath are shared by all patients on the ward. Each room has two beds and both are generally occupied. When a patient requires isolation, the second bed must remain unoccupied. No single rooms exist, nor does a laminar flow chamber or similar room, which could be put to use.
NIH recommendations include a minimum of 100 square feet of floor space per patient exclusive of bathroom and wardrobe, and that at least half of the research patients be housed in private rooms. Additional room size guidelines are listed in Facility Notes.
Because of the bulky equipment currently used in some studies performed in patient rooms, it has been found that the largest room, of 308 square feet, is inadequate in size as a double room, but would be adequate as a single room. Several rooms should provide this kind of space. The toilet rooms are adequate, with the exception of the sink size. Shared shower and bath facilities are found to be acceptable although showers in each room would prove to be a great convenience to the patient. The closets are inadequate.
Nursing amenities in the patient rooms would include a blood pressure cuff mounted in each room to do away with the necessity of rolling around portable cuffs. Additionally, more shelf space is needed to store equipment.
Doors to patient rooms must be sufficiently large to permit passibility of a 3'8 bed. The window sill must be three feet or less from the floor, and children should be considered when locating windows. Although literature suggests carpeting as a floor covering of choice, the blood drawing that takes place on the Adult CRC ward has proved to be quite messy and an easily cleaned floor surface would prove superior in these areas. Pediatric areas, however, should provide for floor play areas and carpeting should be used in these areas. Pleasant colors should be used on the walls and ceilings.
DIRTY UTILITY ROOM
This room is used for cleaning and emptying, for specimen storage in refrigerators and freezers, and for storage of related equipment. Currently, this is an 80 square foot area with two entries and contains a counter with a double sink, a large refrig-erator/freezer, a second -70 freezer used by the laboratory, shelves, cabinets and a large flushable utility stool. It has been found to be adequate.
CLEAN UTILITY ROOM
The clean utility room is used for equipment
preparation and for regularly used equipment storage. It contains a sink and counter, cabinets, several carts and a patient scale. At 100 square feet, it has been found to be adequate.
The medication room is used for drug preparation and storage. It contains counter space, a sink and cabinets. At 65 square feet, it has also been found to be adequate.
The storage room contains office supplies, bulky items and equipment. At 100 square feet, many items clutter the floor and additional space is required. The clean linen cart is located in a niche off the corridor.
The nursing staff gives report, three times daily when shifts change, to discuss patients and procedures. Currently this is done in the very small staff lounge. This is an inappropriate space for this. Their report area needs to accomodate about six people. It could double as a doctor/pa-tient and family conference room.
Currently no patient lounge exists. As a result patients often do not dress or leave their rooms because there is little incentive to do so.
No dining facility accentuates this. Patient vis-
itors often sit in the halls. Accomodations need to be made to accomodate patients and visitors. DINING ROOM
Currently no patient dining room exists. It is felt that such a facility would encourage social interactions and would also encourage patients to dress. This would benefit the patients' well being and would also be amenable to both the kitchen and nursing staff.
Currently the nursing service has available various devices for transporting materials and information. Pneumatic tubes are used for chart transport and occasionally drug transport. Phones are located throughout the nursing area and in patient rooms. Patient call lights are used to summon the attending nurse to the patient's room. There is also an emergency phone for monitored telemetry patients, and a buzz for the surrounding area in event of emergency.
ADJACENCY STUDY OUT-PATIENT CLINIC
WAITING ROOMS 2 G> 556 1112
NURSING STATIONS 2 P 96 192
DOCTORS STATIONS 2 G> 40 30
OFFICE 2 0 90 100
EXAM ROOMS 12 0 96 1152
2 0 120 240
2 P 96 192
STORAGE 2 @ 90 180
Currently the out-patient clinic, located on the eighth floor, covers about 275 square feet and includes waiting and reception areas, four exam rooms, two treatment rooms, and a conference room. Located in another facility, the ground floor would be preferred. Out-patients should not have to pass through any other department.
Although confidential conversations may occur between the receptionist and patients, the open access to the reception area has not been found to be a problem. The internal portion of the reception area is also used for temportary storage of patients' records. The reception area needs to be visible to the waiting area and should be adjacent to record storage. There is need for an additional exam room at the present patient population size.
It is procedure to schedule clinic sessions involving a certain disease in large blocks of time. For instance, the melanoma clinic is scheduled on Tuesday mornings. This way the doctors involved can see all the patients involved on the same clinic visit. Patients generally receive similar procedures and similar lab work and so it has been found most convenient to schedule clinic sessions. Individual appointments are made within the time slot. Un-
scheduled walk-in or emergency visits also occur. Doctor tardiness and patients' early arrival have been known to cause the 160 square foot waiting area to be inadequate at times.
A large impersonal waiting space should be avoided. A sense of seclusion should be provided from other traffic. Waiting bays are suggested for more than five consulting rooms.
Toilets should adjoin the waiting space.
A pediatric out-patient clinic needs to be separated from an adult out-patient clinic. A play area or diversions should be provided for children. EXAM/TREATMENT ROOMS
In the exam/treatment rooms minor operative procedures are carried out. The current exam/ treatment rooms are about twelve by eleven feet and are quite adequate. It is suggested that eight feet by twelve feet is ideal for an exam room. Currently no two exam rooms are alike, as the area was remodeled from a hospital ward. Righthanded and lefthanded exam rooms exist and have not been found to be a problem, although literature suggests otherwise. Exam/treatment rooms do not require windows and should windows be provided it is suggested that they start at 36 inches off the floor so that cabinets may be put under them and patient privacy not be invaded. Further exam/treatment room requirements and suggestions are listed in
The conference room of the CRC out-patient clinic is primarily used by doctors to review patient records, discussion, to make phone calls, and for doctors' review of blood smears. A private conference room where doctors may privately talk to patients and their families is not currently provided. It is suggested that a space to accomodate four or five persons grouped around a coffee table is most suitable and would be a great asset.
Another adjacency consideration in out-patient clinic location is laboratory access. Although most out-patient laboratory results are not urgent, several clinics require as soon as possible or stat results. An example is the case of the leukemia clinic where each hematology specimen is hand delivered to the laboratory and each result is hand delivered to the doctor as the patient waits. Much leg work is involved. It is also beneficial to have more than one entry to the out-patient clinic to separate patient and staff circulation.
ADJACENCY STUDY LABORATORY
LABORATORY ASSAY ROOMS
1 0 624 624
1 & 576 576
1 @ 792 792
LAB DIRECTOR 120
LAB SUPERVISOR 96
The activities of the laboratory include routine lab analysis and research and development for the CRC and as support for other centers.
Current facilities include five rooms, each of about 220 square feet, where analyses take place, and supporting areas for dishwashing, storage, and specimen storage. Vented fume hoods are provided in each of the main rooms. All rooms also have sinks, vacuum and air lines. Basic activities are grouped as hematology, chemistry, and special studies.
Hematology includes whole blood counts, microscopic work, tests surrounding plasma counts, and urine analysis. Probably a slight majority of ASAP and stat work required by the clinic and nursing unit takes place here. All equipment sits on the two room length counters in the room. Cabinets are located beneath the counters and shelves above. It is felt that this is an adequate area and could support additional work and an additional staff member.
Chemistry includes mainly serum testing, but also urine chemistry testing, and the majority of specimen processing. Lab equipment is located on the two room length counters and a floor model centrifuge is also located in the room. Shelves are located above the counters and cabinets below. The
space is adequate for up to three staff members.
Special assay rooms contain laboratory equipment in much the same manner as the above described rooms. One room contains two large floor model radioactivity counters. Three desks and five refrigerators are dispersed throughout the rooms. Small amounts of low grade radioactive materials, caustic and hazardous chemicals are used in the lab. Waste disposal is handled through radiation safety located in the basement. Storage of radioactive chemicals exists throughout the laboratory in lead containers.
It is felt that the laboratory is capable of handling the additional work of pediatric microchemistry space-wise. An alternative to the present situation of individual rooms to house the activities of the laboratory is an open lab layout. The laboratory staff has mixed feelings about this.
Presently an active lab room is used for office space by the laboratory supervisor. A regular office would be preferred. The lab director maintains an office in the CRC office area. It may be better located in the laboratory area.
Currently storage is provided for the laboratory in several areas. A powder room is used for dry chemical storage. Additionally old records and some equipment are stored there. Hazardous chemicals are stored
in an explosion proof cabinet in the dish washing area. Supplies, some equipment and miscellaneous items are stored in a storage room. A walk-in refrigerator houses hazardous chemicals that must be stored cold, reagents, and specimens. In addition to storage on the floor, unused equipment is stored remotely in the basement of the Medical School. More storage room is required to alleviate items on the floors of storage rooms as is presently done. DISHWASHING
A dishwashing room services the laboratory.
It contains a sink drying area, a dishwasher and drying oven. The still, used for production of distilled water is also in this area.
Specimens received within the CRC are presently hand delivered to either chemistry or hematology rooms by a member of the nursing staff. Specimen collection areas are located in both rooms. Although much leg work is involved, mainly by the nursing staff, it is believed that direct communication between the nursing staff and laboratory personnel increases staff contact in a beneficial way for the betterment of staff cohesiveness and toward appropriate and timely specimen handling.
ADJACENCY STUDY DIETARY
The activities within the dietary department include precise and complicated dietary preparations, independent dietetic research by dietitians, and research training for dietetic interns and graduate dietitians. Facilities included with the Dietary Department are a kitchen, storage areas, and offices. KITCHEN
The kitchen currently services fourteen inpatients and four out-patients, and was designed to provide food service for a maximum of 22 beds. The situation, however, is a crowded one, and food service to an increased number of beds would be impossible. At 440 square feet, the kitchen is within the NIH guidelines of a minimum of 240 square feet for food preparation based on six metabolic diet patients and four to ten non-metabolic patients.
The present layout of the kitchen is found inadequate in its confusion of food preparation areas and garbage disposal areas. Food preparation areas, including washing, food handling, cooking, and tray set-up activities should be separated from clean-up of returned food and dishwashing activities. Sinks should be located in both areas and should be equipped with garbage disposers. Clean dishes should be stored with easy access to both the tray set-up area and the dishwasher.
The balance area, used to weigh components of formulas, should be equipped with a sink. In addition, a separate is required for handwashing.
The kitchen is equipped with an oven, a broiler, a microwave, and a stove with burners. Kitchen staff suggestions include consideration to shorter people in location of broilers, a grill rather than burners for a larger cooking surface, and a niche for the microwave that is located on a cart blocking a passageway. They would also like a view to the outside to rid themselves of the claustrophobic, cut-off feeling they currently have.
Storage areas for the kitchen are currently very inadequate. At the present time most food is ordered and supplied by the main hospital kitchen located in the basement. Small items are also purchased by the kitchen staff. Storage areas are located in scattered areas surrounding the kitchen. Presently eight freezers (one is a four-door) and four refrigerators (one is a four-door) are used.
Dry food storage covers about 36 square feet of floor space. It is estimated that about one and a half times as much storage space is needed at the kitchen's current capacity. The staff feels a walk-in freezer with an exterior walk-in refrigerator would be a better arrangement than refrigerators and freezers in the hallway, and consolidation would be
Currently meals are delivered on carts to patient rooms. Dietary is very favorable towards a dining room to facilitate their functioning and feel it would also benefit the patient. It is the desire, considering health risks associated with food preparation, that the kitchen staff not enter patient rooms.
It is considered that with a warming cart, a service elevator, and an increase in kitchen size, that another floor could be serviced by the kitchen. OFFICES
Dietary office space has been another sorely lacking area. At present, office space is required for the research dietitian and the kitchen supervisor. They presently share half of a treatment room in the out-patient clinic. As diet consults occur at the desk of the research dietitian, a separate office is much needed. It is preferable that this activity occur in the office of the research dietitian rather than a conference room because too much paper shuffling would have to take place to prepare for a meeting in another location. These offices should be adjacent to the kitchen.
ADJACENCY STUDY CLINFO
TERMINAL ROOM 264
SUPERVISOR OFFICE 132
MAIN COMPUTER 1
CLINFO is a data management and retrieval system specifically designed for clinical investigators. It is a computer facility for storage of information, with word processing capabilities. Currently three terminals and printers are being installed along with a central processing unit. In addition to main clinical investigators, it will be available to staff members of the CRC.
The area for CLINFO, still being remodeled, will consist of about 200 square feet. It is assumed that this area will be noisy. Within the CLINFO area will be the office of the CLINFO systems manager. Since the facilities are as yet untried, user input is unavailable.
ADJACENCY STUDY MAIN OFFICES
ADMINISTRATIVE ASSISTANT 132
AUXILIARY OFFICE 130
SECRETARY/ RECEPTION 210
STORAGE, XEROX, ETC. 192
CONFERENCE ROOM/ LIBRARY 567
The general CRC offices are presently housed on the eighth floor of University Hospital. Included in the office area are offices for the Director, the Administrative Assistant, the Core Lab Director, the Secretary, and a room for the xerox rachine, storage, files, a word processing unit, and a billing terminal.
Rearrangement of these offices is felt to be needed, with possible relocation of the Core Lab Director and an additional office for another secretary, social worker, or investigator. The storage facilities are inadequate and the printer for the computer unit has been found to be quite noisy.
ADJACENCY STUDY AUXILIARY
HOUSEKEEPKEEPING UTILITY CLOSETS
3 0 128 384
1 0 32 32
STORAGE 2 0 96 192
GIFT SHOP 696
TOILET ROOMS 2 0 120 6 0 96 2 0 42 4 0 221
Storage and utility areas need to be made available for housekeeping. These should include ample space for vacuums, mops, and waste facilities. A mop sink should be included and shelves for supplies.
Rest rooms need to be available to staff and should be separated from patient rest rooms.
The staff lounge is currently a converted office. Inadequately small, not everyone who may wish to use it is able to do so.
No library exists for the CRC. Books that once lined the walls of the conference room have been dispersed. Resource materials should be more available, although Dennison Library across the street, has extensive medical journals and books. Availabli1ity of reading material of interest to patients would be readily accepted.
No conference room exists for the CRC since the current director took over that space for his office. There is a need for a conference room as
meetings take place in precarious spaces. The conference room should accomodate meetings of Up to fifteen people.
ENTRIES AND LOBBIES NURSING STATIONS
ENTRY LOBBIES 1792 1 0 384
RECEPTION 256 1 0 195
ABOVE GROUND LOBBIES 2048 DOCTORS' STATIONS
BRIDGE 896 1 0 96
ADMISSIONS 4992 SF 1 0 90 MED ROOM 1 0 96
RECORD STORAGE 576 1 0 60
RECEPTION 120 CLEAN UTILITY
OFFICE 88 1 0 320
WAITING 384 1 0 112
ADMINISTRATION 1168 SF DITRY UTILITY 1 0 320 1 0 112
DIRECTOR 210 CONFERENCE ROOMS
ADMINISTRATIVE ASSISTANT 182 1 0 154
AUXILIARY OFFICE 180 1 0 143
SECRETARY/ RECEPTION 210 STAFF LOUNGES
STORAGE, XEROX, ETC. 192 1 0 130
974 SF 1 0 96 OFFICES
CONFERENCE ROOM/ LIBRARY 567 HEAD NURSE
DIETARY 567 SF 1 0 104 1 0 88 ASST. HEAD NURSE
KITCHEN 1952 1 0 104
OFFICE 96 STORAGE
2048 SF 1 0 216 1 0 317
DINING ROOM 1928 PATIENT LOUNGE
ADULT NURSING UNITS PATIENT ROOMS 1928 SF EXERCISE ROOM ADOLESCENT NURSING UNIT
18 O 307 5526 PATIENT ROOMS
2 0 400 800 18 0 307
2 0 384 768 NURSING STATION DOCTORS' STATION
MED ROOM 96
CLEAN UTILITY 320
CONFERENCE ROOM 154
STAFF LOUNGE 130
HEAD NURSE 104
ASST. HEAD NURSE 104
PATIENT LOUNGE 307
EXERCISE ROOM 307
WAITING ROOMS 2 0 556 1112
NURSING STATIONS 2 0 96 192
DOCTORS' STATIONS 2 0 40 -80
OFFICE 2 0 90 180
EXAM ROOMS 12 0 96 1152
2 0 120 240
2 0 96 192
STORAGE 2 0 90 180
LABORATORY ASSAY ROOMS
1 0 624 624
1 0 576 576
1 0 792 792
LAB DIRECTOR 120
LAB SUPERVISOR 96
TERMINAL ROOM SUPERVISOR OFFICE MAIN COMPUTER
HOUSEKEEPING UTILITY CLOSETS 3 0 128 1 0 32
STORAGE 2 0 96
TOILET ROOMS 2 0 120 6 0 96 2 0 42 4 0 221
25 % CIRCULATION TOTAL
GARAGE LEVEL MECHANICAL STORAGE PARKING
608 SF 696 SF 264 SF
40930 SF 10233 SF 51163 SF
Confidential conversations may take place between patients & receptionist
Reception should be immediately apparent & welcoming
Patients should arrive as relaxed as possible
A large & impersonal waiting space should be avoided & should provide a sense of seclusion from other traffic; could be separated into bays if more than 5 consulting rooms (appointment system lessens this)
Must accomodate at least 1 hr of patients
SOURCE DESIGN SUGGESTIONS
Cox & Groves
SPACE ACTIVITY GUIDELINES/ASSUhPTIONS/DATA
DIET KITCHEN Precise & complicated dietary preparations Min of 240 sq ft for food prep Min of 100 sq ft for refrigerated & canned storage; based on 6 metabolic diet patients & 4 10 non-metabolic patients
Independent research by dietitians Diet office adjacent to kitchen
Research training for dietetic interns & graduate dietitians Dining facilities help disruption of life Presently have 8 freezers (one is a 4-door), 4 refrigerators (1-4 dr) Need 1.5 times as much currently Would like walk-in freezer with exterior walk-in refrigerator Kitchen should be arranged to serve clean & dirty areas (food prep & dirty dishes/garbage) Need sinks in both plus handwashing sink separate Need more canned good storage; have about 36 sq ft (floor-up) Want microwave niche Need sink in "balance" area
Want windows cooks often "dim kitchen" for variety & watch tv
SOURCE DESIGN SUGGESTIONS
DIET KITCHEN Current patient census is 14 in & 1 out-patient (varies) Need proper office for patient consult/ office space required for research dietitian & kitchen supervisor Could not service another floor with present kitchen size; would need service elevator to do so Food comes from main kitchen (basement); small items from outside Rounds to patient rooms 3 times daily (after meals) by research dietitian or kitchen staff Want grill (flat top) instead of burners for larger area Want low broilers (too high for short people) Want disposals in all sinks--other than handwashing sinks Need more cupboard area Want kitchen personnel out of patient rooms
SOURCE DESIGN SUGGESTIONS
ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
Data management & retrieval system specially designed for clinical investigators & under control of CRC
Has systems manager & central processing unit at center & terminals located at appropriate points
NIH Group in noise isolated
area; need not be associated with other functions
SPACE ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
NURSING STATION Review charts, make notes, dictate Linearly, spokes, racetrack circular CRC
Size & shape of nursing unit depends on: 1) type of patient population to be served 2) system used to deliver nursing care 3) the concept of care II
Personal storage Need place to store purses, etc bright, cheerful, convenient II
Currently too small as doctors use it because they don't like their own area Brigitte Hermann Head Nurse
Min staffing: 3 nurses/24 hours Avg: 4.5 FTE's/shift \ II
Need more office space
SOURCE DESIGN SUGGESTIONS
Surgical dres- Requires usual facilities for sings can be at- lighting and ventilation tended to
Minor operative Supplementary exhaust from out-
procedures car- side building
ried out with
minimum risk of
Portable adjustable lamp
Lighting 100 fc on top exam table, dimming to 30 fc
Double electric outlets on "
each wal 1
Do not create right & left handed Malkin exam rooms by stacking plumbing back to back; all exam rooms should be identical
Need not have windows in exam "
Windows with mullions at 4 ft o.c. function well, permitting exam rooms to be 8 ft wide and consulting rooms along the window wall to be 12 ft wide
Windows should start at 36 in off floor so that cabinets be put under them and patient privacy not be invaded
8 ft x 12 ft is ideal for exam rooms (7'6" x 11'6" inside rooms)
WARD No ward should be used as prin-
ciple means of access to another
The entrance to every ward should be capable of strict control
Rooms grouped in clusters give privacy to patients & minimize walking; also allow nurses to observe patients more easily
Doors to fire exits equipped with alarms lest children wander
Patients will congregate at entrance hallways and around nursing stations; interest in coming & going of visitors transcends desire to watch tv
Many older patients cannot distinguish soft hues so identifying colors should be well-saturated ones
Admissions Office (30 min), they call for room assignment
Present admissions materials to ward clerk Electronically checked out by ward clerk
Cox & Groves
Clustered ward would save legwork
SPACE ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
WARD Currently position heavy-care patients near nursing station B. Hermann
Patients leave ward for x-ray, (2nd floor), Nuclear Medicine (basement), Pulmonary Function (6th floor) II
ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE
AREAS Long halls should have stops of CRC
interest along the way for children
Children need easy to clean walls "
Children should not traverse a- "
Educational displays are diversity "
and need not take health as a basic theme; lab exams & x-rays can be worthwhile exhibits
Floors should be soft & comfortable for play area
Teenagers may need own areas "
Pediatric requirements are not just spaces for small adults, nor should they be designed for parental eyes
For older children sunlight & views to outside insure a healthy relationship to environment
Adolescents need separate facilities Lindheim
If a hospital looks like a fortress, he can imagine being locked up there and reacts with fear
Hard shiny materials are chosen instead of materials that mellow with age and generate an atmosphere of
Provide recreational facilities for free time & for adult supervision of siblings
PEDIATRIC AREAS warmth; the building tells the user that he need not become involved Make the child's path pleasant, simple, and direct between family car, taxi, bus, or ambulance and nursing unit
SOURCE DESIGN SUGGESTIONS
Lindheim Provide a separate entrance for pediatric patients, as well as a separate emergency entrance and waiting area
II Connect the ped emergency area to the nursing unit by a special elevator or short corridor
Should be on ground gloor Cox & Groves
Toilets should adjoin waiting "
Out-patients should not have to "
pass through any other department
conversations between patients & receptionist
Easy access from records to con- "
Waiting A large & impersonal waiting space "
should be avoided & should provide a sense of seclusion from other traffic; could be separated into bays if more than 5 consulting rooms (appointment system lessens this)
Waiting should be visible from "
Small subsidiary waiting spaces good if consulting room is a long way from waiting area
Consideration should be given to NIH
future use of electronic devices & ample electric power and conduit runs should be provided
Should have sick & well baby rooms Malkin
ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
A good view contains information CRC
about sky, objects on a distant horizon, and near objects on ground
20 302 of window wall acceptable
Immediate surrounding of pale yellow linen may enable a better recognition of jaundice & pale blue for cyanosis than white
Window heights for children from standing and from bed heights; use adequate safety devices
It is possible given enough base space to use furniture to create atmosphere of privacy in a two-bedroom
Controlled environment, laminar NIH
flow chamber or isolation bedroom may be supported
Min of 100 sq ft of floor space/ patient; exclusive of bathroom & wardrobe
Recommend at least half of research patients be housed in private rooms
Patients in single rooms appear to CRC
become lonely and more demanding
A shelf in patients' room for pictures helps in disruption of the patient's 1 i fe
Ambulation should be encouraged
PATIENT ROOMS View to scenery or activity CRC
Pleasant colors on walls & ceilinq "
Wary of blank walls; scenic photos "
good; abstract art harmful; representational art ok
Uncluttered rooms; storage for fold- ing chairs
Doors must be sufficiently large to permit passibility of bed: 38" x 7*0"
Toilet room available to every room "
Carpeting is material of choice--not sii ppery
Must have window that can be opened without special tools (except in case of engineered smoke control system)
Window sill must be 3' or less from floor
Safety glass should be used H
Avoid hard corners to bumprounded edges or padded
TV's on a boom can be hazardous "
Lighting source on head of bed rather than above bed
SPACE ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
PATIENT ROOMS 50 sq ft for 24 day confinement CRC
150 sq ft for 60 day confinement
less than 130 sq ft per person poor "
131 215 sq ft adequate greater than 215 sq ft good
US Dept of Health:
100 sq ft singles (exclusive of toilet, closet, lockers, vestibule 80 sq ft for multi room
3'8" at end of bed for passibility
Restroom of glazed hlock is less costly than ceramic tile
Like present view B. Hermann
Like more shelves to store equipment
Sink too small "
Not enough closet space
Valuables stored in hospital safe
Problems with blood spilled in rooms "
carpet not preferred
Would be nice to have blood pressure cuff mounted
SPACE ACTIVITY GUI DELINES/ASSUMPTIONS/DATA SOURCE
LABORATORY Research & development Routine lab May provide specimen collection areas; cold rooms; and walk-in freezers NIH
analysis Support for other centers as a courtesy or Exhaust air from fume hoods should be conducted through noncorrosive ducts to building roof Malkin
collaboration Currently nurses deliver samples to appropriate rooms; takes time and legwork but increases staff contact and allows for better communication in cases of stat & asap work B. Hermann
Access to clinic & nursing unit should be easy
SPACE ACTIVITY GUI DELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
DIRTY UTILITY ROOM Emptying & cleaning Central location good B. Hermann
Freezers (specimen storage) Good place for specimen storage ll
DINING ROOM Not currently provided M. Strahan
Easier to serve out-patients "
who currently dine in the hall
Would encourage social interaction "
Presently nurses serve patients in their rooms
Provide dining rooms 1 per ward
Group around small tables to promote social interaction
Must be accessible to kitchen
SPACE ACTIVITY GUI DELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
CONFERENCE ROOM Private doctor/ patient/family conference Nurses' report To accomodate 4 or 5 persons plus physician grouped around coffee table To accomodate coming and leaving shift plus dietitian (about 6 max) CRC B. Hermann Provide 1) Staff conference room for 15-20 2) Nurses' conference room for report for 6 people
Teaching -training Should not be lounge or waiting room CRC
Research seminars NIH
Patient consult Furnished like living room; min size 10' x 12'; 12' x 12' is better Malkin
SPACE ACTIVITY GUIDELINES/ASSUMPTIONS/DATA SOURCE DESIGN SUGGESTIONS
LIBRARY Could be conference room also CRC Double as conference room
Maintain a current & complete bibliography of center related publications NIH
SIGNAGE Visible for at least 15 feet CRC
Flixible for changing names "
Should not blend into background "
black sign/ white letters
Should project into hall "
Min size of letters: 3/4" "
CIRCULATION Color coding helps circulation "
Simplicity & clarity in circu- Cox & Groves lation flow of patients; clarification between patient & staff flow
Flow patterns: "
Arrival at center & disposal of vehicle (covered & secure)
Reporting at reception Waiting
Consulting room/ exam room treatment room
Out; perhaps visiting reception again; collecting children
External ramping should not exceed CRC
1 in 20 except over short distance (20') where 1 in 12 permissible
Highrise engenders more social "
For skilled nursing & intermediate "
care facilities street level facilities are safer & more manageable
Locate hard areas next to soft areas for expansion
How can it grow? Cox
No one will be fooled by a home atmosphere
Should provide appearance of "caring" & "curing"
Patient may not expect hominess but does expect comfort, consideration, and efficiency
The same space will have a different effect on the patient when he is sick than well
Patient stresses to be addressed only by human encounters:
1) Unfamiliarity of surroundings
2) Loss of independence
3) Separation from spouse
4) Financial problems
5) Lack of information
6) Threat of severe illness or death
7) Separation from family or friends
8) Problems with medication & pain
Flush, mounted fixtures are easier for cleaning
Terrazzo stairs are good if they do not open to the outside where wet or
& Groves CRC
snowy weather may cause slip- CRC
periness; rubber yardage with the grit set in strips makes a safer stair but is not as long lasting
The initial cost for stainless steel handrails in time pays for the difference over conventional metal
A vinyl or rubber floor with satiny finish requires only a nonbuffable floor finish or sealsaves on maintenance costs
Cleaning time for vinyl is double that for carpeting
Best carpet is nylon fiber with static & dirt resistant chemical added
Stairwells with glazed block walls are easy to clean
Warm colors enliven & cheer; cool colors sooth & comfort; saturated colors, particularly in patterns stimulate & enliven; dark colors depress
People congregate in areas of color stimulus
Other than using patient's CRC
Could use mounted alcohol foam; expensive
Atmosphere comfortable & human Cox & Groves in scale
Ambulation should be encouraged
Doctors may need own entry "
Research institutions often associated with teaching facilities
Geographically discrete (CRC) NIH
Regular patient traffic routes must not transverse the center
Close to or within a hospital setting so that patient services & emergency facilities are readily available (CRC)
CRTS, pneumatic tubes, telephones & CRC messenger service, switchboard
Currently use: pneumatic tubes, B. Hermann phones, patient call light, emergency buzz in public restroom (located outside ward) and buzz in 8 North, communications log, emergency phone for telemetry patients
1. National Institute of Health, "Guidelines for The General Clinical Research Centers Program of the Division of Resources", pg. 1, 1982
1. U of Co Med C., Plan for the Long Range Development of the IJ of C.M.C., Part K
2. pgs. 222-224, 1976 Ibid, pgs. 244-245
3. Ibid, pgs. 84-87
4. Ibid, pgs. 228-236
5. Ibid, pg. 240
6. Denver City and County; Zoning Ordinance,
7. City and County of Denver, 1982 Gale Research Co, Climates of the States,
8. 2nd Ed. Vol l,pg. Ill, 1980 McGuinness, et al, Mechanical and Elec-
trical Equipment for Buildings, pgs. 30-33, 1980
9. Beck, William C. and Ralph H. Meyer,
Health Care Environment: A User's View-point, pg. 59, 1982
Architectural Record, Buildings for Researh,
U.S.A.: R.W. Dodge Corp, 1958
Architectural Record, Hospitals, Clinics, and Health Centers, New York: McGraw-Hill Book Co, Inc. 1960
Beck, William C. and Meyer, Ralph H., Health Care Environment: The User's Viewpoint, Boca Raton, Florida: CRC Press, Inc., 1982
Canter, David and Canter, Sandra, eds., Designing for Theraputic Environments, New York: John Wiley and Sons, 1979
Claman, Henry M.D, The Birth and Development of the University of Colorado School of Medicine: 1883-1924, Denver: University of Colorado School of Medicine, 1865
Cox, Anthony and Groves, Philip, Designing for Health Care, Boston: Butterworths & Co. Ltd, 1081
Denver, City and County, Zoning Ordinance City and County of Denver, Tallahassee, Florida: Municipal Code Corporation, 1982
Everett, K and Hughes, D., A Guide to Laboratory Design, Boston: Butterworths & Co. Ltd, 1981
Gale Research Co, Climate of the States 2nd Ed. Vol 1, Detroit: Gale Research Co, 1980
Lindheim, Rosyln, Changing Hospital Environments for Children, Cambridge, Massachusetts:
Harvard University Press, 1972
Malkin, Jain, The Design of Medical and Dental Facilities, New York: John Wiley and Sons, 1980
McGuinness, William J. Stein, Benjamen and Reynolds, John S., Mechanical and Electrical Eguipment for Buildings, 6th ed. New York: John Wiley and Sons, 1980
National Institute of Health, "Guidelines and Information for the General Clinical Research Centers Program of the Division of Research Resources", Bethesda, 1982
Redstone, Louis G. ed, Hospitals and Health Care Facilities, 2nd ed, St. Louis: McGraw-
Hill Book Company, 1978
Shikes, Robert H. M.D. and Claman, Henry R. M.D., The University of Colorado School of Medicine,
A Centennial History 1883-1983, Denver: University of Colorado School of Medicine, 1983
University of Colorado Medical Center, Plan for the Long Range Development of the U^ of C M.C., Denver: U of Co Med. C., 1976
Wilde Anderson DeBartolo Pan Architects, Inc, Hoi 1 ywood West Hospital Expansion Program, 1976
DESIGN & CONCLUSION
MAiJTERS IHCSH 1a/ 11/03
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