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Saint Anthony's Central Hospital development

Material Information

Title:
Saint Anthony's Central Hospital development
Creator:
Zankiewicz, Teresa
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
Publication Date:
Language:
English

Thesis/Dissertation Information

Degree:
Master's ( Master of architecture)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
College of Architecture and Planning, CU Denver
Degree Disciplines:
Architecture
Committee Members:
Clymer, George

Record Information

Source Institution:
University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
Copyright Teresa Zankiewicz. Permission granted to University of Colorado Denver to digitize and display this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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AUKAKIA LIBRARY
SAINT
ANTHONY’S
CENTRAL
HOSPITAL
DEVELOPMENT
AN ARCHITECTURAL THESIS PRESENTED TO THE COLLEGE OF DESIGN AND PLANNING, UNIVERSITY OF COLORADO AT DENVER IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DECREE OF MASTER OF ARCHITECTURE
SPRING 1984
AlJRADf * 1 —


THE THESIS OF TERESA ZAMKIEWICZ IS APPROVED.
COMMITTEE CHAIRMAN
ADVISOR
MAY 1984
UNIVERSITY OF COLORADO
AT OENVER
COMMENTS


CONTENTS
INTRODUCTION 3 Nursing Units Patient Rooms and Services
Project Introduction
Personal Goals Supply
Hospital Planning Processing Engineering
HISTORY 17 Communication
General Transportation within the Hospital
History of St. Anthony's Hospital Light and Color
"Flight For Life" COST AND FINANCING ya
SITE S3 Cost
Location Financing
Climate Financial Feasibility
Design Suggestions PROGRAMMING 70
CODES 3B Programming Considerations Gross S.F. Projections
Federal
Handicapped Department Requirements Relationship of Spaces
REQUIRED SERVICES ai
Diagnostic and Therapeutic DESIGN B7
Emergency Service Outpatient Service BIBLIOGRAPHY
Clinial Laboratories Radiology
Surgical and Obstetrical Occupational Therapy, Physiotherapy, Rehabilitation


INTRODUCTION


INTRODUCTION
The hospital scene should express a spirit of kindliness, generosity, sympathetic understanding, efficiency, scientific accuracy and economy.
A new St. Anthony's part of the hospital is intended to serve better all ill or injured patients who come for elective procedures, as well as those who have undergone a trauma, or have been involved in an injury requiring emergency treatment.
The hospital is located at 4231 16th Avenue in Denver, surrounded by the sea of parking lots and low-rise
single-family homes.
At the present time St. Anthony's "Flight For Life" serves many
emergencies, yet the inadequate construction of existing helopad and lack of up-to-date life-saving equipment allows only 35% of all emergency cases brought to St. Anthony's.
The hospital has extensive history (see History), with the most recent addition done in 1964. Hospital's tend to be outdated as soon as they are constructed.
St. Anthony's is 20+ years old with no
provisions for minor remodeling. It needs a major addition if it wants to compete with 34 other hospitals in the area.
As sophisticated technologies grow many institutions equipment becomes outdated and even absolete.
St. Anthony's hospital is unable to accommodate the latest what technology has to offer.
The new addition to the existing facil it y will be designed in stages and it will increase the accommodation of existing 95,000 patients per year to 150, 000 patients per year.
The facility will have 300 more beds making it a total of 816 bed.
My main goal is to make St. Anthony's more efficient, advanced in the latest technologies. The approach involves the refinement of this type of health facility to maintain the continuum of care and quality assurance program system-wide, it is appropriate to establish following areas:
1. The existing parking lots, do not allow patients, doctors and visitors to walk to the main
B


entrance the shortest distance safely.
2. Also, the sea of parking surfaces take the valuable space, which could be utilized for health care facility.
3. Existing building (except the latest addition) has single corridor nursing units, which forces the nurse to walk long distances to each patients' room, causing delay in nursing care for the suffering patients, causing discomfort, even death to the patients. Double corridor nursing units are more efficient in providing the shortest possible route for the nurses, decreasing the length of endless corridors, and most importantly reducing patients suffering and even saving
precious life.
4. Provision of conference rooms on
each nursing unit to prov ide
privacy to both patients and
doctors.
5. Semi-private rooms are the most
efficient and econom ical rooms to
build, also provide privacy to the patients (with the curtain dividing two beds). Semi- private room can be turned into a singleroom, or a bed could be added in case of room shortage.
6. Intensive care units should be
arranged in a circle with the
nusing station in the center allowing equal distance for a nurse to travel.
7. Each room should have daylight, where patients could look outside, causing them to recupporate much faster.
8. Each room should have a bathroom,
with shower, because it provides a patient with the comforts of home, and reduces the distance a patient has to walk to the bathroom, preventing possible fall or
injury.
9. Patients room should have adequate closet space, lighting, color, because patients being away from the comforts of home is traumatic enough, and the pleasant atmosphere would speed-up the


10.
recovery.
Communication between the patient and nurse is vital to the well-fare of the patient, the latest communication equipment should be a priority in hospital design.
11. Extra wide doors should be designed in patients room in case of an emergency when patients bed has to be wheeled out of the room.
12. The distance between the beds in the room should be large enough to assure comforable traffic for staff and patients, and in case of overcrowding more beds could be added.
13. Lighting in the room should be individually controlled by each patient to assure privacy and independence to each patient.
14. Corridors should be wide enough to accommodate easy traffic of patients with the IV's, wheelchairs, staff with the equipment, and bed and stretchers. Corridors should be wider to accommodate chairs for patient sitting. Experiments show that
this provision fills the time for the patient and speeds up their recovery.
15. There should be at least two stairways on each floor maximimum 200 ft. apart and wide enough for safety in case of fire.
16. Surgical rooms should be large enough to accommodate the equipment, staff and enough circulation space for ease and speed of movement of staff. The walls should be painted green, because the red color of blood eased eye strain against green. The floor should have copper inlayed in the tiles to avoid electricution or explosion of many gases used in the operation room. Lighting should be efficient enough to accomodate emergency power generated in case of failure of the first one. The air should be filtered to avoid the spread of germs, and bacteria.
17. The X-ray Department should be located close to the operating room in case the patient needs to


have X-rays done for location of bullet, or the setting of a broken bone. The X-ray Department should have extra wide walls with lead imbedded in the concrete, to eliminate radiation transfer.
18. X-ray should be located next to the Emergency Department in case a patient needs to be X-rayed to avoid unnecessary transport.
19. The Emergency Department entrance should be visible from the road, with adequate driveway and protected from the weather, and it should have adequate parking.
20. T ransportation corridors in the hospital should be separated between patients staff and visitors to avoid unnecessary contact and to assure comfort and speed for staff to circulate.
21. The dining room should be large enough to accommodate staff and visitors, there should be a separate private dining room for doctors, because during lunch time doctors may discuss their patients and consult one another. Kitchen
should accommodate patients and staff at the same time. The location of the kitchen should be central, for ease of
transportation of carts with patients trays.
22. Administration should be centrally located to Assure efficiency and supervision over all of the departments.
23. There should be a physical link between all of the departments, to assure ease of communication.
29. The mechanical room should be able to accommodate the comfortable temperature inside each room, corridors and offices, able to pipe oxygen when needed, supply the laundry room and the rest of the hospital with hot water.
It is appropriate to establish a new service for the following reasons:
1. Improved access and availability for expanding community.
2. Permits low cost expansion of acute emergency services, (Flight for Life) also provides to a rapidly expanding population.
J


3. Addresses public mandate for reorganization of hospital
transportation system to more effective and efficient modes.
The principles of a hospital design concept call for:
a) Development of site based on community needs assesment and the nature of community growth.
b) The incorporation of prov iders. multiple
c) Diverse financing options for the
consumer and the develope r.
d) Emphasis on preventive as well as
restorative care.
e) Delineation of multiple points. entry
f) Maintenance of continuum of care
and quality assurance programs system-wide.
It is hopeful that the proposed project would diminish or eliminate overcrowding of the existing facility in the following areas.
1. Current surgical suites meet or exceed optimum levels, surgery capacity cannot be expanded. The proposed project will be up-graded
with the future in mind.
2. Current and projected utilization levels of St. Anthony's Hospital out-patient services frequently approach capacity. The proposed project will assist in offset growing out-patient needs.
3. Space available at St. Anthony's is limited even with a new facility St. Anthony's North at 194 beds shortage is currently experienced. Expanding without hurting other facilities in existing building is impossible.
4. St. Anthony's because of its unique "Flight For Life" service is most demanding and fastest growing in the region.
Long and short term development plans call for expanding specialized and high acuity services and extending outpatient and other lower acuity programs to health center satelites, community based locations.
This strategy promotes sharing, non-duplication, access, continuity, and cost containment,


as well as relief of out-patient
services and concentrating on major life-saving service a hospital should provide.
From this thesis project I hope to achieve the basic goals:
1. Successfully integrated functions
and aesthetics in an energy
concious facility while meeting
economic limits.
Obtain insight to medical
facilities from a general
architectural viewpoint for
further architectural endeavors.
3. Exhibit the areas of skills I have accumulated during my education, in a convenient format.


PERSONAL
GOALS
I was employed as a Registered Nurse at a medical center in Detroit, Michigan. As a nurse I observed the spaces being used by both patients and staff. I was always fascinated by architecture and interior design of these spaces, how they influence the wellfare of patients and well-being of staff.
This thesis is a challenge for me to combine the two fascinating fields. I hope I will be able to contribute to the profession of architecture by observing and combining the architectural spaces from the point of view of a designer as well as a staff member using these spaces.
The specific topic that I have chosen for my thesis is the St. Anthony's Hospital redesign and addition. The client is St. Anthony's Hospital, 4231 16th Avenue, Denver, Colorado. I have chosen a health care facility of this type for several reasons. First the size and complexity of the problem lend themselves to a challenging application of my previous profession.
The complexity of a hospital design involves many problem solving in
T 2
circulation patterns, system design, and need for flexibility and expandibility.
Hospital design is one of the most challenging specialties in arch itecture. Both cost constraints and energy considerations are important factors to take into account. At the same time, aesthetic quality of the design has a direct effect on both the well-being of the patient and on the degree of comfort of the staff.
My personal goals are to understand the complexitites of hospital design and to explore the contributions as well as the limitations of the architect.
From this thesis project I hope to achieve the basic goals:
1. Successfully integrated functions and aesthetics in an energy conscious facility while meeting economic limits.
2. Obtain insight to medical
facilities from a general
architectural viewpoint for
further architectural endeavors.
3. Exhibit the areas of skills I have accumulated during my education in a convenient format.


HOSPITAL
PLANNING
In order for a hospital design to be successful a considerable amount of planning must take place. Planning in the health care field has in the past been poor. Obtaining an optional
long-term outcome depends directly in the quality of the planning effort. Over the past decade when is known as the systems approach has been one of the most widely used methodologies for the planning of operational health systems. The systems approach involves problem solving and planning tackeled according to a predefined methodology. Planning
problems are analyzed as a total process rather than on a piecemeal basis and conclusions drawn are utilized in the decision making inherent to planning.
The complexity of hospital implies that their planning and design demands the efforts of a multidisciplinary team. Guidelines for teamwork and decision making should be agreed on early. In the case of hospitals, functional
complexities far outweight physical complexities. These demand the inclusion in the planning and design team of persons who understand not only the work
processes of the individual departments, but these of the hospital operating as a simple functional system.
Quality of care and treatment are directly affected by the degree to which design accommodates both inter- and intra- departmental functions.
Functional planning is a new discipline
in itself developed over the past two
decades.
People trained and experienced in this field are making substantial
contributions to the planning and designing process. Functional planning involved the following steps:
1. Perception of need for building program.
2. Need survey and feasibility
evaluations. This step involves
analyzing local, community, and regional needs. The needs of the
specific health care center are
considered. Medical personnel requirements must be carefully
determined in conjunction with an analysis of the existing medical staff.
After the need survey has been
13


completed and accepted by the hospital governing body and appropriate governmental agencies as the planning guide for the factory capital costs and the projects basic financial
feasibility must be determined. This primary criterion in evaluation financial feasibility is a hospital's ability to generate cash payments to repay a loan with interests according to a schedule.
3. Organizing for planning
In order to organize to undertake the project, the following must occu r:
Develop a decision making mechanism
Appoint a director of planning Organize for internal review of planning documents Select the professional planning team
Organize the planning team and formulate operating procedures The team should include a financial feasibility consultant, a functional
planning consultant, an architect/
engineer,and a construction manager.
4. Determine the planning, designing and construction approach.
5. Scheduling, planning, design, and construction.
Today, most hospital officials
recognize that planning, from a programatic standpoint, is a management responsibility. In program planning, plans with other providers of health care should be taken into account. Related
community characteristics such as economy, highway systems, transportation facilities, and housing problems should be considered. In order to predict demands, patients origin studies should be made, and the service area of the proposed facility
identified. The rate of visitors per 1000 population can be a useful figure. Population trends
help predict demands. An
examination of the historical pattern of utilization trends should be made.


Average length of stay, average patient days, average daily census, and bed requirements are relevant. An analysis must also be made of the medical resources available in the area, what specialties are represented. Planning the financing of large construction programs has become increasingly complex and
demanding. Steps in financial planning involve:
a) Initial steps involving
assessing the probable
financial feasibility of the project. An investment banker should be selected and a preliminary evaluation of the situation made.
b) Workload projections.
c) Refining estimates of
department capacity and determining a financial
method.
d) Certificate of need.
e) Establishing construction
costs and determining feasibility.
f) Formalizing documentation.
g) Obtaining the funds and starting construction.
The next step in planning involves physical and function evolution, i.e.: The determination of necessary specific physical aspects of the building and how they must function and relate to each other. Physical evaluation can be broken down fairly successfully into the following categories:
1. Site characteristics and parking
2. Fire safety - The code for safety to life from fire in buildings and structures contains the necessary reference standards.
3. Plumbing System - Most older
hospitals do not possess adequate plumbing systems. Considerations should be given to adequacy of water supply, distribution
throughout the building, hot water supply, stream lines, fixtures, and sewage systems.
4. Medical Gas Systems
5. Electrical Systems
6. H VAC
7. Transportation System


8. Disposal Systems - The functional evaluation is concerned with functional features of the proposed facility. It concerns the way in which the physical components of the building are used and how they relate. It emphasizes people and processes rather than physical mechanisms. Functional analysis involves the determination of departmental relationships, planning for expandibility and flexibility, and determination of circulation patterns. The following types of internal traffic should be considered:
a. Emergency traffic from other
traffic
b. Inpatient from outpatient
c. Visitor from patient
d. Supply from pedestrian
e. Soiled from clean
f. Entering personnel from other
traffic
g* Entering doctors from other
traffic
h. T raffic of one department from
another
16
In order to perform a functional evaluation a spatial analysis must be made, and analysis of pedestrian, supply and vehicular traffic patterns must be determined and departmental relationships analyzed. A relationship matrix is useful. A system analysis and equipment analysis must be performed.
'




GENERAL history Before the turn of the century, the hospital was used mainly as a charitable institution for the care of the poor. As medical technology began to develop further, the more affluent and their doctors began to make greater use of the inpatient facilities of the hospital. 1 n the last decade or so, serious changes have taken place in the planning appraoch to hospital design. Important medical advances have resulted in a greater variety of treatments and in the use of more advanced equipment, causing the medical profession to rely more heavily on the use of the hospital for ambulatory care, and causing hospital design to respond to more complex situations. Federal government financial involvement and health insurance programs such as Medicaid and Medicare have also had a hand in chaging trends. Whereas in some areas the development of those programs has allowed the lower income population to seek out the private doctor, in metropolitan areas it has caused a large percentage of the population to turn to hospital clinics
ia
for care.
There has been an increasing trend toward a hospital - based approach to group practice. The increasing need for more costly and diverse equipment has made it financially more attractive for the doctor to rely on the hospital for treatment of the abulatory patients.
There are also legal aspects of medicine that currently make this alternative an attractive one.
Hospital design has also had to respond to changing population trends. The movement of large segments of the population to the suburbs has created a need for local hospital facilities to supplement the central general hospital.
All of those trends have meant that flexibility and expandability have become increasingly important factors in hospital design. Mechanical systems design must respond both to the need for flexibility and to the increasingly complex needs of more advanced equipment and techniques.


HISTORY
OF
T. ANTHONY’S
13
St. Anthony Hospital Systems is the result of the pioneering spirit of a few Franciscan Sisters who set out from their religious community in Germany in 1875. The Roman Catholic Order of the Sisters of St. Francis first provided nursing care for the patients of the Union Pacific Railroad Company in Omaha, Nebraska, and as the railroad moved west, the sisters were asked to take charge of the railroad's new hospital in Denver.
Foresight, the tradition of excellence, and a desire to serve the extended community prompted the Sisters to seek a hospital of their own, and on June 13, 1893, St. Anthony Hospital
formally opened its doors to the township then known as "The Hihglands".
Much has changed at St. Anthony since those early beginnings, however, St. Anthony has followed the lead of the first founding Sisters by continuing in the tradition of excellence and innovation in the delivery of health care.
Symbolic of the spirit of those hardy women and their dreams, additions were made to Saint Anthony to provide for the
needs of the community.
In 1916 an X-ray department was opened and in 1929 Saint Anthony became the first hospital in Denver to be approved for the training of X-ray technicians. The organization of the pathology laboratory and the approval of the medical records library in 1920 opened the way for the accrediting of Saint Anthony in 1921 as Denver's first Class A hospital by the American College of Surgeons.
The School of Professional Nursing opened in 1919, and in September 1938 the hospital was one of the first to sign a Blue cross hospital contract. A nurses' residence was built in 1940.
A School of Practical Nursing was opened in 1949, and a Physical Theraphy Department in 1954. In 1956 the
hospital's readioisotope laboratory was licensed by the Atomic Energy Commission.
By this time the main building was aging. In 1958 planning began for an $11.5 million expansion and replacement program.
A new South Wing was completed in 1962. It contains facilities for


surgery. X-rays, laboratories, pharmacy, physical therapy, central supply, outpatient and emergency rooms, a 50-bed obstetrical department and 48 additional medical or surgical beds.
A new West Wing was completed in 1964, with kitchen and dining areas and 232 beds.
A self-care unit. Dental Clinic, Radioisotope Laboratory and EEC Laboratory are examples of the sisters' ever present determination to provide service to the expanding community of the Rocky Mountains. Recent advances in the field of Cardiology have been met with the installation of an Intensive Coronary Unit in 1967, reducing the mortality rate due to heart disease by more than 50 percent. The mortality rate was further reduced by use of diagnostic procedures made by the completion of the $160,000 Cardiovascular Laboratory in 1968.
No historical overview of St. Anthony would be complete without some mention of the hospital's dedication to emergency medicine. St. Anthony is nationally credited with the nation's first complete emergency air service. Flight for Life,
20
first operative in October of 1972.
The familiar orange and white helicopters and their crews continue to be more than instrumental in providing vital life-saving techniques and expertise on the scene as well as en route to waiting facilities.
Today St. Anthony is one of the largest private hospitals in Colorado with a 710-bed capacity. St. Anthony Hospital Systems has a medical staff of over 725 physicians, representing specialties in all areas. Facilities
include trauma, surgical, and medical intensive care units, coronary care units, a whole body CT scanner, a linear accelerator and countless other examples of the latest in diagnostic and emergency state-of-the-art technology.
Each year St. Anthony Hospital Systems treats over 95, 000 patients and yet it is their commitment to deliver the best that modern medicine and genuine caring have to offer to each and every patient.
GEOGRAPHICAL SCOPE
Since its inception in October of


1972, Flight for Life has transported well over 14,000 patients on its 10,000 helicopter flights and some 3,000 turboprop aircraft flights. In Colorado alone. Flight for Life has served over 200 communities. The program, however, is not limited to Colorado or even the Rocky Mountain region. Flights have been completed to more than 200 cities in 35 states, Canada, Mexico and even Costa Rica. And Flight for Life's national reputation is still growing.
AIRCRAFT
Two medically equipped Alouette helicopters designed for high altitude flying in the Swiss Alps area based at St. Anthony Central and St. Anthony North hospitals to serve the 150 mile area around Denver. Twin-engine, turbo-prop
pressurized aircraft. stationed at
Stapleton 1 nternational Airport in
Denver, are readily available to
transport ill and injured patients from distances beyond this 150 mile radius. In addition, Learjets are available for longer flights.
Upon receving a "go" request, the flight staff is easily mobilized and the helicopter lifts off within three minutes. The turbo-prop aircraft are airborne within thirty minutes after a call is received.


FLIGHT
FOR
LIFE
FLIGHT FOR LIFE
Thousands of emergency situations -automobile accidents, heart attacks, mountain accidents - have required the expertise of the familiar orange helicopters of Flight for Life.
Flight for Life is a community service that complements any Emergency Medical Service (EMS) system. It originated in 1972 in Denver, the heart of the Rocky Mountain empire, where the mountainous terrain and distances between communities are major factors in any emergency.
This nationally recognized airborne emergency medical delivery system was an outgrowth of the M.A.S.H. units developed under fire during the Korean conflict. Here, as in Korea, the Service provides air evacuation that saves hours when minutes are critical. But, unlike the M.A.S.H. concept. Flight for Life brings sophisticated medical equipment and highly skilled critical care nurse practitioners directly to the scene.
aa


Aircraft
Two medically equipped Alouette helicopters designed for high altitude flying in the Swiss Alps are based at St. Anthony Central and St. Anthony North hospitals to serve the 150 mile area around Denver. Twin-engine, turbo-prop pressurized aircraft, stationed at Stapleton International Airport in Denver, are readily available to transport ill and injured patients from distances beyond this 150 mile radius. In addition, Learjets are available for longer flights.
Upon receiving a “go” request, the flight staff is easily mobilized and the helicopter lifts off within three minutes. The turbo-prop aircraft are airborne within thirty minutes after a call is received.
Geographical Scope
Since its inception in October of 1972, Flight For Life has transported well over 14,000 patients on its 10,000 helicopter flights and some 3,000 turbo-prop aircraft, flights. In Colorado alone, Flight For Life has served over 200 communities. The program, however, is not limited to Colorado or even the Rocky Mountain region. Flights have been completed to more than 200 cities in 35 states, Canada, Mexico and even Costa Rica. And Flight For Life’s national reputation is still growing.
23


Images of bright orange helicopters, piloted by men who flew rescue missions in Vietnam and carrying resourceful nurses in dark blue flight fatigues make Flight for Life seem dramatic, even glamorous. But to the professionals, the unusual is routine and the drama is not in terms of images, but in the reality of saving lives and serving the community.
The Flight for Life program of today is viewed as a true community service because it takes the best of emergency room service directly to the scene, bringing all the technology and skills necessary to save lives. In Colorado alone. Flight for Life has served over 250 communities. In the beginning ( 1972), St. Anthony Hospital Systems received 70% of the patients carried by Flight for Life. But as the concept became understood and the program turned from one of mere acceptance to one of genuine appreciation, other hospitals began to construct helipads. Today only 55% of the patients are brought back to St. Anthony Hospital Systems. Of the 34 hospitals in Denver, 12 have constructed helipads so they can also benefit from
St. Anthony's unique emergency program.
"St. Anthony's flight program is for the community" says Dan Dracon, M.D., Director, Emergency Services, St. Anthony Hospital systems. "Not all Patients are transported back to St. Anthony's North or Central facilities." for this reason the flight for Life program keeps a close affiliation with other area hospitals... those which have a neonatal intensive care unit...a rehabilitation spinal cord injury center and other appropriate facilities. By maintaining close contact with these specialty hospitals, St. Anthony Hospital Systems is able to apply its particular expertise in solving a very real problem in assessing the extent of injury at the scene of the accident and then making a determination as to where that particular patient with a specific injury should be taken.
For example. Flight for Life coordinates with the Denver Department of Neonatal Services. Children's Hospital, University of Colorado Medical Center and fitzsimons Army medical Center to provide emergency care and transport of newborns. In these cases, a team composed of flight


nurse and a physician is dispatched by helicopter of fixed wing aircraft to an out-of-state hospital or distant physician requesting assistance. At destination, the team institutes intensive care for the infant in distress and, when stabilized, the child is transferred to the Neonatal Center in Denver. A full isolette, providing a portable environment for infants, is standard equipment on such flights.
To coordinate such an operation is a sophisticated and technically up-to-date communications system located at St. Anthony (Central) Hospital. The center is staffed 24-hours-a-day, seven-days-a-week, by a total of 15 experts, trained in medical terminology who maintain, monitor and record radio contact with over 90 users agencies, including 40 ambulance services, a dozen hospitals, 24 law enforcement agencies and 20 fire departments, on 15 radio frequencies.
Flight for Life is now logging an average of seven flights per day, with over 20,000 flights recorded since its inception in 1972. The program makes the hospitals and physicians in the greater
Rocky Mountain region available to the trauma victim.
The two Aloutte 316-B helicopters and two turbo prop jets aircraft are outfitted with standard equipment such as oxygen, high intensity lights, specially designed stretcher racks and orthopedic equipment. Special equipment includes stryker frames, traction apparatus for spinal injuries, shock trousers, Life-Pak V monitor/defibrillator, isolette
transport units, endotracheal intubation equipment, intraveneous fluids and emergency drugs. Blood is readily available for longer flights.
Each helicopter has a maximum capacity of two adult patients, two flight nurses and a pilot. Flight nurses are R.N. Critical Care Practitioners, as certified by the American College of Surgeons' Trauma Committee, and a physician when necessary, are aboard the flights to administer life saving care at the scene of the emergency and enroute to one of the 12 helipads located in the immediate Denver community.
Joel, Edelman - President, Rose Medical Center, stated that St. Anthony


I Aurora Community Hospital
2. Aurora Presbyterian Hospital
3. Denver General Hospital
4 Fitzsimons Army Medical Center 5. Lutheran Medical Center 6 Porter Memorial Hospital 7. Rose Memorial Hospital 8- St. Anthony Hospital Central 9 St. Anthony Hospital North 10. St. Joseph Hospital
II St. Lukes Hospital
12. Swedish Medical Center 2B


ought to be commended for providing such a unique and vital service to this community. "It's gratifying to see a private sector of this industry taking such initiative," says Edelman," and not waiting for the government to come up with such a program."
The public's view of the Flight for Life program turned from one of mere acceptance to one of genuine appreciation after proving its worth in emergency and catastrophy situations. Flight for Life has proven that critically ill or injured persons have a better chance of survival if they are adequately treated at the scene of the emergency and quickly transported to a hospital.
Medical guidance for Flight for Life is under the direction of a critical care coordinating committee of St. Anthony physicians which set the principles of care during emergency transport, as well as for the emergency department within the hospital systems. Physicians from other hospitals are consultans to this committee.
Rand Unter, Assistant Administrator, St. Luke's Hospital, emphasized that
27
Flight for Life is used to bring high risk maternity and cardiac patients to their facility. Unter said, "We are very pleased with the cooperation and response time given by Flight for Life and St. Anthony's Hospital."
Flight for Life has progressed considerably from its beginning a little over nine years ago when it was believed that one helicopter, backed by a two-way hand-held portable radio communications, set-up, could adequately service emergency medical needs within a radius of 150 miles. However, since the program's inception, it became apparent that hits service was needed in an area encompassing the entire Rocky Mountain Region - and even beyond. Thus, the fixed-wing craft were added.
To date, these planes have transported patients, flying as far east as New York and as far West as Washington. This air service has even logged a 5,500 mile trip to transport a seriously injured man in Costa Rica back to Denver.
To date, thirty airborne emergency room programs have been organized by other hospitals across the United States.


4
St. Anthony's is presently working with community agencies (Fire, Police, Sheriff’s and Highway Patrol Departments) with its EMT classes, instructing law enforcement agencies on how to recognize injuries and to sustain a life in an emergency situation; and to discriminate as to whether ground or air transportation is needed. Since 1979, all the new recruits for the State Highway Patrol have received EMT training from St. Anthony Hospital systems.
This progress, coupled with the development of sophisticated telemetry within the communications center, has earned Flight for Life national recognition. St. Anthony Hospital
Systems has received numerous visits from hospital and medical personnel seeking to begin similar program in other parts of the country and the world.
The future looks promising for Flight for Life and the emergency service offered through St. Anthony Hospital. Thanks to community support throughout the state. Flight for Life will continue to respond to community needs of saving lives that might otherwise have been lost.
I
I
FLIGHT
SB


Child Development Center
I
W. 29TH AVE.
W. 28TH AVE.
1 W. 27TH AVE.
1 W. 26TH AVE.
0*


LOCATION
SITE LOCATION
The site for the proposed project is located between 17th Avenue and on the North, West Conejos Place on the south, Stuart Street on the West and Perry Street on the East.
The Major North-South arterial on the west of the site is Wadsworth Avenue which traverses the entire quadrant from a Southerly intersection with Colorado C-470 to a Northerly intersection with Highway 1-285. The site is just south of Sloan Lake and just North of Colfax Avenue. On the East, Federal Boulevard is the main North-South arterial.
The site is comprised of almost 15 acres of developed land. The existing hospital is a 516 bed hospital constructed from 1940 to 1964. Future plans call for a 120 - 300 beds (if
justified) hospital, as well as parking facilities for staff, employees and visitors.
The interrelationship of the other hospitals in the Denver region and St. Anthony's Central Hospital and its central location will cement it as a
regional center for health and human services.
Around the site are single family houses with the majority of low-income spanish-speaking community.
17th Ave.
St. Anthony Hospital Central
Location
4231 West 16th Avenue Denver, CO 80204
30




LOCAL TRANSPORTATION SYSTEM




Colfax Ave.



1

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CLIMATE
Denver is located on the South Plate River on the eastern slope of the Rocky Mountains. The climate is characterized by low relative humidity, light to
moderate winds, mild temperatures, and light precipitation. The average monthly temperature varies from 30.4°F in January to 73.3° in July. Occasional Chinook winds help to moderate winter
temperatures. Annual snowfall averages 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.
Thundershowers occur fairly frequently on summer afternoons.
1
MEAN AND EXTREME TEMPERATURE SUMMARY l°FI DENVER. COLO.
MEAN AND EXTREMES OF WINDS DENVER, COLORADO
Kon t h Mean Wind Speed (»ph) Prevail In* Direct Ion Maalmum Wind Speed Recorded (mph) Direct Ion Associated with Ma ■ 1 mu'*
Jan 9.7 S 5) N
frb 9.4 S 49 NU
Mar 10.1 S 5 J NW
Apr 10.4 S 56 NV
May 9.6 s 4) SW
Juft 9.2 s 47 s
Jul 8.5 s 56 SU
Aur 8.2 s 42 SW
s*p 8.2 s 47 NW
Oct 8.2 s 45 NW
Nov 8.7 s 48 W
Dec 9.0 s 51 NE
Annual 9.1 s 56 NW


DAILY, MONTHLY AND ANNUAL PRECIPITATION DATA [inches!
MONTHLY AND ANNUAL SUNSHINE AND CLOUD DATA Denver, Colorado
SHADOW LENGTHS FOR SELECTED SLOPES AND TIMES
35
EFFECT OF DATE ON SOLAR ANGLES FOR 40° N LATITUDE
Winter Sol at Ice f.qu I no art S>a« Ore . l (H-r. 2 | /Sept . 21) {June 21)
So Ur T Ur A)l1lude At Lmul h Al1 11 ude At laut h AltItude Atlaut h
4 : 00 a.a. .. -- .. 0. * -121. 3‘
1:00 a.a. — -- -- — 4.2* -117.)*
6:00 a.a. — — 0. • -90.0* 14.8* -108.4*
7:00 a a. 0. * -sb. ; 11.4* - 80. 2 * 26.2* -99.7*
8;00 a.a. s.s* -sj.o* 22.S* -69.6’ 37.4* -90. 7*
9:00 a.a. 14.0* -41.9* )2.8 ’ -S7.J* 41.9* -80.2*
>0:00 a.a. 20. 7* -29.4* 41.6* -41.9* 39.8* -65.8*
11:00 a.a. 2} .0* -IS.2* 47.7* -22.6* 69.2* -41.2*
12:00 noon 26. S* 0.0* 30.0* 0.0* 7).4* 0.0*
SUMMARY OF AVERAGE DAILY SOLAR AND SKY RADIATION IN LANGLEYS lcal/cm'2/dayl
SOLAR POSITION AND INTENSITY;
SOLAR HEAT GAIN FACTORS' FOR 40° N LATITUDE


DESCRIPTION OF SOLAR RADIATION DATA
The Public Service Company of Colorado established two solar radiation measurement sites in Denver early in 1977. These two sites are a part of an extensive network in the Southwest established for the purpose of supplying solar radiation data to public utilities who use the information for heating load calculations and for design and evaluation of solar energy projects. Spectrolab SR-75 pyranometers are used to measure hemisperic radiation. A regular maintenance schedule is employed and thorough calibrations are performed at 6-month intervals (Yinger, 1978). Although the period of record is short, the data quality appears to be excellent.
The 1978 data were not yet available in a useable form at the time this publication was prepared.
DESIGN SUGGESTIONS
In building for this predominantly cold climate and with so much radiation available, let the sunshine in. Attempt
to block out sun between april and October, using shading devices, overhangs or appropriate planting (i.e. Deciduous trees at south side). Orient the building along an east west axis.
Protect buildings from the cold N.W. winds, by clustering groups of buildings and planting coniferous trees along the north and northwest, or berming earth against the north wall to both protect and decrease heat loss. Place service and secondary functions (i.e. bathrooms, closets, storage) along the north wall to "buffer" against the cold.
Medium sized opening or glazing between 25 and 40% of the wall should be used along the south and east walls. Minimal glazing, less than 10% of the wall should be used along the north wall, and approximatley 20% openings at the west wall. The walls and roof should be alight color to reduce the effect of solar radiation.
A heavy roof of over 8 hours time lag is recommended (i.e. well insulated or cold roof). Walls should also have a 8 hour time lag using heavy "mass" materials (i.e. masonry, stone). Walls,


rood and floors should be well insulated - R-30 for roof, R-20 for walls.
It WITH
SOLAR ANGLES. SEASONAL VARIATION, DENVER.|40*N|
SOLAR CHART-DENVER
LAT. 39°50'n L0NG104°50'W
ELEVATION 5280 FT.
37
MfiTiNG DIGRfl OATS BASE 65* f COOLING OCGACC Days
HEATING AND COOLING CHART, DENVER, COLORADO
PLAN OF SOLAR ANGLES




FEDERAL CODE
1. Minimum public corridor width shall be 5'-0" except that corridor in the operating room section where patients are transported in stretchers or beds shall be 8'-0".
2. I terns such as drinking fountains, telephone booths, veding machines, and portable equipment shall be located so as not to restrict corridor traffic or reduce the corridor width below the required minimum.
3. The hospital shall have not less than two exits to the exterior.
4. Toilet rooms in patients rooms shall be equipped with doors and hardware which will permit access from the outisde in an emergency.
5. The minimum width of doors for patients access to examination and treatment rooms shall be 2'-0". The minimum width of doors to rooms needing access for beds (or recovery) shall be 3'-8".
6. Doors on all openings between corridors and room or spaces subject to occupancy, except elevator doors.
shall be swing type.
Doors, sidelights, borrowed lights, and windows in which the glazing extends down to within 18 inches (46 cm) of the floor shall be glazed with safety glass, wire glass, or plastic glazing material that will resist breaking and won't create dangerous cutting edges when broken.
Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use of wheelchairs and carts and shall be designed to resist passage of smoke.
The minimum ceiling height shall be 8'-0" with the following exceptions:
a. Boiler rooms shall have ceiling clearance not less than 2'-6" above the main boiler header and connecting piping.
b. Radiographic and other rooms
containing ceiling mounted
equipment and including those with ceiling mounted surgical light fixtures shall have height requirements to accomodate the equipment and or fixture.
c. Ceiling in corridors, storage


rooms, toilet rooms and other minor rooms may not be less than 7'-8".
d. Suspended tracks, rails and pipes located in the path of normal traffic shall be not less than 6'-8" above the floor.
HANDICAPPED CODE
Entrances: At least one entrance shall
be usable by those in wheelchairs.
Publ ic walks : 48" minimum width, 5%
maximum slope, 5' x 5' level platform, extend T beyond each side or door. Parking Space: 12' minimum width.
Ramps: Maximim slope of 1 in 12, level
platform at 30' intervals minimum.
Toilet Stalls: One handicapped stall in
each toilet room.
Lavatories: Useable by individuals in
wheelchairs.
Mirrors: Not over 40" above floor.
U rinals: Appropriate number mounted 19"
above floor or at floor.
Towel Racks: Mounted no more than 40" above the floor.
Water fountains: Accessible to the
handicapped.
T elephone: Accessible to handicapped
(wheelchairs)
Doors: Minimum door opening of 32",
level floor 5' each side.
Graphics: Raised letter and identifying
devices mounted between 4'-6" and 5'-6" above floor. Minimum height of 7'-0" when suspended from ceilings.




DIAGNOSTIC
AND
THERAPEUTIC
GENERAL CONSIDERATIONS
The doctor is the most important person in the service of the hospital patient. without him there is not hospital.
I n the horse-and-buggy days the physician had little reason for seeking collaboration with colleagues and little use for a hospital, because all his knowledge was in his head and a few books on his shelf, and all the tools he needed were carried in his little black bag.
But, as medicine developed, doctors were forced to specialize, and today there is not a doctor in existence who knows all of medicine. To practice medicine now, doctors have to work in teams, specialists need a common meeting ground which is a hospital. Present day medical practice requires complex technical equipment and a variety of trained personnel to man it. Because of this, the patient as well as the doctor must come to the hospital.
In today's practice, then, the diagnostic therapeutic facilities
constitute the workshop of the doctor.
and hence are one of the most important divisions of the hospital.
The diagnostic-therapeutic facilities, then should be a unit-division, in fact -located on the most accessible floor from the street or road, from the inpatients' quarters and from the outpatient clinics.
Inasmuch as the public and practically all patients (particularly outpatients) will be entering the hospital by the front door, the ground floor should be so planned as to create an orderly pattern of circulation - allowing both inpatients and outpatients easy access to the diagnostic-therapeutic services. It
should be discretely arranged so that patient and staff movements do not interfere with the movement of supplies and non-patients.
The principal diagnostic-therapeut ic services are: the outpatients' service
and/or doctors' offices and the emergency treatment service, which, if possible, should adjoin the outpatient department so that in case of catastrophe, emergency treatment can preempt as much of the outpatient space as necessary. Inpatients, outpatients and emergency
C2


treatment patients frequently need laboratory or X-ray attention (sometimes both), inhalation theraphy, etc. Therefore, these departments should be closely connected to the
diagnostic-therapeutic division. From emergency treatment it may be necessary to rush a patient to an operating room, for ease of collaboration between specilists. These services should be within easy reach of each other. Then certain post-operative cases and many other kinds of patients may need physiotheraphy and other forms of therapy, so these services too should be contiguous to the diagnostic-therapeutic division. In addition, physiotheraphy should be oriented to surgery, because it is frequently desirable for a surgeon to look in on his former patients and see how they are adjusted to post-surgical life. It is also important that
post-surgical patients, and other patients with impaired mobility, have ready access to physiotheraphy from the point of their arrival at the hospital.
Finally there must be a recovery nursing unit attached to the surgical
43
suite, and there should be an intensive care unit for patients likely to arrive via the emergency service or the recovery unit.
Intensive care units should be located where there are always apt to be nurses on duty. However, the great deal of flexibility in the utilization of personnel and consequent economy as well as benefit to the patient can be achieved if the intensive care unit is arranged en suite with the post-operative recovery unit. Proximity of intensive care and recovery units presents significant advantage.


EMERGENCY
SERVICE
In all cases possible, emergency service should be in an easily accessibly recognizable location from the outside, and within easy reach of other services which the patient may need. Entrance to the energency service should be placed at the front of the hospital and arranged in interiorly that the night information clerk, who is frequently also the telephone operator, can see a case approaching and summon help quickly.
The entrance to the emergency service should be shielded from sight of the main hospital entrance. It should have space for unloading about three vehicles simultaneously, and there should be parking space where waiting cars can be parked without obstructing access and maneuverability in front of the entrance. The stretcher of an ambulance can be directly wheeled to the side of the treatment table, but a patient arriving in a private vehicle or taxi frequently has to be placed on a stretcher or wheelchair upon removal from the car. It is desirable to arrange the entrance as a drive-in enclosure where the transfer of patients from vehicle to stretcher can be
aa
accomplished without discomfort or hazard from bad weather.
Immediately behind the ambulance garage there should be a relaxation room for drivers, a toilet and shower, and space for a cot or two where drivers on night duty can take turn to rest or sleep.
The door opening to the service should be wide enought (6 feet) to permit a stretcher with attendants and even transfusion apparatus to pass through with ease. Space must be provided at the entrance for wheelchairs and wheel stretchers.
Emergency is one of the fastest-growing services in the contemporary hospital, and many institutions enlarge this service with such urgency that they cannot wait to place this item under their general construction program.
Emergency units should have a seperate waiting room with toilets. There should be a large nurses station, seating at least 3 persons, and an admitting office. Not only do many emergency patients have to be admitted to the hospital as


inpatients, but it is becoming the custom in the U.S. to make all admissions at other than regular hours, through emergency service.
The emergency service should have treatment stations and a doctor's office. St. Anthony's hospital has interns, who under the supervision of a resident physician performs service in the emergency suite. the doctors take turns at duty in the emergency service so that it is covered at all times.
In this community of St. Anthony's hospital many patients are fracture cases. This service should have
additional treatment rooms which could be used for setting simple fractures. These rooms should have direct access to X-ray service. Utilities and supplies should be accessible to treatment rooms. Laboratories should be also nearby and discrete movement of patient to surgery or to nursing units by elevators should be possible via the staff-patient corridor.
UTILITY SERVICES
The emergency service should be provided with places where sterile supplies can be had on clean carts and where used supplies can be collected for discarding or processing. There should be ample sinks and a janitor's closet, and at all treatment stations there should be outlets for electricity, oxygen, compressed air and suction services.


OUTPATIENT
SERVICE
In a sense the emergency service is a phase of the outpatient service, which is another reason for bringing them as closely together as possible. Out patients, too, need the diagnostic-therapeutic services required by emergency patients.
Treatment room outpatient services should have a control station facing the combined hospital lobby-waiting room, toilets. also an office for director of the service and a chest X-ray room, as well as a "screening" room, used to obtain speciments of urine and blood.
The main body of the service should consist of typical treatment rooms arranged in a double-corridor configuration. In the middle strip there should be a utility room, accessible from both corridors.
It should also have a seperate waiting room and an outdoor play space and treatment rooms for examination of infants and young children.
Each typical room should have a treatment table with extensive drawers containing equipment for any specialty examination. Each room should have a
desk, making the room an office for one of the staff physicians.
In addition to the above multi-purpose rooms, there should be a special suite of rooms - eye, ear, nose and throat, and an extensive dental department.
as


CLINICAL laboratories Patholoqy - is concerned with the analysis of diseased tissue or fluids and other elements in the body. It is usually divided into gross and micropathology. Histoloqy - is concerned with the structure, composition and function of tissues and also with the preparation of tissue for analysis. Chemistry - is concerned with the chemical analysis of body tissue and fluids. Bacterioloqy - is concerned with the bacteria or pathogens found in the body or the environment. Hematoloqy - is the study of blood specimens. The laboratory should have a specimen collection station as near the entrance to the laboratories as possible, equipped with a counter, a sink, a bunsen burner, a cabinet for supplies and a toilet. Blood acquisition for transfusions, and the processing requires a comfortable reception room with easily accessible toilets and a receptionist's desk so situated that the donor can answer
<47
questions for the record in relative privacy. The blood drawing room should be quiet, not a thoroughfare, and should be divided into cubicles for privacy.
After processing the blood is kept in a blood bank within the blood processing room, in special refrigerators.
Other activities usually connected with the department of laboratories are:
1. Specimen collection station
2. Blood acquisition for transfusions and the processing
3. Cardiography
4. Electroencephalography
5. Isotopes
6. Cardio-pulmonary laboratory
7. School of laboratory technicians
8. Autopsy and necropsy
9. Forensic medicine
10. Photography and illustration
11. Pathology museum
12. Animal quarters
GENERAL CONSIDERATIONS
A modern laboratory would consist of open alcoves with movable partitions which rest on the floor, straddling


tables with as much glass in them as possible for seeing through the whole department. Then there would be a corridor space connecting the alcoves and, on the corridor wall facing the alcoves, heavier equipment, such as refrigerators, centrifuges, fume hoods would be arranged.
UTILITIES
It is important to rationalize the installation of the many utilities serving the laboratory suite in such a manner as to permit getting to them quickly for repairs and changes of layout. Among the utilites are was lines (which should be of noncorrosive metals because of the chemicals used) hot and cold water, steam, gas, electricity (direct and) or alternating current -perhaps both), compressed air and vacuum.
CLASS WASHING AND STERILIZING SUPPLY
Other plan elements of a laboratory suite are a glass washing and sterilizing room and supply room.
4B
ADMINISTRATION
The department, of course, has to have its administrative facilities. There
would be a receptionist, a waiting room combined with adjoining X-ray suite, then there would be the office of the pathologist, a secretarial office, a smaller office for the assistant pathologist and an office or alcoves for the resident in pathology.
FLEXIBILITY
Flexibility can be achieved by a modular system of laboratory planning in terms of desks, utilities, floor space between desks and the setting of dividing partitions on the desks.
Desks or counters are gnerally of two heights; 31" for work in sitting position (microscopy), and 37" for work in standing position (chemistry). It would be an excellent idea to develop desks or counters which can be adjusted to either position and be interchangeable.


LABORATORY


RADIOLOGY
LOCATION
Radiation service should be placed between the laboratory service and the operating suite.
One of the reasons for this is that if a patient is found to need surgery as soon as certain laboratory and X-ray determinations have been made, then lives can be saved by shortening the trip to surgery. Also the ease of crossconsultation among internist,
pathologist, roentgenologist and surgeon is most important. Yet another reason for keeping radiology near the operating suite is that in certain surgical procedures - for example, in the setting of bones (orthopedics) - the operating tabie has to serve as the X-ray table as well.
The radiation department should also be conveniently located to the emergency and the ambulance clinic services.
The radiation department should be approached by patients, doctors, nurses, technicians, via a seperate (non-public) or professional corridor so as to separate, as much as possible, the
movement of patients from the public, who should move by a different corridor.
HIGH VOLTAGE PROTECTION
Where high voltages, or in any case, high-powered radiation sources are used, it is no longer economical or practical to employ lead as protection. Instead, the equivalent in concrete is used, which accounts for the thickness of walls enclosing the treatment rooms. It is impractical to install hinged or even sliding doors containing enough lead to do the job. Therefore, a kind of make is used through which patients and personnel circulate. At entrances to treatment rooms, overlapping walls are tapered. There should be a window, seperating the patient and the operator, consisting of a glass tank of clear water or of an assembly of laminated sheets of poslished glass. there should be an electronic speaking arrangement for communication between operator and patient while they are seperate from, each other.
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RADIOISOTOPES
Isotopes are used in diagnosis to locate lesions, tumors. The rooms in which isotopes are used need to have protection against radiation by the use of lead bricks or lead containers. However patients who have been given strong therapeutic dosages can be injurious to their roommates through prolonged exposure. For this reason a patient having in or on him isotopes of therapeutic strength should be lodged in a single room and preferably in an end corner room.
An isotopes room should be approximately 16'-6" x 18'-0". In
addition there should be a small scanning room 10'-0" x 16'-6".
All counters and their splashbacks should be of smooth nonporous material for ease of decontamination.
sn


surgical
AND
OBSTETRICAL
THE OPERATING SUITE
The planning of operating suites has been undergoing drastic changes, especially since World War II. They used to be located on the top floor of the hospital with skylights facing north to benefit from even, shadowless daylight.
In those days most operations were done by daylight. Improvements in artificial illumination changed that, and today operating suits are planned on any floor of a hospital building. The operating suite should be arranged in a double-corridor plan situation because the total building depth is considerably greater than in the conventional single-corridor structure.
The operating suite should have its own independent circulation in the interest of asepsis and order.
The easiest condition under which to achieve this would be at ground level, where the location would also offer the advantage of contiguity to related diagnostic-therapeutic services and expansion.
The average size of the normal
operating room today is 20' x 20', and surgeons ask for even larger rooms as times goes on, primarily because of the constant growth of monitoring and other equipment which frequently has to accompany even more sophisticated surgery.
Operating suites are currently designed to be under positive air pressure so that air will leak out rather than in. It was the concern over the infusion of untreated outside air, on the one hand, and the development of air conditioning, on the other hand that gradually convinced surgeons of the unserviceability of windows in operating suites and brought about the windowless rooms with artificial light and 100% fresh conditioned air.
NUMBER OF OPERATING ROOMS
A rule of thumb is one operating room per 50 acute general hospital beds.
A standard operating room could be used six times a day for minor surgery or three times for major surgery.
52


OXYGEN THERAPHY, HYPERBARIC CHAMBERS
Most new hospitals today are piped for delivery of oxygen gas to patients rooms, operating rooms, maternity-delivery rooms, nurseries, emergency suites, intensive care and recovery rooms, and many other suites and locations throughout the hospital.
Some hospitals have hyperbaric chambers; the use of oxygen under pressure- high pressure chamber for treatment of certain conditons. Often pure oxygen is given to patients. The fire hazard, therefore, becomes particular serious.
All electrical wiring in the high-pressure chambers is explosion-proof.
Doctors, nurses and patients must be decompressed slowly, just as divers are.
ASEPSIS
Asepsis is a big problem in all aspects of physical planning where human life is inolved, and open wound are inev itable.
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EXPLOSION AND SHOCK IN THE OPERATING ROOM
A very important problem in operating rooms where flammable anesthetics are used is the accumulation of static electricity, a spark from which can cause fatal explosion.
To approach this problem as far as flooring materials are concerned we should examine alternatives:
1. Use of terrazzo with brass grid imbedded in the floor spaces 4 to 6 inches to insure that a person's foot would have contact with the grid at all times. The grid would be grounded through a resistance coil to a metal riser - preferably a cold water pipe.
2. The principal way is to have the flooring material itself possess the capacity of the requisite limited conductivity of minimum of 25,000 ohms resistance between ground and any point on the floor.


Section through Jean Walter’s operating theatre at Lille, showing observation gallery and lighting
enclosure to reproduce the plastic bag enclosure. In this case the entire surgical team is enclosed.
Vertical and horizontal laminar air flow rooms used in operating rooms for ultra asepsis. This is. as are the other air enclosure methods, only warranted for use for surgery where air contamination can be important source of infection.
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OBSTETRIC DELIVERY SUITE
The obstetrical suite and maternity patients, plus infants, should be housed in horizontal contiguity, and together they should be isolated from other hospital patients and activities as much as possible.
There should be provided two labor beds per delivery room. Simple, sound-insulated rooms are preferred to cubicilized, curtained or congragated labor rooms.
Doctors and nurses lockers, toilets, showers should be laid out similarly to the surgery suite with one notable exception: the doctors' lounge rooms
should have a cot or two where the obstetric can rest, during the night.
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REHABILITATION
OCCUPATIONAL THERAPY
Occupational therapy is mainly a diversionary effort intended to give relief to emotional conditions while simultaneously allowing the development of muscular skill, strength and reeducation of certain muscles.
PHYSIOTHERAPHY
Phsiotheraphy concerns itself
primarily with teh reeducation of muscles and body, such a learning to walk again after orthopedic surgery, etc. While the occupation theraphy room is a fairly simple space, furnished by tables, a sink and cupboards for storing supplies, physical therapy has become fairly complex. It is generally divided into an exercise room or gymnasium, a series of curtained-off cubicles for massage and various forms of electrotherapy and hydrotheraphy - with various tanks containing surging water to produce stimulation and toughening of muscle or skin - and if possible, a swimming pool.
Speech therapy made necessary by
throad surgery, mental deficiency, deafness etc., has come to be considered part of physical theraphy.
REHABILITATION
Rehabilitation is a department in which all forms of physical theraphy are
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NURSING
UNITS
DOUBLE CORRIDOR PLAN
The double corridor folds the linear or single corridor plan on itself and in so doing accomplishes two things: it shortens the building or floor and it increases its capacity because the services are removed from the perimeter and sandwiched between the two corridors. Other types of nursing units are:
1. Single corridor nursing unit
2. Parly double corridor nursing unit
3. Square nursing unit
4. Pinwheel nursing unit
5. Circular nursing unit
DISTRIBUTION OF BEDS
The two-bed room is probably the most flexible, both economically and functionally and therefore is the American standard.
A hospital should have the following classifications of care:
1. Home care: medical, nursing, reha-
bilitative under hospital supervision
2. Intensive care: for the very sick
3. Intermediate care: for the bulk of
patients understood to be past the stage of imminent danger.
4. Self care: for patients who stay at the hospital for extended diagnosis, therapy, convalescence, rehabilitation of other forms of treatment.
Federal regulations prohibit patient rooms of more than four beds with no more than a two bed depth from the window. Arranging beds three deep from the window in not only perceptibly economical in construction cost, but is more convenient in nursing because the arrangement shortens the length of the nursing units, thus shortening the walking distance from the service care to the patients.
PEDIATRICS
It is desirable to seperate the pediatric service (for aseptic reasons) from other nursing units as much as possible, retaining ease of access to diagnositc, therapeutic and other services.
A pediatric nursing unit should have an environment all its own.
The following are come of the problems
57


which must be met:
1. To create a conductive environment.
2. The environment should be cheerful, bright, colorful, natural and uncluttered.
3. There should be a adjoining garden at the ground level or adjoining roof.
U. There should be sleep-in facilities for the mothers of small children.
5. There should be large unobstructed spaces for indoor play for the young kindergarten type, and spaces where older children can indulge their legitimate need for diversion.
6. There should be facilities for continuing the normal schooling process in collaboration with the local school system.
7. Some furniture should be sized to the age groups.
8. For certain clinical situations special temperature and humidity conditioning are desirable. It should be possible to condition each room to accord with the need of its occupant or occupants.
9. There should be enough small rooms to accomodate children which require
5B
isolation.
10. There should be ample glass in the partitions for children to see each other especially children in isolation, also to ease nursing supervision.
11. The pediatric service should be divided into small groups of 10, by age, sex, or according to clinical considerations.
12. Ample cupboard space should be provided for toys.
13. There should be facilities provided for mentally sick and retarded children.


PATIETS
ROOMS
AND
SERVICES
BEDROOMS
The fully mechanized bed is usually 3'-3" x 7'-6" and six extra inches are allowed at the head of the bed, thus making the total required floor space 3'-3" x 8'-0".
The infants bassinet is V-5" x 2'-7" x 2'-6" high to 4'-6" high and junior beds 2'-6" x 5'-9".
To one side of the bed has be space for a bed-side table. There must be room enought to turn the bed to get it in and out of the room.
I n terms of modern pateint room furniture, the width of the room should be generally 12'-6" on center of partition, allowing 4'-0" between pair of beds, 3'-0" between the bed and the sidewall, and 4'-6" next to the corridor partition, the total depth of the room, should be 2 T—0".
The closet for each patient should be large enough to hold the patient's clothing, suitcase and extra blankets. There must also be a wash basin with cabinet overit to hold the patient's toiletries.
The general rule of 80 sq. ft. per bed
in multi-bed room is required, and a single room not less than 100 sq. ft.
The rule also requires a toilet and shower in each room. It is also desirable to include in the corridor partition two cabinets: one for clean supplies and another for soiled. These are accessible from both corridor and the room side.
NURSING UNIT SERVICES
The nursing unit consists of patient bed rooms and of services which are more or less grouped together. These are usually the following:
1. Nurses station Medication station Doctor's charting station Nursing supervisor's office
2. Utility rooms
3. Treatment rooms
4. Pantry
5. Baths
6. Dayroom
7. Nurses' lounge
8. conference classroom
9. Stretcher and wheelchair space
59


Typical paiicnt module
10. Corridors
11.Stairs, lobbies, elevators 12.Dumbwaiters, pneumatic tube stations, drinking fountains, nurses call system, television etc.
The maximum distance between stairways should not exceed 200 ft. also there must be at least two stairways per floor. They should be built of strictly fireproof materials and have an unobstructed passage of not less than 3'-8" in width throughout.
Doors connecting stairs to the building should be self-closing at least 3'-8" wide.
Isometric view of typical room
LEGENO
1 Pan and basin cabinet
2 Clean material
3 Soiled material
4 Emergoncy nurse call
5 Staff communication system
6 Soap dispenser
7 Vanity
8 Mirror
9 Paper towol
10 Wardrobe
11 Wardrobe
12 Overbed table
13 Night table
14 Reading and examination lights
15 Service console
16 Television


SUPPLY
In planning, it is recognized that stores, storage, and shops must have a definite organization.
Grouped with these, because of functionally desirable proximity, would be the laundry, central sterile, supply, pharmacy, necropsy, incinerator, etc.
DELIVERY PLATFORM
There should be a proper delivery platform to which vehicles can backup. The height of the platform should coincide with the floor of the average vehicle. The service yard and the road to it should be of ample dimensions, of proper gradients to avoid flooding and to accommodate standing and moving trucks. It is for the architect to see that under no foreseeable circumstance would access to the hospital be blocked.
Purchasing office should be planned very near the point of their delivery and if possible overlook the delivery platform. The average purchasing office would consist of waiting space to accommodate salesmen, plus receptionistsecretary and an office for the purchaser.


PROCESSING
LAUNDRY ROOM
The laundry room should be within the hospital building contiguous to stores, central supply and other services comprising the third division of the hospital.
The laundry room should be clean and airy, and air conditioned. The
ventilation system should contain lint-collecting apparatus.
The soiled-lined and sorting room should be physically partitioned off from the rest of the laundry for sanitary reasons.
Each laundry room should have a storeroom for soaps and detergents, there is also need of a supervisor's office and a closet for machinery maintenance lubricants, repair tools and minor parts. Also there is a need for sewing room.
STERILIZATION
It is desirable that the pharmacy and the central isterile supply service have a common partition glazed to an extent
which would permit the pharmacist to see what is going on in central sterile supply. There is still another advantage in this contiguity and that is that certain equipment such as that needed for the preparation of sterile or distilled water can be shared by the two adjoining services.
PHARMACY
Of all the supply services the pharmacy is the most sophisticated. It should be located near the source of supplies (stores) and distribution point. There should be a strongly constructed and fireproof safe for such things which may give strong temtation to steal, such as alcohol and narcotics. Special
precautions, such as direct ventilation to the outdoors should be provided for stored flammables.
The pharmacy proper is lined by the usual specilized cabinets which hold the packaged and pre-bottled drugs. There must be a counter or a desk for recording and label typing.
62


OXYGEN SUPPLY
With the development of liquid oxygen, a piped-oxygen system is currently supplied directly from an oxygen tank on the hospital grounds.
The oxygen supply consists of a cylindrical tank resting on a concrete pad. As a safety measure, the tank may not be closer than 200 ft. from the hospital. In any case, the tank has to be accessible from either the street or an internal road.
A ward in the Investigation’s experimental ward unit at Larkfield Hospital, Greenock: the patient’s view
63


FOOD
SERVICE

KITCHEN
The kitchen should be placed as centrally as possible, in relation to the hospital's center of supply, processing, assembly, distribution, renewal and disposal.
The kitchen would be best located on the same floor and as near as possible to where supplies are delivered stored and distributed and also adjacent to the cafeteria.
the distribution systems may consist of elevators, capable of transporting whole tray carts, or tray conveyors.
The kitchen floor space should be squarish. This is necessary to reduce steps, to avoid conflicts in circulation and to facilitate supervision.
A hospital kitchen should have 18 -2 0 sq. ft. per bed. A planner must consider: supply and waste disposal, dry
and perishable stores; preperation facilities, cooking and baking areas; potwashing and dishwashing space; salad, dessert and beverage preperation; serving setups of hot and cold foot containers bordering a moving belt conveying trays
to carts or to vertical tray conveyor; means of transporting (carts, elevators, dumbwaiters, vertical tray conveyors, cart garage and cart cleaning area); administration offices for dietician, and the chef; and finally sanitation areas such as janitor's closet, toilets and hand-washing facilities.
DINING ROOMS
If possible, the dining room should adjoin the kitchen.


ENGINEERING
Steam in the hospital is used to generate hot water for laundering, for general use, cooking, etc., and for space heating and air conditioning.
Placing laundry and steam generating plant within the hospital building, particularly in multi-story buildings, is not only convenient and economical, but also permits incorporation of the smoke stack inconspicuously, as part of the building.
EMERGENCY ELECTRICITY
The use of electricity is increasing constantly, not only as a primary source of energy, but also in low voltage and wireless forms, (electronics).
The uninterrupted flow of electricity through the hospital of today is of prime importance.
In some instances, the failure of the service could be a matter of life and death. Therefore, the hospital needs a standby or emergency source of electricity of its own. This is usually an emergency gasoline-driven generator which turns itself on automatically when
the public source fails.
The emergency source of electricity automatically takes over lighting of corridors and stairs; and operation of at least one elevator, emergency, operating, delivery, recovery, and intensive care departments.
FINISHING MATERIALS AND MAINTENANCE FLOORING
Today, the most frequently used material is vinyl plastic used in sheets instead of tiles to reduce the number of joints in the interest of asepsis and economy.
Vitreous tile is still used in wet rooms. More recently, hospitals have been experimenting with nylon carpeting, for patient rooms, corridors and public spaces. Experiments show that bacteria falling on a carpet are apt to sink into the nap and not be readily swept up by air currents. Carpeting seems to be favored also for its color, texture, acoustical properties, easy on the feet and economy of housekeeping effort.
65


WALLS AND CEILINGS
Partitions in the hospital are more and more made of one or more layers of gypsum board, clipped to metal studs. This has the advantage or rapid and dry construction adequate sound proofing, and convenient raceways for electric conduit and small pipes between the perforated metal studs.
The walls are currently sprayed-on with the new kind of paint. Such walls are washable, practically without limit and durable.
When protection is needed against hard impact, such as wheeled carts, 6" x 2" wood plank rails along corridor walls should be used.
These are aesthetically pleasing, can take heavy punishment from carts, and at the same time can act as rails along which a weak as handicapped patient can propel himself.
Carpeting is also beginning to be used increasingly on walls as wainscotting. This would be particularly feasible in public spaces and corridors where carts mar walls. And if useful on walls, why
66
not on doors which are marred and scarred by passing wheelchairs or beds.
CEILINGS
Are either of fire-safe acoustical tile hung from or applied directly to the slab, or the slab is painted, after thin coats of plaster are applied.
DOORS
At hospital entrances are most frequently of laminated glass with practically
invisible top and bottom hardware. Doors to rooms are usually flush wood veneered on a solid core. Regulations require minimum door widths of 3'-8".
Swing of such a door is strenuous, also the large amount of floor space needed over which to swing a wide door, the double door of uneven leaves should be considered. One V-4" which generally
stands in closed position and is opened only when a bed has to be brought through, and the other of 2'-8" door for normal passage of persons. the hardware on the doors should permit a patient or


staff to open it with ease even when the hands are full.
Structural systems should be designed to adopt a multiple use of spaces served. Due to highly restrictive fire protection associated with hospitals, basic structural frame will generally be non-bearing brick walls.
Steel construction will be used for this project. Trusses allow for depth of mechanical spaces and provide long spans.
Steel construction is generally less expensive than concrete. The use of steel construction would also include a fire proofing agent. Spans should be as wide as possible with as few column as possible. Shallow roof construction is recommended for multi-story facilities.
The design of hospitals has been significantly affected by the increasing complexity of mechanical and electrical considerations. One half of total
construction cost is now typically accounted for by mechanical and electrical systems.
In general, mechanical and electrical systems should be designed to account as much as possible for multiple use of
spaces served. This may be accomplished in part by designing for the capability of taking greater loads.
In designing mechanical and electrical systems, an important consideration involves planning for the future, both, in terms of expansion and introduction of new technology.
Finding space requirements for more and more utility lines is an increasing problem. Ducts, pipes, conduits, medical gas systems, HVAC, and communication systems must be taken into account. There is an increasing tendency towards use of piped medical gases. One solution to these problems has been the intorudciton of interstitial floors devoted totally to mechanical and electrical systems. the ceiling height is generally enough to allow maneuverabil ity.
Electrical systems typically include a hospital communication system, a telephone system, a dictating system, an emergency power supply, and doctor's registry system. this seperate source are usually needed and automatic throw over to the second side. General


lighting, in temrs of foot candles, should be designed for work levels as stated in applicable codes.
Typically, fluorescent lighting with TOO foot candles for general lighting and 2000 FC (adjustable) in operating room is sufficient. The number, location and type of outlets is dictated by code and by need. A hospital emergency standby source is necessary. There should be 220 volt available @ X-ray and all surgery equipment and an isolated transformer in the cardiac room.
HVAC requirements include the following:
1. Distribution system
2. Thermal and acoustical insulation
3. Ventilation system
4. Air conditioning system
5. Humidity controls
6. Filters
7. Thermostats and
8. Air pressure
MECHANICAL REQUIREMENTS
A. Federal Regulations
1. Design Capacity of HVAC system
6 S
a. minimum rel 50% ative humidity -
b. maximim rel 60% ative humidity -
c. condinuous recording
hydrometer installed
d. T emperature 68-78°F.
2. General HVAC
a. Duct linings shall not be used in systems supplying operating and recovery rooms unless terminal filters of at least 90 percent efficiency are installed downstream of linings.
b. All air supplied to operating rooms shall be delivered at or near the ceiling of the area served; all return air from the area shall be removed near floor level. At least two return air outlets shall be used in each operating room.
c. Each space routinely used for
the administering of
inhalation anesthetizing
agents shall be provided with a separate scavaging system


for venting of waste anesthetizing gases. Pressure balance must be such that the gas collecting system does not interfere with required room pressure relationship or with breathing circuit that my affect patient safety,
d. Filters: a minimum of 2
filter beds with 25% efficiency at no. 1 and 90% at no. 2 are required on all central ventilation or air conditioning systems. No. 1 shall be upstream of AC equipment and No. 2 located downstream of the supply fan.
69


FACE-TO-FACE COMMUNICATION
The best way to communicate is by means of face-to-face conversation.
TELEPHONE
The next most important means of intra and extra mural communication is the telephone. The telephone is also the most convenient and currently the most readily available instrument and the most widely used.
MICROPHONE
A microphone makes it possible to broadcast religious services, addresses, urgent announcements, music and other entertainment, lecture to the staff, alert doctors, etc.
DOCTORS PAGING SYSTEM
Most frequently used system in the hospital is the traditional paging system. The doctor upon entering the hospital, registers with the hospital's
switchboard operator. when a call comes in for the doctor the operator determines whether he is in by looking at the doctor "in-and-out board" and calls him through the PA systems.
The radio "beep" system is much less anoying and convenient, and serves the radius of 1-1/2 to 2 miles from the hospital.
NURSES CALL SYSTEM
Nurses' call system remains the backbone of communication between patient and nurse.
The patient pushes the "button" in the call piece which he held in his hand. By doing this several lights were turned on; one over the patient's bed one over the door to the room and one at the nurses' station, also in the utility room and floor kitchen a buzzer would sound. The nurse would thus be guided to the calling patient. The nurse can lift the
telephone receiver and asks the patient what he wants.


MEDICAL LIBRARY
There should be two or more libraries in every hospital. One is a professional library for the medical, nursing, and technician staff and the other is largely for the diversion of inpatients.
Adjoining the libraries are the
doctors' rest room, lockers and toilets.
PNEUMATIC TUBES
The pneumatic tube system serves two purposes: communication, since such
things as mail, laboratory reports. X-ray plates, messages etc., can be sent
through it; and transportation, since
pharmaceuticals and almost any kind of small article of suitable size can also be sent through it.
I think a pneumatic tube service is a matter of prime importance and a legitimate conserVer of human labor and perhaps even of human life.
The success of a hospital plan can depend largely on the selection of the proper type of transport system.
ELEVATORS - Are generally considered the vertical transportation system.
DUMBWAITERS - Operation becomes considerably more efficient, especially be removing the human element from the loading and unloading operation.
STAIRS - In the United States are as a rule purely utilitarian; they are seperated from the rest of the building by at least 6" of masonry and metal-clad fireproof self-closing doors. They can generally not have more than 13 risers to a "run" without being interrupted by a landing and the width of the stairs may not be less than 3'-10".


LIGHT
AMD
COLOR
LIGHT
Patient room lighting should consist of one 40 watt tube (41 longe) under the reflector sending light upward for
general illunination and one tube of the same voltage sending it downward for reading, etc.
There should be also a night light behind the runner consisting of a 7 watt incandescent bulb. All 3 light sources
should be controlled by the patient from one control piece. The same piece also controls the television set on the wall opposite the bed.
COLOR
The sensitive architect of today spends much time studying natural and artificial light and color to suit every situation in the hospital. At the same time, he should keep in mind the necessity of keeping the whole hospital in harmony.
Most well-designed American hospital interiors today have walls and ceilings in a neutralized white, perhaps leaving
72
one wall in some neutralized bright primary color.
COLOR IN THE OPERATING ROOM
The surfaces in operating room should be green which is less fatiguing to the eyes than white.




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COST
COST
An architect should provide cost estimates when preliminary or "development" drawings are completed. Estimated cost of a project considers some of the following:
1. Cost of professional services should include the fees for consultant, architect, perhaps for special subsoil and/or drainage investigations, topographic survey, cost of services of professional cost estimator, etc.
2. Building cost estimates per square foot.
3. Work to be done outside the bilding generally consisting of underground utilitites, grading, roads, walks, parking spaces, and general landscaping.
4. Cost of movable equipment and furnishings. (employment of the interior designer).
1. Federal funds
2. State and local governments
3. Philanthropy
4. Proprietary equity
5. Hospital indebtedness
6. Hospital operations
FINANCING
The following are the sources of construction investment:
75


FINANCIAL
FEASIBILITY
New construction (total sq. ft. 50,000 @120,000 sq. ft.) Renovation construction (sq. ft.)
Site Development Equipment 1,000,000 Fixed Movable Architects Fee
Other fees (soil survey, engineering, inspection, loan, ins. fees) Contingency (construction, change order, inflation)
Financing Fee
Consulting Costs (e.g. planning environmental impact, etc.)
Feasibility Study
Net Capitalized Interest
Temporary Relocation Expenses
Start-up costs-supply stocking
Bond Issue Costs:
Trustee Fee Legal Fee Printing Expense Title and Recording Rating Fee
Total capitalized project cost
$6,000,000
340,050
500.000
500.000 370,463
25,500
672,750
150,000
9,498,763
76


Need survey (role study)
Preliminary feasibility evaluation
Demand study (workload projections)
Estimate debt capacity
Determine financing method
Secure certificate of need
Schematic design and outline
specifications
Formally appoint investment banker
Render underwriting commitment
Complete financial feasibility study
Prepare leases a7 bond trust indenture
Finalize official statement
Review, approve and release official statement
Issue commitment to
Market bonds and hospital
Phased (fast track)
purchase bonds deliver proceeds
construction
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PROGRAMMING CONSIDERATIONS
A number of considerations are involved in assigning space to an individual room or area, and such considerations may vary for different rooms throughout the hospital. It has been stated that an architect can design an individual space (including assigning dimensions and net square feet) if he knows: (1) what is to be done in the spce, (2) who will be doing it, and, (3) what equipment and environment are needed.
State and federal regulations affect space assignments in a number of
instances. For example, most states stripulate minimum square footage requirements for spaces assigned to
operating rooms, central storage areas, certain specified examination-treatment rooms, etc. In addition, such minimum requirements have long appeared in
federal standards and are currently published in minimum requirements of
Construction and Equipment for Hospital and Medical facilities, DHEW Publication No. (HRA) 74-4000, 1974. Therefore,
simply for new consturction to be licensed for operation minimum space assignments for a number of functions have to be met.
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GROSS S.R PROJECTIONS
. PROJECT STATEMENT
82
Existing St. Anthony's Hospital is a complex composed of series of buildings constructed in phases; the oldest from 1906 and the most recent addition, the East Wing dating from 1967°
The site is located in the city of Denver and serves 95fOOO patients per year, 65$ of whom live near the hospital. The other 35$ of the patients are brought in by the emergency "Flight for Life" helicopter service from the 150 mile radius surrounding the hospital .
The project provides an excellent challenge, since it has a wonder-full view of Sloan Lake at the North. East, West and South sides are surrounded by single-family housing.
I would like to approach this problem by solving the problems in phases.
A- First I shall eliminate the existing numerous parking lots by providing a parking structure at the South-East or South-West corner. This approach will provide additional space for the future expansion of the hospital.
B- Secondly the existing 1928 mechanical room is outdated and inadequate to handle existing structure and the proposed addition. I would like to provide new mechanical room in the 1963 South Wing’s basement. At the present time this space is unoccupied or used for storage.
C- Thirdly the existing Nursing School is a 1906 historic preservation building. At the present time this building is under renovation. I propose to move the convent and chapel into this building. This step will help me to achieve 2 things:
1. It will eliminate "additions" and "fingers" sticking out from the East wing.


2. It will provide privacy for the convent nuns by occupying a seperate building. This building is connected to the East wing by the underground tunnel.
D- In the new main North addition wing will be housed the following:
1. The new operating suite, recovery rooms, anesthesia office
2. The Medical Records Department, Credit Union, Security Dept., new chapel, business office, and administration office.
3. 48 bed nursing unit
4. 36 bed nursing unit
5. 24 bed nursing unit
6. Intensive Care‘Unit 7 . New Helopad
E- The existing operating room suite will be renovated and turned to a 53 addition patient's rooms.
F- This new addition will help to establish a more prominent main entrance to the site by taking advantage of the North's 17th ‘.Ave . and Sloan Lake.
This new access to the site will provide new identity to the medical facility. Existing access from Canejos St. will remain and will be used as a secondary entrance, because it is not dominant enough, and confuses newcommenrs who can not locate the entrance. Handicapped and visitor's parking will be provided contiguous to the new main entrance.
II. SITE DESRIPTION A- Topographic
The site is located in the North-Western Denver. It is surrounded by single- family housing on the East, West by sinago-gue and single-family housing, by professional building and 2 and 3 story apartments at the south and Sloan Lake at the North.The site slopes gradually down form South-West to the


Norht-East 10'.
B- The new proposed building shall be as energy efficient as
possible in all seasons. Building orientation and form, shading use of natural lighting and energy efficiency shall be considered and incorporated into the design.
III. PROGRAM REQUIREMENTS
A. SITE CIRCULATION
1. Public transportation (buses) service on 17th Ave.
2. Automobile circulation
a. Public parking facilities contiguous to the main entrance,
handicapped and other visitors 50 spaces 1500S.F.
b. Parking strusture for staff, doctors,
selected visitors, and handicapped persons, 150,000 S.F.
3. Service - service access shall be from Perry St. and Canejos St. Emergency access shall be from the Perry St. in addition to the existing.
Existing main access shall remain and serve as a secondary access.
B. NORTH WING HOSPITAL ADDITION
Space requirements indicated are net square feet
Basement Level 18,500 SF
a.Operating suite(l6) (1 per 50 patients) 6,400 SF
b.Recovery room (4) 1,600 SF
c.Anesthesiology dept. 1,000 SF
d.Sterilization room 0 0 SF
e.Physician's room 1,000 SF
f.Dirty utility Room 0 0 SF
g.Clean Utility Room V_n O O SF
h.Storage for operating equipment 2,500 SF
i.Stairs (2) elevators (2) O O SF


B 5
2
joHolding room, circulation 2,000
k.Doc tor's lounge 1,000
First Floor Level 18,500
a. Chapel 3.000
b. Medical Records Dept 6,000
c. Business Office 1,000
d. Administration 1,000
e. Security Dept. 1,000
f. Credit Union 1,000
g. Stair (2) Elevators (2) 500
h. Lobby (public toilets, janitor, public phone Lf000
cashier, cafeteria) 500
i. Library
Administration accessible from lobby This space will house the administrator's office, administrator’s aid, conference room.
Medical Records shall have Med. Records Librarian office, open office for the staff of 5, record storage for 360,000 patients charts, microfilm storage, movable files, computer master file system, distributing dumb waitor„
First Floor will also have cafeteria for 150 visitors and a chapel for 200 visitors and patients.
SF
SF
SF
SF
SF
SF
SF
SF
SF
SF
SF
3. Second Floor (b8 bed Nursing unit)
a. 2b patient's semi-private rooms & toilets
b. Corridor & circulation
c. Nursing station
d. Medication room
e. Physician's dietating/resting room
f. Employee's lockers & toilets
18,500 SF 9,000 SF ^,000 SF 500 SF 100 SF 200 SF 500 SF


500 SF
B6
g. Clean Utility room ho Dirty Utility Room i0 Conference Room
j. Stair (2) Elevator (2)
k. Pantry, dumb waitor
l. Equipment storage
m. Patient's lobby/sitting room
(used as a surgery waiting room on 2nd floor) ^. Third Floor
Same as the second floor but 36 patient's beds instead of ^8
5. Same as the second floor but Zk patient's beds instead of ^8 (Fourth Floor)
6. Fifth Floor (Intensive Care Unit - ICU)
a. Circular Nursing Station
b. 6 beds
c. Toilets
do Equipment storage
e. Monitoring Room
f. Physician's chart room/rest room
g. Stair, elevator
7. New helopad shall be located above 6th floor
on the roof, it should have a direct undisturbed connection with the operating room and ICU
8. Convent in the renovated building
a. Recreation
b. Dining
c. Kitchen
d. Rooms & toilets
e. stairs & elevator
1.000 SF 500 SF 200 SF
1.000 SF
1.000 SF
17,000 SF
15,000 SF
5.000 SF
1.000 SF
1.000 SF 500 SF 500 SF
• '500 SF .1,000 SF 500 SF
5.000 SF
6.000 SF
1.500 SF 500 SF 500 SF
1.500 SF 200 SF







ST. ANTHONY’S REDEVELOPMENT











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ST ANTHONY'S REDEVELOPMENT












CONCLUSION
I would like to dedicate this thesis to my husband, who helped me a great deal emotionally and physically, and without whom I wouldn'' be doing the thesis at all.
existing Canejos Place entrance, which is confusing to visitors(hospital entrance should be easy to find). I would like to turn the existing main entrance into an outpatient entrance.
Ten years ago, when I became a registered nurse I never thought I will be designing a hospital someday. For four years, working at the Medical Center in Detroit, Michigan, I observed the problems, that the staff and patients have to face every day in the hospital design. I also observed the psychological effect of room color and views to the outside on patients' time of recovery and mood. Also the effect of hospital design and color on the efficiency of staff.
In my thesis - "St. Anthony Hospital redevelopment" I tried to remedy and solve some of the problems which are very obvious to me.
The- hospital needs a more prominent entrance. My solution to this problem is a new entrance on the 17th St. across from Sloan Lake instead of the
Very obvious problem on the site is the sea of parking lots surrounding the existing building, as well as the 1928 mechanical structure blocking a wonderful view to the Sloan Lake. To solve this problem I propose a new-parking structure in the Southeast corner of the site, with two floors below grade and two above (being sensitive to the surrounding low residential buildings, adjacent to the site. The parking structure will house 750 cars of the staff and employees, and will have an underground tunnel connecting parking structure with the main building. Adjacent to the parking structure I will locate a new mechanical structure hiding the oxygen tanks behind a brick wall.
Along the tunnell there will be located pipes running from the mechani-


cal room to the main building, providing easy access in case of malfunction. There will be a small parking lot at the main entrance for visitors and at the outpatient entrance.
Another problem which I intend to solve is the existing 1928 North wing, which at the present time is mostly vacated or used for thrift shop and other non-related hospital functions. I propose a new 136 bed North wing addition. The new structure will provide a new Medical Records, Library, Administration, Lobby, Business Office, Chapel, Visitors Cafeteria, Patients' Rooms, Nursing Stations and my main focus - the patients' loun ge. Taking advantage of the Sloan Lake view, patients' lounge is located on the north side facing the lake.
On the national TV the experiment with the patients having surgery shows that the patients where their views from their rooms were facing to a plea sant view of landscape or water, these patients recuperated twice as fast as the patients, whose room windows faced a wall or other building.
In the patients' lounge I tried to provide a feeling of calm and comfort, as well as feeling of sharing, where the patients from different floors could share the space, look down to the floor below, enjoy the view of the lake through the trees and plants.
An important point I want to make in this desing is that a hospital is like an expensive hotel, where the paying customers are the patients. They should be provided with all of the comforts of homeu I tried to accomodate the patients with the rooms, where the two beds are the same (neither one is better than the other) facing each other, with curtain for privacy, and handicapped bathrooms, include baths and shower in every room.
The private rooms will have a seperate sitting area apart from the bed area, with removable wall for flexibility.
Also these rooms will have private balconies facing the lake.
Since my new North wing Addition I would like to also treat the north facades of East and West wing. I will remove the existing chapel, convent and


business office. The 1906 Historical preservation building located on the East part of the site could accommodate a convent very well.
By eliminating these "fingers" on the east wing the north facades of both east and west wing will be reconstruc-ted to blend with the new addition.
I am very satisfied with the resulting design of my thesis. Both advisors -George Clymer and Ron Rinker have been most helpfull in offering their expertise. I have realized how complicated the hospital design really is, but it provides me with a challenge which I would like to continue in the future. Hospital design, with its problems and interesting and innovative solutions, provides constant awareness and excitement. It is my goal to become a specialist in health care facility design.


Full Text

PAGE 1

ARCHIVES LD 1190 A72 1984 Z36

PAGE 2

AI NT NTHONV1S CENTRAL HOSPITAL DEVELOPMENT AN ARGIITECTURAL THESIS PRESENliD TO THE COLLEGE OF DESIGN AND PLANNING, UNIVERSITY OF COLORADO AT DENVER IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARQ-HTECTURE TERESA NKIEWICZ SPRING 1984 A URA 01" '

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THE THESIS OF TERESA ZANKI.EWIC:Z IS APPROVED. COMMITTEE CHAIRMAN A D VISOR MAY '1984 UNIVERSITY OF COLORAOO AT CENVER COMMENTS -----------------

PAGE 4

CONTENTS INTRODUCTION Project Introduction Personal Goals Hospital Planning HISTORY General History of St. Anthony's Hospital "Flight For Life" SITE Location Climate Design Suggestions CODES Federal Handicapped REQUIRED SERVICES Diagnostic and Therapeutic Emergency Service Outpatient Service Cfiniaf Laboratories Radiology Surgical. and Obstetrical 5 17 29 38 41 Occupational Therapy, Physiotherapy, Nursing Units Patient Rooms and Services Supply Precessing Engineering Communication Transportation within the Hospital Light and Color COST AND FINANCING Cost Financing Financial Feasibility PROGRAMMING P rograrnming Considerations Gross S.F. Projections Department Requirements Relationship of Spaces DESIGN BIBLIOGRAPHY 74 79 87 Rehabilitation j ------------

PAGE 5

INTRODUCTION

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INTRODUCTION The hospital scene should express a spirit of kindliness, generosity, sympathetic understanding, efficiency, scientific accuracy and economy. A new St. Anthony's part of the hospital is intended to serve better all ill or injured patients who come for elective procedures, as well as those who have undergone a trauma, or have been involved in an injury requiring emergency treatment. The hospital is located at 4231 16th Avenue in Denver, surrounded by the sea of parking lots and low-rise sin gle-fam if y homes. At the present time St. Anthony' s "Flight For Life" serves many emergencies, yet the inadequate construct ion of existing helopad and lack of up-to-date life-saving equipment allows only 35% o f all emergency cases brought to St. Anthony's. The hospital has extensive history (see History), with the most recent addition done in 1964. Hospital's tend to be outdated as soon as they are constructed . 6 L An-th _ o _ n _ y _'s--is ---' 2'--0+--y e _ a _ r_s_ol d w it. h no provisions for minor remodeling. It needs a major addition if it wants to compete with 34 other hospitals in the area. As sophisticated technologies grow many institutions equipment becomes outdated and even absolete. St. Anthony's hospital is unable to accommodate the latest what technology has to offer. The new addition to the existing facility will b e designed in stages and it will increase the accommodation of existing 95,000 patients per year to 150,000 patients per year. The facility will have 300 more beds making it a total of 816 bed. My main goal is to make St. Anthony's more efficient, advanced in the latest technologies. The approach involves the refinement of this type of health facility to maintain the continuum of care and quality assurance program system-wide, it is appropriate to establish following areas: 1. The existing parking lots, do not allow patients, visitors to walk doctors torthe and main

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7 entrance the shortest distance safely. 2. A I so, the sea of parking surfaces take the valuable space, which could be utilized for health care 3. facility. Existing building (except the latest addition) has single corridor nursing units, which forces the nurse to walk long distances to each patients' room, causing delay in nursing care for the suffering patients, causing discomfort, even death to the patients. Double corridor nursing units are more efficient in providing the shortest possible route for the nurses, decreasing the length of endless corridors, and most importantly reducing patients suffering and even saving precious I if e. 4. Provision of conference rooms on each nursing unit to provide privacy to both patients and doctors. 5. rooms are the most efficient and economical rooms to build, also provide privacy to the patients (with the curtain dividing two beds). Semi-private room can be turned into a sing! e-room, or a bed could be added 1n case of room shortage. 6. Intensive care units should be arranged in a circle with the nusing station in the center allowing equal distance for a nurse to travel. 7. Each room should have daylight, where patients could look outside, causing them to recupporate much faster. 8. Each room should have a bathroom, with shower, because it provides a patient with the comforts of home, and reduces the distance a patient has to walk to the bathroom, preventing injury. possible fa II or 9. Patients room should have adequate closet space, lighting, color, because patients being away from the comforts of home is traumatic enough, and the pi easan t atmosphere would speed-up the

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1 0. 11. 12. 13. 14. recovery. Communication between the patient an d nurse is vi t'a I to the we 11fare of the patient, the latest communication equipment should be a priority in hospital design. Extra wide doors should be designed in patients room in case of an emergency when patients bed has to be wheeled out of the room. The distance between the beds in the room should be large enough to assure comforable traffic for staff and patients, and in case of overcrowding more beds could be added. Lighting in the room should be individually controlled by each patient to assure privacy and independence to each patient. Corridors should be wide enough to accommodate easy traffic of patients with the I V's, wheelchairs, staff with the equipment, and bed and stretchers. Corridors should be wider to accommodate chairs s itting. Experiments for patient show that 1 5. 16. 17. this provision fills the time for the patient and speeds up their recovery. There should be at least two stairways on each floor maximimum 200 ft. apart and wide enough for safety in case of fire. Surgical rooms should be large enough to accommodate the equipment, staff and enough circulation space for ease and speed of movement of staff. The walls should be painted green, because the red color of blood eased eye The floor inlayed in strain against should have the tiles to green. copper avoid electricution or explosion of many gases used in the operation room. Lighting should b e efficient enough to accomodate emergency power generated in case of failure of the first one. The air should be filtered to avoid the spread of germs, and bacteria. The X-ray Department should be located close to the operating room in case the patient needs to B

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have X-rays done for location of bullet, or the setting of a broken bone. The X-ray Department have extra wide walls with lead imbedded in the concrete, to eliminate radiation transfer. 18. X-ray should b e located n ext to the Emergency Department in case a patient needs to be X-rayed to avoid unnecessary transport. 19. The Emergency Department entrance should be visible from the road, with a dequate driveway and protected from the weather, and it should have adequate parking. 20. Transportation corridors i n the hospital should be separate d between patients staff and visitors to avoid unnecessary contact and to assure comfort and speed for staff to circulate. 21. The dining room should be large enough to accommodate staff and visitors, there should b e a separate private dining room for doctors, b ecause during lunch tim e doctors m a y disc uss their patients and consult one another. Kitc h e n should accommodate patients and staff at the same time. The location of the kitche n should b e c entral, for ease of transportation of carts with patients trays. 22. Administration should b e centrally locate d to Assure efficiency and supervision ove r all of the departments . 23 . The r e should b e a physic a l link between all of the departments, t o ass ure eas e o f comm unicat ion. 24. The mech ani cal r oo m should b e abl e to accommoda t e the comfortable temper ature insi d e each r o o m , corridors a n d offices, a ble to pipe oxygen when nee d ed, supply the laundry room and the rest of the hospital with h o t water. It is appropriate to establish a new service for the following reasons: 1. Improved access and a v ailability for expandi n g c omm u n ity. 2. Permits low cost expansion o f acu t e emergency services, ( Flight for Life) also provides to a rapidly expanding population. 9

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10 3. Addresses pub I ic mandate for reorganization of hosp ita I transportation syste m to more effective and efficient modes. The principles of a hospital design concept call for: a) Development of site based on community needs assesment and the nature of community growth. b) The incorporation of multiple providers. c) Diverse financing opt ions for the consume r and the developer. d) Emphasis on preventive as well as restorative care. e ) Delineation points. of multiple entry f) Maintenance of continuum of care and quality assurance programs system-wide. It is hopeful that the proposed project would diminish or eliminate overcrowding of the existing facility in the following areas. 1. Current surgical suites meet or exceed optimum levels, surgery capaCity cannot be expanded. The proposed project will be up-graded with the future in mind. 2. Current and projected utilization levels of St. Anthony's Hospital out-patient services frequent! y approach capacity. The proposed project will assist in offset growing out-patient needs. 3. Space available at St. Anthony's is limited even with a facility St. Anthony's North at 194 beds shortage is currently experienced. Expanding without hurting other facilities 1n existing building is impossible. if. St. Anthony's because of its unique "Flight For Life" service is most demanding and fastest growing in the region. Long and short t erm development plans call for expanding specialized and high acuity services and extending outpatient and other lower acuity programs to health center sa tel ites, community based locations. This strategy promotes sharing, non-duplication, access, continuity, and cost containment,

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11 as well as relief of out-patient services and concentrating on major life-saving service a hosp ita I should provide. From this thesis project hope to achieve the basic goals: 1. Successfully integrated functions and aesthetics in an energy concious facility while meeting economic limits. 2. Obtain facilities insight from to a medical general for 3. architectural viewpoint further architectural endeavors. Exhibit the areas of skills I have accumulated during my education, in a convenient format. r / I I I I \ ---/ !

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PERSONAL GOALS 12 I was employed as a Registered Nurse at a medical center in Detroit, Michigan. As a nurse I observed the spaces being used by both patients and staff. was always fascinated by architecture and interior design of these spaces, how they influence the wellfare of patients and well-being of staff. This thesis is a challenge for me to combine the two fascinating fields. hope I will be able to contribute to the profession of architecture by observing and combining the architectural spaces from the point of view of a designer as well as a staff member using these spaces. The specific topic that I have chosen for my thesis is the St. Anthony's Hospital redesign and addition. The client is St. Anthony's Hospital, 4231 16th Avenue, Denver, Colorado. have chosen a health care facility of this type for several reasons. First the size and complexity of the problem lend themselves to a challenging application of my previous profession. The complexity of a hospital design involves many problem solving in circulation patterns, system design, and need for flex ib il it y and expandib il it y. Hospital design is one of the most challenging specialties in architecture. Both cost constraints and energy considerations are important factors to take into account. At the same time, aesthetic quality of the design has a direct effect on both the well-being of the patient and on the degree of comfort of the staff. My personal goals are to understand the complexitites of hospital design and to explore the contributions as well as the I imitations of the architect. From this thesis project achieve the basic goals: 1. Successfully integrated 2. and aesthetics in an conscious facility while economic limits. Obtain facilities insight from to a hope to functions energy meeting medical architectural viewpoint genera I for further architectural endeavors. 3. Exhibit the areas of skills I have accumulated during my education in a convenient format.

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HOSPITAL PLANNING 13 In order for a hospital design to be successful a considerable amount of planning must take place. Planning in the health care field has in the past been poor. Obtaining an optional I on g-term outcome depends directly in the quality of the planning effort. Over the past decade when is known as the systems approach has been one of the most widely used methodologies for the planning of operational health systems. The systems approach involves problem solving and planning predefined tackeled according methodology. to a Planning problems are analyzed as a total process rather than on a piecemeal basis and conclusions drawn are utilized in the decision-making inherent to planning. The complexity of hospital implies that their planning and design demands the efforts of a multidisciplinary team. Guidelines for teamwork a n d decision making should be agreed on early. In the case of hospitals, functional complexities far outweight physical complexities. These demand the inclusion in the pla-nning and design team of who understand not only the work processes of the individual departments, but these of the hospital operating as a simple functional system. Quality of care and treatment are directly affected by the degree to which design accommodates both inter-and intra-departmenta I functions. Functional planning is a new discipline in itself developed over the past two decades. People trained and experience d in this field are making substantial contributions to the planning and designing process. Functional planning involved the following steps: 1. Per c eption of need f o r building program. 2. survey and feasibility evaluations. This step involves analyzing local, regional needs. specific health community, and The needs of the care center are considered. requirements Medical must be personnel careful I y determined in conjunction with an analysis of the existing medical staff. After the need survey has been

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14 completed and accepted by the hospital governing body and appropriate governmental agencies as the planning guide for the factory capital costs and the projects basic financial feasibility must be determined. This primary criterion in evaluation financial feasibility is a hospital1s ability to generate cash payments to repay a loan with interests according to a schedule. 3. Organizing for planning In order to organize to undertake the project, the following must occur: Develop a decision making mechanism Appoint a director of pi ann ing Organize for internal review of planning documents Select the professional planning team Organize the .planning team and formulate operating procedures The team should include a finanCial feasibility consultant_ a functional planning consultant, an architect/ engineer, and a construct ion manager. 4. Determine the planning, designing and construction approach. 5. Scheduling, planning, design, and construction. Today, most hospital officials recognize that planning, from a programatic standpoint, is a management responsib il it y. In program planning, plans with other providers of health care should be taken into account. Related community characteristics such as economy, highway systems, transportation facilities, and housing problems should be considered. In order to predict demands, patients origin studies should be made, and the service area of the proposed facility identified. The rate of visitors per 1000 population can be a useful figure. help predict examination of Population trends demands. An the historical pattern of utilization trends should be made.

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15 Average length of stay, average patient days, average daily census, and bed requirements are relevant. An analysis must also be made of the medical resources available in the area, what specialties are represented. Planning the financing of large programs has become complex and increasingly demanding. Steps in financial pi ann ing involve: a) Initial steps involving probable assessing the feasibility of the financial project. An investment banker should be selected and a preliminary evaluation of the situation made. b) Workload projections. c) Refining department determining method. estimates capacity of and a financial d) Certificate of need.e) Establishing costs and .feas ib if it y. construction determining f) Formalizing documentation. g) Obtaining the funds and starting construction. The next step in planning involves physical and function evolution, i.e.: The determination of necessary specific physical aspects of the building and how they must function and relate to each other. Physical evaluation can be broken down fairly successfully into the following categories: 1. Site characteristics and parking 2. Fire safety The code for safety to life from fire in buildings and structures contains the necessary reference standards. 3. Plumbing System Most older 4. 5. 6. 7 . hospitals do not possess adequate pi umbing systems. Considerations should b e given to adequacy of water sup pi y, d i s t r i b u t ion throughout the building, hot water supply, stream lines, fixtures, and sewage systems. Medical Gas Systems Electrical Systems HVAC Transportation System

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16 8. Disposal Systems -The functional is concerned with evaluation functional features of the proposed facility. It concerns the way in which the physical of the building are used and how they relate. I t emphasizes people and processes rather than physical mechanisms. Functional analysis involves the determination of departmental relationships, planning for expandibilit y and flexibility, and determination of circulation patterns. internal The following types of traffic should be considered: a. Emergency traffic from other traffic b. Inpatient from outpatient c. Visitor from patient d. Supply from pedestrian e. Soiled from clean f. Entering personnel from other traffic g. Entering doctors from other traffic h. Traffic of one department from another In order to perform a functional evaluation a spatial analysis must be made, and analysis of pedestrian, supply and vehicular traffic patterns must be determined and departmental relationships analyzed. A relationship matrix is useful. A syste m analysis and equipment analysis must be performed.

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HISTORY -

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GENERAL HISTORY 18 Before the turn of the century, the hospital was used mainly as a charitable institution for the care of the poor. As medical technology began to develop further, the more affluent and their doctors began to make greater use of the inpatient facilities of the hospital. In the last decade or so, serious changes have taken place in the planning appraoch to hospital design. Important medical advances have resulted in a greater variety of treatments and in the use of more advanced equipment, causing the medical profession to rely more heavily on the use of the hospital for ambulatory care, and causing hospital design to respond to more complex situations. government financial involvement and health insurance programs such as Medicaid and Medicare have also had a hand in chaging trends. Whereas in some _ areas the development of programs has allowed the lower income population to seek out the private doctor, in metropof itan areas it has ca,used a . farge percentage of the population . to turn to hospital clinics for care. There has been an increasing trend toward a hospital -based approach to group practice. The increasing need for more costly and diverse equipment has made it financially more attractive for the doc;::tor to rely on the hospital for treatment of the abulatory patients. There are also legal aspects of medicine that currently make this alternative an attractive one. Hospital design has also had to respond to changing population trends. The movement of large segments of the population to the suburbs has created a need for local hospital facilities to supplement the central general hospital. A II of those trends have meant that flexibility and expandab il it y have become increasingly important factors in hospital design. Mechanical systems design must respond both to the need for flexibility and to the increasing! y complex needs of more advanced equipment and techniques.

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HISTORY OF 3T. ANTHONY'S 19 St. Anthony Hospital Systems is the result of the pioneering spirit of a few Franciscan Sisters who set out from their religious community in Germany in 1875. The Roman Catholic Order of the Sisters of St. Francis first provided nursing care for the patients of the Union Pacific Railroad Company in Omaha, Nebraska, and as the railroad moved west, the sisters were asked to take charge of the railroad's new hospital in Denver. Foresight, the tradition of excellence, and a desire to serve the extended community prompted the Sisters to seek a hospital of their own, and on June 13, 1893, St. Anthony Hospital formal! y opened its doors to the township then known as "The Hihglands". Much has changed at St. Anthony since those early beginnings, however, St. Anthony has followed the lead of the first founding Sisters. by continuing in the tradition of excellence and innovation in the delivery of health care. Symbolic of the spirit of those hardy wom .en and their dreams, additions were made to Saint Antho.ny to provide for the needs of the community. In 1916 an X-ray department was opened and in 1929 Saint Anthony became the first hospital in Denver to be approved for the training of X-ray technicians. The organization of the pathology laboratory and the approval of the medical records library in 1920 opened the way for the accrediting of Saint Anthony in 1921 as Denver's first Class A hospital by the American College of Surgeons. The School of Professional Nursing opened in 1919, and in September 1938 the hospital was one of the first to sign a Blue cross hospital contract. residence was built in 1940. A nurses' A School of Practical Nursing was opened in 1949, and a Physica l Theraphy Department in 1954. In 1956 the hospital's readioisotope laboratory was licensed by the Atomic Energy Commission. B y t.h i s t i me t he m a i n b u i I d i n g w a s aging. In 1958 plan.ning began for an $1 ). 5 million expansion and replacement program. A new South Wing was completed in 1 9 6 2 • I t con t a i n s fa c i I it i e s f o r

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20 surgery, physical X -rays, laboratories, therapy, central pharmacy, supply, outpatient and emergency rooms, a 50-bed obstetrical department and 48 additional medical or surgical beds. A new West Wing was completed in 1964, with kitchen and dining areas and 232 beds. A self-care Radioisotope unit, Dental Laboratory and Clinic, EEG Laboratory are examples of the sisters' e v e r P . res en t de t e r m i n a t ion to pro v ide service to the expanding community of the Rocky Mountains. Recent advances in the field of Cardiology have been met with the installation of an Intensive Coronary Unit in 1967, reducing the mortality rate due to heart disease by more than 50 percent. The mortality rate was further reduced by use of diagnostic procedures made by the completion of the $160,000 Cardiovascular Laboratory in 1968. No historical overview of St. Anthony would be complete without some mention of tne hospital's dedication to emergency medicine. St. Anthony is nationally credited with the nation's first complete emergency air service, Flight for Life, first operative in October of 1972. The familiar orange and white helicopters and their crews continue to be more than instrumental in providing vital I ife-sav ing techniques and expertise on the scene as well as en route to waiting facilities. Today St. Anthony is one of the largest private hospitals with a 71 0-bed capacity. in St. Colorado Anthony Hospital Systems has a medical staff of over 725 physicians, representing specialties in all areas. Facilities include trauma, surgical, and medical intensive care units, coronary care units, a whole body CT scanner, a linear accelerator and countless other examples of the latest in diagnostic and emergency state-of-the-art technology. Each year St. Anthony Hospital Systems treats over 95,000 patients and yet it is their commitment to deliver the best that modern medicine and genuine caring have to offer to each and every patient. GEOGRAPHICAL SCOPE Since its inception in October of

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21 1972, Flight for Life has transported well over 14,000 patients on its 10,000 helicopter flights and some 3, 000 turbo-prop aircraft flights. In Colorado alone, Flight for Life has served over 200 communities. The program, however, is not limited to Colorado or even the Rocky Mountain region. Flights have been completed to more than 200 cities in 35 states, Canada, Mexico and even Costa Rica. And Flight for Life's national reputation is still growing. AIRCRAFT Two medically equipped Alouette he I icopters designed for high altitude flying in the Swiss Alps area based at St. Anthony Central and St. Anthony North hospitals to serve the 150 mile area around Denver. Twin-engine, turbo-prop pressurized aircraft, stationed at Stapleton International Airport in Denver, are readily available to transport ill and injured patients from distance s beyond this 150 mile radius. In addition, Learjets are available for longer .flights. Upon receving a 11go11 request, the flight staff is e asily mobilized and the helicopter I ifts off within three minutes. The t urbo-prop air c raft are airborne within thirty minute s after a call is received.

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FLIGHT FOR LIFE 22 FLIGHT FOR LIFE Thousands of emergency situations automobile accidents, heart attacks, mountain accidents -have required the expertise of the familiar orange helicopters of Flight for Life. F I ight for Life is a community service that complements any Emergency Medical Service (EMS) system. It originated in 1972 in Denver, the heart of the Rocky Mountain empire, where the mountainous terrain and distances between communities are major factors in any emergency. This nationally recognized airborne emergency medical delivery system was an outgrowth of the M.A.S.H. units developed under fire during the Korean conflict. Here, as in Korea, the Service provides air evacuation that saves hours when minutes are critical. But, unlike the M.A.S.H. concept, Flight for Life brings sophisticated medical equipment and highly. skilled critical care nurse practitioners directly to the scene.

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23 Geographical Scope Since its incept i on in October of 1972, Flight For Life has transported well over 14,000 patients on its 10,000 helicopter f lights and some 3 ,000 turbo-prop aircraft flights. In Colorado alone, Flight For Life has serv'ed over 200 communities . The program , however , is not limited to Colorado or even the Rocky Mounta i n region . Flights have been completed to more than 200 cities i n 35 states , Canada , Mexico and even Costa Rica . And Flight For Life ' s national reputation is still growing . Aircraft Two medically equipped Alouette hel i copters designed for high altitude flying in the Swiss Alps are based at St. Anthony Central and St. Anthony North hospitals to serve the 150 mile area around Denver . Twin-engine , turbo-prop pressurized aircraft , stationed at Stapleton International Air port in Denver, are readily available to transport ill and injured patients from distances beyond this 150 mile radius. In addition , Learjets are available for longer flights. Upon receiv i ng a "go" r eq uest , the flight staff is easily mobilized and the helicopter lifts off w i thin three minutes . The turbo-prop aircraft are airborne within thirty minutes after a call is . received .

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24 Images of bright orange helicopters, piloted by men who flew rescue missions in Vietnam and carrying resourceful nurses in dark blue flight fatigues make Flight for Life seem dramatic, even glamorous. But to the professionals, the unusual is routine and the drama is not in terms of images, but in the reality of saving I ives and serving the community. The Flight for Life program of today is viewed as a true community service because it takes the best of emergency room service directly to the scene, bringing all the technology and skills necessary to save lives. In Colorado alone, Flight for Life has served over 250 communities, In the beginning (1972), St. Anthony Hospital Systems received 70% of the patients carried by Flight for Life. But as the concept became understood and the program turned from one of mere acceptance to one of genuine appreciation, other hospital:; began to construct helipads. Today only 55% of the patients are back_ to St. Anthony Hospital Systems. Of the 34 hospitals in Denver, 12 have constructed ipads so they can also benefit from St. Anthony's unique emergency program. "St. Anthony's flight program is for the community" says Dan Dracon, M.D., Director, Emergency Services, St. Anthony Hospital systems. "Not all Patients are transported back to St. Anthony's North or Central facilities." for this reason the flight for Life program keeps a close affiliation with other area hospitals . . . those which have a neonatal intensive care unit ••• a rehabilitation spinal cord injury center and other appropriate facilities. By maintaining close contact with these specialty hospitals, St. Anthony Hospital Systems is able to apply irs particular expertise in solving a very real problem in assessing the extent of injury at the scene of the accident and then making a determination as to where that particular patient with a specific injury should be taken. For example, Flight for Life coordinates with the Denver Department of Neonatal Services. Children's Hospital, University of Colorado Medical Center and fitzsimons Army medical Center to provide emergency care and transport of newborns. In these cases, a team composed of flight

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25 nurse and a physician is dispatched by helicopter of fixed wing aircraft to an out-of-state hospital or distant physician requesting assistance. At destination, the team institutes intensive care for the infant in distress and, when stabilized, the child is transferred to the Neonatal Center in Denver. A full isolette, providing a portable environment for infants, is standard equipment on such flights. To coordinate such an operation is a sophisticated and technically up-to-date communications system located at St. Anthony (Central) Hospital. The center is staffed 24-hours-a-day, seven-days-aweek, by a total of 15 experts, trained in medical terminology who maintain, monitor and record radio contact with over 90 users agencies, including 40 ambulance services, a dozen hospitals, 24 I a w e n f o r cement a g en c i e s a n d . 2 0 f i r e departments, on 15 radio frequencies. _Flight for Life is now logging an average of seven flights per day, with over 20,000 flights recorded s ince its inception in 1912. The program makes the hospitals and physicians in the greater Rocky Mountain region avail able to the trauma victim. The two Aloutte 316-8 helicopters and two turbo prop jets aircraft are outfitted with standard equipment such as oxygen, high intensity lights, specially designed stretcher racks and orthopedic equipment. Special equipment includes stryker frames, traction apparatus for spinal injuries, shock trousers, Life-Pak V monitor I defibr ilia tor, isolette transport equipment, units, endotracheal intubation intraveneous fluids and emergency drugs. Blood is readily available for longer flights. Each helicopter has a maximum capacity of two adult patients, two flight nurses and a pilot. Flight nurses are R.N. Critical Care Practitioners, as certified by the American College of Surgeons' Trauma Committee, and a physician when necessary, are aboard the flights to administer life saving care at the scene of the emergency and enroute to one of the 12 helipads located in the immediate Denver community. Joel, Edelman President, Rose Medical Center, stated that St. Anthony

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DENVER AREA HOSPITALS SERVED BY FLIGHT FOR LIFE 1 Aurora Community Hospital 2 . Aurora Presbyterian Hospital 3 . Denver General Hospital 4 Fitzsimons Army Medical Center 5 Lutheran Medical Center 6 . Porter Memorial Hospital 7 . Rose Memorial Hospital 8 . St. Anthony Hospital Central g St. Anthony Hospital North 10 . St. Joseph Hospital 11 St Lukes Hospital 12 . Swed1sh Medical Center 28

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27 ought to be commended for providing such a unique and vital service to this community. "It's gratifying to see a private sector of this industry taking such initiative," says Edelman, 11 and not waiting for the government to come up with such a program." The public's view of the Flight for Life program turned from one of mere acceptance to one of genuine appreciation after proving its worth in emergency and catastrophy situations. Flight for Life has proven that critically ill or injured persons have a better chance of survival if they are adequately treated at the scene of the emergency and quickly transported to a hospital. Medical guidance for Flight for Life is under the direction of a critical care coordinating committee of St. Anthony physicians which set the principles of care during emergency transport, as well as for the emergency department within the hospital systems. Physicians from other hospitals are consultans to this committee. Rand Unter, Assistant Administrator, St. Luke's Hospital, emphasized that Flight for Life is used to bring high risk maternity and cardiac patients to their facility. Unter said, "We are v ery pleased with the cooperation and response time given by Flight for Life and St. Anthony's Hospital. 11 F I ight for Life has progressed considerably from its beginning a little over nine years ago when it was believed that one helicopter, backed by a two-way hand-held portable radio communications, set-up, could adequately service emergency m edic a l needs with in a radi u s of 150 miles . However, since the program's inception, it became apparent tha t hits service was n eede d in an are a e n compassing the entire Rocky Mountai n Region -and even b eyond. T hus, the fixe d -wing craft wer e added. T o date , these pla nes have tra n spor ted patients, flyi n g as f a r east as New York and as far Wes t as Washington. This air service has e v e n logged a 5, 500 mile t r i p to transport a seriously injured man in Costa Rica back to Denver. To date, thirty airborne emergency room programs have been organized by other hospitals across the United States.

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• 28 St. Anthony's is presently working with community agencies (Fire, Police, Sheriff's and Highway Patrol Departments) with its EMT classes, instructing law enforcement agencies on how to recognize injuries and to sustain a life in an erne r gene y situation; and to discriminate as to whether is ground needed. transportation all the new recruits for or Since the air 1979' State Highway Patrol have received EMT training from St. Anthony Hospital systems. This progress, coupled with the development of sophisticated telemetry within the communications center, has earned Flight for Life national recognition. St. Anthony Hospital Systems has received numerous visits from hospital and medical personnel seeking to begin similar program in other parts of the country and the world. The future looks promising for Flight for Life and the emergency service offered through St. Anthony Hospital. Thanks to community support throughout the state, F I ight for Life will continue to respond to community needs of saving lives that might otherwise have been lost.

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SITE . ;.•. " • . . _Center .-_::""*'1 W I I . . 29TH AVE _ Qll" W . 28TH AVE.. -w . 27TH lve. -_ -f-ai w . 26TH lvE ....., I 1 1 1. . _ I W. BYRON PL. t CD I z a ffi \ I (/) I I N Sloan Lake W . 20TH AVE. I W 17THAVE

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LOCATION 30 SITE LOCATION The site for the proposed project is located between 17th Avenue and on the North, West Conejos Place on the south, Stuart Street on the West and Perry Street on the East. The Major North-South arterial on the west of the site. is Wadsworth Avenue which traverses the entire quadrant from a Southerly intersection with Colorado C-470 to a Northerly intersection with Highway 1-285. The site is just south of Sloan Lake and just North of Colfax Avenue. On the East, Federal Boulevard is the main North-South arterial. The site is comprised of almost 15 acres of developed land. The existing hospital is a 516 bed hosp ita I constructed from 1940 to 1964. Future plans call for a 120 300 beds ( if justified} hospital, as well as parking facilities for staff, employees and visitors. The interrelationship of the other hospitals in the Denver region and St. Anthony's Central Hospital and its central location will cement it as a I regional center for health and human services. Around the site are single family houses with the majority of low-income spanish-speaking community. 17th Ave . Parkong 1;::::::=:== li D rs . Parkong St. Anthony Hospital Central Loca t i on 423 1 W est 1 6 t h A venue D e nv er , CO 80 204

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I I LEGEND HERLTH & HO/PITRL/ FRCILITIE/ • HO/PITAL/ * nEIGHBORHOOD HEALTH CEnTER o HEALTH ITATIOO/ • WELL BABY CLiniC/ • FIELD OFFICE! • mEnTAL HEALTH PROGRAm/ 0 DRUG ADOICTIOO / ALCOHOLitm PROGRAm/ 0 /OCIAL /ERVICE PROGRAm/ OORTH

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32 LOCAL TRANSPORTATION SYSTEM 1-70 Colfax Av e . "0 > ;-------+---it--i--t-CiS Sloan Lake " QJ "0 --+--+-+-r:f • r--r-........ 1-f; St. Anthony North 84th Ave . r I

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33 -------_ _ _ _ W _ o _ 17_,t !!. h _ _:S:._T !..!.! R .!: E...:E:...T !.. --------o ---00 \ \ '. '. '. '. \ '. \0 ' 0 '. '. '. '. '. '. '. '. '. \ '. '. '. \ . \ -\\ \ \ ' \\\ \ \\ \\\\ \ \ , \ \ \ \ \ \ \ \ \ \ \ \ \ ', \\\ \ \\ \ \ \ ,. /,. ,. i /,. ,. . ,. ,,. / ,. , / /,. ,. /// ; i,. ,. . '. \ ' '. '. '. '. \ \ '. \ \ \ '. '. ' '. ' '. '.' '. \ '. \l \ \ \ \ \ \ \ • \ \ \ \._!..._\_\ \ \ \ ) \ \ \ ' \ \ \ I ... '\ \ Cl) ! >-' ::o, >-0 I I .' I o ' I I ' I I • I 1 • ', o • I • I • , 1 • I I ltll.-JIIttlitlt / .' : :' .' 1_: . . I : I I : / / () I I ' ' I 1 I 1 • /I "' I r 1r I I '---_) 0' '. '. '. ' . '. '. \ \. '. \ \ \ '. '. \ '. , ,,,,,,,,,,,,,,, '• •' '' • ' .. \'\ I ''' ' ......... ' ... \. ,,,,,,,,,,,,,,,, o// .............. / /o _,..; II : i I ::I \ li i ... '' .. '' .. ''/l ;4t I : d I / I I 1 , 7 I I -..I I , 1 I I I / I .,., \...,..//'','/.''/ 1/iLJ• : ','/'t; !!l (\. ' 0 , 00.\\\\'-_\\\\s r'\\\\\\\\\' \\i!! 1 '--__ 0_:_ ___ 0 ____ 1 \._0_ 0 ---_j) W o CONEJOS P L ACE , , \ '. ,0 '. '. '. \ '. '. , 0 '. • ,0 '. \ '. '. B \\\\\\\\\\ ,' '<\\\' \\\\\\\\\\\\\\\\\ ... -' ; ... ' / .' ... / "'0) /

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34 CLIMATE D enver is located on the South Plate River on the eastern slope of the Rocky Mountains. The climate is characterized by low moderate relative humidity, light to winds, mild temperatures, and light precipitation. The average month I y temperature varies from 30. 4F in January to 73.3 in July. Occasional chinook winds help to moderate winter temperatures. Annual snowfall averages M EAN AND EXTRE M E TEMPERATURE SUM MARY 1FI DEN VER . COLO. ...... , ... . ..... ,. ,..., u , t It, , H , t ' ' 1-----f-__ .................. 1-......... +-_:.:-+ _ _::_-1 1-----1---f--62 inche s but persistent snow-cover i s _ . . _ .. . ' ' -......... + ......... -1---..:.._--1--.:._1 unusual. month. March is typically the snowiest Precipitation averages about 15. 5 inches per year. Little precipitation --: : : ----" --. falls during the winter. More than 50 • .. " percent occurs of from the annual precipitation April through July. Thundershowers occur fairly frequently on summer afternoons. / MEAN AND EXTRE M ES OF WI N DS DENVER, COLORADO K.ut .. ,• "'"•" Vtn d l"rev•lllna \ltnJ vllh S ceJ (anh) Dlrretlon (•ntl) "•.-u,. .l•n 9.1 S H --------9 . 4 s 4q ------------""-' IO. l S 'iJ ----------1------. . Apr 10 . 4 S )b -----------1-------4------l !Uy 9 . 6 s 4) sw ------\--------Jun 9.2 S 4J Jul 1.) )6 sw ••• 1.2 42 sw 1 . 2 41 O
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35 DAILY, MONTHLY AND ANNUAL PRECIPITATION DATA (inches! DENVER, COLORADO .... __ u • ,_ "-••-••" •I ..... etol r •I ,..,,,., lllro ' '"'-" """''" _,,.,, -1 , 0100f" 1-----"--, . _ , .. -_ . _ . __ ":'_-__ : .. . ?.;-r-7.-----; -l , H • 1.• 11. 1 . --, ___ _ --t----1 .11 1 l . • 11.1 I ... --.. . ----.-. . -+--+---1 ' ' • _ , .. h ... , , , . -..... , ... . ............... . ....... _ ,,, ......... _ . . _,,_ ............... , .. , ,,_ MONTHLY AND ANNUAL SUNSHINE AND CLOUD DATA Denv e r , Colorado J •r ....... , __ ,.,,c••t • f , ... , .. , . " , , " " --------011;, .... , , l•tol " I _,_,., . ,......,., . , . ''"''ca .... , " " ' j II I • ' l " --I ---:: --+ .. '" Ill I , . ............ ,. t:l••"' • 0.0•• " II " -----" '\oo ooo !o,, I r,.,.p,o l 'l .,.--' ,, > . 0 ----------, 1 .. -!-----' ' ... ' ' SHADOW LENGTHS FOR SELECTED SLOPES AND TIMES (in feet per one foot of obstruction! 40 N LATITUDE v .... a 11 s 11 • It w It ' Solar TlCround Slop• Slop• Slop• Slope \llnt•r 10 :00 . . . . 1 . 1 1 . 4 ) . 0 1 . 8 1.1 Sohtlce 9:00 ... . . 4 . 0 ).1 4 . 1 4,7 ) . I tqvlnoua 10 :00 ... . . 1.1 1.1 I. I 1.2 1.1 9 :0<1 • • • • ... 1.1 ... 1.1 1.1 s"""""'' ' 'f:OO . . . . o . • 0.' 0.' o . • o . • Sohltce 11:00 . . . . 1.) 1.) 1.) ... 1.1 1:00 . ..... 1.1 1 . 1 >.0 1.) ... '" d6"'""'•'d .. ... ...... th ., , .. , .. of I ,,.., ... 100 feet ... )KlflltJont .. l d 1111111\Ce • EFFECT OF DATE ON SOLAR ANGLES FOR 40 N LATITUDE Sol.u Tl•" 1.:00 • ••. ... . . • :oo • 1:00 • . • . 1 :00 • . • • t :OO • • 10:00 • • • . 11:00 • . • . 1 2 :00 ftoon WlrHef Solul ct> Or('. II Allll...OC' A I llaut h o . -)8. ,. 1.1' )).0' u . o -41.9' 20 . 1 ' -19.4' 2). 0 " -1). 1 ' u. )' o . o " I ,, I All llu.Jt 0. \1.4" 11 . )" )l.t. 41.11:!" 41 .1' )0.0" Solu lc:or II I Atl•uth A It lludt> Atl•...,th 0. -12\.)' 4 , 2 ' _ , 11. )" -90.0' 14, 8 ' -101 .... -80.1 ' llb , l " -99 . 1 ' _.,_ .. )1 .... -90.1' H.l' 41.9' -80. 2 " -41.9" . • • -o}.l" -22.6" U.l" -4l.P o . o 1),4' o.o SUMMARY OF AVERAGE DAILY SOLAR AND SKY RADIATION IN LANGLEYS (cal/cm-2 /dayl \,,,,_ ... ,,, I .. -'' ... "'' M O\•o t ot1o,tolll "' ' I I I "' '" ! ... I 1'> I ... , , hollo , , .... '"' .. ... ! ... "' ..., ... ... kO . .. ,, ... .... . U•l ' " .•. ... ... "' .., ... ... -.... ,,,,.,.,,(olll "' '" •'"' '" ... i ... . ., ' '" ... -... . ..... llh, . . . !HI ... '" ! "" ... '" ... : "' ... ... "' ........ c .tu ... ... "' ,.. ... ... ... "' ... i ... I . . . ' " ...._ .... . .... ... ' " ' ... ..... i ... ... . .. . ... -... ........ ... ..... ' I" ... . ... "' I ... kO . .. ... !:: I ... ..... ....... , .. "' ..• '" I kO I ... ... i ... '" I "' ,,.,.,,( t o o ....... "' ... '" ... "' ! "' ... ... I ... IH I ... Ito , """•••• n "' ... ' " ..... ... .... : ... I :; I .... ' "-'''"' ..... ... ! • \ "' . . . "" ... '" I '" ... ... '" ' " ' ' ....... ho,. ... ... " ' I I ... I ... I ... . .. I ... ... i .. 1 -loo.o ... ... ... ... ... . . . I "' I ... ....... . ........... ,., '" , . , ... i . . . ... I ... ... I . .. I '" . ........ ... -.... ;!>\ ... "' : '" ... ... ' " ........... ,_ ....... ..._ "' : I ... ... I "' '" .... I .. ... I '" loo•• •.<•• .. •"' , .. In ... i "' I kO ... ... ... .. . . . ... ''•••• "" ...... ... to .... h.-,,,, ,... ,,.. o-.." \ .. ,,,.,., ' "'''" .. l ... ,,,,., "' P•••U I • ••• o ... 1• o•fl"" •• ,,,.,,,. SOLAR POSITION AND INTENSITY ; SOLAR HEAT GAIN FACTORS' FOR 40 N LATITUDE ..... . . . .................. .,_ , . , , , . ......... . 1--,---,--,--r--r-...---.---.----l ...... , ... , I : • 1 '"I , . i . . : . . 1 .:.: .'II , . I'' ' ,. , ... .... i I ........... ...... ..... .. . ........ ,, • ,..,._ .. H•olo

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36 DESCRIPTION OF SOLAR RADIATION DATA The Public Service Company of Colorado established two measurement sites in 1977. These two sites extensive network in solar radiation Denver early in are a part of an the Southwest established for the purpose of sup pi ying solar radiation data to public utilities who use the information for heating load calculations and for design and evaluation of solar energy projects. Spectrofab SR-75 pyranometers are used to measure hemisperic radiation. A regular maintenance schedule is employed and thorough calibrations are performed at 6-month intervals (Yinger, 1978). Although the period of record is short, the data quality appears to be excellent. The 1978 data were not yet available in a useable form at the time this pubf ication was prepared. DESIGN SUGGESTIONS In building_ for this predominantly cold climate and with so much radiation available, let the sunshine in. Attempt to block out sun between april and october, using shading devices, overhangs or appropriate planting (i.e. Deciduous trees at south side). Orient the building along an east west axis. Protec t buildings from the cold N. W. winds, by clustering groups of buildings and planting coniferous trees along the north and northwest, or berming earth against the north wall to both protect and decrease heat I oss. Place service and secondary functions (i.e. bathrooms, closets, storage) along the north wall to "buffer" against the col d. Medium sized opening or glazing between 25 and 40% of the wall should be used along the south and east walls. Minimal glazing, less than 10% of the wall should be used along the north wall, and approximatley 20% openings at the west wall. The walls and roof should be alight color to r educe the effect of solar radiation. A heavy roof of over 8 hours time lag is recommended (i.e. well insulated or cold roof). hour time Walls should also have a 8 lag using heavy "mass" materials (i.e. masonry, stone). Walls,

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SOLAR ANGLES , SEASONAL VARIATION , OENVER.I40•N I SOLAR CHART-DENVER ELEVATIO N 528 0 FT. N ''\ I I \--1 / / / I / . .. , I ... 37 H E ATING AND COOLING CHART, DENVER, COLORADO 0 8 :::::-:._;._;::: N0AWA l. H[ATIH C OECRE. O.t.'t'S ..,... HO'\WA.L COOLI,..C DECJ:IEE O A'f'S ---SU H AHCL 4 4 0.N0ATH LATITUD E \ I PLAN OF SOLAR ANGLES I •-'

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CODES

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C:OOES FEDERAL CODE 1. Minimum public corridor width shall b e S' O'' except that corridor in the operating room section where patients are transported in stretchers or beds shall be 8'-0". 2. I terns such as drinking fountains, telephone booths, veding machines, and portable equipment shall be located so as not to restrict corridor traffic or reduce the corridor width below the required minimum. 3. The hospital shall have not less than two exits to the exterior. 4. Toilet rooms in patients rooms shall be equipped with doors and hardware which will permit access from the outisde in an emergency. 5. The minimum width of doors for patients access to examination and treatment rooms shall be 2'-0". The minimum width of doors to rooms needing access for beds (or recovery) shall be 3'-8". 6. D oo r s on a II openings between c o rridors and room or spac e s subject to occupancy, except eleva tor doors, 3s L _ ______________________ _ shall be swing type. 7. Doors, sidelights, borrowed lights, and windows in which the g l azing extends down to within 18 inches (46 em) of the floor shall be glazed with safety glass, wire glass, o r plastic glazing material that will resist breaking and won't create dangerous cutting edges when broken. 8. Thresholds and expansion joint covers shall be made flush with the f loor surface to facilitate use of whee l chairs and c a rts and s hall be d e s igne d to resist passage of smoke. 9. The minimum ceiling height shall be 8' 0 " with the follo w ing e xceptions: a . Boiler room s shall have cei li n g clearance n o t less than 2'-6" above the main boiler header and connecting pip in g . b. Radi ographic and o ther rooms c . containing ceiling mounted equipment a n d including those w it h ceili n g mounted surgical light fixtures shall have height requirements t o accomodat e the equipm ent and or fixture. Ceiling in corridors, storage

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40 rooms, toilet rooms and other minor rooms may not be less than 7'-8 II • d. Suspended tracks, rails and pipes located in the path of normal traffic shall be not less than 6'-8" above the floor. HAND I CAPPED CODE Entrances: At least one entrance shall be usable by those in wheelchairs. Public walks: 4811 minimum width, 5 % maximum slope, 51 x 5' level platform, extend 1' beyond each side or door. Parking Space: 12' minimum width. Ramps: Maximim slope of 1 in 12, level platform at 30' intervals minimum. Toilet Stalls: One handicapped stall in each toilet room. Lavatories: Useable by individuals in wheelchairs. Mirrors: Not over 4011 above floor. Urinals: Appropriate number mounted 1911 above floor or at floor. Yowel Racks: Mounted no more than 40" above the floor. Water fountains: Accessible to the handicapped. Telephone: Accessible to handicapped (wheelchairs) Doors: Minimum door opening of 3211, level floor 5' each side. Graphics: Raised letter and identifying devices mounted between 4'-6" and 5'-6" above floor. Minimum height of 7'-0" when suspended from ceilings. ----, /

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REBUIRED SERVICES

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CIAGNOSTIC: ANC THERAPEUTIC 42 GENERAL CONSIDERATIONS The doctor is the most important person in the service of the hospital patient. without him there is not hospital. In the horse-and-buggy days the physician had little reason for seeking collaboration with colleagues and little use for a hospital, because all his know ledge was in his head and a few books on his shelf, and all the tools he needed were carried in his little black bag. But, as medicine developed, doctors were forced to specialize, and today there is not a doctor in existence who knows all of medicine. To practice medicine now, doctors have to work in teams, specialists need a common meeting ground which is a hospital. Present day medical practice requires complex technical equipment and a variety of trained personnel to man it. Because of this, the patient as well as the doctor must come to the hospital. In today's practice, then, the diagnostic therapeutic facilities constitute the workshop of the doctor, and hence are one of the most important divisions of the hospital. The diagnostic-therapeutic facilities, then should be a unit-division, in fact -located on the most accessible floor from the street or road, from the inpatients' quarters and from the outpatient clinics. Inasmuch as the public and practical I y all patients (particularly outpatients) will be entering the hospital by the front door, the ground floor should be so planned as to create an orderly pattern of circulation -allowing both inpatients and outpatients easy access to the diagnostic-therapeutic services. It should be discrete! y arranged so that patient and staff movements do not interfere with the movement of supplies and non-patients. The principal diagnostic-therapeutic services are: the outpatients' service and/ or doctors' offices and the emergency treatment service, which, if possible, should adjoin the outpatient department so that in case of catastrophe, emergency treatment can preempt as much of the outpatient space as necessary. Inpatients, outpatients and emergency

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43 treatment patients frequently need laboratory or X-ray attention (sometimes both), inhalation theraphy, etc. Therefore, closely these departments should be connected to the diagnostic-therapeutic division. From emergency treatment it may be necessary to rush a patient to an operating room, for ease of collaboration between specilists. These services should be within easy reach of each other. Then certain post-operative cases other kinds of patients physiotheraphy and other and many may need forms of tlierapy, so these services too should be contiguous to the diagnostic-therapeutic division. In addition, physiotheraphy should be oriented to surgery, because it is frequently desirable for a surgeon to look in on his former patients and see how they are adjusted to post-surgical I if e. It is also important that post-surgical patients, and other patients with impaired mobility, have ready access to physiotheraphy from the point of their arrival at the hospital. Finally there must be a recovery nursing unit attached to the surgical suite, and there shouid. be an intensive care unit for patients to arrive via the emergency service or the recovery unit. Intensive care units should be located where there are always apt to be nurses on duty. However, the great deal of flexibility in the utilization of personnel and consequent economy as well as benefit to the patient can be achieved if the intensive care unit is arranged en suite with the post-operative recovery unit. Proximity of intensive care and recovery units presents significant advantage.

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EMERGENCY SERVICE 44 In all cases possible, emergency service should be in an easily accessibly recognizable location from the outside, and within easy reach of other services which the patient may need. Entrance to the energency service should be placed at the front of the hospital and arranged in interior! y that the night information clerk, who is frequently also the telephone operator, can see a case approaching and summon help quickly. The entrance to the emergency service should be shielded from sight of the main hospital entrance. It should have space for unloading about three vehicles simultaneously, and there should be parking. space where waiting cars can be parked without obstructing access and maneuverability in front of the entrance. The stretcher of an ambulance can be wheeled to the side of the treatment table, but a patient arriving in a private vehicle 'or taxi frequently has to be placed on a stretcher or wheelchair upon removal . from the It is desirable to arrange the entrance as a drive-in enClosure where the transfer of patients from vehicle to. stretcher can be accomplished without discomfort or hazard from bad weather. Immediately behind the ambulance garage there should be a relaxation room for drivers, a toilet and shower, and space for a cot or two where drivers on night duty can take turn to rest or sleep. The door opening to the service should be wide enought (6 feet) to permit a with attendants and even stretcher transfusion with ease. apparatus to pass through Space must b e provided at the entrance for wheelchairs and w heel stretchers. Emergenc y is one of the fastest-growing services in the contemporary hospital, and many institutions enlarge this service with such urgency that they cannot wait to place this item under their general construction program. Emergency units should have a seperate waiting room with toilets. There should be a large nurses station, seating at least 3 persons, and an admitting office. Not only do many emergency patients have to be admitted to the hospital as

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45 inpatients, but it is becoming the custom in the U.S. to make all admissions at other than regular hours, through emergency service. The emergency service should have treatment stations and a doctor's office. St. Anthony's hospital has interns, who under the supervision of a resident physician performs service in the emergency suite. the doctors take turns at duty in the emergency service so that it is covered at all times. In this community of St. Anthony's hospital many patients are fracture cases. This service should have additional treatment rooms which could be used for setting simple fractures. These rooms should have direct access to X-ray service. Uti I ities and supplies should be accessible to treatment rooms. Laboratories should be also nearby and di_screte . movement of patient to surgery or to nursing units by elevators should be possible via the staff-patient corridor. UTILITY SERVICES The emergency service should be provided with places where sterile sup pi ies can be had on clean carts and where used supplies can be collected for discarding or processing. There should be ample sinks and a janitor's closet, and at all treatment stations there should be outlets for electricity, oxygen, services. compressed air and suction

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OUTPATIENT SERVICE 46 In a sense the emergency service is a phase of the outpatient service, which is another reason for bringing them as closer y together as possible. Out patients, too, need the diagnostic-therapeutic services required by emergency patients. Treatment room outpatient services should have a control station facing the combined hospital lobby-waiting room, toilets. also an office for director of the service and a chest X -ray room, as well as a 11screening11 room, used to obtain speciments of urine and blood. The main body of the service should consist of typical treatment rooms arranged in a double-corridor configuration. In the middle strip there should be a utility room, accessible from both corridors. 1 t should also have a seperate waiting room and an outdoor pi a y space and treatment rOOfTIS for examination of infants and young children• Each typical room should have a treatment table with extensive drawers containing equipment for any specialty . . . examination. Each room should have a desk, making the room an office for one of the staff physicians. In addition to the above multi -purpose rooms, there should be a special suite of rooms -eye, ear, nose and throat, and an extensive d e n t al department. _.,, Iii 'I

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CLINICAL LABORATORIES 47 Pathology is concerned with the analysis of diseased tissue or fluids and other elements in the body. It is usually divided into gross and micropathology. Histology is concerned with the structure, composition and function of tissues and als. o with the preparation of tissue for analysis. Chemistry is concerned with the chemical analysis fluids. Bacteriology is of body tissue concerned with and the bacteria or pathogens found in the body or the environment. Hematology is the study of blood specimens. The laboratory should have a specimen collection station as near the entrance to the laboratories as possible, equipped with a counter, a sink, a bunsen burner, . a cabinet for supplies and a toiret. Blood acquisition for transfusions, and the processing a comfortable reception room with easily accessible toilets and a receptionist's desk so situated that the donor can answer questions privacy. for the record in relative The blood drawing room should be quiet, not a thoroughfare, and should be divided into cubicles for privacy. After processing the blood is kept in a blood bank within the blood processing room, in special refrigerators. Other activities usually connected with the department of laboratories are: 1. Specimen collection station 2. 3. Blood acquisition for transfusions and the processing Cardiography 4. Electroencephalography 5. 6. Isotopes Cardio-pulmonary I aboratory 7. School of laboratory technicians 8. Autopsy and necropsy 9. Forensic medicine 10. Photography and illustration 11. Pathology museum 12. Animal quarters GENERAL CONSIDERATIONS A modern laboratory would consist of open alcoves with movable partitions which rest on the floor, straddling

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tables with as much glass in them as possible for seeing through the whole department. Then there would be a corridor space connecting the alcoves and, on the corridor wall facing the alcoves, heavier equipment, such as refrigerators, centrifuges, fume hoods would be arranged. UTILITIES It is important to rationalize the installation of the many uti I ities serving the laboratory suite in such a manner as to permit getting to them quick I y for repairs and changes of layout. Among the utilites are was lines (which should be of noncorrosive metals because of the chemicals used) hot and cold water, steam, gas, electricity (direct and) or alternating current -perhaps both), compressed air and vacuum. GLASS WASHING AND STERILIZING SUPPLY Other plan elements of a laboratory suite are a .glass washing and sterilizing room and supply room. ADMINISTRATION The department, of course, has to have its administrativ e facilities. would be a receptionist, a waiting combined with adjoining X -ray suite, there would b e the office o f The r e room then the pathologist, a secretarial office, a smaller office for the assistant pathologist and an office or alcoves for the resident in pathology. FLEXIBILITY Flexibility c a n be achieved by a modular sys t e m of l aboratory p l anning i n terms of desks, utilities, floor space between desks a n d the setting of d ividing partitions on the desks. Desks or counters are g nerally o f two heights; 31" for work in s itting posi t i o n (microscopy), and 3 7" for w o r k i n standing position (chemistry). It w ould be an excellent idea to develop desks or counters which can be adjuste d to either position and be interchangeable .

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I LABORATORY I

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RADIOLOGY so LOCATION Radiation service should be placed between the laboratory service and the operating suite. One of the reasons for this is that if a patient is found to need surgery as soon as certain laboratory and X-ray determinations have been made, then lives can be saved by shortening the trip to surgery. Also the ease of cross-cohsultation among internist, pathologist, roentgenologist and surgeon is most important. Yet another. reason for keeping radiology near the operating suite is that in certain surgical procedures for example, in the setting of. bones (orthopedics) the operating table has to serve as the X -ray table as well. The radiation department should also be convenient! y located to the emergency and the ambulance clinic services. The radiation department should be approached by patients, doctors, nurses, technicians, via a seperate. (non-public) or professional corridor so as to separate, as much as possible,. the movement of patients from the public, who should move by a different corridor. HIGH VOLTAGE PROTECTION Where high voltages, or in any case, high-powered radiation sources are used, it is no longer economical or practical to employ lead as protection. Instead, the equivalent in concrete is used, which accounts for the thickness of walls enclosing the treatment rooms. It is impractical to install hinged or even sliding doors containing enough lead to do the job. Therefore, a kind of make is used through which patients and personnel circulate. At entrances to treatment rooms, overlapping walls are tapered. There should be a window, seperating the patient and the operator, consisting of a glass tank of clear water or of an assembly of laminated sheets of posl ished glass. there should be an electronic speaking arrangement for communication between operator and patient while they are seperate from, each other.

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51 RAD I 0 ISOTOPES Isotopes are used in diagnosis to locate lesions, tumors. The rooms in which isotopes are used need to have protection against radiation by the use of lead bricks or lead containers. However patients who have been given strong therapeutic dosages can be injurious to their roommates through prolonged exposure. For this reason a patient having in or on him isotopes of therapeutic strength should be lodged in a single room and preferably in an end corner room. An isotopes room approximately 161-611 X should 1s•-o". be In addition there should be a small scanning room 101-011 x 161-6". All counters and their splashbacks should be of smooth nonporous material for ease of decontamination.

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SURGICAL ANC OBSTETRICAL 52 THE OPERATING SUITE The planning of operating suites has been undergoing drastic changes, especially since World War II. They used to be located on the top floor of the hospital with skylights facing north to benefit from even, shadowless daylight. In those days most operations were done by daylight. Improvements in artificial i llumination changed that, and today operating suits are planned on any floor of a hospital building. The operating suite should be arranged in a double-corridor plan situation because the total building depth is considerably greater than In the conventional single-corridor structure. The operating suite should have its own independent circulation in the interest of asepsis and order. The easiest condition under which to achieve this would be at ground level, where the. location would also offer the advantage. of contiguity to related diagnostic-therapeutic expansion. services and The average size of the normal operating room today is 201 x 20', and surgeons ask for even larger rooms as times goes on, primarily because of the constant growth of monitoring and other equipment which frequently has to accompany even more sophisticated surgery. Operating suites are currently designed to be under positive air pressure so that air will leak out rather than in. It was the concern over the infusion of untreated outside air, on the one hand, and the development of air conditioning, on the other hand that gradually convinced surgeons of the unserv iceabil it y of windows i n operating suites and brought about the windowless rooms with a rtificial I ight and 100 % fresh conditione d air. NUMBER OF OPERATING ROOMS A rule of thumb is one operating room per 50 acute general hospital beds. A standard operating room could be used six times a day for minor surgery or three times for major surgery.

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53 OXYGEN THERAPHY, HYPERBARIC CHAMBERS Most new hospitals today are piped for delivery of oxygen gas to patients rooms, operating rooms, maternity-delivery rooms, nurseries, emergency suites, intensive care and recovery rooms, and many other suites and locations throughout the hospital. Some chambers; pressuretreatment hospitals have hyperbaric the use of oxygen under high pressure chamber for of certain conditons. Often pure oxygen is given to patients. The fire hazard, therefore, becomes particular serious. A II electrical wiring in the highpressure chambers is explosion-proof. Doctors, nurses and patients must be decompressed slow I y, just as divers are. ASEPSIS Asepsis is a big problem in all aspects of physical planning where human life is inolved, and open wound are inevitable. EXPLOSION Af\D SHOO< IN THE CFERATING RCXA\1 A very important problem in operating rooms where flammable anesthetics are used is the accumulation of static electricity, a spark from which can cause fatal explosion. To approach this problem as far as flooring materials are concerned we should examine alternatives: 1. Use of terrazzo with brass grid imbedded in the floor spaces 4 to 6 inches to insure that a person's foot would have contact with the grid at all times. The grid would be grounded through a resistance coil to a metal riser preferably a cold water pipe. 2. The principal way is to have the flooring material itself possess the capacity of the requisite limited conquctivity of minimum of 25,000 ohms resistance between ground and any point on the floor.

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54 " \ \ \ I ' \ \ \ \ "' \ Section through J ean Walter's operating theatre at Lille, showing observation gallery and lighting SEATS 1 I I I I I I I I I I I I /' ...... ---.... \ \ I / _ ..... ,..___________ .., ------=---=-------__ ..., -> ,--' ' ....... ___ _ Vertical arid laminar air flo w rooms used in operating rooms for ultra a sepsis. This is, as are the other ai r enclosure methods. only warranted for u s e for surgery where air contamination ca n be important source o f infection. REflECTING DOME SEATS enclosure to reproduce the plastic bag enclosure. In this case t he entire surgical team is enclosed.

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55 OBSTETRIC DELIVERY SUITE The obstetrical suite and maternity patients, plus infants, should be housed in horizontal contiguity, and together they should be isolated from other hospital patients and activities as much as possible. There should be provided two labor beds per delivery room. Simple, sound-insulated cubicilized, labor rooms. rooms are preferred to curtained or congragated Doctors and nurses lockers, toilets, showers should be laid out similarly to the surgery suite with one notable exception: the doctors' lounge rooms should have a cot or two where obsletric can rest, dudng the night.

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56 OCCUPATIONAL THERAPY Occupational therapy is main I y a diversionary effort intended to give relief to emotional conditions while simultaneously of muscular allowing skill, the development strength and reeducation of certain muscles. PHYSIOTHERAPHY Phsiotheraphy concerns itself primarily with teh reeducation of muscles and body, such a learning to walk again after orthopedic surgery, etc. While the occupation theraphy room is a fa irly simple space, furnished by tables, a s ink and cupboards for storing supplies, phy_sical therapy has become fairly complex. It is generally divided into an exercise room or gymnasium, a series of curtained-off cubic! es for massage and various forms of electrotherapy and hydrotheraphy with various tanks containing surging water to produce stimulation and toughening of muscle or skin -and if possible, a swrmming pqol. Speech therapy made necessary .bY throad surgery, mental deficiency, deafness etc., has come to be considered part of physical the r aphy. REHABILITATION Rehabilitation is a department in which all forms of physical theraphy are employed. f1)

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NURSING UNITS 57 DOUBLE CORRIDOR PLAN The double corridor folds the linear or single corridor plan on itself and in so doing accomplishes two things: it shortens the building or floor and it increases its capacity because the services are removed from the perimeter and sandwiched between the two corridors. Other types of nursing units are: 1. Single corridor nursing unit 2. Parly double corridor nursing unit 3. Square nursing unit 4 . Pinwheel nursing unit 5. Circular nursing unit DISTRIBUTION OF BEDS The two-bed room is probably the most flexible; functionally both and Amei-ican standard. economically therefore is and the A hospital should have the following classifications of care: 1 Home care: medical, nursing, reha-bilitative under hospital supervision 2. I ntensiv. e care: for the very sick 3. I nt_ermed iate care: for the bulk of patients understood to be past the stage of imminent danger. 4. Self care: for patients who s tay at the hospital for extended diagnosis, therapy, convalescence, rehabilitation of other for ms of t reatment. Federal regulations prohibit patient rooms of more than four beds with no more than a two bed depth from the win dow. Arranging beds three deep from the window in not only perceptibly economical in construction cost, but is more convenient in nursing because the arrangement shortens the l e n gth of the nursing units,. thus shortening the walking distance from the service care to the patients. PEDIATRICS I t i s desirable t o seperate the pediatric service (for aseptic reasons) from other nursing units as much as possible,. retaining ease of access to diagnositc, services. therapeuti c and other A pediatric nursing uni t should have an environment all its own. The following are come of the problems

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58 which must be met: 1. To create a conductive environment. 2. The environment should be cheerful, bright, colorful, natural and uncluttered. 3. There should be a adjoining garden at the ground level or adjoining roof. 4. There should be sleep-in facilities for the mothers of small children. 5. There should be large unobstructed spaces for indoor play for the young kindergarten type, and spaces where older children can indulge their legit.imate need for diversion. 6. There should be facilities for continuing the normal schooling process in collaboration with the local school system. 7. Some furniture should be sized to the age groups. 8. For special certain clinical temp.erature and conditioning are desirable. situations humidity It should be P.OSSible to condition each room to accord with the need of its occupant qr occupants. 9. There should be enough small tooms to accomodate children wbich require isolation. 10. There should be ample glass in the partitions for children to see each other isolation, especially also to supervision. children in ease nursing 11. The pediatric service should be divided into small groups of 10, by age, sex, or according to clinical considerations. 12.Ample cupboard space should be provided for toys. 13. There should be facilities provided for mentally sick and retarded children. ---------------------------

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PATIETS ROOMS AND SERVICES 59 BEDROOMS The fully mechanized bed is usually 3'-311 x 71-611 and six extra inches are allowed at the head of the bed, thus making the total required floor space 31-311 X 81-011• The infants bassinet is 1'-511 x 21-711 x 21-611 high to 41-611 high and junior beds 21-611 x 51-911• To one side of the bed has be space for a bed-side table. There must be room enought to turn the bed to get it in and out of the room. In terms of modern pateint room furniture, the width of the room should be generally 121-611 on center of 411 partition, allowing 41-011 between pair of beds, 31-011 between the bed and the sidewall, and 41-611 next to corridor partition, the total depth of the room, should be 211-011• The closet for each patient should be large enough to hold the patient's clothing, . suitcase and extra blankets. There m u s t a I so be a was h bas i n w it h cabinet overit . to hold the patient's toiletries. The .general -rule of 80 sq. ft. per bed in multi-bed room is required, and a single room not less than 100 sq. ft. The rule also requires a toilet and shower in each room. It is also desirable to include in the corridor partition two cabinets: one for clean supplies and another for soiled. These are accessible from both corridor and the room side. NURSING UNIT SERVICES The nursing unit consists of patient bed rooms and of services which are more or less grouped together. usually the following: 1. Nurses station Medication station Doctor's charting station Nursing superv isor1s office 2. U til it y rooms 3. Treatment rooms 4. Pantry 5. Baths 6. Dayroom 7. N urses1 lounge 8. conference classroom These are 9. Stretcher and wheelchair space

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10. Corridors 11. Stairs, lobbies, elevators 12. Dumbwaiters, pneumatic tube stations, drinking fountains, nurses c all system, television etc. The maximum distance b etween stairways should not exceed 200 ft. also there must be at least two stairways They should be built fireproof materials and per of floor. stricti y have an unobstructed passage of not less than 3'-8" in width throughout. Doors connecting stairs to the bui)ding shoul d be self-closing at least 3'-8" wide. Isometric view o f t y pical room. LEGEND 1 Pan and basin c abinet 2 Clean material 3 Soiled material Emergoncy nurse c a lf 5 StaH comm4nicatlon system 6 Soap dispenser 7 Vanity 8 Mirror 9 towel to Wardrobe 11 Wardrobe 12 Overbed table 13 N ight table 14 Reading and examination lights 15 Service console 16 Television s o...__ ___ _ Typical patient module . I ..... ;:. --.---------. ty pical patie nt modul e

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SUPPLY 61 In planning, it is recognized that stores, storage, and shops must have a definite organization. Grouped with these, because of functionally desirable proximity, would be the laundry, central sterile, supply, pharmacy, necropsy, incinerator, etc. DELIVERY PLATFORM There should be a proper delivery platform to which vehicles can backup. The height of the platform should coincide with the floor of the average vehicle. The service yard and the road to it should be of ample dimensions, of proper gradients to avoid flooding and to accommodate standing and moving trucks. It is for the architect to see that under no foreseeable circumstance would access to the hospital. be blocked. Purchasing office should be planned very near the point of their delivery and if possible overlook the delivery pi atform. The average purchasing office would consist of waiting space to accommodate salesmen, plus receptionistsecretary and an office for the purchaser.

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PROCESSING 62 LAUNDRY ROOM The laundry room should be within the hospital building contiguous to stores, central sup pi y and other services comprising the third division of the hospital. The laundry room should be clean and airy, and air conditioned. The ventilation system should contain lint-collecting apparatus. The soiled-lined and sorting room should be physically partitioned off from the rest of the laundry for sanitary reasons. Each laundry room should have a storeroom for soaps and detergents. there is also need of a supervisor's office and a closet for machinery maintenance lubricants, repair tools and minor parts. Also there is a need for sewing room. STERILIZATION It is desirable that the pharmacy and the central sterile supply service have a common partition glazed to an extent which would permit the pharmacist to see what is going on in central sterile supply. There is still another advantage in this contiguity and that is that certain equipment such as that needed for the preparation of sterile or distilled water can be shared by the two adjoining services. PHARMACY Of all the supply services pharmacy is the most sophisticated. the It should be located near the source of sup pi ies (stores) and distribution point. There should be a strongly constructed and fireproof safe for such things which may give strong temtation to steal, such as alcohol and narcotics. Special precautions, such as direct ventilation to the outdoors should be provided for stored flammables. The pharmacy proper is lined by the usual specilized cabinets which hold the packaged and pre-bottled drugs. There must be a counter or a desk for recording and label typing.

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63 OXYGEN SUPPLY With the development of liquid oxygen, a piped-oxygen system is currently supplied direct I y from an oxygen tank on the hospital grounds. The oxygen supply consists of a cylindrical tank resting on a concrete pad. As a safety measure, the tank may not be closer than 200 ft. from the hospital. In any case, the tank has to be accessible from either the street or an internal road. A ward in the Investigation's experimental ward un i t at Larkficld Hospital, Greenock: the patient's view

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FOOD SERVICE 64 KITCHEN The kitchen should be placed as centrally as possible, in relation to the hospital's center of supply, processing, assembly, distribution, renewal and disposal. The kitchen would be best located on the same floor and as near as possible to where supplies are delivered stored and distributed and also adjacent to the cafeteria. the distribution systems may consist of elevators, capable of transporting whole tray carts, or tray conveyors. The kit chen floor space should be squarish. This is necessary to reduce steps, to avoid conflictS in circulation and to facHitate supervision. A hospital kitchen should have 18 -2 0 sq. ft. per bed. A pi anner must consider: supply and waste disposal, dry and perishable stores; preperation facilities, cooking and baking areas; potwashing and dishwashing space; salad, dessert and beverage preperation; serving setups of hot and cold foot containers bordering a moving belt conveying trays to carts or to vertical tray conveyor; means of transporting (carts, elevators, dumbwaiters, vertical tray conveyors, cart garage and cart cleaning area); administration offices for dietician, and the chef; and finally sanitation areas such as janitor's closet, toilets and hand-washing facilities. DINING ROOMS If possible, the dining room should adjoin the kitchen.

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ENGINEERING 65 Steam in the hospital is used to generate hot water for laundering, for general use, cooking, etc., and for space heating and air conditio(ling. Placing laundry and steam generating plant within the hospital building, particularly in multi-story buildings, is not only convenient and economical, but also permits incorporation of the smoke stack inconspicuously, as part of the building. EMERGENCY ELECTRICITY The use of electricity is increasing con.stantly, not only as a primary source of energy, but also in low voltage and wireless forms, (electronics). The uninterrupted flow of electricity through the hospital of today is of prime importance. in some instances, failure of the s e r v ice c o u I d be a matter of I if e and death. Therefore, the hospital needs a standby. or . emergency source of ele,ctricity of its own. This is usually an emergency gasoline-driven generator which turns itself on automatically when the public source fails. The emergency source automatically takes over of electricity lighting of corridors and stairs; and operation of at least one elevator, emergency, operating, delivery, recovery, and intensive care departments. FINISHING MATERIALS AND MAINTENANCE FLOORING Today, the most frequently used material is vinyl plastic used in sheets instead of tiles to reduce the number of joints in the interest of asepsis and economy. Vitreous tile is still used in wet rooms. More recently, hospitals have been experimenting with nylon carpeting, for p atient rooms, corridors and public spaces. Experiments show that bacteria falling on a carpet are apt to sink into the nap. and not be readily swept up by air currents. Carpeting seems to be favored also for its color, texture, acoustical properties, easy on the feet and ec.onomy of housekeeping effort.

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66 WALLS AND CEILINGS not on doors which are marred and scarred by passing wheelchairs or beds. Partitions in the hospital are more and more made of one or more layers of gypsum board, clipped to metal studs. This has the advantage or rapid and dry construction adequate sound proofing, and convenient raceways for electric conduit and small pipes between the perforated metal studs. The walls are currently with the new kind of paint. sprayed-on Such walls are washable, practically without limit and durable. When protection is needed against hard such as wheeled carts, 6" x 2" wood plank rails along corridor walls should be used. These are aesthetically pleasing, can take heavy punishment from carts, and at the same time can act as rails along which a weak as handicapped patient can propel himself. Carpeting is also beginn_ing to be used increasingly on walls as wainscotting. This would be particularly feasible in public spaces and corridors where carts ma r walls. And. if useful on walls, why CEILINGS Are either of fire-safe acoustical tile hung from or applied directly to the slab, or the slab is painted, after thin coats of plaster are applied. DOORS At hospital entrances are most frequent! y of laminated glass with practically invisible top and bottom hardware. Doors to rooms are usually flush wood veneered on a solid core. Regulations require minimum door widths of 31-8". Swing of such a door is strenuous, also the large amount of floor space needed over which to swing a wide door, the double door of uneven leaves should be considered. One 11-4" which generally stands in closed position and is opened only when a bed has to be brought through, and the other of 21-8" door for normal passage of persons. the hardware on the doors should permit a patient or

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67 staff to open it with ease even when the hands are full. Structural systems should be designed to adopt a multiple use of spaces served. Due to highly restrictive fire protection associated with hospitals, basic structural frame will generally be non-bearing brick walls. Steel construction will be used for this project. Trusses allow for depth of mechanical spaces and. provide long spans. Steel construction is generally less expensive than concrete. The use of steel construction would also include a fire proofing agent. Spans should be as wide as possible with as few column as possible. Shallow roof construction is recommended for multi-story facilities. The design of hospHals has been significantly affected by the increasing complexity of mechanical and electrical considerations. One half of total construction cost is now typically accounted for by mechanical and electrical systems. In general, mechanical and electrical systems should be. designed to account as much as possible for mu'lt ipl e use of spaces served. This may be accomplished in part by designing for the capability of taking greater loads. In designing mechanical and electrical systems, an important consideration involves planning for the future, both, in terms of expansion and introduction of new technology. Finding space requirements for more and more utility lines is an increasing problem. Ducts, pipes, conduits, medical gas systems, HVAC, and communication systems must be taken into account. There is an increasing tendency towards use of piped medical gases. One solution to these intorudciton problems of has been the interstitial floors devoted totally to mechanical and electrical systems. the ceiling height is generally enough to allow maneuverability. Electrical systems typically include a hospital communication system, a telephone system, a dictating system, an emergency power sup pi y, and doctor's registry system. this seperate source are usually needed and automatic throw over to the second side. General

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68 lighting, in temrs of foot candles, should be designed for work levels as stated in applicable codes. Typically, fluorescent lighting with 100 foot candles for general lighting and 2000 FC (adjustable) in operating room is sufficient. The number, location and type of outlets is dictated by code and by need. A hospital emergency standby source is necessary. There should be 220 volt available @ X-ray and all surgery equipment and an isolated transformer in the cardiac room. HVAC following: requirements 1. Distribution system include 2. Thermal and acoustical insulation 3. Ventilation system 4. Air conditioning system 5. Humidity controls 6. Filters 7. Thermostats and 8. Air pressure MECHANJCAl REQUIREMENTS A . • Federal Regulations the 1. Design Capacity of HVAC system a. minimum relative humidity SO% b. maximim relative humidity 60% c. condinuous recording hydrometer installed d. Temperature 68-78F. 2. General HV AC a. Duct linings shall not be used in systems supplying operating and recovery rooms unless terminal filters of at least 9 0 percent efficiency are installed downstream of linings. b. All air supplied to operating rooms shall be delivered at or near the ceiling of the area served; all return air from the area shall be removed near floor level. At least two return air outlets shall be used in each operating room. c. Each space routinely used for the administering of inhalation anesthetizing agents shall be provided with a separate scavaging system

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d. 69 for venting anesthetizing gases. of waste Pressure balance must be such that the gas collecting system does not interfere with required room pressure relationship or with breathing circuit that my affect patient safety. Filters: a minimum of 2 filter beds with 25% efficiency at no. 1 and 90% at no. 2 are required on all central ventilation or air conditioning systems. No. shall be upstream of AC equipment and No. 2 located downstream of the supply fan. ' ----( --=--

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MMUNICATION 70 FACE-TO-FACE COMMUNICATION The best way to communicate is by means of face-to-face conversation. TELEPHONE The next most important means of intra and extra mural communication is the telephone. The telephone is also the most convenient and currently the most readily available instrument and the most widely used. MICROPHONE A m i crop hone m a k e s it p o s s i b I e to broadcast religious services, addresses, urgent announcements, music and other entertainment, lecture to the staff, alert doctors, etc. DOCTORS PAGING SYSTEM Most frequently used system in the hospital is the traditional paging system. The doctor upon ent-ering the hosp ita I, registers with the-hospital's switchboard operator. when a c all comes in for the doctor the operator determines whether he is in by looking at the doctor 11in-and-out board11 and calls him through the PA systems. The radio 11beep11 system is much less anoying and convenient, and serve s the radius of 1-1 I 2 to 2 miles from the hospital. NURSES CALL SYSTEM Nurses' call system remains the backbone of communication bet ween patient and nurse. The patient pushes the 11button11 i n the call piece which h e h eld in hi s h a n d . By doing this several lights were turned on; one over the patient's bed one over the door to the room and o n e at the nurses' station, also in the utility room and floor kitchen a buzzer would sound. The nurse woul d thus b e g u i ded t o the c allin g patient. The nurse c a n l ift the telephone receiver and asks the patient what he wants.

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71 MEDICAL LIBRARY There should be two or more libraries in every hospital. One is a professional library for the medical, nursing, and technician staff and the other is largely for the diversion of inpatients. Adjoining the libraries are the doctors• rest room, lockers and toilets. PNEUMATIC TUBES The pneumatic tube system serves two purposes: commun-ication, since such things as mail, laboratory reports, X-ray plates, messages etc., can be sent through it; and transportation, since pharmaceuticals and almost any kind of small article of suitable size can also be sent through it. I think a pneumatic tube service is a matter of prime importance and a legitimate conserver of human labor and perhaps even of human I if e. The success of a hospital plan can depe-nd largely on the selection of the proper type of transport system. ELEVATORS -Are generally considered the vertical transportation system. DUMBWAITERS Operation becomes considerably more efficient, especial! y be removing the human element from the loading and unloading operation. STAIRS In the United States are as a rule purely utilitarian; they are seperated from the rest of the building by at least 611 of masonry and meta l-ei ad fireproof self-closing doors. They can generally not have more than 13 risers to a 11run11 without being interrupted by a landing and the width of the stairs may not be less than 31-1011•

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LIGHT AND COLOR 72 LIGHT Patient room lighting should consist of one 40 watt tube ( 4' Ionge) under the reflector sending light upward for general illunination and one tube of the same voltage sending it downward for reading, etc. There should be also a night light behind the runner consisting of a 7 watt incandescent bulb. All 3 light sources should be controlled by the patient from one control piece. The same piece also controls the television set on the wall opposite the bed. COLOR The sensitive architect of today much time studying natural and artificial light and color to suit every situation in the hospital. At the same time, he should keep in mind the necessity of keeping the whole hospital in harmony. Most well-designed American hospital interiors today have walls and ceilings in a neutralized white, perhaps leaving one wall in some neutralized bright primary color. COLOR IN THE OPERATING ROOM The surfaces in operating room should be green which is less fatiguing to the eyes than white.

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I I I I I . , "' .. Ill I I • • • • ! • • • • • I I --I -------I • I I I I ! ! 73

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• COST

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COST 75 COST An architect should provide cost estimates when preliminary or "development" drawings are completed. Estimated cost of a project considers some of the following: 1 . Cost of professional services should include the fees for consultant, architect, perhaps for special subsoil and/or drainage investigations, topographic survey, cost of services of professional cost estimator, etc. 2. Building cost estimates per square foot. 3. Work to be done outside the bilding genera II y consisting of underground utilitites, grading, roads, walks, parking spaces, and general landscaping. 4. Cost of movable equipment and furnishings. (employment of the interior designer). FINANCING . ' The following. are the sources of con.struction investment: 1. Federal funds 2. State and local governments 3. Philanthropy 4. Proprietary equity 5. Hospital indebtedness 6. Hospital operations

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FINANCIAL FEASIBILITY 76 New construction (total sq. ft. 50,000 @120,000 sq. ft.) Renovation construction (sq. ft.) Site Development Equipment 1,000,000 Fixed Movable Architects Fee Other fees (soil survey, engineering, inspection, loan, ins. fees) Contingency (construction, change order, inflation) Financing Fee Consulting Costs (e.g. planning environmental impact, etc.) Feasibility Study Net Capitalized Interest TemPorary Relocation Expenses Start-up costs-supply stocking Bond Issue Costs: Truste e Fee Legal Fee Printing Expens e Title and Recording Rating Fee Total capitalized project cost $6,000,000 340,050 500,00 0 500,000 370,463 25,500 672,750 150,000 9 ,49 8 ,763

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77 Need survey (role study) Preliminary feasibility evaluation Demand study (workload projections) Estimate debt capacity Determine financing method Secure certificate of need Schematic specifications design and Formally appoint investment banker Render underwriting commitment Complete financial feasibility study outline Prepare leases a7 bond trust indenture Finalize official statement Review, approve and release official Issue commitment to purchase bonds Market bonds and deliver proceeds to hospital Phased (fast track) construction

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78 MOJIT&I 1 I I 4 I 1 I I 11 U 1.1 1.1 l4.lol Ji1 U 11 II • &1 •• 111111 IUIYIT IIOLI ITUDTI I PIILIII JIAIIIILITT IYALUATIOI DIIIAJID ITUIIT IWOIILOAII PIOJICTIOJIII IITIIIATI DIIT CAPACITY I DITIIIIIIII IIJIAJICIJIQ M ,ITIOII I• u rur.LU L.&.LaU • 10t111 nun DIDIIfTVII II rtJI.U.ID orncta.1. rT 4 n IGitT EXAMPLE OF FINANCIAL PLANNING MODEL, TYPICAL TAX-EXEMPT BOND FINANCING PROCESS LEGEND IM!*ffA MCnOIW. n..uocu I !MU UCJQ"TWCTISJtOtxUI U
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PROGRAMMING

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ao P R 0 GRAMM I N G C 0 N S I DE RAT I 0 N S A number of considerations are involved in assigning space to an individual room or area, and such considerations may vary for different rooms throughout the hospital. It has been stated that an architect can design an individual space (including assigning dimensions and net square feet) if he knows: (1) what is to be done in the spce, (2) who will be doing it, and, (3) what equipment and environment are needed. State and federal regulations affect space assignments in a number of instances. For example, most states stripulate minimum square footage requirements for spaces assigned to operating rooms, central storage areas, certain specified examination-treatment rooms, etc. In addition, such minimum have long appeared in federal standards and are current! y published in minimum requirements of Construction and Equipment for Hospital and Medical facilities, c(HRAi 74 74000, DHEW Publication 1974. Therefore, simp I y for new consturction to be licensed for operation minimum space assignments for a number of functions have to be met. • • • C. Ol\. -tiMu.td (.(... +; V 5a..-fi Ol\. ofoa:..u.A"5. f;l t:''][ ... J u '-=------'=' c:=::=! • servia ou; -r

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GROSS S.F. PRO..JECTIONS ! . PROJECT S TATEMENT Existing St. Anthony' s Hospital is a complex composed of series of buildings constructed in phases; the oldest from 1906 and the most recent add i t i o n , the East Wing dating from 1967, The site is located in the city of Denver and serves patients per year, 65% of whom live near the hospital. The o ther 35% of the patients are brought in by the emergency "Flight for Life" helicopter service from the 150 mile radius surrounding the haspi tal. The project provides an excellent challenge, sinc e it has a wonderfull view of Sloan Lake at the North, East, West and South sides are surrounded by single-family housing. I would like to approach thi s problem by solving the problems in phases. A-First I shall eliminate the existing numerous parking lot s by providing a parking structure at the South-East or corner. This approach will provide additional space for t h e future expansion of the hospital. B -Secondly the existing 1 928 m echanical room is outdated and inadequate to handle existing s tructure and the proposed addition. I would like to provide new mechanical room i n t h e 1963 Sou t h Wing's basement. At the present time t his space is unoccupied or use d for s torag e . C -Thirdly the existing Nursing School is a 1906 histori c preservation building. At the present time this building is under renovation. I propose to move the convent and chapel into this building. This step will help me t o achieve 2 thing s : 1 . It will e liminate " additions" and "fingers" sticking out from the East wing .

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2 . It will provide privacy for the convent nuns by occupying a seperate building. This building is connected to the East wing by the underground tunnel. D -In the new main North addition wing will be housed the following : 1. The new operating suite, recover y roo ms , anesthesia office 2 . The Medical Records Department, Credit Union, Security Dept., new chapel, business office, and administration office. J . 48 bed nursing unit 4 . 36 bed nursing unit 5 . 24 bed nursing unit 6 . Intensive Care unit 7. New Helopad E -The existing operating room suite will be renovated and turned to a 53 addition patient' s rooms. F -This new additi-on will help to establish a more prominent main entrance to the site by taking advantage of the North' s 17th.Ave. and Sloan Lake. This new access to the site will provide new identity to the medical facility. Existing access from Canejos St. will remain and will be used as a secondary entrance, because it is not dominant enough, and confuses newcommenrs who can not locate the entrance. Handicapped and visitor' s parking will be provided contiguous to the new main entrance. II. SITE DESRIPTION A-Topographic The site is located i n the North-Western Denver. I t is surrounded by single-family housing on the East, West by sinagogue and single-family housing, by professional building and 2 and 3 story apartments at the south and Sloan Lake at the North.The site slopes gradually down form South-West to the

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r------------------------------------------------------------------Norht-East 10'. 3The new proposed building shall be as energy efficien t as lh all seasons. Building orientation and form, shading use of natural lighting a d energy efficie cy shall be consi dered and incorporated i nto the design. III. PROGRAM REQUIREMENTS A. SITE CIRCULATION 1. Public transportation (buses) service on 17th Ave. 2 . Automobile circulation a . Public parking facilities contiguous to the main entrance, handicapped and other visitors 50 spaces b . Parking strusture for staff, doctors, selected visitors, and handicapped persons, J , Service -service access shall be from Perry St. and Canejos St. Emergency access shall be from the Perry St. in addition to the existing. Existing main access shall remain and serve as a secondary access. B . NORTH WING HOSPITAL ADDITION Space requirements indicated are net sguare feet 1 . Basement Level a .Operating suite(16) (1 per 50 patients) b .Recovery room (4) c .Anesthesiology dept. d .Sterilization room e .Physician' s room f .Dirty utility Room g .Clean Utility Room h .Storage for operating equipment i .Stairs (2) elevators (2) 84 L._ ______________________________ ---1500S . F . 150,000 S.f. 18,500 SF 6 ,400 SF 1 ,600 SF 1 ,000 SF 500 S F 1 ,000 SF 500 SF 500 SF 2 ,500 S F . 500 F

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j.Holdin g room, circulation k .Doctor' s lounge 2 . First Floor Level a . Chapel b. Medical Records Dept c . Business Office d . Administration e . Security Dept. f . Credit Union g . Stair ( 2 ) Elevators ( 2 ) h . Lobby ( publi c toilets, janitor, public phone cashier, cafeteria ) i . Library Administratio n a ccessible from lobb y This s pace will house the adm i n i s trato r ' s office, administrat or's a i d , conference room . Medical Records shall have Med. Records Librari a n office, open office for the staff o f 5 , r ecord storage for 360,000 patients charts, microfilm storage, movable file s , com puter master file system , distributing dumb waiter. 2 ,000 S F 1,000 S F 18, 500 S F 3 ,000 S F 6 ,000 S F 1 ,000 S F 1,000 S F 1, 000 SF 1 ,000 S F 500 S F 4 ,000 S F 500 S? First F loor will also have cafeteria for 1 5 0 v isitors and a chapel for 200 visitors and patients. 3 . Second Floor ( 4 8 bed Nursing unit) a . 24 patient's semi-private rooms & toilets b . Corridor & circulation c . Nursing station d . Medication room e . Physician' s dictating/resting r oom f . Employee' s lockers & toilets 1 8 ,500 S F 9 ,000 S F 4 ,000 S F 500 S F 100 S F 200 S F 500 SF . !

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g . Clean Utility room h. Dirty Utility Room i. Conference Room j . Stair (2) Elevator (2) k . Pantry, dumb waitor l . Equipment storage m . Patient' s lobby/sitting room (used as a sur&ery waiting room on 2nd floor) 4 . Third Floor Same as the second floor but 36 patient' s beds instead of 48 5 . Same as the second floor but 24 patient' s beds instead of 48 (Fourth Floor) 6 . Fifth Floor ( Intensive Care Unit I CU) a . Circular Nursing Station b . 6 beds c . Toilets d. Equipment storage e . Monitoring Room f . Physician' s chart room/rest room g . Stair, elevator ? . New helopad shall be located above 6th floor on the roof, it should have a direct undisturbed connection with the operating room and ICU 8 . Convent in the renovated building a . Recreation b . Dining c. Kitchen d . Rooms & toilets e . stairs & elevator 500 SF 19000 SF 500 SF 200 S F 1 ,000 SF 1,000 SF 17,000 SF 15,000 SF 5 ,000 SF 11000 SF 1 ,000 SF 500 SF 500 SF '500 SF . 1 , _000 S F 500 SF 5 , 000 SF 6 ,000 SF 1 ,500 SF 500 SF 500 SF 1 ,500 SF 200 SF BBL_ ______________________________________________________________________________ , __ _,

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' J DESIGN

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LOW TAAFP:IC ___ .... ._ _______________________ --L BUN eVNACIDOU W t N T .. 1 I I I I I I I w. 17 TH. AV•. LOW' NCII8 • • -.,: WSIIT WIN G • I • I :::;; I ! ++--..J w. CONE.JOB PLACE • HntA-IC •••••••••••••••••••••••••••••••••••••••••• . . ..... . ..... + I " LOCATION ( ___ . ..

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1\---..

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FfRST FLOOR ., ........ • ,.....,...I"''Om_,_. "'............,_ ... ........... . _, 7--10 ..,...._...,... ...... 11 •"*'*"8 1:11---SECOND FLDDR

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T1 II 1D & J. OlSfTH FLOOR 't p8tienc• MY' cype .. • pett.nc• MY' type • 31 •c•Cion • •""P'Dv••• a t:r-t...-..nc ,.,.. 7 • 5Hit'-"t• tounv• FIFTH & SIXTH FLOOR

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SECTION A A SECTION B-B

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_ _j TYPE 2

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CONCLUSION I would like to e1icate this thesis to m y h usband, Nho h e lped m a great deal emotionally and physically and without wh o m I wou2.dn ' 'ue dolng the thesis at all. Ten years ago, when I became a regisexisting Canejos Place entrance, which is confusing to v isitors,hospital entrance should be easy to find). I w ould like to turn the existing main eDtrance into an outpatient entrance. Very obvious problem on the site is tered nurse I never t_ought I will b e the sea of parking lots surrounding designing a hospital someday. For four the existing building, as well as the years, working at the Medical Center 1928 mechanical structure blocking a in Detroit, Michigan, I observed the wonderful view t o the Sloan Lake. To problems, that the staff and patients solve this problem I propose a new have to face every day in the hospital parking structure in the Southeast design. I also observed the psychological effect of room color and views to the outside on patients' time of recovery and mood . Also the effect of hospital design and color on the effi ciency of staff. In my thesis "St. Anthony Hospital redevelopment" I tried to remedy and solve some of the problems which are corner of t h e site, with two floors below grade and two above (being sensitive to the surrounding low residential buildings, adjacent to the site . The parking structure will house 750 cars of the staff and employees, and will have an underground tunnel connecting parking structure with the main building. Adjacent to the parking structure I very obvious to me. will locate a new mechanical struc-ture hiding the oxygen tanks behind hospital needs a more prominent a brick wall. entrance. My solution to this prob-lem is a new entrance on the 17th St. Along the tunnell there will be loacross from Sloan Lake instead of the cated pipes running from the r

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cal room to the main building, providing easy access in case of malfunction.There will be a small parking lot at the main entrance for visitors and at the outpatient entranc e . Another problem which I intend to solve is the existing 1928 North wing, which at the present time is mostly vacated or used for thrift shop and other non-related hospital functions. I propose a new 136 bed North wing addition. The new structure will provide a new Medical Records, Library, Administration, Lobby, Business Office, Chapel, Visitors Cafete-In the patients' lounge I tried to provide a feeling of calm and comfort, as well as feeling of sharing, where the patients from different floors could share the space, look down to the floor below, enjoy the view of the lake through the trees and plants. An important point I want to make in this desing is that a hospital is like an expensive hotel, where the paying customers are the patients. They should be provided with all of the comforts of home" I tried to accomodate the patients with the rooms, where the two beds are the same (neither one is better than the ria, Patients' Rooms , Nursing Stations other) facing each other, with curtain and my main focus -the patients' loun-for privacy, and handicapped bathrooms, ge. Taking advantage of the Sloan Lake include baths and shower in every room. view, patients' lounge is located on the north side facing the lake. The private rooms will have a seperate sitting area apart from the bed area, On the national TV the experiment with removable wall for flexibility. with the patients having surgery shows that the patients where their views Also these rooms will have private balconies facing the lake. from their rooms were facing to a plea-Since my new North wing would like to also treat facades of East and West Addition I the north wing. I will sant view of landscape or water, these patients recuperated twice as fast as the patients, whose room windows faced a wall or other building. remove existing chapel, convent and

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-------------------business office. The 1906 Historical preservation building located on the East part of the site could accommodate a convent very well. By eliminating these "fingers" on the east wing the north facades of both east and west wing will be reconstructed to blend with the new addition. I am very satisfied with the resulting design of my thesis. Both a dvisors -George Clymer and Ron Rinker have been most helpfull in offering their expertise. I have realized h o w complicated the hospital design really is, but it provides me with a challenge which I would like to continue in the future. Hospi design, with its problems and interesting and innovative solutions, provides constant awareness and excitement. It my ;oal to become a specialist in health care facility design.

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BIBLIOGRAPHY I

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1. American Hospital Association. A Portfolio of Architecture For Health. Library of Congress Cataloging in Publication Data 1977. 2. Bard, Bernard. A College Health Center Library of Congress Catalog. 3. Beck, William C. The Health Care Environment, The Users• Viewpoint. CRC Press Inc. 1982 4. Cammock, Ruth. Primary Health Care Building. Nichols Pub I ishing Co. 1981 5. Devise, Pierre. Misused and Misplaced Hospitals and Doctors. Library of Congress Catalog 1973. 6. Malkin, Jain. The Design of Medical and Dental Facilities. Van Nostrand Reinhold Co. Library of Congress Cataloging in Publication Data. 1982 7. N uffield Provincial Hospital, F arreii B rown, Le'slie, Ernest R. Carling. Studies in The Function and Design of Hospitals. Oxford University Press 1957. 8. P Ianning with Climate and Solar Energy Denver Planning Office City and County of Denver 1981 9. Public Facilities Inventory. City and County of Denver 1980 Denver Planning Office 1 o. Rosenfield, Isadore. Architecture Van Reinhold company 1971 11. Rosenfield, Isadore. I ntergrated Design. Pub I ishing Corp. 1950 Hospital Nonstrang-Hospitals Reinhold 12. The American Association of Hospital Consultants Function Planning of General Hospital McGrawHill Inc. 1969.