Ways of development of hospital construction

Ways of development of hospital construction

L. Yurovsky, the candidate of architecture

New organizational forms of medical care, carried out by the Ministry of Health in recent years (the association of hospitals with polyclinics) and in the common organic fusion of inpatient and outpatient care, in a rather largely change the structure of the old hospital, regardless of its organization (decentralized, mixed, centralized ).

In this regard, the architects there is a problem — to develop a new structure of the hospital, while ensuring appropriate conditions for hospital and outpatient.

One of the major issues that have a significant impact on the bulk composition of the whole medical complex is the question of the location of the clinic in this complex.

Should the clinic located in the same building with a hospital or to be (in the hospital) in a separate building?

Centralized hospital is often called monohull. This definition, however, is conditional. A number of central offices of the hospital in accordance with their functions should be separated from the main medical building. These offices, for example, include the post-mortem room, laundry room, garage, and so on. N. They also should include and clinic.

The merger of inpatient and outpatient care determines the creation of a single hospital (in one area), and yet not necessarily placing hospital and clinic in the same building.

Unfortunately, this issue is solved differently in the practice of engineering.

Typical projects combined central general hospitals in the 75 and 200 medical places designed Giprozdravom USSR, provide the location of the hospital and clinic in the same building.

The head of the architectural studio Giprozdrava Soviet Leonid Chernyak, in his article «Develop advanced design techniques» 2 states that the union Polyclinic hospital in the same building provides a synthesis of the actual treatment and prevention. Is it not a mechanical interpretation of the question?

The principle of such a plan and the architect defends the castle was in the article «On the integrated» design of hospitals and poliklinik2. He also refers to the fact that the meeting on the construction of the hospital, conducted in 1951 by the Academy of Architecture of the USSR expressed in general for combining hospital and clinic in the same building.

However, it was not a unanimous decision. There were other points of view. We were and still seems to be that the inclusion of outpatient clinics in the building of a hospital, as a rule, is not desirable and acceptable only in special cases, with extenuating circumstances (lack of land area, and so on. N.).

This question is so serious that it should be more detail.

In the opinion of the supporters of the «marginal» centralization of hospital and clinics major advantage of combining these treatment facilities in the same building is the convenience of visiting outpatient treatment and support departments (physiotherapy complex radiotherapeutic offices and so on. F.), Which shall be common to the hospital and clinics. However, this advantage is substantially little much: after all, at the location of the auxiliary offices in the building of hospital outpatients visiting these offices (so-called exchange of patients), generally do not have to go to the clinic or to the adoption of procedures, even more so after them.

A second advantage of combining the hospitals and clinics in the same building is supposedly saving the cost of construction. But this is only apparent savings. Location substantial number of small area (8-12 m2) outpatient surgeries in the lower floors of the hospital ward under sections causes an inevitable increase in the area of ​​cabinets against the existing norms. This happens due to the fact that the depth of the chambers should be at least 6.0 m, and, consequently, the minimum width — 3.0 m. The types of projects that the combined hospitals overrun the area, according to our calculations, overlaps the aforementioned savings in construction cost not to mention the fact that the submission of planning clinics planning scheme ward sections leads to a significant deterioration in the quality of the functional clinic. Isolation of the clinic in a separate building would provide an opportunity to resolve it organically and economically.

A third advantage is the convenience of a single building, produced for the medical and administrative and technical staff, hospital and clinic attendants, and a fourth — urban advantages: one medical building responds to the trend of the known high-rise urban areas.

These benefits are indisputable. But whether they are large in comparison with the main negative points that arise poi clinic location in the building of a hospital? We believe that these benefits are negligible.

What are the disadvantages of the location of clinics in the building of a hospital?

The first and main disadvantage is that the placement of a hospital clinic in the building will certainly lead to a deterioration in the conditions of the inpatients to a breach of peace and quiet in the hospital. However, outpatient almost no additional facilities are not created. Poi hospital location in the depth ration zone will inevitably pass a large number of outpatients through the zone, and therefore will break the silence and peace inpatients. So. for example, in a hospital of 200 medical places number of outpatient visits per day will be about 900 — 1000 and in the hospital for treatment of 400 seats — 1800 -2000 visits.

One may argue that it required the location of the hospital in the back of the hospital grounds and surrounded by a protective green zone? We believe that this arrangement is to be the rule.

The entire course of development of the socialist health care. which is based on a truly humanistic attitude toward man, it suggests that the farther. especially Soviet hospital is closer in type to the hospital-sanatorium.

This hospital in our view should be located in the center of a thick enclosure of the park, where there is no access to outsiders lindens: medical building itself is full of plenty of terraces, verandas, balconies and TP 1.

The transition from a multihull (Pavilion! System to a centralized as the groove and creates an environment where the size of poi green protective zone around the hospital can be significantly increased.

There is no doubt that in the big cities, in areas with high population density, is not always possible to implement these optimal conditions. But in the small towns. in workers’ settlements, as well as in the cities of the allocation of land for new buildings in central hospitals, best meets the requirements, it is realistic.

Everything on the central nervous system of the patient gives a favorable reaction, the treatment should be used to the greatest extent. Needless to say, as a favorable response in the diseased organism causes the maximum silence, peace in the House. in the park?

Is it possible to avoid a negative impact on the conditions of the inpatients department busy as her clinic at the location in the building of a hospital? By various organizational and planning activities can only be weakened somewhat this weakness, but it is impossible to eliminate it completely.

Some architects and doctors push even more categorical demand that deserves, in our opinion, endorsement, namely that both is «noisy» room, as the administrative and public (office, hozchast, meeting room and scientific conferences, premises of public organizations, etc. . n.), it was given the building of the hospital and clinics included in the building.

The second drawback arrangement hospital clinic in the building is the possibility of free (unregulated; contact inpatients who use the park, with outpatient solo, with any unauthorized persons.

Comparing the «pros» and «cons», we conclude that the issue should be resolved in favor of placing the hospital and clinics in separate buildings. The practice of medical protective regime, which has already become the norm for our patients, it inclines to that conclusion. The architectural composition of any complex or building (and even more sick, should be primarily justified the fullest satisfaction of the functional process requirements. All other benefits will be actual weight only when they coincide with these requirements (in this example — with the requirements of medical business ).

Of course, needless to say, that in one main medical building (plus a hospital clinic) much easier to decide the composition of central hospital complex and that a town planning point of view, setting buildings closer to the street, to be included in the overall ensemble of buildings, is more effective. But hospital-health center in the first place should be full-fledged health resort.

Just look at the draft master plans of hospitals listed in the aforementioned article Gradova G. and L. Chernyak, to see how improved the conditions for hospitalized patients if the hospital building was relegated deeper into the park, and took the place of a hospital clinic.

Noteworthy in this respect, a model project for 400 hospital beds and 750 medical outpatient visits per shift made for Moscow Special architectural and design bureau APA Moscow City (authors -arhitektory M. Hoffmann-Py-barks, J. Ostrovsky, M. and N. Smurov Kapitsa, 1952).

In general, it is interesting conceived through spatial structures clearly visible tendency to overcome the authors considered in the article, the basic contradiction of the joint centralized hospitals. Hospital solved like a single building. But essentially clinic (which is also taken control of the hospital) is separated from the hospital. Last submitted to an independent ten-volume and polyclinics (children and adults) are solved in two, as separate four-storey buildings (wings), arranged parallel to the hospital in front of it (approximately 15 m), and connected to it by two narrow galleries on the second floor. Solution of the problem turned out to be a palliative, because, firstly, the relationship between the hospital and the clinic turned neorganichno 2. Secondly (and this is significant), in favor of urban development had the effect of hospital move up relatively close to the street, while the site allows you to place the it in depth, in the center of a large array of greens.

It should be emphasized that the possibility of placing polyclinic hospital building, as we mentioned, is not to be excluded. It is possible the circumstances under which such a combination would be the way out of a difficult situation.

Concluding its consideration of the placement of clinics, it must be said that the fundamental importance of this issue for the centralized architecture of the hospital is so weighty that it should be made the subject of special discussion.

Has matured a lot of questions, whose resolution is necessary in order to further improve the construction of the hospital.

Thus, the creation of conditions in the hospital a maximum of peace and quiet to a large extent to promote the application in the construction nezvukoprovodnyh designs. Basically, it refers to the intermediate floors and partitions, as well as at the door. The practice of hospitals showed that the applied current ceiling of the prefabricated panels and walls of precast shlakoalebastrovyh or a gypsum hollow core slabs as thick as 10 cm are unsatisfactory in relation to sound insulation and its urgent need of improvement.

Due to the wide use in the medical practice of climatotherapy treatment the building should be equipped with open spaces, porches, terraces, balconies, which are especially necessary in the climatic conditions of the southern regions of the country.

Meanwhile, the model projects of urban central hospitals Giprozdravom designed, for the most part do not include any devices for patients stay in the open air. Is this evidence of underreporting the requirements of medical science?

The experimental design central hospitals conducted by the Academy of Architecture of the Ukrainian SSR (1949 — 1953 years.), Suggests that the possibility of providing such devices, as well as the allocation of outpatient clinics in a separate building, can be found within the regulatory cubic capacity, without increased cost of construction cost building.

A very significant factor for wellness in the hospital is a comfortable microclimate. It is known that the air conditioning is the most «perfect form of ventilation. It would have required a timely design and installation of conditioned every new hospital construction. Otherwise, in the finished building will have to perform complex technical work.

Particular attention should be paid to the problem of the interior.

The interiors of most of the pre-revolutionary prevailed hospital official spirit prevailed, particularly dreary monotony of cold white. Many doctors and architects today believe that the white color, fast «signaling» of the slightest contamination, it is only acceptable in the interior design of hospitals. This, of course, wrong. We must not forget the presence of a person of color «hearing» of psychophysiological significance of color.

The interior of the hospital (especially the interior chambers) should be deeply thought out and differentiated, depending on the destination premises, on their orientation to the cardinal, sizes and so on. N.

Meanwhile, in our model (and in private) hospital project questions the interior, color, decor, furniture, fixtures are often out of sight of the designers. The composition of the interior must be addressed fully, in full, as is done in any public building projects.

It would, of course, wrong to say that all the above — creating conditions of maximum peace and quiet conditions for climate, comfortable climate, beautiful, cozy and hygienic interior and so on. N. — Previously was not in one way or another the subject of attention of architects and doctors. But the fact that all these issues were considered only from the standpoint of the general culture of hospital.

Now, with the extensive development of Paul’s teachings about the impact of the environment on the human body, the unity and interdependence of mental and physical phenomena, these issues must be addressed in order to improve the therapeutic process. Hospital building must be such as where each element in a separate and generally perform a kind therapeutic function.

What does this mean for an architect? This means that the architect, organizing the physical environment, in this case, the hospital can actively, in the right direction of a doctor, to influence the processes occurring in the body of the sick person.

A few words about the industrialization of the hospital building. In this area as in any other public building, large number of types of buildings. A conservative estimate of only the major hospitals in hospitals of different profiles, there are about 40 types.

Under the current practice, the design of a piece of standard hospitals can not, of course, a high degree of standardization and typing structural elements of buildings. Suffice it to point out. that existing types of projects the combined hospitals (work the last two years), the vast majority of diverse nature of similar construction elements is extremely high.

It seems that only the transition to the serial design method will provide maximum industrialization of the hospital building, a translation of his mostly on prefabricated assembly processes.

Developed in the Soviet Union, the serial method of designing a model is applied only in housing construction. Its positive qualities are now so obvious that he was in the construction of the leading determinant plays an important role in the industrialization of the construction and to improve the quality of architecture residential complexes, streets and entire cities.

Of course, there is a significant difference between the goals of the serial design of residential and public buildings. If the serial design of the home is the goal of an integrated building, the design of public buildings, such a goal is not, as these structures are built separately. Yet the significance of serial design of public buildings, especially hospitals, in improving the industrial building is extremely high.

Currently, the Academy of Architecture of the USSR and Ukrainian SSR is working on the design of standard serial hospitals. The novelty of the problem, of course, has caused the search for different ways to resolve it. Moreover, it is necessary that the work of the fundamental provisions became public criticism. It certainly helps to avoid errors, hospital construction will raise the level of modern requirements of medical science and architecture.

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