Proposal for setting up
In accordance to our discussion we submit herewith our brief proposal for setting up 10 District hospitals on “Design, build and fund model’ in the state. E ach hospital will comprise of 500 beds and will offer most modern state of the art facility. The following facilities are proposed for consideration of the Government, based on which, a detailed proposal will be submitted.
•Obst. & Gynae
•Cardiology and Cardiac Surgery
•Nephrology and Urology
•Neurology and Neuro Surgery
The hospital will primarily be a multi speciality hospital providing facilities to the tertiary and apical care level in the specialies. The hospital will also provide secondary to tertiary care facility in major broad specialities of Medicine, Surgery, Paediatrics and also in the super speciality of Cardiology and Cardiothoracic surgery. Backup of other superspecialities will also be provided.
Hospital will provide the following functional areas and services:
•Casualty and Accident emergency care
•Intensive Care Areas
•Cardiology & Cardiac OT complex
•Blood Bank with component facilities
•Conference room with audio-visual aids
•Manifold room and liquid oxygen tank
•Medical Record Department (MRD)
•Telephone Exchange (EPABX)
CASUALTY AND ACCIDENT EMERGENCY CARE
Hospital will have a state of the art Casualty and Accident Emergency facility. The casualty will be well equipped and provide prompt care round the clock. Two beds in the Casualty will be equipped with Critical Care facilities including monitor and ventilator to provide prompt management of very serious cases.
Out Patient department
•OPD Consultation Units
•Injection cum Dressing Room
•Lab Sample Collection
•Endoscopy and day care
•Plaster Room cum Procedure Room
•Physiotherapy and rehab
INPATI ENT FACILITY
The inpatient care area will provide services based on the concept of progressive patient care. It will consist of wards and the Intensive Care areas.
THE INTENSIVE CARE AREAS (Critical Care Areas)
The Intensive Care Unit will be equipped with latest facility for treatment of very sick/ terminally sick patients. The Intensive care team will man the unit round the clock. Patients predominantly requiring assisted support will be kept in this area.
Each ICU will have a standalone AC unit with prefilters and micro V filters. A n isolation facility with positive and negative pressure ventilation . In addition, a HDU (High Dependency Unit) will also be provided where the patients can be shifted once the patient is better.
The complex will also provide facility for treatment of serious patients of Cardiac, non – cardiac or surgical specialities. Preferably, a three ICU system will be created:
• The surgical and trauma ICU
• The Cardiac ICU
• The critical care ICU for other serious patients.
• Paediatric ICU (PICU)
• Neonatal ICU
• Neuro ICU
• Respiratory ICU
OPERATION THEATRE COMPLEX
We propose to provide 10 OT’s. Each OT will be modular and equipped with
• Anaesthesia machines
• Multipara monitors
• Surgical and anaesthesia pendents
• AGS (Anaesthesia gas scavenging) system
• Central piped medical gases (oxygen and nitrous oxide), suction and compressed air
• Laminar flow with HEPA filters
• One AHU per OT
• PRD (Pressure release dampers)
• C Arm
• 7 bar air pressure
• Temperature and humidity monitoring and control in the OT itself.
One OT will be planned for ultra clean surgery where no infected or potentially infected case will be taken. One OT will be dedicated to Cardiac Surgery. One OT will be dedicated for Obst. & Gynae cases. The OT complex will have a TSSU (Theatre St erile Supply Unit)
Hospital will have the following sections in the Laboratory
• Clinical Pathology
Imaging department comprising of the following main equipment
• MRI 3 T
• CT scan 256 slice with facility for angiography including coronary vessels
• Ultra sound machines
• Colour doppler
• Bone Dexa
• Image Intensifier (IITV)
Hospital will have an in-house blood bank comprising of whole blood as well as component facility. The Blood Bank will be planned according to the norms for blood bank.
The kitchen will provide therapeutic diet as required by the condition of the patient . The hospital will appoint dieticians to over view the diet served to the patients.
Hospital will have a central store to provide all the hospital supply. The Central store will have the subsections of Medical and non-medical store and space for waste items for sale through auction like IV bottles, used fixer and developer solutions etc. Hospital will also have an inspection store.
CENTRAL STERILE SUPPLY DEPARTMENT (CSSD)
Sterilisation of equipment is one of the most essential requirements of the hospital, and will be given the utmost consideration. The department will be centralized to ensure efficiency, economy and better supervision and control.
The CSSD department will be responsible for the complete sterile supply requirements of the hospital including the operation theatre . However, the OT will also have a Theatre Sterile Supply Unit (TSSU) to meet the emergency requirement. The department will provide provision for high -pressure steam sterilization and ETO sterilisation .
The hospital will have a Chemist shop for the OPD patients. Hospital will also have an inpatient pharmacy for supply to the admitted patients of the hospital.
The mortuary will provide facility for proper storage of the dead bodies. The bodies will be stored in a refrigerated mortua ry cabinet.
Hospital will have a central supply for oxygen, nitrous oxide, suction , compressed air and 7 bar pressure air for the vital areas of the hospital . All beds will be provided with central oxygen and suction. The intensive care ar eas and the casualty will be provided with oxygen suction and compressed air facility. The operation theatres will in addition be provided with Nitrous oxide and 7 bar pressure air.
These facilities will be provided from the manifold room. Oxygen will be provided through a liquid oxygen tank. Stand by facility for supply of central oxygen through oxygen cylinders will also be made available.
MEDICAL RECORD DEPARTMENT (MRD)
Hospital will provide up-to-date facilities for systematic maintenance of record s. The record keeping will be fully computerised to start with. The record department will provide ready
statistics on the hospital patients for administrative review as well as for clinical meetings and conferences. Soft copy of both the inpatient and the OPD patient will be available. MRD will maintain hard copy of the inpatient record. The OPD record will be given to the patient.
All the services of the hospital will be computerized to start with. To manage the computerization network, the hospital will have an EDP department functioning round the clock. The department will manage the hardware as well as the implementation of software in the hospital. The hospital is visualized as having a paperless working as far as possible. To achie ve the paperless requirement, the hospital will make all out effort to as far as possible have all working on centralized computer system. Blade server system will be provided.
The data storage will be made in the EDP department. Preferably a backup data will also be stored somewhere outside the main building.
Hospital will have a centralised EPABX system with adequate capacity. The system installed will be expandable to suit the later requirements of the hospital.
Selected areas of the hospital will be on Central air -conditioning. The Operation Theatre will have installation of HEPA filters . The HEPA filters will be preceded with pre filters and micro V filters. OT will have provision for 1 8 to 20 air changes per hour. Each OT will have an independent AHU. The Intensive care areas will have the installation of micro V filters. The isolation ICU beds will have negative and positive pressure ventilation.
All the offices of the hospital will be located in the administrative wing. The wing will comprise of the offices for the Management, offices for the administration and other areas of the hospital. The hospital will in addition have a control room near the casualty of the hospital to be working round the clock to handle the day to day problems.
The hospital will have a conference hall of suitable capacity. The hall will be used for academic activities, teaching and training programs of the hospital.
Hospital will have a good library to create an academic atmosphere.
Hospital will provide an area exclusively for consultants where, the consultants could rest during the spare time at the hospital. This will encourage availability of consultants at the hospital and cut down on their need to go home or elsewhere.
A community area will be provided that will take care of the immediate essential needs of the patient. The community area will have a cafeteria for the relations of the pat ients.
COMMUNICATION SYSTEM AND SURVEILLANCE
Communication in the hospital will mostly be through internal telephone for which a telephone exchange will be installed. The system will also have facility for out of hospital calls and for direct inward d ialing (DID). In addition there will be direct line from outside in certain areas where immediate communication may be required like in the Casualty, OT, reception etc. in addition, team leaders in certain areas will be given a mobile phone to be contactable round the clock. The phone will be kept with and be handled by the person on duty in that shift.
In addition there will be speakers installed at various locations of the hospital where any announcement could be made. The announcement will be controlled at one central point.
The hospital will also have installation of CCTV cameras at sensitive areas of the hospital and facility for round the clock recording. Live transmission will be available at the TV of the Directors, MS, administrators and the secur ity officer. In addition, certain areas like the ICU will have a facility of live transmission through internet to be available on the computer and mobile phone of the authorized persons. This facility may also be installed in other sensitive areas like the casualty.
The hospital will plan a paperless system to start with. An intranet or an internal messenger service will be available on all the computers of the hospital and all documents will be transmitted as soft copy. Minimal documents will be moved o n paper.
The hospital will have a PACS software for transmission of images from the imaging department of the hospital on to all computers of the hospital to be assessable against password to authorized persons. The images will also be available through i nternet on doctors laptops and mobile phones. Facility for online reporting will also be made available.
Facility will also be made for live two way transmission from the Operation Theatre to the conference hall for teaching, discussion and conference pu rpose. This transmission will be facilited through a camera on the OT light to cover the surgical field as well on the operating microscope.
Hospital will have a facility of recording all telephonic conversation on the main telephone console and on all the direct line telephones for play back in case of any controversy.
Will also have facility of audio visual recording in sensitive areas like where patients are counselled.
All vehicles of the hospital will have a GPRS system to track the vehicle and also obtain a 24 hour record.
Hospital will have a system of RFID card at selected points to be able to track the patients. A RFID band will be affixed on the wrist of the patient at the time of admission and removed at the time of discharge when he is going out of the hospital.
A QR code system will be installed from the time of admission itself. This will fully automate the patient care services in the hospital.
The various reports of the patients will be available online through email and on the hospital website.
Wifi internet access will be made available for patients and doctors .
Computers will be installed at various areas for patient information, feedback, enquiry and for online payment, complaints etc.
ARRANGEMENT FOR WATER SUPPLY
Water will be available in all areas, in all the taps, round the clock so that good hygienic practices are carried out and various hospital procedures are aseptically performed. Water supply will comprise of the underground water storage tank, the overhead supply ta nks and the fire tank. Provision for tube well water will also be kept as stand by in case Municipal supply is insufficient or for supplementing the water supply. Adequate provision of water softening will be available depending on the quality of bore well water. Water softening may also be required for the recycled STP water. Municipal water supply will primarily be used for drinking, wash basins and other areas where alternate supply cannot be used. Where ever bore well water is used, the water will be fi rst treated and made soft prior to use.
The following water supply arrangements will be considered:
Municipal water supply
Municipal supply will be used for drinking, cooking, wash basins, wherever water supply is required for equipments etc.
There will be 2 RO installation. One for the purpose of drinking water and other for dialysis and other equipment. Both will draw water from the Municipal supply. The RO drinking water supply will be made to all the drinking water coolers as well as to the Kitchen and canteen for cooking purposes. Alternatively we may have small RO or water filter on every cooler. The second RO system will supply water for dialysis and the auto analyser in the laboratory.
The bore well softened water
This water supply will be used for all areas except where x Municipal water is supplied
recycled water of STP reject water of RO is used.
In case municipal supply is adequate, the bore well softened water could be kept as stand by supply only. The water will be got teste d to ascertain suitability for drinking purpose in case of failure of Municipal supply.
STP recycled water
The STP recycled water will be collected in over head tanks. This water may need to be resoftened prior to use. STP tank recycled water will be used for WC supply and gardening.
RO reject water
This water will also be collected in overhead tank and will be used for wash basins, laundry, gardening, AC chillers, cooling towers etc.
Hot water supply to patients rooms, nursing station etc
This may be made through a central boiler with a pump either in the basement to supply the various areas or through over head storage tanks for hot water. The pump system is preferable as there is less wastage of water. In case we install a boiler, we could provide steam for the laundry.
OVER HEAD SOLAR PANELS
As per govt regulations, all hospitals need to install solar panels. The energy from the panels will be used to pre heat water for supply to the central boiler or geyser.
Water supply from the fire tank will sup ply the fire line and be pumped to the ring mains and other fire requirements.
The sewage and the effluent will be treated prior to disposal in the corporation supply. Waste water from all areas of the hospital will be treated in the STP p lant.
Waste water from the laundry will first go to the ETP plant. The treated waste of the laundry will go to the STP plant. Waste water from the kitchen will first go to the grease trap prior to discharge to the STP tank.
The treated water from the ST P will be collected in an over head tank and the reject water from the RO will be collected in another tank. They will be used as mentioned above.
RAIN WATER HARVESTING
A rain water harvesting pit will be created where the rain water from the roof will b e discharged. This pit will be connected with a pipe to discharge the water to the ground as per the rain water harvesting regulations.
Hospital will have a HT line supply preferably from 2 grids to ensure continuity of electricity in care of power failure of any of the Grids. Hospital will have a step down transformer that will step down the supply to required levels. Hospital will have 2 standby Generators to ensure continuity of emergency requirement of the hospital in the event of Power fa ilure. The generators will be on AMF panel to ensure that the electricity supply is restored
automatically within a few seconds of power failure. Selected areas of the hospital will also be backed by UPS connection to ensure ‘zero’ breakdown’. We may insta ll either central UPS, or provide suitable capacity UPS equipment wise. A central UPS system is preferable.
BIO MEDICAL WASTE DISPOSAL
Hospital will strictly adhere to the Pollution control norms for Bio Medical Waste management. The garbage arising out of the hospital will be segregated at the source itself in 4 different colour coded bags. These bags will be stored in the corresponding colour coded garbage drums. An agency duly approved by the Pollution control department will be appointed to collect the waste in accordance to the DPCC norms. It is not proposed to install an incinerator or any other equipment for the purpose.
Syringes, needles and plastic waste will be destroyed prior to disposal.