The utility and success of hospital plans depend to a large extent on the circulation routes on hospital site and within buildings.
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Way finding in hospitals is a major problem for most new patients and many old ones too, leaving them with a feeling of helplessness and frustration.
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To ensure placement of departments and equipment in proper relationship, flow charts depicting movements of patients, personnel and visitors should be developed for predicted movements between departments and within departments. These charts should be provided to the architect and checked later against his preliminary drawing.
A basically linear circulation system simplifies the development of the project in stages. There are two types of circulation in the hospital: internal and external.
(i) Internal Circulation:
Internally, traffic routes are required for linking major clinical departments for use by patients and staff, and for delivery of supplies to these departments.
The circulation space involves corridors, stairways and lifts. Corridors with less than 8 feet width are not desirable in hospitals, and protective corner beading is a necessity in hospital corridors.
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A large volume of internal traffic in hospital involves use of patient trolleys. Supplies and stores are also moved on trolleys. In multistoreyed buildings, provisioning for vertical movement of patient trolleys has, therefore, to be catered for.
In high-rise buildings the problems of internal circulation arise from wide dispersion of vertical circulation points.
It may be economical in effort to concentrate lifts at one place than distribute them among different parts of the building: four lifts banked together will give the same service as eight individual lifts scattered at separate points.
Two lifts are the minimum for any multi storeyed buildings. In not so high buildings, planning for ramps for trolley traffic (ramp well) must also be considered in addition to the stairwell.
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The point to remember while considering internal circulation is that internal traffic should remain orderly, and there is no undue criss-crossing of the patients, staff, supplies and visitors.
Use of multi-storeyed buildings is more economical than low buildings connected by long corridors and scattered lifts. In the linear spine concept of a building, additional departments are entered from a central spine, which may have several levels.
It steers the circulation, takes the hospital growth easily, and labyrinthine patterns, so common in large buildings, are avoided. An example of the linear spine concept is depicted
In considering the feeling of getting lost in the labyrinth of a large hospital, the hospital is compared to a village where its central focus is the high street or the market square, wherefrom everyone living or visiting the village are able to orientate themselves.
Planning for efficient internal circulation should therefore consider a central recognisable main communication artery serving the whole complex, which cannot be confused with departmental corridors.
But it is quite surprising that entrances to major departments in hospitals are given so little prominence and so little identity.
The entrance door to a department should be approached through a “pause space” which serves as a transition between the public and the private domain. Like the transition from outside to the hospital is through the main hospital entrance, so the transition from the hospital street to the department should be through its distinctive pause space.
Ramps, steps, and stairs: Handrails must be provided on both sides of steps and stairs, and should extend beyond the first and the last steps on at least one side. Hard, level, nonskid surfaces are essential for steps and stairs, and handrails must not be of slipery material.
(ii) External Circulation:
Only one entrance to the hospital for vehicular traffic from the main road is desirable.
Provided the entrance and exist points are wide enough to take two lanes of traffic, one entry has the advantage of clarity for all visiting traffic, and one exit the advantage of security from administrative viewpoint.
The volume of external traffic reaching a hospital is quite enormous. Not only the patients but supplies, ambulances, staff and visitors need access to the hospital at different points. Supplies and stores also arrive on handcarts, pushcarts, rickshaws and other vehicles.
Patients, their attendants and visitors come to hospitals in a variety of transport. Therefore, appropriate areas have to be earmarked for scooter, car, rickshaw and bicycle parking facilities for patients, visitors and staff.
The main bulk of hospital stores are delivered at one or two central points. Independent access will be helpful in transport of heavy or bulky articles directly to the point at which required.
These could also be useful to bring in fire flighting vehicles in case of fire in the hospital.
The circulation routes will be influenced by the orientation of the site, e.g. a site with its broadside facing the main entrance from the road, a narrow site at right angle to the main road, or a site which is irregular in spread and level.
Some site may be sloping, but a sloping site is not necessarily a disadvantage. The architect can exploit it by planning part of the structure on stilt columns and using the basement for car parks, goods delivery points, soiled disposal, and storage.