Designing an Ophthalmic Setup

Posted on 21-May-2020 at 04:35 AM

Afree-standing Ophthalmic setup is an Ambulatory Surgery Centre (ASC). Designing and Building an ASC can increase your practice’s profitability, or it can become an attractive but underutilised money pit. Careful research, planning and financial analysis can pave the way for success.


When we start designing a facility, whether new or renovate an existing one, we need to focus on:

1.     Outpatient Departments

2.     Surgical spaces for cataract and other eye surgeries

3.     Diagnostic and treatment spaces for Outpatient care

4.     Indoor bed facilities for inpatient care


Moreover, we also need to plan for other spaces such as entrance & reception areas, administrative offices, conference halls, medical records, lounges, canteen, library, pharmacies and outlets for lenses and other optical devices and so on. 


It must be remembered that patients using these facilities are visually impaired. The facility should be designed in such a way that these visually impaired patients find it easy to navigate through the facility. The design should pay special attention to reducing and/or eliminating obstacles that may hinder smooth mobility of these patients. 


There are several design principles that need to be kept in mind when we begin designing a facility. The order of these may vary, but Hygiene must always be a priority in any healthcare facility. 


Hygiene


Hygiene is a concept which has never been alien to the medical fraternity. We are probably more obsessed with cleanliness than anyone else, close to the point of being an obsessive-compulsivedisorder.


Yet we have probably never thought about incorporating the concept of hygiene in the design of a healthcare facility. The major thrust areas are:


a.     Limit Dust & Mould

Countries with Tropical climate like ours, cannot eliminate dust completely. Air-conditioning helps to a great extent. But we need both extra filters to keep out dust and humidity control to prevent moulds.


b.     Handwashing

The importance of handwashing in any healthcare set-up cannot be overemphasised. Design of hospitals have to make provisions for handwashing at all necessary point. These is overwhelming evidence that frequent hand hygiene has reduced SSI and VAPs. There cannot be a bigger proof than this.


c.      Asepsis

Surgical spaces are our top priority when we design an Ophthalmic set up. Asepsis in the OTs and designing a unidirectional flow in the CSSD are an important and integral part of the design process.


d.     CSSD

The space allotted should be adequate and there should be no segmentation. The design must include designated spaces for each of the activity involved in CSSD while maintaining a unidirectional flow.


Appropriate & sustainable Technology


Technology is an ensemble of mechanical and scientific methods, products or systems invented for achieving human goals. Appropriate & sustainable technology reminds us to be aware of the consequences of our choices.


a.     Flexibility & change

Use building systems that are simply built and can be altered or augmented. Provide modest component of excess capacity


b.     Medical technology & technical support.

Facility design should support up-to-date technology with the needed space, structural support, electrical services, communication lines, piped medical gasses and other services.


c.      Sustainability.

The hospital building should meet good building standards for structure, ventilation, HVAC, maintenance, ease of cleaning & energy conservation. A reliable level of human comfort & air quality should be provided. Incorporating natural lighting into the design is perhaps the most important thing to do.


Function


The hospital building must be designed to help staff work effectively and efficiently.


a.     Form follows Function

The building should support good medical practices. It should not stand in the way of staff efficiency. The building should allow easy repairs and renovation.


b.     Make Clear Functional Layout

It can either be Doctors hopping from one area to another or patients going from one point to another. One of these concepts should be followed in the design of the workplaces.


c.      Functional requirements and design criteria


d.     Waiting Areas

Combined waiting or De-centralised waiting? Both have their positives. But locating waiting near the professional staff rather than searching for patients in a general waiting area makes better sense as it improves efficiency and reduces wastage of time in searching for the patient.


Response to Social Context and Community Design


a.     Support local patterns of life.

Respect for and response to the local customs and the overall way of life goes a long way in building patient loyalty. A hospital design should incorporate all of this.


b.     Community & Privacy

There are many intricate community practices on how they sleep, how they prefer ventilation etc. All of these small choices into the design helps to develop that extra bond with the community.


c.      Care-by-kin

A very controversial point. But if the community prefers that way the facility needs to be designed to educate the kin on personal hygiene, eating habits, wound care etc. the facility needs to have a dedicated area for such training activities.


Beauty


a.     Celebrate Eyesight

The eye should have something to celebrate in an eyecare facility. Local artists and craftsmen can be used to showcase local talent. Consider using textured surfaces, colours and shapes that can be appreciated in different ways by people with different visual acuity – they appreciate more vibrant colours with higher contrast.


b.     Site Repair.

Builders often tend to select the most beautiful spot on the site and replace them with a building there. The aim should be to conserve that spot and build the new building around it on probably the worst area on that plot.


Economic Issues


a.     Hotel Care & Medical Care

Very often we see lavish interiors in hospitals that compete with lobbies and rooms of a 5* or 7* hotel. What hospitals need are functional interiors that are high on their utility quotient, pleasing to the eye, yet, are easily amenable to HIC policies of the organisation. The LEAN concept of eschewing ornamentation is more important here than anywhere else.


b.     Outpatient Care

Ophthalmology is one branch that has embraced outpatient care, positively. However, facilities located in remote areas need to factor in whether effective post-op care is possible at home after discharging patients immediately after surgery as is routinely done. Patients coming from remote areas may not be able to go and comeback for routine post-op visits; some may have co-morbidities that may need to be monitored. Inpatient facilities may have to be created for such patients.


c.      Finances.

Finances is a separate topic by itself and can be discussed ad nauseum. But to sum up in short, in planning a budget for a hospital it is critical to remember that the construction is not the whole project cost. It is equally important to consider the life cycle cost implications of building decisions.

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