Emerging Trends In Planning And Designing In Indian Hospitals

Dr K B Sood

Hospital is the most visible face of the healthcare industry. It handles the dynamics of life and death situations during the process of rendering healthcare. Peter Drucker, the management Guru has said, “Hospitals are the most complex human organisation ever devised”. Today, hospital buildings are considered the most complex building forms. Integration of developing technologies into healthcare delivery is making hospital buildings more complex. Therefore, planners and designers of hospitals must be conversant with emerging trends in the fields of technological developments, which shall be deployed in foreseeable future. They must understand the complexity of integrating these technologies with the building systems and forms, to create hospitals where the healthcare provider can utilise these comfortably to deliver most appropriate healthcare.

This process had started by middle of 19th century when new emerging technologies like X-ray machines, new drugs and better instrumentation was integrated into the healthcare delivery. The pace of integration of technology was slow and deliberated at length. But encouraged by the results, healthcare providers started adopting new technologies at a faster pace, so much so, that in middle of 20th century, it was said that the hospital building has become obsolete by the time they are built.

It was at this time that hospital planners evaluated the emerging trend in technological developments in various fields like Space Technology, Information Technology, Aviation Technology, etc, and made a forecast for the emerging trends, which may soon be seen in hospitals. These technologies were integrated with existing healthcare delivery models and the new healthcare delivery models that emerged were tested and if found useful, were made part of hospitals. This required that all hospital planning consultants keep a track of all emerging trends in various developing technologies. As and when the trends start finding an application in healthcare delivery, the hospital buildings are ready to adapt to them without many structural changes.

Let us look at these emerging trends as they are available to us for planning and designing Indian hospitals in the next three to five years. We shall group these trends into three categories.

• Technology trends which directly affect delivery of healthcare.
• Technology trends which affect hospital engineering and support services and thereby indirectly affect the delivery of healthcare.
• Non-technology trends which directly affect delivery of healthcare.

In this article, we will discuss the Technology Trends Directly Affecting Healthcare Delivery.

Digitisation of Hospital Equipment & Processes

Imaging services, especially radiology, has now been fully digitised. Physiology monitors have been digitised. as well as clinical laboratory. The patient file is being digitised. This has also enabled hospitals to archive full patient files on hospital servers to be shared between various healthcare providers.

After digitisation, virtual doctors shall become a reality. There shall be centralised control rooms to monitor clinical and administrative data. Digitisation will enable hospitals to become paperless and film-less. Patient files shall be issued as smart cards. The doctors, on ward rounds, shall carry a laptop and accessories on a trolley and review patient data online. The doctor orders shall be transformed into hospital vide activities on real times basis. Even the prescribed treatments can be evaluated for incompatibility, patient’s allergy history, past history, etc.

This will provide maximum benefit to the patient being evacuated to a hospital because the digitisation will enable patient monitoring and possibly, provisioning of critical care from the start point. When standardised, it shall be most useful for cases of heart attack where “Time is Muscle”. By the time patient reaches the hospital, the latter shall be geared to provide all needed services immediately.

This will impact the way cross consultations are carried out because after digitisation, geographical distances shall lose their meaning. It shall also enable vertical integration across healthcare providers in primary care, secondary care and tertiary care as well as across healthcare providers in rural centres and in specialised centres located anywhere in India.

Hospitals have to gear up to meet the challenge of digitisation of patient data in terms of digitised equipment, interpretation, staff skills and training. Essentially, it shall require deployment of optical fibre networks within the various departments of the hospital for very fast transfer of data. It shall also require broad band connectivity across majority of healthcare providers in India to realise the full potential of digitisation. This shall specially require evaluation of interference across various cable and data transfers.

It shall also require deployment of ambulances, which shall provide critical care while moving and will need proper communication links on the move. We feel, if this happens, some staging stations shall need to be created whenever the patient is being evacuated long distance say over 100 Km.

To make future hospitals compatible with older machines or less digitised hospitals, some additional equipment like film scanners, film printers shall also be installed all across the chain of hospitals and other facilities in a hospital group or at state level or national level.

We believe that this trend is going to affect all hospitals, small or big in the next three to five years because digitisation also has been reducing the costs and all kinds of hospitals shall gradually upgrade to digitised equipment for up-linking themselves to various networks for various purposes like insurance, cross consultations, tele-medicine, etc.

Optical Coherent Reflectometery

Optical Coherent Reflectometery is the integration of infra red or lasers with guide wires to visualise as well as treat obscure lesions when conducting any intervention procedure on any organ using various systems of minimally invasive procedures or surgeries. This will enable superior management of 100 per cent coronary blocks as well as other vascular accidents and prevention of vascular accidents on table during procedures. This requires integration of an additional monitor in cath labs, vascular labs and operating rooms to beam the images as generated by the addition of electromagnetic rays. At times, it shall involve placing the standard monitor rails, if the pendants are not deployed.

Hospitals have to gear up by providing adequate interstitial area over false ceiling, which can take extra rail mounts. This requires proper planning at structural design stage to plan the structural beams in a manner that it causes least interference with other accessories in the room. This is a trend that will have its maximum impact on tertiary care hospitals.

Computer Assisted Surgical Planning & Robotics

This involves deploying the computers to support precision surgical techniques for all complex procedures like hip implant or coronary by-pass surgery thereby reducing the operating time & better outcomes. In fact, it shall become possible for the Surgeon to practice the proposed surgery – by deploying on-screen surgery, plan the rational activities for problem areas, determine activities for support team including a robot, if available, and improve the results of surgical intervention.

It shall require integration of an additional robotic control room in surgical operating rooms. At a later date when stem cell therapy has been approved, another room for a bio-reactor may be needed along with the robotic room for transferring the scaffoldings to the patient from the Bio-reactor. Adequate considerations for nosocomial infections due to presence of robots in the operating room need special mention here. The operating room planning must be simulated to check activity traffic, robot movement and placement of trolleys for providing a well laid out work area for the surgeons. This is a trend that will have its maximum impact on tertiary care hospitals.

Image Guided Surgery

Image Guided Surgery is integration of Diagnostic – Monitoring – Operative Technologies. The operating room shall have combined operating table with a CT Scanner workstation or a Vascular Intervention workstation. It shall provide intra operative use of these workstations thereby reducing trauma, enhance surgical precision and improve surgical access to literally every cell in the human body. The process of treatment planning shall be monitored by a computer and based on artificial intelligence models for online evaluation of treatment modalities – may be across the world in multiple centres. The concept is not very new as Operating Room have been using mobile X-ray machines or ultrasound for making diagnostic or therapeutic studies while surgery is being performed. But the new modalities, which are being used, require much more technical back up.

This shall totally change the planning of Surgical Suites and Vascular Laboratories. In addition to addressing the concerns of nosocomial infections, it shall have to meet the installation requirements for scanners or flat panel vascular Laboratory in the Operating Room. The Operating Room shall have to interface with control rooms and panel rooms and meet the scatter radiation safety norms. The surgical techniques shall also be realigned to work with radiation safety screens. This is a trend that will have its maximum impact on tertiary care Hospitals.

Virtual ICUs and Deployment of Robots in ICUs

Digitisation of Physiological Monitors, Cameras, Pumps, Ventilators and other accessories have made it possible to deploy robots to assist the ICU nurse to render intensive care more effectively.

First step in this direction is creation of Virtual ICU where a control room is created. In Virtual ICU, a Critical Care Internist monitors a large number of patients with the help of computers and monitors. The patient data and live images from various ICUs in a given hospital or across a number of Hospitals are constantly monitored and evaluated for variation from set benchmarks. These are generally missed out by the staff on duty due to human factors of stress and fatigue. The Critical Care Internist, with the help of two-way audio-video communications, helps the staff deployed in ICU to monitor the patients and effects of therapy in more intensive manner.

Once the protocols of Virtual ICU have been standardised, a walking robot can be deployed to assist ICU staff to carry out many of the repetitive activities in an efficient manner. This shall not only reduce the cost of care because the expensive Critical Care Internist resource is shared across a larger number of beds, it improves the outcome of intensive therapies by reacting faster to various alarms and by providing adequate instant support to ICU staff.

Hospitals have to gear up by providing adequate number of data ports, audio-video communication ports and plan the ICU layout in such a manner that unobstructed view of the patient at all times is possible.

We believe that this trend is going to affect hospitals, which have provided ICUs, small or big in the next three to five years because virtual ICUs provide for a far superior care at a reduced cost.

Integration of Various Diagnostic Modalities Into A Single Machine

The CT Scanner has integrated Gamma camera and the MRI Scanner has integrated PET scanner. This is being done to reduce the diagnostic time of the patient. Hospital laboratory already has such machines, which perform tests across various organ systems from same sample of blood.

Easy & Functional Mobility of Patient & Critical Care Equipment

One of major problems in rendering critical care is managing the critical care equipment that is used to provide infusions, ventilator support, monitors, etc. When patient is moved from the ambulance to triage station to ward or operating room, these present a major problem for provisioning of continuous care. Though it is being managed with success, the modalities involve deploying additional staff and lot of special care during transits.

Development of Satellite Care Systems coupled with Standard Docking Stations provides for provisioning of standardised equipment at all places. The critical care equipment moves with the patient attached to trolley or bed with its captive power and gas supply and in ICU, triage station or operating room, it is docked on to special pendants which provide total connectivity at the turn of a knob. The docking station provides for changeover from cylinders or battery power as available in Satellite Care Systems to centralised services at the turn of a knob. Simultaneously, the battery in Satellite Care Systems is put on charging mode. A single attendant can move the patient over a reasonable distance without any fear of any mishap.

This trend is going to become the universal standard for movement of critical patients., affecting all hospitals, small or big in the next three to five years. Hospitals need to plan for a comprehensive set of piped medical gases, electrical services and data cable provisioning at all docking stations for satellite care systems. It must also consider sanitation requirements when the satellite care systems are moved into clean or sterile zones.

To be concluded in the next issue The writer is New Delhi-based hospital consultant.
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