Escolar Documentos
Profissional Documentos
Cultura Documentos
Form Approved
6a. NAME OF PERFORMING ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION
Malcolm Grow USAF (If applicable) U.S. Army-University Graduate Program
Medical Ccnter SGA in Health Care Administration
6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code)
Andrews AFB, MD 20331-5300 AHS
San Antonio, TX 78234-6100
8a. NAME OF FUNDING, SPONSORING 8b. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER
ORGANIZATION (If applicable)
8c. ADDRESS (City, State, and ZIP Code) 10. SOURCE OF FUNDING NUMBERS
PROGRAM PROJECT TASK WORK UNIT
ELEMENT NO. NO. NO ACCESSiON NO.
17 COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number)
FIELD GROUP SUB-GROUP Construction, Renovation, Planning, Design, Emergency Room
SUBJECT.
Graduate Management Project
A LEVEL II m
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EMERGENCY CARE DEPARTMENT
M
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of
30 APRIL 1989
91041
91-04219
ACKNOWLEDGEMENTS:
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TABLE OF CONTENTS
AcknowledQements. ............................... I
CHAPTER
2;
I. IfNTRO DUCTION ................................... I m
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Statement of Problem .......................... 1 0
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Objectives .................................... 2a
G)
Criteria ...................................... C
Assumptions . .................................. 3 z
r I
LimitAtions ................................... 3 z
m
Plannin . . 9
.......................................
ii
I i. DISCUSSION .................................... 24
Medical Center.................................. 25
Department ..................................... 25 m
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Staffing ................................. .... 28 o
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Criteria and Functional Programing ............ 29 0
Table I .................................. 33 M
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F.
Tabie 2 ..................................... 34 Z-4
Table 3..................................... 35
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Obstacles to Building or i
. ........................
Renovation of Present ER... 36
IV. CONCLUSION......................................44
End Notes........................................... 4?
V. APPENDIZx . ...................................... 50
Center ..................................... 58 m
M
BIBLIOGRAPHY ....................................... 76
iv
INTRODUCTI ON
situation. 0
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Statement of Problem
0
USAF Medical Center! Andrews AFB, Md. 0
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Object i ves o
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p an t.
d. Functional assessment.
faci I i ty.
Assumt ions z
Limitations
Research Methods
the design of facil ities and specific appl ication for the
emergency room.
kr, amer 4
Defini tions
tunnel .
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Functional Program -- The methodolocix used in making a compar icor
s,)
measured.
Psychiatry, Radiology.
3) Nursing requirements:
unit.
on cal .
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Kramer 7
END NOTES
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Kramer 8
LITERATURE REVIEW
P1 ann i ng
1987, 19).
changes and growth? The chosen project should fit into the
0
overall objectiues and master plan for the facility. m
Z
amen i t i es.
programmi ng.
0
utilization, such as projected work load data, anticipated M
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procedures per- year, average duration of procedures, and other rM
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--4
basic concepts of functionality (Rostenberg 1986, 26). The scope m
Once the general ized planning of how the project will fit
m
site for primary care, and a productive entry point form patients
into the hospital system (Peisert 1984, 2). Also, many hospitals
emergency departments.
Kramer 13
Beachley and Snow (1988, 24) state that the evolution which
emergency care. in
in
(NFPA), the Basic Building Code, and many other federal, state,
Kramer 14
1. Entrance m
z
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2. Triage area x
z
3. Registration area in
m
4. Waiting room
- Cardiac
- Trauma
- Psychiatric
- Orthopedic
- Minor surgery
- Pediatric
I0. Administration
near the entrance, but should allow some privacy. The treatment
are also notable. The Nurses's station should allow for maximum
the core type of design, the arena type, and the corridor type.
corridor outside the core, and the support rooms (cast room,
obstetrics and gynecology room and supply room) are along the
Kramer 18
view of all Ihe cubicles. Many steps are saved since the work 0
times this plan has only one entrance for both ambulance and
ambulatory patients.
nursing station that procgresses out into the needed care areas.
process.
may not remain the same during the duration of the planning and
1987, 250).
0
Becker (1980, 101) found that during the development of a m
z
plan for a department, input from those individuals involved in
z
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the day to day activities is -ritical in choosing the design for x
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a new facility. He found that when the workers were involved,
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End Notes
Welfare. 1978.
Aspen. 1985.
1984: 98-103.
1988: 15-16.
54 (6) 1986:16-19.
1987: 247-254.
Kramer 23
m
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Kramer 24
DI SCUSSION
look to the future needs of the facility and address these areas -
0
also. The members of the organization should build a consensus
z
of what their needs are and express their viewpoint. This m
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information has to be complied and transferred to both the m
"0
the "Capital Belt Way." This makes the MGMC emergency department
Kramer 25
was covered and the approach was not congested. The basic design
Kramer 26
staff break room, administration room, EENT exam room, and two
m
private exam rooms. The trauma room has two beds utilized for 0
0
C
cardiac admissions and trauma admissions. This room maintains a m
0
is also the location for much of the clean and sterile storage.z
and work area. A storage area and locked pharmacy area are each
The two private exam areas are located in a small corridor going
becomes available using the primary care clinic waiting from the
place for such exchanges is in the staff break room. This room
0
also contains the department refrigerator, computer, and library. m
z
During episodes such as the admission of a rape victim, M
-4
gunshot victim or other patients who require the presence of x
m
officials from outside the hospital, there is no room for them toz m
is also the location of the cast area and dirty utility area.
Lar'e LliniL (ihe patient intake area for this clinic is shared by
Kramer 28
the emergency room during the ev.ening and night shift), and
patient rooms. These nine areas for patient care are confined in m
z
2436 Gross Square Feet (GSF). xm
V
Z
Staffing Q)
1985, 6). Not counting the physicians, this is 22 FTE (Full Time
staff. Using a facility which has over 29,000 patient visits per
m
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year, they found with their patient mix presented a need for 27 M
0
C
c
FTE's but in reality were only staffed with 20 FTE's, which is 0
m
0
The populations served and the future outlook for the department
include those individuals who carry their own records and seek
emergency department.
Room. The most important factor expressed by her was that the
close are the entrances and the triage area. Also, the
m
administrative spaces, such as offices and conference rooms i
Spatial Programing
which the facility is doing, or the workload that might occur and
fac i l i ty.
Kramer 34
Table I
The historical work load for the MGMC emergency department is the
Table 2
ER = PAV x PPP
3 x 365 x ERH
ER= 10
Kramer 35
Once the number of rooms have been decided upon than other
space and the amount of square footage can be calculated for the
Sub total NSF Authorize 2901 Sub Total NSF Authorized from workload 2025
anything, rule two you cannot afford rule one, the major obstacle
r
emergency room is to be expanded out from the main building. m
-4
Another aspect to expansion from the building is the vehicle X
emergency medical system are just a few who can put up major
proceeding.
the base paper and bulletin, local news media, and law
buying a car or building that you have seen elsewhere - each site
design a unit which will fit the plan and build an appropriate
Nelson and Okojie both (1988) point out that specific work
rooms, which are used for pediatrics, OB/Gyn and other patients
space with the nursing station observing the patient care areas.
Walter Reed Medical Center, the largest Army hospital, has less
walls and doors. The ER at Walter Reed does utilize the adjacent
design. Lt. Tom Fifer, also from the facility department, has m
C
(n
m
z
ri
Kramer 42
End Notes
1985: 36 - 43.
Welfare. 1978. z
r.i
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Falick, James. "The Design Process or, How Not to Be Afraid of -A
M
X
751-760.
CONCLUSI ON
status of the unit. This department has been given higher levels
staffed ER.
time of the plans. Given this aspect, the amount of staffing was o
0
Appendix L.
acoic.i t nal space will bring the facil ity ir I ine with stated
DOD space requirements for this activi ty. At the present time
department must accompl ish (see Appendix L). Once the space for x
-D
m
administration has been moved out of the emergency area, anotheri
by the emergency room is also used by the primary care cl inic and
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Kramer 49
END NOTES
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APPENDIX
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Kramer 51
APPENDIX A
ELEMENTS TO BE CONSIDERED IN PLANNING AN EMERGENCY DEPARTMENT
Preentry
Signs, access from street/highway, covered entrance;
parking-well-lit, ample space, short time versus permanent;
parking for physicians, law enforcement, ambulances
(turn around versus drive-through).
Entry
m
Ambulatory separate from ambulance, lack of danger to
ambulatory from "speedingu ambulances; greeter, available 0
0
wheelchairs, stretcher; type of doors-sliding, swinging, C
automatic, fire exits; curbs to accommodate wheelchairs; M
security room.
0
Reception <0
Triage, mostly for ambulatory, desk near entry, constantM
presence, electronic space board, registration, adequater z
number for speedy registration; privacy, seat two per z
cubicle, space for wheelchair, computer access to previous m
data, proximity to treatment areas, separate waiting for
registration; greeter/transporter, volunteer, pa**nt z
representative, ambulance reception-by triage, directed by rn
radio, squad room (reports, equipment)
Waiting area
Comfortable, pleasing, no smoking versus smoking; grouping
of seats, table lamps, plants, TV, a.-t on walls, carpeted
floors; adequate seating, restrooms, telephones; "grief
room, intercom, TV screen with patient status, play area,
patient representative/volunteer desk, video patient status
board.
Treatment areas
Major trauma/resuscitation, general minor trauma, major
medical, minor medical, open versus closed rooms, flexible
specialty rooms - OB/GYN, EENT, dental, orthopedic, suture,
secure room, fast-track rooms; central work station,
physician's room, telemetry, medication station(s)
dictating, resident/intern work station, secretary/ward
clerk station, computer station; pediatric section;
decontamination room (nuclear waste, separate air flow);
observation/holding area, monitoring; communications/
patient tracking/dispatch console.
Support areas
t:-rage, utility (clean and dirty), locker room, lounge,
physicians' sleep room (shower, toilet), transport equipment
room, medical director's office, nurse supervisor's office,
secretarial office, conference room, EMS coordinator's
office, radiology suite, laboratory, offices for other
supervisory personnel (associate medical director, education
Kramer 52
Miscellaneous
Corridors-width, fire codes; bumper guards on walls;
ceilings, lighting (separate per room) emergency light;
conduits for present and future cables (computer, etc.);
antennas for radios (UHF, VHF), telemetry; monitoring r
equipment - networking, central; doors- width, locks,
automatic; intercom-to triage, registration, waiting room, 0
treatment rooms, pagers for key personnel versus general
m
paging; video camera for surveillance and education stack
carts, crash carts, refrigerators (space for).
APPENDIX B
CORE DESIGN
0
0
On-call II >
if z
Doctors' z
office Y m
Triage
ReWeiting
Adapted from:
Jenkins, A.L. and John van de Leuv. Emergency Department
Organization and Management St. Louis. C.V. Mosby. 1978.
Peisert, Mz-rgaret. The Hospital's Roe in Emerguency Medical
services Systems. United States. American Hospital. 1984.
Kramer 54
APPENDIX C
ARENA DESIGN
Lounge o m
0
x
0 1 0
z
-0- Exam
Main entrance U cn Ex m
- -- - - -- - - -
-- - ---- --
Doc f
oftice Exam
Waiting
u L
EE Monitor FTC
Adapted from:
Jenkins, A.L. and John van de Leuv. Emerqency Department
OrQanization and ManaQement St. Louis. C.V. Mosby. 1978.
Peisert, Marqaret. The Hospital's Roe in Emeroency Medical
services Systems. United States. American Hospital. 1984.
Kramer 55
APPENDIX D
CORRIDOR DESIGN
Utility and
storage Dental Major
trauma m
0
T------ C
I 0
I/ o
IOrthopedics
- I11
z
Examining 1711
room X
1"1
- z
Head
nurse's
Doctors'
office and Staff X-ray
lounge oftice view ing
Sroom
OjO Adrnssion
0O0 X R Waiting
room
To ambulance
ramp
Adapted from:
Jenkins. A.L. and John van de Leuv. Emergency Department
Organization and Management St. Louis. C.V. Mosby. 1978.
Peisert, Margaret. The Hospital's Roe in Emergency Medical
services Systems. Uni ted States. American Hospital. 1984.
Kramer 56
APPENDIX E
MODULAR OR CELLULAR DESIGN
m
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0
c0
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0
U 0 WAITI NG WAITING X-RAYl AS
f~EC*Y ROOM
ROOM C
STORAGE
S
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LOUNG ECLEAN i
UTILITY
T REATMEN T
] U TREATMENTE ]
_ I I
Adapted from:
APPENDIX F
TRIANGLE DESIGN
* -- Aff6Ldw=c
0
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__ 0
~ Fbm
r a. -2
- ~ b E1T I? U
iai z
Stpff %
zi
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FuttC
A Mh hftr W"z
Adapted from:
Ludman, Dianne. "Emergency/ambulatory Department New 'Front -A
APPENDIX G
equipped personnel.
situations. 0
0
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0
4. Provide aerornedical support to Andrews AFB and to other M
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efficient manner.*
7. Provide support to Reserve components.
Support.
system.
provided.
13. Provide health care in a highly personal and sensitive
manner.
21. Modernize and improve the existing and new facility property. 0
0
30
C
0
22. Upgrade institutional systems and equipment.
APPENDIX H
FLOOR PLAN MGIC IST FLOOR
0
0
C
,ross Square 0
Feetxof ERM
58x42 - 2436
,T . 0l ///Main Entrance >
LV. 1 / Entrance
rj L1 , :Emerency -M
Liti
1TE ~ 70KL27 z
APPENDIX I
I 1]Hospital Lobbyl _ 2
[ 2]Vertical Transl 1 1 3
I 3]CCowand Suite I 1 1 14 m
[ 4]Medical Librarl I I 1 1 5
f 5]MedSuadron I I II I I I 1
0
I 9]Achinistrati0 I I I II I I 1 0
LEGEND
E - Essential: The functions are closely related and need to be located in
close proximity.
I - Important: The functions are closely related but closeness of location is
not as critical
D - Desirable: The closeness of location is desired to expedite work functions
but is not necessarily for their completion.
APPENDIX J
[ I]StoraQe I 12
I 2]Waitin Area I I I 3
[ 3]Tr iae Area I ID 1 4o
0
[ 4]Ambulatory EntlI IDIE 1 5 C
0
[ 5]Treatment Roml I I I 1 16 0
[ 6]Staff BreakI' I I I I 1 17 >
[7]OB/6yn Exam IIl I I 8
[ 8]Cast Room I I I I I I I I 19 0
I 9]lsolation Areal 1 1 I 1I 1 110 M
[10]EENT Treat. II I III z
[11INursing Statiol I1 I I ID I I I I I __12 z
[I2]Trauma Room IIIIII I I I IE 113
[13]Clean Utility ID I I I I I I I I I I__ 114
[14]Contaminat. Pal I I I II I I 115 m
z
En
[I5]Cardiac Treat.I I I I I I I I I I E I I I I 116
_
[16]Observation s I I I I I I I II II I I I I 1 117
17]A in.Of ice I I II I I I I I I I I I I I I 1 2118
[18]Comunicationsl I I I I I II I ID I I I I 1 119
II
[]gi)Mbulance Entrl 1E
I 1 I 12 I I
[20]Registration I ID 11 1 1 1 1 1 1I 121
[21]Toilet I I I II I I I I I I I 122
LEGEND
E - Essential: The functions are closely related and need to be located in
close proximity.
I - Important: The functions are closely related but closeness of location is
not as critical
D - Desirable: The closeness of location is desired to expedite work functions
but is not necessarily for their completion.
This matrix describes how areas within the emergency department should relate
to other areas within the emergency department.
Kramer 63
APPENDIX K
The following data was taken from one week's patient visits to
the MGMC emergency room. Total data reviewed 818 patient visits.
KI - - - - - - - - - - - - small
s example from one page of data
computer software. 0
C
M
z
K2 - - - - - D e s c r i p t iv e s t a t i s t ic s / m
Variable 1. CATEGORY frequency data Z
M
APPENDIX K1
MALCOLM GROW MED CTR RUN DATE: I DEC 1988
ER CATEGORY REPORT
FOR DATES: 06 NOV 1988 THRU: 13 NOV 1988
PRIVACY ACT - (5U.S.C. 522A)
ARR TIME DISP DISCH
CATEGORY LOG# CHIEF COMPLAINT DISCHARGE DIAGNOSIS TIME SEEN TIME TYPE
EMERGENT 38 Chest/Abd Trauma Chest Crush Inj 1000 1000 1100 admit
EMERGENT 77 Chest Pain Esophageal Reflux 1425 1430 1610 home
EMERGENT 106 Cardiac Arrest Cardiac arrest 1908 1908 1920 erd m
EMERGENT 35 Abdom Cramps Dysmonorrhea 1610 1625 2005 admit
1618 erd 0
0
EMERGENT 69 Cardiac Arrest Cardiac Arrest 1545 1545 C
NON-URGENT 2 Redness in OS Conjunctivitis 0014 0025 0045 home 0
m
NON-URGENT 3 Not Feeling well ETOH abuse 0040 0100 0115 home o
NON-URGENT 4 Insect Bite Insect Bite/allergy 0056 0120 0130 home
0
m
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K
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m
x
z
in
APPENDIX K2
APPENDIX K3
HEADER DATA FOR: C:ER LABEL! EMERGENCY ROOM CASES 6 NOV - 13 NOV 88
NLMBER OF CASES: 818 NUMBER OF VARIABLES: 5
VARIABLE: 3. SPECIALTY
I.SURG 2.MED 3.EENT 4.ORTHO 5.ORAL 6.MENTAL 7.CARDIAC 8.GYN
9.URO/OTHER.
M
•CUMULAT IVE. "0
APPENDIX K 4 a
HEADER DATA FOR: C:ER LABEL: EMERGENCY ROOM CASES 6 NOV - 13 NOV 88
NUMBER OF CASES: 818 NUMBER OF VARIABLES: 5
VARIABLE: 4. HOUR
24 HOUR CLOCK (TIME FROM DATA 0001 WOULD BE WITHIN THE HOUR 24)
...CUMULATIVE... m
====CLASS LIMITS=== FREQUENCY PERCENT FREQUENCY PERCENT
.98 0o
1.00 < 2.00 8 .98 8
2.00 < 3.00 12 1.47 20 2.44 0
m
3.00 < 4.00 12 1.47 32 3.91 o
4.00 < 5.00 8 .98 40 4.89 4
APPENDIX K4 b
HEADER DATA FOR: C:ER LABEL: EMERGENCY ROOM CASES 6 NOV - 13 NOV 88
NUMBER OF CASES: 818 NUMBER OF VARIABLES: 5
VARIABLE: 4. HOUR
24 HOUR CLOCK (TIME FROM DATA 0001 WOULD BE WITHIN THE HOUR 24)
mM
APPENDIX K5a
HEADER DATA FOR: C:ER LABEL: EMERGENCY ROOM CASES 6 NOV - 13 NOV 88
NUMBER OF CASES: 818 NUMBER OF VARIABLES: 5
VARIABLE: 5. TIME
TIME IS THE AMOUNT OF TIME THE VISIT TOOK. TIME IS ROUNDED OFF TO THE NEAREST 15
MINUTE INCREMENTS (.25 OF HOUR).
m
...CUMULATIVE... 0
--- CLASS LIMITS=--= FREQUENCY PERCENT ===LS LM PERCENT
FREQUENCY 0
c
.25 < .50 55 6.72 55 6.72 0
m
.50 < .75 109 13.33 164 20.05 o
.75 < 1.00 98 11.98 262 32.03
1.00 < 1.25 124 15.16 • 386 47.19
• 0
APPENDIX K5b
HEADER DATA FOR: C:ER LABEL: EMERGENCY ROOM CASES 6 NOV - 13 NOV 88
NUMBER OF CASES: 818 NUMBER OF VARIABLES: 5
VARIABLE: 5. TIME
TIME IS THE AMOUNT OF TIME THE VISIT TOOK. TIME IS ROUNDED OFF TO THE NEAREST 15
MINUTE INCREMENTS (.25 OF HOUR).
m
...CUMULATIVE... m
----CLASS LIMITS==== FREQUENCY PERCENT FREQUENCY PERCENT 0
c
.25 < .50 55 : o
m
.50 < .75 109 :---------- -------- 0
.75 < 1.00 98 :-- ->
1.00 < 1.25 124 : ==
1.25 < 1.50 67 <
m
1.50 < 1.75 93 ------- - -
z
1.75 < 2.00 65 r.
m
2.00 < 2.25 60 z
-4
2.25 < 2.50 26 m
x
2.50 < 2.75 34 :D
m
2.75 < 3.00 13 z
3.00 < 3.25 20 --
3.25 < 3.50 14
3.50 < 3.75 3
3.75 < 4.00 5
4.00 < 4.25 8
4.25 < 4.50 4
4.50 < 4.75 3
4.75 < 5.00 3
5.00 < 5.25 1
5.25 < 5.50 0
5.50 < 5.75 1
5.75 < 6.00 2
6.00 < 6.25 1
6.25 < 6.50 3
6.50 < 6.75 2
6.75 < 7.00 2
7.00 < 7.25 0
7.25 < 7.50 0
7.50 < 7.75 0
7.75 < 8.00 0
8.00 < 8.25 0
8.25 < 8.50 1
8.50 < 8.75 0
8.75 < 9.00 1
Kramer 71
APPENDIX L
HOSPITAL \m
MAIN ENTRANCE <--- \ Drive way-...............->> 0
C
Adapted from: Evaluation and Space Proramming Methodology for the Emergency
Department Canada. Minister of National Health and Welfare. 1978. pg.
34.
Kramer 72
APPENDIX M
DD FORM 1391
m
0
0
m
0
m
M
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I COMVONt: r[• OT
OATE
PROJECT DATA
FY 19 MILITARY CONSTRUCTION
AIR FO
1 INSTALLATION ANO LOCATION 4 PROJECT TITLE
1,188
9 C-OST '5TIMATES
Primary Facility 0
Medical Facility Addition SF 481 c
Alteration SF 473 m
LS 119 a
Support Facilities 1,072
Subtotal 5
Contingency(5.00%) 53 0
m<1,26
Total ContrauL Cost (TCC)
62 M
z
Supervision, Inspect & OVHD (5.50%) K
Equipment Provided from other Appropriations
(12% of TC C) 135 1
Total Request 1,188 ×
Total Scope IGSF 7400 M
m
REQUIREMENT:
CURRENT SITUATION:
z
IMPACT IF NOT PROVIDED: r
m
Medical care will continue to be degraded in an inefficient, space z
constrained, and functionally impaired facility. Staff and patients m
will continue to be at risk due to the facilities which are outdated
and impair progress into state of the art medical care.
AF A !LTY
I?-~ .
L.C CZNS-1 i~CN P9CjE---. DATAJ
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aIL *
+ W* I
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'POP"C
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.
Kramer 76
Bibli oqraphy
1985: 36 - 43.
Welfare. 1978.
M
Fal ick, James. "The Design Process or, How Not to Be Afraid of
my!
Aspen. 1985.
1984: 98-103.
17-23. 0
m
0
Hanson, Lorra *,e. "New Construction Projects Cited in Report."
0
0
Hospitals 62 (1). 1938. 98. <
z
Hardy, Owen and Lawrence Lammers. Hospitals The PlanninQ and m
z
-4
Desiqn Process. Rockville. Aspen. 1986. m
m
Hayward, Cynthia. "Functional and Space Programming." The cZ
m
751-760.
1988: 46-48.
(1 :
8136,) D-7.
Kramer 79
1986: 92-93
Omens, Robert. "Building and Remodel inJ: What You Need to Know
1980: 10-13.
1980.
1981: 79-81.
1987: 247-254.
Kramer 81
Webb, Liza and Mary Townsend. "Your New Critical Care Unit: