Upgrading of the Operating Complex Hospital Universitario de
Transcription
Upgrading of the Operating Complex Hospital Universitario de
International Upgrading of the Operating Complex Hospital Universitario de Caracas Health Consultants Hospital Management Hospital Design Hospital Planning Content 1.Introduction International Health Consultants 2. Hospital Universitario 3. Project Proposal Korte Muiderweg 2 P.O. Box 5120 1380 GC WEESP The Netherlands 4.Budget Tel. +31 (0)294 45 77 88 Fax +31 (0)294 41 68 36 www.ampc.nl © 2010 5. Project Implementation 1. Introduction 2. Hospital Universitario During the second half of 2008 the Ministry of Healt of Venezuela, Hospital Universitario de Caracas was constructed through its execution organization FUNDEEH, made an agreement its foundation the hospital has been a national with AMPC International Health Consultants for a feasibility study in 1956 and grew to be an icon in Caracas. Since pioneer in the training of new generations in the area of medicine. Besides the doctors, paramedical staff, administrative staff and workers, the Hospital Universitario has been hosting medical for the improvement of the Venezuelan health infrastructure. students from the Central University of Venezuela who use hospital facilities to complement the knowledge received in the classroom. The main objective of the study was to design a maintenance program. Within the national The hospital was designed according to the most Hospital Universitario is integrated into the National project to adequately equip a group of 10 selected priorities the Ministry of Health concluded that modern international medical and architectural Health System of Venezuela and plays an important regional secondary level hospitals contributing to developing a project to upgrade the operating standards of its time. Due to the effort in its interior national reference role integrating, medical care and the objectives of the Ministry of Health of Venezu- complex and adjacent areas of Hospital Universitario as well as exterior design Hospital Universitario medical teaching and research. The hospital provides ela laid out in the Program “Barrio Adentro I-IV”. de Caracas would be the most suitable for such a was considered a hospital of international reference. medical care with highly trained professionals After visiting the selected hospitals AMPC concluded project approach. The structure of the building arises from a large and is equipped with several of the most modern that it would be hard to design a coherent, sustainable central volume where four pavilions are inserted instruments and medical devices. However, those and manageable project incorporating the selected at the front and four pavilions behind, as the prow high-end medical technologies cannot always be hospitals, due to the fact that various scattered of a ship. The design principle, where the rooms used with the desired effectiveness. This is mainly projects were already implemented or under are lined with shade corridors, demonstrates the caused due to the original architectural spatial execution in those hospitals. importance given to the local tropical climate. organization that is still in place. Modern medical The design of each of the floor levels show a treatment methods as well as modern hospital After a presentation to the Ministry of Health of the functional operation scheme, organizing the spatial management, however, require organizational first results of the preliminary study it was agreed distribution into four vertical circulation nucleus. and architectural adjustments, especially in the upon that the Venezuelan Health Infrastructure After completion of the hospital the Venezuelan areas of surgical and adjacent services. would benefit most from an integral project approach artist Mateo Manaure was asked to make a design including upgrading the physical infrastructure, for exterior finishing. The architectural exterior Currently the hospital has more than 20 operational medical equipment, extensive medical and non- design nowadays is part of the National Patrimonial operating theatres organized in a decentralized medical training programs and a sustainable heritage of Venezuela. manner. The main surgical block consists of 10 2. Hospital Universitario operating theatres, mainly used for trauma, neuro-, control relatively difficult. Furthermore, the physical cardio-thoracic and general surgery. Throughout infrastructure of the operating theatres is more the hospital decentralized specialist operating than 50 years old and requires a technical update. theatres can be found for gynecology, urology, ophthalmology, ENT and pediatric surgery. Each of those decentralized blocks are responsible for their own organization, such as operational planning as well as sterilization of the required equipment. The decentralized approach was very common in the era when the hospital was designed, however, the operational costs of such a decentralized system are relatively high and make quality 2. Hospital Universitario 3. Project Proposal 3. Project Proposal The objective of the project is to create, develop decreases and hygienic and infectious procedures and implement an integrated health care processes improve. The conceptual designs are added as an in the operating complex and adjacent areas of the annex to this report. Those drawing give a good highest quality, trough prevention, care, research view about the proposed concept. During the and teaching activities; with the aim of assisting second phase the concept plans will be discussed patients and institutions and train students of in detail with all departments involved in order to the Faculty of Medicine of the Central University develop a final implementation plan. All observations of Venezuela. and remarks of the hospitals management and medical staff will be taken into account in order to Based upon the most recent architectural and or- establish a final design. ganizational views on hospital design it is proposed to re-design and re-equip the central operating To realize this a full fletch new operating complex complex and adjacent area of Hospital Universitario. including recovery beds will be implemented on The following departments are included in project: the 6th floor in the area where momentarily the · Operating Complex, operating complex, sterilization, recovery, ICU and training areas are located. The complex will (in total 18 new operating theatres); · Recovery department, be vertically connected to the 5th floor where a modern central sterilization department serving (incorporating 38 new recovery beds); · Central Sterilization department; · Adult, pediatric and neonatal the whole hospital and ICU department will be implemented. intermediate and intensive care. On the west side of the sixth in one of the two 3.1 Architectural design beams new dressing rooms for doctors and nurses The basic principle of the architectural design is are foreseen, whereas in the other western beam to centralize all the hospitals critical care services relaxation areas, offices and training room are such as operating theatres, recovery, sterilization planned. The existing angiograph rooms are not and intensive care units (ICU). By centralizing those being touched. In the available space opposite services it is expected that that quality of the care the angiograph intervention rooms, the exiting offered increase significantly, operational cost cardiac recovery room will be integrated with the 3. Project Proposal 3. Project Proposal patient pre-surgery preparation area. Architectural On the eastern end of the sixth floor a recovery measures will be taken to avoid contact with the area with space for 38 recovery beds is foreseen patients in recovery from the cardiac intervention in the fish spine shaped beams. Furthermore and pre-surgery patients. along the central corridor a pharmacy, equipment storage, sterile instrument storage, instrument In the central part of the sixth floor all the way up pre-washing and teaching rooms and office are to the emergency exit ramps 18 operating theatres foreseen. The first draft lay-out of the sixth floor in are planned. Within the first draft lay-out design added as an annex to this report. The northern half of the fifth floor will be completely remodeled to house a complete up-todate Intensive Care Unit (ICU) and a full fletched central sterilization department. The departments currently situated at the fifth floor levels will be dislocated to other areas according to the Hospitals Master Development Plan. This plan will be developed during the next phase of this project. On the western part of the fifth floor a separate 5 extra large operating theatres are foreseen. ICU departments for neonatology (18 beds) and Those theatres are designed in such a manner pediatrics (13 beds) are planned. In the central part that student will be able to see the operation live of northern corridor a 40 adult intensive and through a large glass window mounted above intermediate care area is foreseen, half of those the theaters. In the draft planning it is foreseen beds will be situated in individual cubicles. Finally that one operating theatre will be dedicated to on the eastern side of the fifth floor a fully equipped the Davinci operating robot, two for orthopedic central sterilization department will be implemented. surgery, two for cardio-thoraxic surgery, one for This department will not only supply sterile equip- neuro surgery, one for ENT, one for ophthalmo- ment and clothing to the operating theatre, but to logy, three for minimal invasive surgery and seven the whole hospital. The first draft lay-out of the theatres for general surgery. patient pre-surgery preparation area. 3. Project Proposal 3. Project Proposal Architectural measures will be taken to avoid con- The northern half of the fifth floor will be is presented in a bill of quantity that can be found video recording, facilitating telemedicine activities as tact with the patients in recovery from the cardiac completely remodeled to house a complete up-to- in an annex to this report. well as teaching due to a two-way conference system. intervention and pre-surgery patients. date Intensive Care Unit (ICU) and a full fletched Based upon the level of the hospital and its national central sterilization department. The departments reference role the equipment chosen can be 3.3Maintenance In the central part of the sixth floor all the way up currently situated at the fifth floor levels will be defined as a high end level. Practically this means To assure the sustainability of the project it is to the emergency exit ramps 18 operating theatres dislocated to other areas according to the Hospitals that the hospital will be equipped with modern mportant to safeguard the functioning and the are planned. Within the first draft lay-out design Master Development Plan. This plan will be state-of-the-art equipment. During the fine tuning functionality of the equipment. All medical 5 extra large operating theatres are foreseen. developed during the next phase of this project. of the final equipment list characteristics like user equipment supplied through this project will be Those theatres are designed in such a manner On the western part of the fifth floor a separate friendly, beneficiary to the healing environment, maintained during a period of 2 years after instal- that student will be able to see the operation live ICU departments for neonatology (18 beds) and maintenance friendly and the hospitals preferen- lation. Maintenance consists of preventive as well through a large glass window mounted above pediatrics (13 beds) are planned. In the central part ces will be very important. The total package of the as corrective maintenance and will be organized the theaters. In the draft planning it is foreseen of northern corridor a 40 adult intensive and medical equipment is taking into consideration and executed by local Venezuelan companies in that one operating theatre will be dedicated to intermediate care area is foreseen, half of those using the following criteria: order to guarantee active and rapid response. the Davinci operating robot, two for orthopedic beds will be situated in individual cubicles. Finally surgery, two for cardio-thoraxic surgery, one for on the eastern side of the fifth floor a fully equipped · State-of-the-art; · Experience of manufacturers, brands 3.4 neuro surgery, one for ENT, one for ophthalmo- central sterilization department will be implemented. and/or types with equipment used As an integral part of the project a training program logy, three for minimal invasive surgery and seven This department will not only supply sterile equip- under similar conditions; aiming at Technical Assistance and Institutional theatres for general surgery. ment and clothing to the operating theatre, but · Local representative of manufacturers Strengthening will be implemented. This program to the whole hospital. The first draft lay-out of the mainly focuses on clinical training programs and fifth floor in added as an annex to this report. · User friendly and beneficiary to the an environmental and hospital management program. These programs aim to empower the On the eastern end of the sixth floor a recovery area with space for 38 recovery beds is foreseen in the fish spine shaped beams. Furthermore 3.2 Medical Equipment along the central corridor a pharmacy, equipment The supply of medical equipment is an integral storage, sterile instrument storage, instrument part of the overall project and will be based upon pre-washing and teaching rooms and office are the actual needs of the hospital and the medical foreseen. The first draft lay-out of the sixth floor in terms of reference for the hospital. Apart from added as an annex to this report. medical equipment also standard supporting for service and maintenance; healing environment; Technical Assistance · Accessories needed to run the equipment, hospital in order to increase its capabilities for as much as possible non-disposable to successful medical intervention as well as general keep the running cost (and availability) management. The goals of the training program are: as low as possible. · Guarantee sustainability and ownership of the delivered infrastructure, goods Due to the national importance of the Hospital and services to the hospital organization; equipment, like trolleys and office furniture are Universitario and to facilitate its teaching activities · Knowledge transfer to contribute to foreseen. An overview of the equipment planned the operating theatres will be equipped with a full fletched information system, including sound and · Introduce quality of care standards by professional standards; 3. Project Proposal improving clinical skills; · Improve environmental management 4. Budget and Financing 4.1 Project budget money. It can be bilateral or multilateral, and To realize the rehabilitation of the critical depart- usually exists parallel to monetary systems in most based upon the principles of ecological ments at Hospital Universitario de Caracas the developed countries, though to a very limited footprint; total investment is estimated at USD 50.000.000. extent. The British-Swiss company is interested in The clinical training foreseen is defined as an applied The mayor investment needed is for equipping the a barter trade through oil with Venezuela to educational program directed to improve the skills operating complex, ICU and central sterilization finance the upgrading hospital Caracas. of the professional user to the level necessary to department, about 34 mln USD. The complete use the equipment in an efficient way with maximum remodellation of the fifth and sixth floor including result in the diagnosis or treatment of the patients. reallocation of the department currently housed Based upon the type and level of equipment at the fifth floor is estimated at 10 mln USD. installed through this project it is foreseen that a The maintenance cost for three years is estimated partnership will be established with an international at 5 mln USD. Finally, the cost for a custom made well known medical university to assure the level training program is estimated at 1 mln USD. of training offered. Project budget estimate in mln USD Furthermore, based upon a custom made assessment Budget of the ecological footprint of the upgraded depart- Equipment ments environmental improvement program will Construction9-11 be drafted and implemented taken in to conside- Maintenance4-5 ration aspects such as energy consumption, water Technical Assistance consumption, (medical) gas consumption, waste Total50 32 - 35 1-1,5 production, etc. 4.2 Barter Trade To be able to finance the project, the project team has contacted a British-Swiss barter trading company. Barter trade is a medium in which goods or services are directly exchanged for other goods and/or services without a medium of exchange, such as 5. Project Implementation 5. Project Implementation In this chapter a project implementation strategy implementation plan installed and intensive custom made training is drafted. The strategy described aims to a smooth B. Technical elaboration program for medical as well as non medical staff and phased implementation with the objective a. Thorough elaboration of the main will e started. to keep the hospital fully operational during the technical infrastructure i.e. the electrical execution of the upgrading works. power supply, heat generation, cooling In the figure below a draft implementation time plant, medical gasses etc. ; schedule is given. The final and complete elabo- To assure a high quality final result, the project is b. Final design and elaboration of the ration of the project will take 9 to 12 months after divided in a number of phases. The finalization of architectural plans; signing of the letter of intent by the hospital and each phase can be considered as a milestone. c. Elaboration about level of medical the Venezuelan government. The execution of the These milestones are considered crucial decision equipment and technical specifications; construction works will be done in 2 distinct phases. moment where go-no go decisions must be taken. d. Final interior design of the hospital. Each of those phase will take 1 up to 1,5 years. The project is divided in the following phases: C. Financial elaboration Finally operations and training will last up to three Phase 1: Technical Design and elaboration a. Elaborating and negotiation on years after finishing the first construction phase. Phase 2: Construction and equipping Barter Trade; Phase 3: Operations and training b. Preparation final budget. D. Elaboration of the project organization strucutre E. Planning/Time schedule Phase 1 – Technical design and elaboration The first phase starts after a written intention of the hospital Universitario of Caracas and the Phase 2 – Construction and supervision Venezuelan government to remodel the operating During this phase the project will be implemen- complex, ICU and central sterilization based upon ted. Most likely the execution will take place in the current proposal. The following items will be two phases. Those phases are crucial to safeguard elaborated: the full functionality of the hospital during the A. Development of a Master Plan execution of the construction and equipping works. a. Development of a master plan for the restructuring of the hospital based, Phase 3 – Operations and training including technical solution as well as The third phase starts after the finishing of the analyses of operational costs; first part of the construction. During this phase b. Development of a detailed project the project team will maintain the equipment Implementation planning 20102011201220132014 Final Design Construction - Phase 1 - Phase 2 Operations Annex I Architectural lay-out Annex I Architectural lay-out Annex I Architectural lay-out Annex I Architectural lay-out Annex II Equipment list Annex II Equipment list Bill of Quantity Hospital Universitario Bill of Quantity Hospital Universitario Item Description Qty ItemDescriptionQty Item Description Qty ItemDescriptionQty Esterilization23.06.00.001 office furniture, lumpsum 16 20.06.12.100 trolley, clean linen 4 40.36.15.001 lamp, examination 1 20.06.09.007 trolley, instrument, general 16 23.09.12.100 bed, ICU 40 20.06.12.200 trolley, soiled linen, laundry 8 40.36.15.100 lamp, examination, mobile 2 20.06.09.100 trolley, instruments, sterile 30 23.12.07.001 cabinet, storage, open 4 20.06.15.001 trolley, medicine 4 44.06.07.001 ventilator, short-term 4 20.06.09.111 trolley, transport, loading for autoclave 4 23.15.25.100 cabinet, medicine 8 20.06.21.002 trolley, dressing 3 44.06.08.001 ventilator, long-term (ICU) 5 23.03.00.007 changing room furniture, lumpsum 2 23.15.26.100 cabinet, disposable materials 2 20.06.33.005 crash cart with defibrillator/monitor 2 44.06.08.002 ventilator, long term, neonatal (ICU) 10 23.12.07.001 cabinet, storage, open 60 23.18.03.001 chair, desk 1 22.27.00.001 bedroom furniture, lumpsum 2 44.06.13.001 ventilator, CP AP 6 23.25.00.001 fixed furniture, lumpsum 3 23.18.14.001 stool, doctor, mobile, surgical 6 23.03.00.001 waiting room furniture, set 2 45.42.01.001 bilirubinemeter 2 23.25.01.003 workbench, packing, sterilization 6 23.25.00.001 fixed furniture, lumpsum 8 23.06.00.001 office furniture, lumpsum 9 46.03.03.001 ECG machine, multichannel, standard 2 29.03.02.100 sterilizer, low temperature 1 23.79.28.001 screen / curtains 16 23.09.12.101 bed, ICU, pediatric 13 46.39.01.003 baby scale, digital 2 29.03.03.102 autoclave, 6 x 6 x 17, front loading 3 24.12.00.001 harware, lumpsum 13 23.12.07.001 cabinet, storage, open 4 46.42.10.010 patient monitoring post 2 29.06.06.002 washer disinfector, endoscopes 2 29.09.01.001 bedpan washer 4 23.15.26.100 cabinet, disposable materials 4 46.42.16.001 monitor, neonatal, multiparameter 15 29.06.07.002 scopy drying cabinet, front-and backdoor 2 40.15.03.001 infusionpump, volumetric 52 23.18.14.001 stool, doctor, mobile, surgical 6 46.42.22.001 monitor, multiparameter 13 29.09.04.001 instrument, washing and drying, 40.15.06.001 syringe pump 104 23.18.15.300 chair, patient/visitor 28 high volume, pass through 4 40.15.07.001 infusion stand, mobile 42 23.21.01.200 table, patientroom 1 Operation theatres 29.09.08.001 ultrasonic cleaning machine 4 40.15.08.001 infusion pump, enteral feeding 39 1 23.25.00.001 fixed furniture, lumpsum 6 16.70.04.001 timeregistration system, central clock 40.30.11.001 lift, patient, floor 2 23.79.28.001 screen / curtains 1 16.70.05.001 wall clock, operating theatre, ICU40.30.11.100 20.06.09.002 lift, patient, celing hoist 40 24.12.00.001 harware, lumpsum7central system 18 trolley, general transport 4 40.30.13.001 mattrass, anti-decubitus 40 29.09.01.001 bedpan washer 1 16.70.05.003 wall clock, central system 6 20.06.12.100 trolley, clean linen 8 40.36.15.001 lamp, examination 40 40.12.01.001 phototherapy lamp, mobile 3 20.06.09.002 trolley, general transport 4 20.06.12.200 trolley, soiled linen, laundry 12 43.12.12.400 ceiling supply unit, ICU 40 40.15.03.001 infusionpump, volumetric 36 20.06.09.009 trolley, Mayo, height adjustable, 20.06.15.001 trolley, medicine 8 44.06.07.001 ventilator, short-term 6 40.15.06.001 syringe pump 72hydraulic 20 20.06.21.002 trolley, dressing 6 44.06.08.001 ventilator, long-term (ICU) 12 40.15.07.001 infusion stand, mobile 36 20.06.33.005 crash cart with defibrillator/monitor 4 44.09.07.001 nebuliser 4 40.15.08.001 infusion pump, enteral feeding 17 with drawers 20 20.79.01.003 trolley, patient, shower 2 46.03.03.001 ECG machine, multichannel, standard 2 40.21.01.001 incubator, baby 18 20.06.09.100 trolley, instruments, sterile 18 22.09.01.200 refrigerator, medicine 2 46.42.10.010 patient monitoring post 4 40.21.04.001 radiant heater, baby 3 20.06.12.100 trolley, clean linen 4 22.27.00.001 bedroom furniture, lumpsum 4 46.42.22.001 monitor, multiparameter 40 40.30.02.001 suction pump, electrical (1 liter) 2 20.06.12.200 trolley, soiled linen, laundry 10 23.03.00.001 waiting room furniture, set 2 40.30.02.004 suction pump, baby 4 20.06.21.002 trolley, dressing 20 23.03.00.004 lounge furniture, set 3 NICU and Pediatric ICU 40.30.11.100 lift, patient, celing hoist 13 20.06.33.005 crash cart with defibrillator/monitor 3 23.03.00.007 changing room furniture, lumpsum 1 20.06.09.002 40.30.13.002 mattrass, anti-decubitus, paediatric 13 20.79.01.002 trolley, patient, examination 10 trolley, general transport 6 20.06.09.010 trolley, anesthesia instruments, Annex II Equipment list Annex II Equipment list Bill of Quantity Hospital Universitario Bill of Quantity Hospital Universitario Item Description Qty ItemDescriptionQty Item Description Qty 20.79.01.101 trolley, patient, operating complex 42 43.12.02.002 operating lamp, ceiling mtd. 2 lamps 20 47.41.01.201 ultra-sound unit, color & doppler 1 22.09.01.200 refrigerator, medicine 3 43.12.03.100 operating microscope, ophtalmology 1 47.66.07.002 viewer, x-ray film 18 22.21.12.001 kick bucket 18 43.12.03.101 operating microscope, ENT 1 22.27.00.001 bedroom furniture, lumpsum 2 43.12.03.102 operating microscope, neurology 1 23.03.00.004 lounge furniture, set 11 43.12.03.500 operating microscope, ophtalmology, 23.03.00.007 changing room furniture, lumpsum 30 ceiling mtd 1 23.06.00.001 office furniture, lumpsum 32 43.12.03.501 operating microscope, ENT, ceiling mtd 1 43.12.03.502 operating microscope, neurology, 23.12.07.001 cabinet, storage, open 3 23.15.25.001 cabinet, dangerous drugs 4 ceiling mtd 1 23.15.25.100 cabinet, medicine 20 43.12.12.100 ceiling supply unit, aneasthesia 17 23.18.14.002 stool, laboratory 5 43.12.12.200 ceiling supply unit, surgery 17 23.18.14.005 stool, mobile, 5 castors, hydraulic 36 43.12.15.001 Intelligent OR system, basic 7 23.25.00.001 fixed furniture, lumpsum 20 43.12.15.002 Intelligent OR system, advanced 10 23.25.21.201 scrub-station, 6 sinks 5 44.03.03.002 anesthesia unit, ventilator/monitor 20 23.79.28.105 curtain, seperatain, around bed 16 44.06.07.001 ventilator, short-term 8 24.12.00.001 harware, lumpsum 28 45.03.01.001 microscope, binocular 1 24.12.06.001 computer; central server 1 45.03.05.001 microscope, binocular, fluorescent 1 29.09.01.001 bedpan washer 2 45.06.01.002 centrifuge, bench top, electric 1 40.15.03.001 infusionpump, volumetric 59 45.09.11.001 balance, chemical 1 40.15.06.001 syringe pump 40 45.48.04.002 haematology analyzer 1 40.15.07.001 infusion stand, mobile 34 46.30.08.001 endoscopy, videotower 4 40.18.03.001 blood transfusion heater, 46.30.08.003 endoscopy, accessories endoscopy continuous flow 15surgery 1 40.24.02.001 defibrillator 2 46.42.10.010 patient monitoring post 2 40.24.02.003 defibrillator with internal paddels 3 46.42.22.001 monitor, multiparameter 38 40.30.02.002 suction pump, electric, surgical (3 liter) 22 46.79.00.500 instrument set, cardio-thoraxic surgery 2 42.30.01.000 heart-lung machines, integrated 2 46.79.00.501 instrument set, minimal invasive surgery 3 43.09.02.010 electrosurgical machine, 400W 22 46.79.00.502 instrument set, neurosurgery 1 43.12.01.002 operating table, major operating theater 18 47.11.45.010 X-ray unit, C-arm, mobile, 2 monitors 3 AMPC International Health Consultants • Korte Muiderweg 2 • P.O. Box 5120 • 1380 GC WEESP • The Netherlands Tel. +31 (0)294 45 77 88 • Fax +31 (0)294 41 68 36 • www.ampc.nl