Upgrading of the Operating Complex Hospital Universitario de

Transcription

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
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
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 II Equipment list
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
23.18.03.001 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
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
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
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
20.06.12.200 trolley, soiled linen, laundry
12
43.12.12.400 ceiling supply unit, ICU 40
20.06.09.009 trolley, Mayo, height adjustable,
20.06.15.001 trolley, medicine 8
40.15.06.001 syringe pump 72hydraulic 20
20.06.21.002 trolley, dressing 6
44.06.08.001 ventilator, long-term (ICU) 12
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
40.21.04.001 radiant heater, baby 3
20.06.12.100 trolley, clean linen 4
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
20.06.09.010 trolley, anesthesia instruments,
ItemDescriptionQty
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
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,
23.15.25.001 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
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
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
45.06.01.002 centrifuge, bench top, electric 1
45.09.11.001 balance, chemical 1
40.15.06.001 syringe pump 40
45.48.04.002 haematology analyzer 1
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
40.24.02.003 defibrillator with internal paddels 3
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

Upgrading of the Operating Complex Hospital Universitario de

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