ENERGY MANAGEMENT
Intuitive design
One of the hallmarks of successful design is user intuition. This is most evident in children who use technology without any instruction. Indeed, with good intuitive design users will participate in the intended way and sometimes a desired change in behaviour can be observed. The Echuca Hospital provides many intuitive elements that have been designed into the core of the delivery strategy and are used by staff and patients with great success. One such example is sensor taps,
which have been around for many years now. The five stages of hand hygiene are considered the front line defence against infection. World Health Organization (WHO) standards indicate that correct hand washing with water should take around 15 seconds. This is actually quite a long time. I have observed many hospital staff using sensor taps for less than five seconds from pre-rinse to final rinse. The sensor taps installed at Echuca
have a 15 second minimum run time from sensor operation to turn off. Some staff were initially embarrassed when walking away while the water was still flowing but have adapted to washing until the water stops. Current observations indicate staff are hand washing for the full 15 seconds. This is very pleasing as most hand hygiene is achieved using alcohol foams. As alcohol foams do not kill bacterial spores and tropical parasites, it is most important that when water is used it is used correctly. Published results from Hand Hygiene Australia show an average compliance of 83.9 per cent across Australia. ERH is trending well above this. It is interesting to note that the lowest compliance rate in Australia is among medical practitioners, with 72.5 per cent compliance.
Reflected ceiling plans All engineers will be familiar with reflected ceiling plans. ERH viewed these as patient ceiling plans. All paths that required patient transport from one department to another were identified and areas requiring patient transport included strip lighting at the side of the corridor. This minimised the strobe effect on patients while being transported.
Fenestration Hospitals typically require deep ceiling voids of up to two metres clearance to conceal building services systems. The original design incorporated roughly three metres floor to ceiling height within occupied zones and a ceiling void of around 1700mm providing a floor to floor height of roughly five metres. A typical south facing ward room would receive dramatically better daylight penetration and uniformity by simply rotating banded landscape format windows to portrait.
IFHE DIGEST 2018 Nurse call handset with blind control.
Initially, to realise the benefit of this arrangement the ceiling void was going to be chamfered back at around 45 degrees to admit diffuse daylight deeper into the room. This would also allow operable windows for natural ventilation. Alternative arrangements were adapted
that allowed a 100 per cent fresh air system while still maximising the diffuse daylight penetration. Each bedroom has triple glazing with the outside double glazing providing thermal benefits to the building, while a third glazing on a hinged panel conceals a motorised venetian blind. This motorised blind is controlled via the patient pendant and allows the patient to control the natural light entering the room. Coupled with a 100 per cent fresh air system, the patient has fresh air and excellent controllable natural light.
Personal belongings Each room has a motel style safe for personal belongings. The code can be set by the patient. This added level of security was determined to best suit the needs of patients who bring valuable items in to hospital with them. It is common for patients to bring items such as wallets, keys and mobile devices. ERH provides peace of mind to patients that their valuables are safe while they are using our facilities.
Indoor and outdoor spaces The hospital is filled with indoor and outdoor spaces with seating. The patients
Room signage.
and their visitors intuitively use these spaces to promote the healing process. Evidence based design worldwide shows that an inviting space that provides natural light and entices visual stimulation is much less draining on patients and encourages them to move out of the bedrooms. This improves mental health by enabling engagement with others as well as encouraging mobility, which has physical benefits.
Signage Each bedroom incorporates a patient journey board that is updated daily. It is used by staff to communicate to patients and their families. It incorporates simple things like a direct phone number, what day it is and messages such as “patient is currently having an X-ray”. Each bedroom has a sign indicating the room number and a second sign for further information that can be tailored to the patient’s individual needs. This consistent, professional solution negates the need for ad-hoc arrangements.
Workflow terminal Each bedroom has a workflow terminal that is connected to the over door light and integrated to the site messaging and building management systems. The workflow terminal allows staff to highlight nursing functions such as infection risk and falls risk. It also has cleaning functions, portering functions and room status functions. Each function can be tailored to send reminder messages to the individual work group responsible in the care plan and can only be reset at the work flow terminal in the room of origin. This provides the focus on patient centred care and places the needs of the patient first and foremost. The technology is robust and flexible, allowing for any changes in the future.
A bedroom workflow terminal.
Stairs The entrance stairs were deliberately placed front and centre of the pedestrian
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