BUILDING DESIGN Sonia Cedrés de Bello – Architect
Remodelling healthcare facilities with limitations
This article analyses the design, project management and construction of the renovation of the emergency department and surgery suite of an old healthcare facility of high complexity which holds a School of Medicine and has high demand because it is located in the center of the metropolitan area of Caracas. The design, with an area of 3,000 m2
, has limitations
including security, site and surrounding location. This paper describes the diversity of the space use, distribution, density, proportions and equipping. Separation of internal traffic, and functional areas according to pathologies and critical stages, also are described.
In 2006 the Venezuelan Government launched a healthcare initiative called Barrio Adentro III which manages the renovation of existing hospitals, including implementing new technologies and building additions to meet new requirements. Priority areas to be updated included surgery suites, emergency departments and intensive care units (adults, pediatrics, neonatal). Emergency rooms are being remodelled in-line with current protocols of medical attention and to cope with growing demand caused by the increase in criminality, car accidents and the
deterioration of quality of life. Hospitals and health systems are now
deep into their post-reform planning on how to meet community needs and the rising number of patients that need treatment. The Hospital Vargas, the oldest hospital of
the city, and second of the country was included in this programme. The Hospital Vargas is a national referral public hospital that offers comprehensive medical and surgical services to adults and children; it is the site of a medical school and research institution. The original hospital, built in 1891, had a capacity for 400 beds and a pavilion scheme, following the design of the Lariboisiére Hospital build in Paris in 1854. The hospital was declared as a national historic monument in 1979. The hospital has a group of buildings,
which were built over a long period of time, raising to 600 beds in 1974. In later remodelling in 2006, the number of functional beds was reduced to 441. One of the additions to the original
hospital is a three-floored building, built in 1963 and which started functioning in 1965,
housing facilities for surgery, emergency, intensive care unit and central sterile supplies. This building has a rectangular shape, with an area of 3,000 m2
three floors of 1,000 m2 each. The last
remodelling started in 2007 and concluded in 2013. It now houses adult and children emergencies, observation units, a surgical suite, central sterile supply and rooms for residents and staff. The Emergency Department, receives
around 100,000 emergency visits a year (in recent years this demand dropped 60% due to the partial closing of the facility during remodelling) and around 6,000 surgeries a year before the remodelling1
(surgeries also
dropped 80% due to remodelling). It was one of the busiest emergency centres in the city. In 2002 160,000 patients attended.2
Due
mainly to the location in the center of the metropolitan area of Caracas, surrounded by areas of high depression, poverty and criminality.
Emergency entrances The building is located in front of a street with a depth inclination that make it possible to have direct entrances to two floors, allowing for the separation of the pediatric and adult emergency departments, as required by the national norms and regulations of Venezuela.3
The main entrance
and façade of the hospital is over the same street. At the south border is a contemporary tall
building which holds imaging and lab services, and on the east side is the internal access to the hospital through a corridor
Sonia Cedrés de Bello
Sonia Cedrés de Bello is a Doctor in Architecture (UCV, 2006) Master of Architecture (University of Washington, 1978) Architect (UCV, 1973). Professor and researcher at Experimental Development Institute (IDEC), School of Architecture and Urbanism at the Central University of Venezuela (UCV) since 1982.
She has over 40 years of experience in different areas of healthcare facilities planning and design, programming and evaluation. She is a member of the International Union of Architects Public Health Group, and member of the Organization of American experts in health technologies (EXAIS) and is a consultant on health facility planning and design.
The Hospital Vargas is the oldest hospital of the city of Caracas. IFHE DIGEST 2015 35 divided in
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