IUSS HEALTH
FACILITY GUIDES
Outpatient
Facilities
Gazetted
8 May 2015
Task Team: B:03
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8 May 2015
Gazetted
Name
E Fleming
E Fleming/M Coetzer
E Fleming/M Coetzer
E.Fleming/CduTrevou
E Fleming/M Coetzer
E Fleming/Meirovich
G Abbott
National Health Act,2003(Act
no.61 of 2003)
INFORMATION
NOTES
Form:
Health facility guides
Status:
Gazetted,8 May 2015
Title:
Outpatient Facilities
Original Title:
Outpatient Services
“Outpatient Facilities” contains planning and design guidance in five parts
covering the infrastructure norms and standards for outpatient facilities
providing district, regional, tertiary, central and national referral services. It is to
be read in conjunction with the full norms and standards suite and covers
policy and service context (Part A), planning and design (Part B), room data
(Part C), accommodation schedules (Part D), and case studies (Part E) of a
health facility
CSIR 59C1119 A:08 - 001
Description:
Reference:
Authors:
Stakeholders:
IUSS N and S task group B:03
National Department of Health, Provincial Departments of Health and Public
Works
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides:
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Accessing of these guides
This publication is received by the National Department of Health (NDoH), IUSS Steering
Committee Chairman, Dr Massoud Shaker and Acting Cluster Manager: Health Facilities and
Infrastructure Management, Mr Ndinannyi Mphaphuli. Feedback is welcome.
The CSIR and the NDoH retain the moral rights conferred upon them as author by section 20(1) of
the Copyright Act, No. 98 of 1978, as amended. Use of text, figures or illustrations from this report
in any future documentation, media reports, publications, competition entries and advertising or
marketing material is solely at the discretion of the Health Infrastructure Norms Advisory
Committee and should clearly reference the source. This publication may not be altered without
the express permission of the Health Infrastructure Norms Advisory Committee. This
document (or its updates) is available freely at www.iussonline.co.za or the forthcoming
Department webportal.
Application and development process
These IUSS voluntary standard/ guidance documents have been prepared as national
Guidelines, Norms and Standards by the National Department of Health for the benefit of all South
Africans. They are for use by those involved in the procurement, design, management and
commissioning of public healthcare infrastructure. It may also be useful information and reference
to private sector healthcare providers.
Use of the guidance in this documentation does not dissolve professional responsibilities of the
implementing parties, and it remains incumbent on the relevant authorities and professionals to
ensure that these are applied with due diligence, and where appropriate, deviations processes are
exercised.
The development process adopted by the IUSS team was to consolidate information from a range
of sources including local and international literature, expert opinion, practice and expert group
workshop/s into a first level discussion status document. This was then released for public
comment through the project website, as well as national and provincial channels. Feedback and
further development was consolidated into a second level development status document which
again was released for comment and rigorous technical review. Further feedback was
incorporated into proposal status documents and formally submitted to the National Department
of Health. Once signed off, the documents have been gazetted, at which stage documents reach
approved status.
At all development stages documents may go through various drafts and will be assigned a version
number and date. The National Department of Health will establish a Health Infrastructure
Norms Advisory Committee, which will be responsible for the periodic review and formal update
of documents and tools. Documents and tools should therefore always be retrieved from the
website repository www.iussonline.co.za or Department webportal (forthcoming) to ensure that
the latest version is being used.
The guidelines are for public reference information and for application by Provincial Departments
of Health in the planning and implementation of public sector health facilities. The approved
guidelines will be applicable to the planning, design and implementation of all new public-sector
building projects (including additions and alterations to existing facilities). Any deviations from
the voluntary standards are to be motivated during the Infrastructure Delivery Management
Systems (IDMS) gateway approval process. The guidelines should not be seen as necessitating
the alteration and upgrading of any existing healthcare facilities.
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
Health Facility Guides:
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Acknowledgements
This publication has been funded by the NDoH.
IUSS Norms and Standards Task Team (Outpatient Facilities): Edwina Fleming, Magda Coetzer,
Documents of significant contribution
NHS Estates: HBN 12, Outpatients Department, 2004.
Abbreviations
CHC
CR
DICOM
DR
EC
ENT
GIT
HIS
HPCSA
IHPF
IUSS
NDoH
OoM
OPD
PHC
PACS
POPD
RIS
STP
-
-
Community Health Centre
Computer Radiography
Digital Communication System
Digital Radiography
Emergency Centre
Ear-nose-throat
Gastro-intestinal Therapy
Hospital Information System
Health Professionals Council of South Africa
Integrated Health Planning Framework
Infrastructure Unit Support Systems
National Department of Health
Order of Magnitude
Outpatients Department
Primary healthcare
Picture Archiving Communication System
Paediatric Outpatient Department
Radiology Information System
Service Transformation Plan
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TABLE OF CONTENTS
TABLE OF CONTENTS .....................................................................................................5
LIST OF TABLES ...............................................................................................................9
LIST OF FIGURES........................................................................................................... 10
OVERVIEW ...................................................................................................................... 11
PART A -
POLICY AND SERVICE CONTEXT ........................................................ 13
1.
Policy context ........................................................................................................................... 13
2.
Services ....................................................................................................................................... 14
2.1.
Outpatient services per hospital category ....................................................................... 14
2.2.
Referral system ............................................................................................................................ 14
2.3.
Determining the size of an outpatient department ..................................................... 15
3.
Patient profile ........................................................................................................................... 18
PART B -
OPD PLANNING AND DESIGN .............................................................. 20
1.
Overview..................................................................................................................................... 20
2.
Planning and design considerations ................................................................................ 20
2.1.
General considerations ............................................................................................................ 20
2.2.
Functional requirements ......................................................................................................... 21
2.3.
Clinical Requirements .............................................................................................................. 22
2.4.
Environmental requirements ................................................................................................ 23
3.
Outpatient activities ............................................................................................................... 26
3.1.
Main activities .............................................................................................................................. 26
3.2.
Treatment activity ...................................................................................................................... 26
4.
OPD location ............................................................................................................................. 27
5.
Interdepartmental relationships ...................................................................................... 27
6.
Intradepartmental relationships ...................................................................................... 28
7.
Functional zones within the Outpatients Department .............................................. 29
8.
Flow Patterns ............................................................................................................................ 30
8.1.
Patient Flow .................................................................................................................................. 31
8.2.
Staff and service routes ............................................................................................................ 31
9.
Outpatient suites ..................................................................................................................... 32
PART C -
GENERAL OPD ROOM DESCRIPTIONS ............................................. 39
1.
Overview..................................................................................................................................... 39
2.
Public zone................................................................................................................................. 39
2.1.
Information desk (help desk)................................................................................................ 40
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2.2.
OPD waiting area ........................................................................................................................ 40
2.3.
Play area ......................................................................................................................................... 40
2.4.
Ablutions ........................................................................................................................................ 40
2.5.
Reception and records ............................................................................................................. 40
2.6.
Secondary entrance ................................................................................................................... 40
3.
Patient zone ............................................................................................................................... 40
3.1.
Patient sorting .............................................................................................................................. 41
3.2.
Patient vitals/ preparation suite ......................................................................................... 41
3.3.
Wheelchair accessible toilet/ specimen room............................................................... 42
3.4.
Sputum collection cubicle ....................................................................................................... 42
3.5.
Consulting room .......................................................................................................................... 43
3.6.
Counselling room ........................................................................................................................ 45
3.7.
Phlebotomy room (injection and blood taking) ............................................................ 46
3.8.
Procedures room ........................................................................................................................ 46
3.9.
Treatment room – dressings ................................................................................................. 47
3.10.
POP room ....................................................................................................................................... 48
3.11.
Multipurpose group rooms and associated stores ...................................................... 48
4.
Administration spaces........................................................................................................... 49
4.1.
Office Space ................................................................................................................................... 49
4.2.
Nurses’ station ............................................................................................................................. 49
5.
Staff zone .................................................................................................................................... 49
6.
Support zone ............................................................................................................................. 50
6.1.
Sluice room .................................................................................................................................... 50
6.2.
Clean utility ................................................................................................................................... 50
6.3.
Dirty utility .................................................................................................................................... 51
6.4.
Medicine store.............................................................................................................................. 51
6.5.
Linen store ..................................................................................................................................... 51
6.6.
Medical and surgical sundries store ................................................................................... 51
6.7.
Cleaners’ room ............................................................................................................................ 51
6.8.
Storage and management of paper patient records .................................................... 51
6.9.
Storage of consumables and portable equipment ....................................................... 52
PART D - SPECIALIST OUT PATIENT SERVICES .............................................. 53
1.
Dental suite................................................................................................................................ 53
1.1.
Overview ........................................................................................................................................ 53
1.2.
Clinical management of patients.......................................................................................... 53
1.3.
Sizing and location of the dental suite............................................................................... 54
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1.4.
Accommodation required ....................................................................................................... 55
1.5.
Dental Surgery (Consulting/Treatment) ......................................................................... 56
1.6.
Dental laboratory/ utility room ........................................................................................... 58
1.7.
Dental reception, administration and records .............................................................. 58
2.
Stoma therapy ......................................................................................................................... 58
3.
Rehabilitation Unit ................................................................................................................. 58
3.1.
Speech therapy and audiology .............................................................................................. 58
4.
Occupational and Staff Health Clinic ................................................................................ 61
5.
Ophthalmology outpatients................................................................................................. 61
5.1.
Primary health care optometry services .......................................................................... 62
5.2.
Regional ophthalmology services........................................................................................ 63
6.
Termination of pregnancy suite ........................................................................................ 66
7.
Renal unit ................................................................................................................................... 67
7.1.
Dialysis services .......................................................................................................................... 67
7.2.
Dialysis patient ............................................................................................................................ 67
7.3.
Location .......................................................................................................................................... 68
7.4.
Interrelationships ....................................................................................................................... 68
7.5.
Accommodation requirements ............................................................................................. 68
7.6.
Haemodialysis room.................................................................................................................. 69
7.7.
Water-treatment plantroom16 .............................................................................................. 71
7.8.
Peritoneal dialysis room .......................................................................................................... 72
8.
Victims of violence unit ......................................................................................................... 73
8.1.
Establishing a service for victims of sexual abuse ....................................................... 73
8.2.
General considerations ............................................................................................................ 74
8.3.
Location .......................................................................................................................................... 75
8.4.
Fundamental unit requirements .......................................................................................... 75
8.5.
Accommodation requirements ............................................................................................. 76
9.
Day Surgery Unit ...................................................................................................................... 77
10.
Engineering and mechanical requirements .................................................................. 77
PART E 1.
CASE STUDIES .......................................................................................... 79
Worcester Hospital ................................................................................................................. 79
PART F -
ROOM DATA AND ROOM REQUIREMENT LISTS ........................... 82
1.
Generic room data sheets..................................................................................................... 82
2.
Room requirement lists ........................................................................................................ 82
PART G - ........................................................................................................................... 83
1.
Applicable legislation ............................................................................................................ 83
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2.
Glossary of terms ..................................................................................................................... 84
3.
References ................................................................................................................................. 85
4.
Further reading ........................................................................................................................ 86
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LIST OF TABLES
Table 1: IUSS: General hospital support (GNS) reference documents ................................................... 12
Table 2: Outpatient care provision per service type .................................................................................... 14
Table 3: Calculating number of consulting/examination rooms required for a general clinical
service ................................................................................................................................................................................ 16
Table 4: Calculating number of treatment/procedures rooms required for a general clinical
service ................................................................................................................................................................................ 17
Table 5: FUNCTIONAL ZONES ................................................................................................................................. 30
Table 6: Typical consulting suites per health facility .................................................................................... 33
Table 7: Patient rooms per suite ............................................................................................................................ 35
Table 8: OPD rooms per zone by hospital category ....................................................................................... 37
1.
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LIST OF FIGURES
Figure 1: The referral pattern of health facilities within the health services ........................ 15
Figure 2: Directional signage ...................................................................................................................................... 22
Figure 3: Location ............................................................................................Error! Bookmark not defined.
Figure 4: District Hospital Outpatients – Intra-relationships and patient flow ................................ 29
Figure 5: Rooms relationships that promote the principal of ‘clean to dirty’ flow .......................... 29
Figure 6: Functional zone relationships .............................................................................................................. 30
Figure 7: One-way patient flow ............................................................................................................................... 31
Figure 8: Regional Hospital Outpatients – Intra relationships, patient flow and suite
arrangement .................................................................................................................................................................... 33
Figure 9: Tertiary Hospital Outpatients - Intrarelationships, clusters and patient flow ............... 33
Figure 10: Example of a Consulting room ............................................................................................................. 45
Figure 11: One-way patient flow through day unit ...........................Error! Bookmark not defined.
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Overview
This document outlines the policy and service context and attempts to illustrate the desired
planning and design considerations for hospital based outpatient services.

Part A outlines the national and provincial service and policy context for the hospital
and out-patient services in particular and addresses the scope and size of the unit

Part B contains planning and design guidance relevant to the OPD as a whole
including location and inter- and intra-departmental relationships and flow patterns

Part C addresses zone, space and room requirements for general out-patient services

Part D discusses specialist out-patient services

Part E provides illustrated case studies of out-patient departments, and

Part F includes a check list of generic room data sheets highlighting those applicable
to OPD’s.
While this document outlines focusses on planning and design requirements which have an
impact on clinical services, these requirements need to be seen within the framework of the
full set of IUSS guidance documents and should not be viewed in isolation.
Table 1 outlines the full set of IUSS documents and highlights those documents which are key
or desired cross reference documents for out-patient services.
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Table 1: IUSS: General hospital support (GNS) reference documents
Adult inpatient
services
Admission,
administration
and related
services
General
hospital
support
services
Clinical and
specialised
diagnostic
laboratory
guidelines
Mental health
x
Adult critical
care
Emergency
centres
x
Maternity care
facilities
x
Adult oncology
facilities
Outpatient
facilities
x
Paediatrics and
neonatal
facilities
Pharmacy
x
Primary
healthcare
facilities
Diagnostic
radiology
Adult physical
rehabilitation
Adult postacute services
Facilities for
surgical
procedures
TB services
x
Catering
services for
hospitals
Laundry and
linen
department
Hospital
mortuary
services
Nursing
education
institutions
Health facility
residential
Central sterile
service
department
Training and
resource
centre
Waste disposal
x
x
Integrated
infrastructure
planning
x
Hospital design
principles
x
Briefing manual
x
Building engineering
services
x
Space guidelines
x
Environment and
sustainability
Materials and
finishes
x
x
Future healthcare
environments
x
x
Essential
Generic room
requirements
Recommended
PROCUREMENT
AND OPERATION
Recommended
HEALTHCARE
ENVIRONMENT/
CROSS-CUTTING
ISSUES
Essential
Recommended
Essential
Recommended
SUPPORT
SERVICES
Essential
CLINICAL
SERVICES
x
X
Cost guidelines
x
Procurement
x
Commissioning
health facilities
Healthcare
technology
Inclusive
environments
x
Maintenance
x
Decommissioning
Infection prevention
and control
x
Capacity
development
Information
technology and
infrastructure
Regulations
x
x
x
x
x
x
Colours legend
Planners and Consultants
Procurement Administrators
Related documents
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
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PART A - POLICY AND SERVICE CONTEXT
1. Policy context
The Outpatients Department (OPD) is
the ‘shop window’ of the healthcare
facility. It is one of the departments
everyone is likely to visit at least once,
and the initial impression of the
service, building and its organisation is
likely to remain.
Outpatient care covers clinical care or treatment administered in
a medical office, clinic, community health centre or hospital that
does not require an overnight stay in a hospital or medical
facility. Such treatment is also referred to as ambulatory care and
includes preventive, promotive, curative and rehabilitative
services.
This document addresses the planning and design of
accommodation for outpatient departments that are attached to,
or part of, an acute hospital that offers either district, regional or
tertiary services.
Hospital based outpatient services may include:

Outpatient department which may include general services or specialist clinics in
family medicine, internal medicine, surgery, orthopaedics, paediatrics, obstetrics,
gynaecology, cardiology, gastroenterology, endocrinology, ophthalmology, dentistry
and dermatology – depending on the level of services provided by the hospital

Day care facilities where patients have surgery that is “same-day”1 i.e. The surgery is
performed on the patient as an out-patient service and the patient goes home the
same day. Day surgery procedures do not require hospitalisation of the patient

Rehabilitative outpatient services which may include physiotherapy, occupational
therapy, speech therapy, audiology, and

Hospital emergency centre (EC): Most visits to hospital emergency departments do
not require hospital admission and can include walk in patients (ambulatory).
Although generally classified as outpatient services, this document does not include the
following:
1

Emergency care covered in the IUSS document “Emergency Centres”

Rehabilitative care covered in the IUSS document “Adult Rehabilitative Facilities”

Clinic and Community Health Centre outpatient services covered in the IUSS
document “Primary Healthcare”

Maternity outpatient care covered in the IUSS document “Maternity Care Facilities”
and

Paediatric outpatient care covered in the IUSS document “Paediatric Facilities”
NHS Estates: HBN 12, Outpatients Department, 2004
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2. Services
2.1.
Outpatient services per hospital category
The business case and the health brief define the correct package of service and the required
bed distribution per facility. These are based on the Provincial Strategic Transformation Plan.
Categories of public hospitals – district, regional, tertiary, central and specialised hospitals –
are defined in the government policy document: Government Notice - R. 185, 2 March 2012,
National Health Act 61/2003 Regulations: Categories of hospitals : No. 35101. The level and
scope of outpatient services will generally be guided by the category of hospital.
Table 2 gives a broad outline of the distribution of services between categories of hospitals.
Services may, however, need to be tailored to the particular needs of the province and area of
implementation. Priority setting and planning processes at sub-district and district levels
should highlight local priorities and a profile of services should then be developed that is
based on the particular profile of need in the area concerned.
Table 2: Outpatient care provision per service type
District hospital
50–600 beds
Family medicine
Regional hospital
200–800 beds
Internal medicine
Central hospital
Max 1 200 beds
Super specialties
in the disciplines
listed for tertiary
care and including
oncology and
nuclear medicine
Paediatric
Rehabilitation
Infectious diseases
including TB
Tertiary hospital
400–800 beds
Internal medicine
and sub-specialities
of internal medicine
Including GastroIntestinal Therapy
(GIT)
Surgery and subspecialities of
surgery
Specialities and
sub-specialities:
- Obstetrics and
Gynaecology
- Orthopaedics
- Ophthalmology
- Neurology
- Urology
Paediatric
Rehabilitation
Infectious diseases
including TB
Mental health
Optometry
Dentistry
Mental health
Opthalmology
Orthodontics
Mental health
General surgery
Specialities:
- Obstetrics and
Gynaecology
- Orthopaedics
- Ophthalmology
HIV/Aids
Rehabilitation
Infectious
diseases
including TB
Mental health
Optometry
Dentistry
2.2.
Specialist hospitals
Max 600 beds
TB
Mental health
Paediatric
Rehabilitation
Infectious diseases
Referral system
When planning an out-patients service at a particular facility it is essential that the planning
team consider the totality of services required in the community served and provided by the
different facilities in the referral network. In rural areas the outpatient department will usually
provide the full range of out-patient services required by the community plus certain specialist
services wheras in some major urban or metropolitan situations there will be a closer network
of clinic, CHC and district hospitals serving the community and the district hospital may then
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT
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serve more of a referral role with clinics and CHC’s providing the bulk of PHC family medicine
outpatient services.
Figure 1: The referral pattern of health facilities within the health services
2.3.
Determining the size of an outpatient department
Initial determinants
Consulting and treatment rooms are together seen as the planning units (PU’s) for the OPD
and are used as the basis for determining the size of the OPD. In the OPD the PU’s can also be
seen as patient contact spaces. Each planning unit is then supported by a range of other spaces
required to enable the primary service. PU’s should be provided for the population served at a
rate in accordance with its projected needs as described in strategic planning.2
This strategic planning should be done by the provincial Department of Health planners.
In assessing the service and calculating the size and number of PU’s for the OPD the strategic
planner will source and determine:

population density, age distribution and economic profile

geographical and other factors impacting transport and access time to the facility and
to adjacent and/or referral facilities

the scope of services required (service package)

the range of hospital services to be delivered

anticipated activity levels for each out-patient service

the types of patient contact space required for each service

operational assumptions

the calculated number of patient contact spaces required for each service, and
2Adapted
from: Department of Health (DoH). 2011. Facilities for primary and community care services: Policy and service
context manual. (2685:1.6). London, UK: DH.
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
the range and number of support spaces required.
The healthcare infrastructure component of strategic service planning will be covered in more
detail in the IUSS Integrated Infrastructure Planning Guide. The following is provided as an
interim outline of the considerations and current service planning ratios.
Variety of patient contact space required for each service
Outpatient spaces can be generic or specialist. Most individual services will require access to
more than one room type, for example general clinical services require access to consulting
and treatment rooms (primary planning units) supported by a range of ancillary or support
accommodation. Where an individual service requires access to more than one room type it is
necessary to identify the percentage of patients using each room type; for example, analysis
may show that 100% of patients require access to a consulting room but only 20% require
access to a treatment room.
Operational assumptions
To enable patient contact spaces to be quantified, assumptions about the following operational
factors will be required:

opening hours per week (eg. 8hr day for 5 days a week; or 24hr service for 365 days a
year)

average duration of each appointment by service and room type (high, acute care, or
low preventive health and chronic care, turnover), and

average room utilisation rate.
The room utilisation rate allows for non-attendees, unplanned activity and the complexity of
scheduling a variety of staff. As a rough guideline utilisation rate of at least 60% should be
achieved during normal operating hours, and probably not more than 80% at which point
workflow is adversely affected. However, the impact on room requirements of using a higher
utilisation rate to test other operational scenarios should be investigated.
Calculate the number of patient contact spaces required for each service
The examples below illustrate the calculation for consulting and treatment rooms for general
clinical services at district level using the steps outlined above. This would apply to both
existing and new facilities. Requirements for specialist patient contact spaces such as for
rehabilitation therapy should be determined in a similar way.
In busier facilities generic patient contact spaces may be shared on a sessional basis to
maximise their use unless required on a dedicated basis for full-time use.
Table 3: Calculating number of consulting/examination rooms required for a general clinical
service
Calculating number of consulting required for a general clinical service
Catchment population
Access rate (non-medical aid portion of
population):
Anticipated annual contacts (per person per
year):
Assume 100% patients use the Consulting
rooms
10 000
People
83%
8 300
People
5
41 500
People consults per
year
41 500
Consultations per year
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Patients accessing Consulting room
Assume open 52 weeks per year: patients per
week
Appointment duration (average 20 mins):
Patient appointment time required per week
(hours):
Operation hours per week:
Room utilisation per week:
Room availability per week
Number of Consulting rooms required:
Round up
52
798
Consultations per week
0.33
hours
264
hours
40
hours
32
hours
8.25
rooms
9
rooms
80%
80% of 40=32 hours
Table 4: Calculating number of treatment/procedures rooms required for a general clinical
service
Calculating number of treatment rooms required for a general clinical service
Catchment population
10 000 People
Access rate (non-medical aid portion of
83%
8 300 People
population):
Anticipated annual contacts (per person per
People consults per
2 16 600
year):
year
Assume 20% patients use the treatment
0.2
3 320 Treatments per year
rooms: patients accessing a treatment room
Assume open 52 weeks per year: patients per
52
64 Treatments per week
week
Appointment duration (average 25 mins):
1 600 minutes
Patient appointment time required per week
27 hours per week
(hours):
Operation hours per week:
40 hours per week
Room utilisation per week:
80%
Rooms available
32 Hours per week
Number of treatment rooms required:
1 rooms
Obviously, where a higher percentage of people utilise the treatment room (eg. surgical OPD
and orthopaedic OPD) and for a longer period, then the factors in the calculation need to be
adjusted accordingly which will result in the number of treatment rooms being increased.
These calculations are by way of example only and are to be adjusted to suit local circumstances.
Calculate the total number of patient contact spaces required
Once these room quantification calculations have been undertaken for all services, and all
room types, the results can be added together to establish overall requirements for primary
patient contact spaces for delivering care. At this point, room numbers should be rounded, as
appropriate. These spaces will effectively become the “schedule drivers” for the project.
For regional, tertiary and central hospitals, attendance is by appointment. The number of
required consulting, treatment and procedure rooms will be determined by the demand for
services, the distribution of specialities between regions and facilities and anticipated
attendance. Note that demand for services is related to population served distributed between
facilities providing similar services and is not a factor of an expressed need for teaching beds.
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Appointment time will differ depending on the speciality. As a rule in district and regional
hospitals allow 20 minutes per person per consultation, in tertiary hospitals allow 45 mins.
Support space
In order to function efficiently, the patient contact spaces (planning units) require access to a
range of support spaces (for example utility rooms, storage spaces, etc.). The number and mix
of support spaces required should be identified from an analysis of the number and mix of
patient contact spaces....
Staff spaces
The staff spaces that are needed can be quantified by referencing the staff organogram and the
staff structure in the department....
Research and teaching space issues...
Where the facility will be used for teaching students and for conducting research, the design
must facilitate and foster teaching and undertaking of research.
Space for the following may be required (project level motivation):

Additional administration space for research administrators...

Video-conferencing facilities to support collaboration with academic centres without
travel

Meeting space for research planning and development

Additional clinical space for research investigators, and

Routine activities and collaboration with non-governmental organisations (NGOs).
Public spaces
Requirements for waiting spaces and public toilets (except independent wheelchair toilets)
may be based on the number of patient contact spaces in the hospital. ...
Independent wheelchair toilets should be quantified according to the size of the building and
number of patients anticipated...
As a general assumption most patients attending an outpatient service will be accompanied by
a family member or carer. The waiting areas need to be sized accordingly. The number of
reception stations is determined by the peak load of patients attending, arrivals management
and the ratio between appointments and non-appointment patients.
3. Patient profile
The profile of patients presenting at an OPD could be one or more of the following:

New patients requiring assessment or consultation with a health practitioner

New patients referred for specialist intervention from another facility or a
practitioner

Patients with booked specialist appointments

Patients who require specialised investigations to confirm diagnosis or evaluate
progress

Patients requiring repeat prescriptions
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
Patients booked for day surgery

Patients attending a repeat consultation

Patients who require treatment, but who do not require the facilities of either an acute
day patient or inpatient ward

Patients who require screening for the selection for day case treatment, day surgery
or inpatient procedures

Patients requiring pre-operative assessment

Patients that need follow up and monitoring of their condition after treatment, day
surgery or inpatient procedures

Patients to be discharged from the care of the hospital, with referral if necessary to
other health service providers
Outpatient unit activities are centred on diagnosis and initial patient treatment and care, but
should also enable concurrent clinical and clinical support activities such as teaching and
learning and the taking of laboratory specimens, as well as unit level support service activities
such as portering, records management, clean linen and pharmaceutical supplies, dirty linen,
general domestic waste, medical waste and sharps, cleaning etc..
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PART B - OPD PLANNING AND DESIGN
1. Overview
The service and policy context
should be the basic determinant of
planning and design principles of the
Outpatient Department design
Part B includes general planning principles and design
considerations for the Outpatient Department and includes
general OPD planning and design considerations, describes
primary activities within the OPD, locates the OPD within the
hospital and defines the relationship of the OPD to other units
within the hospital.
OPD related intra-departmental relationships and workflow diagrams are provided to explain
the flow of patients, clinical staff, support goods and services, maintenance staff as well as the
flow of the public through the facility. Workflow diagrams within the department are provided
to assist in understanding the intra-departmental relationships in support of functional flow to
ensure productive service delivery.
2. Planning and design considerations
The planning and design of the OPD will need to respond to the relatively high numbers of
patients passing through the unit and, depending on the size of the unit and level of service
provided, may be designed as a single unit or a set of specialised OPD suites. The OPD should
be easily accessible from the hospital entrance and admissions unit and should provide a
patient-centred environment which provides accommodation suitable for a variety of clinical
uses depending on the level of services provided by the facility.
2.1.
General considerations
Planning and design principles for the Outpatient Department (OPD) should include that the
unit be:

fully utilised for the full 8 hour workday, unless it has a high proportion of specialised
services

informed by current and well informed strategic service and estate planning to avoid
over-capacity and under-utilisation

informed by the users i.e. consultations with clinicians, nurses, stakeholders, the
public and relevant statutory bodies during the planning and design process

underpinned, as far as possible, by the use of generic spaces to enable multifunctional use

adaptable to changing service needs and pathways

safe, secure, physically accessible and welcoming to the communities they serve

simply laid out to aid patient journeys, minimise staff movements and allow for
efficient maintenance

a clinically safe and effective healthcare patient environment maximising patient
safety and reducing the risk of service errors and accidents, and

compliant with quality assurance principles.
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2.2.
Functional requirements
Communications
A patient communication or call system must be provided. It is suggested that an electronic
communications board that will flash the patient’s service number be used instead of an
intercom to reduce noise and to allow for flexibility of waiting space.
Inclusive environments
A healthcare facility will have a high proportion of occupants, patients and visitors who are
unable to function without some form of assistance. To ensure minimum patient dependence
on staff and others, consideration should be given to designing for optimum patient
independence and enhanced staff productivity (Australasian Health Facilities Guidelines,
2010).
A ‘person with a disability’ is defined by national legislation as a person that is ‘limited in one
or more functional activities’. This includes communication, hearing, and seeing, learning,
moving, intellectual and emotional disabilities. The impairment may be permanent, recurring
or transitory. While 5% of the population has some form of recognised disability 3 this
proportion will be far higher amongst those using healthcare facilities.
Disability may be sensory, physical, cognitive or psychological. Consideration should be given
to the wide range of disabilities, including the following:

mobility impairment

visual impairment

hearing impairment

cognitive impairment, e.g. patients with brain injury or dementia, and

mental illness.
In addition, cultural and literacy issues should be considered as they can impact on access and
safety (Australasian Health Facilities Guidelines, 2010).
Further detail is provided in the IUSS Inclusive Environments in Healthcare guide.
Horizontal circulation
The width of corridors is generally determined by the traffic carried. For pedestrian and
wheelchair access, corridors should be a minimum of 1 500 mm wide, and 1 800 mm wide in
passing places. Where trolleys need to be maneuvered, this should increase to 2 600 mm. Main
corridors designated as ‘hospital streets’ in firecode-compliant buildings, need to be a
minimum of 3 000 mm wide, especially where pedestrian traffic is high.
Way-finding 4 and signage
Way-finding is particularly important for patients attending outpatients where patients may
be first time service users, may need to report to a new or different primary service point or
may be referred on to other sections within the OPD or to other departments within the
hospital, such as radiology, pharmacy, rehabilitation, wards, etc.
3
StatsSA 2007 Community Survey – as quoted in IUSS Inclusive Environments, section 1.4
4
Growth Solutions Group: Specialist clinics wayfinding guidelines: The outpatient journey: August 2008 www.gsg.com.au
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General way-finding and signage principles are included in the IUSS Hospital Design Principles
Guide.
Signage is a critical ‘way-showing’ component of way-finding. Detailed signage guidance and
examples are included both in the IUSS Hospital Design Principles guide and the IUSS Inclusive
Environments guide. Key signage directional points in OPD’s are shown in figure 2 below.
Figure 2: Directional signage
Signposting shall clearly identify staff, patient and visitor areas, and draw attention to
restricted areas.
Way-finding and signage must be considered from the inception of the design process when it
is possible to ensure that pathways can be designed to be logical, simple and easy to follow.
Way-finding maps should be located at strategic points throughout the site and allow visitors
to orientate themselves. The maps should be consistent with the signage and the typology
needs to be clear and concise. Guidance for and examples of way-finding maps and signage are
included in the IUSS Hospital Design Principles guide.
2.3.
Clinical Requirements
At all stages planners and designers must remember that the primary purpose of the outpatient department is to provide a safe, secure, effective and efficient working environment
enabling the examination and treatment of the out-patient.
International literature indicates that some 10% of patients treated in hospitals suffer from
“adverse events” which could include hospital acquired infections, medication errors or
injuries while in the hospital environment.
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Infection prevention and control
Healthcare facilities by their nature bring together people who are immuno-compromised
(often with HIV) with those who have either diagnosed or undiagnosed infectious diseases
(often TB). Special attention needs to be taken in the planning and design of communal areas
(primarily waiting areas) and patient care areas in OPD’s to reduce the opportunity for
hospital acquired infection for both patients and staff. Detailed guidance on the principles of
healthcare-associated infection control, standard precautions and additional transmission
based controls are contained in the IUSS Infection Prevention and Control (IPC) guide. The
following provides a brief summary of some of the key features that need to be considered in
the OPD:

where possible the planning and design should limit the opportunity for cross
infection to occur. This could be through procedures such as queue monitoring to
separate out and fast track potentially infectious patients

the provision of appropriate natural ventilation or where this is not possible, forced
ventilation

the use of large volume waiting areas to reduce the concentration of infectious
particles in the air

appropriate use if unavoidable of UVGI to neutralise airborne contaminants

appropriate selection of materials and finishes

provision of sufficient hand hygiene facilities

provision for the display of appropriate information posters

separation of clean and dirty work flows, and

appropriate waste management systems.
2.4.
Environmental requirements
Patient satisfaction, privacy, dignity and respect
Patients must be attended to in spaces that offer privacy, dignity and respect, whether being
examined and treated or merely speaking with the staff. This means that rooms need to be
reasonably soundproof and well partitioned and screened from other activities in the facility.
Artwork 5
Viewing nature scenes plays a key role in creating a healing environment which can improve
patient outcome. Research suggests that nature art can:

reduce stress and anxiety

lower blood pressure

reduce the need for pain medication

increase patients’ trust and confidence, and

be a positive distraction for patients, visitors and staff.
Other research6 has indicated that the art preferred by patients, in order of preference is as
follows:
55
http://healingphotoart.org/
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
nature landscapes (most popular)

animals

scenes of everyday life

portraits

urban landscapes

abstract (least popular)
Photograph 1: Courtesy of Mitchells Plain Hospital, Cape Town: Outside waiting area
It is particularly important to provide positive distractions in waiting areas. This can be
achieved through the use of appropriate artwork, views and access to nature, music and water
sounds.
“The research findings of Roger Ulrich, PhD, indicate that psychologically appropriate art can
substantially affect outcomes such as blood pressure, anxiety, intake of pain medication, and
length of hospital stay. In particular, representational nature art is shown to have a beneficial
7
effect on patients experiencing stress and anxiety.”
Cultural elements and age group have a strong influence on the reaction to various artworks,
therefore it is essential that the architects and health planners consult with people (of all ages)
from the surrounding communities that will attend the clinic to establish preferences.
Natural and artificial lighting
Design features that incorporate natural light will contribute to enhancing the patient
experience and, under normal daytime operating conditions, reduce the need for artificial
lighting. Corridors and waiting rooms should have external windows providing natural light and
ideally natural ventilation. Where natural ventilation is used the flow of air needs to be carefully
considered to avoid potentially contaminated air moving into functional rooms. Staff spending a
full day in consulting rooms are more vulnerable than patients who spend limited time in the unit.
Study: “Beyond traditional treatment… establishing art as therapy,” was conducted by the Foundation for Photo/Art
in Hospitals in collaboration with the Italian Oncology Group of Clinical Research (GOIRC), coordinated by Prof.
Francesco Di Costanzo, director of the Oncology Department of Careggi Hospital in Florence, Italy. Three cancer
centres in Italy – Ancona, Perugia, and Messina – participated in the research. 345 patients from these centres were
tested on their perception of the hospital environment before and after the display of nature photos in the treatment
rooms of their Cancer Centres.
6
7
Friedrich, MJ. 1999. The arts of healing. Journal of the American Medical Association (JAMA), 281(19)
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Noise control
The OPD is a busy area with patients, escorts, staff and service staff constantly moving to and
from the consulting rooms, to treatment rooms, service points as well as to and from other
departments. As it is important to create a calm welcoming environment methods to reduce
noise levels should be employed. This can be done through positioning specific rooms
appropriately (noisy areas away from those areas requiring quiet) and applying materials that
have better soundproof qualities. Information on material selection is contained in the set of
IUSS Internal Finishes in Healthcare Facilities guides.
Ergonomics
Ergonomics is the scientific discipline concerned with designing according to the human
needs, and the profession that applies theory, principles, data and methods to design in order
to optimise human wellbeing and overall system performance. (Wikipedia)
Badly designed recurring elements such as workstations and the layout of critical rooms have
a great impact on the Occupational Health and Safety (OHS) of staff and the welfare of patients.
There are five principles to consider when designing ergonomic spaces:

safety

comfort

ease of use

productivity/ performance, and

aesthetics
All workspaces should be adaptable to the users occupying that space. Therefore it should be
capable of adjustment or modification to suit that user. For instance, conventional work
surface heights for seated users are not suitable for people who use wheelchairs and in this
case dual-height surfaces should be provided. Worktop heights and widths in work areas
should be designed taking into account the type of work to be performed in this space and
users..
Ventilation
The air management in the waiting areas should be designed to reduce the spread of airborne
pathogens such as tuberculosis. At least 12 air changes per hour should be achieved.
It is recommended that UVGI lamps be appropriately fitted in all large waiting spaces.
While natural ventilation with good cross ventilation provides higher air changes per hour and
is more cost effective, it can be adversely affected by weather conditions and the need to close
windows and openings, especially in winter, heavy rainfalls etc. Hybrid systems that use both
natural and artificial systems of ventilation should be investigated.
Further information on ventilation and airborne IPC risk is contained in the IUSS documents
Building Engineering Services, and TB Services.
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3. Outpatient activities
3.1.
Main activities
Most outpatient care services involve one or more of the following activities:

counselling

consultation

examination

observation

diagnosis

treatment

rehabilitation

teaching, and

patient triage – fast-track patients that require admission to the day ward or for
special investigations to the point of service.
Generally, activities involve a nursing or medical practitioner and an individual patient/client,
although certain forms of physical therapy and counselling may take place in groups.
Most activities can be delivered from the following generic patient/client contact spaces:

interview room

consulting/examination room

treatment room

procedure room

rehabilitation room/ suite, and/ or

group room
In busier facilities generic patient-contact spaces should be shared on a timetabled basis to
maximise their use unless dedicated use on a fulltime basis can be justified by activity demand
and staffing availability.
3.2.
Treatment activity
Treatment activity requires special consideration. Treatments given in health facilities fall
under a number of categories, and can occur in different room types.

non-invasive and minimally-invasive treatments may take place in a consulting room,
or a treatment room, depending on space requirements. A non-invasive procedure is
one that does not break the skin, for example changing a dressing. A minimallyinvasive procedure is one that breaks or punctures the skin, for example injections
and taking blood.

an invasive procedure is one that cuts the superficial layers of the skin, for example
removal of moles, warts or corns and biopsies. A local anaesthetic or sedation may be
required with an invasive procedure. Most invasive procedures can take place in a
generic treatment room. Procedures that generate heat (for example ultrasound)
and/or unpleasant odours (for example cautery) should only take place in a procedure
room (with mechanical ventilation).
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Some invasive procedures may require all-round couch access, including access to the head of
the couch.
4. OPD location
OPD’s attract the highest volume of patients attending the hospital. Many of these may be in
wheelchairs or have mobility problems. The OPD should therefore be located directly off
hospital admissions and must be on the ground floor. If, in extreme cases where it is not
possible to locate the OPD on the ground floor, lifts must be provided.
The out-patient travel route needs to be as short and direct as possible from the main hospital
arrival point through admissions to the OPD for all patients and their escorts but particularly
so for the infirm and for those with disabilities. Approprite signposting is essential. All
patients should pass the security checkpoint at the entrance. Dedicated porters situated in
OPD will assist patients requiring wheelchair or trolley assistance. A wheelchair and trolley
parking space should be provided at the OPD entrance.
The OPD must be separate from the inpatient areas. Patients should be able to move into and
out of the OPD without entering other parts of the hospital.
5. Interdepartmental relationships
In order to create a coherent, user-friendly building it is essential to achieve the correct
adjacencies for the different functional zones, departments and spaces. Key considerations
with regards to outpatients and other departments within the hospital include the following:

a single main entrance to the health facility, which should be overseen by a main
security/information/help desk

from here, patients and visitors should be directed to either the inpatient areas or the
records and admissions area prior to attending outpatients

depending on the size of the facility, central OPD records and day patient admissions
desks should be at the entrance to the OPD. This area may be part of the main records
and admissions area upon entry into the hospital and should be adjacent to the OPD.

the admission and discharge area for inpatients should be separate to the records
waiting area, but should connect to the records area. It is from this point that inpatient
and outpatient flow paths should not cross and the two areas should be separate

the Medical Records Department need to be readily accessible due to the constant
movement of health records between OPD and Medical Records. Therefore, this
department must be placed immediately adjacent to, or below the admissions floor on
the lower level, to assist file retrieval and to reduce waiting times for patients at
service points

there should be easy access to the rehabilitation unit from the outpatient and the
inpatient accommodation. After consultation, patients may be referred to the
Rehabilitation Department, Dietetics and Social Work

most administration spaces are located separate from both the inpatient and
outpatient areas

should the health facility have a cafeteria, this should be close to the outpatients’ area
and accessible from the inpatient areas
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
the pharmacy should be close to outpatients and have easy access from the inpatient
facilities. Patients attend the hospital pharmacy to collect dispensed medicines after
consultation and/or treatment in outpatients

there should be block ablutions to assist in keeping these facilities clean and well
serviced, and

there must be good access to the diagnostics radiology from the waiting area and
consulting suites as patients may attend the Diagnostic Radiology Department during
the course of an outpatient session.
Figure 3: DEPARTMENTAL RELATIONSHIPS
OUTPATIENTS
RADIOLOGY
ENTRANCE
& EXIT
RECORDS &
ADMISSION
S
PHARMACY
INPATIENTS
EMERGENCY
SERVICES
HOSPITAL SUPPORT SERVICES
REHABILITATION
UNIT
THEATRES
6. Intradepartmental relationships
Key considerations with regards to the layout within the OPD include the following:

in the outpatients, there should be a centrally-placed general waiting area adjacent to
the records counter where patients register and collect their records/file before
proceeding to the cashier or the clinical areas within outpatients

adjacent to a waiting area is the preparation or vitals room where patients’ vitals and
data are recorded by a nurse before the patient is directed to one of the consulting
suites’ sub-waiting areas. Depending on the size of the clinic and services offered, this
may be only one suite or could be several different suites (e.g. orthopaedic, medical.
ophthalmology and separate surgical suite)

access to some suites may be controlled from local staff communications bases or
secondary reception desks

OPD staff rest areas are located separate, but close to the consulting suites

utility spaces are distributed close to the consulting and treatment areas, but central
stores, decontamination areas, disposal holds and maintenance accommodation are
located in a separate non-patient services area, with discrete access. Vehicular access
serving this entrance is separated from public vehicular and pedestrian routes, and
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
sub-waiting areas with vending machines should be provided at central points in the
different OPD suites to avoid congestion of people.
Figure 4: District Hospital Outpatients – Intra-relationships
Ablutions
CONSULTING
MAIN
WAITING
AREA
MAIN OPD
ENTRANCE
STAFF
AREAS
TREATMENT
Storage &
Utilities
COUNSELLING
RECEPTION
EMERGENCY
PUBLIC
PATIENT
STAFF &
SERVICES
Figure 5: Rooms relationships that promote the principal of ‘clean to dirty’ flow
Surgical
store
Clean
utility
Treatment
room
Sluice
Dirty
utility
It is important that key room relationships are maintained such as illustrated in Figure 5 in
order to allow principles of a one directional flow from clean to dirty to be enforced.
7. Functional zones within the Outpatients Department
The OPD consists of five separate functional zones, which together create the therapeutic
environment required for successful healthcare delivery:

public spaces

patient spaces (in larger, more specialised units the patient area may be subdivided
into separate suites)

administration spaces

staff spaces, and

support services spaces.
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Table 5: FUNCTIONAL ZONES
PUBLIC
PATIENT
STAFF
ADMINISTRATION
SUPPORT
• Entrance
• Main waiting
area
• Play area
• Help desk
• Reception
• Sub waiting areas
• Ablutions
• Triage/Assessment area
• Consulting rooms
• Counselling
rooms
• Treatment rooms
• POP room
• Speciality rooms
• Specimen
collection
• Sputum
collection
• Staff room
• Staff Ablutions
• Seminar room
• Offices
• Cashier
• Storage - linen,
equipment,
medicine,
consumables,
surgical sundries
• Sluice
• Clean utility
• Dirty utility
• Waste area
(external)
• Laboratory
• Cleaners room
Figure 6: Functional zone relationships
8. Flow Patterns
The design of the OPD must facilitate efficient patient and staff movement both linking into
and from the OPD to other areas in the hospital as well as between and within the zones and
groups of spaces within the OPD. Consider:

patient routes

staff routes

routes for the collection and removal of waste

routes for the delivery and distribution of supplies

routes for emergency evacuation, and the

design and layout of circulation spaces.
New records – med aids, workmens compens
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Admission & discharge
Info counter / front desk – get card, 1 person with computer, wait in triage, ... whic h opd
suite to go to in opd - where
8.1.
Patient Flow
To support an efficient workflow and effective human resource allocation, one-way patient
flow must be achieved. OPD patient routes should not cross those of in-patients and visitors to
in-patient areas.
Out-patient flow into and through OPD includes:

Car park/taxi or bus drop-off point or ambulance drop-off

Pass security

Enter hospital reception/ admission and primary waiting area / inquire at the
Information/ Help Desk (triage)

Waiting in the general primary waiting area before reporting to the Reception/
Registration Desk (collect card/ file)

Pay at the cashier’s office or register for medical aid payment if required

Transfer to out-patients department

Report to information desk for referral to appropriate waiting area

Wait in the waiting area before being attended to in the Patients Vitals or Phlebotomy
rooms

Wait in the sub-waiting area before being attended to in a specific consulting suite

Wait in the sub-waiting area before being attended to in a Treatment or Procedure
room if required

Transfer to radiology and wait in the sub-waiting area before being attended to in
radiology if required

Transfer to pharmacy and wait in the sub-waiting area before collecting medication
from the pharmacy if required

Finally, either be admitted to ward or go home
Figure 7: One-way patient flow
At the information desk, fast-track patients that require admission to the day ward or for
special investigations will be directed to the point of service.
8.2.
Staff and service routes
Routes should be planned to minimise clashes between the movement of patients and the
movement of materials (service routes). A separate entrance for staff and services is
recommended, especially for larger departments.
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9. Outpatient suites
Certain specialist spaces and associated support spaces will be grouped together in an
outpatient department. These groups of spaces have been defined as ‘suites’.
Figure 8: District Hospital Outpatients: Patient flow
A district hospital will, depending on its size, consist mainly of a family medicine suite only.
OPD’s in larger district, regional and tertiary hospitals are usually arranged into individual
specialist “suites” with support rooms and dedicated sub-waiting areas. For example an
orthopaedic clinic suite may consist of a sub-waiting area, consulting room, procedure room,
POP room and support rooms (stores, utilities etc). These areas may or may not share support
services. The orthopaedic suite may also share the sub-wait and support rooms, including a
procedure room, with the surgical suite.
Each suite functions according to the clinical requirements of the particular suite. An
orthopaedic suite will be configured differently to a medical suite as it will have a procedure
room and POP room with additional storage. Consultation with the project user group prior
to planning is essential to establish the number and type of rooms per “suite”.
The size of each suite is determined by need and the number of patient contact rooms that can
be effectively managed by a team of available practitioners. Each suite should be large enough
to maximise work efficiency but not so large that it becomes impersonal or difficult to
navigate. These suites may host a range of different specialty clinics throughout the week or
month, on a timetabled basis.
It is important to establish which services will share the suite on a timetabled basis as this has
a bearing on the provision of space.
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Figure 9: Regional Hospital Outpatients – Intra relationships, patient flow and suite arrangement
A regional OPD will be configured differently to a tertiary facility OPD as patients will enter the
hospital, obtain their records from the main admission records area and may wait in a
common waiting area to have their vitals taken before they are directed to the appropriate
suite. However, some suites may have their own record storage which means patients may go
straight to the sub-wait area dedicated to the suite concerned. These operational issues must
be decided and discussed with the user departments prior to design to determine the flow of
patients through the system and to determine those areas that will be shared and those that
will not.
Figure 10: Tertiary Hospital Outpatients – Intra-relationships, clusters and patient flow
Table 6: Typical consulting suites per health facility
Clinic
District
hospital
Family Medicine
Surgical Outpatients
Medical Outpatients
x
Diabetes
Endocrinology
General medical
Regional
hospital
Tertiary
hospital
x
x
x
x
Comment
Clinic space is grouped
together and shared on
a scheduled timetable
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Hypertension
Rheumatology
Burns
Cardiology – Adults
Cardiology - Paediatrics
Cardio-thoracic
Dentistry
Dermatology
EMG
ENT
EEG
GIT/Scope clinic
Geriatric
Gynaecology
Haematology
Hepatology
HIV/ ARVs
Infectious Diseases Clinic
Maxillo-Facial
Neurology
Neurosurgery
Nephrology
Nuclear Medicine
Obstetrics
Occupational Health
Oncology
Ophthalmology
Optometry
Orthopaedic
Pain Clinic
Paediatric Medical
Paediatric surgical
Plastic Reconstruction
Pulmonology (Lung) clinic
Stoma therapy
Stroke Clinic
Termination of Pregnancy
Clinic (TOP)
Tuberculosis (TB)
Urology
Vascular
Allied disciplines
x
x
May share space with
plastic reconstruction
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Close to Neurology and
Neurosurgery
x
x
Gamma
PET CT
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
May share with burns
x
x
Audiology
Dietetics
Occupational therapy
Physiotherapy
Podiatry
Social Welfare
Speech
x
x
x
x
x
x
x
x
x
x
x
x
x
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Table 7: Patient rooms per suite
PATIENT ROOMS
Consulting
Counselling
rooms
rooms
Treatment
rooms
Procedure
rooms
Family Medicine
Surgical
Medical
Rheumatology
Endocrinology
Diabetes
Hypertension
General medical
Burns
Cardiology – Adults
Cardiology Paediatrics
Cardio-thoracic
Dentistry
Dermatology
EMG
ENT
EEG
GIT/Scope clinic
Geriatric
Gynaecology
Haematology
Hepatology
HIV/ ARVs
Infectious Diseases
Clinic
Maxillo-Facial
Mother and Child
Neurology
Neurosurgery
Nephrology
Nuclear Medicine
Obstetrics
Oncology
Ophthalmology
Optometry
Orthopaedics
Occupational Health
Pain clinic
Paediatrics medical
Paediatrics surgical
Plastic
Reconstruction
Pulmonology (Lung)
clinic
Stomatherapy
Stroke Clinic
Termination of
Pregnancy Clinic
(TOP)
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
OPD SUITE
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Phlebotomy room
Share POP Room
Clinic space is grouped
together and patient spaces
shared on a scheduled
timetable. Phlebotomy
room required
Consulting rooms larger to
accommodate additional
equipment
x
x
x
x
x
x
x
x
x
x
Special requirements
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Dental surgery rooms
x
Holding and recovery space
Colposcopy Room
x
x
x
x
x
x
x
x
x
Gamma and PET CT rooms
Ante natal and Post natal
x
x
x
x
x
x
x
Specialist rooms required
Specialist?
POP Room
x
x
Body box room
x
x
x
x
x
x
Tuberculosis (TB)
x
x
Urology
x
x
Vascular
x
x
x
x
Dedicated toilet with
uroflow machine
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Consulting
rooms
Counselling
rooms
Treatment
rooms
Allied Disciplines
Audiology
X
Dietetics
Occupational therapy
X
X
X
Physiotherapy
X
X
Podiatry
Social Welfare
Speech
X
Special requirements
Sound booths
Tymp Room
Hearing Aid Testing Room
Adult Gym
Paediatric Gym
Group Therapy
Adult Gym
Paediatric Gym
Chest Treatment Cubicles
Resuscitation Cubicle
X
X
X
Procedure
rooms
Group Therapy
Group therapy
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Table 8: OPD rooms per zone by hospital category
Standard
Public zone
Patient zone
Administrative
spaces
Staff spaces
Support
services
spaces
Entrance lobby to
hospital
Security/
info desk
General waiting area
Play area
Ablutions
Outpatients reception/
registration/
appointments counter
Cashier
Triage area
Preparation/
vitals rooms
Specimen collection
room
Sub-waiting consulting
Consulting rooms
Counselling rooms
Treatment room
(dressing)
Treatment room
(injections/
blood taking)
POP room
Procedure room
Stoma therapy room
Speech therapy room
Audiology room with
sound booth
Dieticians office with
store
Office – medical
manager
Office - sister
Nurses’ station
Staff room
Staff ablutions
Locker area
Seminar room
Records room
Clean utility
Dirty utility
Emergency trolley bay
Cleaners room
Sluice room
District
hospital
large
x
Regional
hospital
x
District
hospital
small
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
*
*
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Tertiary
hospital
x
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Standard
Store – equipment
x
Store – consumables
x
Store – surgical
x
sundries
Store – medicine
x
Store – clean linen
*Depends on service availability
District
hospital
small
x
x
x
District
hospital
large
x
x
x
Regional
hospital
Tertiary
hospital
x
x
x
x
x
x
x
x
x
x
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PART C - GENERAL OPD ROOM DESCRIPTIONS
1. Overview
This section provides room information, requirements and diagrams for all general out-patient
department rooms and spaces. Additional more specific room requirement specifications and
layouts of rooms that are generally common to more than one department, such as consulting,
treatment, counselling rooms, offices, utility rooms and ablutions, are covered briefly in this
section and cross referenced to the separate set of IUSS Generic Room Data Sheets (currently
under development). These contain room design issues, finishes, fittings, fixtures with
associated services, services, loose equipment and room plans, elevations and isometric
drawings.
Details of the requirements for specialist out-patient services and suites will be found in Part D
following.
The design of any space in a healthcare environment must be based on:

the intended function of the space

the activities required to enable that function to be accommodated including
frequency and duration of activities

the people who will perform or be involved in the activities

the equipment and stock required to enable the activities

the environment necessary to enable the activities (lighting, ventilation...) and to
ensure occupant safety, and

the engineering services necessary for equipment, for environmental control and
general operational needs.
The focus of this section will be on providing general information that has primary functional,
spatial and service implications for the designer. Once approved the data in the generic room
data sheets will provide more comprehensive information on each of the points above and will
take precedence over general information in this guide.
Refer also to the IUSS Building Engineering Services guideline for service design principles and
detail requirements.
Lists of standard room requirement schedules for different levels of out-patient services with
cross referencing to the Generic Room Data Sheets are included in Part F.
2. Public zone
As indicated in section B:4 above patients coming to the OPD will have first gone through an
admission process through the main hospital admissions department where they will have
been received, registered, collected their files or cards, paid if required to do so and directed to
the OPD. The admissions department manages primary access to the whole hospital and is
covered in the IUSS Admission, Administration and Related Services Guide.
The public zone spaces shown here are within the OPD and presume that the general
admissions process has been fully covered in the admissions department.
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2.1.
Information desk (help desk)
The information desk is required to provide assistance where required and to manage the
patients attending the OPD. Patients will have been directed from the admissions unit. The
need for an information desk will depend on the size of the unit. In tertiary facilities separate
reception points may be required in each specialist clinic with provision for records keeping
and management. These will serve the function of the information desk.
The information desk needs to be located in the OPD waiting area and can also serve as the
control point for managing patients into the vitals room. The desk should be clearly visible to
those entering the OPD and in the waiting room.
2.2.
OPD waiting area
An initial waiting area is required in the OPD for patients arriving from admissions. Patients
will be referred from here to the vitals/ preparation room and on to the consulting/
counselling rooms. Patients may need to wait for some time and provision should be made for
information sharing and patient education.
The general design principles for waiting areas outlined for primary waiting in the admissions
unit must also be applied to the OPD waiting area.
2.3.
Play area
Depending on the size of the OPD a play area may be attached to the main admission or OPD
waiting area and should be visible to parents seated in the waiting area. Staff should also have
a clear view of the play area at all times. General requirements are covered under the hospital
admissions unit.
2.4.
Ablutions
Public ablutions and baby change areas need to be provided so as to be readily accessible to
those waiting in the out-patients unit. General requirements are covered under the hospital
admissions unit.
2.5.
Reception and records
Covered as part of the hospital admissions unit.
2.6.
Secondary entrance
A secondary entrance linking the Outpatients to the main hospital services is advisable to
allow for easy access for staff; delivery of supplies as well as the disposal of waste and to allow
passage for patients being admitted from OPD to the inpatient wards where required. Security
will be required at this point to control access in and out.
3. Patient zone
Public access to the various suites within the outpatients unit needs to be controlled, and to be
as direct as possible, from the admissions unit and public waiting areas. In small buildings this
control may be provided by the main reception desk. In larger buildings, with more suites, a
number of additional control points (staff communication bases) may be required.
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3.1.
Patient sorting
Provision of an area to sort patients upon entry into the OPD is dependent on the policy of the
OPD and the size of the unit. Some facilities will sort patients while they are in the main
hospital admissions area. In sorting a nurse will identify the patients according to their acuity
level and specific condition and direct them accordingly.
Alternatively, patients will pass through a dedicated “sorting” area where staff will rapidly
evaluate the patient and direct the patient according to their condition and requirements:

priority cases which require rapid assessment and treatment are directed to a priority
sub-waiting area

elective cases that are non-urgent will await their turn, either in the general waiting
or in the sub-waiting area.
The sorting area can be an area attached to the waiting area with access through to the
consulting rooms.
Space:
Minimum floor space of 12 m2
Services:

clinical hand basin set (elbow taps) (IUSS generic set BEI)

electrical points and telephone
Furniture:

examination couch

space for staff to write notes

chair for patient’s escort
Staff:
3.2.
Professional nurse
Patient vitals/ preparation suite
The patient vitals area is where basic patient observations are undertaken by the nursing staff
and entered into the patient record before a patient is seen by the doctor in the consultation
room. This process improves on OPD efficiency by saving on medical time and manpower.
Observations include weight and height, urine tests, blood pressure and pulse recording. The
suite comprises one or more assessment spaces, shared measurement area, a single disabledfriendly toilet for urine specimen collection with a pass through hatch to a urine test space.
The preparation room must have cupboards for storage, a hand basin, soap dispensers and
adequate worktops and cupboard space. .
Once observations are complete, the patients are referred to a sub-waiting area adjacent to the
consulting rooms. Waiting along a central internal corridor is not acceptable.
Refer to IUSS Generic Room Data sheets AID for detailed room requirements, layouts and
clinical equipment lists.
Space:
Depending on layout and brief. Minimum suite net area for 2 assessment rooms,
shared vitals area and toilet: 32m2
Location:
Close to the OPD waiting area and before the consulting rooms so that patients
are prepared prior to being referred to the consulting doctor
People:
Professional nurse with patient and possible accompanying person/ child
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Fittings – assessment area:
Workspace worktop/desk/ shelf/ cupboard unit for staff for storage and filling in
of forms during consultation
Fixtures with associated services:
Clinical hand basin set (elbow taps) directly available for staff performing
assessment and preparation/ urine test functions (IUSS generic set BEI)
Sink with drainer for urine test – link to hatch from urine test toilet
Shelving for supplies storage
Services – assessment area:
Electrical socket outlets for electronic equipment, room cleaning
Telephone point
Services – vitals and urine test area:
Electrical socket outlets for electronic equipment, room cleaning
Furniture and equipment – assessment area:
Office chair and 2 x patients chairs per assessment point
Waste bin
Furniture and equipment – vitals and urine test area:
Scales – infant and adult
Stadiometer (height measure)
Electronic infant scale
Fan
Portable oxygen
Portable suction
Waste bin (at urine test sink)
3.3.
Wheelchair accessible toilet/ specimen room
A disabled friendly toilet adjacent to the preparation/vitals room is required with a hatch
from the toilet opening onto a workspace in a small specimen collection and testing area,
which may be part of the preparation/vitals room. Hatch to be openable from the toilet side
only with shelf area on the receiving room side.
Refer to IUSS Generic Room Data sheets BEAAG for detailed room data and layouts.
3.4.
Sputum collection cubicle
Provide an external sputum collection cubicle off the preparation/vitals room. The door
between the two shall be protected from the prevailing wind so as to prevent droplet
infectious material being blown back into the preparation room. A stainless steel hand basin is
required in the sputum booth which must be well ventilated.
Refer to IUSS Generic Room Data sheets AIE for detailed room data and layouts.
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3.5.
Consulting room
OPD facilities will have two or more standard consulting rooms depending on the facility size.
The rooms will be used for consultation, diagnosis and initial clinical treatment of outpatients.
Patients may be prepared for and referred on from the consulting room to the OPD treatment
room or other parts of the hospital such as to the wards or delivery room in order to receive
additional services. Patients may also be discharged for home, community-based care,
transferred out to another facility or to sub-acute services. Patients may need to be transferred
to trolleys or wheelchairs (lifting assistance may be required), and receive medication and or
intravenous fluids in the consulting room. In emergencies patients may require resuscitation.
Patients may or may not be ambulatory (walking).
The consulting rooms must provide suitable space for the clinician to talk to the patient
(sometimes with a family member, caregiver and/or a translator), to take notes, to undertake
a general examination (sitting and supine) and, as appropriate, to initiate clinical treatment.
There must be good lighting and appropriate space around the examination couch for the
clinician to properly examine any patient for any condition. Many patients are examined
sitting or standing, children on their mother’s laps and others require full supine examination
on an examination couch. A few patients will need to be examined from left and right side of
couch (orthopaedics) and lithotomy examinations at the foot of the couch with a good light
(obstetrics and gynaecology).The examination couch can be moved away from a wall for these
examinations.
Special design considerations:
All rooms should have full-height walls and doors for privacy and to help
minimise the risk of cross infection. The use of curtained cubicles is
unacceptable. Note special door width to allow for trolleys, prams and large
equipment. Door swings should not impede movement or activities within the
rooms. 360° access to the examination couch/trolley is essential to allow
patients to be attended to from both sides. 8
There should also be sufficient space to accommodate a minimum of one
caregiver and equipment such as a buggy, pushchair or wheelchair
Worktop space to be provided to accommodate a computer workstation for
recording clinical information and viewing digital image and to be able to write
notes/reports
Natural light and a view to the outside are recommended while recognising that
patient privacy during examination must not be compromised.
Refer to IUSS Generic Room Data sheet AFAA for detailed room data, layouts and equipment
list.
Location:
the consulting rooms are situated after the preparation/vitals room and en-route
to the treatment zone, dispensary and admissions/ exit
Space:
recommended floor space of 13.5 m2
People:
professional nurse / doctor/specialist; patient and accompanying person/ child/
children
Fittings:
curtain track round examination bed
8
NHS Estates, 2004. Health Building Note 23 (HBN 23) – Hospital accommodation for children and young people. London:
The Stationary Office (TSO).
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fitted worktop/ desk with drawers, storage below worktop; wall mounted
storage cupboards
notice board
Fixtures with associated services:
clinical hand basin set (elbow taps) (IUSS generic set BEI)
X-ray viewing panel
examination lamp
Services:
telephone and data connection points
power outlets for computer and desktop equipment (2), examination equipment,
room cleaning and equipment
emergency call
Furniture and equipment:
1 office chair for clinician and 2 chairs for patient/s
examination couch with curtained zone
wall-mounted diagnostic set
clock
waste bin
peak flow meter
growth charts
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Figure 11: Example of a Consulting room (See generic room sheets for other layouts)
3.6.
Counselling room
The counselling room is required for patient counselling, support and education. In order to
allow for flexibility in use and possible reallocation the counselling rooms should ideally be the
same size as the consulting rooms.
Refer to IUSS Generic Room Data sheets AGA for detailed room data and layouts.
Space:
minimum floor space of 10 m2, preferred 13.5m2
People:
patient (with or without support), 1-2 counselling staff
Fixtures with associated services:
clinical hand basin set (elbow taps) (IUSS generic set BEI)
Services:
electrical point and telephone
Furniture and equipment:
desk with three chairs
notice board
filing cabinet
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3.7.
Phlebotomy room (injection and blood taking)
This is an optional room (or space) and depends on how the activities will be processed in the
facility. The room is set up to take blood samples from patients or give injections to patients.
Special design considerations: A non-threatening environment is essential.
Refer to IUSS Generic Room Data sheets AKV for detailed room data and layouts.
Location:
adjacent to the consulting rooms
People:
professional nurse, patient
Fittings:
work surface and under counter storage space; storage shelving over
Fixtures with associated services:
clinical hand basin set (elbow taps) (IUSS generic set BEI)
Services:
2 electrical points at the desk, refrigerator, room cleaning
Furniture and equipment:
patients chair with side table
worktop
covered injection trolley
refrigerator
notice board and clock
waste bin
sharps and hazardous waste bins
3.8.
Procedures room
The OPD will have one or more procedure rooms, large enough to accommodate an
examination couch or theatre table, depending on their size. A scrub sink is usually contained
in the procedure room, as well as good lighting to enable procedures to be carried out. The
number of procedures rooms required will depend on the range of procedures being provided
in the outpatients’ facility. Local anaesthesia may be used; no procedures requiring general
anaesthesia will be undertaken here. ...pre/post recovery waiting area, access to counselling
(ToP...) ...
Procedures may include the following:

Suturing of wounds

Male circumcision

Insertion of IUCDs, PAP smears

Termination of pregnancies (see ToP suite D6)
Refer to IUSS Generic Room Data sheet AK for detailed room data, layouts and equipment list.
Location:
accessible from the waiting and consulting areas and close to the sluice room
Space:
each room should have a floor space of 25 - 30 m² and a minimum wall length of
4.3 m
People:
professional nurse;
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Fittings:
work surface and storage space
Fixtures with associated services:
stainless steel scrub sink (elbow taps)
clinical hand basin set (elbow taps) (IUSS generic set BEI)
stainless steel sink and drainer built into worktop along one wall; cupboards
below sink; storage shelves above worktop
X-ray viewing box
Services:
four to eight electrical points
oxygen and suction point
examination light 100 000 lux over theatre table
Equipment: (consult with user department)
theatre table
full resuscitation trolley
clock with second hand
basin kickabout
soiled linen, instrument trolleys
loose instruments (as appropriate)
consumables
3.9.
Treatment room – dressings
The treatment/dressing room will be used for changing of dressings, removal of stitches and
similar procedures. The room should provide clean and dirty areas, clean for uninfected
wounds and dirty for infected sores and wounds. The room requires a hand basin with clinical
taps, lock-up cupboards, worktops, a patient couch, and good lighting. There must be
screening facilities to separate examination couches within the room where there is more than
one examination couch.
A small shared sub-waiting area is required in front of this room, the specimen room and the
POP room. Note the ‘clean to dirty’ relationship flow highlighted in figure 5 under
intradepartmental relationships.
Refer to IUSS Generic Room Data sheet AJA for detailed room data, layouts and equipment list.
Location:
accessible from the waiting area and close to the sluice room
Space:
floor space 16 to 20 m2; minimum wall length of 4.3 m
People:
professional nurse
Fittings:
work surface and storage space
gabler rail for each cubicle
curtains around each cubicle
Fixtures with associated services:
clinical hand basin set (elbow taps) (IUSS generic set BEI)
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stainless steel sink and drainer built into worktop; cupboards below sink
X-ray viewing box
Services:
four electrical points per cubicle
one oxygen and suction point cubicle
examination light 60 000 lux
Equipment: full resuscitation trolley
clock with second hand
medicine cupboard
fridge
HB meter, glucometer, peak flow meter
general surgical sundries
examination couch and chair/bench
NIBP and sats monitor
infusion pump and stand
3.10. POP room
This is a room provided for the removal or application of Plaster of Paris to a patient’s limb.
The area is similar to a procedure room with at least two additional electrical points for the
saws to remove the plaster casts. There should be a POP basin with the correct water outlets,
an adjacent store room for equipment and POP stores, as well as a store for crutches and
assistive devices.
Refer to IUSS Generic Room Data sheet AKP for detailed room data, layouts and equipment list.
3.11. Multipurpose group rooms and associated stores
Depending on the size of the OPD, one or more large group rooms are usually provided within
the outpatients unit. The best location is usually near the counselling suite and main waiting
area. This room will be used on a timetabled basis for the following:

Physical therapy requiring a large open space and access to handheld equipment

Health promotion/disease management events

Antenatal classes

Keep-fit classes

Voluntary sector classes, such as stroke club

Large meetings

Social events
Spaces should be sized to suit activity. Consideration should be given to providing one large
space, subdivided by acoustic folding walls.
Storerooms with wide-opening doors should be located immediately adjacent to enable
furniture to be wheeled away when not in use.
The provision of catering facilities nearby should be considered.
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4. Administration spaces
4.1.
Office Space
Office space is to be in accordance with the Government Gazette, Department of Works, 2005:
Space Planning Norms and Standards for Office Accommodation used by Organs of the State.
Notice 166 of 205, Vol. 483 No. 27985. The following considerations should apply:

The number of offices depends on the size of the facility. There should at least be an
office for the sister in charge or unit manager

Dedicated workstations should be provided for desk-based staff (for example team
secretaries, managers and other staff in non-clinical roles)

Practitioners requiring intermittent access to workstations for paperwork and other
admin activities can have a designated area provided for this purpose. This will
prevent patient contact spaces being blocked for admin work

The workstations within the practitioner admin area should be shared. However,
dedicated lockable storage units should be provided for personal items and files.

The IT system should enable any worker to log on at any workstation

Telephones should be cordless to enable confidential calls to be taken in quiet areas

Open-plan work areas may need to be subdivided using acoustic screens to reflect
team working patterns and/or for space charging reasons, and

Single-person offices may be provided where fulltime access to workstations and
constant privacy are required.
4.2.
Nurses’ station
The station is the hub of the service. It must be central to the service suite, have a good view of
the suite and the sub-waiting area.
Photograph 2: Courtesy of Mitchells Plain Hospital, Cape Town: Nurses’ Station
(Refer to the IUSS Generic Room Data sheets for detailed information.)
5. Staff zone
The following standard rooms are required:

Staff room

Staff ablutions
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
Staff locker area
Refer to IUSS Generic Room Data sheet BKNA for detailed room data, layout and equipment list.
6. Support zone
The support zone should be located away from the admission and patient circulation zone
close to the link to hospital circulation but still be accessible to procedure and treatment areas
and consulting rooms.
The following standard rooms are required:

Sluice room

Clean utility

Dirty utility

Store – medicine?

Store - linen

Store- equipment

Store - medical and surgical sundries

Cleaners room
The briefing schedule will identify the number of utility spaces and cleaners’ rooms required
to satisfy clinical functionality. Additional rooms may be required, however, because of the
layout of the building or based on facilities management operational policies. The numbers of
such rooms may consequently be adjusted in the project accommodation schedule. Additional
rooms may be located within suites or between them or adjacent to lift and stair cores.
6.1.
Sluice room
The Sluice Room provides for:

cleaning and disinfecting of bowls and other receptacles used in treatment as well as if
required the normal decontamination, sluicing, cleaning and disinfecting and storage
of bed pans, urinals, sputum mugs and wash basins

cleaning and temporary holding of used medical instruments for collection and
sterilisation at CSSD

testing and disposing of patient specimens as well as temporary storage of laboratory
samples, and

hand washing by staff before leaving the room.
At the Sluice room soiled linen may be rinsed and bio-hazardous waste such bodily fluids disposed
of . The first point of washing of soiled linen is the sluice room, after which the dirty linen and items
are bagged and transferred to the dirty utility.
Refer to IUSS Generic Room Data sheet BMF for detailed room data, layout and equipment list.
6.2.
Clean utility
The Clean Utility is for the storage and preparation of clean and sterile materials and
equipment for patient treatment, and, in some instances, for the secure storage and
preparation of medications including intravenous fluids.
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The Clean Utility should have direct access from the unit passage. It should be adjacent to the
surgical sterile store room (if provided) and the treatment/ procedure room/s.
Refer to IUSS Generic Room Data sheet BIA for detailed room data, layout and equipment list.
6.3.
Dirty utility
The Dirty Utility Room is the waste disposal room providing for the temporary storage of
contaminated waste, sharps, sluiced and soiled linen and recyclables prior to collection. The
room must be located near the unit exit from which collections will be made. Provide wall
protection rails, shelving and hand washing facilities.
Refer to IUSS Generic Room Data sheet BMC for detailed room data, layout and equipment list.
6.4.
Medicine store
Refer to IUSS Generic Room Data sheet BGLA for detailed room data, layout and equipment list.
6.5.
Linen store
The Linen Store provides for the storage of clean linen prior to distribution to point of use. The
size of the room is dependent on the linen distribution system and policy, frequency of top-up
and size of the unit. Provide adequate ventilation and space for unpacking from and loading
onto linen trolleys.
Refer to IUSS Generic Room Data sheet BSH for detailed room data, layout and equipment list.
6.6.
Medical and surgical sundries store
The store provides for sterile packs and instruments used in treatment and procedures. It
should be adjacent to the clean utility and close to the treatment and procedures room.
Refer to IUSS Generic Room Data sheet BMC for detailed room data, layout and equipment list.
6.7.
Cleaners’ room 9
Space and facilities must be sufficient for parking and manoeuvring cleaning machines and for
the cleansing of cleaning equipment and the disposal of fluids and used cleaning materials.
Hand-washing facilities are also required. Shelving and vertical storage should not encroach
on the working space or restrict access to the cleaner’s sink. Not requiring a close relationship
with any particular area within the unit, the cleaners’ room should be located away from the
principal routes used by patients. The door to the room must be lockable. A locked cupboard
for the safe storage of cleaning materials etc. should be provided within the room.
Refer to IUSS Generic Room Data sheet BLA for detailed room data, layout and equipment list.
6.8.
Storage and management of paper patient records
Generally provided for under the Hospital Admissions Unit except in tertiary facilities where
separate specialist clinics are provided with specialist clinic level reception and patient
management.
9
National Health Service Scotland. 2002. Scottish Health Planning Note (SHPN52): Accommodation for day care part 1- day
surgery unit. (Version 1). Scotland: Borders General Hospital NHS Trust.
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Requirements are detailed in the IUSS Admissions and Administration Unit Guide.
6.9.
Storage of consumables and portable equipment
In order to maximise the flexibility and adaptability of patient/client contact spaces, and for
the control of infection, fixed storage cupboards within rooms are not recommended.
Information in this guide is based on the following principles:

working stocks of sterile supplies and consumables, when and where required, should
be held on supplies trolleys in patient contact spaces. Supplies trolleys should be
restocked in clean utility rooms

portable equipment and consumables should be stored in dedicated storerooms when
not in use. Equipment may be mounted on wheels/trolleys. Trolleys may be preprepared for particular clinics

loose items such as crutches and walking aids may be stored on racking and wall
hooks. A small store may be provided within each suite for this purpose, or part of a
larger store may be set aside for this

larger equipment stores may be provided and shared between suites

bulky and infrequently used items may be stored here, on large trolleys or in mobile
cages

space should be provided, in accessible strategic positions, for storing a resuscitation
trolley or grab bag containing a defibrillator. Access to medical gas cylinders and a
portable suction machine may also be required, and

small captive key lockers should be provided for staff within each suite, for handbags,
wallets and mobile phones.
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PART D - SPECIALIST OUT PATIENT SERVICES
This section covers specialist services which may be found at district or regional level
facilities. Specialist tertiary level out-patients services and units such as cardiology, gastrointestinal unit, etc. will be covered later in separate IUSS guides.
1. Dental suite
It is important before commencing design of the dental suite that the design team consult the
user department and suppliers of the dental chairs to ensure that not only is the space
provision appropriate but that the electrical and mechanical services are correctly planned for
the safe provision of all services.
1.1.
Overview
People attend oral dentistry departments as out-patients for specialist consultation,
examination and treatment. Out-patients attending oral surgery, orthodontic and restorative
dentistry departments

are mainly ambulant

are often accompanied by an escort, and

many of the patients are children and , as such, waiting areas should include a play
area.
Treatment carried out differs according to the level of speciality in different facilities:

Primary Health care Facilities which include clinics, community health centres and
district hospitals
Services: general dental practitioners perform general dental examinations and
treatment

Regional Hospital
Services: general dental practitioners perform general dental examinations and
treatment

Tertiary Hospital
Services:
o
treatment of referred cases beyond the skill of a general dental practitioner
o
orthodontics
o
trauma work
o
dental treatment required because of general medical conditions, such as
AIDS, hepatitis, severe heart disease and haemophilia, and
o
oral and maxilla-facial surgery.
This guide covers dental services at clinic, CHC, district and regional hospital levels. Specialist
dental facilities will be addressed in a separate document.
1.2.
Clinical management of patients
The following services are undertaken at facilities covered by this guide:
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
advice and/or treatment planning, which may involve computerised and manual
techniques

dental consultation, examination and treatment of patients

follow-up of out-patients

referral if necessary to other health care services

Radiography, that is intra-oral X-rays, (orthopantomographs, cephlostats and other
specialist X-rays are carried out in the radiology departments in Tertiary hospitals)

taking plaster study models, or impressions, and

surgery of the mouth such as extraction of teeth, fillings etc.
Infection control and safety
High standards of hygiene are essential in all areas.
Hand-washing facilities must comply with infection control policies.
Careful consideration should be given to the provision of facilities for washing, disinfecting
and sterilizing instruments It is essential that bench-top sterilizers conform to regulations in
respect of the sterilization of unwrapped instruments.
Where hazardous equipment and substances are used appropriate warning signs are to be
displayed.
1.3.
Sizing and location of the dental suite
Sizing accommodation for an oral health department
A similar process should be used for sizing the dental suite to that described for the OPD in
section 2.3 above. A dental chair is used as the primary planning unit for the dental suite.
A minimum of two dental consulting rooms is required in all PHC and Regional facilities.
Location
The dental suite is part of the general out-patient service and should be located next to the
OPD of the hospital or Community Health Centre both for general patient accessibility by
patients and other medical professionals as well as ready access in case of medical emergency.
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Figure 12: Room relationships within the Dental Suite
Entrance
WAITING
OFFICES
RECEPTION &
RECORDS
DENTAL
SURGERY 1
LAB
STAFF
FACILITIE
S
1.4.
DENTAL
SURGERY 2
Accommodation required
Where general dental services are to be provided from new or significantly refurbished
facilities, the following facilities will be required:
Public area

reception with records (this may be shared with the main admissions unit)

waiting with access to ablutions and baby change area, and

children’s play area.
Patient area

dental surgery (consultation, examination and treatment)

single dental chair

Space for clerical work

Space for equipment including intra oral X-rays- mobile set and lead apron(orthopantomographs, cephlostats and other X-rays are done in radiology)
Support spaces

offices

small laboratory / utility room set between two consulting rooms

dirty utility

sluice – access?

A lab area set off from the main dental room (this could be a clean utility room)

compressor room.
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1.5.
Dental Surgery (Consulting/Treatment)
The dental surgery is the primary activity space of the dental unit. The dental surgery room
will be used by an oral health professional (OHP) i.e. dentist, dental therapist or oral hygienists
for consultation, examination and treatment.
Activities 10
The OHP will work seated on a stool from the patients’ right or left-hand side behind his head
and will be assisted by a dental assistant seated or standing on the patient’s left or right side.
The instrument trolley, dental cabinet, refuse bin and wash-hand basin should be within easy
reach of the OHP. An exception to this could be the wash-hand basin fixed to the opposite
window wall.
Dental X-rays would be taken using mobile equipment or equipment fixed permanently in the
surgery.
Dental instruments, drugs, medicines and materials are stored in drawers or cabinets with
doors out of sight of the patient, and only the essential supplies and instruments are on the
instrument trolley during procedures.
The OHP would normally wear surgical gloves, protective glasses and a mask during
procedures and these must be readily available in the surgery.
A sink and draining board to be provided if the used instruments are washed and disinfected
within the surgery. This function, however, is better centralized where the instruments can be
sterilized using a small autoclave
A clinical wash hand basin is to be provided in the room and must have elbow action taps or
hands free action taps.
Room requirements
Refer to IUSS Generic Room Data sheet AKA for detailed room data, layouts and equipment list.
Key factors which affect the space requirements include:

the size and shape of the room

the types and positions of fixtures, specialist built-in units and fittings

the types and position(s) of the dental chair(s) and associated equipment

space to allow for optimal working positions around the patient seated in the dental
chair

space to accommodate any required mobile equipment that may be required, and

the position of the dental chair in the consulting/treatment room should be such that
access to the chair is both easy and obvious to a patient.
The dental treatment room will contain specialist built-in cabinetry, a reclining chair, ceilingmounted lamp, wall-mounted inter-oral periapical X-ray machine and a console adjacent to the
chair supplying dental gases.
Specialist advice should be sought on the need for X-ray protection.
A resuscitation trolley should also be provided nearby.
NHS Estates: 1992: Health Building Note 12: Supplement 2: Oral surgery, Orthodontics, Restorative dentistry,
London : HMSO
10
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Electrical
Provision of electrical outlets to be discussed with the user department prior to design.
Suggested provision includes:

3 x 15amps outlet on wall near operator.

1 x 15amps outlet by the sink draining board for sterilizer if provided.

3 x 15amps outlet on wall above work top level on assistant’s side of room.

Connection box in front of the base of the dental chair on the floor with a 220V supply
and other services for connecting the dental chair.

Double 15 Amp electrical outlet sockets to be supplied in positions indicated on
drawings.
Dental examination/operating lamp
One ceiling-mounted lamp must be provided with each dental chair: The ceiling-mounted lamp
is preferred as it is less likely to inhibit the movement of staff around the dental chair.
Mechanical requirements

low voltage wire, 20mm water supply, 12mm air supply, 220V electrical supply,
40mm PVC vacuum to be supplied in position indicated on the drawings. These points
are to be supplied where chair mounted equipment is required

a dental vacuum system must be provided to serve the dental aspiration equipment at
each chair. This removes from the patient’s mouth saliva and water used to flush away
debris arising from treatment, or to cool high speed dental tools. This dental vacuum
system is entirely separate from the medical vacuum system

medical oxygen and medical vacuum should be piped to wall-mounted outlets close to
the dental chair;

plumbing must be done by an experienced plumber and be according to dental
plumbing specifications;

service duct: Provision must be made for leading an under-floor electric cable, a
20mm water supply pipe, a 40mm PVC vacuum pipe and 12mm compressed air
supply pipe to a point in front of the base of the dental chair in the room. Reference is
to be made to the dental chair supplier to obtain the necessary details for the duct and
the service inlets and outlets.

compressed air: Compressed air should be provided in each consulting/treatment
room to supply the dental unit and a wall-mounted outlet for the use of portable tools.
The piped medical compressed air system may be used where convenient, otherwise a
small compressor set to serve the department will be necessary. The compressor and
its associated air receiver, driers, separators and other accessions should be located in
a separate plant area externally (with external access for cleaning and maintenance)
to minimise noise in the department. This area must be caged for security purposes,
well ventilated, tamper and vandal proof. The air intake should be sited in a dry
position outside the plantroom and be fitted with a silencer and filter as appropriate

This room requires ventilation and acoustic treatment. Amalgam from waste water
will be captured and stored here.

Dental gases may be piped from a central manifold or provided from bottles. If a bottle
store is provided, it should be located on an outside wall with good ventilation. When
nitrous oxide is used, a gas scavenging system must be fitted.
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1.6.
Dental laboratory/ utility room
This room is the storage and preparation area for:

all clean and sterile supplies, including instruments

drugs, medicines and lotions which need safe-keeping and are used in the treatment
of patients, dressing trolleys

sterilisation of instruments.
Location:
positioned between two dental surgery (consulting/ treatment) rooms
Fittings:
worktop with space for autoclave
storage for equipment and materials required for packing on the worktop and on
shelves
Fixtures with associated services:
sink with drainage
Furniture and equipment:
worktop autoclave
Refer to IUSS Generic Room Data sheet BRN for detailed room data, layouts and equipment list.
1.7.
Dental reception, administration and records
Preferably centralised with general admission but may be localised depending on the size of
the unit and local requirements. The principles of shared reception and separating admin
space from clinical space apply.
2. Stoma therapy
The service will provide both in- and outpatient support for new patients and for patients with
stomas or incontinence. The service is managed by a trained stoma therapist. The unit
requires a small waiting area, consulting rooms, and a procedure room that could double-up
for patient teaching and a large store room for outpatient stoma issue. The support rooms
required will be shared with the main OPD.
3. Rehabilitation Unit
Hospitals should have a rehabilitation area where professionals can provide physical therapy
and work with groups such as occupational therapy, physiotherapy, basic rehabilitation
support, speech therapy and audiology, as well as issue- and fit-assistive devices. The unit will
serve both in- and out-patients and should be located close to the OPD to facilitate out-patient
access and limit the flow of out-patients into the main hospital. There should also be easy
access by rehabilitation unit staff to in-patient wards. The unit will also support outreach
services by rehabilitation workers to the communities and clinics.
Full details of the rehabilitation unit are covered in the IUSS Rehabilitation Facilities Guide.
3.1.
Speech therapy and audiology
The Rehabilitation Facilities Guide is based on the premise of an integrated rehabilitation
service, team and unit. Speech and audiology is associated with the rehabilitation unit but
should be located in a quiet area away from noise. Patients on treatment for TB may suffer
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hearing loss as a side effect of drugs and will need to have base line and follow up audiology
assessments. As for other OPD patient areas, airborne disease transmission is a risk that needs
mitigation through effective ventilation and other preventive measures (refer IUSS TB Services
Guide). The unit consists of the following:

Sub-waiting area

Speech therapy consulting room (large enough for group therapy sessions)

Audiology consulting room with sound booth

Store room
Speech therapy
Audiology
Consulting room with audiology booth in room
Sound booths
Tymp Room
Hearing Aid Testing Room
Audiology booth Specification 11
The purpose of the proposed audiology booth is to provide a sufficiently quiet and safe
environment in which patients may receive air conduction and bone conduction audiometric
testing for diagnostic purposes, specifically for the early identification of hearing loss related
to the treatment of MDR TB.
Location:
The proposed audiology booth is to be installed within the audiology suite.
11
CSIR and Andrew Wade, Sound Research Laboratories South Africa (Pty) Ltd .
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Regulatory compliance:
The proposed audiology booth is to comply with SANS 10182: 2006 as amended– the
measurements and assessment of acoustic environments for audiometric test. The
audiometric test equipment to be installed must be suitable for audiometric testing according
to SANS 8253-1:2011 – Acoustics – Audiometric test methods Part 1: Pure-tone air and bone
conduction audiometry.
Ambient sound pressure level:
The ambient sound pressure level per octave band inside the booth must be in accordance
with SANS 10182: 2006 for both air conduction audiometry and bone conduction audiometry.
The ambient sound pressure level at each octave band in the booth must be assessed
according to SANS 10182. Note that the ambient sound pressure level in the booth is
dependent on the ambient sound pressure level of the specific site and this must be taken into
consideration in the design of the booth envelope.
General requirements:
The audiometric testing equipment to be installed is to meet the test requirements of the
audiologists who will be conducting the tests and shall be in compliance with SANS 82531:2011 – Acoustics – Audiometric test methods Part 1: Pure-tone air and bone conduction
audiometry.
The proposed booth is to be sized appropriately to accommodate a patient in a wheel chair or
an assisted patient (a child with an assistant). The height is to be at least 2,2m high.
The booth must be accessible by a patient in a wheel chair.
The booth must be mounted on anti-vibration mounts to avoid any structural transfer of
sound from the main structure.
The booth must be fitted with a viewing pane and a door that is at least 900mm wide. Both
door and viewing pane must be appropriately acoustically sealed and must not compromise
the required ambient sound pressure level inside the booth. The door must be openable from
the inside and not lockable from the inside.
Ventilation:
The booth is to be fitted with an appropriate silent ventilation system that does not generate
sound in the booth or conduct sound through the envelope of the booth resulting in an
ambient sound pressure level above the prescribed limit per octave band (SANS 10182: 2006).
There must be supply of 7,5l/s of outside air. A portion of room air may be mixed when
temperature control is required. The ventilation system shall not be directly connected to the
building ventilation system. The booth must be able to be flushed with outside air only at 12
air changes per hour (ACH) for 20 minutes between occupancies. Air must be supplied into the
booth at high level and extracted at low level. All extracted air shall be exhausted safely to
outside. Air velocities in the occupied booth shall not exceed 0.1m/s
Lighting & electrical provisions:
There must be sufficient lighting provided inside the booth with a service illuminance of at
least 300 lux and not exceeding 520 lux at any point. The lighting shall achieve a colour
rendering index of minimum RA80.
The lighting equipment shall not compromise the required ambient sound pressure level
inside the booth.
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Provision must be made for the installation and operation of audiometric testing equipment
without compromising the acoustic integrity of the booth’s envelope.
All penetrations through the envelope for electrical services must be sealed and must not
compromise the ambient sound pressure level inside the booth.
Commissioning:
The suitability of the booth once installed is to be assessed according to SANS 10182. Only if
none of the measured octave band sound pressure levels exceed the corresponding maximum
levels giving in the standards is the booth deemed suitable for the particular site in which it is
installed.
All testing must be done with the correct equipment as prescribed in SANS 10182, including
calibration.
Documentation of the calibration and testing of the booth must be handed over to the client
upon completion.
References:
South African Bureau of Standards, 2006. SANS 10182:2006 The measurement and
assessment of acoustic environments for audiometric tests. Pretoria South Africa: SABS
Standards Division.
South African Bureau of Standards, 2011. SANS 8253-1:2011 Acoustics – Audiometric test
methods Part 1: Pure-tone air and bone conduction audiometry. Pretoria South Africa:
SABS Standards Division.
4. Occupational and Staff Health Clinic
The unit provides clinical consulting to all hospital staff for work related issues. This includes
initial assessment on assuming duty, after injury, such as needle stick injuries, or injury on
duty.
This unit will include the following:

Small reception desk

Consulting room

Treatment room

Ablution
Refer to IUSS Generic Room Data sheets AFAA, and AJA for detailed consulting and treatment
room data, layouts and equipment list.
5. Ophthalmology outpatients
The main functions of an ophthalmology out-patients department include specialist
consultation, examination and treatment in respect of eye disorders and diseases that do not
require either day-case or in-patient activity. Accommodation must be suitable for the
examination, treatment and care of ophthalmic out-patients.
The paramedical services related to ophthalmology are:

orthoptics

optometry
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
low visual aid services, and

ophthalmic (fluorescein) photography.
This document will outline only Optometry and Ophthalmology services
Optometry services
Optometry is a healthcare profession that is autonomous, educated, and regulated
(licensed/registered) where optometrists are the primary healthcare practitioners of the eye
and visual system who provide comprehensive eye and vision care, which includes refraction
and dispensing, detection/diagnosis and management of disease in the eye, and the
rehabilitation of conditions of the visual system. An optometrist is not a medical doctor and
they are not trained or licensed to perform surgery in an operating room.
Ophthalmology services
Ophthalmology services are delivered as a regional (or tertiary) service by an ophthalmologist
who is a medical or osteopathic doctor and who specializes in eye and vision care. As a medical
doctor, an ophthalmologist is licensed to practice medicine and surgery. An ophthalmologist
diagnoses and treats all eye diseases, performs eye surgery and prescribes and fits eyeglasses
and contact lenses to correct vision problems. Ophthalmology can be divided into the
following clinical specialties:

cataract

glaucoma

medical retinal

cornea/external diseases

oculoplastics

paediatrics

ocular motility

vitreo retinal

strabismus

lacrimal, and

orbital.
Orthoptics services
Within ophthalmology, orthoptics is a diagnostic, assessment, therapeutic and monitoring
service for children and adults with eye muscle abnormalities and visual function problems.
This service is usually a separate facility (or a dedicated room within ophthalmology) close to
the ophthalmology clinic.
5.1.
Primary health care optometry services
Primary Health Care facilities offer optometry services only providing an assessment, care and
dispensing service for adults and children with visual impairment.
An optometry clinic at a primary healthcare facility (CHC and district hospital) is where all
new patients will be received for assessment and initial consultation. Basic tests will be
carried out such as recording of visual fields, taking intra-ocular pressures, and measuring
visual acuity. Q – prescription of glasses, manufacture? and fitting?
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Those patients requiring further consultation and treatment will need to attend the
appropriate specialist ophthalmology clinic in a Regional Hospital out-patients facility.
5.2.
Regional ophthalmology services
In regional hospitals optometry and specialist ophthalmology out-patient services are usually
provided concurrently. Patients treated at regional facilities are usually referrals from a
primary healthcare facility.
Clinical management of patients includes 12:

examination, treatment, and monitoring which may involve computerised and manual
techniques

visual field assessment

refraction

orthoptics

radiology

biometry

medical photography and imaging, including fluorescein angiography

ultrasound

laser treatment

minor surgery of the eye, for example the removal of eyelid cysts and ingrowing
eyelashes. This may be carried out with the patient under local anaesthesia

nursing procedures, such as dressings, drops etc;

the fitting of contact lenses and prostheses and the provision of low vision aids.
Provision for children
Waiting areas with play areas should be provided and should ensure that children do not
witness anyone receiving treatment or being assessed. As the percentage of children attending
is higher than in other disciplines, the waiting areas and facilities for patients should be child
friendly and non-threatening.
Physically challenged patients: 12
Many patients attending the ophthalmology outpatients will be partially sighted or blind. The
department should therefore be designed to enable these patients to find their way around
independently:

areas must be well lit

good signage, easy to read and positioned well

floor surfaces should be even, with tactile indications of direction, and

there should be no obstructions in corridors and other public areas.
The department should preferably be located on the ground floor close to an entrance, or main
entrance, thus avoiding the need for elderly and partially sighted people having to travel too
far into the hospital building complex.
12
NHS Estates: 1996. Ophthalmology: Health Building Note 12: Supplement 4: London: HMSO
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Accommodation in an ophthalmology suite:
Public spaces

waiting room with play area

reception

public ablutions – separate male, female and disabled facilities
Patient spaces

vision testing spaces

visual fields test room

consulting/examination suite

ultrasound room

laser treatment room

photography room

darkroom

treatment room

recovery room

low vision assessment room

refraction/contact lens room

psychophysical and electrophysiology tests room

prosthetics room

consulting/examination suite – orthoptics

special examination room

offices for consultants
Staff

staff rest and lockers

staff toilet – separate male and female

offices
Support

clean utility

dirty utility

cleaners room

stores

medicines

equipment

records & consumables storage.
The size of an ophthalmology out-patients suite will depend on the population it serves, the
clinical staff availability and the intended service provision (especially with regards to the
specialities). It is essential that the design team consult with the relevant user group to ensure
that what is provided is appropriate for effective service provision.
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Figure 13: Functional relationships within a regional ophthalmology out-patients suite13
ADMINISTRATION &
STAFF
Return visits
ORTHOPTICS
Reception
Pharmacy
MAIN
WAITING
AREA
Play
Area
Ablutions
Interview
Refraction/contact
lens room
Psycho-physical and
electrophysiology
tests
Low visions aids
New referrals
OPTOMETRY
Vision testing
spaces
Prosthetics
Visual fields
Sub wait
Sub wait
Ophthalmology (speciality)
Consulting
Ultrasound
room
Laser
room
KEY
Consulting
(general)
Photography
room
Treatment
rooms
Dark room
Recovery
Clean utility
General clinic
Patient flow
Note: this layout is indicative only and needs clinical input
13
Adapted from the NHS Estates: 1996. Ophthalmology: Health Building Note 12:Supplement 4:London: HMSO
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6. Termination of pregnancy suite
This suite is limited to procedures to terminate pregnancy performed on pregnant women as
determined in the “Choice on Termination of Pregnancy Act, 1996 (Act No. 92 of 1996)” which
is the law governing abortion in South Africa.
The service offered is considered an outpatient service as patients do not stay overnight. ToP
services are provided at district and regional hospital levels.
It is important that this facility is in a discrete location with clear access to the theatre suite for
emergencies.
Care must be taken to ensure patient privacy throughout the design of this facility.
The following accommodation is required:
Public zone

separate entrance

reception

waiting area, and

access to public ablutions – separate male, female and disabled toilets
Patient zone

private counselling room

private consulting/examination room

35m² procedure room with theatre lighting and attached scrub area (this may be in
the procedure room)

recovery room for minimum of 4 beds, with

patient toilet and shower attached to the recovery room
Staff zone

staff toilet and change area with a shower provided, and

staff rest
Support services

sluice room with a freezer

dirty utility

storage for
o
medicines
o
linen
o
consumables
o
sterile packs

clean utility, and

cleaners room.
Depending on the size of the unit some rooms may be shared with the adjoining OPD but the
privacy of ToP patients must not be compromised.
Refer to Generic Room Data sheet links in Part C for detailed descriptions of the generic rooms
referenced above.
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7. Renal unit
The Renal Unit is considered an outpatient service especially in a Regional Hospital as patients
come in for treatment and leave within the same day. The renal unit is made up of a number of
sub units which, together, share common rooms such as staff rooms and service facilities.
7.1.
Dialysis services14
Dialysis, or the artificial process for cleansing the blood, is one of the most common treatment
options for patients with end-stage renal disease. There are two main types of dialysis:
haemodialysis and peritoneal dialysis
Haemodialysis
Haemodialysis is a type of dialysis that uses a special filter to cleanse the blood. During
haemodialysis treatment, blood is passed from the body through a set of tubes to a filter. The
cleansed blood is then returned to the body through another set of tubes. On average,
haemodialysis treatments are typically administered three times per week and last two and a
half to four hours.
Haemodialysis treatments are typically performed in an outpatient dialysis centre.
Peritoneal Dialysis
Peritoneal dialysis (PD) is a process in which blood is artificially cleansed using a man-made
solution that is delivered into and removed from the abdominal cavity.
In PD, the peritoneal cavity in the abdomen is used as a reservoir for the dialysis solution. The
thin membrane lining of this cavity provides a suitable barrier through which blood can be
filtered. A tube or catheter is surgically placed in the abdomen to create an access for
peritoneal dialysis. PD can be undertaken through the CAPD process (Continuous Ambulatory
Peritoneal Dialysis) or using a cycling machine using the CCPD (Continuous Cycling Peritoneal
Dialysis).
In Peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube
into the peritoneal cavity, where the peritoneal membrane acts as a semipermeable
membrane. The dialysate is left in the peritoneal cavity for a period of time to absorb waste
products, and then it is drained out through the tube and discarded. This cycle is repeated 4-5
times during the day.
7.2.
Dialysis patient
Many dialysis patients spend three or more days a week in renal units, so where they are
located, and how they are designed, can impact greatly on their quality of life. Dialysis
treatment can take up to 12 hours of a patient’s day
A renal dialysis unit is not just another treatment centre. For many patients, it is almost like a
second home – a place where they spend almost half their week, every week, and will do for
the rest of their lives unless they are among the lucky few who receive a transplant. 15
14
http://www.emoryhealthcare.org/dialysis/treatments.html
15
BBH: Renal unit design: focus on the patient http://www.hpcimedia.com/Building_Better_Healthcare/newsletter/page1
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7.3.
Location
Ideally the unit should be located on the ground floor and should have its own entrance.
Preferred relationships include:

Radiology

Cardiology

Critical care areas

Vascular surgery

Urology

The transplant unit
7.4.
Interrelationships
The layout of the unit must take into account the functional relationships between three zones
– patient treatment stations, service support facilities, and staff areas. Staff must be able to see
patients in the dialysis area; balancing adequate observation with patient privacy. Utility
areas, equipment storage and maintenance areas should be located to enable ease of access
from patient treatment stations, and the layout of the multi-station dialysis area should enable
patients to talk to each other and for nurses to be able to call for assistance from one station to
another15
Figure 14: Renal Unit interrelationships
Phleboto
my Room
Renal
Entrance &
Reception
Waitin
g area
Patient
ablution
7.5.
Consultatio
n/Counselli
Patient
Change
&
Haemodialysi
s Rooms
Staff station
Peritoneal
Dialysis
Rooms
Shared
support
facilities
Shared
Staff
Facilities
Accommodation requirements
The following accommodation is required:
Public zone

entrance

reception

waiting

public ablutions – separate male, female and disabled toilets, and

patient change room with lockers
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Patient zone

phlebotomy room (vitals room)

consultation/ counselling room

haemodialysis rooms

peritoneal dialysis rooms

procedure room, and

patient toilet and shower (wheelchair friendly)
Staff zone (shared)

staff rest

staff change and locker room

staff toilet and shower

nurses station, and

office
Support zone (shared)

water treatment plantroom

resuscitation trolley bay

sluice room

dirty utility

clean utility

cleaners room

kitchenette

IT switch room

storage for
o
linen
o
equipment
o
fluids
o
general
o
consumables, and
o
sterile packs.
Refer to Generic Room Data sheet links in Part C for detailed descriptions of the generic rooms
referenced above.
7.6.
Haemodialysis room
The following guidelines are drawn from the NHS Renal Unit Guide16
The area set aside for dialysis should consist of dialysis stations in increments of three to four.
There should be sufficient space allowed for (treatment) chairs to be fully reclined and for
nurses to carry out procedures, with a slightly larger space allowed where beds are used
16
NHS, UK 2011. Main renal unit - Main renal unit: Planning and design manual 6381:0.4:England
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instead of chairs. There should be a combination of chairs and beds used with the majority of
treatment spaces being chairs.
The space between dialysis stations should be at least 900mm – 1200mm to prevent cross
infection and allow a degree of privacy for patient.
The nurses’ station (staff station) must have a clear view of patients at all times.
Facilities at each dialysis station should include storage space for medical items that can be
easily reached by patients and staff, as well as other facilities that enable patients to carry out
seated activities, including a mobile table for storing books, papers and other belongings, and a
computer point and network connection point.
Fixtures with associated services:
clinical hand basin set (elbow taps) between two stations (IUSS generic set BEI)
Finishes:
floor to be slip-resistant, easily cleanable and have an impervious finish with
coved skirting, as the risk of spillage of body fluids and contaminants is high
Services:
adequate adjustable lighting on walls and ceilings, with controls within easy
reach of patients and staff, to enable staff to carry out procedures and for
patients to be able to read and write
Air conditioning should ideally be installed from the outset in order to help keep
rooms at a comfortable temperature for both patients and staff
medical gases, including oxygen, medical air and suction should be provided at
each treatment space
emergency call button per dialysis/teaching bay, and
water point for the purified water must be at each dialysis bay.
Refer also to IUSS Building Engineering Services Guide
Furniture and equipment:
reclining treatment chair
mobile side table/ overbed table
dialysis machine
equipment and supplies trolley
clinical and non-clinical waste bin and sharps container shared between two
stations
Photograph 3: Renal dialysis patient undergoing treatment
Dialysis
Machine
Treatment
chair
Google pictures: barbourproductsearch.info: Dialysis Unit, Middlesex
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Photograph 4: Courtesy of Great Ormond Street hospital: Paediatric dialysis treatment bay with
chair and dialysis machine
7.7.
Water-treatment plantroom16
Water to be used for dialysis needs to be treated to remove impurities. For haemodiafiltration,
the water quality must achieve ultra-pure standards. To achieve ultra-pure water standards
“double pass reverse osmosis (RO)” may be required, and this will have an effect on the space
allocated to the water treatment room.
The specification for the water treatment plant will be determined by the composition of the
water supply; project teams should seek the advice of the local water authority, a renal
technologist, the specialist water treatment plant supplier and the medical physics
department.
It is important that the plant be close to the dialysis area (although not adjacent to it because
of noise considerations) as this will shorten the distance covered by the distribution ring. It
should also be located close to vehicle access to enable deliveries of chemicals and salt (if
softening is required).
There should be sufficient space to accommodate a maximum of two people to monitor, adjust,
service and repair the water treatment plant.
The plantroom should be sized to accommodate the plant and storage of chemicals. Areas
within the plantroom providing bulk storage of any corrosive liquids should be suitably sealed
and bonded.
The plantroom floor should be sloped to a drain and treated with a chemical resistant sealant,
and the door accesses should have a lip and ramp to prevent water seeping to the rest of the
unit in the event of a large water leak. The floor should also be bunded17 to contain any major
water leakage.
The door should be lockable for security. The plantroom should be adequately lit and
ventilated. Mechanical ventilation may be necessary if the heat gain from the water treatment
plant cannot be controlled by natural ventilation.
17
Raising of all edges of the floor to create a pond sufficient to retain any liquid spills within the room.
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The plantroom should have provision for local and remote monitoring of the water treatment
plant.
The water treatment plant room should not house any other equipment (for example
calorifiers) other than that which is specific to its function.
7.8.
Peritoneal dialysis room
This area is for patients who are ready to begin their peritoneal dialysis treatment. Patients
need to learn about the different solution strengths to control fluid weight gain and also need
to practise carrying out exchanges. Description of activity... Is it all done in facility or are p’s
trained to do at home... Both CAPD and CCPD?
The PD area consists of a number of bays which include treatment chairs, fluid bag holders and
an easy chair for escorts. The number of bays which could be accommodated should relate
directly to the number of patients a nurse can supervise at the same session: probably two per
nurse.
This layout is similar to the haemodialysis area except more patients are treated in adjustable
beds in which case the space between each bed bay must be 1500mm to prevent cross
infection and allow a degree of privacy for patient. The area set aside for dialysis should
consist of dialysis stations in increments of four with sufficient space allowed for nurses to
carry out procedures around the beds.
Facilities at each dialysis station should include storage space for medical items that can be
easily reached by patients and staff, as well as other facilities that enable patients to carry out
seated activities, including a mobile table for storing books, papers and other belongings; a
communication and entertainment system with individual TV, radio, video and stereo
headphone systems and telephone handset, and a computer point and network connection
point.
The nurses’ station (staff station) must have a clear view of patients at all times.
Fixtures with associated services:
clinical hand basin set (elbow taps) between two stations (IUSS generic set BEI)
Finishes:
floor to be slip-resistant, easily cleanable and have an impervious finish with
coved skirting, as the risk of spillage of body fluids and contaminants is high
Services:
adequate adjustable lighting on walls and ceilings, with controls within easy
reach of patients and staff, to enable staff to carry out procedures and for
patients to be able to read and write
Air conditioning should ideally be installed from the outset in order to help keep
rooms at a comfortable temperature for both patients and staff
medical gases, including oxygen, medical air and suction should be provided at
each treatment space
emergency call button per dialysis bay
water point for the purified water must be at each dialysis bay.
Refer also to IUSS Building Engineering Services Guide
Furniture and equipment:
reclining treatment chair
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mobile side table/ overbed table
PD dialysis cycling machine
equipment and supplies trolley
clinical and non-clinical waste bin and sharps container shared between two
stations.
8. Victims of violence unit
8.1.
Establishing a service for victims of sexual abuse
In setting up a new or modifying an existing service for victims of sexual violence the following
need to be considered:

Is there a specific need for such a service in the community?

What types of health care facilities, if any, already exist?

What types of services are to be offered in the facility?

Where will the facility be located?

What are the hours of operation of the facility?

Are there enough qualified female health care providers in the area?

What are the local laws and regulations governing health care facilities and
personnel?

What are the laws regarding abortion, sexual violence, procedures for forensic
evidence collection and the distribution of emergency contraceptive pills?

Will services be provided to male and child victims?

Are their potential local partners?

What types of laboratory facilities are available?

What types of medicines and equipment are available?

What types of referrals are available in the local area (e.g. specialist physicians, rape
crisis programmes, emergency shelters, specialized children’s services)?
The structure of the proposed facility and the staffing requirements also need careful
consideration, for example:

How will the organization be structured?

What are the mission, goals, and objectives of the programme?

Who will be in charge and what qualifications do they require?

Who will provide the services and what qualifications do they need to have (i.e.
nurses, physicians, social workers, health aids)?

How many personnel are required?

What are the roles of the director and staff?

Who will conduct programme education, training, research and evaluation of staff and
other members of the multidisciplinary team?

What monitoring and evaluation tools are needed and how will they be developed?
Consideration must also be given to the development of:
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
Policies, procedures and protocols for treating victims of sexual violence if they do not
already exist;

Protocols for collecting forensic evidence;

Protocols for the administration of emergency contraception for pregnancy
prevention, and for STI testing and prophylaxis;

Protocols for HIV Testing and post-exposure prophylaxis;

Community awareness programmes and counselling services;

Data collection processes.
The following guidelines are drawn from:
WHO. 2003. Guidelines for the design of medico-legal care for victims of sexual violence.
Chapter 3: Service provision for victims of sexual violence
http://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap3.pdf
8.2.
General considerations
Priorities
When caring for victims of sexual violence, the overriding priority must always be the health
and welfare of the patient. The provision of medico-legal services thus assumes secondary
importance to that of general health care services (i.e. the treatment of injuries, assessment
and management of pregnancy and sexually transmitted infections (STIs), performing a
forensic examination- medical and forensic services.
The setting
Appropriate, good quality care should be available to all individuals who have been victims of
sexual assault. Consultations should take place at a site where there is optimal access to the
full range of services and facilities that may be required by the patient, for example, within a
hospital or a clinic. Individuals should be able to access services 24-hours a day.
Regardless of the setting (i.e. hospital-based or community-based) and location (i.e. urban,
suburban or rural area), care should be ethical, compassionate, objective and above all,
patient-centred.
Safety, security and privacy are important aspects of service provision.
The ideal is that the medico-legal and the health services are provided simultaneously; that is
to say, at the same time, in the same location and preferably by the same health practitioner.
Policy-makers and health workers are encouraged to develop this model of service provision.
In practice, victims of sexual violence present at any point or sector of the health care system.
Therefore, all health care facilities should be in a position to recognize sexual abuse and
provide services to victims of sexual violence (or at least refer patients to appropriate services
and care), irrespective of whether a forensic examination is required. If not already in place,
health care facilities need to develop specific policies and procedures for dealing with victims
of sexual violence.
Multiple services
Provision of comprehensive services to victims of sexual violence requires a team approach in
order to provide a coordinated range of services to victims.
Apart from a healthcare worker, other members of the interdisciplinary team may include:
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
Counselling staff: In some places, specially trained counsellors are available to assist in
the provision of information and social services to patients
Counselling services may also be provided by social workers, psychologists,
community-based support groups and religious groups

Laboratories: Medical and forensic scientific laboratories are responsible for analysing
specimens taken from patients. In most settings, these services are provided by
separate facilities. The medical laboratory (which is often attached to a hospital) has
responsibility for testing the specimens taken for assessing the health needs of the
patient (e.g. STI testing). The forensic laboratory will examine evidential specimens
(e.g. clothing or specimens that may contain trace material from the assailant)

Hospital: Sexual assault health services are often provided within a hospital setting;
this arrangement assures that medical issues can be addressed without delay.
Alternatively, hospitals may be used to provide emergency or ancillary medical care
for victims

Police: The main role of police is to investigate allegations of criminal activity. Police
may be involved with both the victim and the alleged assailant. Some police forces
have dedicated teams of officers for investigating sexual offences, and

The criminal justice system: In cases that proceed to prosecution, the health worker
may have contact with the various individuals involved in the court process.
Facilities
High quality facilities for providing medical services to sexual assault victims are characterized
by a number of key features, namely, they are accessible, secure, clean and private. All of these
features should be incorporated when planning a new facility or modifying an existing facility.
8.3.
Location
The ideal location for a health care facility for sexual violence victims is either within a
hospital or a medical clinic, or somewhere where there is immediate access to medical
expertise. For instance, a patient may present with acute health problems (e.g. head injury,
intoxication) that require urgent medical intervention and treatment. Similarly, there should
be ready access to a range of laboratory (e.g. haematology, microbiology) and counselling
services.
Minimum accommodation:

waiting room/reception area

separate consulting/examination room with access to a dedicated toilet and waiting
facilities.
Additional room(s) for others (e.g.family, friends, police) may be required.
Where services are provided to children, the physical surroundings should be child-friendly.
Special equipment for interviewing the child (e.g. two-way mirrors or video recording
facilities) may be required.
8.4.
Fundamental unit requirements

Accessibility: 24-hour access to service providers is preferable (Mandatory in District
and Regional Hospitals)

Security: At both an individual and community level there may be some antagonism to
sexual assault services. There should therefore be adequate measures to protect
patients, staff, health records and the facility itself. Strategies could include the use of
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a guard to control access, access control into the unit, adequate lighting, videosurveillance, lockable doors and cabinets, and fire prevention equipment.

Cleanliness: A high standard of hygiene is required in the provision of any medical
service. The facility should also comply with local safety and health regulations as
they apply to fire, electricity, water, sewerage, ventilation, sterilization and waste
disposal.

Privacy: Unauthorized people should not be able to view or hear any aspects of the
consultation. Hence, the examination room(s) should have walls and a door, not
merely curtains.

Assailants (perpetrators) must be kept in a separate unit from their victims.
8.5.
Accommodation requirements
It is recognized that very few places will be in a position to provide and enjoy the perfect
facility. However, there is a need for “a private, discrete suite” with ready access to an
emergency department”, comprising:
Consultation/examination room(s)

The room must contain an examination couch positioned so that the health worker
can approach the patient from the right-hand side; the couch must allow examination
with the legs flopped apart (i.e. in the lithotomy position)

The temperature in the room must be thermally neutral (i.e. not too cold or too hot);

Auditory and visual privacy (particularly for undressing) is essential

Clean bed-linen and a gown for each patient must be provided for

Lighting provision should be sufficient to perform a genito-anal examination

Clinical hand-washing facilities (with soap and running water) with hands free taps
(IUSS generic set BEI)

Provision for the storing of forensic supplies is required

A table or desk for documenting and labelling specimens is required

The door into the room must be lockable to prevent entry during the examination

Provision for a telephone, computers and data is required

Where possible, this should be a separate facility for child victims and may require a
two way mirror with an adjacent observation room

Minimum 25m²

Refrigerator and cupboard for the storage of specimens, preferably lockable.
Shower and Toilet
A shower and toilet situated directly off the consulting room is required for privacy. The
patient must not have to go out of the consulting room to access the shower/toilet.
Counselling room
A separate room containing a table and chairs where a support person could talk with the
patient.
Waiting area
A dedicated waiting area within the Victims of Violence unit is critical:
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
The entrance to a dedicated waiting area should be access controlled

There should be facilities for offering patients refreshments, and

A play area, observable from reception should be adjacent to the waiting area.
A room for the police
Reception area
A reception area that could also be used as a room for waiting family and friends.
Record room

To store examination records;

Consideration must also be given to matters of confidentiality; completed records
must be stored securely and accessed only by authorized staff.
Storage
Storage should be provided for:

Linen

Sterile packs

Consumables

Stationery, and

Medicines.
Laboratory services
Specimens collected from victims can be broadly divided into two categories, those used for
diagnostic health purposes and those used for criminal investigation.
9. Day Surgery Unit
The day surgery unit is “a self-contained, dedicated unit suitable for carrying out surgical
procedures and treatments on adult and child patients whose discharge is planned for the
same day as their admission.”18
Daycare services mainly include day surgery, endoscopy, and medical investigation and
treatment.
This service is fully described in the IUSS document Facilities for surgical procedures.
10.
Engineering and mechanical requirements
Detailed information on the following is contained in the IUSS document Building engineering
services:

Plant and services

Mechanical
18
National Health Service Scotland. 2002. Scottish Health Planning Note (SHPN52): Accommodation for day care part 1- day
surgery unit. (Version 1). Scotland: Borders General Hospital NHS Trust.
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
Piped medical gases

Gas

Heating

Ventilation

Hot and cold water

Internal drainage

Acoustics

Fire safety

Fire detection

Electrical services

Power

Lighting, and

Emergency systems.
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PART E - CASE STUDIES
1. Worcester Hospital
Drawing 1: Compliments of Worcester Hospital and TV3 Architects: outpatients department
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Drawing curtesy of Worcester Hospital, Western Cape Provincial Administration and TV3 Architects
The outpatients department at Worcester is clearly arranged in a series of “suites” as
illustrated in Drawing 1:






1- Internal Medicine OPD Suite
2-HIV/AIDS & Family Medicine OPD Suite
3- Sub Specialities OPD Suite
4- Surgical OPD Suite
5- Orthopaedic OPD Suite
6- Paediatric OPD Suite
PART F - ROOM DATA AND ROOM REQUIREMENT LISTS
1. Generic room data sheets
The following generic room data sheets are referenced in this document.
2. Room requirement lists
Tables for 1. standard district level services, 2. regional level (with standard in col 1 and
specialist services in col 2)
PART G 1. Applicable legislation 19
Basic Condition of Employment Act Amendment (Act 10 of 2002). Cape Town South Africa:
Government Gazette.
Child Care Act Amendment (Act 74 of 1983). Cape Town South Africa: Government Gazette.
Child Justice Bill 2003
Criminal Procedure Act 1977 (Act 51 of 1977). Cape Town South Africa: Government Gazette.
Correctional Service Act Amendment (Act 122 of 1992). Cape Town South Africa: Government
Gazette.
Domestic Violence Act 1998 (Act 116 of 1998). Cape Town South Africa: Government Gazette.
Drug Trafficking Act 1992 (Act 140 of 1992). Cape Town South Africa: Government Gazette.
Employment Equity Act 1998 (Act 55 of 1998). Cape Town South Africa: Government Gazette.
Heath Act 1977 (Act 63 of 1977). Cape Town South Africa: Government Gazette.
Health Professional Act 1974 (Act 56 of 1974). Cape Town South Africa: Government Gazette.
Labour Relations Act 1995 (Act 66 of 1995). Cape Town South Africa: Government Gazette.
Medicine and Related Substance Control Act Amendment (Act 59 of 2002). Cape Town South
Africa: Government Gazette.
Mental Healthcare Act 2002 (Act 17 of 2002). Cape Town South Africa: Government Gazette.
Non-Profit Organizations Act 1997 (Act 71 of 1997). Cape Town South Africa: Government
Gazette.
Nursing Act 1978 (Act 50 of 1978). Cape Town South Africa: Government Gazette.
Occupancy Health and Safety Act 1993 (Act 85 of 1993). Cape Town South Africa: Government
Gazette.
Pharmacy Act 1974 (Act 53 of 1974). Cape Town South Africa: Government Gazette.
Prevention and Treatment of Drug Dependency Act 1992 (Act 20 of 1992). Cape Town South
Africa: Government Gazette.
Probation Services Act 1991 (Act 116 of 1991). Cape Town South Africa: Government Gazette.
Promotion of Equality and Prevention of Unfair Discrimination Act 2002 (Act 52 of 2002).
Cape Town South Africa: Government Gazette.
Public Management Act 1999 (Act 1 of 1999). Cape Town South Africa: Government Gazette.
South African Constitution Act 1996 (Act 108 of 1996). Cape Town South Africa: Government
Gazette.
South African School Act 1996 (Act 84 of 1996). Cape Town South Africa: Government Gazette.
Social Work Act Amendment (Act 110 of 1978). Cape Town South Africa: Government Gazette.
19
National Department of Social Development (NDSD). n.d. Minimum norms and standards for out-patient treatment
centers. (A manual developed with the support of the United Nations office on drugs and crime). Pretoria South Africa:
NDSD.
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National Health Act 2003 (Act 61 of 2003). Cape Town South Africa: Government Gazette.
University of Pretoria in partnership with Southern African Legal Information Institute, 2012.
Regulations relating to categories of hospitals: Government notice R185. Cape Town South
Africa: Government Gazette.
Tobacco Products Control Act Amendment (Act 12 of 1999). Cape Town South Africa:
Government Gazette.
2. Glossary of terms
Accreditation:
The official authorisation of a service by the public body legally entitled to
confer that authorisation by the laws of the country, based on a prescribed
set of quality standards (WHO, 2003).
Acute care:
Intensive treatment for an immediate and urgent problem.
Admission:
An administrative and clinical procedure by which a suitable applicant
enters the centre. This occurs only after a pre-admission screening.
Administration:
The direct application of a prescribed drug, whether by injection,
inhalation, ingestion or any other means.
Evaluation:
The systematic identification of a service user’s condition and needs
within a framework based on professionally accepted best-practice
guidelines.
Child:
Any person under the age of 18 years.
Clinical record:
An individual, permanent medico-legal document of the patient’s history,
assessment and treatment progress.
Consulting:
The taking and writing up of the clinical history from the patient.
Counselling:
A therapeutic intervention that offers support and guidance and is
undertaken by a relevantly trained accredited and professional staff
member.
Examination:
Conducting a physical examination of the patient, whether seated on a
chair, lying on an examination couch or standing.
Clinics:
A clinic refers to a health care facility designated for the purpose of
providing outpatient care on a regular basis. Clinics can range in size from
very small to large, with a wide range of clinical services and are confined
to outpatient care usually for at least 8 hours a day, five days a week.
Clinics are the main sites for ambulatory care in rural areas. This is the first point of care for
patients as it is usually the closest point of care for the patient.
Community Health Centres (CHC):
A CHC refers to a PHC facility designated for the purpose of providing both
out-patient and inpatient care on a regular basis but which inpatient care
is short-stay and cannot be considered to be a hospital. CHCs provide
comprehensive integrated PHC services 24 hours a day, seven days a
week.
Hospitals:
A hospital refers to a facility designated for the purpose of providing both
outpatient and inpatient care on a regular basis. Hospitals provide
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comprehensive medical and surgical services 24 hours a day, seven days a
week. This includes outpatient departments, emergency centres and other
hospital-based services such as day surgery services and mental health
services.
Rehabilitative centres:
A facility designated for the purpose of providing rehabilitative care. This
may include physiotherapy, occupational therapy, speech therapy, and
audiology.
Treatment:
Procedure:
The action or manner of treating a patient medically or surgically.
Conducting a nursing or medical intervention.
3. References
Australasian Health Facility Guidelines and Australasian health infrastructure alliance, n.d.
Guidelines. [Online] Available at: http://www.healthfacilityguidelines.com.au/guidelines.aspx
[Accessed 22 February 2014].
Bending M, Lowson, K, Saxby, R and Whitehead S. 2009. Cost-effectiveness of hospital design:
options to improve patient safety and wellbeing systematic literature review of single rooms.
YHEC, University of York.
NHS Estates, 2004. Health Building Note (HBN) 12: Out-patients. Norwich England: TSO (The
Stationery Office).
NHS, UK 2011. Main renal unit - Main renal unit: Planning and design manual 6381:0.4:
England
NHS Estates: 1996. Ophthalmology: Health Building Note 12: Supplement 4: London: HMSO
References – oral health:

Specifications For Oral Health Delivery Services 19 March 2014

NHS Estates: 1992: Health Building Note 12: Supplement 2: Oral surgery,
Orthodontics,Restorative dentistry, London : HMSO

The Department of Surgery – National Department of Health
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4. Further reading
Artwork
20
Suggested reading :

“Art in Healthcare” In: HEALTHCARE DESIGN MAGAZINE, December 2011.
20

Domke, H. “Picture of Health – Handbook for Healthcare Art”.

“Putting Patients First – the essential healthcare art book” February 2009.
Available: WWW.HEALTHCAREFINEART.COM.

“Beyond traditional treatment: Establishing art as therapy” by Elaine Poggi.
In: healthcare design magazine, november 2006.

Hathorn, K. “Current Research in Evidence-Based Art Programs” November 2006.
American Art Resources.

“The Arts of Healing” In: Journal of The American Medical Association, 281:9.
http://healingphotoart.org/
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