SITE VISIT

VISIT OF THE COMPETITION SITE


FOREWORD

MUDr. Michal Hudík, Medical deputy FN HK

English transcription

Our hospitals are among the largest and most prestigious hospitals in the Czech Republic. The history of the hospital is very long, dating back to 1889 when the hospital developed not in here, but in the area just by the Orlice stream. From today’s point of view, it was one district, small hospital of an urban type, where neither surgical nor non-surgical patients were distinguished. Understandably, as medicine evolved, this type of hospital ceased to be sufficient and it was already over thirty years of its emergence to be overcome. That is why in 1928, here, at the confluence of Labe and Orlice, a new campus was constructed, then called “new hospital”, we call it today the “historical part” of our hospital. At that time, it was the most modern hospital in the Czechoslovak Republic, a totally top-class and architecturally well-designed facility for eight branches, counting over 700 beds. And for the sake of interest, at that time the average patient’s hospitalization time was about 16 days, which would be totally unacceptable today. Today, the hospital has 39 separate workplaces, of which 24 clinics, a capacity of 1375 beds, and an outpatient treatment of more than 700,000 patients every year, 400,000 hospitalized, and around 27,000 operations annually, our hospital’s operating budget is close to CZK 6 billion. For a long time, we have also been the largest employer in the Hradec Králové Region. In addition to health and medical-preventive care, we also have other tasks, namely educational ones. We closely co-operate with local faculties such as the Faculty of Medicine and the Faculty of Pharmacy of Charles University or the Faculty of Military Health at the University of Defense. Apart from teaching, we also participate in research projects.

Let me now be a little personal and a little deviate from the official documents. I, as an employee, looking at the campus and running of our hospital makes me so proud. I am proud of how our hospital looks, what medicine is practiced here. Our pride, but not our merit. The merit of generations ahead of us who have invested their diligence, their financial and material potential to get the hospital where it is today. And of course, as managers, we would like to push the high-set bar of the hospital even higher, so that our successors could also be proud. This is also the reason for organizing this architectural competition. As a doctor, of course, I can tell you that the care for our patients should be comprehensive. But this complexity is not just good medicine but, of course, the communication and the environment in which it takes place. This environment is very important not only for patients but also as a working environment for our employees. It should be remembered that hospitals have continuous operations and these people spend a substantial part of their lives here. Believe me that between the satisfied doctor and the satisfied employee is the equator (the equation: a satisfied doctor makes a satisfied patient) and I think that a nice environment really gives all the prerequisites for both patients and our employees to be satisfied. Other reasons for initiating an architectural competition are prosaic and operational because when you go through our premises you will see that it is a pavilion concept. The pavilion concept has some strengths and some weaknesses. Among those strengths is a kind of airiness and an overlook of the architectural arrangement, a park arrangement that makes the environment very nice. But it also has its shady side, and of course, it is a somewhat inefficient operation, by breaking down human and material potential, great instrument diagnostics, etc. Another reason is, of course, the life of some buildings on our premises. The hospital has a long history, so some buildings are on the edge of their life, and their repair and possible relocation of their operations should be considered.

All of this led us to a competition for a new surgical center and through our founder, the Ministry of Health, we presented the project to the government, where it was approved and accepted into the system of strategic projects of Czech healthcare. The total investment in this project will amount to about CZK 2.5 billion, which is a huge amount of money, and we are bound by such responsibility, that we have agreed in the hospital management that this is an absolute priority for us. We have just said in the introduction, that we do not want to just overturn existing buildings from one building to another, but that we would like to look at the project a little more visionary. That we want, just as our predecessors in 1928, to fulfill the “next level” motto, which has succeeded in establishing a truly new quality in patient care. We’d like to get closer to this and we’d like to get the hang of it. So that our patients will recover well and work well.

During the preparation, we have been largely inspired not only in the Czech Republic but also abroad. We were looking at the workplaces where new operating theatres were being built and we were also looking at logistic centers which might seem to be unrelated to healthcare. We really tried to build our concept as best as we possibly can, because we know that the building will serve some 40-50 years, and future technological trends are hard to estimate. Which one of us could imagine twenty years ago that everybody is going to have smartphones today, and so on? These trends are simply too difficult to estimate, but we have tried to design the assignment so, that we limit to a certain extent, but on the other hand, do not tie the hands. When preparing the documents, we found out that, although being medical professionals, we were able to describe the principles, procedures, and processes of our actions fairly well, but it turned out that due to the complexity of the care provided, sometimes our demands are against one another. A good example is the placement of magnetic resonance imaging (MR) in operating theaters for neurosurgical intervention when you suddenly realize that such expensive technology, such an expensive machine, could not be used in the operating room alone. The patients who need to be examined by the machine are very few, so it is necessary to combine the operation of this device, for example, with an outpatient operation. And as you can see yourself, the combination of operation and ambulance is definitely not ideal, but it is still needed. So we decided to go through the architectural competition, too, in order to get the widest range of solutions possible. It might seem impossible to you sometimes. Because on one hand it would be very useful if you planned a monoblock of surgical disciplines here, but at the same time we would like to preserve a specific atmosphere of this pavilion arrangement of the hospital complex, and we understand that we are probably asking for some contradiction. But we believe that at least one of you will succeed.


PRESENTATION OF THE COMPETITION BRIEF

parts: B – ABSTRACT OF THE COMPETITION CONDITIONS, C – COMPETITION JURY, D – VISION, LOCALITY AND INTENTIONS IN THE AREA, F – COSTS, TIMETABLE AND ORGANISATION OF THE HOSPITAL CONSTRUCTION, G – DOCUMENTS

Ing. arch. Igor Kovačević, Ph.D., MOBA studio, Ltd., preparer of the the competition conditions and brief

English transcription

I would probably also start with a personal comment. For us, as for CCEA MOBA, it is a seventeenth competiton we are preparing and in the Czech Republic we have not met with such professionalism on the part of the contracting authority. The reputation of Hradec Králové in the Czech Republic is excellent. It sets a high bar for the competition and we are very glad that we have been selected and that we can organize this competition.
The competition is two-phase and international, which means that it is possible to compete in both Czech and English. Here I would like to point out this brief scheme of the materials submitted. After the experience of previous competitions, to avoid some confusion and inconvenience, we will also prepare another map of where you should submit you competition designs. It is in Prague in the office of our legal advisers. We will issue this instruction as additional information, where the exact map will be, where to ring, where to open, it is at the reception, so that you do not spend the last five minutes before the deadline with some searching and confusion.
This is the jury and I am very glad that, both on the part of the dependent part, so independent, we have all those who create the hospital both conceptually and practically. The independent part of the jury is interesting because it was for the first time that most of the jury members were foreign. It is for the simple reason that in Czech Republic new hospitals are built, but do not reach the level investor here expects. That is why we have asked jurors that have some experience with similarly significant structures. The first is Mario Corea, a professor who has built at twenty hospitals in Spain. Then Richard Klinger, who is from Austria and his hospital project you are likely to know, is VEZ Clinic in Klagenfurt. Furthermore, Sergio Bruns, who is from Switzerland and has experience with the Triemli Hospital in Zurich, that has a similar story like FN HK. It was a new building that temporarily hosted the premises from an old building and returned to it after a reconstruction. In addition, Professor Zdeněk Zavřel, who is known as Dean of the Faculty of Architecture, Czech Technical University (CTU). Then Kristina Richter Adamson, who is from Slovakia and now works in Great Britain, and then Martin Tycar from the office called Znamení čtyř, who won the Albertov Campus competition.

The subject of the competition is very simple, it can be summarized in two sentences. It is necessary to build a new building next to the existing building, to move the premises from the existing building to the new, completely reconstruct the existing building and then to return the premises from the new building to the reconstructed building. Seemingly simple assignments, which, when we started to make diagrams of what they belong to, turned out to be quite complicated. Another requirement is that you really got to think about every detail, because it is not that you have to design three phases (new building, reconstruction, operation), but in the final phase of the reconstruction there is a need for a lot of steps, and the care has to be fully operation over the whole time, which is a main requirement of the investor.
It has already been said that the hospital should be formed for both patients and staff. Because quality of care cannot be created without quality facilities for staff. So, as architects, we have a great challenge to fulfill the saying “Architecture not only educates but also heals”.
The red dotted line markes a wider area where all the investments and actions related to the completion and reconstruction will take place. This square marked with a thick red line is a place where a new building should be built, and Bedrna pavilion which needs to be reconstructed. As you can see, today there is a number of parking lots at this point, which we cannot get rid of in any of the phases. At all phases (new building, reconstruction, operation) you need to find replacement for these parking lots. It is for this reason that the reconstruction and construction sites are affected, thus the area is called the affected area. Here is a description of all existing buildings, aerial photography and logistics. The camp has two main entrances, we are close to this one. It is the entry that most visitors and employees enter, and here, this second gate works more for supply. We have prepared a map of planned or upcoming investments that are not FN HK hospital investments. These are the investments of the Road and Motorway Directorate (ŘSDC), followed by the city, which is the parking of FN HK, the investments of Charles University (UK) and private developers … These plans are detailed in the appendix. And here we would like to point out, these two photos might seem a little weird, but they should illustrate to just how detail this hospital should be devised and thought out because the placement of a staircase or even three stairs in an inappropriate location has brought a number of accidents and injuries. It is really unpleasant to have an accident at the hospital because it is exactly the place where the opposite should be provided.
For parking and transport solutions, I have already mentioned that these parking spaces must be preserved throughout the construction, the reconstruction and the operation, so there is a possible temporary parking space in this area. eventually including some interventions to these buildings. The new building itself should have 170 parking spaces, meaning that the total number is increased by 170 parking spaces.

We skip to the end of the presentation because Mrs Bartošová will present the operational aspects. Here I would like to draw attention to the costs, as already mentioned, the entire reconstruction and the new building are financed from the government budget. Funding is ensured with the co-financing of FN HK. The timetable is set to 2027, which means that in 2027, both the renovated building and the new pavilion should be operating, and that year the hospital should be operating fully. At the end of 2017, we will finish the competition and we plan to start finalizing the competition proposal in 2018, and this work should end in 2020 by selecting a general contractor. Subsequently, the construction itself should start.

Organization of the construction is absolutely crucial for this competition. The new building is basically the easiest part, because in fact there will be a new construction in addition to the existing construction, which then takes over some functions. What is important, however, is how the reconstruction of Bedrna pavilion will take place because it is necessary for the new building to function during the reconstruction with the pavilion number 50, ie Emergency, heliport, interventional radiology, optical center and control room. This is some of the five elements that have to work basically constantly, and the five-minute shutdown of these five elements is not possible and is not even necessary. There is a need to figure out how to make this happen, as we are still in a hospital environment with high demands on clean environment and hygiene. This will be probably the biggest issue of the whole competition, how to plan out the reconstruction to meet these requirements. I think that in the first round of the competition it is necessary to schematically show the principle, which will be detailed in the second round, including all the steps and the investments.
I will very briefly go through a valid land-use plan and also maybe this property map is important. The whole activity is exclusively on the land of FN HK. As neighbors, we have Charles University (UK), the city, private owners… And during the construction work, it is important to take into account that these neighbors should be disturbed as little as possible, as well as the operation of the entire hospital complex. These are spatial-analytical documents, here are the materials for the heliport, which we provide mainly due to the air corridors and the organization of the construction site. Here are the engineering networks that are available and there is a hydrogeological survey to clarify and understand what we are building in.
I would now ask Mrs. Bartošová to return to part E. Thank you for your attention


PRESENTATION OF THE COMPETITION BRIEF

E – SERVICE, FUNCTION AND INDIVIDUAL DEPARTMENTS

INTRODUCTION

E 1 OCHAP OUTPATIENT SURGERY DEPARTMENT

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

INTRODUCTION

Good afternoon, I will present the chapters that relate to the function and operation of individual departments. The preparation of the building program, in fact, took two maybe three years, lately under the guidance of Professor Jan Vojáček, Primary of the Cardiac Surgery Clinic, who motivated the twenty-headed team of medical and non-medical staff to create these seventeen chapters, which contain and summarize the complete building program of the planned surgical center.

Between the seventeen chapters shown here, eight chapters describe healthcare operations, seven non-medical operations, and two chapters describe the links and last but not least – the key issue for the so-called transitional period, which was already presented by Mr. Kovačević. I would now go through all the chapters as they are shown here. On the left side, those are mainly medical chapters, on the right are the non-medical chapters, and I would like to support the competition document information and derive the key information we consider important in each of the basic diagrams and to introduce the philosophy of some departments. What is important to say is that not all the information are included in this competition brief, but a lot of information about the building program is included in the next competition document, and that is Book of rooms. The Book of rooms is refined for different departments in various details. For some departments, it is handled in a very detailed way, such as for Wards, for some departments, it is handled in less detail, basically, it is just a capacitive summary because we may not have any special requirements, as for example for offices. Now let’s take a look at the chapters.

1 OCHAP OUTPATIENT SURGERY DEPARTMENT

On Scheme 1, I would like to present you the department of surgical outpatient clinics. Our idea is that patients to be provided outpatient care will all go through this department of surgical outpatient clinics that will concentrate all investigative units from all involved clinics. The names of these clinics have not yet been reported, so it is the surgical, cardiac, urological, ENT clinic, orthopedic, neurosurgical, stomatosurgical, with pediatric patients in all these clinics.

All of these patients will go through both the ambulatory tract and standard ward. Our idea of an outpatient tract is that it will consist of a treatment area where patients will be treated and will follow what we call the “Restaurant and shopping zone” so that the patients are provided leisure time in the restaurant and business area so that they do not feel like they were in the hospital entirely. It is important for us to have a well-accessible information center where patients will be given information on where the workplace is located.

The outpatient tract alone will pass 3 500 patients a week, but it should be considered in the sense that it is dominated from 8-14 pm Monday-Friday or till 16h, that means that the relatively large mass of people, patients, clients passes through in a relatively concentrated time. Therefore, we would like to use the summoning/ticket system to help organize these patients and their movement around the building, respectively the Outpatient tract and the tract of Imaging Methods. We have it tested from other workplaces and we are happy with the solution.

Diagram 5 shows most of the activities in the treatment zone. Our idea is that patients are heading in three directions, as described in the Workflow chapter. Some patients go to surgeries, which are organized into so-called Sections of expertise. Each Section is designed to have a maximum of 200 patients per day, as described in Chart 4. Patients should first go through a central reception where they should register and then directed to the S1 – S4 Sections. The second group is patients who are ordered for ambulatory performance, that is, patients who will go directly to Section 3 of Reception, and receive care in the Outpatient Care Unit or Day Care, a topic to which I will return later. Approximately 60 patients are going through this department each day. The third group is the patients who will be ordered for hospitalization and pass by the Outpatient tract only to register and be administratively handled because the previous examinations have already passed in the vast majority of cases and went through the Inpatient Department where they will be hospitalized. These patients will walk through the so-called Admissions Office, and from there they will be directed to the departments. Our requirement is that the Central Reception desk and Reception offices are located relatively close to each other, as we assume that during the day, staff will pass between these workplaces, depending on where the peak will be. Outpatients arrive in the morning and hospitalized patients arrive roughly two hours later.

An Outpatient department is part of the Outpatient Surgery department, which is a relatively large department, where Outpatient departments provide patients with local anesthesia or more complex and time-consuming care. Very often, patients are directed to a so-called “Recovery Unit” or “Day care Ward”. This means that the treatment that is given to them is very often ended with some recovery phase that still has to take place inside the Surgical Center. The department of Ambulatory care consists of instrumentation departments dealing with the issue of the Urology clinic. It consists of the department of One-day surgery, our understanding under “One-day surgery” means an activity when the patient comes to the medical facility in the morning, is given an operative treatment, and leaves the facility the same day. That whole action should take place within a maximum of 24 hours. This department must be closely linked to the operating theaters, but these theatres for One-day surgery will not be part of this department and will be part of the Surgical tract, so that they can be used universally and are needed to be easily available. Patients will come to the department of One-day surgery and actually become hospitalized at first and will be treated as if they were hospitalized, but we will release them at the end of the day. The Department of Outpatient Surgery also includes the Department of Cardiosurgery and the Clinic of Anaesthesiology and Resuscitation Clinic. Importantly, there are also three small surgical theatres. The small surgical theatres should be connected to the so-called clean green zone, but they do not belong to it – that is described in the competition brief.

An outpatient department is also a Day care Ward that serves both for recovering patients who have undergone some of the procedures in the Outpatient department, so that patients from the department of the One-day surgery depart at the end of their procedure. It means that it is the last department that will be open in the evening. All outpatient departments will be phased out over the course of the day, and the stationary will be the last one from where patients will be dismissed, typically patients after surgery from 1DS (One-day-surgery). I think that the workflow of individual patients is described in detail on page 57. I want to remind you that a part of the Outpatient department is an Administrative zone, consisting of the Information center I have already mentioned, the Central reception desk, the Admissions office, and such as departmental Receptions, which should be located in the individual Sections so that patients can get the necessary information, documents, etc., and it should serve as a  kind of a contact point. In the Transient phase, ie during the construction of the extension and the operation of the existing Bedrna Pavilion, it is necessary to create Sections S1 and S2, the entire department of Outpatient Surgery, the whole workplace of One-day-surgery (1DS), all Receptions and management of Surgical Outpatient department. Which sections are to be created, I think is quite clearly presented in the Brief in Diagrams A and B at the beginning of Chapter E, where you can see the final layout and the layout of the Transient phase, but I will mention it within each chapter.


E 2 OS OPERATING THEATRES

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Another very important one, I would say perhaps the most important workplace, within the Surgical Center, are Operating Theaters. It’s really the core of the building. The Operation tract consists of several zones, which are described on page 60 and on the following pages. The Surgical tract will pass through 13,200 patients a year, meaning that just as many surgical procedures are performed, with up to 70 patients per day.

The goal of the announcer is to create 21 operating theaters (according to Diagram 8), with 9 Operating theaters in the existing Bedrna Pavilion, and because during the Transient period when Bedrna Pavilion will be reconstructed, we will not have them but we need them, it is these 9 theatres that are needed should be in a new building/extension. We have marked them for the sake of simplicity with the numbers 13-21. These 9 operating theaters also include a Hybrid operating theatre under number 21, which is then described in Diagram 10. Next, there is the operating theater 20, which is nothing special. Only in its proximity should be left such a space reserve, that if in twenty-thirty years with the development of medicine, we will realize that we need another hybrid operating room, this place will be adjustable so this operating theater is expandable so that a second hybrid operating theatre can be created here.

In the current Bedrna Pavilion, as mentioned, are 9 operating theaters, of which 4 are newly upgraded, we are completely satisfied with them, there is no need to interfere with them and they operate autonomously, that means they have separate air-conditioning, separate wiring, etc.  And we want to conserve these operating theaters during the reconstruction of Bedrna Pavilion, we will not use them and once the surgical center is put into operation, we will return to use them again. These are the operating theaters marked 1 – 4. As stated by Mr. Hudík, theater number 10, which is connected to Perioperative Magnetic Resonance Unit, is part of the assignment. The issue of Perioperative MR is described in Diagram 11. This surgical theatre is not required during the Transient period. In the Transient period, therefore, we require nine operating theaters (13-21), one being hybrid and one being expandable, as there are sufficient spatial reserves in its vicinity.

Our idea of the operating theaters is to be arranged in twins, which is evident from Diagram 9. It is a concept that has been proved as suitable for us. This concept of twins is used in the four modernized operating theaters I have already talked about, with the fact that these rooms share a washroom, a storage area, and in the vicinity is a storage of instrumentation. Our requirement is, for the operating theaters, to be grouped together into larger units, for example four five operating theaters, so that they are spatially detachable and independent (air conditioning, wiring, etc.) in case of future reconstructions. This means that if we are going to change some technology in the future, for example, or to reconstruct or modify the operating theatre, the dust from one side of the operating tract would not go through the air conditioning to the operating theaters at the other end of the operating tract. That is, we want independent air-conditioning ducts, as it is written in the assignment.

Operating tract is not just the operating theatres itself, but there is also an Entry zone and Patient transfer point, that is, the place where patients enter. Part for the staff is also included. This all is also in an Operating zone, which is a zone where not only the day rooms of the staff of the central operating theaters are, but also the management of the clinic and the seminar room, which should serve the teaching of medics and non-medical staff directly inside the operating tract. We can imagine that this operating facility will be located on the adjacent floor, so that staff does not have to change clothing. This means that once they enter the so-called green zone, they will be able to move freely within it and have everything available. The operative tract contains also a Supply zone, that is, the Cleaning of the operating desks, where the operating desks will be treated after the patient undergoes the operation.

I would like to draw attention to the end of this chapter, in which chapter E 2.11 describes the functional links of the operating tract to another department. The Surgical tract should be closely associated with cardiosurgery since patients after cardiac surgery usually do not get on the so-called Recovery Unit but are transported directly to the cardiosurgery Intensive Care unit (JIP). Neurosurgical Intensive Care unit should also be very close. The key is the interconnection of the Sterile Processing unit with the Operating theaters, I talked about, the connection with the Outpatient Surgery department in the context of the 1DS, the Physiotherapy dept. and the Standard Wards.


E 3 CS STERILE PROCESSING DEPARTMENT

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Sterile Processing Department, Chapter E 3. The Sterile Processing Department is a service that has to be built up entirely in the new building. It serves both the Surgical Centre as well as all the other surgical services that will not be in the Surgical Centre. It is the workplace of the gynecological-obstetrics department or of the ophthalmology department that will not move to the Surgical Centre, though they also have tools for sterilization. At the same time, the Sterile Processing Department serves also for external customers of Hradec Králové. Therefore, the Sterile Processing Department needs to be built during the transient period; the description of this workplace is in chapter E 3. The workplace annually uses 287 000 tools and 38 000 so called sets, i.e. containers filled with sets of instruments. It holds therefore a very large capacity, and our goal is to minimize the transport distances of these tools between the surgery wing that I have been talking about, and the sterile processing department. The location of the Sterile Processing department workplace needs to be chosen in such a way that it will take into account the future replacement of the technical facility. As every ten or twelve years, all sterilizers, washers and similar devices need to be replaced. The connection to the surgical wings is supposed to be vertical as drawn in the schematic diagram, i.e. through the unclean lift that comes from the unclean zone of the surgical wing, the tools in the transport containers are administratively accepted here, and are inserted into the dishwashers in the decontamination zone, they pass through the walls into the setting-up zone where they are checked, or repaired if necessary and placed into so called nets( from here setting up zone), from where the instruments pass through the sterilizers, where the sterilization process itself takes place, and in the clean zone, therefore the 4th zone, they are inserted into the so-called vertical storage and lift system. This is the issue mentioned by Deputy Hudik, we have been inspired by industrial design, and we think that this system should reduce the amount of storage space needed to store both sterile material and then the special medical material that is used for surgical interventions. And through these systems, we should achieve that a transport box will be prepared for each patient in the assembling zone, in which will be placed the instrument kit, that went through the central sterilization, as well as the material equipment – in this way, a personalized instrument and medical set will be therefore prepared for a given surgical procedure, a given patient and at a given time. From the completion zone, this transportation box will be transported through the clean lift to the operating theatre, basically in the “just in time” mode. Otherwise, the sterile processing department works 24 hours a day, meaning it is a non-stop service. Part of the department is the water treatment plant, which needs to be thought about as well.


E 4 DJ RECOVERY UNIT

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Another workplace is the patient’s recovery unit. This workplace should have a total capacity of 24 positions, which corresponds to the number of procedures and the total frequency analysis. We have had our frequency analysis processed to know when we start individual operations, when we finish individual operations. So when individual patients enter the recovery unit, it is based on the fact that 24 beds will be sufficient for patients exiting the 21 operating theatres, in a 1,5-3hours scope for recovering in the recovery unit spaces. Not all patients are going through the recovery unit, as I have mentioned earlier, some patients go directly from the operating theaters to the intensive care unit. During patients´ recovery, the monitoring of the patient’s life functions and convalescence takes place, with having an access to the operating theatre via the so-called transcription point. Of the 24 positions in total, 16 are open positions, 2 are isolation boxes and one box is for 6 child patients, which we want to have separately, simply because children respond to anesthesia differently, they are louder, and in this way, they will not have to interfere with adult patients. Please consider the size of this box as if it was designed for adults. In the transient period, the sufficient capacity for the recovery unit is of 12 beds for adults and two isolation boxes.


E 5 JIP INTENSIVE CARE UNIT

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

The intensive units are described in Chapter E 5. The total capacity to be created in the surgical center is of 4 intensive care units, grouped again into twins. One twin is made up of ten and twelve beds, with the fact that each twin is dedicated to one of the predominant disciplines, neurosurgery, cardiac surgery, but there will always be another surgical field within the twin. These intensive care units need to be located as close as possible to the operating theaters, the intensive care unit (twin) of cardiac surgery must have a direct construction link on the same floor – as I said earlier, the cardiac surgery patients are going there after surgery. It is important for us that the Intensive Care units have a good access to the Emergency workplace in building number 50, because the department of anesthesiology and resuscitation is located there, with which the intensive care units work closely together. It is also important for intensive care units patients to have good access to the diagnoses workplaces i.e. to CT, magnetic resonance imaging and interventional radiology.

Concerning the organization of intensive care units, the U-shaped arrangement has proven practical, as shown here. We have used the example from the building number 50 (Emergency), which is the newest building with intensive care units in a U-shaped arrangement, with nurseries in the middle and about ten to twelve beds around, this arrangement is working well in terms of service running.

We expect that all of these boxes will be single bed, optimally they should have 25 m2. The corner boxes can have double beds, but we require that there be at least 20 m2 per bed. Two boxes within the intensive care unit (one twin) should have an isolation box. The construction requirements for the intensive care units, in relation to some of the patient illnesses, show a need for isolation. The building requirements for intensive care units are more specifically described in detail in Table no. 5 of the competition brief and are of course included in the Book of rooms. As I have said earlier, each of these chapters refer to a separate chapter in the Book of rooms.


E 6 LO STANDARD WARD

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

The next chapter is chapter E 6, the standard ward, which looks quite simple. Today, we have 25-bed dormitories, as shown in the diagram in columns C and D, have a total of about 100. In the new building, we require the establishment of the bed units according to columns A and B, where one column has a capacity of 25 beds and one has 30 beds overall. The entire Surgical Centre should have 420 beds, of which 18 beds will be dedicated to the accompaniment of pediatric patients. In the transient period, columns A and B will be sufficient, as clearly the bed capacity created according to the A and B range will be still more than what we have in the existing Bedrna Pavilion. Two departments will be, as I have said, for children. A very detailed description of the ward is done in the Book of rooms, all the wards are conceived in the same way and any minor differences are specified in the Book of rooms. It is probably suitable to explain that there are either bed decontamination rooms or shared exercise rooms between the bed units so they are always accessible for two floors. The horizontal circulation is also important between these departments so that the doctors that have night or other shifts will be able to serve the entire floor level. This means that the orthopedist who works in the C and D departments should also be able to go to the A and B departments. Especially for night shifts, this is very important for staff. We anticipate that this passage may not work for patients, but definitely needs to be working for the staff in terms of a good building link.


E 7 OF PHYSIOTHERAPY DEPARTMENT

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Figure 17 shows the physiotherapy issue, which leads us to Chapter 7. Physiotherapy will be ran in two ways within the building – first, it will be provided in four detached exercise rooms, as I briefly  mentioned before, and secondly, it will be provided within the Physiotherapy department. This department should be located on the same floor level then the department of traumatology and rehabilitation, therefore here. While department management will be located on all other floors, here it will not be the case. Instead of management, there should be the rehabilitation department, which will include a room for ergotherapy, five physiotherapy rooms, the large gym and facilities for staff and patients. In the transient period, this department is not required to be built up, because it is a development activity, It is though necessary to have two exercise rooms, as described in the competition brief.


E 8 ZM IMAGING METHODS WING

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Figures 19 to 22 describe the imaging methods wing. The imaging methods (or radiology) wing will work in the Surgical Centre in three units. The first is perioperative magnetic resonance, which is described in the operating theaters chapter, including diagrams. The second is a workplace that will provide care primarily to hospitalized patients who go through the Emergency Medicine Department, which is located in building number 50, mentioned earlier. We expect that the technology will be organized into twins, apart from the exceptions, as the staff can handle the devices very efficiently in this way. To organize the movement of patients in these wings, we rely again on the summoning system. The cluster of magnetic resonance for hospitalized contains two CT examination rooms, two ultrasound examination rooms, two skiagraphies, one fluoroscopy and a reception. In the same time, a good follow-up to the department of emergency medicine must be ensured. On the contrary, the outpatient cluster will consist of one CT, two ultrasound devices, two skiagraphs and two magnetic resonances. Interestingly, I note that these technologies are in large parts moving. It is not a development activity in the sense that these devices are more and more in the hospital, but in terms of the need of moving them towards the patients. Today we have magnetic resonance near the neurosurgery department, and when the patients of the neurosurgical department are moved, it is logical to move the diagnostic with them, which is somehow addressed for them.


E 9 PUBLIC SPACES, RESTAURANT AND SHOPPING ZONE

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Chapter E 9 describes the mentioned restaurant and business zone, I will go through this relatively briefly, because there is no need for a large description and we have not given any. This chapter addresses the issue of patient arrival at the center, including patient entry, waiting for ambulance vehicles, where patients pay an entry fee, or pick up a seat for assistance close to a particular ambulance. As far as patient arrival is concerned, our idea is that, given the number of patients I have already mentioned at the outset, it might be appropriate to separate the patient flow, but we leave this to you to decide upon. We do not have any special requests for a separate entrance for employees to the building; we also leave this on you. Part of these public spaces is the so-called visitor rooms, which are the meeting spaces for hospitalized patients with their loved ones. It is also a place where patients can “escape” from the wards but still are in their reach. There is a fairly complex assignment for the restaurant and shopping area, where patients, their loved-ones and employees should be able to take advantage of standard additional features that are offered in healthcare facilities. So, they should be able to use a health dispenser that will be part of our hospital pharmacy, which we will run. There should also be refreshments, food and mixed goods shops, which will be run by external entities. There should also be a children’s playground area so as to make the waiting time for child patients more pleasant. In addition, there should be a cash desk for patients, an ATM and a patient information center. This is a new capacity as there is no information centre today but we think that this capacity should be available in the future. I have not mentioned an ecumenical or meditation room, this capacity is located in building number 10 of the pavilion of internal medicine and we expect that the patients of the surgical center can use it as well. This means that we do not need to build a new one, even though we are very aware of its needs, as the existing space is sufficient.


E 10 CLINIC FACILITIES, OFFICES AND MEETING ROOMS

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

In chapter E 10, we describe the department facilities. Each facility consists of a department management, which consists of seven offices, medical rooms, which are also seven, and a seminar room with a capacity of 30 seats. The goal is to achieve a unified aesthetics of the facilities, the facilities should be seven, with here, as mentioned before, between the traumatology and the rehabilitation, there is the department of physiotherapy, which is precisely the quantity that suits us. In the transient period, we require four facilities i.e. for the radiology department, the outpatient surgery department, the central operating theaters and the sterile processing department. These are part of the individual units of those workplaces and are described in the book of rooms. We basically do not have any special requirements. Chapter E 10 includes a description of the workplace of the couriers and the orderly room.


E 11 EDUCATIONAL DIVISION

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Chapter E 11 describes the educational division, as Mr Hudik has already said, educating peri-gradually and post-gradually, both physicians and non-medical staff. Therefore, we require the construction of a lecture hall for 100 people, which will be divided into two parts and will be connected to the academy on the one hand, and connected on the practical training room on the other side. This will allow us to have two seminars running in parallel – both theoretical, in the lecture hall, and practical, either in the practical training room or in the academy. Part of this workplace is a tea kitchenette and a dressing room. Part of this educational section is the Department of Surgery, the War surgery department, our two affiliated organizations. The Department of Surgery is ran by the Faculty of Medicine of the Charles University in Hradec Králové and the Department of War Surgery is part of the Faculty of Military Medicine of the University of Defense. A set of these offices should be created already in the transient period. Part of this educational division is also facilities for a a nursery and primary school for the University Hospital Hradec Králové. This in practice means that there is a need to build a school directory and two common rooms for teachers who will teach the children patients, not only in the surgical center but also in the other departments.


E 12 CENTRAL STAFF CHANGING ROOMS

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Part of the surgical center is the central staff changing rooms, described in Chapter E 12. I note that information about which workers put off clothing where is contained on Sheet 17 in the Book of Rooms, where it is seen that we really dealt with every employee and his workflow, passing through the surgical center and where the cloakroom will be. Physicians are dressed in on-call rooms, and medical staff largely dresses in these central changing rooms. These changing rooms should have a total capacity of 920 people, which is quite a lot, of which 815 women. We require there to be a capacity for the pupils of the same quality, 250 for students and trainees, but no longer in the shape of cabins, but rather in the form of lockers, as it is only doctors that postpone their outer garments while the students and trainees put the white cloak over civilian clothes. During the transient period, only half of the capacity is enough.


E 13 OPERATIONAL FACILITIES OF THE BUILDING

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Chapter E 13 quite comprehensively describes the building’s operational facilities. The main issue of the chapter is the registry. It is unfortunately still the case and probably will be for some time, that there will be not only electronic documents in the healthcare system, but also documentation in paper form. We know that for two and a half years, the surgical center will need to store about 2,000 meters of A4 paper documentation. In the transient period, the capacity need is half. As part of the building’s operational facilities, there is also the cleaning facilities. Central cleaning, cleaning machine charging room and a room for cleaning machines… because we expect to clean up all the corridors, public spaces and ambulances with machines.

In Chapter 13.3, the supply and storage issues are described in a fairly comprehensive manner, and in Table 8 there is shown which commodities are delivered to the center, in what volume and how often. And then the following chapters describe the organization of this issue. All of these services are run by our entities; we do not basically use outsourcing in the hospital. There is also described the problems of warehouses and issues of burning bodies of the deceased, the question of the decontamination rooms, which I have already spoken, and the question of mattress disinfectors that we would like to start using. It is a facility that we do not yet operate.


E 14 TECHNICAL FACILITY MANAGEMENT, CENTRAL CONTROL ROOM

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

From the point of view of the transient period, chapter E14 is important – it deals with the issue of the central control room. The Central Control Room is the supervisory and control center of the technical administration of the FN HK. There is not only the information from Bedrna pavilion, but from the entire hospital. This means that it runs the 24 hour monitoring and control of the operation of all of the systems needed for the smooth running of the hospital. This workplace, if it should be moved, needs to be moved smoothly and very quickly, there cannot be a major downtime. We monitor key parameters, such as the functioning of medicinal gases, which cannot be without supervision or electrical supply. Part of the technical report of the building is also part of the technical report of the buildings, which in a simplified description is the workplace maintenance, individual technological equipment of buildings (medicinal gases, electrical maintenance, ventilation, measurement and regulation, pneumatic mail system and routine maintenance).


E 15 INFORMATION AND COMMUNICATION TECHNOLOGIES

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Chapter 15 describes the IT. First, in terms of the question of the data network and the server room, here are briefly described summoning systems and other issues related to IT security and communication equipment. This chapter is not exhaustive, but rather it is about describing the essential things that need to be addressed in the future. All of these entities, which are described in Chapter 15.6, have been thought out, tried out, we know how they are working, but we think it is not worth noting in such detail at this stage of the competition.


E 16 CONNECTIONS WITHIN THE CENTRE AND TOWARDS THE OTHER HOSPITAL SITES

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

Chapter E 16 is a clear recapitulative chapter to see which workplaces follow which. They are divided in color – yellow, red, green, depending because of whom the link exists. The strength of those bonds is described by numbers. Maybe I said here today that a cardio surgery JIP with a department of the central operating theaters, so here is the link drawn. Each link should be shown here.


E 17 TRANSIENT PERIOD AND MANTAINING THE CONNECTIONS

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

English transcription

I have already talked about the transient period and the remaining ties; I have already mentioned what needs to be done during the transient period, so this is just a recapitulation. Therefore, these are fixed limits for the running of the new building, as well as fixed limits for the running of other buildings. These are the things mentioned by architect Kovačević, such as the connection to the Emergency building, connection with interventional radiology, and connection to the pavilion of internal medicine, heliport and parking. Thank you.


COMMENTED VISIT OF LOCALITY AND HOSPITAL INTERIOURS

TECHNICAL FACILITY MANAGEMENT, CENTRAL CONTROL ROOM, BASEMENT

Ing. Veronika Bartošová, Operational and technical Deputy FN HK

ACADEMIC BEDRNA PAVILION

English transcription

It is the technical floor level, where most of the installations are going through, especially everything to do with the air circulation system.

The air conditioning, sewerage and water go through here. A great advantage of the floor is that the technology is easily accessible in case something needs to be repaired. But on the other side, the level is not efficiently used for service running. We wish that in the new building this space will be combined with the parking space – Two in one, so that those different systems go somewhere over the parking lots and therefore, a space that is efficiently being used.

You can see in praxis the food delivery. This is how the food is delivered for dinner. This is how they are distributing it to the individual departments. All of the manipulation happens in the Bedrna Pavillion.

If the supply ramp will be in the form of a ramp – which we assume will be – it is important that the transfer of the deceased bodies happen in the way that the carriage with the deceased body goes through the ramp and then, with the help of one single person, will be taken down. We already have this kind of adjustable ramps, which level goes to the level of the floor of the car and then the body is taken from the side unto the car, all this manipulated by one single person.

This is the workplace of the central control room. This workplace is a key space for the smooth running of the hospital. Many technologies are managed from here as well as monitored. it is important that during the construction of the new building of the Bedrna Pavilion, this workplace needs to remain functioning and in the moment where the construction ends, the workplace needs to be or moved to its new space or it needs to remain here, but in such a way that during the reconstruction, it will remain untouched – basically, it needs to work all the time and shouldn’t be interrupted.


DAY CARE AND OAV

Stanislava Macháčková, Head nurse

PAVILION OF INTERNAL MEDICINE

English transcription

00:00 Reception

The patients are reported to the secretary and she gives the documentation to the nurses.

00:18 Day care ward

Here patients are mainly after short-time daily medicine. After checkup the patients come here. A doctor-cardiologist examines them, he looks to see if they are ready for intervention. And then they go to coronarography. Then we decide. Either he’s really sick and goes to hospital, or it’s okay and he’s here. Here the nurses measure the patient’s pressure. Totally here they will stay for an hour to an hour and a half. After that, the patient is released and the patient either goes to the hospital where they brought him or he goes home. Analgesic infusions and transfusions are here. The GP will send the patient with the medical report and the patient will come here behind us. For example, patients from the psychiatric department will come for transfusion. The stationaries are also in surgery, internally, neurology but we serve as a central stationary.

The opening hours are from 7 a.m. to 3:30 p.m. We also have an extended opening time from 3:30 p.m. to 7 p.m. when there is no longer a doctor. It serves for patients who end up with their transfusion. There is a cleaning room with a dishwasher and toilet for urinals from patients who are after surgery. There are 4 sisters who are stable and then one nurse who is here occasionally. This is a small handy store for nurses. Here are the infusions and the infusion is being prepared on this counter.

1:48 Corridor

1:51 Small operating theater – surgical bay

This is a small operating theater. For example, the doctor injects analgesics against the back, knee and shoulder pain. There is a laser workplace.

2:06 Staff room

There is a shower for staff, WC men, women’s WCs and this is a day room for staff.

2:21 Outpatient area

Here the patient is being examined, the pressure is measured, the patient’s doctor listens, he talks to him. This department is administrative. For example, dehydrated patients come to us or patients with knee pain. The rheumatology clinic looks exactly the same.

2:48 Corridor

Here is the room that has adapted to hygiene. It serves for re-bandaging wounds.

2:55 Blood sampling point

At the doctor’s office, the nurse writes the request. She gives the request to the patients and he goes to the office window. Nurses will take the request and take it to the boxes. There they prepare everything and then they take blood. Then blood samples are put into the pipe mail. Here is the counter where the nurses take the request and prepare the syringes and so on. This is a pipe mail. And this is a small warehouse for gloves, needles or syringes. It is good that there is always a small warehouse.


STERILE PROCESSING DEPARTMENT

Marie Šilhanová, Section nurse for Sterile Processing Department

ACADEMIC BEDRNA PAVILION

English transcription

STERILE PROCESSING DEPARTMENT

All the materials get in through here. Unfortunately, the zones are mixed a little here – there is a passage through the clean and half-clean way. The material gets here inside decontamination containers. These are from the operating theatre’s wing, these are from other departments. Another type of delivery is a collection from the entire Faculty Hospital. The pickup system is electronic, that interconnects all users and customers. Every customer submits a requisition.  The request goes with the material all the way up to the expenditure, where in the final is the material requisition made – electronic and paper one.

Do you receive material from the hospital and also from outside?

Yes, we accept the externalists and we have paper requests for them. Every customer will fill out – number, type of sterilization, packaging.

Here ladies take the material from the decontamination, rinse it and put it on the wash screens/stand.  Stands are brought to the washer. This only applies to tools that are washable in a washer. The washer washes metals, some plastic and glass material. There are things that can´t go into the washer. These things are washed by hand. Here we have a window where we send hand washed material to the setting zone. This is another part – half-clean part, there the material is packed and it continues to sterilization. These machines are washers, chemo-thermic disinfectors. Those are interlace-able, on this unclean side we input the used material and from the other side, we get the clean disinfected material. After that, the material is ready for setting. There is an ultrasonic cleaner in the corner. We use it to clean up tiny things. For washing decontamination and sterilizing containers, we have a high-capacity washer, also a chemo-thermic washer. Here we have the washers for shoes, also chemo-thermic. All the shoes from operating theater’s wing are washed here. Here we have a storage unfortunately very small one – Storage of packaging and chemicals for washers.

Here is the half-clean zone, unfortunately, this zone is connected with the corridor. Containers that pass the chemo-washer will be brought here. You can´t push it through the window. Here we set the tools into sterilizing containers. This lady has new replenishment tools. Tools must be oiled, check if they are working. All tools, when taken out of the washer, must be checked for integrity and functionality. They can´t be rusty etc. They are oiled and folded into the setting boxes. We have lists for setting boxes that are unfortunately only in paper form. It includes the name of the screen/plate, the numbers and the types of tools.

There is plasma sterilization, where the cycle takes 50 minutes.  It is the fastest cycle. There are tools that are packed individually. Ladies put tools in the packaging and seal them. This way looks the sealed tool. Again, we work with a requisition and we generate a barcode on the computer. Each tool has its own barcode and sterilization setting box. Then we put its number into the computer system. When the setting box is full, we put it to the sterilizer. Here’s where we have sterilizers. Most of them are interlace-able, outside we have the plasma and formaldehyde sterilizers. Unfortunately, they do not fit into the line. This lady is in charge of sterilization. She organizes when and how to start sterilization. Behind these sterilizers, there is another zone – clean one, where the staff picks up sterilized tools.

This is the clean zone.


RECOVERY UNIT

Zuzana Kačerová, Nurse manager

ACADEMIC BEDRNA PAVILION

English transcription

We are located at the anesthesia clinic. Here are patients from operating theater which they need intensive care. We have a 12 beds here. Ambulant patients usually stay here 2 hours, and after 2 hours they are taken to the standard department. There are 3 sisters working here. The department is opened from 3 am to 7pm. The patient is always dismissed by the doctor and the nurse documentation is dismissed by nurse. If this is an ambulant patient, he is handed over by doctor. Patients should not be manipulated. They are in induced sleep, they can do nothing. If the patient gets worse, he move into  ICU. Each bed has a table and monitor. This room is for 6 beds. We serve for post-operating care  for almost every department.

We have a storage and a cleaning room. Also in here is the patient medicated and prepared for the recovery. From here you can go at the stationary or standard department.


INTENSIVE CARE UNIT

Mgr. Lenka Smolová, Nurse manager of KARIM

PAVILION 50, KARIM

English transcription

Patient intake, including hygiene procedures or resuscitation, is taken care of right here. We do not have the facilities to operate in here. We only take patients from “emergency”. All procedures are taken care of within the boxes. Right here.

The only thing here is the bathroom, an assisted bath or something like that?

Here we have the background or rear. I don’t want to say storage, but it´s something like that, we store there some things for hygiene purposes. We don´t use it for all patients.

Does the patient leave this room?

Very rarely unless the patient needs a CT examination or tomography – on other equipment we don’t have in this space in order to get a diagnosis.

Is this sufficient in terms of routine?

I think so.  I remember the old department and we are glad that this one is opened and bright. We couldn’t imagine non-opening windows but we got used to it. The air conditioning works quite well. However, we would prefer it if the air-conditioning is on the sides as it is unpleasant for the patients who are underneath the vents.

This department contains of 12 beds of which 8 are resuscitation beds and 4 are for higher intensive care. It was opened in 2008. We provide postoperative care for urological patients.

It varies and depends on the diagnosis. Patients after surgery can stay from 48hours

So the seriously injured patients, unconscious or in artificial sleep, they are here?

Yes, they’re taken care of here.

This is the thing called bridge?

Yes, this is the bridge.

Do these things, hanging from it, stay here?

Monitor including modular complement and infusion technology stay here.

The ventilation unit  is portable. Originally we thought, as we have here an older unit, that this one would be placed on one of the shelves. But at the end we had two switch the unit between boxes, and there were different equipment in each box, we left the units standing on the floor. If we could redesign it, we would put the unit on the shelf.

In the past were the patients under closer observation and were more medicated. The trend today is to do that less.

The KPR team, that’s us, we pick up the phone with the alarm and then we “run”

Are you running with all equipment?

Yes.

So that why the backpacks?

Yes. The hospital is divided into parts. We take care of one of the parts with this KPR Congolese.

This serves to lift patients – Verticalizer, it’s a new machine. What you can see here is needed for patient hygiene. This is for patients who can walk here. This is not a HIC bathroom – we saw them on the boxes.  Here is an assisted bath for patients.

This is a room for teaching and relaxation, but the girls from the front desk do not have the chance to come here, it’s too far.

This is really just for a quick relax. It’s for the nurses on supervising duty. That other room is too far away.


EMERGENCY

Iveta Lodrová, Head nurse of Emergency Department

PAVILION 50, EMERGENCY

English transcription

EMERGENCY

When the patient arrives, by an ambulance, he comes to the crashroom – a serious patient, that is a resuscitated or a polytraumatic patient. Otherwise, patients who come on their own, walk through the reception that is 24/7. There goes patient either without recommendation or with a recommendation from a GP. They come on their own through the reception, which is in serviced for 12 hours a day – from eight to eight by nurse who will make “triage”. For 24 hours there is an orderly, who in case calls the nurse from the front desk. She picks up the patient and makes triage and decides whether to go to the X-ray and what examination to take. If they arrive by the rescue service, they ride straight out of here – right here.

Trauma-team or internal resus-team is called, then the patient is treated and diagnosed. All treatments are done here, through the X-ray, which is here – you can see a ceiling X-ray. The patient undergoes a CT scan, which is on the MIM pavilion and when diagnosed is taken from us and according to the type of injury transferred to surgical ICU or KARIM.

These are expectation boxes. Those are for patients who can also come by ambulance or rescue service, but they are conscious, non-ventilated patients and patients who need to be treated and diagnosed internally. That means that the patients need an ECG. After that patients are discharged to go home or they are accepted to the hospital. The patients stays here for 24 hours maximum.

There on the other side are ambulances, where the ambulant patients are treated, ie. injuries, suture, plastering, etc.

This one and another crashroom are the same in the equipment, only this one is equipped with ventilation unit when the chest is acutely opened in case of serious injury when the patient is unable to reach the operating theater.

Here’s the plastering.
If there are a lot of patients, we plaster in doubles. We can manage.

When the patient goes to outpatient reception, he goes this way, if we talk about surgical ICU and AR, then it is by this elevator. One floor above is AR (KARIM) and above that is surgical ICU. Other patients that goes e.g. to the Internal medicine, or with the head injury and he goes to the neurosurgery pavilion he goes outside by an ambulance car.


STANDARD BED WARD

Blanka Macáková, Nurse manager of dept. C – Standard Ward of Internal Medicine

PAVILION OF INTERNAL MEDICINE

English transcription

STANDARD BED WARD

The size of the room is satisfying, this isn’t a problem. However there is a bit of a problem with the size of the bathroom and the shower. If the patient is less mobile, he has trouble getting into the bathroom. There is a stair in the shower and also the nurse has a problem getting there if she wants to help patients. This room is in the optimal distance from the nurses’.

We try to keep a patient who is less mobile in this corner, because there is more space around him.

That corridor is very long. When you run over 100 times per day, and I’m not exaggerating, your feet hurt after 12 hour shift. We have to have a correct number of rooms here, which is the reason for the long hall, so there were no other option, but it’s really very long. Single rooms there are situated on the end of the hall. When we have a patient in a very difficult condition, we need him close to the nursery. We should have single rooms here as close as possible to us because they are mostly for the most difficult patients. Not always, but mostly.

The nurses‘ has its rear section, physician’s office, which is right next to it, preparatory where the medication is mixed and prepared, examination room and storages, which we are very short of. There is no place for material and aid.


OPERATING THEATRES

Olga Lochmanová, Section nurse for General Surgery

ACADEMIC BEDRNA PAVILION

English transcription

This is an emergency or acute theatre. This door will lead to the point, where we enter. It was formally the 1st acute theatre. The theatres are now divided into branches where as previously they were used universally. Times have changed and technology is rapidly developing and today we have a number of departments- traumatological, robotical, urological.

Today we know the condition of the patient when he gets in, so we direct them to the specific theatre, which is equipped for the particular intervention.

This is where the patient enters, here he is then transferred onto operation desk were the surgical procedure commences. This is mostly for the internal conditions such as stomach and likewise. When it is a traumatological patient, for example a car crash etc., he is directed to the theatre no. 6. The technical solution for transferring of the patient is that we have this “square“, where we have two types of carts – one is used for the transport from the department and the other is used for the transport on the operating theatres department.

The transfer point, that is planned, will simplify the procedure and ensure that clean and unclean zones will not cross.

These are storage rooms, entrance filters, and rooms for students, nurses, cleaning and sanitation. This whole corridor is for service and routine – inspection room, head nurse, sanitary workers, economist, secretaries and writing room – the whole management. We don‘t have a canteen here, we have to go outside, currently we have the option of catering, so the food is delivered, but we don’t have a special room for the canteen; that would be a huge advantage.

We are on the “new“ operating theatres. Theatre no. 6 – traumatology, also the theatre no. 7, which is sometimes used as for general surgery. This is the “filling room“, this space is big and all the medical material is placed here and there is also storage for boxes. The sterile material for use within the surgery comes into this room, it is prepared by nurses for the specific surgical procedure.

There are two sizes of instrumental tables. The big table is additional, where the instruments that might be needed are placed and the small one is used for approach to the patient and holds the necessary instruments. These are the tables – the big one and the small one.

Patients come through the “square”, they’re transferred to the bed “green zone” and are transported though this corridor to the theatres.

These are again the “new” theatres. The dimensions of the rooms are lot bigger than the “old” ones. It is much brighter here and the surgeons prefer to work in these new theatres. There is also a contact with the exterior. The contact with the daylight is very useful.

This is the way the patient enters and the transfer to the operating desk. This is the way to the filling room, where the sterile material comes in – that is taken by sanitary personnel. From the opposite side comes the surgical team.

This is our “octopus“, a deployed robot with the screen. The surgeon is not sitting next to the patient, but by the console. The robot needs its own theatre, optimized for its dimensions. That is the main problem – it is stored here and we have to drive it. This is inconvenient because it is expensive machinery and every time it is transported it can cause damage. We want to have it placed in the theatre and for that it is necessary to have sufficient space.

Every scrub for the operating theatre is on its own. It is equipped with the stainless basins. Here proceeds the surgical wash and disinfection. After that the surgeon enters the theatre. This is the theatre background, where everything has to be documented. Here we have some things for surgeries. Used surgical instruments are placed in these containers where they are decontaminated and after that they are handed in for sterilization. Everything is placed in the trolleys and transferred to the central sterilization plant where everything is washed, sterilized, set and transported back here. The problem is the crossing of the clean and unclean zones-ways not being separated.

These are doors leading to the theatres, where the patients enter the theatre. This is the perfusionists station.


The visit of the site took place on 20. 5. 2017 with commentary of the announcer.