Div_01_Attachments_-_Phase_1_.pdf

IDBO MATOC 4.0:Div 01-General Requirements IDBO MATOC 4.0:

Div 01-General Requirements (Phase 1 Scenario)

ATTACHMENT A-CONCEPT OF OPERATIONS

25 MARCH 2016

REQUEST FOR PROPOSAL: ATTACHMENT A-CONCEPT OF OPERATIONS (25 Mar 16) IDBO MATOC 4.0: Division 1-General Requirements

1 TABLE OF CONTENTS

1 Introduction

2 World-Class Medical Facility

3 MTF Goals & Objectives

3.1 Department 1-Surgery

3.2 Department 2-Labor & Delivery

4 Functional Zones (General)

4.1 General

4.2 Public & Visitor Zone

4.3 Patient Zone

4.4 Staff Zone

4.5 Work Zone

5 Department 1—Surgery

5.1 General

5.2 Manpower*

5.3 Services Offered

5.4 Functional Flow (Department)

5.4.1 Public & Visitors

5.4.2 Patient

5.4.3 Staff

5.4.4 Work (Supply/Materials)

6 Department 2—Labor and Delivery (L&D)

6.1 General

6.2 Manpower

6.3 Services Offered

6.4 Functional Flow (Department)

6.4.1 Public & Visitors

6.4.2 Patient (Mother)

6.4.3 Patient (Baby)

6.4.4 Staff

6.4.5 Work (Supplies/Material)

1 INTRODUCTION

The Concept of Operations (aka “ConOps”) in general describes the: 1) Medical Treatment Facility‘s (MTF) strategic vision to healthcare delivery, 2) the departmental healthcare delivery model, and 3) operational and/or functional plan for how public/visitor, staff and patients will function within the facility and/or department. The Concept of Operations is provided so the Contractor can provide a solution that:

1) Dovetails into a strategic or overarching plan and meets the definition of a “World-Class Medical Facility”.

2) Accommodates mission, vision, organizational considerations, workload and targeted services.

3) Addresses functional requirements such as departmental flow and adjacency/interdependency needs.

2 WORLD-CLASS MEDICAL FACILITY

A World-Class Medical Facility is a highly interwoven collaboration between highly skilled medical professionals, suppliers of state-of-the-art technologies, and highly effective facility planners, designers and builders. The World-Class Medical Facility provides exceptional comprehensive healthcare in an environment that promotes comfort, speeds healing, fosters teamwork, and promotes innovation. The design of a World-Class Medical Facility is to include evidence-based principles, well executed planning, and incorporation of technologies that create a healing environment, provides patient and family-centered care, and facilitates communication between caregivers, patients and family. Through enhanced and modernized design and intelligently realigning functions, a World-Class Medical Facility improves efficiency, accuracy, communication and attitude. It is able to easily and economically adapt to changing practices, technologies, and fluctuating operational demands. It is able to accommodate all patients for a lifetime of medical care. The environment must meet the needs of the client-patient by providing the best physical, mental, social, and spiritual care.

3 MTF GOALS & OBJECTIVES

Project X resides in a major US Air Force Hospital. The Medical Treatment Facility (or “Medical Group” (MDG)) vision is to be the “patient’s first choice for recognized quality and comprehensive healthcare”.

Current enrollment has grown from approximately 32,000 patients (2011) to 36,633 (2016) with a new enrollment target of 50,0001 (the total eligible population within a 20-mile radius). The primary goal is to recapture workload and purchased healthcare from the local economy. To support the overall goals and operational objectives, provide a design that addresses at a minimum:

1. Efficient, attractive, healing environments within the facility and its surrounding landscape.

2. Incorporate environmentally sensitive and sustainable design.

3. Ease of constructability to minimize impact on on-going operations.

4. Optimize functional adjacencies for ease of operations and efficiency.

5. Enhance access to services.

6. Reduce the risk of medical errors.

7. Empower patient/family to communicate with caretakers.

8. Enable family members to provide support and care to loved ones who are hospitalized.

9. Enhance patient and caregiver safety.

1 “USAF Surgeon General’s Program Analysis and Evaluation Division” Review

10. Design in flexibility to allow for future adaptability and expansion to include new technologies or services within the space, and within existing structural components.

11. Provide convenient and clear patient access points to the departments to include a unidirectional flow of the patients from entrance to exit.

12. Reduce patient/staff redundant movement throughout the department.

13. Provide wide clinical corridors to accommodate strollers, gurney’s, equipment, supply carts, and wheelchairs.

14. Way-finding solutions, such as varying color schemes, to help direct patients.

15. Separate procedure areas from patient room areas as much as possible to decrease the amount of traffic through and around those spaces.

16. Separate circulation for patient and staff / supply functions.

3.1 DEPARTMENT 1-SURGERY

Surgery goals and objectives include:

1. Recapture inpatient care to increase bed-occupancy by 70% to support more diverse and complex surgical cases.

2. Reduce general surgery specialty referrals currently deferred to purchased-care by 10% of FY14 averages.

3. Recapture/reduce orthopedic surgery specialty referrals of complex cases currently deferred to purchased-care.

4. Expand the Central Sterile Supply (aka “Sterile Processing Department”) to support the modernization of L&D and

Surgery and the MTF sterilization needs.

This will in part be achieved by diversifying and expanding surgical staff capabilities to include: two (2) new plastic surgeons, one (1) inbound plastic surgeon, one (1) new bariatric surgeon, one (1) projected vascular surgeon, and three (3) cardiologists and a heart catheterization laboratory. To provide additional opportunities and caseloads for doctors to remain current and credentialed in their field (aka currency), outreach programs will also be employed to complex populations like veterans through VA referral offices. This modernization project is, in part, is a response to the increase in surgery cases in 2014.

3.2 DEPARTMENT 2-LABOR & DELIVERY

As the second busiest USAF L&D with more than 750 births annually, L&D goals and objectives include:

1. To be the number one, first choice for OB patients in the area.

2. Deliver safe and trusted patient care to our beneficiaries.

3. Provide excellent customer service and compassionate care to all patients

4. Increase enrollment through OB care in order to protect the “whole-family care” concept.

5. Facilitate patient flow, and patient care information, between the OB Clinic and L&D.

6. Continue to train personnel to provide the best quality care.

4 FUNCTIONAL ZONES (GENERAL)

4.1 GENERAL

Plan and design each functional zone to address the goals and objective outlined above. The four primary functional zones include: 1) public/visitor, 2) patient, 3) staff, and 4) work/support areas.

In each of the departments, provide an “on-stage/off-stage” concept to separate patient care from staff, work or support activities. It’s important to separate potentially noisy activities and staff support functions from patient care areas to maintain a stress-free, quiet and calm environment that promotes healing and recovery. The goal is to enhance patient movement throughout the department, minimize their travel distances, and ensure staff movement is minimized of repetitive movements to accomplish tasks and oversee patient’s care.

Refer to DOD SPACE PLANNING CRITERIA for definitions of the departmental functional areas. Refer to MHS TEMPLATES for the required configuration of FFE-LVS and associated infrastructure (Note: contents listed in the PRCL and UFC 4-510-01 DESIGN: MILITARY MEDICAL FACILITIES takes precedence over information found in MHS TEMPLATES).

4.2 PUBLIC & VISITOR ZONE

These spaces are where patients and visitors flow through the department, moving towards, or waiting for, healthcare delivery services. Examples include: registration, reception, corridors, bathrooms, waiting rooms, etc.

4.3 PATIENT ZONE

These are areas where patients receive healthcare services and include clinical support spaces. Examples include: exam and treatment rooms, patient rooms, sub-waiting areas, exams rooms, screening and testing areas, pharmacy pickup, etc.

4.4 STAFF ZONE

These areas are purely administrative or “back-of-the-house” functions where patient interaction typically does not take place. Examples include: provider and staff offices, conference/training rooms, locker/lounges, housekeeping, logistics, sterile processing and distribution, on-call rooms, etc.

Provide separate entrances to staff zones with minimal travel through public and/or patient zones such as waiting areas and patient lounges. Provide staff and support spaces, such as provider offices and lounges, adjacent to their clinical department to the extent possible. Unless otherwise noted, do not place provider offices within the patient zone, but close to the patient zone for ready access.

4.5 WORK ZONE

Work zones, provide direct support to patients and must be co-located with exam, treatment and labor and delivery rooms.

Examples include: utility and supply rooms, environmental services, nurses stations, etc.These areas are not typically considered areas where patient care is delivered, but interaction with the patient can occur so locate them for easy patient access.

5 DEPARTMENT 1—SURGERY

5.1 GENERAL

Surgery serves both outpatient and inpatient surgery patients. It maintains 24-hour operations, however typically performs scheduled surgeries between the hours of 7:15 a.m. and 3:30 p.m.

5.2 MANPOWER*

The following table reflects the current manpower for the Surgery department.

Auth Asgd

*PLATT

Model2

Officer 17 16 25

Enlisted 24 30 34 This Civilian 2 1

Contractor 2 12

45 59 59

Three members of the staff currently maintain an office within the Surgery department: 1) OR officer in charge, 2) Certified Registered Nurse Anesthetist (CRNA), and 3) Surgery Flight Chief Technician. The rest of the surgery staff maintain offices on the first floor (if authorized).

On-call on-site support staff (24-hour operations) supports the Emergency Department, the Intensive Care Unit (ICU), Medical Surgical Unit (MSU, and the L&D. The on-call on-site support staff includes: 1) 1 technician and 2) 1 anesthesiologist or nurse anesthetist. An on-call off-site nurse also provides support as needed with a response time of 30-minutes.

5.3 SERVICES OFFERED

Surgery provides a complete line of surgical and sub-specialty surgical care to include general, thoracic, vascular, plastics and reconstructive, otolaryngology, obstetrics and gynecological, neurological, ophthalmology, orthopedic, podiatry and urology. Care is available to all eligible beneficiaries by referral. Surgeons are fully trained board-eligible/board-certified.

The Surgery department’s hours of operation are 07:30 am to 3:30 pm, Monday through Friday, excluding Federal Holidays and the first Wednesday of each month (reserved as a unit-training day from 6:45 a.m. to 12:00 p.m.

5.4 FUNCTIONAL FLOW (DEPARTMENT)

Note: Any room/area titles highlighted in grey are part of department flow but are not listed in the PFD.

5.4.1 PUBLIC & VISITORS

1. Parking: Visitors to the Surgery department are instructed to park in the visitors parking area at the front of the hospital, preferably outside of the “XXX Inpatient Tower” on the east side of the inpatient tower.

2. Facility Entrance: They enter the facility at the “XXX Inpatient Tower/Emergency” entrance.

3. Elevator-Floor 1: They take the public elevators on the right (elevator bank 4) to the second floor.

4. Ambulatory Surgical Unit (ASU): Surgical Patients and visitors proceed to the 2nd floor Surgery department. Patients and visitors will use the available phone on the 2nd floor to speak with ASU personnel who will either escort them to the patients bed/gurney in the preop/postop area or have them wait in the OR waiting room (on the 4th floor) until the patient is ready for them.

2 *The current manpower documents do not support a seven (7) operating room department. This issue is being addressed and corrected via the medical product line analysis transition team (PLATT).

5. Medical-Surgical Patient Room: Visitors should check in at the 4th Floor nurses station. Staff members will allow the visit if the patient is ready to receive visitors and also gives them permission to enter the room. Visitors are then escorted to the patient location.

6. Waiting Room-Floor 4: Visitors and family will wait in the 4th floor waiting room as needed while waiting for either Ambulatory or Inpatient Surgical Patients.

5.4.2 PATIENT

1. Reporting for Surgery: If a patient is scheduled for same day surgery they will be given a pre-admission appointment.

They are given instructions on the location of ASU and specific reporting instruction. On the duty day prior to surgery, patients are called (or will call pre-admissions) to obtain their arrival time to ASU.

2. Parking/Facility Access: On the day of their surgery patients are instructed to park in the visitors parking area at the front of the hospital, preferably outside of the XXX Inpatient Tower on the east side of the inpatient tower. Elevator #4: After checking in with Admissions and Dispositions, they take the public elevators on the right (elevator bank 4) to the second floor.

3. Patient Check-in: The patients report to the 2nd floor ASU entrance on the day of their surgery. The entrance to the section is directly across from where patients exit the elevator on the second floor. Patients will use the available phone to speak with ASU personnel to notify them that they have arrived for their surgical appointment. ASU staff will either escort them to their patients bed in the preop area or have them wait in the OR waiting room (on the 4th floor) until they are ready for them. Patients begin to check-in at 6:00 am; and continue to check-in until all patients have been admitted to ASU typically no later than 3:00 p.m.

4. Pre-op: ASU personnel will escort the patient to their bed/gurney in ASU where a staff of RNs, technicians, and anesthesiologists prepare them for surgery. The average time to prepare a patient is 45 minutes to 1 hour.

5. Operating Room: Patients transported via gurney into the Operating Room.

a. Patients start occupying the ORS between 7:15-7:30 am.

b. Each Operating room may have 3-4 cases per day with an average clean time of 30 minutes between each case.

c. Outside of the scheduled surgery times the Surgery department is available 24 hours a day to support the

Emergency Room and Labor and Delivery.

6. ICU: Patients with complex medical or surgical issues or if there are complications during surgery, then the patient is transported directly to the ICU located on 3rd Floor West directly above pre and post op on the second floor.

7. Post Anesthesia Care Unit (PACU): Most often the patient is then taken to the PACU.

a. Medical-Surgical Unit: Patients who require follow-on inpatient care are transported via gurney to the Medical-Surgical Unit on the 4th floor after their recovery in PACU.

b. ICU: If there are complications during recovery in the PACU, then the patient is transported to the ICU located on 3rd Floor West directly above pre and post op on the second floor.

c. ICU: If a patient surgery’s is not scheduled and occurs when the PACU is not open the patients are taken to the ICU for recovery.

8. Elevator/Facility Exit: Patients who do not require follow-on inpatient care (aka “ambulatory”) are transported via wheel chair to the facility entrance located at XXX Inpatient Tower where they are picked up. Patients are not permitted to drive themselves home and must arrange for transport home. Those who cannot find transport may be admitted to the Medical-Surgical Unit.

5.4.3 STAFF

The staff primarily uses the spaces found in Functional Area 4 (see PFD). The typical flow of staff in this department includes:

1. Parking: Staff parking is located on the west side of the XXX Inpatient Tower.

2. Facility Access/Elevator #4: The staff accesses the facility from elevator 4 or by using the stairs on the East and West side of the main first floor corridor in the XXX Inpatient Tower.

3. Locker Room/Toilet & Shower (Female/Male): The staff enters the lockers on the 2nd floor where they change into surgical attire. The locker rooms provide one way changing flow from staff entrance to semi restricted area.

4. Scrub Distribution (Female/Male): Note: This needs to be adjacent to or combined with locker room so scrubs are available to all staff members. It can be a combined, centrally located area for all to pull scrubs from.

5. Nurse’s Station (Control Desk): The staff uses this space as a meeting point. This nurse station monitors caseloads and the operational aspects of surgery department and should be centrally located for control of the Surgery Suite.

6. Staff Lounge: The staff uses the space to take a break and relax as well as for eating a meal.

7. Medication: The staff uses this room for the storage and preparation of patient medications and has additional security requirements. This room must be collocated with the Nurse Station and Operating Rooms.

8. Operating Rooms (1-5): 2nd floor; The staff access the operating rooms via a Clean Sub-sterile Core to have no cross traffic of clean supplies and soiled/decontaminated areas. The staffs move clean and soiled / decontaminated supplies and equipment within the suite itself and the space shall be designed to not compromise universal precautions or aseptic techniques.

9. OR Sub-Sterile: The staff accesses the Operating rooms from this clean space to prevent the crossing of clean and soiled items. It may be located between two ORS or a group of adjacent ORs.

10. Scrub Sink (1-5): The scrub sink should be located near the entry point to each Operating room so the staff can scrub up before entering the room.

11. Alcove (Mobile Lead Apron Rack): The staff accesses the storage space for the lead apron when they need to use the x-ray C-arm in an Operating room. The staff will move the apron from the storage location to the respective OR.

12. Alcove (Blanket/Fluid Warmer + Flash Sterilizer): This space must be adjacent to ORs clean core area for staff to quickly acquire warm blankets/fluids for the operating room patient or for the staff to take items from the operating rooms to the flash sterilization equipment and then retrieve them.

13. OR Equipment Storage: The staff accesses the OR equipment storage, used to store larger freestanding items needed for the Operating rooms.

14. Storage (Equipment and Shelving): The staff uses the space for storage of surgical instruments and supply, typically smaller items. It should be in close proximity to the Operating rooms so that staff can access the items in preparation for the Operating room cases. Staff would bring items here for storage after they have been appropriately sterilized after use.

15. Clean Linen Room: Staff will access the clean linen room to acquire linens when they are preparing the operating rooms for the next case. The room should be in close proximity to the ORs.

16. Receiving/Breakdown Room: There is a staff member assigned to work receiving supplies transferred from the medical supply warehouse and the Medical facility loading docks. The staff needs adequate circulation to remove outer packaging and discard and recycle materials. Outer cardboard must be removed before transfer to clean supply storage area. This space will be contiguous to "Storage, Instrument/Supply, and Sterile (CSS)" where staff will transfer the supplies for storage.

17. PACU/Pre-op: Provider and Technicians walk back and forth to the Ambulatory Surgical Unit (ASU) and Post Anesthesia Care Unit (PACU) for pre and post-operative care.

18. Janitor Closet: The custodial staff works out of this room to aseptically clean the department and to ready patient care spaces for a new patient.

19. Neptune (Dornoch) Docking: Neptune/Dornoch Waste Management Systems are used in operating room (OR) suites and surgical facilities to collect and dispose of surgical fluid waste. The staff accesses this space to connect the portable suction unit to the docking stations that clean and sterilize them for their next use.

20. Conference Room: This space is used by the staff for meetings and for a large number of the staff to be trained at once. The function of this space for the staff requires a location away from the patient surgery areas.

21. Consult room: This is a consultation room for family members to meet with the staff physicians or other providers privately. It should be located near and easily accessible from the waiting room.

5.4.4 WORK (SUPPLY/MATERIALS)

5.4.4.1 STERILE PROCESSING DISTRIBUTION (CENTRAL STERILE SUPPLY)

1. Department Sterile Processing and Distribution: The SPD (or CSS) supports the sterilizing requirements for all inpatient units and outpatient clinics at the MTF, with the exception of dental which is housed in another building.

2. Decontamination Vestibule (Clean): The staff uses this room to put on their personal protective equipment for their duties in the SPD/CSS. It should be designed as the entry point from the sterile hall for staff that work in the SPD/CSS.

3. Central Sterile Receiving (Soiled Cart): This area is a transition zone separating the main circulation corridor from the Decontamination Work Area. It accommodates the temporary holding of soiled carts, totes, and medical equipment, without directly entering the Decontamination Work Area. Items are dropped off in the trash drop off room or the dirty linen holding area in the space prior to equipment or instruments being passed to the decontamination room.

Included in this area is an electronic tracking system with wall mounted scanner to be used for instrument and equipment tracking. Refer to OSHA and ANSI Standards. Room should also be accessible for hospital staff from other departments to drop off dirty instruments without entering the decontamination area.

4. Decontamination (Trash Drop-off/holding): This should be a separate room off of the Sub area of "Central Sterile, Soiled Cart, Receiving (CSS)" that is used for collection and storage of large amounts of trash and (empty) E-tank med gas storage.

5. Cart Wash: Note: The cart wash is used after items have been removed from the cart in the "Central Sterile, Decontamination, Large (CSS)", after the carts are cleaned they will go to Sterile Storage to be prepared for the next OR case.

6. Central Sterile Decontamination: Carts are brought from Central Sterile, Soiled Cart, and Receiving (CSS) into the decontamination space. The decontamination space provides for cart unloading and instrument cleaning, preparation and inspection. All contaminated (dirty) instrument sets are brought to this area for initial cleaning (bio-burden reduction) and prepared for decontamination process. After instruments have soaked, the instruments are cleaned and a determination is made for whether they can go through the washer or ultrasonic cleaner or pass through cabinets;

with the exception of gastrointestinal scopes that are decontaminated and then taken back down to the Gastroenterology department (they are not sterilized at this location). This area is considered “dirty”. Instruments are further cleaned and prepared for decontamination process in a washer-decontamination unit. Some items may be decontaminated and transferred directly to the “Central Sterile, Assembly, Large (CSS)” through a pass-through cabinet. Washer decontamination units must have a pass through capability from the receiving / decontamination area into the assembly / sterilization area. After the carts are emptied they are moved directly to the “Cart Wash, Manual & Automatic (CSS)” for cleaning.

7. Central Sterile Assembly: After items come directly from the decontamination area this assembly space provides for instrument set assembly, packing and wrapping and quality assurance inspection.

It will also accommodate storage for supplies and materials used for those purposes including items such as instrument containers, wrappers, pouches, etc. Instruments entering the assembly area from the Receiving, Decontamination areas are now safe for handling by staff members. At this location, instruments are assembled into sets, placed in sterilization containers or sterilization packs and prepared for the next step, the sterilization process. A technician pulls 1 tray at a time, to inspect and prepare items for sterilization. The washer should have the capability to dry items. The sterilization prepping area should have individual workstations and incorporate more automation. The person that retrieves the dried items physically inspects them and then proceeds to pass them to another individual who prepares, packs and inspects to ensure that the items are ready for sterilization.

Once the assembled sterilization items are ready they are then moved to the sterilizer. Packaged instrument sets from the Assembly area are loaded onto sterilization transport carts, placed into sterilizer units where sterilization process occurs. Carts are removed from sterilizer and are received from the other side of the pass-thru sterilization units in the “Storage, Instrument/Supply, and Sterile (CSS)”.

8. Sterile Storage (Instrument/Supply): Once the sterile items have been removed from the pass thru sterilizer, they sit in the sterile room from 3 to 24 hours, depending on the type of sterilizer used, until spore test are complete that confirm that the sterilization process was a success. There is a 24 hour holding period for items sterilized within a Sterad® device. The extended holding period is required to conduct a proper spore test. The 24 staging should occur within the sterile room. After the spore tests are complete the items are then either moved to individual case carts or other distribution carts to be delivered to using departments or moved to their storage location in the room. Items will be retrieved from other Departments so the room should be accessible for hospital staff from other departments to pick-up without entering a sterile storage area.

This area will be utilized for the storage of instruments and sterile storage for supplies. SPD will complete all sterilization of instruments. Sterile supplies will be distributed to using areas by staff pickup.

a) All disposable items that do not require processing and sterilizing will be stored and distributed to the using area by Medical Materiel.

b) Equipment requiring SPD handling will be cleaned, decontaminated, and stored in the SPD in a clean environment.

9. Clean Holding (Surgical Cart): This space is used for case cart storage and production and includes: clean empty carts, clean in-process carts and clean completed carts. Two days in advance of operations, soft goods (disposable supplies) are pulled in the Sterile Supply room to ensure critical items are available the day of the operation. These items are then staged in the surgical cart clean holding area. If the supply chain issues can be fixed a one day pull for supplies is preferred. Supplies are manually moved from carts to this room and the carts are rotated back to the storage area as they are emptied.

10. Central Sterile, Soiled Cart, Receiving (CSS) should contain shelving to support the receiving of dirty supplies (outer packing boxes, a break down room) from Logistics and general storage.

11. Receiving / Breakdown Room: this area is used to receive supplies transferred from the medical supply warehouse and the Medical facility loading docks. Adequate room is required to remove outer packaging and discard / recycle materials. Outer cardboard must be removed before transfer to clean supply storage area. Space will be contiguous and be accessible to sterile storage "Storage, Instrument/Supply, and Sterile (CSS)".

6 DEPARTMENT 2—LABOR AND DELIVERY (L&D)

6.1 GENERAL

L&D maintains a 24-hour operation with visiting hours scheduled from 10:00 am to 8:00 pm each day of the week. The department operates in two (2) shifts.

Shift Hours Staffing

Day 0545-1800 4 Nurses 2-3 Techs

Night 1745-0600 5 Nurses 2 Techs

6.2 MANPOWER

Providers and nurses from the OB/GYN clinic, support the section on a 24-hour on-call basis. The OB/GYN staff and Family medicine residency providers who support Labor and Delivery have offices in their respective clinics. Two to four L&D Providers are on the floor at any given time and can include Anesthesia, Pediatrics, Obstetric (Doctors, Residents and Midwifes).

Section Name

Position Name

FY15

Authorizations

FY19

Authorizations

Labor and Delivery Unit, Maternal Child Inpatient Flight

Obstetrical Nurse

24 27

Medical Technicians

16 18

Providers*

6.3 SERVICES OFFERED

L&D services include examination, preparation, antenatal testing, labor/delivery/recovery, cesarean section birthing, and other routine medical and surgical treatments for mother and child.

6.4 FUNCTIONAL FLOW (DEPARTMENT)

Note: Any room/area titles highlighted in grey are part of department flow but are not listed in the PFD.

6.4.1 PUBLIC & VISITORS

1. Parking: Visitors to the Labor and Delivery department are instructed to park in the visitors parking area at the front of the hospital, preferably on the east side of the XXX Inpatient Tower.

2. Facility Entrance: Visitors enter the facility at the XXX Inpatient Tower/Emergency entrance.

3. Elevator-Floor 1: Visitors take the public elevators (elevator bank 4) on the right, north side of the hallway, to the third floor.

4. Waiting Room-Floor 3: L&D is directly to the left after exiting the elevators on the third floor. Visitors who wish to visit mother’s use the available phone located at the entrance to labor and delivery, next to patient waiting area, to call the nurses station to speak with Labor and Delivery personnel. Visitors notify the staff that they’re there to visit. Visitors will wait in the Labor and Delivery waiting room until the patient is ready for them. The labor and delivery waiting room is directly outside the departments secure entry door and the waiting room is shared with ICU on the same floor.

5. RN Station: After visitors call the nurse’s station the staff validate with the patient that they are both ready for and want to see the visitor(s). The visitor is then escorted into the department and stops at the nurses’ station for identity verification.

6. LDRP/Post-Partum Room: After visitors have their identity validated they are escorted to the correct room by the staff.

7. Exam/Triage: Same check-in procedures as per step 1- 5. Visitors will be escorted to the room if no procedures are taking place.

8. Operating/C-Section Room: Same check-in procedures as per step 1- 5. The partner is escorted to the room. No other guests are allowed in the C-section room.

9. ICU/PACU: Same check-in procedures as per step 1- 5. If visitor needs to go elsewhere in the hospital to visit the mother the staff will instruct them on how to get there. ICU is across the hall from the Labor and Delivery on the 3rd floor. The Post anesthesia care unit is on the 2nd floor west side of the floor. Patients are only sent to the ICU or the PACU when the mother has had a general anesthesia and needs additional monitoring.

6.4.2 PATIENT (MOTHER)

1. Parking: Patients to the Labor and Delivery department are instructed to park in the visitors parking area at the front east side of the hospital. There are 3 designated parking spaces in front by the Emergency room entrance for pregnant moms.

2. Elevator-Floor 1: The mother enters the MTF’s at the XXX Inpatient Tower/Emergency entrance. They take the public elevators (elevator bank 4) on the right, north side of the hallway, to the third floor.

3. RN Station: Most patients who have any issues or concerns or who are in labor typically call the department nurses station before coming. The staff instructs the patient on what to do and typically it will be to report to the labor and delivery department. Whether the patient calls ahead or goes directly to labor and delivery once she arrives on the 3rd floor she will use the available phone, located at the entrance to labor and delivery, to call the nurses station to notifying the staff of her arrival. The Nurse or Technician unlocks the secure entrance and allows the mother to enter the unit. The mother progresses to the Nurse’s Station. Approximately 80% of the time triage patients call ahead and because they are expected they are assigned a triage room. Note: On average 5-6 mothers present during a 12-hour staff shift.

4. Exam/Triage Room: The mother is taken to the exam/triage room where staff determines the status of her labor. Note:

Approximately 95% of the time the mother is not in active labor. If she is in active labor she will be moved within 15 minutes to a LDRP rooms. If it has been determined that she is not in labor then the patient will be discharged to home with management instructions.

a. If she’s scheduled for a C-section, she is taken to a post-partum room from the exam/triage; if a post-partum room is not available she is taken to an LDRP.

b. Patients are instructed to call ahead when coming to L&D so Staff should already be aware that a patient is arriving and an exam/triage room is determined prior to the patient arriving. If there are no rooms available then the L&D charge nurse will call the MSU to arrange for a post-partum patient to go upstairs before the patient presents to the unit.

c. Toilet: Patient may need to use a toilet that has direct access from the exam/triage.

5. LDRP/Post-Partum Room: The mother is moved from exam/triage to the LDRP/post-partum room. In the LDRP the mother labors, delivers, recovers and post-partum in the same room if there are no complications. If the mother has had complications she may be transported to a higher acuity facility located in the area. Note: in-room birthing tubs are not permitted by the MTF due to infection control concerns.

a. Post-Partum/Patient Room: If all LDRPs are occupied or unavailable, then mothers who have already delivered are moved to a post-partum room or the medical-surgical unit on the 4th floor.

b. Mothers post-partum an average of 24-48 hours for vaginal deliveries and are discharged directly from the LDRP/Post-Partum Room.

6. C-Section Room: Mother’s who deliver in a C-section operating room stay there for an average of 1-hour. They are then moved to: in order of availability a Post-Partum room, a LDRP, or the medical surgical unit room where the Mother post-partum. If the mother has had general anesthesia or there are complications, then they may be moved from the C-Section OR to ICU or PACU before being returned to her room. If the mother’s condition warrants she may be transported to a higher acuity facility located in the area. Mother’s are typically discharged directly out of the LDRP, Post-Partum or Medical-Surgical Unit bedroom. The C-Section room is then cleaned and prepped for the next case.

This takes approximately 30-minutes.

a. Surgery OR: If the C-Section room is occupied, then the mother is moved to a Surgery OR on the 2nd floor.

Note: Most C-sections are scheduled and pre-determined prior to the Mother’s arrival to L&D.

b. Mothers post-partum an average of 48-72 hours if they had a C-section.

c. Other types of obstetrics (OB) procedures that require general anesthesia are scheduled through the OB/GYN clinic and are carried out in the Surgery OR.

6.4.3 PATIENT (BABY)

1. LDRP: The baby is delivered in the LDRP rooms.

a. Babies presenting with issues are taken to the warmer within the room where the staff conduct necessary steps to work on the baby.

b. Medications are also administered within the room.

c. Babies are bathed in the room.

d. Nursery: If the baby needs additional support, the baby goes to the Nursery/Transition Observation Room

2. C-Section OR: Babies birthed in the C-Section room go to the warmer and are prepared to be presented to the parents.

If the C-Section is an emergency, the baby is stabilized in the OR.

a. LDRP: If there are no complications the L&D technician and nurse will take the baby to the assigned post-partum/LDRP room and the father or family member has the option to go to the room with the baby.

b. Nursery: If the baby needs additional support, the baby goes to the nursery.

3. Nursery (Level 1):

a. If the baby requires additional resuscitation efforts or is in distress, they are taken out of the LDRP or C-section room to the nursery (this occurs on average only 2-3 times a month). The nursery (level I) has more advanced resuscitation capabilities to include x-ray.

b. The average stay within the nursery for each baby is a few hours. If the baby is transferred out, the baby’s duration in the nursery may take longer.

c. Other Medical Treatment Facilities: High acuity infants are transferred to a Level 3 facility located at either Ft Walton Beach or Sacred Heart Medical Centers. The receiving facilities provide transport for the babies. They are picked up at the emergency room ambulance loading/unloading directly below the labor and delivery department and located at the first floor level.

4. Procedure Room: The Nursery procedure room should be collocated next to or within the nursery. This will be beneficial during circumcisions. Circumcisions occur about 25 times a month. The procedures take about 30 minutes and the baby goes back to the LDRP or post-partum rooms

5. Exam /Lactation Room: Two to four days post-partum, babies come back to the hospital for their initial check-up.

Often times they come back to L&D for this check-up because the check-up occurs on a non-duty day for the pediatric clinic. This function requires a standard exam room with infant accommodations. The computer station in this room is also used by the lactation consultant when she is making rounds on the floor or if she needs to bring a mother and baby into the room to instruct on breast feeding. Due to the utilization rate for both of these functions the room can be shared.

6.4.4 STAFF

1. Parking: Staff parking is located on the west side of the XXXInpatient Tower.

2. Facility Access/Elevator #4: The staff access the facility from elevator 4 or by using the stairs on the East and West side of the main first floor corridor in the XXXInpatient Tower.

3. Waiting Area: Staff do not discuss personal issues in the waiting rooms, visitors/family are taken to a private room

(Office or open space) to discuss private information.

4. Exam/Triage (1-3): the staff provide patient care every day in the exam/triage rooms for the myriad of mothers who present with different issues or who present in labor. The staff needs to be able to provide constant oversight of these rooms with the rooms being centrally located near the nurse’s station. The location should minimize staff walking distances.

5. Toilet: Collocated with LDRPs, post-partum, and Exam/Triage rooms. For mothers who are unsteady in any way the staff will assist patients to the restroom and assist them back to their beds. Emergency call mechanisms are placed in reach of the patient.

6. Equipment Room (1-4): For LDRPs, the staff will retrieve equipment from the room that is needed in the delivery rooms for pre and post birth.

7. LDRP (1-8): The staff provides vigilant oversight of these rooms when mothers are in active labor. The rooms shall be centrally located near the nurse’s station. The location should minimize staff walking distances.

8. Patient Room/Post-Partum Room (x2): The staff brings patient to this room prior to their C-section, patients are prepared in this room by the staff. After their delivery is completed in the C-section room the staff returns patients to this room for their recovery. These rooms are also used as overflow for the LDRP when the LRDPs are full. The staff will move mothers who have already delivered to these rooms to make space for another mother in a LDRP.

9. Nurse Station: The staff uses the nurse station for command and control of the Labor and delivery suite. Multiple things are going on at any given time at the desk such as patient charting, phones calls to patients and staff, reception and greeting of patients and visitors. The space should be logically design to provide work zones for the functionality of the equipment and furniture items for this space in the project room contents list.

a. RNs and technicians repeatedly travel from the RN Station to LDRPs, RN Station to Exam/Triage, and RN Station to Clean Supply.

10. Alcove, Anesthesia Cart: This space needs to be placed near RN Station for the staff to retrieve and dispatch to the required patient room when needed.

11. Alcove, Crash Cart: The crash cart should be centrally located for the staff to retrieve and respond quickly.

12. Exam/Lactation: The staff does infant follow-up care in this exam room and the lactation consultant uses the room when she does her rounds on the floor. She primarily does bed side consulting in the department and uses the rooms as a workstation when she is on the floor. However some moms that have already discharged will receive breast feeding consultation in this room.

13. Janitor Closet: The custodial staff works out of this room to clean the department and to ready patient care spaces for a new patient.

14. Medication Room: This space is stocked by the pharmacy staff as needed. The labor and delivery staff retrieves and dispense medications regularly from this room. The medication room should be collocated to the nurses Station.

15. Nourishment Room: The station is used by staff and patients so it should be convenient and readily accessible in the department.

16. Nursery (Level 1 Combo) also referred to as the Transition Observation Room: The holding nursery space is for the staff to observe and treat issues with the babies. Staff observation care may last from 1-6 hours. The care is provided at the bassinets in an open area. If the baby is determined to need higher acuity care the staff prepares the baby for transport in the nursery. Once the baby is determined to need to be transferred the transfer is typically to the Ft Walton Beach Hospital and occurs within 30 minutes.

17. Nursery Procedure Room: The staff conducts infant procedures in this room - most typically they are circumcisions.

The rooms should be connected to the Nursery.

18. Storage, Formula: The staff retrieves infant formula from this room.

19. Storage, Wheel Chair: The staff retrieves wheels chairs from this area for the daily moving of patients around and out of the department.

20. Utility Room, Clean/Linen Supply: The staff takes supplies from this room for immediate use or to restock supplies distributed in patient care rooms.

21. Utility Room, Soiled: The staff takes dirty items to this room to stage before they go to Sterile Processing and distribution. Also dirty linens are staged here for pickup by the housekeeping staff. Disposable items are thrown away in either the patient room or in this room.

22. OR-C-Section: The C-section suite should be located near the LDRPs to facilitate staff quickly transferring patients requiring unanticipated C-section deliveries.

23. Scrub, Sink Area: The staff will use the scrub sink that should be located near the entry point to each C-Section OR. This area will be accessed from the restricted corridor.

24. Storage, Equipment: The staff uses the equipment room to stage and charge equipment items.

25. Supply Room, Sterile: the staff uses this room to store instruments and sterile storage supplies. The logistics staff brings up the disposable sterile items. For items sterilized in the MTF sterile processing and distribution area once items are ready labor and delivery technician retrieves them from the SPD/CSS Sterile storage on the 2nd floor. Items are brought back to this room for storage until they are needed.

26. Civilian Supervisor Office: This staff member works a lot of administrative issues for the department. Locating the office away from the high traffic areas would work best for functionality.

27. Flight Commander and Flight Chief Office: These are the offices for the leadership in the department. The offices should be located next to each other. These members of the staff work a lot of administrative issues for the department. Locating them away from the high traffic areas would work best for functionality.

28. Conference Room and lounge: These two spaces should be consolidated to accommodate a large number of the staff at once for training. The staff uses the lounge to take a break and relax as well as for eating meals. The functions of these spaces for the staff require a discrete location away from patients care areas and patient rooms.

29. Locker (Female & Male): Combine with scrub distro for staff to easily access and change. Lockers should be located away from patients care areas and patient rooms.

30. Toilet/Shower (Female & Male): Provide a connecting toilet/shower to the locker rooms.

31. Office, Copy/Supplies: The copy supplies should be Co-locate to RN Station

32. Office, Share Admin: This office will support approximately 4 of the on-call medical staff working on a shift. It should be Co-locate to the nurses Station.

33. Office Doc/Team collaboration: The staff uses this team collaboration room to have conversations regarding patients and clinical matters without being heard by patients or visitors. They also use this room for shift transfer information exchange about patients.

34. On-call Room: The on-call provider works and rests out of this space for a 24 hour shift. This room should be in a quiet area of the department with low traffic that could cause noise and disturbance.

35. Toilet/Shower (On-Call): Provide a connecting ‘private’ toilet/shower.

36. Scrub Distro Room: The staff scrub supply is stocked by housekeeping and should be combine with Locker rooms for ease of access at point of use.

37. Toilet (L&D Staff): Staff toilets shall be located close to the nurses’ station but placed discretely for privacy.

6.4.5 WORK (SUPPLIES/MATERIAL)

1. Corridor/Elevator Lobby: The service elevator is directly behind the public elevator #4. Staff uses the service elevators to transport equipment, supplies and material to different floors of the hospital.

2. Equipment Room: Numerous items of equipment are used during the birth of an infant. Traditionally, in the LDRP

(labor, delivery, recovery, postpartum) concept, the equipment needed at the time of birth can be shared between two rooms and kept in a common equipment room/alcove. Equipment storage is provided in a dedicated area for each room. Additionally, there is a requirement for common storage space for equipment on the unit. The staff moves the items to and from the patient rooms as needed.

3. Janitor Closet: The janitor’s closet stores the cleaning supplies and material used for aseptic cleaning of labor and delivery. The housekeeping staff keeps the room stocked as supplies are depleted.

4. Medication Room: The medications are stocked by the pharmacy as needed. Discharge medications are retrieved by the nursing staff from the inpatient pharmacy that is on the 4th floor.

5. Nourishment Room: This room should provide convenient access to water, ice and snacks stored on the floor for patients. Nourishment stations should be accessible to staff and patients.

6. Storage, Formula: This room is used to store nourishment for the newborns. This room is stocked by logistics.

7. Utility Room, Clean/Linen Supply: The Logistics staff delivers supplies to the clean supply room. Ideally this should be one consolidated area. Supplies come up once daily to the floor. Supplies are then distributed by the L&D staff to the Triage room, L&D rooms, C-Section, etc. Technicians stock the department rooms as needed. Housekeeping delivers and removes linens daily. Linens from the clean room go to the LDRPs, Triage rooms, etc.

8. Utility Room, Soiled: Dirty items are stored until they are removed. Housekeeping removes trash and dirty linens and the Labor and delivery staff transports any items that need to be sterilized to the SPD/CSS department on the 2nd floor.

9. Supply Room, Sterile: The staff uses this room to store instruments and sterile storage for supplies. SPD/CSS will complete all sterilization of supplies and instruments. Sterile supplies will be picked up by labor and delivery staff from the SPD/CSS on the 2nd floor for storage. All disposable items that do not require processing and sterilizing are distributed to this area by Logistics staff.

PROGRAM FOR DESIGN

PROJECT X

REPAIR HOSPITAL

LOCATION X

Projected Year: 2016 Midpoint Year: 2018

1391 Processor ID: 11111 DMIS ID: 0000 State:

Facility: FLAG FOR DEERS PROGRAM OFFICE Installation:

Project Created: 28 Jul 2015 01:44PM ET by Justin Szajnecki Space Plan Last Edited: 10 Dec 2015 02:38PM ET by Chad Shaffer

Contents List Created: 12 Aug 2015 10:53AM ET by Chad Shaffer Contents List Last Edited: 10 Dec 2015 02:28PM ET by Chad Shaffer

Report Generated: 10 Dec 2015 02:39PM m4pmsekl Typewritten Text (Phase 1 Scenario)

Department: 1 - 2ND FLOOR- SURGICAL / INTERVENTIONAL SERVICES & AMBULATORY SURGERY CENTER (ASC)

GOVT take offs are approximately 13,404 GSF for SX area--for Heavy LOR.

Approximately 510 GSF for Common corridor in elevator lobby--for Light LOR.

Functional Area: 1 - COMMON CORRIDOR/ELEVATOR LOBBY

Qty Room Code Room Name Unit Area

Net Area

Const Phase

Const Type Staff Net

Staff

1 LOB03 Corridor/Elevator Lobby 510 510 1 0 0 0

FA Totals: Room Qty: 1 Net Area: 510 Gross Area: 734 Staff: 0

Department: 1 - 2ND FLOOR- SURGICAL / INTERVENTIONAL SERVICES & AMBULATORY SURGERY CENTER (ASC)

Functional Area: 2 - SURGICAL SERVICES PROCEDURES

Qty Room Code Room Name Unit Area

Net Area

Const Phase

Const Type Staff Net

Staff

1 RCA02 Alcove, Mobile Lead Apron Rack 50 50 1 0 0 0

1 RCA04 Blanket-Fluid Warmer Alcove 30 30 1 0 0 0

1 RCA04 Blanket-Fluid Warmer/Flash Sterilizer Alcove 40 40 1 0 0 0

1 CWSH1 Cart Wash, Manaul & Automatic (CSS) 120 120 1 0 0 0

1 CSIA3 Central Sterile, Assembly, Large (CSS) 1,200 1,200 1 0 0 0

1 CSCR1 Central Sterile, Soiled Cart, Receiving (CSS) 150 150 1 0 0 0

Room also serves as collection point for…