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Function program Landspitali-University Hospital Surgery General

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					Function program Landspitali-University Hospital

Surgery

General surgery - User Group 16A

Final edition, January 2007




Function programme Landspítali Háskólasjúkrahús
            General surgery                        Date:   2.1.2007
Dokument :                                         Page:     1 of 11
1 Contents

1 Contents ........................................................................................................................................................... 2
2 General surgery: Functions, capacities, and areas ..................................................................................... 3
    2.1 Short description of each function....................................................................................................... 3
    2.2 Activity ................................................................................................................................................. 5
    2.3 Capacity............................................................................................................................................... 5
    2.4 Areas and room program .................................................................................................................... 6
    2.5 Proximity and special requirements .................................................................................................... 6
3 Discrepancies to the Competition Program ................................................................................................. 7
4 Comments from user group ........................................................................................................................... 7
5 Room program ............................................................................................................................................... 10




Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                                                                 Date:            2.1.2007
Dokument :                                                                                                                                  Page:              2 of 11
2 General surgery: Functions, capacities, and areas
2.1       Short description of each function
2.1.1 General surgical functions in the new hospital
General surgery includes upper and lower gastro-intestinal surgery, endocrine and breast surgery, and trauma.
The functions of the department as well as the staff are fragmented into these specialties.
For general surgery the following functions are planned in the new hospital:
      •   Bed ward (including all specialities of the department, beds for children are located at the children’s
          centre)
      •   Outpatient unit, including upper- and lower gastro surgery close to gastro medicine outpatient unit and
          with good connection to the endoscopy unit.
      •   Mamma centre, which today is not part of the hospital and is suggested as a new unit as well from this
          user group as from the radiology user group. Mamma screening is performed by an institution related
          to the Cancer Society, including mammography. The steering committee has approved to establish the
          mamma centre as part of the new hospital.
      •   Office unit
Operations on inpatients, including trauma surgery, will be performed in the central OR. Day surgery will be
performed at the day surgery unit.
The endoscopy unit is common for gastro surgery and gastro medicine. The function program has been made
in the user group for gastro medicine.


2.1.2 Bed ward
The general surgical beds will be located in a unit designed after common principles for bed wards, as planned
in user group 10. The standard bed ward will consist of 1-bed rooms, totally 24 beds in each ward. The
number of beds occupied by a given specialty depends on the actual number of beds needed, see under
capacity below.


As part of the standard bed ward a multifunctional room/area is planned (60 m2), where specific needs of the
clinical department can be covered (e.g. rehabilitation / training / examination).

For general surgery no special rooms are needed.


General surgical patients in need of intensive care, e.g. traumatic patients or post operative treatment, are
situated in the central intensive care unit. It is possible to use the common beds in the ward as ‘step down’
beds (with increased nurse staffing).


Acute examination for gastro surgical patients can be performed in the examination room for gastro medicine
in connection with the day beds unit. It is assumed that gastro surgical and gastro medicine wards are located
close together.


The user group has mentioned obesity surgery as a growing activity. Some of the bedrooms can be equipped
with special beds and doors, patient lift equipment a.o.


A new calculation has been done regarding the size of the hospital. This calculation or forecast has taken into
account changes in treatment such as increased emphasis on day- and outpatient treatment and a patient hotel

Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                     Date:       2.1.2007
Dokument :                                                                                      Page:         3 of 11
of 80 beds on the hospital side. This has resulted in fewer hospital beds than in the competition. The new
number of beds for somatic wards is 417 beds.

Therefore the number of standard beds has been moved from the room program
for the function and placed in a bed pool for the hospital
The final number of beds for the department will be decided later in the
process.


2.1.3 Outpatient unit
There will be standard examination rooms as well as specially equipped examination rooms. There will also be
a nurse consultation room (stoma nurse).


There will be a common reception and waiting area for the patients.


Day surgery will take place in the common day surgery unit of the new hospital. Minor surgery on outpatients
is performed in the outpatient unit.


The outpatient unit should be located close to the outpatient unit for gastro medicine and the endoscopic unit,
which is common for gastro surgery and gastro medicine.


2.1.4 Mamma centre
The plan, the ministry is working on – establishing a mamma centre at the hospital – includes the work done at
the Cancer Society today. They organise the screening and have approximately 12.000 visits for screening
procedures and 2.000 formal visits for women with breast diseases.

Mamma surgery is today as well as in the future performed by the general surgery department. The
department’s outpatient activity with breast patients (approximately 450 outpatient visits in 2005) is assumed
to be part of the mamma centre.

The future mamma centre at LSH includes examination rooms for mammography and medical examination, as
well as biopsy. Secondary rooms for patients and staff etc. are needed.

2.1.5 Office unit
In this unit there will be office desks for all the physicians, the leading nurse, the secretaries, and other staff
with the need for an office desk.


The offices will be organized as a combination of cell offices and open space solution (as discussed in user
group 42: offices). In addition to the office desks in the open solution there will be ‘quiet rooms’, smaller
meeting rooms, and a lounge.


The conference rooms for general surgery will be located in the office unit. Due to the size of the department
there will be two rooms.

The office unit can be located near the outpatient unit or near the bed ward.




Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                       Date:        2.1.2007
Dokument :                                                                                        Page:          4 of 11
2.2      Activity

Inpatients
                                                              2003                2005                Estimate
                                                                                                       2025
Number of inpatients                                            2.451               2.790             (1)    2.330
Number of beddays                                              14.125              13.581                   15.773
Average length of stay                                             5,8                 4,9                      6,7
Bed-utilization in %                                                                                             85
Number of beds                                                                                                   51
   (1) According to the user group the number of inpatients in 2025 will more likely be close to 3.000-3.500. The
         reason being mainly ‘age-change’ and increasing number of cancers, in particular colon cancers and breast
         cancers.

The estimated number of beds for 2025 is the basis for the general surgery bed ward, i.e. 51 beds. Beds for
children are not included.


A general comment: The number of beds is taken from the Competition Specification. There will be conducted
a new analysis on the future number of beds. The evaluation might result in a new number of beds.

Outpatients and day-patients
                                                              2003                2005               Estimate
                                                                                                        2025
Number of outpatient visits                                 (1)    1.522                 2.417      (1)      2.085
Number of daypatient visits                                 (2)      143                            (2)      1.760
(1) Including breast cancer patients. There were 450 outpatient visits for breastcancer patients in 2005, i.e.
approximately 1.600 outpatient visits, breast cancer patients excluded.
(2) Including breast cancer patients.

The estimate 2025 for outpatients is the basis for the capacity in the outpatient unit. The user group finds the
number to be an underestimation. They estimate 3.500 – 4.000 visits in 2025 for gastrointestinal surgery
patients only, breast patients not included.


The estimated number of day patients is part of the basis for the common day surgery unit.

2.3      Capacity
Standard examination rooms in the outpatient unit
 Outpatient         Visits pr day     Minutes pr          Total          Calculated       Suggested no
 visits 2025             1)             visit          examination      no. of rooms        of rooms
                                                       hours pr day          2)
      1.600 (3)                 8                 20           2,5-3               0,5                 1
      4.000 (4)                18                 20               6               1,0                 2
1) Visits pr day is calculated for working 230 days pr year.
2) Number of rooms is calculated for 6 working hours a day
3) As estimated in the competition programme.450-500 breast cancer patients subtracted.
4) As suggested by the user group


Specially equipped rooms in the outpatient unit
The specially equipped rooms are located in the endoscopy unit.

Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                            Date:      2.1.2007
Dokument :                                                                                             Page:        5 of 11
Staff
                                                                 2005      Comments
Number of physicians, specialised (fully educated)                      16 8,11 FTE, 16 heads
Number of physicians, in education-jobs
Number of secretaries                                                    - Part of medical secretaries in surgical
                                                                           division, total 21 FTE, 42 heads
Number of nurses a.o. in leading positions                               1
Number of nurses a.o. in not-leading jobs
Number of other staff with a need of a personal office
desk (specify under comments)
Number of other staff
Total staff number

The staff number for 2005 is the basis for estimation of future rooms.


The number of full time positions is generally lower than the number of persons. If the full time positions will
increase in the future, we assume that the number of persons will be constant, i.e. each person will, as an
average, have a higher number of working hours on the hospital.

2.4      Areas and room program
See attached list of rooms for detailed room program. The total area for each unit is shown in the table.


Calculated area
Unit                                       Net m2
Bed ward                                            *
Outpatient unit                                   130
Mamma centre                                      351
Office unit                                       270
Total                                             751
* beds have been removed till the final number is decided.



2.5      Proximity and special requirements
The gastro surgical outpatient unit should be located close to the gastro medicine outpatient unit.


The bed ward for general surgery (including gastro surgery) should be located close to the gastro medicine bed
ward.


The endoscopy unit should be placed in the area between inpatient house and outpatient house. Both elective
and acute endoscopy procedures on inpatients will take place here. At the same time approximately 60% of the
patients visiting the unit are outpatients.


The mamma centre could be placed away from the acute hospital departments, maybe in some of the existing
buildings. A majority of the visitors are healthy women.




Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                    Date:        2.1.2007
Dokument :                                                                                     Page:          6 of 11
3 Discrepancies to the Competition Program
The mamma centre was not part of the competition program.


4 Comments from user group
According to the user group the number of inpatients in 2025 is underestimated and it will more likely be close
to 3.000-3.500. The reason for this being mainly ‘age-change’ and increasing number of cancers, in particular
colon cancers and breast cancers.

The user group also finds the number of outpatient visits to be an underestimation. They estimate 3.500 –
4.000 visits in 2025 for gastrointestinal surgery patients only, breast patients not included.


The user group has made a comment to the capacity of operating theatres in user group 21. The user group
general surgery finds that a total capacity of 22 operating theatres leaves very little room for future increase
above the number of operations expected in the competition program.




Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                     Date:       2.1.2007
Dokument :                                                                                      Page:         7 of 11
5 Room program
Specialty          Type of room                   No of roomsArea of roomArea LSH Area Uni   Comments
Ward General                                                                                 Room list in the Function Programme from group standard ward. Standard area for
Surgery            Standard ward 51 beds                                        0            1 bed is 35 m2 including secondary rooms.
                   Total bed ward                                               0


                                                                                             The unit should be integrated with the outpatient unit for gastro medicine. Common
Outpatient unit    Examination rooms                                                         reception and waiting area as well as secondary rooms are included in this unit.
                   Standard examination rooms              2         18        36
                   Examination room students               1         18
                   Minor surgery/procedures                1         24        24
                   Nurse consultation room                 1         18        18            Stoma
                   Secondary rooms patient area
                   Reception                               1         15        15
                   Office Head nurse                       1          8         8
                   Waiting area                            1         15        15            10 seats: 1,5 m2 pr seat
                   Toilet patient hc                       1          5         5
                   Toilet patient                          1          2         2
                   Secondary rooms staff
                   Work station                            1         10        10
                   Staff room                              1         15        15
                   Toilet staff hc                         1          5         5
                   Secondary rooms supply
                   Disinfection                            1          8         8
                   Equipment storage                       1         15        15
                   Soiled storage                          1         11        11
                   Niche medicins                          1          2         2
                   Niche cupboards                         1          2         2
                   Niche trolley linen/clothes             1          2         2
                   Cleaning room                           1          2         2
                   Total Outpatient Unit                                      195




Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                   Date:        2.1.2007
Dokument :                                                                                    Page:        10 of 11
Specialty          Type of room                      No of roomsArea of roomArea LSH Area Uni         Comments
Office unit        Office desks for physicians                16          10      160                 Combination cell offices and open solution. Incl. toilets and print/copy rooms
                   Office desks for leading nurse
                   and nurse-coordinater                      2          10          20               do. Incl. toilets and print/copy rooms
                   Office desks for secretaries               4          10          40               do. Incl. toilets and print/copy rooms
                   Office desks for other staff               0          10           0
                   Meeting room                               2          25          50               app. 25 persons in each room. Rooms located en suite, with flexibel wall.
                   Total Office Unit                                                270

Mammacenter        Examination rooms
                   Screening units                            3          24          72               With mammography and clinical examination
                   Ultrasound examination                     1          24          24
                   Standard examination room                  1          18          18
                   Nurse consultation room                    1          18          18               Mamma nurse
                   Secondary rooms patient area
                   Reception                                  1          15          15
                   Office Head nurse                          1           8           8
                   Waiting area                               1          30          30               20 seats: 1,5 m2 pr seat
                   Toilet patient hc                          1           5           5
                   Toilet patient                             1           2           2
                   Secondary rooms staff
                   Work station                               1          10          10
                   Staff room                                 1          20          20
                   Toilet staff hc                            1           5           5
                   Secondary rooms supply
                   Disinfection                               1           8           8
                   Equipment storage                          1          15          15
                   Soiled storage                             1          11          11
                   Niche medicins                             1           2           2
                   Niche cupboards                            1           2           2
                   Niche trolley linen/clothes                1           2           2
                   Cleaning room                              1           2           2
                   Office unit Mammacenter
                   Office desks for physicians and
                   secretaries                                8          10          80               Combination cell offices and open solution. Incl. toilets and print/copy rooms
                   Meeting room                               1          25          25
                   Total Mammacenter                                                374

                   Total                                                            839           0

A general comment: The number of beds is taken from the Competition Specification. It may be subject to change in the future.




Function programme Landspítali Háskólasjúkrahús
            General surgery                                                                            Date:         2.1.2007
Dokument :                                                                                             Page:         11 of 11

				
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