Addition Planning Rapped
Daily Observer
One
would think that for this sum each bed would be in a private, spacious,
luxuriously appointed room with a private cabana overlooking a swimming
pool. But the blueprints show that all
the community will get will be more of the same: inefficient semi-private arrangements at
about $100,000 per room.
The
Hospital presently is less efficient than it should be because of the architectural
hodgepodge designed around the semi-private room. The better minds of the 18th
century designed more efficient hospital floor plans.
The
semi-private concept is the bane of modern hospital construction. First, of course, it should be pointed out
that semi-private and semi-pregnancy are generic twins: neither condition exists in reality. The semi-private room is actually a
semi-public room. Any semblance of
privacy is immediately diluted by a roommate and his or her visitors.
Aside
from the lack of privacy, the semi-private room interferes with medical care in
the following ways:
It
hides the patients from the nurses.
It
requires more energy to heat and service, than, say a multibed unit (formerly
known as a ward) would.
It
requires more aides, practical nurses, and registered nurses than would a ward
or multibed unit.
It
requires more square footage, thus acreage to construct, than would a ward or
multibed unit.
Despite
this, the entire nation of the
I
asked this question of officials at both the state and federal levels. The answers are intriguing. The entire nation builds semi-private
accommodations because that is what Blue Cross and Medicare promised that they
would buy their respective subscribers.
The promise arises from the misbegotten notion that the community at
large would not stand for multibed rooms, and from the exorbitant expense of
providing the subscribers with private rooms.
One
might reasonably ask why the hospital doesn’t break with tradition and build
according to the plan most suitable to its medical needs. The answer is startling. In order for a hospital to expand it must get
permission from the state in the form of a certificate of need. Any departure from usual architectural plan
might raise questions, invite inspection, flood the premises with auditors, and
in general complicate matters so that finally, permission may be either delayed
or denied. No community in need of
hospital beds wants to invite these risks, so it plays it safe, compounds old
errors, and submits the safe semi-private hospital plan.
The
argument that the members of the community won’t stand for ‘wards’ or ‘multibed
units’ is guileful, but when in reality, has the community had possession of
the facts, when indeed, has the community been asked?
The
fact of the matter is that to provide the utmost in efficient medical care
hospitals have created multibed units called coronary care units, or intensive
care units. The community to date has
understood the purpose of these facilities and accepted them. In these units man and women are placed
side-by-side, there are no toilet facilities, little privacy, and patients must
relieve themselves in either bedpans or commodes. Despite these drawbacks, the nursing care is
superlative, medical care therefore is efficient. Certainly without detracting from the
advantages of the multibed unit, more elegant quarters for this type of care
could be designed. Presently they are
crude because they were established as an afterthought, after the semi-private
rooms were built.
The
community must ask whether or not it wouldn’t be better to build some multibed
units for intermediate care, for geriatric fare, for pediatric care, and
reserve the semi-private units for the convalescent patient ready to go home. The community must ask whether it wants to
build hotel accommodations or hospital accommodations. The community must ask whether it wants to
spend $9 million to increase the privacy and comfort of the patients at the
expense of good patient care, or whether it wouldn’t be wiser to build
according to medical priorities.
Although
I opt for multibed accommodations in the belief that they would increase the
quality of medical and nursing care and decrease costs, Mr. John W. Reese chief
of the Architectural Branch of the Federal Office of Architecture and
Engineering informs me that their figures suggest that the least expensive and
most efficient plan is a hospital composed entirely (with the exception of
emergency care units) of private, one bed rooms. That is because if a room is not in use it
does not have to be cleaned, whereas a two bed room requires daily care even if
occupied by only one person; because of the exorbitant but hidden expense
involved in moving patients from one semi-private room to another in order to
match males and females. This comes to,
believe it or not, $50 per move. On a
plan of all private rooms each room would have its own nursing station and a
cluster of four rooms could be serviced by one nurse.
Perhaps
Mr. Reese is correct. Personally I
believe that private rooms would simply increase the hospital sprawl and be
wasteful of space, heat and services.
But in no instance have I been able to find information to support the
semi-private room as the best architectural (movability) for hospital
care. Certainly the semi-private is a
compromise, but for $9 million the community should have more than a
compromise. It should have the best
plan.
Perhaps
the community would be wiser to allocate only $8 million for the hospital and
save half of the last million dollars to investigate the problem thoroughly,
and the other half to fight in the courts these agencies that might want to
obstruct progress by denying the necessary permits required by the state and
local community for construction.
Certainly the certificate of need seems of questionable
constitutionality. Certainly the power
of the insurers and the government through Medicare to withhold payments to
hospitals not constructed according to federal and state regulations (except of
course safety) is of questionable constitutionality.
But
whatever the outcome, the community should develop a broad interest in the
problem.