Description
The floor plan of a two-bed room
The design of patient rooms is a particularly demanding task that generations of architects, hospital planners and interior designers have grappled with. The challenge is to accommodate a wide range of specific needs and users’ interests in a room of limited size. Despite its small floor area, the patient room is the most frequently reproduced unit in a hospital and can quickly become the primary determinant for a hospital design. The repetition of the rooms in a ward is not only legible from outside on the building’s façade; it can also define the typology, for example in the case of a “bed tower block” through vertical repetition where the upper floors are typically exclusively patient wards. The patient room is therefore a central element of the planning of a hospital. This section discusses the planning principles for designing a two-bed room and examine its constituent structural elements.
First and foremost, the design of a patient room is always a specific, individual response to the existing needs and prevailing contextual conditions. Whether the design is for a new building, for an extension to an existing building or for the renovation and upgrading of existing facilities, the context and the available budget are key determining factors for the room design.
Likewise, regulations and guidelines have a direct impact on room planning and floor plan design and can sometimes be very constraining by defining minimum distances and optimised care provision procedures that must be ensured without exceeding a certain room size or financial parameters.
While this may create the impression that there is little remaining scope for design, a wide range of different patient room designs have been created over the past few decades. Architects and hospital planners have succeeded in developing and implementing various original concepts, especially for two-bed rooms, often in the context of clinical studies. A study of these room types reveals the entire spectrum of design possibilities.
Two-bed rooms are a particularly interesting typology to study. This chapter examines the different options in the design of a patient room and the design principles that guide them. It details the design possibilities available to the planner when designing a patient room and presents them in a scheme with the aid of a corresponding example.
This study takes the floor plan as its basis and therefore describes only those aspects that actually manifest themselves in or influence the floor plan, and that can be seen as design principles. Likewise, it also considers the essential fittings and equipment that influence the room layout.
A key aspect that has a decisive impact on the floor plan design of two-bed patient rooms is the wet cell – the patient’s bathroom within the room. It determines the remaining layout of the patient room and often also the placement of other key fittings within the room. To understand how the different elements in the room interact, it is instructive to look at each part of a room configuration and identify how these can be grouped according to recognisable interdependencies or principles.
The patient room
The patient room is divided into an area for the patient and the corresponding patient bathroom.
Floor area requirements
Minimum standard
While the hospital building regulations of many German federal states prescribe only 8 m² per bed place, the State Office for Health and Social Affairs in Mecklenburg Vorpommern states that a two-bed room should have an area of at least 21 m². In either case, the minimum distances must be observed (Fig. 1)
In the context of the floor plan, accessibility considerations primarily concern spaces of free movement. At least one area of 120 × 120 cm must be available for turning and swivelling, and walking and mobility aids must be available in the room and additionally along one long side of the bed (DIN 18040-2). As not all accessibility requirements can be evaluated based on the floor plan, we use the term “low barrier” to denote the minimising of barriers (Fig. 2).
Floor plan types on a ward
Standard floor plan
The standard room layout is the most frequently found room type on a ward (Fig. 3).
Floor plan combination/variation
Different floor plan types can be combined, e.g. single and two-bed rooms. In such cases a two-bed room may be a combination of two types or a modified variant of a floor plan layout → (Figs. 4, 5).
Specific floor plan
Particular situations may require a specific, atypical floor plan arrangement, such as in the case of corner rooms or rooms that connect to other functional spaces. Where these are a response to structural constraints in the building plan, they typically recur at the same position on each floor (Fig. 6).
Additive principles for patient rooms
The most common additive principle is a repeating row of patient rooms along a ward corridor. Different repetition patterns are possible:
Same-handed
The same-handed configuration is the simplest form of the additive repetition of rooms along a hospital corridor. Each room is identical in its orientation and fittings. The name derives from the underlying principle that carers can always tend to patients from the same preferred side → (Fig. 7).
Mirrored floor plan
Each patient room and the orientation of fittings and equipment is mirrored along the dividing wall. This configuration is popular because it allows a common vertical duct to serve two adjacent wet rooms, effectively halving the amount of plumbing and supply lines, saving materials and costs. The repetition principle is like that of the same-handed configuration, except that each repeated unit comprises two rooms with mirrored layouts (Fig. 8).
Floor plan combination or variation
With this configuration, a room layout may be combined with another typological variation of the same floor plan, or alternatively a completely different floor plan type. This pairing is then repeated as often as needed (Figs. 9, 10).
Unsystematic arrangement
In some cases, the additive principle follows no clear pattern. The position of necessary functional rooms, or the unique structural configuration of a building may hinder the application of a clear repeating arrangement. In such cases, varying room layouts are typically used (Fig. 11).
Room depth
The room depths given here are defined in terms of the bed placement principle rather than a precise dimension. There are two main arrangements for two-bed rooms:
One bed deep
The room depth is defined by the placement of one bed arranged parallel, orthogonal or rotated at an angle to the ward corridor (Figs. 12, 13).
Two beds deep
The depth of the room must accommodate two beds placed along the crosswall, positioned parallel, orthogonal or rotated at an angle to the ward corridor (Figs. 14, 15).
Room geometry
Any number of room geometries are conceivable for patient rooms, but not all are practical or realisable. The key determining factors are their potential for useful repetition and their contribution to forming a ward. Rectangular floor plans are therefore predestined, but various hospitals show that other, more complex floor plan configurations are also possible. This results in two typical types of room geometry:
Compact spatial geometry (rectangular)
A rectangular floor plan is compact and simplifies the arrangement of fittings and equipment in the room (Fig. 16).
Complex spatial geometry (polygonal)
A polygonal or non-rectangular floor plan figure can be applied for specific situations, for example to ensure optimum visibility of the bed area from the ward corridor. As most standardised fittings and objects, such as patient cabinets and tables, are rectangular, their placement is more complex. In some cases, custom-made fittings may be necessary (Fig. 17).
Zoning
The zoning of a room designates the respective areas of the patient room in which the different users of the room remain, move around in or which they use actively. A room’s users include the hospital staff, the patient and their visitors.
For two-bed patient rooms, there are three necessary zones:
Movement zone and transport,
Patient and patient care zone, and
General activities and visitors’ zone.
While these zones may overlap, they should not fall completely within the scope of another zone. Given the small area of a two-bed room, the placement of furniture and standard room fittings often determines the zoning. Three typical zoning options are outlined below. The diagrams provide an abstract indication of the zoning principles without showing the movement spaces of each user group.
Three-zone room
The three-zone floor plan is the classic arrangement of a two-bed room. It comprises a movement area for the staff, a patient and patient care zone and a general activity zone for patients and visitors (Fig. 18).
Three-zone plus room
Where there are more than three zones, one speaks of a three-zone plus room layout. Additional zones can include, for example, a balcony for the patients. A special variant of the three-zone plus room layout occurs when one of the three zones, for example the patient zone, is subdivided into two (Fig. 19, 20).
Two-zone room
Given the limited space for movement in two-bed rooms, there is inevitably some overlap of the different users’ zones. But when the visitor zone, for example, falls entirely within the staff movement areas (see the example), a three-zone arrangement no longer applies (Fig. 21).
Room entry
Room entry denotes the means of entrance from the ward corridor, typically through one or two doors. Most two-bed rooms have a single entrance (Fig. 22); however, some room layouts may have a separate entrance for each patient. This also provides a better view of the patient from the corridor (Fig. 23).
Ward corridor
The floor plan of the patient room can influence the form of the ward corridor and thus also defines the nature of the threshold between the hospital and patient room, and between everyday hospital operations and the patient. While the precise articulation can vary, there are two main variants:
Patient rooms end flush with the ward corridor
The serial repetition of patient rooms produces a flush wall along the ward corridor (Fig. 24).
Ward corridors have an alcove area in front of the patient rooms
By setting back part of the patient room, or the wet cell, in the floor plan, an alcove in front of the room can be created that acts as a buffer space to the ward corridor (Fig. 25).
Flexibility
Patient room floor plans are often so spatially optimised that the room zones and elements can seem rigidly defined. However, a degree of flexibility is often beneficial for use and positive for the room’s atmosphere. The following measures can contribute to a room’s flexibility:
The bedside trolley positionable on both sides
The bedside trolley can be positioned on either side of the bed without obstructing access to nearby cupboards (Fig. 26).
Retrofittable airlock
Even in standard care wards, there may be a need to isolate patients with contagious pathogens. In most cases, however, improvised ISO rooms do not meet the requirements to function effectively as a means of infection prevention: many entrance areas that are retrofitted to act as an airlock zone or anteroom are too small to be divided into separate clean and unclean zones. In addition, the airlock may block access to the patient bathroom from within the room. Even though airlocks are not a requirement of standard care wards, provisions for temporarily retrofitting a patient room with an airlock can still be made in the room design (Figs. 27, 28).
Fittings
While it is not possible to exhaustively list all the fittings in a patient room, certain aspects and elements are common to nearly all patient rooms. All of them can exist alongside one another in a room.
Standard fittings
In addition to the patient beds, the standard fittings include a bedside table or trolley, lockers or cupboards for patients’ belongings and a table and at least two chairs for receiving visitors (Fig. 29).
Staff workplace in patient room
A washbasin or other worktop for all activities relating to care, preparation and documentation of the patient may be provided for use by nursing staff. This can also include a cupboard or storage area specifically for storing medical supplies and aids. A glove box and disinfectant dispenser, as well as additional storage space is often also part of the staff work area (Fig. 30).
Washbasin
In addition to hand disinfection, clinical practice may require staff to wash their hands to remove coarse dirt. In the past, fitted washbasins in patient rooms unfortunately contributed to the spread of pathogens and nosocomial outbreaks. We list them nevertheless as they are still planned for patient rooms in new buildings (Fig. 31).
Privacy screen between patients
A movable privacy screen in the form of a curtain or partition can screen patients from their neighbours, for example when examinations need to be undertaken in the room (Fig. 31).
Patient desk
A separate desk for patients – ideally one per patient – can add another personal space for the patient(s) in the room, sometimes obviating the need for a desk for receiving visitors (Fig. 32).
Guest accommodation
This typically takes the form of furniture designed to allow next of kin to stay the night in the patient’s room. Fold-out furniture, for example, can serve as seating during the day and as a bed for relatives at night. This is most commonly found in children’s wards (Fig. 33).
Openings in the façade
The façade is the interface between the patient and the outside world. It allows light into the room, creates a visual connection to the world outdoors and can serve as a spatial extension of the patient room.
Room with window and standard sill
A conventional window with one opening casement (Fig. 34).
Room and bathroom with window and standard sill
An outboard bathroom (placed on the exterior wall) may have its own additional window (Fig. 35).
Room with window and seat-level sill
A window with a lower sill height can be used as seating through the insertion of a bench into the window reveal. In most cases the window sections are fixed, or only certain sections can be opened (Fig. 36).
Internal façade extension
Indentations or projections in the façade can be used to create bay windows or conservatories that provide an internal transitional space between the rooms and the world outdoors (Fig. 37).
External façade extension
External extensions to the façade are outdoor fresh-air areas such as balconies, terraces and loggias (Fig. 38).
Bed positions
Bed positions describe the spatial relationship between the beds.
Side by side
The beds are positioned next to each other in a parallel arrangement, creating a two bed deep room (Fig. 39).
Opposite one another
The beds are placed facing each other directly opposite one another in a one bed deep room (Fig. 40).
Staggered opposite one another
The bed places are placed facing each other but offset in a staggered arrangement (Fig. 41).
Right-angle arrangements
The beds are arranged at right angles to each other, irrespective of the depth of the room (Fig. 42).
Turned towards each other
The beds can also be turned to face each other at an angle, again irrespective of the depth of the room (Fig. 43).
Facing apart
The head ends of the beds can be turned to face away from each other, so that neither sees the other. This can be further reinforced by a headwall separating the two (Fig. 44).
Views in and out of the room
Two visual connections play a key role in the spatial configuration of patient rooms:
The patients’ view outdoors
This denotes the view the patient has of the window and in turn of the world outdoors. The room design should ensure that both patients have an equally good view (Figs. 45–47).
The staff’s view of the patient
Ideally, the placement of the beds should ensure that patients are immediately visible from the doorway when the door is opened. In some cases, however, only one patient can be seen clearly while a view of the second is restricted. In some countries it is common to see glazed sections in the room doors of standard care wards so that staff in the corridor have a clear view of the patients in bed (Figs. 48–50).
Patient bathroom
Floor area of wet cells
The floor area of wet cells is determined largely by requirements for freedom of movement and minimum distances within the patient bathroom. In this study, we classify them into two groups:
Minimum standard
The bathroom complies with the prescribed minimum distances between the individual bathroom components and the passage width of the door, but this does not guarantee barrier-free access (Fig. 51).
Barrier-free/low barrier standard
In terms of the floor plan, the focal consideration is the provision of sufficient freedom of movement. An area of at least 120 × 120 cm must be provided in front of sanitaryware such as the toilet bowl, washbasin, bathtub and shower area (DIN 18040-2). As not all accessibility requirements can be evaluated using the floor plan, we use the term “low barrier” to denote the minimising of barriers (Fig. 52).
Position of wet cells
In this study, we only evaluate two-bed rooms that comprise a wet room. Within these units, the position of the wet room is of central importance as it determines the remaining disposition of the floor plan. Four basic arrangements are commonly used:
Inboard
An inboard wet room is placed next to the room entrance adjoining the corridor and is the standard and therefore most common arrangement seen in hospitals (Fig. 53).
Outboard
An outboard wet room is located along the exterior wall. This much less common arrangement reduces the size of the window opening of the two-bed room, and thus limits the degree of light entering the room but has the advantage of being able to naturally ventilate and illuminate the bathroom (Fig. 54).
Alternating inboard/outboard
Inboard and outboard wet cells can be employed alternately in a row of rooms with the room constellation switching. Alternatively, one room can have two bathrooms (Fig. 55).
Nested
In the nested arrangement, two bathrooms are placed between two patient rooms. This has the advantage of allowing the patient rooms to be open and rectangular. A minimum planning unit therefore comprises two patient rooms and two intermediate wet cells (Fig. 56).
Additive principles for wet cells
Additive principles apply equally to the serial repetition of wet cells as they do to the patient rooms. Although the bathroom arrangement is linked to that of the patient rooms, it is not identical and therefore warrants its own consideration. The following patterns of repetition apply to patient bathrooms and echo those of the patient rooms described earlier.
Same-handed
The size, orientation and fittings of the wet rooms are identical throughout the ward. Because of the identical layout, carers can always approach patients from the same side (Fig. 57).
Mirrored floor plan
The wet cell and the orientation of fittings and equipment within it are mirrored along the dividing wall. As previously mentioned, this configuration is encountered frequently because it allows a common vertical duct to serve two adjacent wet cells, effectively halving the amount of plumbing and supply lines, saving materials and costs. The repetition principle is like that of the same-handed configuration, except that each repeated unit comprises two cells with mirrored layouts (Fig. 58).
Floor plan combination or variation
With this configuration, two different wet room configurations are used in combination within a row. Alternatively, variations of a single type of bathroom are also possible, for example when additional requirements need to be met or the size or equipment is adapted to meet a specific need (e.g. rooms for obese patients) or where modifications are necessary for design reasons (Figs. 59, 60).
Use of wet cells
Bathrooms may be used by patients in different ways.
One bathroom for shared use
A two-bed room usually has a single shared bathroom, which is about 3–4 m² in size (Fig. 61).
Two bathrooms for shared use
Two bathrooms in a patient room can be equipped differently to serve two different purposes. They are used by both patients (Fig. 62).
Two identical bathrooms for separate use
In this configuration, two identical bathrooms are created, one for each patient (Fig. 63).
Fittings in wet cells
Fittings are all essential components and equipment in a patient bathroom that influence the layout.
Standard fittings with shower
Wet cells with a washbasin, toilet and shower are now standard fittings in general care wards in German hospitals, but that is a relatively recent development. Patient toilets are still often located in the corridor and collective shower rooms or a ward bathroom are still permissible → (Fig. 64).
Second washbasin
In addition to the standard fittings, an additional washbasin is provided so that each patient has his or her own place to wash (Fig. 65).
Second WC
In such configurations, each patient has his or her own WC, regardless of the number of bathrooms.
Sliding door
A sliding door can be employed in floor plan arrangements where conventional hinged doors would lead to overlaps in the use of space (Fig. 66).
Originally published in: Wolfgang Sunder, Julia Moellmann, Oliver Zeise, Lukas Adrian Jurk, The Patient Room, Birkhäuser, 2020.