Avoid hospital traffic jams

By E. John Knapp, AIA

Do veterinarians and staff members constantly trip over each other's feet at your practice? Or maybe you round corners with caution to avoid taking out unsuspecting clients. Even remodeling or expanding your facility may not fix the problem if you don't develop an efficient floor plan.

To find and resolve traffic problems in your practice--or your new floor plan--analyze the traffic flow of each work area, from the reception area to the kennel runs. Then consider possible traffic-flow solutions.

Getting started

To start your critique, grab a copy of your floor plan and some colored pencils. Use one color to mark the paths taken by veterinarians, another for staff members' routes, and a third for clients. When you're done, you'll see how far everyone must travel and where their paths intersect. This simple exercise uncovers problem areas and helps you focus on how to improve traffic in each of the three main areas of your veterinary facility--the "greeting zone," the "working zone," and the "dwelling zone."

The greeting zone

Start with your front desk--the first thing clients see when they enter. I prefer separate check-in and checkout areas--with plenty of space for medical files, computers, staff members, and clients. Keep in mind that staff members need an easy path through these areas because they often must come out from behind the desk to help clients. Clients and their pets also need plenty of room to maneuver, so allow six feet of space around the reception desk.

Behind the reception desk, you need to allow six feet of counter space for every computer station to ensure plenty of work space on either side of the computer. So, if you employ two receptionists and each uses a computer, you need a 12-foot-long counter.

I consider exam rooms part of the greeting zone because clients spend so much time there. I've identified at least 16 exam-room designs, and I recommend starting with an 8-by-12-foot standard exam room with two doors. The door pet owners use should open to seating, and the door for doctors should lead to the sink, supplies, and workstation.

As you plan your exam rooms, don't forget to include storage space. There's a mindset that storage belongs in the back. But this approach wastes space, so I prefer the "store it where you use it" plan. For example, receptionists need easy access to retail supplies, so install shelves or cabinets in a nearby corridor or in the receptionist's work area. And keep back-up supplies right in the exam room. Hallways make great storage spots as well. If you're planning a five-foot-wide corridor, consider going two feet wider and putting two-foot-deep cabinets on one side.

The working zone

The working zone is the heart of the hospital and integrates the pharmacy, lab, treatment area, and surgery. Grouping these areas and placing large glass windows between rooms lets staff members communicate easily and offers an efficient transition from the greeting zone.

In fact, for maximum efficiency, you should center all other areas around the work zone. This arrangement lets staff members in the treatment area monitor surgery and still respond quickly when veterinarians need assistance in exam rooms. When you're deciding how to fit the pieces of the working zone together, think about how big each room needs to be, where to store critical supplies, and how team members will move among the various working areas. Here's a guide:

Pharmacy. Locate the pharmacy near exam rooms so staff members can access stored supplies easily, and make it at least eight feet wide to keep traffic moving efficiently.

Work room (treatment). Island consoles, which incorporate wet and dry tables, a column for such mechanical elements as electric outlets and dental equipment, and plenty of storage room, offer great space efficiency. Allow five feet of work area on all sides of the island console.

Surgery. To determine the ideal size for your surgery suite, start in the center and work your way out. You need three feet of space on all sides of the surgery table for the doctor and any assistants and two additional feet to accommodate mobile equipment. Even if you don't need all this space for equipment right now, give yourself room to grow. If you want a dual suite, allow five to six feet of space between the tables. This means the ideal size for a single surgery is about 15-by-12 feet; for a double surgery it's 15-by-18 feet.

Pack and scrub room. Adjacent to the surgery and treatment areas, your 9-by-12-foot pack and scrub room contains storage, work surfaces, a scrub sink, and a pass-through to the surgery suite.

Radiograph suite. A 12-by-9-foot room gives you ample space to bring in a gurney, turn it around, and exit. Position the radiograph table in the center of the room with three to four feet of open space on either side. Flank the radiograph room with a 4-by-9-foot dark room on one side and a 6-by-9-foot viewing room on the other, and use the viewing room to store film, too.

Isolation ward. Ideally, employees pass the isolation room regularly and check pets through a window, but you don't want visiting pets or boarders exposed to sick animals. So consider placing isolation near a rear, outside door.

Cleaning supply closet. You'll want a traditional cleaning supply closet at the back of the clinic and another one near the reception area. If space is at a premium, you can use an open service sink in the back that fits in less than three feet of space. If you've got room, install an enclosed closet with a floor-mounted sink, shelving for supplies, and enough room for a mobile cart, pails, mops, and other cleaning equipment. Shoot for a 6-by-6-foot closet with at least a three-foot door.

The dwelling zone

The dwelling zone offers the most design flexibility; you can put it anywhere traffic flow allows. Besides wards and runs, include bathing facilities, food storage, a general storage room, a cleaning supply closet, heating and air conditioning equipment, the water heater, and possibly the vacuum cleaner canister. Keep in mind, the dwelling zone also needs to accommodate the delivery of supplies. Your wards and kennels can be the greatest problem area in a veterinary facility, so plan carefully. One of the main problems is odor, which often occurs when staff members can't clean the runs satisfactorily. A functional design and the right construction materials help alleviate these problems.

Cage manufacturers offer a plethora of cage types and arrangements, so do some research and decide what configuration will best fit your needs. I've seen runs as wide as four feet and as long as 11 feet, depending on the size of the patients treated. Make the wards accessible from all areas and convenient for receptionists, who need to retrieve pets.

Of course, these traffic-flow guidelines don't cover every issue you need to consider as you plan your design project--but thinking about how you and your team members work is a great step in the right direction. And the extra effort you put into planning will pay off with smoother traffic flow and more efficient workdays.

E. John Knapp, AIA, is an architect and analyst in Eagan, Minn., and a Veterinary Economics Editorial Advisory Board member. He's specialized in veterinary hospital design and demographics for more than 25 years. You can reach him at (651) 882-1840 or ejohnknapp@aol.com.

August 2000 Veterinary Economics