Approximately 80 percent of the clinical laboratory's operating budget is related to personnel costs. The clinical laboratory, therefore, is an area where introducing new technology will not only show a cost benefit through reduced total labor or increased throughput, but will also provide the capability for more readily absorbing the enormous problem of increased workloads.

Radiology System

The typical, general-purpose, radiology room contains a table, a generator head, and a generator/control unit. The cost of one complete suite ranges from $22,000 to $53,000, and the cost of the generator/control unit ranges from $9,000 to $17,440. Special procedure suites are even more expensive. Such costs represent a very sizable expenditure for most hospitals, particularly if they operate a large radiology department.

However, a recently developed technique allows one generator/control unit to drive two tables and head units, which can produce substantial cost savings. Although not applicable to fluoroscopic rooms, the technique can be used effectively in both general and special purpose rooms.

Outpatient Surgery

One way of meeting the growing demand for hospital space is to establish an outpatient surgery service. An outpatient service performs surgery of the type that is conducted in a physician's office or which requires admission to a hospital for from 12 to 48 hours. When the procedure is performed on an outpatient basis, the operating suite is used for both inpatient and outpatient surgery, and the rapid turnover of patients reduces the number of beds needed.

Construction System

More than a billion dollars per year are being spent for hospital construction in the United States; by 1976, the estimated amount invested in all hospitals will be $32 billion." However, much of this money is spent

2

2McGibony, J. R., Principles of Hospital Administration.

G. P. Putnam's Sons, New York, 1969, p. 13.

indicates

on extensive remodeling and major additions to existing hospitals. This
plus the fact that many hospitals are obsolete before they open
that more effective hospital planning is required.

In planning hospitals, the architect, engineer, and medical professional must strike a balance between an initially expensive hospital which easily accommodates change and an initially less costly facility which may require expensive future alterations. To do so, planners must be aware of how initial hospital construction (and thus the amount spent for it) will affect the operation of the entire hospital over its projected life cycle.

Private Rooms Versus Conventional Bed Mix

Considerable controversy is currently centered on what types of patient room should be constructed for short-term general hospitals. A recent hospital trend is toward constructing all private rooms. According to several consultants, physicians, and administrators, this approach has several advantages:

Eliminates patient incompatibility due to age, sex, personalities, environment, etc.

Increases privacy for examination and consultation between patient and physician and facilitates communication between patient and staff. Enables social contacts between patients to occur when desired

in lounges, solarium, and other public areas.

Allows patients to continue personal habits such as late night
reading, watching television, listening to the radio without
disturbing other patients.

Reduces patient transfers.

Although these advantages represent a substantial argument for all

private rooms, the quality of health care patients receive depends upon a number of factors which have little or no bearing upon type of patient room, including nurses travel time, patient condition, availability and accessibility of equipment and services.

Whether the use of private rooms only will reduce costs depends on such factors as the cost of moving patients, reasons for patient transfer, and effect on nursing time.

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STUDY ANALYSIS AND RESULTS

REFERENCE HOSPITAL PLANNING APPROACH

The reference hospital is a medium-sized general hospital with the most modern facilities for medical, diagnostic, surgical, and therapeutic departments. There is no obstetrics department. It has been located at its present site since 1876.

In 1908, a 220-bed hospital was built which was increased to 248 beds in the early 1940's. In 1958, preliminary discussions began on replacing the existing hospital. In 1964, an application was submitted under the Hill-Burton Act for a new hospital and medical center. The need for a new acute care facility was based on both the need to replace non-conforming beds and the need to meet the increasing occupancy rate. In 1962, the occupancy rate was 67.34 percent, with an average patient length of stay of 9.6 days; in 1964, the rate had increased to 72.58 percent with an average patient length of stay of 10.1 days.

The following are excerpts from the reference hospital's "Acute General Hospital and Diagnostic and Treatment Facility Project Construction Application," outlining the hospital's basic planning rationale:

The reference hospital's immediate need is for replacement,
bed for bed, of its present 250-bed capacity, with provision to
meet the needs of anticipated growth.

It is worth noting that nearly 40 percent of the hospital's
admissions are for patients referred from outside the City
and County in which the hospital is located/, and include
patients referred from other states and even other countries.
Approximately 25 percent of the hospital's/ admissions and
30 percent of patient days are for patients referred by
industrial compensation sources. The percentage of outside
referrals plus the large number of compensation referrals
points out the competency and prestige of the hospital's/
staff and the quality of care enjoyed by patients in the
existing obsolete and inadequate facility.

It is, therefore, reasonable to expect both a higher
census and a higher general activity level if the hospital
were provided with contemporary facilities.

How soon