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SYSTEMS ANALYZED

As a result of the redesign and incorporation of the selected alternatives, the initial hospital construction cost of the improved hospital was as much as 8.6 percent, or $1,544,200, lower than that of the reference hospital. Incorporation of the selected alternatives, however, resulted in an increase in equipment cost of $29,900 and a net reduction of $1,514,300 in the initial costs of construction and equipment. The incorporation of the improvement alternatives into the improved hospital with interstitial space over the diagnostic/treatment area resulted in a total lifecycle savings of as much as $10,368,800.

The systems currently in use at the reference hospital, the systems considered, and the systems selected for the improved hospital are discussed below. The schedule on page 86 summarizes the results of these comparisons.

The results reflect the maximum savings estimated by Westinghouse and do not necessarily agree with the results of the preceding general life-cycle analyses because the general analyses (1) represent average hospital costs which include a combination of geographic and operating distinctions and (2) do not consider the interactions of improvement alternatives with other systems analyzed.

Dietary

The dietary system in use at the reference hospital was a conventional system. This system and three alternative dietary systems--ready foods, total use of convenience foods, and convenience foods plus abbreviated kitchen--were evaluated. On the basis of the life-cycle cost analysis, a total convenience food system was chosen for the improved hospital.

Pharmacy

The pharmacy system in use at the reference hospital was a mechanical dispensing system. This system and two alternative pharmacy systems--the ward stock prescription system and the unit dose system--were evaluated. On the basis of the results of the life-cycle analysis, the recommended pharmacy system for the improved hospital was the unit dose system.

Waste disposal

The reference hospital's system of waste removal was pulping. This system and four alternative waste disposal systems--unprocessed, compacting, shredding, and high intensity incineration--were evaluated. On the basis of the life-cycle analysis, the recommended alternative for the improved hospital was the compacting system.

Radiology

The radiology units at the reference hospital were powered separately. The cost effectiveness of powering two radiology rooms with one generator and set of controls was evaluated. On the basis of the life-cycle analysis, the technique of powering two radiology rooms with one generator was recommended in the improved hospital.

Laundry

An inhouse laundry system was used at the reference hospital. This system and three alternative laundry systems-contract, rental, and shared services (cooperative)--were evaluated. On the basis of the life-cycle cost analysis, the inhouse laundry method was recommended for the improved hospital.

Material handling

The reference hospital's material handling system was basically a manual system, although automation was used to some extent in the pharmacy, central services, and laundry departments. The manual and five alternative systems--manual with exchange carts, manual with automated dumbwaiters, manual with pneumatic handling of soiled linen and trash, manual with pneumatic handling of soiled linen and trash and dumbwaiter, and a chain driven monorail--were evaluated. The manual system with pneumatic handling of soiled linen and trash was recommended, on the basis of the life-cycle analysis, for the improved hospital.

Clinical laboratory

The clinical laboratory at the reference hospital was a highly automated department. The present equipment is the

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best available for the reference hospital's diagnostic and operation workload. The laboratory staff should be reduced, according to the analysis, by one full-time laboratory technician for a total of 14 full-time equivalent personnel in the two sections of the laboratory analyzed. These 14 personnel should be able to handle a greater workload than was currently being handled by the 15 personnel in the reference hospital.

Outpatient surgery

The reference hospital performs come-and-go surgery similar to that performed in a physician's office. The study considered whether greater use could be made of outpatient surgery. A review of the type of surgical procedures being performed on an inpatient basis showed that a substantial number of such procedures could be done on an outpatient basis. According to the life-cycle analysis, the use of outpatient surgery in the improved hospital is recommended whenever possible.

Floor covering

The reference hospital uses six different types of floor covering. Five alternative floor coverings--sheet vinyl, vinyl-asbestos tile, carpeting, ceramic tile, and terrazzo-were evaluated. Vinyl-asbestos tile was recommended, on the basis of the life-cycle analysis, as the primary flooring material for the improved hospital.

Construction

The reference hospital as designed and constructed included four separate buildings--an acute hospital (259 beds); an extended care unit (128 beds); a rehabilitation unit (38 beds); and a doctors' office building--using a combination of concrete and steel framing.

Our consultants designed a structural system for the improved hospital similar to that in the reference hospital, using conventional steel framing. A preliminary evaluation of a concrete structural system showed that this system was more expensive and offered no greater flexibility than steel

construction.

Once the facility was redesigned, interstitial space/ long span construction was evaluated over three levels-diagnostic/treatment zone only, between alternate floors, and over every floor. The analysis showed that interstitial space/long span construction over the diagnostic/treatment zone was cost effective and was recommended for the improved hospital.