Planning

Accessible Patient Toilets – to Plan Effectively is to Plan Early

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20161110_final_clearance-diagrams_wheelchair-friendlyFresh from planning new inpatient units through to design development my recent experience of designing code compliant patient toilets for 150 newly constructed rooms has given me insight on a few key planning considerations in the future will save me time and re-work (and possibly some sanity).

First and foremost, I cannot stress enough the importance of studying the applicable codes and understanding the impact they will have on the patient room design early in the planning process. Here are a few more:

  • Gain an early understanding of the projects goals and objectives around handicap accessibility needs. A few examples:

– Space program must include a minimum of 10% of all room types shall meet code but clients may ask for more.

– Identify construction constraints such as back-to-back toilets for shared chases, no fixtures to be placed on exterior walls; door size and type requirements

– Is the planning/design team considering creative space-saving ideas, such as sliding glass doors or an open “European” shower concept that allows for greater mobility in the toilet room?

  • Reach out to the accessibility code consultant early and often and give them the opportunity to weigh in on design options and considerations. Having a collaborative relationship provides the best outcomes
  • Plan in enough time for the design process. Don’t underestimate the hours it will take to review code requirements and their positive and negative impacts on the proposed design.
  • Research all the applicable accessibility codes for your project. They vary from state to state. Projects in Massachusetts need to meet both federal ADA Standards and MAAB (Massachusetts Architectural Access Board) 521 CMR.
  • Know that it is not possible to have only 1 type of handicap accessible patient toilet room on a Massachusetts project. 521 CMR states that of the 10% handicap accessible rooms, 5% need to meet “Transfer Type” shower, and 5% need to meet “Standard Roll-In Type” shower.
  • Identify specific requirements between applicable codes. There are different requirements between ADA Standards and 521 CMR and we have to design to the most stringent code. If a discrepancy doesn’t yield a more stringent requirement, then both codes need to be met.

– For example: ADA Standards requires the 36″x48” clear floor space for transfer type shower to be adjacent to the shower and aligned with the shower control wall (#608.2.1). However, MAAB 521 CMR requires the 36″x48” clear floor space to on center of the shower enclosure (#42.7.2 [b]). Because neither one is more stringent, a 6” offset is required at the control wall in order to maintain the 24” clearance from the enclosure’s center line, resulting in an overall clear floor space of 36”x54”.

  • EUROPEAN SHOWERS – Well-designed European showers (open shower concept with 2 walls instead of 3) are a great idea for gaining more space in a toilet room where space is a constraint and when showers are used infrequently but still required. If you are planning on European showers, please be aware that a variance may be required in order to achieve a code compliant intended design.

 

Designing with Decorative Glass

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Below are images of a new inpatient beds and emergency department that incorporates interior glazing in multiple ways. Never compromising on function for the sake of aesthetic but in fact marrying the two to create a soothing, timeless, light-filled and sophisticated interior environment.

  • Glass at Patient Areas
    • Switchable Smart Glass
      • with the flick of a switch the vision glass in the ICU doors and observation stations changes from clear to translucent, allowing patients and staff to control privacy and eliminate need for blinds or cubicle curtains.
    • Frosted Glass
      • frosted glass slot window at the patient room toilet creates a light feature and allows natural light to filter through from the exterior windows in the toilet room and into the patient care area while obscuring detail.
  • Glass at Public Areas
    • Decorative Patterned Glass
      • used at in the family living room lounge areas to give a sense of screening but not block natural light.
    •  Fade Gradient Glass
      • used in the Emergency waiting room to obscure view to wheelchair storage and seating while allowing maximum lighting transmittance. More visibility is achieved as the gradient gets smaller extending up the glass panel for full view at eye level.

    Glass at Staff Areas

    • Decorative Patterned Glass
      • used at work station areas along the patient corridors, staff are able to see through the glass while giving a sense of a barrier without blocking view and natural light.
Fade Gradient Glass panels at entry vestibule
Decorative patterned glass at work stations
Decorative patterned glass at Family Living Room
Decorative slot window in toilet room creates light feature and allows natural light to filter through
Fade Gradient Glass at seating area in ED waiting

Planning to Code Minimum

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key legend

Color Coded Key Legend of different spaces on inpatient unit

I have found that one of the biggest challenges in planning new inpatient units has been balancing the needs of patients, families and staff. They all are wanting and deserving of adequate space on the unit and inevitably there is never enough square footage to give everyone everything they need.

It is especially true for units that have been programmed with the code minimum requirements, which has become an increasingly popular practice mainly to control high construction costs.

I recently experienced this situation on a new inpatient unit project and was required to plan to a program developed with code minimum requirements. Throughout the planning process everyone was fighting for space and in the end they all had to compromise and no one was really satisfied with the end result.

I was constantly being challenged to create spaces that provided adequate size and quantity of staff offices, on-call rooms, and workrooms for training, teaching, consultation and rounding. (DPH guidelines require only 1 staff office on a unit). I’m not advocating for staff spaces to overrun the unit – of course everyone wants their own office – but there are critical functional requirements that are not addressed in the guidelines.

Never mind providing quiet family respite areas, child play areas, and dining for families on the unit. More often than not these functions are all crammed into the “Family Lounge” on the unit with bus-stop style seating and bare minimum amenities.

It is critical to the success of the project for the planner to look beyond code minimum and be allowed to address proper flow, function and design of these spaces.

It is an unrealistic goal for a planner to meet current clinical demands (never mind state-of-the art), implement best practices in healthcare design and truly create healing environments without looking beyond the required codes. To really be successful and gain high patient and staff satisfaction projects need to create programs that truly reflect the needs of staff, families and patients without being narrowly focusing on meeting code minimums.