Dialysis center Design

[student]

Hello,

I am actually a student designing a dialysis center for my Capstone project. I came across this chat room and wanted to post my survey to help me with my research. The survey is anonymous and will just help me with making the interior space more comfortable and a little less stressful for patients. If anyone will take a minute to take my short survey I would greatly appreciate it! If you have any thoughts or questions let me know.
Thank you for your time!!

Dialysis Patient Survey
<a href="http://www.surveymonkey.com/s/Q769CJV">

[Zog]

I work for a general contractor and we have built a few dialysis centers.

There are some guidelines that vary from state to state on dialysis center layouts.  The typical patient treatment area is 8' x 8'.  There is usually one or two isolation chair areas per center for people who are really sick or contagious.  These isolation areas can be walled off rooms or sometimes just glass partitions.  Most centers have treatment room with 20-30 chairs in an open area, nurses stations, a separate home hemo/PD office and training room, several offices for nurses, social workers, director and the nutritionist, a staff break room and storage.

A center has a "water room" that holds the equipment for preparing the water for the dialysate.  These rooms can be quite large (20'x20') and really need a curb around them and floor drains if something happens to leak.  If the room is on the second floor of the building the floor will most likely need structural reinforcing for the weight of the water tanks.

Most centers will have individual TV's at each chair, but not all centers have this amenity.  Some have internet, but I don't think that is a given either.

Most dialysis patients don't talk to each other and most want to be left alone for the treatment.  I can foresee a day where a nocturnal dialysis clinic might have individual bedrooms.

Most of the waste lines and RO (reverse osmosis) piping (water for dialysate) from individual dialysis machines are carried in easy to access knee wall chases behind the chairs.  They usually cover the chases with laminated marine grade plywood topped with plastic McNichols grates for visual access and ventilation.  Most machines have a compatible wall unit that is recessed into the chase wall.

There is usually a recessed slab area with a highly precise scale for weighing patients in between the waiting room and the treatment room.

Several patients coming to dialysis centers are being bused in from nursing homes and they require a nice (hopefully covered) drop off area with wheelchair access and automatic doors at the front entrance/waiting room.

I haven't seen a dialysis center do this, but a few hospitals I have worked in are installing luminous sky ceilings from The Sky Factory.

Luxury vinyl wood plank flooring seems to be a popular choice in healthcare in clinics trying to feel more like home.

You can probably find some actual plans for a dialysis center online.  Most of us general contractors put plans online now days for bidding purposes.

[fearless]

I am grateful to have input into something like this.  My clinic is much like described in the second post, but from a patient's point of view, it really leaves a lot to be desired.  The chairs are around the perimeter of a big room, and there's a row that goes across the center of the room and faces the "front"  I'm always seated in that row, so I sit for four hours looking at a sink, the end of a counter, and a door in the wall.  One afternoon i had to go in at a different time and got to sit in a chair that was facing a window (even though it was across the room, and the blinds were only partly open.  What a difference it made to be able to see the tree branches outside the building, and the sun as it was shining that day!  For me the biggest factor is: what do i have to have in my view for four hours, 3x a week?  Anything OUTSIDE would be good: a tree, a bird bath, cripes! even the cars going by would be better than a wall.  It also really sucks that when people come through the door into the area where the chairs are - there I am facing the door, with my blood running through a line coming out of my chest, a cuff on one arm and a needle in my arm - I feel like a display in the "chamber of horrors" - for people picking up patients on stretchers, etc.  Not a HUGE deal, but still.  The chairs are definitely arranged for access by the nurses - which is important.  But the main thing is: WINDOWS!  Thank you

[Zog]

Privacy is an issue most of the patients want, but you will hardly ever see cubicle curtains in a treatment room.  The nurses like to be able to keep an eye on everyone and their machine.  The hospital dialysis floor has curtains that segment the room into stalls, but they hardly ever use these.  DaVita has no visual obstructions whatsoever in their room excluding the half high chase walls for RO piping.

Tiered open seating levels facing a large glass curtain wall beside a natural area would be nice, but very expensive and would require lots of ramps.

[fearless]

My clinic's treatment room has windows on three sides.  All they would have to do to have all the chairs facing the windows is turn one row in the other direction.  For some reason they've divided the room into two general areas by having a shorter row across the middle that faces the wall with no windows.  It seems like it would be pretty simple, and would not obstruct care or efficiency in any way.  There's nothing spectacular outside the windows, just some small planted trees that you can see the upper areas of.  But it's much nicer than staring at a wall or a sink.  It's not even necessarily being able to see something out there that's nice, it's just looking up and seeing the outside world, instead of feeling like you're in a basement or closet.  All the chairs are on one level.  It's just that about 3/4 of the patients get to see a window, and about 1/4 don't.
I just have a feeling that what a patient would be looking at while sitting in one of the chairs for four hours was not taken into account in the design.  I'm not asking for a view of the Sierra Nevada, just a window to the outside world!     cheers

[Riki]

The unit I'm in now is in the basement of a nursing home, though I'm thinking that most would call it a semi basement, as not all of it is underground.  There are nine chairs in all, and they are all in a line.  There are essentially 2 rooms, 3 if you include the isolation room.  In one room, there are 6 chairs, the next room there are 2. All that divides the rooms is a door with a half wall divider.  It was build that way, because there is a sink on one side of that half wall.  In the larger room, the nurse's station is backed into 4 large windows, which we in the chairs face.  The windows look out at Charlottetown Harbour.  In the summer time, we see all kinds of boats, the cruise ships coming in and leaving, all the people walking the trails along the water, it's great. 

They've built a new unit for us that is supposed to be open in the spring.  It's in a new wing of the hospital.  I have yet to see the layout or anything.  I don't even know which floor it will be on.  If it's on the top floor, which I doubt, we might be able to see a little bit of the harbour through the trees, but it's from a different direction than from the nursing home, but most likely, all we'll be able to see is the parking lot or the highway.  I'm not really looking forward to that.

[RightSide]

There are a couple of things I wish my own dialysis center had--things that this student's survey didn't ask about.

1.  Adequate parking spaces, well lighted all the way to them, maintained and snowplowed in winter.  I hate having to park far from the entrance, and then having to walk to my car on a dark night and risk slipping on the ice or snow because the area wasn't plowed.

2.  Adequate heat in winter.   The dialysis chairs are all around the periphery of the floor near the windows. And it gets damn cold during the winter.

(By now you can guess that I don't live in Florida or Hawaii.)

[Lovebelle]

When I did In-center Hemo I HATED the room we were seated in. There were windows on one side of the room but for whatever reason all the chairs faced the center of the room which contain counters with Medical supplies, sinks, disinfectant, etc. Needless to say very ugly to look at. I also hated the feeling like all of us patients were right on top of each other. There literally was less than three feet of space in between chairs on one side and then the dialysis machine separating you from another patient on the other. I would desperately try to tune out patients on either side of me if they were moaning or complaining. It truly stressed me out and I felt like I had no privacy. If something was going on, EVERYONE knew about it. Lastly the room was so frigid and I do live in Florida. Staff said they keep it cold because they get hot, but my goodness sitting still for 4 hours your body temperature drops and I would be painfully cold. No apologies from staff though, they just respond and say, Yeah all the patients complain its cold in here. No wonder I would be so grumpy some days. Now I do Dialysis at home and at least my environment can be controlled by me.

[student]

Thank you for your comments! They have been very helpful!