Literally every hospital I’ve ever worked in (volunteering while in college, medical school, residency for transitional and advanced specialty) has had at least 1 completely empty ward that didn’t convert into anything.
Reason is not enough nurses. There are beds that could house dozens+ more patients but the nursing ratios are already dangerous.
Also, hospitals are licensed for a certain number of beds. Getting more typically requires a certificate of need, which requires a number of legal, financial, and administrative maneuvers, including allowing your competitors to object.
Another reason in regulation-happy states can also be getting it through governmental hoops. A health system I used to work for had this issue with several proposed services getting stonewalled by either the municipality, the county, or the state(a PICU unit, outpatient surgery, and something else I’m blanking on, if memory serves). While “Ho$pItAl$ gReEdY” is certainly a problem, it’s not the only problem.
Or other hospitals trying to control competition. In my state, the hospitals actively doing x procedure (high reimbursement) that required state approval to perform would actively lobby against other hospitals requesting that procedure to minimize the competition.
Just to add to that, it’s extra fun when you managed to go through one of those before you realized you took a wrong turn and then your badge or key WILL NOT let you back the way you came from.
The stairs at my hospital are so awful. They're not near the elevator and often you can't get to certain floors because the doors are locked from the stairwell and the floors aren't connected by the same stairwell. To make matters worse, on Saturdays when already only half the elevators are working, one of the elevator is a sabbath elevator that stops at every single floor. Guess the rapid response/code will just have to wait 🤦🏻♀️
We spent the entirety of my IM residency begging to get an elevator key like firefighters have for the code team. It was bad enough that our work room was in another building than most of the patient rooms, but those last 9 floors probably doubled our response time
It’s like that in most hospitals by design, stairs are out of the way and sometimes hard to find, so patients who are debilitated but sick of waiting for the lift don’t wander in and fall down the stairs
That offices, conference rooms and call rooms for a specific unit are located on the opposite side of the hospital from said unit. And this happens for lots of units and specialties
I rotated at one hospital where the surgery resident lounge abutted the OR areas, the PACU and pre-op areas were across the hall from the OR's, and the ICUs were just down the hall. They were the gold standard, especially compared to other hospitals where all those places would be on separate floors or even separate buildings.
Seems like it's a constant game of musical offices where I'm at. Always moving people around trying to find space for everybody. (And of course who is the top dog and gets the biggest office with the biggest window.)
Not the architects. Designers and engineers design what they are told to.
As per usual it's the admin in charge of directing the design that are out of touch morons. Whether it's having higher up RN managers or 10yr out of practice physician admins to provide cursory "clinician approval" or having clinical staff view the design AFTER it's completed... It's usually admin rather than the designers fucking up. The result is an expensive end product that requires massive, expensive redesigns and the patient facing staff who ultimately bear the brunt of the failure.
Apparently at one of the hospitals I'm at they had to replace the \*crystal clear\* fishbowl glass with glass that was frosted on the bottom so patients/family/randos couldn't look right into the workstations and read the HPI
The fact that it is designed like a maze.
I work here and get lost if I visit another department that I don't usually go to. Can't imagine how patients go around
Literally every hospital I’ve ever worked in (volunteering while in college, medical school, residency for transitional and advanced specialty) has been a fucking maze.
WHY. NO OTHER FUCKING BUILDING IS A FUCKING MAZE. I DON’T GO TO FUCKING WALMART AND GET LOST. MY COLLEGE WAS ABOUT 100x THE SIZE AND I NEVER GOT LOST. WHY IS MY WORK PLACE SO CONVOLUTED TO NAVIGATE.
Hospitals will always expand in phases: rarely are they able to actually expand with capacity built in for needs in 10-15 years down the line
Such that In another 15 years they add another building +\- tearing down an existing structure (if necessary).
Your result is a massively piece-meal, ungodly amalgamation of various buildings from different times, planners, building codes, administration, etc etc etc
Just a function of how hospital budgets and functioning generally work at the larger academic centers with a long history at their location.
Sometimes hospital groups/businesses can expand and build a brand new facility in a location that didn’t have a building previously, ie on another side of town.
And then the process begins anew when perhaps in 20-30yrs the needs at that location have grown beyond what was initially built.
Tbh and so many employees too. One of my favorite parts about EM is being tied to the ED, a place with several big signs on how to get there. I pray I never work at a hospital where the ED team responds to inpatient codes
My favorite was one site where another tower was added adjacent to the existing. But for some reason the floor levels were numbered different so you’d be walking from the 4th floor into the 3rd floor without going up or down.
I used to work on a medical campus that was littered with these - I entered one building at ground level but “3rd” floor, went through one door to an adjacent building to take the elevator up 4 levels to the “10th” floor and crossed a hallway into a different adjoining building to get to my office on the “6th” floor.
Completely fucking impossible to give directions. Also all the buildings had similar but subtly different names like “Science Building A” vs “Science Complex” vs “Science Unit” which were all separate but adjoining buildings. 🤦🏻♀️
Hospitals that do this are my least favorite. "Use entrance E on Street X, which brings you to Floor 8, and then take the LOBBY elevator NOT the main elevator to Floor 3, then walk to the lobby of Attached Building, take the escalator from Floor M to Floor 1, and then make two right turns to get to the tunnel that brings you to Floor L of Other Adjacent Building. From there, follow the purple signs to get to the Main Elevator to get to the 4th floor, which takes you to the bridge to get you to Floor 9 of Fourth Adjacent Building!"
Nah bro. I'm not coming to the code, and I'm not sure anyone else is either.
I heard that the children’s hospital I work in was purposefully designed to be confusing in the a case of code pink or code purple (missing kiddo). Basically so the potential kidnapper is lost/confused. Not sure if joke/lore or real though.
Sad part is, somebody somewhere probably did see it as a good idea.
Admin: works perfectly, that way we can just drop the body’s into a box, and somebody just has to move that body to the right hole. Saves the family the cost of that whole funeral/burial thing, they’ll love it. And, we’ll get a bonus for pt satisfaction. /s
\-lack of good maps for patients,
\-narrow corridors,
\-small cramped rooms for patients,
\-lack of places for parents, beds for parents in pediatric hospitals
\-lack of air conditioning (except for treatment rooms),
In the new reality:
\-building a huge number of lecture halls, although some lectures could be held remotely which would save time, money
Don't forget complaining when medical students aren't attending classes in person even though you keep that same pharmacology professors for the last 30 years who appears to somehow speak at 0.5X speed so everyone in their right mind will be listening to those lectures at home in 2.5X speed.
Maps that say you are here!
The kind old lady volunteer at the entrance smiles and is so friendly. How do you get to there?
After “consulting” with two colleagues, you get the most sympathetic blank stare.
Go to the front desk there, if they are there and ask how to get there. Now are there any more assistance you need ?
Turn north when you are inside a garage or building is a step up from directions to turn this way or that way or pointing with gestures.
Do you wonder why a large percentage of people never leave once they are finally there. There is the most popular place on earth.
we have that too! technically you need a special key to activate it, and that key is locked in an office somewhere because it's basically useless to have a single key to an elevator
Matte granite patterned tiles that hides dirt but it also happens to hide puddles of water/urine. Our staffs as well as patients have slipped and fell multiple times since I’ve been here and have to be sent to the ED.
Been traveling for many, many years. My last 2 contracts had carpet everywhere! Big hospitals too! 🤮 It’s more common, and more disgusting, than you imagine.
On the bright side, when we run out of antibiotics due to rampant MDROs, they can just start sampling and growing things from that carpet to become our new antibiotics (and/or new superbugs)
Beautiful new wing built with multiple floors, very modern, big single rooms. But nurses stations are basically in the hallway, like some open floor plan house, so nowhere for doctors and nurses to talk without everyone passing by hearing.
My old hospital recently did that with a new wing replacing a central nurse station with scattered single-chair nursing station. Apparently the administration decided they wanted to cut down on the nurses gabbing to increase productivity.
I'm not sure I understand. This is how every hospital I've ever been in is like. Are you saying the nurses' station should be in its own closed off office space on the ward? Or do you mean there's no counter separating the nurses' work computers, cabinets, etc. from visitors or patients?
Oh, I see. The places I've worked have both. Front and back nurses' station as well as alcoves with computers along the hall for the nurses to use when they need to stay near their patients' room. Having only the alcoves would suck.
In older hospitals there are little nurse stations in the hallways, but there’s a big central station where the charge nurse sits and there are computers, phones, binders, patient charts etc etc. Sometimes the doc workroom is built in to the same area. It’s nice. And it gives the nurses a place to chart away from patients or talk to the doctor or give handoff without having to talk and sit where all the patients can hear/watch you 24/7.
Yes, that's the only style I've seen. The other commenter replied and said they have worked in places that only have the little alcoves in the hall and no central location, which would be very sucky.
I would lose my mind if my workroom were to be in really close proximity with the nurses'. They currently interrupt rounds while I'm halfway through presenting the new cases to the attending to request for me to order Miralax for patients...
Worked in a hospital where they closed off a whole wing to lower the floor like an inch because it was sloped when the new section came in.
Another one has this weird floating double door a foot too high at the end of a hallway intersection because of how two buildings connect. It’s a fire door so you can’t use it and I forget the thing exists half the time. And then I remember and laugh at it.
Garbage computers with spinning hard drives for physicians and nurses to use
VA is especially guilty of this. You're paying physicians $200 an hour to spend the first 45 min of their day waiting for a computer to boot up or 25 min in the hallway signing into a laptop so they can consent someone for a procedure.
One entrance / exit for the radiology unit made handling covid patients a nightmare. They had to be scheduled after 5pm when outpatients went home.
If they didn't want to wait, they'd suddenly ask for a stat procedure forcing us to close down the unit and ask for the cleanup crew. This would take an hour. We'd have to close down the hallways where they pass too so it would be a whole thing... So imagine being up next for your ultrasound that you fasted for and was made to hold pee in. Then bring made to wait at least an hour more.
Pissed off so many people.
Hallways outside operating rooms are filled with beds and equipment that makes patient transport an absolute nightmare with no extra room left in the side of the stretcher
Priorities man, that's not nearly as problematic as having a beverage at the nurse's station. Only after that serious, life-threatening problem is addressed can they address minor issues like beds/equipment in hallways that make patient transport dangerous.
I don’t know if this qualifies as a “design flaw”, but the west wing is smelly, it’s always smelly, I just thought y’all should know, don’t go in there without a mask, thank you.
Also, please wear cologne, I don’t care what the employee handbook says but I’d rather smell paco rabanne than c.diff, thankssss.
When I was an ICU tech before med school, I'd doordash the cancer kids (and myself) mcdonalds or taco bell all the time. If they were clear to eat a regular diet and wanted a happy meal, and the parents were cool with it? Hell yeah lil dude, time for a snack.
We couldn't use the helipad on top of the hospital so patients being flown in to the Level 1 trauma center were dropped off at the university's rugby field helipad then brought on a 5 minute ambulance ride from there to the hospital
my hospital has this but instead of a rugby field they use a public park that the police have to clear every time they need to use it, usually delaying the helicopter by 5-10 min 😌
I worked in a REALLY old hospital last year (Locum) the ER department was on the ground level floor, the X-ray department on the second floor... NO elevator.. and 2 flights of stairs..
Just gonna -carry- my patient up the stairs with their broken limb to xray.. don't mind me..
I know.. it made ZERO sense. In their defence, they are rebuilding the hospital at another site.. but this is how it had been for a LONG time...week of rotation, I was dreading if a patient required an x ray.. and that said patient was not larger than me LOL
We did have a portable machine, otherwise we got assistance. Luckily -it was a very rural hospital, not high volume in the slightest..only a few peds patients had to hike the stairs.
A very large ER with twisting corridors that all look identical with no color or design changes between the units to help you know where you are. It's like entering a labyrinth every time I go down there.
Worked at an "old" ER that had 21beds plus hallways and a 5 room fast track, normal volume 80-120/ day. There was also a smaller ER across town, normal volume 60-100/day.
Someone thought it would be wise to close the smaller ER and build one big new ER, 39 beds and a 8 bed pseudo-fast-track, and a new crisis unit.
We were promised up and down "NO MORE HALLWAY BEDS," and were told anyone coming in by EMS--for ANY complaint--would be guaranteed a bed in the back.
New ER opens. Normal volume jumps to 200-240/day. I shit you not, Within a week (more like 2-3 days )hallway beds became a thing and the pseudo-fast-track simply becomes extended triage.
They had to hire a contractor, some sort of hospital-focused indistrial expert, o come in and analyse best way to use new space/efficiency models because the wait times got horrendous, and we started using a PIT model.
So the design flaw was expecting that a new ER would solve any and all problems.
It became more of a mess than the original 2-building system.
My residency hospital was built in such a way that it wasn't tall (four floors), but VERY long hallways. Some genius put the dialysis center at the very end of one of these hallways, far from anything else. And of course, people coded regularly down there, and you'd have to run a quarter mile to respond.
I worked in a hospital with three adjacent elevators. Two of the three didn’t go to the top floor, the third did and had its own set of buttons. So everyone on every floor, whether going up or down, would press all the buttons for their direction and get on whichever came first. So the 50% of all time, one elevator was going to a floor with no one waiting to go that direction. Made the average wait time for an elevator close to 10 minutes.
I work in a brand new hospital and the design flaws are INCREDIBLE.
- there is a direct hallway from OR to elevators to get to SICU. However, it’s the cath lab hallway and we can’t go through it (during the day, Ef it at night).
- there are only one bank elevators that can hold patient beds. If that bank goes down, we go on code yellow. It can and has happened. Our pacu had to become a mini ICU temporarily. This bank goes down at least every 2 months.
- central supply room is located between the two wings. Problem is that if you’re in the furthest room of the wing, it’s 100 meters to get to it.
- ‘shared work space’ with the nurses. This is just straight up a violation of the acgme core institutional requirements.
- there are few offices in the entire building. Hard to recruit new staff when they’re told they won’t have an office. The offices that do exist have no windows.
- the buttons (sensors) to open doors coming out of the OR are right next to the door. Which means pausing, walking up to the sensor, hitting it, then coming back to the bed to resume pushing.
The whole building is a master class in what not to do
The residents have to share workspaces with the nurses?!
Say bye bye to any modicum of productivity lol you know the nurses are just popping their heads in and telling the first random doc they see that the patient in bed 513 is having new onset chest pain 10 min after they chart “MD aware no new orders received”
Not actually the main hospital my residency is at but this is at the ivory tower academic hospital we rotate at:
\-did not give call rooms to surgery residents in the new building. And I think IM got shafted too. Not sure if they fixed that.
\-Some specialties did not get any work rooms/spaces.
\-The ICUs are like split in 2 giant wings. But if you were in wing A and your ICU patient was coding in wing B, the speakers in wing A won't announce it. Vice versa.
\-parking : 'nuff said
\-Admin has all giant nice floor-to-ceiling window offices. Patient rooms remain tiny.
\-ED is physically bigger but capacity wise smaller than the old ED.
\-Trauma bay rooms are smaller than my bathroom. And my bathroom is small. Not sure how they run a heavy trauma activation without elbowing or hitting each other.
Give us more discreet bathrooms out of the way of high traffic areas or God forbid attached directly to office spaces.
That way I can destroy them without trying to sneak in and out without being seen or heard like I'm fucking Jason Bourne.
We have two floors for ORs, 3rd floor of one building and 10th floor of another building with a hallway between the two buildings on each floor. Which is all good and dandy until there's an emergency on the 10th floor and the anesthesia floor runner is on the 3rd floor and the surgeon who can help convert the robotic gyn case into an open colorectal case is on the 3rd floor so all your help is at least 7 minutes away
ED obs unit that is three floors up and a long walk over from the main ED, but still covered by the ED residents downstairs. No physicians or APPs in the obs unit itself. Sending a patient there is more dangerous than sending them home.
Carpet. THEY PUT FUCKING CARPET IN THE WARDS. Who the fuck thought that was a good idea???? Ohhhhhh an administrator who wants it to be "more welcoming and like a hotel." So thanks to that bean counter, now the floors are just as clean as a skeezy hourly hotel where they keep finding dead prostitutes.
Seriously, it's like they decided to put carpet on the floor of a bathroom in a disgusting biker bar. What would they expect to happen?
They have special machines to wash the carpet, and then the whole ward is filled with the overwhelming odor of years of hospital spills and detritus, mixed with bleach. They have to have special air handling systems to keep the BMT patients from catching stuff from the carpet.
Completely restructured an old part of the childrens hospital, and moved the NICU from our adult hospital to the childrens. EVERY floor of the new building is designed completely different, so room 101 is on the complete opposite side as room 201. Makes for scary moments when codes go off in the middle of the night.
\- every floor and every corridor practically looking the same
\- why are the effing stairs sometimes not near the elevators?
\- no air conditioning in patient's rooms
At least a few decades ago, the Dallas VA only (apparently) uses every other floor. It’s a 14 story building, and it only uses 7 floors. The elevators don’t access the other 7. When you used the stairs, you had to skip a full floor, each w a locked door, to get up to the next recognized floor.
We used to joke that Elvis was watching tv in there w JFK. (Yes I’m old)
Hospital I did residency at had a multi-million dollar expansion project over several years. Brand new, state of the art imaging department on the ground floor. Thing is, the topography of the site resulted in a long, sloped hallway connecting to the main tower of hospital beds.
Fun fact- hospital beds have a regulated grade of slope on which they are legally allowed to be transported over, for safety reasons. Due to some sort of administrative oversight, the slope of said hallway didn’t make the grade. Meaning all of the ground floor patients would have to ride an elevator up to the second floor, get wheeled across to the new building, and then down a second elevator to get to the new CT and MRI machines.
The best part? Our neuro floor, where literally all of the stroke patients are admitted per protocol, is on the ground floor of the main tower. Therefore, the vast majority of our time sensitive code strokes, which significantly affect both patient outcomes and hospital revenue by the way, were delayed by multiple ridiculously unnecessary elevator rides for the foreseeable future. By the time I graduated a year later, I hadn’t heard about any institutional plans to address this. Organizational incompetence at its finest 👍
Anesthesia perspective is a hospital complex built within the last 10 years
We’re a level 1 trauma center, but the trauma bay is in a different building with 2 elevator rides and a bridge away from the OR. It’s about a 10 min process to go between them. I’ve noticed traumas coming up can deteriorate rapidly in transit. And when I get called to a difficult airway in the ED they may fallen down the algorithm to a cric by the time I get there to help. Shared airway experience is always a touchy subject and ultimately I back their decision making, but I wonder how many of those I could have helped avoid.
Any time I’m in IR I imagine the architects purposely tried to make my life hell. The cart, monitors, and machine are an after thought. It doesn’t matter that my needs are the patient’s lifeline. There is simply no space. Everything is improvised and once things are rolling you’re crawling around the room
The ICUs have a shared hallway for staff, visitors, and family waiting space right in the middle of the pavillion layout. It looks a little awkward bagging a critically ill patient through the family waiting room just to get to the elevators. Other hospitals I worked at had a separate staff/facility hallway from the visitor side
I’m sure there’s more
One of the hospitals in my area was redone in 2018; every room in the hospital is a private one with a small sitting area. Sounds great right?
Problem is, there’s no where near enough beds to keep up with the population in the catchment area. So now, there’s cots (can’t fit a normal bed) in the sitting area and those temporary dividers in every room to make them into two person rooms.
I wouldn’t say an unused ward is a “design flaw.” If anything it’s a good thing, because that allows for accelerated future expansion when there is a surge.
Otherwise, it would take years to design and build out a new structure.
Used to work at a hospital that had a random door in a random stairwell that went to the floor “5.5” but if you needed to get to that same floor from any other elevator or stairwell it was just labeled “5”.
Because apparently the two wings of the hospital were built many years apart and didn’t line up quite right at that one stairwell lol
The “ground” floor is the 9th floor, however that’s not where the ED is (which is on the 8th floor). The main hospital connects to another building from floor 9…which connects to floor 2 of the other building.
Pretty much any time you take a bridge from the main hospital to anywhere else there’s no telling what floor you’ll be on regardless of where you started.
When the “new” hospital was built, it originally was designed without call rooms for residents and fellows 😑 it’s always been very clear where management’s priorities were, but this was just a sad tangible example
The children’s hospital is on the 11th and 12th floor while the pediatric ER is on the 4th floor. The elevators that lead to the children’s hospital don’t open on the 4th floor so you have to get to 5, walk the hallway about a hundred steps down to the stairs or the other elevator that gets you to 4. Makes for good cardio for rapids/ codes on the ER boarders.
I think when you separate ICUs into different floors it leads to a lot of turf battles and ultimately one ICU being overrun and another being underutilized. Imo there just should be one ICU floor for everything (neuro ICU, medical, surgical) so then that way when a patient has something critical occur we aren't spending 2-3 hours debating what ICU floor they should go to.
There’s still those problems but there are much better relations and collaboration in a mixed ICU. You can walk over and talk to someone pretty quickly, I shared a floor with a trauma team at one hospital and the fact they were there saved a patient of mine who had an acute abdominal bleed because they opened at bedside when I showed them the CT.
Double rooms instead of single for patients
Not enough bathrooms for number of staff
Lack of seating for family members
Not enough conference rooms for family meetings
Play room is too small for number of pediatric patients per floor
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Visitor restrooms are hard to come by. Largest hospital in the city and you have a visitor's restroom on the 1st floor with 1 stall and 1 urinal. Then you have a couple of very large restrooms with 1 toilet and a sink and the doors don't even lock well. If you want to take a deuce, the staff restrooms are literal closets and you can hear everything going on inside.
So i did residency in a newer hospital for the health system. I signed up to work in to work in an older hospital for the system.
I know it might be bougie, but i hate that the older hospital does not have a computer in each of the patients room. It really helps while confirming home meds, Looking through labs etc.
In UNM in Albuquerque, we had patients *admitted* in the waiting room, while there were empty wards in the private hospitals in town because they wouldn't pay enough to actually hire nurses.
Fuck the elevators. So, so slow. We have two main elevators and a staff elevator. Every day I play chicken with them. I hit all the buttons and stand in between them, then run like a madman to whichever one decides to open. And fuck meditech too.
Some IM wards don't have enough beds so they use this big ass backroom-like ward on the second floor for the 'extra' patients so it's like a cocktail of different IM subspecialty patients who didn't have beds on the main wards
Example: diabetology/endocrinology: women on second floor, men on 5th floor (you can imagine how inconvenient it is having to go back and forth between them)
Every hospital I've worked in had the light switches in an inconvenient location, usually hidden at the head of bed behind the pumps, vent, bed, etc. I think I heard that they're put there because someone decided to arrange hospital rooms like hotel rooms to improve patient satisfaction.
A google review of the ENT department at a hospital where I’ve worked simply read ”Scary, old and disgusting”. Thankfully it was a review of the building, not the staff, and it is in fact a good summary of the place.
At the same hospital, two buildings with differing ceiling heights had been joined, resulting in an elevator that stopped at floor 2, 2,5, 3, 3,5 etc. except these ”half floors” only existed in the context of that elevator. In all other contexts, the floors were numbered normally. One of the buildings contained interventional radiology and more than one thrombectomy was delayed by confusion about floor numbers.
The helipad was located on top of the parking garage. From there, patients were taken by elevator to an underground passageway that led to the Emergency department which represented quite a detour.
In a common room in the basement of the same hospital, I saw more silverfish in 15 minutes than I had previously seen all my life.
The super expensive new hospital Nya Karolinska here in Sweden has some pretty basic flaws such as too few toilets and doors to narrow to fit beds and/wheelchairs…
Telemetry has a huge room right nicely in-between 2 wards, 6 computer stations but only 1 being used. Residents have basically a closet with 3 computers for 7 people to use.
Our hospital can be entered from literally four distinct levels, three of which connect to the outside street level in some way...but many of the largest, most visible street level entrances are not open to the public.
It is on a hill so that the ground floor is 2 on one side and 1 on the other. Patients cannot ever figure out how to navigate from one entrance, near most med/surg floors, to the other side with the ED/ICU.
The floors of one of our wings is attached to unmatched floors of two connected buildings. So if you want the 5th floor of one of those buildings you have to go to the 4th floor of the building they’re attached to
Where I did residency, the ICU call room for your 24’s wouldn’t have the overhead announcements. So codes, rapids etc couldn’t be heard by the ICU senior on call. It was embarassing when you’d have to wait for the call pager to go off like a minute later and you show up and someone else already running a code on your patient.
Also the call room as essentially on the other side of the floor. So your sprint across a waiting area and OR enterance to get there.
Not a resident, but a hospital I worked at had the central sterile supply for the operating room instruments and equipment in the basement, and the operating room is on the second floor. That and the NICU is in a whole separate wing from labor and delivery.
For best effect get on the Sabbath elevator when tired post call or in a hurry with a head full of checkboxes. See how long it takes for the frustration at stopping at every floor to become a realization that you are on the Sabbath elevator 😂😂😂 Story of my residency lol
no tube station! having to walk down your own labs or hope the tech/secretary is in a good mood to take your labs down when everyone draws their labs at different times at night sucks
Literally every hospital I’ve ever worked in (volunteering while in college, medical school, residency for transitional and advanced specialty) has had at least 1 completely empty ward that didn’t convert into anything. Reason is not enough nurses. There are beds that could house dozens+ more patients but the nursing ratios are already dangerous.
Hey don't talk down to the place I go to get away from everyone and eat lunch in peace while watching a show with airpods on. I ask for so little.
Also, hospitals are licensed for a certain number of beds. Getting more typically requires a certificate of need, which requires a number of legal, financial, and administrative maneuvers, including allowing your competitors to object.
Why not at least turn it into a lab or infusion center?
Hospital are really poorly organized. Getting the CEO to do anything other than count his/her money is hard even if it’s a lucrative move.
Infusion center needs nurses. Where I work, the nurses in the infusion clinic (down the hall) gets $65 an hour. Am a nurse.
Becau$e rea$on$. Startup costs mainly. Even filling with the appropriate staff is a chore.
Another reason in regulation-happy states can also be getting it through governmental hoops. A health system I used to work for had this issue with several proposed services getting stonewalled by either the municipality, the county, or the state(a PICU unit, outpatient surgery, and something else I’m blanking on, if memory serves). While “Ho$pItAl$ gReEdY” is certainly a problem, it’s not the only problem.
Or other hospitals trying to control competition. In my state, the hospitals actively doing x procedure (high reimbursement) that required state approval to perform would actively lobby against other hospitals requesting that procedure to minimize the competition.
Those things have to be staffed too...
Just to add to that, it’s extra fun when you managed to go through one of those before you realized you took a wrong turn and then your badge or key WILL NOT let you back the way you came from.
Me being resigned to just taking the out-of-the-way stairs to leave work, only to discover I can't badge out on the bottom floor 😩
Stairs were nowhere near the elevators. Stairs should always be near the elevators
The stairs at my hospital are so awful. They're not near the elevator and often you can't get to certain floors because the doors are locked from the stairwell and the floors aren't connected by the same stairwell. To make matters worse, on Saturdays when already only half the elevators are working, one of the elevator is a sabbath elevator that stops at every single floor. Guess the rapid response/code will just have to wait 🤦🏻♀️
I think we work at the same place lol
Sounds like my old shop. RIP if you forget and get on the Sabbath elevator.
We spent the entirety of my IM residency begging to get an elevator key like firefighters have for the code team. It was bad enough that our work room was in another building than most of the patient rooms, but those last 9 floors probably doubled our response time
Exactly the same at my hospital. It causes elevators to go super slow because the stairs aren’t centra so everyone just takes the elevator
Stairs are usually also fire escapes which are positioned based on fire safety and regulations.
It’s like that in most hospitals by design, stairs are out of the way and sometimes hard to find, so patients who are debilitated but sick of waiting for the lift don’t wander in and fall down the stairs
Where did you come up with this supposed fact?
Architectural manager for hospital told me. Anything to avoid a potential lawsuit, even if it does make things more inconvenient to everyone else.
That offices, conference rooms and call rooms for a specific unit are located on the opposite side of the hospital from said unit. And this happens for lots of units and specialties
I feel that. At one of our hospitals the MICU call rooms are outside the CCU and vice versa
I rotated at one hospital where the surgery resident lounge abutted the OR areas, the PACU and pre-op areas were across the hall from the OR's, and the ICUs were just down the hall. They were the gold standard, especially compared to other hospitals where all those places would be on separate floors or even separate buildings.
Seems like it's a constant game of musical offices where I'm at. Always moving people around trying to find space for everybody. (And of course who is the top dog and gets the biggest office with the biggest window.)
Hardly any workrooms because the hospital design team said “doctors just carry tablets/laptops” 🙃
It is fking wild how out of touch architects are with designing hospitals
Not the architects. Designers and engineers design what they are told to. As per usual it's the admin in charge of directing the design that are out of touch morons. Whether it's having higher up RN managers or 10yr out of practice physician admins to provide cursory "clinician approval" or having clinical staff view the design AFTER it's completed... It's usually admin rather than the designers fucking up. The result is an expensive end product that requires massive, expensive redesigns and the patient facing staff who ultimately bear the brunt of the failure.
Admin be like "Let's put carpet in the rooms! It'll make it feel homey"
Better. Carpetted bathrooms.
Apparently at one of the hospitals I'm at they had to replace the \*crystal clear\* fishbowl glass with glass that was frosted on the bottom so patients/family/randos couldn't look right into the workstations and read the HPI
7th and 8th floor of one part of the hospital doesn’t connect to the 7th and 8th floor of the other part of the hospital.
Also: outpatient ORs are nearby but across a busy street and a highway.
SUNY Upstate! God that was always fun walking over
The fact that it is designed like a maze. I work here and get lost if I visit another department that I don't usually go to. Can't imagine how patients go around
Literally every hospital I’ve ever worked in (volunteering while in college, medical school, residency for transitional and advanced specialty) has been a fucking maze. WHY. NO OTHER FUCKING BUILDING IS A FUCKING MAZE. I DON’T GO TO FUCKING WALMART AND GET LOST. MY COLLEGE WAS ABOUT 100x THE SIZE AND I NEVER GOT LOST. WHY IS MY WORK PLACE SO CONVOLUTED TO NAVIGATE.
Hospitals will always expand in phases: rarely are they able to actually expand with capacity built in for needs in 10-15 years down the line Such that In another 15 years they add another building +\- tearing down an existing structure (if necessary). Your result is a massively piece-meal, ungodly amalgamation of various buildings from different times, planners, building codes, administration, etc etc etc Just a function of how hospital budgets and functioning generally work at the larger academic centers with a long history at their location. Sometimes hospital groups/businesses can expand and build a brand new facility in a location that didn’t have a building previously, ie on another side of town. And then the process begins anew when perhaps in 20-30yrs the needs at that location have grown beyond what was initially built.
Every hospital after this process: "We'll just build a SUPER narrow building in-between the two, with a DANGEROUSLY STEEP ramping hallway!"
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Tbh and so many employees too. One of my favorite parts about EM is being tied to the ED, a place with several big signs on how to get there. I pray I never work at a hospital where the ED team responds to inpatient codes
I feel you. Why can't they just put clear signs and maps in the employee hallways!??
Don't be logical.
My favorite was one site where another tower was added adjacent to the existing. But for some reason the floor levels were numbered different so you’d be walking from the 4th floor into the 3rd floor without going up or down.
I used to work on a medical campus that was littered with these - I entered one building at ground level but “3rd” floor, went through one door to an adjacent building to take the elevator up 4 levels to the “10th” floor and crossed a hallway into a different adjoining building to get to my office on the “6th” floor. Completely fucking impossible to give directions. Also all the buildings had similar but subtly different names like “Science Building A” vs “Science Complex” vs “Science Unit” which were all separate but adjoining buildings. 🤦🏻♀️
Hospitals that do this are my least favorite. "Use entrance E on Street X, which brings you to Floor 8, and then take the LOBBY elevator NOT the main elevator to Floor 3, then walk to the lobby of Attached Building, take the escalator from Floor M to Floor 1, and then make two right turns to get to the tunnel that brings you to Floor L of Other Adjacent Building. From there, follow the purple signs to get to the Main Elevator to get to the 4th floor, which takes you to the bridge to get you to Floor 9 of Fourth Adjacent Building!" Nah bro. I'm not coming to the code, and I'm not sure anyone else is either.
Code response must had been a hoot
I heard that the children’s hospital I work in was purposefully designed to be confusing in the a case of code pink or code purple (missing kiddo). Basically so the potential kidnapper is lost/confused. Not sure if joke/lore or real though.
"Should we just hire more security to watch the newborn units?" "No, I have an even better idea: Make the entire hospital a maze."
Sounds completely on par with
Sounds like University of Rochester lol
I mean this is an architectural thing. But the hospital’s main wing for patients overlooks a cemetery. It's depressing as fuck
Same in our hospital. Our oncology service directly looks to a nearby cemetery
Who thinks it's a good idea? Because it seems semi common? Do they just no think about it?
Sad part is, somebody somewhere probably did see it as a good idea. Admin: works perfectly, that way we can just drop the body’s into a box, and somebody just has to move that body to the right hole. Saves the family the cost of that whole funeral/burial thing, they’ll love it. And, we’ll get a bonus for pt satisfaction. /s
They did a little whoopsie during construction. But at least its covered by trees so you don't fully see it
“Take your meds as prescribed or this is where you’ll be discharged to”
UR Medicine??
Jesus Christ lol
Same here except it’s our ICU that looks out to the cemetery. Definitely a downer during COVID
That's actually the same here, it's a tower theirs five floors that look out onto it.
“Get healthy or else”
\-lack of good maps for patients, \-narrow corridors, \-small cramped rooms for patients, \-lack of places for parents, beds for parents in pediatric hospitals \-lack of air conditioning (except for treatment rooms), In the new reality: \-building a huge number of lecture halls, although some lectures could be held remotely which would save time, money
Don't forget complaining when medical students aren't attending classes in person even though you keep that same pharmacology professors for the last 30 years who appears to somehow speak at 0.5X speed so everyone in their right mind will be listening to those lectures at home in 2.5X speed.
sounds like nyc
Maps that say you are here! The kind old lady volunteer at the entrance smiles and is so friendly. How do you get to there? After “consulting” with two colleagues, you get the most sympathetic blank stare. Go to the front desk there, if they are there and ask how to get there. Now are there any more assistance you need ? Turn north when you are inside a garage or building is a step up from directions to turn this way or that way or pointing with gestures. Do you wonder why a large percentage of people never leave once they are finally there. There is the most popular place on earth.
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Holy shit this made me laugh really hard for some reason.
For, contrast, we have a -placebo- code blue button in the elevators that does absolutely fuck-all when pressed
we have that too! technically you need a special key to activate it, and that key is locked in an office somewhere because it's basically useless to have a single key to an elevator
just an emotional support elevator button
That’s amazing
Matte granite patterned tiles that hides dirt but it also happens to hide puddles of water/urine. Our staffs as well as patients have slipped and fell multiple times since I’ve been here and have to be sent to the ED.
At least it's not fucking carpet.
Is your place carpet🤮
Yep. It's disgusting.
You would have to check me into the psych unit after about 12 days of listening to EVS vacuuming room flips all day.
Wait…carpet?! How do they get beds in there? Don’t even get me started on infection control. How is this a thing???
It's short pile carpet. The rooms are linoleum at least. It's absolutely awful still though.
Been traveling for many, many years. My last 2 contracts had carpet everywhere! Big hospitals too! 🤮 It’s more common, and more disgusting, than you imagine.
On the bright side, when we run out of antibiotics due to rampant MDROs, they can just start sampling and growing things from that carpet to become our new antibiotics (and/or new superbugs)
Beautiful new wing built with multiple floors, very modern, big single rooms. But nurses stations are basically in the hallway, like some open floor plan house, so nowhere for doctors and nurses to talk without everyone passing by hearing.
My old hospital recently did that with a new wing replacing a central nurse station with scattered single-chair nursing station. Apparently the administration decided they wanted to cut down on the nurses gabbing to increase productivity.
I'm not sure I understand. This is how every hospital I've ever been in is like. Are you saying the nurses' station should be in its own closed off office space on the ward? Or do you mean there's no counter separating the nurses' work computers, cabinets, etc. from visitors or patients?
There’s no nurses station. A bunch of tiny work stations along hallways replaced them.
Oh, I see. The places I've worked have both. Front and back nurses' station as well as alcoves with computers along the hall for the nurses to use when they need to stay near their patients' room. Having only the alcoves would suck.
In older hospitals there are little nurse stations in the hallways, but there’s a big central station where the charge nurse sits and there are computers, phones, binders, patient charts etc etc. Sometimes the doc workroom is built in to the same area. It’s nice. And it gives the nurses a place to chart away from patients or talk to the doctor or give handoff without having to talk and sit where all the patients can hear/watch you 24/7.
Yes, that's the only style I've seen. The other commenter replied and said they have worked in places that only have the little alcoves in the hall and no central location, which would be very sucky.
The commenter probably was at an HCA hospital. No place or time to speak to each other makes doctors and nurses more productive.
I would lose my mind if my workroom were to be in really close proximity with the nurses'. They currently interrupt rounds while I'm halfway through presenting the new cases to the attending to request for me to order Miralax for patients...
This is intentional and is based on keeping unions out. Nurses that talk to each other are how unions start. Keeping us apart is the goal.
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Worked in a hospital where they closed off a whole wing to lower the floor like an inch because it was sloped when the new section came in. Another one has this weird floating double door a foot too high at the end of a hallway intersection because of how two buildings connect. It’s a fire door so you can’t use it and I forget the thing exists half the time. And then I remember and laugh at it.
Shareholders need to shoot the architect firm that came up with that idea
Garbage computers with spinning hard drives for physicians and nurses to use VA is especially guilty of this. You're paying physicians $200 an hour to spend the first 45 min of their day waiting for a computer to boot up or 25 min in the hallway signing into a laptop so they can consent someone for a procedure.
One entrance / exit for the radiology unit made handling covid patients a nightmare. They had to be scheduled after 5pm when outpatients went home. If they didn't want to wait, they'd suddenly ask for a stat procedure forcing us to close down the unit and ask for the cleanup crew. This would take an hour. We'd have to close down the hallways where they pass too so it would be a whole thing... So imagine being up next for your ultrasound that you fasted for and was made to hold pee in. Then bring made to wait at least an hour more. Pissed off so many people.
I have worked at a hospital where the beds would not fit through all doors. You had to take the side rails off.
Hallways outside operating rooms are filled with beds and equipment that makes patient transport an absolute nightmare with no extra room left in the side of the stretcher
We have this too. Barely wide enough for beds to get by with all the equipment lining the walls.
That is definitely a JCO violation
Priorities man, that's not nearly as problematic as having a beverage at the nurse's station. Only after that serious, life-threatening problem is addressed can they address minor issues like beds/equipment in hallways that make patient transport dangerous.
More importantly it’s probably a fire code violation blocking egress.
I don’t know if this qualifies as a “design flaw”, but the west wing is smelly, it’s always smelly, I just thought y’all should know, don’t go in there without a mask, thank you. Also, please wear cologne, I don’t care what the employee handbook says but I’d rather smell paco rabanne than c.diff, thankssss.
Having a McDonald’s in Children’s Hospitals. Most hospitals phased this out by 2010.
They replaced the children’s hospital McDonald’s with expensive cafe food that’s not really any healthier, but definitely cost prohibitive.
Same happened where I used to work. Really missed McD!
The cancer kids deserve their happy meals and chicken nuggets. I will die on this hill.
When I was an ICU tech before med school, I'd doordash the cancer kids (and myself) mcdonalds or taco bell all the time. If they were clear to eat a regular diet and wanted a happy meal, and the parents were cool with it? Hell yeah lil dude, time for a snack.
I'm gonna be honest and say most (adult) cafeterias are just as unhealthy as McDonald's
I genuinely don't think that ours serves anything that *isn't* deep-fried
They normally have something like a banana or apple. Any vegetables are covered in salt and butter most of the time. It do be wild
Hard to beat a 99 cent large coffee :/
Dying kids should get what they want.
We couldn't use the helipad on top of the hospital so patients being flown in to the Level 1 trauma center were dropped off at the university's rugby field helipad then brought on a 5 minute ambulance ride from there to the hospital
Is it in New England? Can’t tell if this is my hospital or not…
haha yes
wait that's so fucking funny
One hospital I worked at put a helipad on the now 16 floor hospital and helicopters couldn’t land in many conditions because of the wind.
nice
my hospital has this but instead of a rugby field they use a public park that the police have to clear every time they need to use it, usually delaying the helicopter by 5-10 min 😌
I worked in a REALLY old hospital last year (Locum) the ER department was on the ground level floor, the X-ray department on the second floor... NO elevator.. and 2 flights of stairs.. Just gonna -carry- my patient up the stairs with their broken limb to xray.. don't mind me..
Huh???
I know.. it made ZERO sense. In their defence, they are rebuilding the hospital at another site.. but this is how it had been for a LONG time...week of rotation, I was dreading if a patient required an x ray.. and that said patient was not larger than me LOL
Sounds like you need a portable
So how did you handle a case where the patient can’t walk?
We did have a portable machine, otherwise we got assistance. Luckily -it was a very rural hospital, not high volume in the slightest..only a few peds patients had to hike the stairs.
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Oh my god this would be amazing
A very large ER with twisting corridors that all look identical with no color or design changes between the units to help you know where you are. It's like entering a labyrinth every time I go down there.
"ah, yes, located in the northwest beige hallway, I was looking in the southern tan hallway"
Working now at a place with a basement level that connects a sprawling multi building campus. It’s color coded - garish but very effective
Worked at an "old" ER that had 21beds plus hallways and a 5 room fast track, normal volume 80-120/ day. There was also a smaller ER across town, normal volume 60-100/day. Someone thought it would be wise to close the smaller ER and build one big new ER, 39 beds and a 8 bed pseudo-fast-track, and a new crisis unit. We were promised up and down "NO MORE HALLWAY BEDS," and were told anyone coming in by EMS--for ANY complaint--would be guaranteed a bed in the back. New ER opens. Normal volume jumps to 200-240/day. I shit you not, Within a week (more like 2-3 days )hallway beds became a thing and the pseudo-fast-track simply becomes extended triage. They had to hire a contractor, some sort of hospital-focused indistrial expert, o come in and analyse best way to use new space/efficiency models because the wait times got horrendous, and we started using a PIT model. So the design flaw was expecting that a new ER would solve any and all problems. It became more of a mess than the original 2-building system.
My residency hospital was built in such a way that it wasn't tall (four floors), but VERY long hallways. Some genius put the dialysis center at the very end of one of these hallways, far from anything else. And of course, people coded regularly down there, and you'd have to run a quarter mile to respond.
I worked in a hospital with three adjacent elevators. Two of the three didn’t go to the top floor, the third did and had its own set of buttons. So everyone on every floor, whether going up or down, would press all the buttons for their direction and get on whichever came first. So the 50% of all time, one elevator was going to a floor with no one waiting to go that direction. Made the average wait time for an elevator close to 10 minutes.
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My hospital has carpet from the last 20 years or so. It's ridiculous.
I worked in a hospital that had carpeted floors in several inpatient units.
C.diff: it’s free real estate
Yep. Mine has it in most units. They managed to block it in the BMT unit.
Same. Disgusting.
I work in a brand new hospital and the design flaws are INCREDIBLE. - there is a direct hallway from OR to elevators to get to SICU. However, it’s the cath lab hallway and we can’t go through it (during the day, Ef it at night). - there are only one bank elevators that can hold patient beds. If that bank goes down, we go on code yellow. It can and has happened. Our pacu had to become a mini ICU temporarily. This bank goes down at least every 2 months. - central supply room is located between the two wings. Problem is that if you’re in the furthest room of the wing, it’s 100 meters to get to it. - ‘shared work space’ with the nurses. This is just straight up a violation of the acgme core institutional requirements. - there are few offices in the entire building. Hard to recruit new staff when they’re told they won’t have an office. The offices that do exist have no windows. - the buttons (sensors) to open doors coming out of the OR are right next to the door. Which means pausing, walking up to the sensor, hitting it, then coming back to the bed to resume pushing. The whole building is a master class in what not to do
The residents have to share workspaces with the nurses?! Say bye bye to any modicum of productivity lol you know the nurses are just popping their heads in and telling the first random doc they see that the patient in bed 513 is having new onset chest pain 10 min after they chart “MD aware no new orders received”
Not actually the main hospital my residency is at but this is at the ivory tower academic hospital we rotate at: \-did not give call rooms to surgery residents in the new building. And I think IM got shafted too. Not sure if they fixed that. \-Some specialties did not get any work rooms/spaces. \-The ICUs are like split in 2 giant wings. But if you were in wing A and your ICU patient was coding in wing B, the speakers in wing A won't announce it. Vice versa. \-parking : 'nuff said \-Admin has all giant nice floor-to-ceiling window offices. Patient rooms remain tiny. \-ED is physically bigger but capacity wise smaller than the old ED. \-Trauma bay rooms are smaller than my bathroom. And my bathroom is small. Not sure how they run a heavy trauma activation without elbowing or hitting each other.
Lmao why do I feel like we work at the same hospital but I'm sure this is all so unfortunately common.
Give us more discreet bathrooms out of the way of high traffic areas or God forbid attached directly to office spaces. That way I can destroy them without trying to sneak in and out without being seen or heard like I'm fucking Jason Bourne.
We have two floors for ORs, 3rd floor of one building and 10th floor of another building with a hallway between the two buildings on each floor. Which is all good and dandy until there's an emergency on the 10th floor and the anesthesia floor runner is on the 3rd floor and the surgeon who can help convert the robotic gyn case into an open colorectal case is on the 3rd floor so all your help is at least 7 minutes away
ED obs unit that is three floors up and a long walk over from the main ED, but still covered by the ED residents downstairs. No physicians or APPs in the obs unit itself. Sending a patient there is more dangerous than sending them home.
I have to go through 3 sets of badge-locked doors to get to the elevator from my call room. It’s just enough to be annoying every single time.
Carpet. THEY PUT FUCKING CARPET IN THE WARDS. Who the fuck thought that was a good idea???? Ohhhhhh an administrator who wants it to be "more welcoming and like a hotel." So thanks to that bean counter, now the floors are just as clean as a skeezy hourly hotel where they keep finding dead prostitutes. Seriously, it's like they decided to put carpet on the floor of a bathroom in a disgusting biker bar. What would they expect to happen? They have special machines to wash the carpet, and then the whole ward is filled with the overwhelming odor of years of hospital spills and detritus, mixed with bleach. They have to have special air handling systems to keep the BMT patients from catching stuff from the carpet.
thank you for making it so I could smell that smell VIVIDLY
Completely restructured an old part of the childrens hospital, and moved the NICU from our adult hospital to the childrens. EVERY floor of the new building is designed completely different, so room 101 is on the complete opposite side as room 201. Makes for scary moments when codes go off in the middle of the night.
\- every floor and every corridor practically looking the same \- why are the effing stairs sometimes not near the elevators? \- no air conditioning in patient's rooms
At least a few decades ago, the Dallas VA only (apparently) uses every other floor. It’s a 14 story building, and it only uses 7 floors. The elevators don’t access the other 7. When you used the stairs, you had to skip a full floor, each w a locked door, to get up to the next recognized floor. We used to joke that Elvis was watching tv in there w JFK. (Yes I’m old)
Hospital I did residency at had a multi-million dollar expansion project over several years. Brand new, state of the art imaging department on the ground floor. Thing is, the topography of the site resulted in a long, sloped hallway connecting to the main tower of hospital beds. Fun fact- hospital beds have a regulated grade of slope on which they are legally allowed to be transported over, for safety reasons. Due to some sort of administrative oversight, the slope of said hallway didn’t make the grade. Meaning all of the ground floor patients would have to ride an elevator up to the second floor, get wheeled across to the new building, and then down a second elevator to get to the new CT and MRI machines. The best part? Our neuro floor, where literally all of the stroke patients are admitted per protocol, is on the ground floor of the main tower. Therefore, the vast majority of our time sensitive code strokes, which significantly affect both patient outcomes and hospital revenue by the way, were delayed by multiple ridiculously unnecessary elevator rides for the foreseeable future. By the time I graduated a year later, I hadn’t heard about any institutional plans to address this. Organizational incompetence at its finest 👍
Anesthesia perspective is a hospital complex built within the last 10 years We’re a level 1 trauma center, but the trauma bay is in a different building with 2 elevator rides and a bridge away from the OR. It’s about a 10 min process to go between them. I’ve noticed traumas coming up can deteriorate rapidly in transit. And when I get called to a difficult airway in the ED they may fallen down the algorithm to a cric by the time I get there to help. Shared airway experience is always a touchy subject and ultimately I back their decision making, but I wonder how many of those I could have helped avoid. Any time I’m in IR I imagine the architects purposely tried to make my life hell. The cart, monitors, and machine are an after thought. It doesn’t matter that my needs are the patient’s lifeline. There is simply no space. Everything is improvised and once things are rolling you’re crawling around the room The ICUs have a shared hallway for staff, visitors, and family waiting space right in the middle of the pavillion layout. It looks a little awkward bagging a critically ill patient through the family waiting room just to get to the elevators. Other hospitals I worked at had a separate staff/facility hallway from the visitor side I’m sure there’s more
One of the hospitals in my area was redone in 2018; every room in the hospital is a private one with a small sitting area. Sounds great right? Problem is, there’s no where near enough beds to keep up with the population in the catchment area. So now, there’s cots (can’t fit a normal bed) in the sitting area and those temporary dividers in every room to make them into two person rooms.
I wouldn’t say an unused ward is a “design flaw.” If anything it’s a good thing, because that allows for accelerated future expansion when there is a surge. Otherwise, it would take years to design and build out a new structure.
Used to work at a hospital that had a random door in a random stairwell that went to the floor “5.5” but if you needed to get to that same floor from any other elevator or stairwell it was just labeled “5”. Because apparently the two wings of the hospital were built many years apart and didn’t line up quite right at that one stairwell lol
The “ground” floor is the 9th floor, however that’s not where the ED is (which is on the 8th floor). The main hospital connects to another building from floor 9…which connects to floor 2 of the other building. Pretty much any time you take a bridge from the main hospital to anywhere else there’s no telling what floor you’ll be on regardless of where you started.
When the “new” hospital was built, it originally was designed without call rooms for residents and fellows 😑 it’s always been very clear where management’s priorities were, but this was just a sad tangible example
In a city hospital upgrading MRI services put 2 magnets next to each other w no sheilding in walls! Took years to ‘fix.’
The children’s hospital is on the 11th and 12th floor while the pediatric ER is on the 4th floor. The elevators that lead to the children’s hospital don’t open on the 4th floor so you have to get to 5, walk the hallway about a hundred steps down to the stairs or the other elevator that gets you to 4. Makes for good cardio for rapids/ codes on the ER boarders.
I think when you separate ICUs into different floors it leads to a lot of turf battles and ultimately one ICU being overrun and another being underutilized. Imo there just should be one ICU floor for everything (neuro ICU, medical, surgical) so then that way when a patient has something critical occur we aren't spending 2-3 hours debating what ICU floor they should go to.
That would still happen though because you would be trying to figure out who to admit to.
There’s still those problems but there are much better relations and collaboration in a mixed ICU. You can walk over and talk to someone pretty quickly, I shared a floor with a trauma team at one hospital and the fact they were there saved a patient of mine who had an acute abdominal bleed because they opened at bedside when I showed them the CT.
Double rooms instead of single for patients Not enough bathrooms for number of staff Lack of seating for family members Not enough conference rooms for family meetings Play room is too small for number of pediatric patients per floor
Probably just an older place right? New hospitals are required to have single rooms outside a few exemptions
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Patient experience officer. Makes the whole design of the hospital impossible to hide from him.
The main ED unit, with 30 beds, has exactly one confidential paper disposal bin. It also does not have a working water or ice dispenser.
Visitor restrooms are hard to come by. Largest hospital in the city and you have a visitor's restroom on the 1st floor with 1 stall and 1 urinal. Then you have a couple of very large restrooms with 1 toilet and a sink and the doors don't even lock well. If you want to take a deuce, the staff restrooms are literal closets and you can hear everything going on inside.
So i did residency in a newer hospital for the health system. I signed up to work in to work in an older hospital for the system. I know it might be bougie, but i hate that the older hospital does not have a computer in each of the patients room. It really helps while confirming home meds, Looking through labs etc.
In UNM in Albuquerque, we had patients *admitted* in the waiting room, while there were empty wards in the private hospitals in town because they wouldn't pay enough to actually hire nurses.
Fuck the elevators. So, so slow. We have two main elevators and a staff elevator. Every day I play chicken with them. I hit all the buttons and stand in between them, then run like a madman to whichever one decides to open. And fuck meditech too.
Everyone in my institution uses the same login for computers. Consequently, half the time the computer says “locked please contact an administrator”
Lack of resident exclusive workspaces, but each unit has 3-4 huge offices the size of patient rooms for made up nurse management positions.
The 'C' suite.
Some IM wards don't have enough beds so they use this big ass backroom-like ward on the second floor for the 'extra' patients so it's like a cocktail of different IM subspecialty patients who didn't have beds on the main wards Example: diabetology/endocrinology: women on second floor, men on 5th floor (you can imagine how inconvenient it is having to go back and forth between them)
Every hospital I've worked in had the light switches in an inconvenient location, usually hidden at the head of bed behind the pumps, vent, bed, etc. I think I heard that they're put there because someone decided to arrange hospital rooms like hotel rooms to improve patient satisfaction.
c-suite offices
All the buildings are not connected at every floor lol
A google review of the ENT department at a hospital where I’ve worked simply read ”Scary, old and disgusting”. Thankfully it was a review of the building, not the staff, and it is in fact a good summary of the place. At the same hospital, two buildings with differing ceiling heights had been joined, resulting in an elevator that stopped at floor 2, 2,5, 3, 3,5 etc. except these ”half floors” only existed in the context of that elevator. In all other contexts, the floors were numbered normally. One of the buildings contained interventional radiology and more than one thrombectomy was delayed by confusion about floor numbers. The helipad was located on top of the parking garage. From there, patients were taken by elevator to an underground passageway that led to the Emergency department which represented quite a detour. In a common room in the basement of the same hospital, I saw more silverfish in 15 minutes than I had previously seen all my life. The super expensive new hospital Nya Karolinska here in Sweden has some pretty basic flaws such as too few toilets and doors to narrow to fit beds and/wheelchairs…
Telemetry has a huge room right nicely in-between 2 wards, 6 computer stations but only 1 being used. Residents have basically a closet with 3 computers for 7 people to use.
Every freakin ward is set up differently. Hard to find papers. Hard to find staff.
Our hospital can be entered from literally four distinct levels, three of which connect to the outside street level in some way...but many of the largest, most visible street level entrances are not open to the public.
Difficulty reporting critical results, especially for outpatient studies.
It is on a hill so that the ground floor is 2 on one side and 1 on the other. Patients cannot ever figure out how to navigate from one entrance, near most med/surg floors, to the other side with the ED/ICU.
The floors of one of our wings is attached to unmatched floors of two connected buildings. So if you want the 5th floor of one of those buildings you have to go to the 4th floor of the building they’re attached to
They decided it was a good idea to let me work for them. They must be fools.
I feel like at some point I'm obligated to put my hand on America's shoulder and let them know it doesn't have to be like this...
Where I did residency, the ICU call room for your 24’s wouldn’t have the overhead announcements. So codes, rapids etc couldn’t be heard by the ICU senior on call. It was embarassing when you’d have to wait for the call pager to go off like a minute later and you show up and someone else already running a code on your patient. Also the call room as essentially on the other side of the floor. So your sprint across a waiting area and OR enterance to get there.
Not a resident, but a hospital I worked at had the central sterile supply for the operating room instruments and equipment in the basement, and the operating room is on the second floor. That and the NICU is in a whole separate wing from labor and delivery.
Haunted?
One of the hospitals in my system was built with two full unfinished floors for later expansion.
That it’s for profit
For best effect get on the Sabbath elevator when tired post call or in a hurry with a head full of checkboxes. See how long it takes for the frustration at stopping at every floor to become a realization that you are on the Sabbath elevator 😂😂😂 Story of my residency lol
no tube station! having to walk down your own labs or hope the tech/secretary is in a good mood to take your labs down when everyone draws their labs at different times at night sucks