North Dublin Regional Hospital Project: development of amaximum care and teaching hospital of 1000 beds for North

Dublin on the site of the existing Mater Misercordiae Hospital:preliminary feasability study

Item type Report

Authors Eichhorn, S; Sahl, R J; Deutches Krankenhausinstitut e VVorstant

Publisher Deutsches Krankenhausinstitut (DKI)

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North

Ocve!opment of a Maximum Care and Teaching Hospital of 1.000 beds for North

Dublin on the Site of the Existing Mater Misericordiae Hospital

Preliminary Feasibility Study

•

July I. 1969

TABLE OF CONTENTS

Chapter 1 Introduction Pagtl 1

Chapter 2 Objectives Page 3

Chapter J General Location of Mater Hospital Page 8

Chapter 4 Site Page 10

Chapter 5 The existing hospital Page 14

Chapter 6 Further development of the existing hospit al Page 17

Chapter 7 First stage of development Page 21

Chapter 8 Conclusions Page 24

Appendix A

Appendix B

Specialised services which would be provided in North

Dublin Regional Hospital

Tentative outline of the provision to be made in Stage I

of the development and facilities which it is envisaged would be shared between the hospital blocks

Page 26

Page 27

LIST OF DRAWINGS

No. I The Hospital in relation to the population to be served

No. 11 Site of the Hospita l within the traffic structure.

No. III Hospital Site with reference to Town Planning

No. IV

Berlin Teaching Hospital ( 1 ,400 beds) on Mater Hospital site

No. V

Basic lay-out of fu ture development

No. VI Lines of basic circulation within the Hospital complex

No. VII

Functional concept of the Hospital complex

No. VIII Basic lay-out of First Stage Development

No. IX Schematic Elevation from South

No. X Allocation of space in First Stage Development

1.0

1.1

Deutsches Krankenhausinstitut (DKI), Dusseldorf

PRELIMINARY FEASIBILITY STUDY

Development of a Maximum Care and Teaching Hospital of 1,000 beds for North Dublin on

the site of the existing Mater Misericordiae Hospital

Introduction

Recommendations of the Consultative Council on General Hospital Services

The Consultative Council recommended that, if it is possible, it would be preferable to use

the existing Mater Hospital as a base on which the major regional hospital group of about

1,000 beds for North Dublin might be developed. (For detai~s as to the nature of the

specialised services which would be provided in the hospital see Appendix A). They pointed

out that as the Mater Hospital is in excellent condition, the development of the remainder

of the site would rcprcsent the most economical and quickest solution of the problem of

providing a comprehensive institution of adequate size in the area. The Council also advert­

ed to the possibility of other property becoming available adjoining the Mater Hospital site,

which could be used in long-tenn plans for the development of the group hospital project.

I.

1.2

1.21

1.22

Problems which are the subject of the Preliminary Feasibility Study

The question is to consider the feasibility and suitability of developing a regional teaching

hospital on the Mater Hospital site. If this is not possible within the boundaries of the

existing site there is the question of approaching this plan on condition that adjoining"

property is acquired and existing buildings in these areas are demolished.

If the questions as to 1.2 1 are answered in the affrrmative is the constuction of a new

hospital block of 420 beds including supporting services which would be shared with the

existing Mater Hospital and the private nursing home thought possible?

2.

2.0

2.1

OBJECTIVES

Reasons for Concentration

The concentration of hospital care recommended by the Consultative Council is considered

important and necessary from the medical point of view as well as from aspects of medical

teaching.

Hospitals which provide medical teaching and regional specialist services must have a

sufficient number of beds in view of the requirements of modern medicine and medical

technology. Significant reasons in favour of concentration are the increasing degree and

inevitable growth of specialisation and super specialisation and in this connection the

resulting requirements of staffing.

In addition, a further important argument is the need for institutes which are a pre­

requisite for modem diagnostic methods and therapy as well as teaching, especially of

anaesthesiology, radiology, laboratory medicine, physical therapy and pathology. According

to modern standards these institutes, too, need as a basis some 1,000 beds .

•

3

Modern hospital care and teaching services require very close co-operation of different

clinical diSCiplines and institutes, Le. in other words, the physical accommoGation for these

should be placed close together. An attempted co-ordination of effort between institutes

and disciplines in separate hospitals at dispersed points would not give the same results as

facilities concentrated in one area.

Another important reason in favour of concentration is the economical aspect. Concentrat­

ion of regional specialist services and teaching facilities means lower capital investments and

operational costs than if the same services and facilities were provided at a number of

locations. The alternative would either be acceptance of a lower standard of services or, in

assuming similar standards of services, a high increase in costs, especially in staff and space

requirements.

4.

2.2 Objectives as regards the situation of patient care in Dublin

In Dublin there is no hospital of bed capacity and range of services which would meet the

requirements of a modern regional specialist and teaching hospital.

Cities which are comparable to Dublin generally dispose of large university hospitals, partly

comprising 2,000 and more beds. We consider from our experience that teaching hospitals

disposing of about 1,000 beds tend to give more acceptable results from the medical and

economical point of view.

Considering the requirements of modem regional specialist services and teaching facilities,

of the hitherto existing development of patient care in Dublin, and of the structure of the

City of Dublin and the surrounding area, it is thought important and suitable, according to

the present experience, to aim at providing regional specialist services and teaching

facilities both in North Dublin and South Dublin.

5.

On the other hand, as regards the population and their need of patient care services, it is

from the medical and economic point of view out of the question to run more than two top

care teaching hospitals in Dublin.

2.3 Outline Programme Provision (See Appendix B)

The outline programme at hand for the development of a regional teaching hospital in

North Dublin on the site of the existing Mater Hospital will on the whole meet up-to-date

requirements. The tentative outlines for the total area including provision for circulation

and communications with a total of about 350,000 square feet will meet with the

requirements of the hospital development proposed.

There are no considerations against starting from this base in the further development of

the programme. It is, however, considered to be extremely important for programming and

designing to emphasize the need to provide for changing requirements in the future, and in

this connection to secure that future expansion will be possible. This applies especially to

such disciplines as radiology and laboratory medicine as well as out·patient services. In these

cases, provision for even minor expansions in the short run should be allowed for.

7.

No. I

The Hospital in relation to the population to be

served

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CITYCENTER

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3.0 GENERAL LOCATIO\,< OF MATER HOSPITAL

The location of the existing Mater Hospital is favourable for a regional teaching hospital in

North Dublin. On the one hand , it is situated favourably as regards the city centre and on

the other hand as regards the arterial roads opening up North Dublin and the adjoining :

northern area (see Drawings Nos. I and 11).

The favourable situation within the traffic network of North Dublin will guarantee that

motor vehicles and public means of transportation will have reasonable access. The centra]

location of the Mater Hospital as compared with a suburban location is looked upon as

favourable above all as regards patients, their visitors and staff.

Central hospitals enjoy a higher popularity than suburban hospitals. The possible advantag­

es of a location with less noise, and more attractive scenic surroundings do not make up for

the disadvantages. In this connection, the relatively short average duration of patient stay in

a highly specialist hospital should be borne in mind .

•

8.

No. II

Site of the Hospital

within the traffic

structure.

CITY CENTER

N ~

Accessibility for out-patients also needs emphasis. As a matter of course, the centrally

situated hospital will also facilitate the visitor of the patient. The advantages of central

location must not be undervalued as regards staffing.

We know from experience that staffing of central hospitals is connected with less

difficulties than the staffing of suburban hospitals.

The central location of the hospital would offer advantages as regards the increasing

number of part-time personnel and the increasing number of married staff that is likely to)

be employed in the future.

9.

No. III

Hospital Site with

reference to Town

Planning

TF .... ('!Ul;': IIOSf'ITAl AREA

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4.0 SITE (See Drawings Nos. JII and IV)

The available site of the Mater Hospital comprises about 534,000 square feet.

About 534 square feet would then be allotted to one bed.

Ideally, we think that between 550 and 715 square feet per bed would be desirable if a

major teaching hospital lies in the centre of a city.

This would assume that provision is made on the site for staff residences, laundry, central

sterile supply services and so on. If such services are provided off-site the area required

ideally per bed can be reduced.

When examining the best location for a building, however, the size of the site is not the

predominating factor but above all the shape of the site .

A further question is whether additional site space can be obtained in the long run in a

location or locations favourable for an expansion of the hospital complex.

o

No. IV

Berlin Teaching Hospit-

al (1,400 beds) on

Mater Hospital site

,

The shape of the Mater Hospital site and the possibilities for land acquisition for extens­

ions offer very favourable prospects for the development of a regional teaching hospital on

the site.

To begin with, it is of advantage that the available site is of such shape and so orientated as

to facilitate the development of the ftrst stage -of the proposed expansion without interfer­

ing with the running of the existing hospital.

Secondly, a development in the location proposed would pennit of later organical develop­

ments and would not interfere with the possibility that the existing main hospital building

might in the future require to be replaced.

The available site could best be extended to the East and South, which is of advantage

looked upon from the angle of hospital planning. Therefore, it is recommended on

principle that all sites obtainable in these areas should be bought.

This recommendation should be given to the Mater Hospital even if the North Dublin ,

Regional Hospital were not to be provided at the site.

11.

The suitability of the Mater Hospital site as one on which to develop a regional teaching

hospital of 1,000 beds was examined by projecting the outlines of a modern 1,400 bed

teaching hospital on the available site.

Furthermore, the suitability was examined by individual model studies of alternative

developments on the site.

A prerequisite for a positive judgment of the available site for the project in question is in

our opinion that for the far future the buildings on the site should only be used for patient

care, teaching and research.

Buildings which are not of fundamental importance for patient care, teaching and research

should be accommodated outside the site in the neighbouring area. This applies especially

to staff residences.

Services such as laundry and sterile supplies could also with advantage be provided off site.

If possible, it would be advantageous to acquire buildings and sites for staff homes at the

southern side of Eccles Street.

12.

From the town planning point of view in such a case as the development of a regional

teou;.iling hospital on the Mater Hospital site a fmal judgment will be facilitated when

alternative designs are available for assessment.

The hospital site is located in an area which has been zoned as residential in the draft

development plan for Dublin City. The zoning of an area as residential imposes planning

restrictions which are not appropriate to a hospital development. The Corporation _'of

Dublin should be asked to take steps so as to ensure that a proper hospital development is

not impeded.

It is considered that in view of the major public importance of the proposed hospital

complex the town planning authorities should keep in mind that the area between North

Circular Road, Berkeley Road, Dorset Street and Eccles Street (including the buildings on

the outskirts of the area) is a sphere of special interest for the hospital and its expansion,

and that this area should be protected by the town planning authorities against develop­

ments in the neighbourhood which might impair the effective operation of the expanded

hospital.

13.

5.0 THE EXISTING HOSPlT AL

The Mater Hospital is a general hospital and has 433 beds. It is used as a teaching hospital.

Included in the main hospital block are a convent accommodating 65 nuns and a chapel,

operating theatre facilities (which are proposed to be extended) and the main kitchen.

The remaining accommodation comprises:

(a) Out-Patients, Casualty, Laboratory and Medical Staff Residency (part single storey and

part four storey block). This building might possibly be utilised for treatment and

research purposes.

(b) Cafeteria, Lecture Hall and Lecture Rooms (three storey block built in 1968). This

building would cpntinue in its present user.

(c) Radiodiagnostic Department and School of Physiotherapy (two storey block), It may

be necessary to demolish this building which is not significant.

(d) Child Guidance Clinic (single storey block built in 1966 and now being raised to two

storeys). This building would continue in use.

14.

{e) Rehabilitation oioclc (gymnasium and remeO ial oaths. si.jg.i~stort!y block, previously

the laundry). It will be necessary [0 demolish this building which is of no signific:mct".

(t) Private Nursing Home (provides for abou t 100 patients and has its own kitch~n) . This

building would continue in use for the present. It does not intcrfac with the planning

requirements cf the first stage of the dcv'elopmcnt

(g) Maids Home (with accommodation for 91 domcstics. 16 nuns and 1 ~ train..:.: nuns.

and with its own kitchen and dining accommodation for m:lids and tht'" train~e num;).

It m~.:be desirable to demolish this building.

(h) Nurses Home and College (construction completed in 1954 ll\:wmlllodation for

240 nurses, kitchen, dining accommodation. etc. ). This building would continue in

use. It does not interfere with the planning requirements of the first stage of the

development.

(i) Boilerhouse and workshop facilities . These buildings would be H'pJacl'u .

1 5.

The nature and scope of the services in the existing hospital are of a high standard although

the physical facilities, including the equipment , seem to be scarcely adequate by modern

standards.

To fulfIl the standards required of a regional teaching hospital, however, the facilities and

scope of services would need to be considerably extended.

This should not be overlooked even though the hospital generally is well maintained and

leaves a very good impression.

As stated before, the age, condition and economic value of the existing buildings differ

widely . There is, however, no doubt that the main hospital block and the buildings

completed in recent years can be used for a long time to come.

No. V

Basic lay-out of future

development

N "..

6.0

6.1

FURTHER DEVELOPMENT OF THE EXISTING HOSPITAL (See Drawing No. V)

Access

In the course of the proposed development of the hospital it would be advisable to

concentrate all access in the one area.

From the traffic point of view it would be advisable to have all approaches from Eccles

Street with the exception of the mortuary from the North Circular Road.

In Eccles Street the area between the main hospital block and the private nursing home

suggests itself as the most suitable location for the entrance area.

From here easy access is possible to the existing buildings as well as the new buildings

proposed.

17.

6.2 Determination of use of site space'

Suggestions are now made for the use of the available site space.

The properties east and south of the present hospital site and extending to Dorset Street

and Eccles Street should be acquired as they become available.

The sites on the south side of Eccles Street are of interest for possible use as staff

residences.

The site between the lecture theatre complex, rehabilitation block and nurses home east of

the main hospital block should be reserved as the site for the first stage development of the

future main teaching hospital complex. The engineering services would be provided in the

north east section of the existing site.

From there an opecitional and structural expansion to both the north/west and south/east

should be envisaged. The grounds of the north/west corner should be reserved as an area for

future research and teaching facilities.

18.

5.3

•

Planned Development

In planning immediate developments care must be taken to ensure that future expansion

and development in building and operation is not interfered with. In this connection

planning should keep in mind the possibility that it may be necessary to replace some of

the existing buildings which for many years to come are fit for use. Only in this way can it

be safeguarded that buildings to be provided now do not some day turn Qut to be of wrong

functional concept.

The availability of financial resources must also be considered in the stage planning of an

overall development.

The basic principle for programming and designing should be that development should be in

stages - small, if necessary - but as part of an overall co-ordinated planned approach. The

gradual development referred to can be achieved commencing on the basis of the frame­

work of the available site and the continued existence of the hospital buildings which are

suitable for retention for the present.

19.

•

The gradual development referred to can be achieved within the framework of the available

site and the continued existence of the hospital buildings which are suitable for retention

for the present.

The development of the future main teaching hospital complex as envisaged in the model

plans complies with accepted principles of modern teaching hospital planning .

20.

No. VI

Lines of basic circulat­

ion within the Hospital

complex

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7.0 FIRST STAGE OF DEVELOPMENT

(See Drawings Nos. VI, VII, VIII, IX and X)

The tentative outline of the provision to be made in the first stage of development (sec

Appendix B) is regarded as an adequate base for further programming and as the nucleus for

the development of a modern teaching hospital. In this connection it is urgently

recommended that attention should be paid to recent experience in the planning of major

hospitals which underlines that in programming and project planning the need for flexibility

and adaptability to meet changing demands should be kept in mind. Programming and

planning should not detennine more than is absolutely necessary the utilisation of rooms

and the organisation of departments.

The skeleton plan for the overall development of hospital facilities on the Mater Hospital

site so as to produce an u~to-date teaching hospital of adequate size envisages that the flrst

stage of the planned development can be carried through in such a way as not to affect the

operation of the present hospital.

21. •

No. VI!

Functional concept of the Hospital complex

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It is recommended that in the first stage of the development planning should be on the basis

of a three or four-storey podium from which will arise the ward block.

The ward block would be developed on a double-corridor (race-track) plan with wards

facing east or west. A technical floor (to house mechanical equipment such as air-condition­

ing plant) would be provided between the podium and the ward block. The planning

conception suggested is designed to meet medical, hygienic and organisational requirements.

Administration and main entrance would be provided in a single storey block connecting

the present Mater Hospital and the proposed new major block.

The lines of basic circulation within the hospital complex are shown on drawing number six.

The internal circulation proposed demonstrates that in the first stage development

communication between the present Mater Hospital and the new hospital block will be •

achieved in such a way as to ensure the availability in a c<rordinated manner of services

(diagnostic and treatment) in the entire hospital complex.

22.

No. VIII Basic lay-out of First Stage Development N

'1'

Drawmg number seven demonstrates the funcTiOnal ordo.:f which ("n bo.: achieved as betWl'l' l1

the different components of the overall hospital complex. The diagrammatic illustration

shows clearly that effective integration can be achieved between the l'xisting hospital bu ild­

ings and the new hospital block.

In regard to catering facilities it is assumed that the kitchen in the southern pari o f t lw main

block will be abandoned and that a new kitchen will be provided at lower grou nd floor level

in the north/eastern section of the podium. Facilities for parking can be provided for staff

on the south side of the complex , adjoining the main entrance area . and for others to the

east of the proposed new block.

23.

No. X

Allocation 0 f space in

First Stage Develop­

ment

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• ,

N '1'

8.0 CONCLUSIONS

According to the studies made it is considered that a regional teaching hospital of 1,000

beds can be developed on the hospital site.

The site is considered adequate for a modern teaching hospital complex provided that it is

used only for patients and teaching and essential ancillary purposes. For the ancillary

facilities such as staff homes, etc. every available site to the East and South of the existing

site should be acquired.

It is also clear from the studies which have been carried out that a new hospital block of

about 420 beds with supporting services can be located within the boundaries of the

existing site without the need to acquire further site space.

The schematic solution suggested shows that it is possible to construct the new buildings

envisaged in the first stage of the development without interfering with the running of [he

present hospital and without affecting the existing hospital buildings which are suitable for

retention.

The proposed new block can be conveniently integrated with the existing hospital

organisation.

24.

•

No. IX Schematic Elevation

from South

The new block can be further developed in such a way that in the future all possibilities will

be open for the development of a completely new teaching hospital complex.

DEUTSCHES KRANKENHAUS1NST1TUT e.V.

VQRSTAND

Dr. S. Eichhorn R. J Sahl .

Dusseldorf, 1 July, 1969

25.

APPENDIX A.

Specialised services which would be provided in the North Dublin Rc-gional Hospital.

Neurosurgery (including oto-neurology).

Vascular Surgery.

Cardiac Surgery.

Urology.

Nephrology, haemodialysis and renal transplantation.

Gastro-enterology.

Major accident service.

Ophthalmology.

Oto-rhin o-laryngology .

Geriatric assessment.

Isolation Unit.

Diagnostic radiology service.

Medical research and medical education facilities.

Comprehensive pathology service.

26.

.\PPENDlX B

Tentative outline of the provision to be made in Stage I of the development and facilities

which it is envisaged would be shared between the hospital blocks.

Department

Total Area (including provision for circulation and communications)

Ward Units (Based on 70 beds on each of 6 floors) •

Special provision for dialysis

Teaching accommodation near wards (with basic laboratory facilities)

Research Laboratories (for staff and post-graduates, including accommodation

for experimental surgery, stores, technicians room, etc.

Intensive Care

Administration

Medical Records

Central Staff Changing Rooms

Private Consultants' Block (waiting rooms, etc. )

Treatment and Diagnostic Departments

Out-Patients Department (including day-ward beds and suite for

out-patients operations, endoscopy, E.E.C., E.C.G., cystoscopy, etc.

(Note - some of the specialities will be linked with their own

accommodation e.g. cardiology)

Operating Theatres

Radio-diagnostic

Medical Illustration and Clinical Photography

Pharmacology

Pathology

Animal Laboratories

Physical Medicine

27 .

. (Square feet)

118,000

4.000

6.000

5,000

5,000

16,000

6,000

8,000

10,000

40,000

23 ,000

21,000

1,000

5,000

25,000

2,000

11.000

. . u

Service Departments

Total Area (including provision for circulation and communications)

Dining

Central Boilerhouse

Workshops and Garages

Stores

Pharmacy

Mortuary and Post Mortem

Total

Note

laundry and central sterilising will be provided off-site.

Facilities which it is envisaged would be shared between the hospital blocks .

(a) Pathology, Clinical investigation, Animal House.

(b) Radio-diagnostic.

(c) Out-Patients Department.

(d) Operating Theatres (to a considerable extent).

(e) Medical Hlustration and Clinical Photography.

(f) Lecture theatres, reading room and library facilities.

(g) Central Supply Department. (h) Kitchen.

(j) Maintenance workshops and garages.

(k) Central Boilerhouse.

(I) Central Staff Changing Rooms (if necessary).

(m) Private Consultant's Block.

(n) Medical Records (eventually).

(0) Accident and Emergency Department.

(p) Residential accommodation for interns and students.

(q) Mortuary and Post-Mortem.

28.

(Square feet)

13,000

2,000

10,000

10,000

2.000

4,000

347,000