Replies

1. 
   coonass | Sep 22, 2007 01:49am | #1

   Doc,

   Here is ADA site http://www.access-board.gov/adaag/html/adaag.htm

   Time-Saver Standards for Building Types has lots of good info. I'll lend you my copy if you want.

   KK

1. 
   Sphere | Sep 22, 2007 02:02am | #2

   "Time -saver standards.."  That rang a bell, so I got mine out.....for architects, designers and draftsmen. 

   A quick look and I see it's from 1954 !!!!!  Yeooowza, time to up date methinks..LOL  Graet book tho'.Spheramid Enterprises Architectural Woodworks

   "If you want something you've never had, do something you've never done"

2. 
   skh | Sep 22, 2007 05:20am | #3

   John,

   Also need to check local codes; sometimes they vary from town to town, ie number of parking spaces you have to have per provider.  We ran into that problem when we did our Ob/Gyn office.

   Steve

3. 
   Hiker | Sep 22, 2007 06:15am | #4

   As mentioned by others, your local jurisdiction may have much to say about your features, with ADA issues among them.  We remodeled two doctors offices year before last and we some huge cost saving in the way the exam rooms were layed out and types of finishes.  Really exam how you would like the exam space to work and I think you will really improve how you work and save money on the space. 

   Some of the things we did to improve space was

   Made all the base cabinets 16" deep with a very small 12" or 14" bar sink  vs.  24" deep with 24 sink. 

   Lowered the upper cabinets so nurses (mostly shorter women could actually reach them

   Include trash, medical waste, and garment receptacles in the base cabinets

   Aligned the layout so patients, exam tables, sinks and doctor are all in comfortable places and functional spaces.

   Layed out adminstrative space to help the flow of patients, keeping incoming and outgoing in different flow areas, obviously keeping in mind all the HIPA requirements.

   Pay attention to the fixtures that get specified.  The original sinks and fixtures for the project cost $2000 per set.  The office was to have 15 sinks.   We found functional sink and faucet for $200 per set.  Client was happy to say $27 grand on sinks. 

   As you build consider the rebates and tax benefits of building high energy efficiency office space.  I do not recall the amount, but it is significant.

   Our biggest challenge was the constant rework of the telecom, computer and all the other IT stuff. The IT provider kept changing strategies and made a mess of the system.  BTW-you can never have too many phone jacks, computer jacks and power receptacles.

   Best of luck with your practice,

   Bruce

1. 
   [email protected] | Sep 22, 2007 05:23pm | #6

   Thanks for the suggestions, I will keep them in mind. Some really good ideas.
   John

4. 
   Robrehm | Sep 22, 2007 07:00am | #5

   I see you are also in Ohio.

   Your plans for everything must be stamped by an achitecht or an engineer. In Ohio all commercial projects have this requirement. Do yourself a favor and find an architecht with a knowledge of medical spaces. You can do your own initial layouts but expect to hear your layout needs to be changed. You are no more an architecht than the architecht is a peds doc.

   I am primarily commercial (Columbus area) and can tell you it isn't worth fighting the system. Ohio uses the international building code and is pushing that it be built to the approved palns with no variation from the approved plans. Make your changes ahead of time. Expect any change that requires a resubmission of the plans  (even for a small alteration) to cost 3 weeks time at a minimum. That can get real expensive in a hurry when you consider the carrying cost for that extra 3 weeks.

   I would ask an architecht what space requirements you will need for what you want to do before you start looking at space. Then find a commercial realtor to work with. It won't cost anything to use the realtor and a good one will save you a ton of money & headaches. I"ve seen too many people not pay attention to the things I have mentioned & it has cost a bundle.

1. 
   [email protected] | Sep 22, 2007 05:27pm | #7

   Thanks. I am working with a commercial realtor, and have a property in mind. This is a small town, and not a lot is available. It is in a strip shopping center, new space, not yet finished out. I know I will need a designer/architect, was just trying to get an idea if the space will work for what I need before I spend the money on a design.
   John

1. 
   Robrehm | Sep 22, 2007 08:24pm | #8

   find the archittecht and or contractor you want to work with & have them do a walk through with you. It will save a boat load of hassle.

5. 
   CapnMac | Sep 23, 2007 03:09am | #9

   My office has a bit of a specialization in renovations of smaller medical facilities--so I have a little bit of back ground in this.

   Like as not, you sould probably plan on a "pubilc" unisex toilet room, and a "staff side" one as well.  The 60" clearance circle you need inside means you wind up needing about a 90 x 84" footprint no matter what.

   You will need more mechanical space than is immediately obvious (especially to the mech eng/hvac guy you use).

   Hallways can be 48" clear, but only if there is an alternate route that is 60".  Plan on blocking in the walls for a hand rail.  Hand rails for medical practices are a wide and varied range of product here of late, and can be very tastefully integrated into elegant design while still being functional.

   Given the way "small office" tomography and diagnostic equipment keeps evolving, what you might schedule up design-wise, would be your private office, two exam rooms, the "lab" room, and a break/coffee area.  You'll need some staff space, and a waiting area with a receptionist.

   Not complicated, really.  Waiting areas, though, strike me in two different directions, though.  We want them comfortable, but they get filled up with sick people (many of whom as not waiting on medical attention <sigh>).  So, you need a waiting area that is comfortable, but has some sort of "manageability" for not become its own "biohazzard"--I've no answers for that.

   Occupational hazard of my occupation not being around (sorry Bubba)
1. 
   [email protected] | Sep 23, 2007 03:59am | #10

   Thanks for the information. Concerning your last comments, my solution to the waiting room dilemma is to not keep patients waiting. My philosophy is to have a small waiting room (since the patient or family may be accompanied by someone that doesn't come back to the exam room), and have adequate exam rooms such that patients never (or almost never) sit in the waiting room, but are immediately brought back to exam rooms. They would be checked in there (which of course requires computers in each room).
   Thanks again,
   John

1. 
   BillHartmann | Sep 23, 2007 04:07am | #11

   I don't know if this is still being done or not. But a number of years ago I heard of peds havae a sick and a well waiting room.But if you can keep them out of the waiting room, except for a quick transistion that sound better.Don't know how well you can do that or not..
   .
   A-holes. Hey every group has to have one. And I have been elected to be the one. I should make that my tagline.

1. 
   [email protected] | Sep 23, 2007 04:11am | #12

   There are some practices that still have sick and well waiting rooms, but they have been shown to be more for appearance than substance. They really don't do anything to cut down on the spread of disease.
   John

2. 
   CapnMac | Sep 23, 2007 06:33am | #13

   patients never (or almost never) sit in the waiting room, but are immediately brought back to exam rooms. They would be checked in there (which of course requires computers in each room).

   Cool idea.  Schedule a bit more circulation space, then, to give a exit path from the various rooms, would likely be a good idea.  Not a bad idea for discrete exits in any event.  That kind of suggests, to my (hack design) mind a "ladder" sort of form.  Exams & spaces down a center line, with hallways flanking them.  Which is not a bad form for using slightly less-expensive non-corner lease space.

   You weren't specific, but are you looking at being a tennant in existing lease space (whether a "professional building" or not) or a free-standing structure?  Medical practice as a business case can be made for either, so I don't see a specific reason for either.Occupational hazard of my occupation not being around (sorry Bubba)

1. 
   [email protected] | Sep 23, 2007 05:17pm | #14

   As a tenant in a new "strip malll" attached to a large chain drugstore. There are 5 units there, none are leased yet.
   John

1. 
   finedesign | Sep 24, 2007 12:28am | #15

   Hire an architect who has done medical offices before. Also, you need to know if you will ever have to be licensed as an outpatinet facility- there are other codes that apply besides building codes. For example, and exam room needs to have 80 square feet of clear floor space not including cabinetry or built ins, and a procedure room needs to have 125 square feet of clear space. There are also clearance requirements around furniture. Hallways must be 60" clear if used by a patient, where the normal building code requires 44" clear. You definitely need separate staff bathrooms from patient. In many areas, you may need two staff restrooms. If you have two patient restrooms, and they are redundant,  (for example both off of the hallways near exam rooms), then only one needs to be ADA compliant. You will need a clean and dirty room, and locked drug closet. Make sure one of your retrooms is near the waiting room in case someone needs to use it and is not a patient (say someone waiting to pick someone up). In large practices, we always have a water fountain and restroom just for the waiting area. Keep in mind the flow for your check in and check out desks, and the need for privacey. They counters must be ada compliant unless all patients use a clipboard in the waiting room to fill out info.

2. 
   rasconc | Sep 24, 2007 03:26am | #16

   Good points but you might try to hit enter about every five lines or so, makes it easier to find where you were when you blink. (;-)