Dave Passant on the importance of hospital layouts

Dave Passant is a Divisional Manager for Facilities at University Hospitals of Morecambe Bay NHS Foundation Trust (opens in new window). His responsibilities include overseeing the portering and patient transport service. Here, he talks about the significant challenges faced by porters working at Royal Lancaster Infirmary, due to the hospital’s design.

What is the size of the portering service at Royal Lancaster Infirmary and what tasks are performed by the team?

The hospital has a team of 30 porters, who cover three different shifts during the day. They are responsible for the transfer of patients between different parts of the hospital, as well as the efficient movement of test samples, bloods and fluids, clinical and domestic waste, linen, post and general supplies.

What is the current layout of buildings on the Royal Lancaster Infirmary site?

Like many hospitals, Royal Lancaster Infirmary has developed over time, with a mixture of buildings from the original 19^th century listed building to the relatively new Centenary Unit. The site is roughly triangular, with a limited amount of space, and is bordered by a main road, school grounds and the Lancaster Canal.

This means that the buildings are well spread out from each other, and the site is not flat, making moving around slow and inefficient for everyone. The geography of the site means there is a significant internal slope leading down to Medical Unit 1, a distance of approximately a quarter of a mile. Medical Unit 2 cannot be easily linked to elsewhere by covered walkways, so is particularly exposed to the elements.

What challenge does the layout of the site pose for moving patients as well as goods around?

The geography of the site means that the only safe way to transfer patients from Medical Unit 2 to another part of the site, for example to go to theatre, for an X-ray or to have a CT or MRI scan, is in a patient transport ambulance. This requires a significant financial commitment to ensure these vehicles are readily available. Inevitably this also means patients are sometimes kept waiting for a transfer.

The ease of moving goods from or to Medical Unit 2 can be affected by the weather, making the task more complicated and longer to complete. For example, the team may need to put on and then remove wet weather gear for certain journeys and the route requires gritting in winter to ensure it is safe.

There can be problems at times of high demand when a large number of patients need transferring on any one day. The risk is that if a transfer is delayed, the patient may miss their pre-booked slot at X-ray or another diagnostic service.

Items also need to be constantly moved around the hospital. Clinical waste and domestic waste need to be taken away and disposed of safely, and new supplies of equipment and linen brought in. The layout of the site means the locations where these items are stored are often much further away than is ideal, adding extra time to each job.

This means that the buildings are well spread out from each other, and the site is not flat, making moving around slow and inefficient for everyone. The geography of the site means there is a significant internal slope leading down to Medical Unit 1, a distance of approximately a quarter of a mile. Medical Unit 2 cannot be easily linked to elsewhere by covered walkways, so is particularly exposed to the elements.

What difference would new hospital buildings make to the efficiency of the portering service and patient transfers?

We already know the existing patient flows and the distance covered by the portering team every day. These could be vastly improved by providing a single well-planned unit which is easy to access with everything under one roof.

This would immediately remove the need to use vehicles to transport patients between different parts of the site. Meaning there would be a huge reduction in the time it takes to move patients and supplies across the hospital.

As well as allowing the porters to do their job much more efficiently, there would be an improvement to the patient experience. For example, cutting out unnecessary journeys and other delays which slow down treatment.

A new hospital layout would also minimise the knock-on delays our clinical colleagues experience while they wait for a patient to be brought to a particular location. Therefore creating a seamless system where important test results and supplies can be moved quickly to where they are needed. I’m excited for the opportunity that new hospital facilities could bring.