THE REBUILDING OF CHARING CROSS HOSPITAL AND MEDICAL SCHOOL PETER F. PHILIP M.S., F.R.C.S. Consultant Surgeon, Charing Cross Hospital; Chairman of the New Hospital Planning Committee IN 1817 DR. BENJAMIN GOLDING founded Charing Cross Hospital, in- itially known as the West London Infirmary, in Suffolk Street, London, W.C.2, with the expressed intention of providing both medical care for the local population and teaching for medical students. The success of this venture was such that larger premises soon became essential. The move into these new buildings, Charing Cross Hospital, designed by Decimus Burton and sited just off the Strand, occurred in 1834. This was the first time a medical school was constructed for a hospital, as Golding stated, 'to provide the want of a University so far as medical education is concerned'. The idea was to be followed immediately afterwards by University College Hospital and King's College Hospital. During its first 150 years Charing Cross has followed the original con- cepts of Dr. Golding; but in this century, despite local expansion, it became too small and the buildings outdated. In 1957 a new grouping with the West London Hospital and Fulham Hospital was arranged. Discussions within the new Group and with the University of London and the Department of Health produced agreement to the building of a new district and teaching hospital on the expanded site of Fulham Hospital. The first phase of this, the New Charing Cross Hospital and Medical School, now by strange chance relocated in West London, accepted its first patients in January 1973. From the outset of planning it was the wish of the Board of Gover- nors of Charing Cross Hospital and the Council of the Medical School that the new hospital should provide a full district service to the people of Fulham and Hammersmith, as well as up to date departments for teaching of preclinical and clinical students, with professorial units in the main specialties. Teaching of all types of medical and technical staff would also be undertaken. In addition to these main aims the brief laid down that: The building should be adaptable-able to change as needs altered -but built to a standard plan where possible. It should provide the patient with a sense of friendly security and privacy. It should encourage integration of the teaching and treatment aspects at all levels. (Ann. Roy. Coll. Surg. Engi. 1973, vol. 52) 335 It t4R.@ . ! V.t g X 336 CHARING CROSS HOSPITAL AND MEDICAL SCHOOL It should provide first-class arrangements for research, which mnust be a prime aim of any teaching school. It must provide, for all who work within it, proper and congenial surroundings to enable all to play a full and rewarding part towards the care of the patients. It should help to foster a close association with the local medical practitioners and the social services of the local authority. Fig. 2. Six-bed ward. Inter-relationships and communications During planning very careful consideration was given to the relative positions of departments, and particularly to communications, both horizontal and vertical, to telephones, and to staff location systems. Desires to provide both increased privacy and increased care for patients are not easy to reconcile. The ward plan after much thought was fixed at 26 beds: two 4-bedded, two 6-bedded, and six single rooms. Consideration of function in design resulted in the acceptance of a race-track plan-service and treatment rooms centrally placed with bed rooms around the periphery-in order to shorten the walking distances for staff. This aim has been further helped by a very extensive inter- communication system. This system, pioneered by Mr. Cass, consists 337 PETER F. PHILIP of an 'intercom' system from each bed and all other ward areas, ac- tuated by a button and connected to a central station adjacent to the telephone exchange. This is manned throughout 24 hours. Immediate contact can be established with the patients in bed, by name, and their needs ascertained. Associated with this is a nursing staff location sys- tem: a light outside each room in the ward, again actuated by a simple button, shows the situation of nurses and sister within the ward and at the central station. The controller at the central station sorts the needs of the patients. 'Housekeeping' requests can be transmitted to the appropriate staff in the ward kitchen, while the nearest available nurse can be informed of a patient's nursing requirements in a much shorter space of time than it takes to read this. In this way a patient's 'call' will always be answered within a very short space of time, helping to give contact and reassurance while retaining privacy. A bleep system will be widely used by all medical and many other staff. They will be able to answer the call from any bedside via the patient call system, thus saving many journeys to a telephone. Within the theatres, loudspeaker phones will enable staff to deal with problems without leaving the theatre if they wish, but these will be operational only at the request of the surgeon using the theatre, and during normal working hours all telephone calls come through a receptionist at the local switchboard. A telephone in the exit room of each theatre is connected to the central dictation system so that, if required, operation notes can be dictated immediately and typed for inclusion in the patient's notes. The tower block plan The basic plan of the main tower block, which houses the wards and the laboratories, is in the form of a cross. Three ward wings of 26 beds lie north, west, and south of the cen- tral core of 13 lifts (Fig. 3). Two of these lifts are within the core, providing quite separate disposal lifts with a good area for collection of waste from the three ward wings. There is thus no reason for dirty material of any sort to remain for any length of time in the ward area. The fourth (east) limb of the cross, or 'link' to the laboratory block, has office accommodation for medical staff, four consultant and two registrar offices, an office for secretaries, an office for a Nursing No. 7 (Salmon staffing structure), a students' laboratory, a teaching room of approximately 350 sq. ft., and research laboratories of about 1,000 sq. ft. Thus, in design, an attempt has been made to assist medical staff to conduct research close to the point of their main work, to provide a unit base with secretarial assistance, and to co-ordinate the patient- service, teaching, and research activities. 338 CHARING CROSS HOSPITAL AND MEDICAL SCHOOL The laboratory block houses the preclinical departments, three tiered lecture theatres with 120 seats, all the service and medical school de- partments, and one floor for clinical research. The professorial units of medicine and surgery each occupies one complete floor of the ward block with beds in two wings. The third ward wing on each floor is specially designed as laboratories for re- search. The 'link' area in the east wing is also adapted for teaching medical and nursing students and for working areas for the academic staff. Thus on one floor the Surgical Professorial Unit has all the clinical, teaching, research, and administration facilities together and, in addition bed lifts supplies disposal lifts room & lifts_ __ _ _ _ _ 'I '1 f passenger lifts Fig. 3. Plan of central core. to spacious biochemical laboratories, there is a well-designed clinical investigation suite including a theatre, equipment with X-ray image intensifier with television display, and videotape recording facilities. Constant-environment and special sampling rooms staffed by part-time experienced nursing staff will enable any clinical investigation to be conducted in maximum comfort for the patients. The operation theatres are ten in number and are located on the 14th floor of the tower block above the wards, thus retaining the use of the central core of lifts for transportation. The actual wheeling dis- tance for patients is reduced to a minimum. Placing the theatres above the wards allowed a completely different floor plan as regards ducts and drainage, although of course restricting the perimeter to that of the ward block. 339 PETER F. PHILIP General theatre plan The theatres are all self-contained-twin theatres were considered unsatisfactory from a cross-infection viewpoint. Every surgeon has in- dividual requirements and therefore it was felt that instruments should not leave the theatre complex, but all drapes, dressings, and re- ceivers are provided from the Central Sterile Supply Department. Flow patterns to prevent cross-traffic between patients, instruments. and surgeons resulted in a basic plan for the theatre (Fig. 4). All theatres have natural light and views of the surroundings of the hospital I theatre 7 ~~~~~~~~2sluice 6 0 2 3 layup 4 anaesthetic room 7] 5 exit room 8 6 scrub up 5 W 4 3 ,8 7 teaching room 8 equipment room 'L,XJlW 0 -t L S99 disposal chute corridor Fig. 4. Plan of a standard theatre. for most surgeons who spend all day in theatre prefer to be able to see out at times, and it was felt essential also to provide the theatre stafT with a view outwards. Entry to theatre. Stafj arrive by lift to the 13th floor, put over- shoes on at a barrier, and then walk into their respective changing rooms. When changed into theatre clothes they pass out on to a clean corridor and up a flight of stairs to the theatre floor. This flight oc- cupies the area which on ward floors is the disposal collection room.