Pavilion of Acute Medicine of the Brothers of Charity Hospital
INTRODUCTION
The tradition of the hospital of the Merciful Brothers in Brno dates back to the mid-18th century when it was founded by Moravian Count Jan Leopold of Ditrichštejn on Polní Street. The first structure built was a convent with a pharmacy and a nursing home with 70 beds according to plans by Brno builder Franz Anton Grim. Thirty years later, a late Baroque church of St. Leopold was added, richly decorated with frescoes. Among those treated in the hospital was Jan Dobrovský, who later died there.
Further expansion of the hospital took place between 1896 and 1898, when a building for a care institute was erected behind the convent on Polní Street, with a capacity of 120 beds. In 1934, the hospital underwent significant modernization with an extension that allowed for new treatment methods, making it one of the most modern healthcare facilities in Brno at that time. The last major construction activity occurred from 1984 to 1986, when a long-term care facility was built on the former garden site, which included kitchen facilities, a heating station, and rehabilitation. This phase of construction posed considerable challenges for the ongoing development of the hospital, as it completely halted potential development areas and did not address the gradual technological and technical degradation of the historic buildings. The long-term care facility, with all the technical and visual awkwardness of panel construction, was wedged between the river and the Baroque monastery.
A fundamental impulse for addressing the accumulated problems of the hospital came from social changes after 1989. Various parts of the institute have been gradually reconstructed since then, leading to a significant change in the overall arrangement of the hospital by 1996. This method of interlinked steps, the scale of which was determined by financial possibilities, could not be applied to the most pressing issues. These included the state of operating rooms, laboratories, X-ray diagnostics, and the outpatient department. While the last two mainly concerned spatial issues, in the case of laboratories and particularly operating rooms, it involved the hygienic feasibility of operations under alarming conditions of functional, spatial, and technical inadequacy.
This period marks the first considerations for a fundamental completion of the complex. In October 1996, a study for the completion of the hospital was proposed, aiming to create spatial and technical conditions for the development of the surgical department, intensive care, laboratories, central sterilization, and outpatient services, and to resolve the spatial and functional connections between individual parts of the hospital significantly, optimize the location of key communication nodes, and free up spaces in the inpatient departments to enhance the standard of inpatient care in the future.
The result of the study was the initial design of the acute medicine pavilion, which addresses the first step in the overall development of the hospital. The lack of space for the construction of the Acute Medicine Pavilion and the requirement for a minimum distance from the convent building led us in 2001 to revise the study to its current form and propose a massive 9-meter overhang of the building, which extended the pavilion towards the current heating station.
Throughout the process, the work was reviewed several times by hospital staff, and the final solution is a result of collaboration between doctors, hospital technicians, and architects.
OVERALL CONCEPT OF COMPLETION
The goal of the completion of the hospital of the Merciful Brothers in Brno was to establish a modern healthcare facility that would provide quality healthcare services through its functional and spatial organization, technological equipment, and high level of medical staff.
The construction of the acute medicine pavilion (hereinafter referred to as the Pavilion) is clearly seen as essential for the further development of the hospital. The specialized departments concentrated in the new building will enable the subsequent reconstruction of inpatient departments in the historic buildings of the hospital.
The Pavilion is designed in the space between the existing wing of the operating rooms and the heating station. This pavilion houses all the spatially and technologically demanding operations: operating rooms, intensive care unit (ICU), emergency room (JIP), central sterilization, laboratories, surgical outpatient department, and X-ray diagnostics. An optimal environment is created here for their proper functioning. Additionally, the pavilion includes a new communication core for the hospital, positioned to ensure that connections between individual operations are as short as possible, minimizing interference with the operations of the inpatient departments in the historic buildings.
After the pavilion is completed, a reconstruction of part of the old building on Polní Street (now the projection of the operating rooms) will be carried out, which is directly affected by the construction of the pavilion.
The project also includes a connecting corridor between the surgical pavilion and the dining facility at the level of the second underground floor (2.PP) and a bridge between the pavilion and the long-term care facility (LDN) on the first floor (1.NP). The construction of the corridor and bridge is very important for operational reasons. The current solution will replace the untenable transport of meals through the sealed inpatient units of the LDN and surgery.
The pavilion also includes a new organization for the arrival and departure of ambulances, in relation to the elevators and waiting area for patients. Spaces are prepared for a new emergency admission system.
ARCHITECTURAL SOLUTION
ACUTE MEDICINE PAVILION
The completion of the hospital is limited by the spatial possibilities of the complex and the close proximity of the monastery building. The Acute Medicine Pavilion is situated in the space between historic buildings along Polní Street and the heating station. The proposed building has four above-ground (NP) and two underground (PP) floors. Both underground floors can be partially naturally lit due to the height difference between the entrance from Polní Street and the courtyard level. The fourth above-ground floor is set back so that the height relationship with existing buildings and the monastery is at the same level. The building is covered with a flat roof, and a large part of the floor area of the fourth floor consists of a rooftop terrace offering a beautiful view of the city skyline.
Architecturally, the pavilion is divided into three parts. The lower brick part of the building is oriented parallel to Polní Street. The upper part, clad in colored enamel glass, is built perpendicular to the street and is cantilevered deep into the lot above the current heating station building. The last set-back floor with a restaurant and spacious terrace for patients and staff is lined with perforated sheet metal. The weight of the top floor is lightened by a pergola with canvas awnings. The base of the building consists of the northern concrete perimeter wall of the second underground floor and supporting walls of the access road. This counter-directional arrangement of the building's main volumes was primarily dictated by the requirement of the Brothers of Mercy for a minimum distance of 25 meters of the upper floors of the pavilion from the convent building. The massive nine-meter cantilever thus became the main architectural motif of the building. The aggressiveness of the cantilever is softened by rounded corners, rich velvet hues of the glass cladding, complemented by striking yellow blinds.
The architectural expression of the building is sober and corresponds to the building's function. The simple form thus reacts neutrally to the significantly varying architectural values of the surrounding buildings. The spatial composition of different volumetric bodies is also supported by a change in materials. The composition is deliberately robust, designed for distant views from the riverbank.
The materials used—refined plasters, enamel glass, quality wood-aluminum window fillings, etc.—are selected not only for their aesthetic qualities but also for their high utility values. A strong emphasis is placed on detail solutions and the overall quality of execution.
The colors of the interiors and patterns on the floors are the work of artist Petr Kvíčala.
OPERATIONAL DISPOSITION SOLUTION
The construction of the acute medicine pavilion has fundamentally changed the operation of the hospital. Among the most important changes in hospital operations are:
1. The main entrance to the hospital from Polní Street has been moved 25 meters westward, roughly to the center of the main hospital buildings. The new entrance leads to an entrance hall, where there are information desks for patients, a small shop, and social facilities. From the hall at the first floor level, access is provided to the waiting areas for the surgical outpatient department, X-ray diagnostics, and in the future, to the CT examination room. A new connecting bridge to the LDN building is also designed from the hall. The closure of the old bridge at the second floor will eliminate transit through the surgical inpatient unit. The freed spaces in the old building can then house gynecological and internal outpatient departments at the entry level.
2. Construction of a connecting corridor for the delivery of food from the kitchen at the second underground level (2.PP). This corridor is a significant improvement in the operation of the hospital, as it will eliminate the current situation where food is transported through the LDN building and the surgical unit on the second floor.
3. Construction of a new vertical communication core, which is located between the pavilion and the old building. Three patient elevators and a staircase will allow for strict separation and restricted access between the inpatient units and the examination and treatment components.
ENTRANCE HALL
The main entrance to the hospital from Polní Street is displaced 25 meters westward, approximately to the center of the main hospital buildings. This new entrance leads into an entrance hall, where information for patients, a shop, restrooms, entrances to the outpatient examination waiting areas, and primarily new elevators are located. The hall opens to the second floor and is illuminated by a skylight. It forms a natural communication hub of the hospital at the interface of the old building and the new pavilion.
OUTPATIENT DEPARTMENT
The surgical outpatient department and X-ray diagnostics are located on the ground floor of the acute medicine pavilion. The area currently occupied by the gynecological outpatient department near the X-ray facilities will be repurposed for a CT workstation with its own waiting area. Freed spaces in the old building will be allocated for expanding the outpatient operations of internal medicine and gynecology and facilities for patients. This solution will enable the majority of outpatient operations to be concentrated on the ground floor of the existing buildings and the acute medicine pavilion, closely connected to the main entrance of the hospital.
SURGICAL DEPARTMENT
The surgical department is located on the first floor and contains four operating rooms with the necessary support areas. Two small operating rooms and two large ones are proposed. Three of the rooms are classified as aseptic, while one will be super aseptic. The surgical department is linked to the central sterilization through clean and dirty materials elevators. Sterile materials are transported to the operating rooms via a clean corridor through an intermediate wall. The operating rooms are designed with daylighting and the option of complete blackout. The facilities of the surgical department also include a shared spacious room for doctors and nurses, including a room for writing surgery reports. The recovery area for patients after surgery will be located outside the surgical tract, in the area of the current operating rooms.
ICU, ARO
The intensive care unit with 9 beds and the anesthesiology-resuscitation unit with 6 beds are designed on the second floor. The units are planned as separate with two service counters for staff. Part of the beds is designed independently behind glass walls, while some in front of the nurse's workstation are divided by mobile screens. The units jointly use only the admissions examination room, storage, and equipment cleaning area. The connection to the sterilization unit serves both departments. The spaces outside the departments in the courtyard of the old building will serve as facilities for doctors.
CENTRAL STERILIZATION
The central sterilization department is located on the first underground floor. The department is divided into sterile and non-sterile sections. It is equipped with two automatic washers, two steam sterilizers, and one plasma sterilizer. A separate section comprises areas for laundry stacking. The department is connected by two elevators to the surgical outpatient department, operating rooms, ICU, and ARO.
LABORATORIES
The laboratories are designed as central at the first underground level. The department includes biochemistry, hematology laboratories, and a tissue bank. Sample receptions will take place in a reception room oriented towards the elevator hall. Sample collections will be performed in the outpatient departments and sample collection room on the ground floor.
EMERGENCY ADMISSION
The emergency admission unit at the first underground level is designed near the ambulance entrance. It will be an examination room equipped with the necessary spatial and technical facilities for serious life-threatening cases. The office will not have continuous staff presence; personnel will be called from individual departments as needed.
TECHNICAL EQUIPMENT
The technical facilities, HVAC machines, central heating systems, data distribution centers, etc., including storage, are located on the second underground floor. Additionally, it houses the clean and dirty laundry storage and spaces for the decontamination of biological waste. The main HVAC engine room and the cooling source are designed on the fourth floor.
RESTAURANT
A small self-service restaurant with 32 seats is designed on the fourth floor, connected to the rooftop terrace with a view of the city skyline.
The tradition of the hospital of the Merciful Brothers in Brno dates back to the mid-18th century when it was founded by Moravian Count Jan Leopold of Ditrichštejn on Polní Street. The first structure built was a convent with a pharmacy and a nursing home with 70 beds according to plans by Brno builder Franz Anton Grim. Thirty years later, a late Baroque church of St. Leopold was added, richly decorated with frescoes. Among those treated in the hospital was Jan Dobrovský, who later died there.
Further expansion of the hospital took place between 1896 and 1898, when a building for a care institute was erected behind the convent on Polní Street, with a capacity of 120 beds. In 1934, the hospital underwent significant modernization with an extension that allowed for new treatment methods, making it one of the most modern healthcare facilities in Brno at that time. The last major construction activity occurred from 1984 to 1986, when a long-term care facility was built on the former garden site, which included kitchen facilities, a heating station, and rehabilitation. This phase of construction posed considerable challenges for the ongoing development of the hospital, as it completely halted potential development areas and did not address the gradual technological and technical degradation of the historic buildings. The long-term care facility, with all the technical and visual awkwardness of panel construction, was wedged between the river and the Baroque monastery.
A fundamental impulse for addressing the accumulated problems of the hospital came from social changes after 1989. Various parts of the institute have been gradually reconstructed since then, leading to a significant change in the overall arrangement of the hospital by 1996. This method of interlinked steps, the scale of which was determined by financial possibilities, could not be applied to the most pressing issues. These included the state of operating rooms, laboratories, X-ray diagnostics, and the outpatient department. While the last two mainly concerned spatial issues, in the case of laboratories and particularly operating rooms, it involved the hygienic feasibility of operations under alarming conditions of functional, spatial, and technical inadequacy.
This period marks the first considerations for a fundamental completion of the complex. In October 1996, a study for the completion of the hospital was proposed, aiming to create spatial and technical conditions for the development of the surgical department, intensive care, laboratories, central sterilization, and outpatient services, and to resolve the spatial and functional connections between individual parts of the hospital significantly, optimize the location of key communication nodes, and free up spaces in the inpatient departments to enhance the standard of inpatient care in the future.
The result of the study was the initial design of the acute medicine pavilion, which addresses the first step in the overall development of the hospital. The lack of space for the construction of the Acute Medicine Pavilion and the requirement for a minimum distance from the convent building led us in 2001 to revise the study to its current form and propose a massive 9-meter overhang of the building, which extended the pavilion towards the current heating station.
Throughout the process, the work was reviewed several times by hospital staff, and the final solution is a result of collaboration between doctors, hospital technicians, and architects.
OVERALL CONCEPT OF COMPLETION
The goal of the completion of the hospital of the Merciful Brothers in Brno was to establish a modern healthcare facility that would provide quality healthcare services through its functional and spatial organization, technological equipment, and high level of medical staff.
The construction of the acute medicine pavilion (hereinafter referred to as the Pavilion) is clearly seen as essential for the further development of the hospital. The specialized departments concentrated in the new building will enable the subsequent reconstruction of inpatient departments in the historic buildings of the hospital.
The Pavilion is designed in the space between the existing wing of the operating rooms and the heating station. This pavilion houses all the spatially and technologically demanding operations: operating rooms, intensive care unit (ICU), emergency room (JIP), central sterilization, laboratories, surgical outpatient department, and X-ray diagnostics. An optimal environment is created here for their proper functioning. Additionally, the pavilion includes a new communication core for the hospital, positioned to ensure that connections between individual operations are as short as possible, minimizing interference with the operations of the inpatient departments in the historic buildings.
After the pavilion is completed, a reconstruction of part of the old building on Polní Street (now the projection of the operating rooms) will be carried out, which is directly affected by the construction of the pavilion.
The project also includes a connecting corridor between the surgical pavilion and the dining facility at the level of the second underground floor (2.PP) and a bridge between the pavilion and the long-term care facility (LDN) on the first floor (1.NP). The construction of the corridor and bridge is very important for operational reasons. The current solution will replace the untenable transport of meals through the sealed inpatient units of the LDN and surgery.
The pavilion also includes a new organization for the arrival and departure of ambulances, in relation to the elevators and waiting area for patients. Spaces are prepared for a new emergency admission system.
ARCHITECTURAL SOLUTION
ACUTE MEDICINE PAVILION
The completion of the hospital is limited by the spatial possibilities of the complex and the close proximity of the monastery building. The Acute Medicine Pavilion is situated in the space between historic buildings along Polní Street and the heating station. The proposed building has four above-ground (NP) and two underground (PP) floors. Both underground floors can be partially naturally lit due to the height difference between the entrance from Polní Street and the courtyard level. The fourth above-ground floor is set back so that the height relationship with existing buildings and the monastery is at the same level. The building is covered with a flat roof, and a large part of the floor area of the fourth floor consists of a rooftop terrace offering a beautiful view of the city skyline.
Architecturally, the pavilion is divided into three parts. The lower brick part of the building is oriented parallel to Polní Street. The upper part, clad in colored enamel glass, is built perpendicular to the street and is cantilevered deep into the lot above the current heating station building. The last set-back floor with a restaurant and spacious terrace for patients and staff is lined with perforated sheet metal. The weight of the top floor is lightened by a pergola with canvas awnings. The base of the building consists of the northern concrete perimeter wall of the second underground floor and supporting walls of the access road. This counter-directional arrangement of the building's main volumes was primarily dictated by the requirement of the Brothers of Mercy for a minimum distance of 25 meters of the upper floors of the pavilion from the convent building. The massive nine-meter cantilever thus became the main architectural motif of the building. The aggressiveness of the cantilever is softened by rounded corners, rich velvet hues of the glass cladding, complemented by striking yellow blinds.
The architectural expression of the building is sober and corresponds to the building's function. The simple form thus reacts neutrally to the significantly varying architectural values of the surrounding buildings. The spatial composition of different volumetric bodies is also supported by a change in materials. The composition is deliberately robust, designed for distant views from the riverbank.
The materials used—refined plasters, enamel glass, quality wood-aluminum window fillings, etc.—are selected not only for their aesthetic qualities but also for their high utility values. A strong emphasis is placed on detail solutions and the overall quality of execution.
The colors of the interiors and patterns on the floors are the work of artist Petr Kvíčala.
OPERATIONAL DISPOSITION SOLUTION
The construction of the acute medicine pavilion has fundamentally changed the operation of the hospital. Among the most important changes in hospital operations are:
1. The main entrance to the hospital from Polní Street has been moved 25 meters westward, roughly to the center of the main hospital buildings. The new entrance leads to an entrance hall, where there are information desks for patients, a small shop, and social facilities. From the hall at the first floor level, access is provided to the waiting areas for the surgical outpatient department, X-ray diagnostics, and in the future, to the CT examination room. A new connecting bridge to the LDN building is also designed from the hall. The closure of the old bridge at the second floor will eliminate transit through the surgical inpatient unit. The freed spaces in the old building can then house gynecological and internal outpatient departments at the entry level.
2. Construction of a connecting corridor for the delivery of food from the kitchen at the second underground level (2.PP). This corridor is a significant improvement in the operation of the hospital, as it will eliminate the current situation where food is transported through the LDN building and the surgical unit on the second floor.
3. Construction of a new vertical communication core, which is located between the pavilion and the old building. Three patient elevators and a staircase will allow for strict separation and restricted access between the inpatient units and the examination and treatment components.
ENTRANCE HALL
The main entrance to the hospital from Polní Street is displaced 25 meters westward, approximately to the center of the main hospital buildings. This new entrance leads into an entrance hall, where information for patients, a shop, restrooms, entrances to the outpatient examination waiting areas, and primarily new elevators are located. The hall opens to the second floor and is illuminated by a skylight. It forms a natural communication hub of the hospital at the interface of the old building and the new pavilion.
OUTPATIENT DEPARTMENT
The surgical outpatient department and X-ray diagnostics are located on the ground floor of the acute medicine pavilion. The area currently occupied by the gynecological outpatient department near the X-ray facilities will be repurposed for a CT workstation with its own waiting area. Freed spaces in the old building will be allocated for expanding the outpatient operations of internal medicine and gynecology and facilities for patients. This solution will enable the majority of outpatient operations to be concentrated on the ground floor of the existing buildings and the acute medicine pavilion, closely connected to the main entrance of the hospital.
SURGICAL DEPARTMENT
The surgical department is located on the first floor and contains four operating rooms with the necessary support areas. Two small operating rooms and two large ones are proposed. Three of the rooms are classified as aseptic, while one will be super aseptic. The surgical department is linked to the central sterilization through clean and dirty materials elevators. Sterile materials are transported to the operating rooms via a clean corridor through an intermediate wall. The operating rooms are designed with daylighting and the option of complete blackout. The facilities of the surgical department also include a shared spacious room for doctors and nurses, including a room for writing surgery reports. The recovery area for patients after surgery will be located outside the surgical tract, in the area of the current operating rooms.
ICU, ARO
The intensive care unit with 9 beds and the anesthesiology-resuscitation unit with 6 beds are designed on the second floor. The units are planned as separate with two service counters for staff. Part of the beds is designed independently behind glass walls, while some in front of the nurse's workstation are divided by mobile screens. The units jointly use only the admissions examination room, storage, and equipment cleaning area. The connection to the sterilization unit serves both departments. The spaces outside the departments in the courtyard of the old building will serve as facilities for doctors.
CENTRAL STERILIZATION
The central sterilization department is located on the first underground floor. The department is divided into sterile and non-sterile sections. It is equipped with two automatic washers, two steam sterilizers, and one plasma sterilizer. A separate section comprises areas for laundry stacking. The department is connected by two elevators to the surgical outpatient department, operating rooms, ICU, and ARO.
LABORATORIES
The laboratories are designed as central at the first underground level. The department includes biochemistry, hematology laboratories, and a tissue bank. Sample receptions will take place in a reception room oriented towards the elevator hall. Sample collections will be performed in the outpatient departments and sample collection room on the ground floor.
EMERGENCY ADMISSION
The emergency admission unit at the first underground level is designed near the ambulance entrance. It will be an examination room equipped with the necessary spatial and technical facilities for serious life-threatening cases. The office will not have continuous staff presence; personnel will be called from individual departments as needed.
TECHNICAL EQUIPMENT
The technical facilities, HVAC machines, central heating systems, data distribution centers, etc., including storage, are located on the second underground floor. Additionally, it houses the clean and dirty laundry storage and spaces for the decontamination of biological waste. The main HVAC engine room and the cooling source are designed on the fourth floor.
RESTAURANT
A small self-service restaurant with 32 seats is designed on the fourth floor, connected to the rooftop terrace with a view of the city skyline.
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João Barbosa
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