The layout of a multi-story hospital follows a general hierarchy, but specific floor functions are not universally fixed. Lower floors are often dedicated to high-traffic, public-facing services like the Emergency Department, imaging, and outpatient clinics. Upper levels are generally reserved for inpatient units where patients stay overnight. The fourth floor, or any mid-level, can house a variety of services depending on the building’s age, size, and regional location.
The Reason Some Hospitals Skip the 4th Floor
The absence of a fourth floor in some hospitals, particularly in East Asia, is a direct result of a superstition known as tetraphobia. This cultural aversion stems from the phonetic similarity between the word for the number four and the word for death in several East Asian languages. For example, in Mandarin Chinese, the word for four, sì, is nearly identical to the word for death, sǐ. A similar linguistic overlap occurs in Japanese, where the pronunciation for four, shi, is the same as the word for death.
Hospitals often skip or renumber the fourth floor to prevent patients and staff from feeling anxiety. This avoidance practice extends to other numbers containing the digit four, such as the 14th floor. In some facilities, the fourth floor might be labeled simply as “F” or “3A” on elevator panels to retain the floor space while avoiding the unlucky numeral.
Common Functions of Hospital Mid-Levels
When the fourth floor is present, it commonly acts as a centralized hub for non-patient-facing functions. This mid-level placement efficiently separates administrative and logistical services from the high-volume treatment areas below and the patient rooms above. These floors often house administrative offices for hospital leadership, finance, and human resources.
The floor may also contain centralized support departments such as Medical Records and Health Information Management (HIM), or the Information Technology (IT) infrastructure hub. Centralized laboratories, which process blood work and other samples, frequently occupy a mid-level floor. These services require proximity to clinical areas but do not require specialized patient space or high foot traffic.
When the 4th Floor Houses Specialized Care
In many medical centers, the fourth floor is strategically utilized for specific patient care units that benefit from a centralized location. This placement minimizes the distance between related services, improving patient flow and staff efficiency. For instance, the fourth floor might house a Surgical Intensive Care Unit (SICU) or a Post-Anesthesia Care Unit (PACU).
Locating these high-acuity units on a mid-level floor allows for quick patient transport to and from the operating suites, which are often nearby. Specialized diagnostic imaging suites, such as cardiac catheterization labs (cath labs) or interventional radiology, are also sometimes placed on this level. These units require heavy, specialized equipment and proximity to both the main hospital services and the acute care units.