FGI Bulletin #4

FGI Hosts Exciting Opportunity to Influence Design of Emergency Departments

Sign up now for the Reimagining the ED workshop in September.

FGI will host a workshop to envision the future of emergency department design at the Healthcare Facilities Symposium and Expo in Austin, Tex., this September. For this workshop, Reimagining the ED, FGI has partnered with the American College of Emergency Physicians (ACEP), Mazzetti, and human-centered design firm DC Design to assemble a group of ED clinicians and design professionals from around the country. Workshop attendees will spend the day tackling challenges and envisioning opportunities at the nexus of clinical operations and ED design. Read more about this workshop in FGI Board Member Walt Vernon’s LinkedIn article Uniting Clinicians and Designers to Push Beyond Fundamental Requirements.

The workshop is a full-day event scheduled for Monday, September 18, 2017. Space is limited to 100 attendees. Click here to reserve your spot.

Flexible Application of the 2018 Outpatient Guidelines

by John L. Williams, Washington State Department of Health

One byproduct of our rapidly changing health care system is the creation and evolution of new classes of outpatient facilities. As providers and designers imagine new ways of moving care closer to the patient, a flexible approach is required to address the unique set of risks in each facility. The FGI 2018 Outpatient Guidelines will support this need by providing a way to assemble a set of minimum facility standards based on the types of services to be provided.

The 2014 Guidelines offered a menu of outpatient facility types with fairly predictable services. The Outpatient Document Group found that structure too rigid to accommodate the mix of different services and functions that can emerge during design and development. In response, they added a section to the 2018 Outpatient Guidelines describing two approaches to applying the requirements in the document.

To illustrate the new concept, consider a small neighborhood clinic that also provides infusion services or an outpatient surgery facility that provides imaging services. These facilities do not fit neatly into a single “facility type” chapter in the Guidelines, and previously designers and owners had to cobble together relevant requirements without clear direction. The 2018 edition seeks to give designers and owners two options to applying the Guidelines requirements: use the facility chapters as usual or create a hybrid facility by choosing pertinent portions from anywhere in the Outpatient document and applying them to a project based on the services provided and risks involved. This approach encourages users to consider the 2018 Outpatient Guidelines as a kit of parts. It does not advocate a scenario where users select the most advantageous path; rather, it asks users to identify the uses and risks and find the corresponding requirements based on them.

This strategy will not be applicable to every project being designed today. However, moving in this direction allows a great deal of flexibility. Providing this option creates structure for new facility types we are only beginning to imagine.

FGI Workshop at Summer Leadership Summit Addressed the Future of ED Treatment Spaces

At the Summer Leadership Summit (SLS) last month in Chicago, FGI presented a workshop on major changes to the 2018 Guidelines. The SLS, hosted by the American College of Healthcare Architects (ACHA) and the AIA Academy of Architecture for Health (AAH), provided FGI an opportunity to discuss new physical environment requirements for telemedicine services and two new tables intended to help designers determine where an exam/treatment, procedure, operating, or imaging room is required. In addition, a new concept for low-acuity patient pods in the emergency department, which was not approved for inclusion in the 2018 edition, was presented.

Led by architects David Vincent (HKS) and Bryan Langlands (NBBJ) and Christine Carr, MD, Professor of Emergency Medicine at the Medical University of South Carolina, the workshop explored the potential use of low-acuity patient pods to better manage “vertical” patients whose treatment doesn’t require a 120-square-foot treatment room. Today, many of these patients are being treated in hallways or makeshift bays that don’t provide a comfortable environment or adequate privacy. While the spatial needs of horizontal patients are well understood and defined in the Guidelines for Design and Construction, the specific needs of “vertical” patients are not addressed.

This workshop presented the innovative low-acuity patient pod concept as a precursor to recommending it for inclusion in the next edition of the Guidelines. The workshop featured mockups of ED pods, with treatment chairs generously provided by Stryker. Although the pod concept has considerable merit and support, feedback received during this workshop echoed that of the Health Guidelines Revision Committee and highlighted why the concept is not yet ready for inclusion in the Guidelines. Moving forward, FGI plans to create a white paper on the topic as well as to present the pod concept at future conferences to further refine the idea.

Presentations from the Summer Leadership Summit can be viewed on FGI’s website under the News & Update tab.

An Update on State Adoption of the 2014 Residential Guidelines

The 2014 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities continues to make advances in state adoption. To date, 22 states have adopted some edition of the Guidelines for one or more residential facility types. Of those, five states have adopted the 2014 edition and Florida is currently pursuing adoption.

States using the Guidelines for residential care facilities often select requirements for specific facility types for adoption rather than the Guidelines in its entirety. This trend is a result of the fact that different state health departments often focus on only a particular type of residential setting. For example, a state agency may oversee requirements for nursing homes yet have no jurisdiction over hospice or assisted living facilities. This division of responsibility may accelerate adoption of parts of the Guidelines as applicable, whereas adoption of the entire Guidelines by the state legislature requires a longer timeline and deeper review.

The following table shows that the Guidelines nursing home requirements have been adopted most frequently, followed by hospice facility requirements. This list is dynamic and regularly updated.

FGI Participation at Conferences

Members of the Health Guidelines Revision Committee (HGRC) have been engaged to speak on the 2018 Guidelines at these upcoming conferences. If you plan to attend any of these conferences, please stop by to learn about the changes coming in the 2018 edition of the Guidelines.

Reimagining the ED workshop, Austin, Tex., September 18, 2017

Leading Age Annual Meeting and Expo, New Orleans, October 29-November 1, 2017

Healthcare Design Expo and Conference, Orlando, November 11-14, 2017

ASHE PDC Summit, Nashville, Tenn., March 25-28, 2018

Environments for Aging, Savannah, Ga. April 21-24, 2018

Have any questions or suggestions about the content of this newsletter? Please write to us here.

To receive this newsletter via e-mail, please sign up to receive FGI updates in the bottom right corner of any page on the FGI website.

About the Facility Guidelines Institute
Founded in 1998, the Facility Guidelines Institute is a not-for-profit corporation founded to provide leadership and continuity to the Guidelines revision process. FGI functions as the coordinating entity for development of the Guidelines series of documents using a multidisciplinary, consensus-based process and for provision of ancillary services that encourage and improve their application and use. FGI invests revenue derived from sales of the Guidelines to fund research and the activities of the next revision cycle.

About the FGI Guidelines for Design and Construction Documents
The FGI Guidelines for Design and Construction documents are updated every four years to keep pace with new concepts, capabilities, and technologies in the delivery of health care. The Guidelines documents are used by states to regulate health care facility design and construction, through adoption of the Guidelines as code, as a basis for state-written codes, as an adjunct to state codes, or for reference.

About the Health Guidelines Revision Committee
The Health Guidelines Revision Committee (HGRC) is a select multidisciplinary consensus body of about 100 clinicians, administrators, architects, engineers, and representatives from authorities having jurisdiction that is convened to revise and update the FGI Guidelines documents. As a group, HGRC members are experts on the many issues addressed in the Guidelines.