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FGI Bulletin #6

FGI Bulletin Archives

Beyond Fundamentals on Deck and Adding Value

The initial response to FGI’s Beyond Fundamentals has been overwhelmingly positive. Formally launched this month on MADCAD, Beyond Fundamentals is a digital library that bridges the gap between Guidelines editions by sharing information about emerging trends, best practices, application of Guidelines requirements, and draft language for the 2022 edition.

Information Currently Available

Following are descriptions of what is available to you at this time. Also see the separate article on FGI advisory opinions.

A Case for the Low-Acuity Patient Treatment Station: Reducing the Length of Stay for Emergency Department Visits

by Bryan Langlands, AIA, ACHA, EDAC, LEED GA; David Vincent, AIA, ACHA, LEED AP; and Christine Carr, MD, CPE, FACEP

The authors of this white paper propose draft guidelines for permitting low-acuity patient treatment stations in the ED in an effort to reduce overcrowding and wait times.

“Without guidelines for low-acuity patient treatment spaces in the emergency department, authorities having jurisdiction (AHJs) are often unable to allow hospitals and freestanding emergency facilities to provide smaller, patient-friendly, medically appropriate treatment spaces to address this situation.”

Checklist for Designing a Geriatric Treatment Room in the Emergency Department

by Kathryn Gallagher, MS, BSN, RN, NE-BC

This quick-reference checklist was inspired by a proposal submitted during the 2018 Guidelines revision cycle that was deemed beyond minimum requirements, but offered excellent suggestions for incorporating best practices in a geriatric treatment room in the ED.

“…health care organizations benefit from implementing geriatric design accommodations because doing so helps them better allocate resources and improves admission and readmission rates.”

Testing Sustainable Flooring: A Johns Hopkins Health Systems Report

by Teri Lura Bennett, RN, CID, CHID, IIDA, EDAC, NIHD

This report summarizes the efforts and recommendations of Johns Hopkins Health System research undertaken to improve the performance, safety, and cost-efficiency of flooring materials and flooring care in the system’s many facilities.

FGI Study of Clearances Needed to Provide Safe Care for Patients of Size

by the 2018 FGI Bariatric Accommodations Topic Group

This presentation outlines the results of work done during the 2018 Guidelines revision cycle by members of the FGI Bariatric Accommodations Topic Group to assess the clearances needed for safe patient handling and transportation of patients of size.

Common Mistakes in Designing Psychiatric Hospitals: An Update

by Jim Hunt and David Sine

By the authors of the Design Guide for the Built Environment of Behavioral Health Facilities, this white paper examines many factors involved in creating facilities that meet the needs of behavioral health patients. The importance of functional programming and use of a risk assessment matrix are discussed.

The Future of Health Care as Predicted Using Scenario Planning

compiled by FGI staff

Health care leaders invited by FGI met prior to the 2018 Guidelines revision cycle to discuss forces likely to affect the future of health care delivery and how anticipated changes in the delivery of care might affect health care facilities. This report summarizes four futures predicted by the group.

Looking Ahead

FGI extends a hearty thank you to the professionals who are making important contributions to the design and construction community through the Beyond Fundamentals program. Many exciting additions are planned to the Beyond Fundamentals library over the course of this year, including:

  • A debrief on the Reimagining the ED workshop held in September 2017
  • An expanded white paper on designing for geriatric patients
  • Low-voltage systems planning and design in health care facilities
  • Hybrid operating room planning and design
  • Functional program development

If you have purchased a site license for the 2018 edition of the Guidelines, you can access Beyond Fundamentals from your eLibrary under “packages.” To purchase a subscription, visit fgi.MADCAD.com. If you have an idea to share through Beyond Fundamentals, please contact us here.

ASHRAE 170 and the 2018 FGI Guidelines

Beginning with the 2010 edition of the Guidelines, ventilation requirements for hospitals and outpatient facilities were moved from the Guidelines to ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities. And, for easier access, Standard 170 has been included as part of the Guidelines beginning in 2010. The 2018 edition of the Guidelines includes the 2017 edition of Standard 170 in both the Hospital and Outpatient documents. FGI chose not to include 170 in the 2018 Residential Guidelines as its requirements are not appropriate for the facility types in the Residential Guidelines.

Despite the close relationship between the Guidelines and Standard 170, development of the content of the latter is solely the responsibility of ASHRAE and ASHE. Members of the ASHRAE technical committee responsible for developing the content of the 2017 edition of Standard 170 worked to divide the document into separate requirements for hospital, outpatient, and residential health, care, and support facilities in recognition of the very different needs of these facilities. However, due to pending appeals to ASHRAE about what constitutes minimum requirements for certain facility types, the committee was unable to finalize that division for 170-2017.

Therefore, as an interim measure, the committee chose to publish three identical tables albeit with different numbers and titles (Table 7.1: Design Parameters—Hospital Spaces, Table 8.1: Design Parameters—Outpatient Spaces, and Table 9.1: Design Parameters—Nursing Home Spaces). This move was intended to acknowledge that the committee agreed the different facility types should have different requirements and intends to continue working to determine what those differences should be. This stance is explained in the foreword of the 2017 edition of ASHRAE 170, a portion of which is quoted below. Because 170 is a continuous maintenance document, the committee’s goal is to publish their breakdown of requirements by facility type as Addendum n.

For questions about the ASHRAE content in general or the effort to finalize Addendum n, please reach out to Pete Hammerling in the ASHRAE office.

From ANSI/ASHRAE/ASHE 170-2017:

The 2017 edition was also editorially reformatted into three sections: hospital spaces, outpatient spaces, and nursing home spaces. This change allows for easier coordination between the standard and FGI documents, which, as of the 2018 edition, consists of three separate books:

  • Guidelines for Design and Construction of Hospitals
  • Guidelines for Design and Construction of Residential Health, Care, and Support Facilities
  • Guidelines for Design and Construction of Outpatient Facilities

Due to timing constraints, these three sections in the standard are identical. Changes to help differentiate outpatient and residential health, care, and support requirements from hospital requirements are currently undergoing final publication approval and will be published as Addendum n. The reformat was included in this edition to simplify the incorporation of these upcoming changes. As always, the standard does not dictate which types of spaces are required in which types of facilities. The requirements for spaces that do not exist in any given facility type may be ignored.

FGI Partnering with ACOG for Reimagining Childbirth Facilities Workshop

“Childbirth is the most common reason for hospitalization in the U.S., but the quality of care varies tremendously from one facility to the next. Emerging research demonstrates that the design of these facilities can play a critical role in either helping or hindering the provision of safe care.” —Dr. Neel Shah

FGI is partnering with the American College of Obstetricians and Gynecologists (ACOG) and Catalysis to host Reimagining Childbirth Facilities, an innovative workshop that will bring together clinicians and designers. This two-day workshop, organized by Mazzetti+GBA, is offered at the end of the ACOG annual conference on April 30 and May 1 at the Fairmont Hotel in Austin, Texas.

The event is designed to bring together leading childbirth clinicians and representatives from health care-focused design firms in an effort to envision how the labor and delivery suite can improve patient care through design. Catalysis, a change accelerator focused on transforming health care value, will guide the process using human-centered design thinking as participants identify issues in the field, possible solutions, and barriers to implementation. The results of the workshop will inform future Guidelines requirements and Beyond Fundamentals ideas and insights.

This is the second deep-dive workshop hosted by FGI. The first workshop, co-hosted by the American College of Emergency Physicians, received excellent reviews from participants. Here’s a sampling of the feedback received from the Reimagining the ED workshop:

  • “Having clinicians and designers, architects, and planners all in the same room rapidly accelerates the problem-solving and solution design process.”
  • “The workshop was further validation of the value of structured time invested in direct collaboration between clinicians, other multi-discipline team members and designers.”
  • “This was a refreshing event that I could not stop talking about. I look forward (to) participating in similar workshops in the future.”

Participating architects can receive 14 AIA HSW LUs. Firms can send senior staff members and an accompanying junior staff member at a reduced rate. For workshop details and pricing, please visit https://www.eventbrite.com/e/reimagining-childbirth-facilities-tickets-42916234613.

FGI Responses to Advisory Opinions in Beyond Fundamentals

For many years, FGI staff have responded to queries from the public asking for clarification about how to apply requirements in the Guidelines. When necessary, information from Health Guidelines Revision Committee (HGRC) has been solicited to craft these responses. In the past, this information was sent only to the inquirer, but FGI is now sharing many of these responses with a wider audience as part of the new Beyond Fundamentals offerings. An example is the following response to an inquiry about the emergency department text on human decontamination spaces:

Q: Section 2.2-3.1.3.6 (8)(a) (Human decontamination area—Location) states the outside entry door for the human decontamination area is to be located no less than 10 feet from the closest “other” entrance. The appendix section for this, A2.2-3.1.3.6 (8)-b, (Decontamination room in the facility) states this minimum separation from ambulance entrances specifically as “no less than 30 feet.” Which do I follow?

A: Section 2.2-3.1.3.6 (8)(a) is in the main text and is the minimum requirement, which means it should apply to all hospital emergency departments and freestanding emergency facilities. Appendix section A2.2-3.1.3.6 (8) is not enforceable but provides recommended design guidance for facilities that see a lot of patients needing decontamination (for example, an emergency facility near an oil-drilling site).

Formal Interpretations of Guidelines Requirements on the FGI Website

FGI offers users of the Guidelines an opportunity to request a formal explanation of the meaning or intent of requirements in its Guidelines for Design and Construction documents. This interpretation process, which compiles responses from five FGI HGRC members, allows designers, owners, and authorities having jurisdiction to seek clarification of language that may be ambiguous or conflict with other sections of a document. Formal interpretations are posted on the FGI website and are considered to express the intent of the HGRC.

The most recent interpretation, issued in December 2017, responded to a query about the requirements for the anteroom in an MRI facility from the 2010 FGI Guidelines for Design and Construction of Health Care Facilities:

Guidelines edition: 2010                                             Paragraph reference: 2.2-3.4.4.2 (3)

Question: In the design of MRI suites, is it the intent of the Guidelines that the anteroom required by Section 2.2-3.4.4.2 (3) be located between the door to the MRI room and the control room so the tech must pass through a door and into the anteroom before reaching the MRI room door?

2.2-3.4.4.2 Design configuration of the MRI suite

(3) An anteroom visible from the control room shall be located outside the MRI scanner room so that patients, health care personnel, and other employees must pass through it before entering the scanning area and control room. This room shall be outside the restricted areas of the MRI’s magnetic field.

Response: The intention was to require a secured area (ACR Zone-III) between the MRI scanner room (Zone-IV) and areas where unscreened individuals (Zone-II) might be. (The zones indicated are from the ACR Guidance Document on MR Practices.) The description of an anteroom, with view from the operator’s console, was not meant to compel the creation of another room (although that would be permitted if desired), but rather to designate an area that is:

  • Located within the controlled access perimeter defining Zone-III
  • Visible from the operator’s console
  • Located prior to the entry to the MRI scanner room (Zone-IV)

In most MRI suites, the control room serves as this intermediate space and the secured area is the region of the control room between the access points to Zone-II and Zone-IV.

Changes to the language in Section 2.2-3.4.4.2 in the 2010 edition (shown above) have been made in the 2018 edition to clarify the meaning. The 2018 text is shown below and can be considered an interpretation of the 2010 language.

2.2-3.4.5.5 Control vestibule

(1) The control vestibule shall be located outside the MRI scanner room so that patients, health care personnel, and other employees must pass through it before entering the MRI scanner room.

(2) The control vestibule shall be permitted to be either a part of the MRI control room or directly visible from the control room.

Please note: This interpretation also applies to Section 2.2-3.4.4.3 (4) in the 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities.

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 more about the 2018 edition of the Guidelines.

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

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

Reimagining Childbirth Facilities workshop, Austin, Tex., April 30-May 1, 2018

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