FGI Bulletin #10

The CEO’s Column: It’s Proposal Time

Doug Erickson

Every four years, the users of the FGI Guidelines have an opportunity to actively engage in the process of developing the next edition. For all the professionals who have approached me at conferences and seminars about needing to make a change in the Guidelines because the requirements are too onerous or too vague and difficult to enforce: Now—while the proposal period is open—is your chance to make a difference!

FGI receives approximately 1,200 proposals for change in every revision cycle, but many of these come from members of the Health Guidelines Revision Committee (HGRC), the body responsible for evaluating and making changes in the documents. We are asking you—users of the Guidelines—to step up to the plate and take a couple of swings at generating proposals to modify the Guidelines. Take out your laptop or get on your desktop and access the FGI website, click “Submit a Proposal” at the top of the page, and become part of the 2022 process. We have a brand-new proposal platform that still has that new car smell. Take it for a spin by submitting at least one proposal for change; it almost drives itself.

In all seriousness, the Guidelines are public documents, and we need input from our community of users to make them stronger and keep them current with the delivery of care and technological advances. So many of you use our documents on a daily or weekly basis; we ask that you take those questions or comments you have noted in the margins and turn them into proposals for 2022. Proposals may be for deletion of text, addition of text, rewrite of existing text for clarification, and editorial corrections.

The FGI staff have done a great job of providing guidance on the writing of proposals. Once you have established a login at https://fgiguidelines.net/login, please visit https://fgiguidelines.net/tutorial to access our tips and tutorials.

Although the deadline of Sunday, June 30, 2019, seems far-off, with spring around the corner and graduation parties on the horizon, now is the time to take advantage of house-bound winter days and submit proposals for change to sections of the Guidelines that have been haunting you. All proposals, including opinions submitted on them, will be reviewed by the 2022 HGRC. Proposals accepted by the committee will be incorporated in the draft 2022 Guidelines manuscripts. In Summer 2020, the drafts will be available for public comment on the proposed changes. We look forward to your participation!

Not Going to the PDC? Get Your LUs with FGI’s Webinars

Conference season is upon us and, while there’s always a lot to be gained from attending these networking events, sometimes it just isn’t possible. Luckily, FGI has webinars on the content of the 2018 Guidelines so you can earn your continuing education credits from the convenience of your home or office. Each webinar is presented by members of the Health Guidelines Revision Committee, so you’re learning about changes to the 2018 Guidelines from the people responsible for updating the documents.

There are 10 webinars in all (priced at $96 each, or $48 if you don’t need continuing education credit):

• 2018 Guidelines Update: Changes to Keep Pace with Clinical Practices
• Appropriate Room Use—Part 1: Exam, Procedure, and Operating Rooms
• Appropriate Room Use—Part 2: Imaging Room Classifications
• Flexible Application of the Outpatient Guidelines
• Accommodations for Care of Patients of Size
• Pod People: Low-Acuity Patient Treatment Stations in the ED
• Breaking Bad: Improving Resident-Centered Regulations
• Sterile Processing Department: Design and HVAC Considerations
• The Functional Program and Safety Risk Assessment: How to Create and Apply Them
• Use of the Guidelines for Design and Construction: An Architect’s, an Owner’s, and an AHJ’s Perspective

[Update 11/21/22: To view 2018 webinars free of charge, visit the FGI YouTube channel.]

Topic Groups Formed and Getting to Work

FGI is finalizing topic groups that will support development of the 2022 Guidelines for Design and Construction. These groups, led by HGRC members and composed of industry subject matter experts, assess how a particular subject is covered in the current edition of the Guidelines and determine what proposals are needed to improve and update the next edition. Based on industry trends and user feedback and inquiries, the 2022 HGRC Steering Committee has identified the following topics as needing attention during the 2022 revision cycle:

• Acoustics and vibration
• Behavioral health
• Behavioral health in the ED
• Facility management
• Geriatrics
• Infection prevention and control
• Lighting
• Nurse call devices, electrical receptacles, and med/gas outlets
• Palliative care
• Resiliency and business continuity
• Rural health
• Technology

The Acoustics Topic Group has already begun its work evaluating the sound and vibration requirements in the Guidelines and will look closely at new guidance from the World Health Organization and Centers for Disease Control that recognizes sound as a public health issue. The Behavioral Health in the ED Topic Group will conduct a survey of health care facilities to gauge how well the 2018 Guidelines requirements respond to the challenges and opportunities of serving behavioral health patients in these spaces, whether an ED in a hospital or a freestanding emergency facility. Finally, FGI is working closely with Mazzetti and St. Vincent’s Indianapolis Hospital of the Ascension Health System to evaluate the appropriateness of Guidelines requirements for nurse call devices, electrical receptacles, and medical gas outlets to ensure the tables keep up with changes in treatment and technology.

It’s not too late to get involved. If you are interested in serving on one of these topic groups or would like to learn more, please write to us and include the topic that interests you, a brief explanation of why you are interested, and your CV/résumé. Participating in a topic group is a great way to get introduced to the activities and community of the HGRC.

Requirements for Mobile/Transportable Units in the News

For many reasons, an increasing number of mobile/transportable medical units are being deployed for general health care services, diagnostic procedures, and support services such as sterile processing. Because these units are not buildings, some safety standards may be lacking when the health care spaces they house are compared to those in a traditional health care facility. To encourage equivalent design requirements wherever services are provided, FGI’s 2018 HGRC recognized the need to update the baseline Guidelines requirements for these units. Skip Gregory, NCARB, who chaired the 2018 HGRC task group that addressed this challenge, has written an article on this effort for Health Facilities Management magazine. “FGI provides updated guidance on designing mobile medical units” shares an inside look at how the task group approached the issues in designing safe health care spaces in a mobile unit setting.

HGRC members write articles for industry publications from time to time to provide deeper insight on Guidelines requirements. See a list on the FGI website of recent articles appearing in Health Facilities Management, and check back periodically to see upcoming stories, including one on sterile processing facilities.

Interpretations and Errata Clarify 2018 Imaging Requirements and an Interpretation Provides a Soiled Holding Option for Psychiatric Hospital Patient Care Units

FGI received an inquiry asking whether it would be permissible to have a soiled holding room rather than a soiled workroom in a psychiatric hospital patient care [nursing] unit. The HGRC task group assembled for this inquiry agreed this would be acceptable as long as no patients with medical issues were being served in the unit.

Another inquirer pointed out conflicting requirements for a door between an imaging room or a hybrid OR and an associated control room. Omission of this required door is permitted for a hybrid OR if the control room is “built, maintained, and controlled” in the same way as the OR, but this exception does not appear in the sections on imaging rooms in the 2018 Hospital and Outpatient Guidelines documents. An HGRC task group determined this was an oversight and the same exception should be permitted for the control room door that opens into a single Class 2 or 3 imaging room.

It was also noted that space requirements for Class 3 imaging rooms (which are OR equivalents) were different in the Hospital and Outpatient documents. A Class 3 imaging room requires a larger footprint than the minimum OR sizes in the Outpatient document, so the task group suggested adding the space requirements for Class 3 imaging in the Hospital document to the Outpatient volume.

These interpretations will be submitted as proposals for the 2022 Guidelines; we welcome opinions on them on the FGI proposal platform.

On the 2018 Hospital and Outpatient errata sheets, the most recent corrections are to the cross-references in the hybrid OR requirements in the 2018 Hospital document and in the imaging room requirements in the 2018 Hospital and Outpatient Guidelines; these now point to the intended space requirements. As well, for both documents, language in the imaging requirements regarding the system component room door has been clarified. These corrections are part of the enforceable language in the Guidelines.

Curious About FGI’s Beyond Fundamentals?

Hear about what FGI is up to at the upcoming ASHE PDC Summit in Phoenix, March 17–20, 2019. We look forward to highlighting pertinent issues influencing health care facility planning and design in five educational sessions. We’re delighted to be represented by a talented group of HGRC members and other subject matter experts. This year, the sessions feature topics included in FGI’s Beyond Fundamentals eLibrary and areas of focus for the 2022 HGRC. We hope to see you at the sessions and throughout the conference.

Rural Right Size Study and FGI Response Monday, March 18, 9:45 – 10:45 a.m.	John Williams Rebecca Lewis, FAIA, FACHA, CID Hui Cai, PhD
FGI’s Beyond Fundamentals: Moving Beyond the Minimum Tuesday, March 19, 8:15 – 9:15 a.m.	Bryan Langlands, AIA, ACHA, EDAC, LEED GA Doug Erickson, FASHE, CHFM, HFDP, CHC
FGI and ACOG: New Ideas in Childbirth Facility Design Tuesday, March 19, 3:00 – 4:00 p.m.	Troy Savage, MESc, MDiv Walt Vernon, PE, FASHE Virginia Pankey, AIA, EDAC, LEED AP Jennifer Ries Sheila Ruder, AIA, ACHA, EDAC, Lean Six Sigma CE, LEED AP Heather B. Livingston
Collaborating for a New Type of ED Space Wednesday, March 20, from 9:45 – 10:45 a.m.	Christine Carr, MD, CPE, FACEP David Vincent, AIA, ACHA, LEED AP Bryan Langlands, AIA, ACHA, EDAC, LEED GA
Design Insights for Geriatric-Friendly EDs Wednesday, March 20, 11:00 a.m. – 12:00 p.m.	Kathryn Gallagher, MS, BSN, RN, NE-BC

If you miss these sessions and still need Guidelines updates, FGI webinars are a great source for information on revisions in the 2018 edition. FGI 2018 webinars are now available free of charge on FGI’s YouTube channel.

The AAH and CHD Offer a Webinar on Using the CHD Knowledge Repository

Jointly presented by the AIA Academy of Architecture for Health (AAH) and the Center for Health Design (CHD), the webinar “Better than Google: What’s out there and how to find it” is intended to build awareness of the CHD Knowledge Repository and how to use it. Presented live on April 9, 2019, from 2:00 to 3:00 p.m. Eastern, the webinar will demo use of the Knowledge Repository to dig into a sample topic (behavioral health), searching the more than 4,000 research studies and 700 summaries for information that can be applied to a design project. Learn more on the AIA website.