Transition to the 2018 Guidelines - MISHE...facilities, mobile/transportable medical units, and dental ... •Residential Healthcare & Support Facilities Guidelines -provides design

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©MSLHealthcarePartners,2018

ExpandingPossibilitiesasweTransitiontothe2018FGIGuidelines

WayneKlingelsmith,FASHE,CHFM,MBAPrincipal,MSLHealthcarePartnersSeptember21,2018


Agenda

• WhataretheFGIGuidelines?– BriefHistoryoftheGuidelines–WhatareweTransitioningfrom?

• ElementsoftheFGIGuidelines• NewandSignificantRevisionsin2018• FGI“BeyondFundamentals”ResourceLibrary• Questions

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WhataretheFGIGuidelines?

• Theindustry’smostwidelyrecognizedguidanceforplanning,designing,andconstructingHealthCare,ResidentialCare,andSupportFacilities.• TheFGI Guidelines documentsconsolidateminimumprogram,space,riskassessment,infectionprevention,architecturaldetail,surface,andbuilt-infurnishingrequirementsinoneconvenientplace.

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WhataretheFGIGuidelines?

• Adoptedby42statesastheminimumconstructionrequirementsfordesignandconstructionofhospitalsandhealthcarefacilities.• ReferencedbyTheJointCommissionandotheraccreditingorganizationsforusewhenhealthcareorganizationsareplanningnew,alteredorrenovatedspace(unlessthereareStateRulesandRegulationswithdesigncriteriatobefollowedwhenplanningfornew,alteredorrenovatedhealthcarefacilityspace).

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HistoryoftheGuidelines

• February14,1947- Federalgovernmentissued“GeneralStandards”forhospitalsaspartofimplementingregulationsfortheHill-Burtonprogram.• 1974- Publicinputusedtoupdatestandards,re-titled“MinimumRequirementsofConstructionandEquipmentforHospitalsandMedicalFacilities”.• 1984- LasteditionoftheGuidelinesrevisedandpublishedbythefederalgovernmentasfederalgrantandloanprogramsexpired.



• 1987- GuidelinespublishedbyAmericanInstituteofArchitectswithaspecialgrantfromthegovernment.• 1998- FacilitiesGuidelinesInstitute(FGI)foundedasanot-for-profit501(c)(3)corporation with stakeholders inhealthcarefacility planning,design,construction,operations andclinical services using aconsensus process to revise/update.• 2001- Guidelinespublished by FGIwith funding andassistance from HHS/Health CareFinancing Administration,AIA,ASHE,and NationalInstitutesof Health.

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• Historyincompletewithoutmentionof:– JArmandBurgun– JosephG.Sprague– DouglasS.Erickson

• Obtainedafederalgranttofundtherevisioncycleintheearly90’sandcreateaSteeringCommitteeconsistingoffederalandstategovernmentrepresentatives,alongwithprivatesectorrepresentativeswithexpertiseindesign,operationandconstructionofhealthcarefacilities.


FGIGuidelinesToday

• Today,theHealthGuidelinesRevisionCommittee(HGRC)isabalancedgroupofstakeholdersconsistingof:– FederalandStateAHJs(24%)– Architects(20%)– MedicalProfessionals(18%)– Engineers(13%)– HealthcareAdministrators(10%)– InfectionControlExperts(4%)– ConstructionRepresentatives(4%)

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FGIGuidelinesToday

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TheFGIGuidelineshasbeenadoptedby42Statesandisbeingconsideredforadoptionbyatleast6more.


WhatareweTransitioningFrom?

2007MINIMUMDESIGNSTANDARDSFORHEALTHCAREFACILITIESINMICHIGAN

This document updates and replaces the 1998 Minimum Design Standards for Health Care Facilities in Michigan, and Interpretive Bulletins issued in 2003 and 2004. It was produced in light of the efforts of the American Institute of Architects Academy of Architecture for Health (AIA/AAH) in their drafting of the 2006 Guidelines for Design and Construction of Health Care Facilities.



• The2007MinimumStandardsrequireSoiledHoldingtohaveahandwashingsink– Section2.1-2.8.12.3of2018FGIGuidelinesallowshospitaltohaveeitherahand-washingsinkorahandsanitationstationforSoiledHolding

• The2007MinimumStandardscurrentventilationtable2ArequiresEndoscopytobepositivepressurewith15ACPH– ASHRAE170-2017inthe2018FGIGuidelineshasnopressurerequirementforEndoscopyandonly6ACPH



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– ASHRAE170-2017TABLE> > >



• 2007MDSSection7.32.G2item1.states:“Bathstationsinshowerstallsandtubsshallbelocated5– 6feetabovethefloor…”– FGIGuidelines2.1-8.5.1.3requiresheightofbathcallstationstobewithin3to4feetabovethefloor.(Thiswouldtypicallyrequireawaterproofnursecallstation)

• 2007MDSTable10isverysimilartoFGITable2.1-2regardingnursecalldevices,but:– FGIrequirescompliancewithUL1069;2007MDSdoesnot


2018FGIGuidelines

TJCreferences2014Guidelines


2018FGIGuidelines

• OutpatientFacilitiesGuidelines– providesminimumdesignstandardsforavarietyofoutpatientfacilitytypes,includinggeneralandspecialtymedicalservicesfacilities,outpatientimagingfacilities,birthcenters,urgentcarefacilities,infusioncenters,outpatientsurgeryfacilities,freestandingemergencyfacilities,endoscopyfacilities,renaldialysiscenters,outpatientpsychiatricfacilities,outpatientrehabilitationfacilities,mobile/transportablemedicalunits,anddentalfacilities


2018FGIGuidelines

• ResidentialHealthcare&SupportFacilitiesGuidelines-providesdesignstandardsfornursinghomes,hospicefacilities,assistedlivingfacilities,substanceabusetreatmentfacilities,settingsforindividualswithintellectualand/ordevelopmentaldisabilities,independentlivingsettings,adultdaycarefacilities,wellnesscenters,andoutpatientrehabilitationfacilities.• HospitalGuidelines– providesminimumdesignstandardsforgeneralhospitals,freestandingemergencyfacilities,criticalaccesshospitals,psychiatrichospitals,rehabilitationhospitals,children’shospitals,andmobile/transportablemedicalunits.


ElementsoftheFGIGuidelinesforHospitals

Part1:GeneralPart2:HospitalFacilityTypesPart3:VentilationofHealthCareFacilities- (ASHRAEStandard170-2017)

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ElementsoftheFGIGuidelines– Part1

• Part1:General– 1.1Introduction(Minimumstandards,earthquake,otherregulations)– 1.2Planning,DesignandConstruction

• FunctionalProgram• SafetyRiskAssessment• PlanningandDesignConsiderations(Acousticdesign,sustainabledesign,accommodationforpatientsofsize,etc.)

• Commissioning– 1.3Site(Lighting,Signage,Parking,Landscaping,etc.)– 1.4Equipment



*1.1-1.2MinimumStandardsforNewFacilitiesandMajorRenovations(Introduction)

1.1-1.2.1Eachchapterinthisdocumentcontainsinformationintendedasminimumstandardsfordesignandconstructionofnew,andformajorrenovationsofexistinghealthcarefacilities.

1.1-1.2.2StandardssetforthintheGuidelines shallbeconsideredminimumanddonotprohibitdesigningfacilitiesandsystemsthatexceedtheserequirementswheredesiredbythegoverningbodyofthehealthcarefacility.



1.1-3Renovation(Introduction)1.1-3.2FacilitiesSubjecttoCompliancewiththeGuidelines1.1-3.3UndiminishedSafety

*1.1-4GovernmentRegulations(Introduction)1.1-4.1DesignStandardsforAccessibility1.1-4.2RegulationsforEarthquakeResistantDesign1.1-4.3FloodProjection1.1-4.4NationalStandardsfortheProtectionofPatientHealth

Information1.1-4.5EnvironmentalRegulations



1.2-2FunctionalProgram(Planning,Design&Construction)1.2-2.1General1.2-2.1.1FunctionalProgramRequirement1.2-2.1.1.1Afunctionalprogramshallbedevelopedfornewconstruction,majorrenovations,andprojectsthatchangethefunctionaluseofanyfacilityspace.1.2-2.1.1.2Thegoverningbodyshallberesponsiblefordeveloping,documentingandupdatingthefunctionalprogram.1.2-2.1.1.3Activitiessuchasequipmentreplacement,firesafetyupgradesorminorrenovationsthatwillnotchangethefacility’sfunctionorcharactershallnotrequireafunctionalprogram.



1.2-4SafetyRiskAssessment(Planning,Design&Construction)1.2-4.1General1.2-4.2InfectionControlRiskAssessment1.2-4.3PatientHandling&MovementAssessment1.2-4.4FallPreventionAssessment1.2-4.5MedicationSafetyAssessment1.2-4.6BehavioralandMentalHealthRiskAssessment1.2-4.7PatientImmobilityAssessment1.2-4.8SecurityRiskAssessment



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1.2-4SafetyRiskAssessment(SRA)(Planning,Design&Construction)• Multidisciplinary,documentedassessmentprocess• Proactivelyidentifyhazardsandrisks• Mitigateunderlyingconditionsofthebuiltenvironmentthatcan

contributetoadversesafetyevents• infections,falls,medicationerrors,immobility-relatedoutcomes,securitybreaches,

andmusculoskeletalorotherinjuries.• Evaluationofthepopulationatrisk• Natureandscopeoftheproject

• modelsofcare,operationalplans,sustainabledesignelementsandperformanceimprovementinitiativesofthehealthcareorganization.

• Proposesbuiltenvironmentsolutionstomitigatepotentialrisks&hazards.



1.2Planning,DesignandConstruction,continued1.2-6PlanningandDesignConsiderationsandRequirements1.2-6.1AcousticDesign1.2-6.2SustainableDesign1.2-6.3Wayfinding1.2-6.4DesignConsiderationsforAccommodationofPatientsofSize1.2-6.5EmergencyPreparednessandManagement

1.2-7Renovation(Phasing,Isolation,AirQuality,ExistingConditions)1.2-8Commissioning1.2-9RecordDrawingsandManuals



1.3Site1.3-1General1.3-2Location(AvailabilityofTransportation,Security,Utilities)1.3-3SiteFeatures

1.3-3.1Signage1.3-3.2Lighting1.3-3.3RoadsandWalkways1.3-3.4Parking1.3-3.5EmergencyAccess1.3-3.6LandscapeDesignFeatures1.3-3.7TransferSupportFeatures

1.3-4EnvironmentalPollutionControl

1.4Equipment



• Part2:HospitalFacilityTypes– 2.1CommonElementsforHospitals– 2.2SpecificElementsforGeneralHospitals– 2.3SpecificRequirementsforFreestandingEmergencyCareFacilities– 2.4SpecificRequirementsforCriticalAccessHospitals– 2.5SpecificRequirementsforPsychiatricHospitals– 2.6SpecificRequirementsforRehabilitationHospitals– 2.7SpecificRequirementsforChildren’sHospitals– 2.8SpecificRequirementsforMobile/TransportableMedicalUnits

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2.1CommonElementsforHospitals2.1-1General2.1-2PatientCareUnits2.1-3DiagnosticandTreatmentAreas(Exam/Treatment,Telemedicine)2.1-4PatientSupportFacilities(Lab,Pharmacy,FoodServices)2.1-5GeneralSupportFacilities(SPD,EVS,Linen,Engineering,etc.)2.1-6PublicandAdministrativeAreas2.1-7DesignandConstructionRequirements2.1-8BuildingSystems



AppendixComments:• Typicallyfoundatbottomofpage• Notintendedtobeenforceable• Additionalinformationorclarity

2.1Indicatesthisisin“CommonElements”

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2.2SpecificRequirementsforGeneralHospitals2.2-2PatientCareUnits2.2-2.1General2.2-2.2Medical-SurgicalPatientCareUnit2.2-2.3OncologyPatientCareUnit2.2-2.4Pediatric&AdolescentOncologyUnit2.2-2.5IntermediateCareUnit2.2-2.6CriticalCareUnit2.2-2.7PediatricCriticalCare2.2-2.8NeonatalIntensiveCareUnit



2.2SpecificRequirementsforGeneralHospitals,cont.2.2-2PatientCareUnits,Cont.2.2-2.9ObstetricalUnit2.2-2.10NurseryUnit2.2-2.11Pediatric&AdolescentPatientCareUnit2.2-2.12PsychiatricPatientCareUnit2.2-2.13In-HospitalSkilledNursingCareUnit2.2-2.14BariatricPatientCareUnit

2.2-3DiagnosticandTreatmentFacilities(ED,Surgery,Imaging,etc.)



2.2SpecificRequirementsforGeneralHospitals,cont.2.2-4PatientSupportFacilities(Lab,Pharmacy,FoodServices)2.2-5GeneralSupportFacilities(SterileProcessing,Linen&WasteManagement,EVS,MaterialsMgmt.,Engineering)2.2-6PublicandAdministrativeAreas2.2-7DesignandConstructionRequirements2.2-8BuildingSystems(HVAC,ElectricalSystems,PlumbingSystems,CommunicationsSystems,ElectronicSafetyandSecuritySystems,OtherSpecialSystems



2.3SpecificRequirementsforFreestandingEmergencyCareFacilities

2.4SpecificRequirementsforCriticalAccessHospitals2.5SpecificRequirementsforPsychiatricHospitals2.6SpecificRequirementsforRehabilitationHospitals2.7SpecificRequirementsforChildren’sHospitals2.8SpecificRequirementsforMobile/Transportable

MedicalUnits





Part3VentilationofHospitalsANSI/ASHRAE/ASHEStandard170-2017– VentilationofHealthcareFacilities(includesalladdendaapprovedthroughNovember2017)ASHRAEkeepsStandard170underacontinuousmaintenanceprocess,permittingofficialchangestobemadeatanypointoverthelifecycleofthedocument.Addendaissuedafterpublicationconsideredpartof2018Guidelines

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NewandSignificantFGIRevisionsin2018

• AirborneInfectiousIsolation(AII)roomsnowpermittedtohaveeitherself-closingdoororaudiblealarmthatcanbeactivatedwhentheroomusedasanisolationroom.

• Accommodationsfortelemedicineservices.• RequirementsforaccommodationsforcareofpatientsofsizeinCommonElementsforhospitals(Part2.1)• Patienthandlingandmovementassessment• Clearancesforroomsbothwithandwithoutoverheadorfloorlifts• Dooropeningsizesalongthepathoftravelforthesepatients



• “PatientsofSize”– thosewhodon’tfitstandarddefinitionof“obese.”• “Bariatricpatient”nowrefersexclusivelytothosewhorequirebariatricsurgery.

• RequirementsmovedfromNursingUnits(Section2.2-2.16in2014)toCommonElements(Section2.1-2.3).

• Section2.2-2.14BariatricPatientCareUnitnowstates,“Whereabariatricpatientcareunitisprovided,itshallmeettherequirementsinSection2.2-2.2(Medical/SurgicalPatientCareUnit)andtherequirementsinSection2.1-2.3(AccommodationsforCareofPatientsofSize).”



• Ownerstilldefinesthe“PatientsofSize”(POS)programanddeterminesthethresholdweightofpatientstheycanaccommodate.

• EveryhospitalneedstotreatpatientsofsizeintheED,buttheycouldhaveatransferpolicyandnottreatthemasaninpatient.

• AnAIIroomdedicatedtoPOSisnotarequirementforeveryhospital.• Aliftsystemisrequiredwherepatientsofsizewillbetreated;ownerhastheoptionofbuilt-inceiling- orwall-mountedliftsormobilelifts.

• Liftsarerequiredforpatientroomsdesignatedforcareofpatientsweighing600poundsormore.

• Liftsinotherareasdeterminedbyfacility’sthresholdweightcapacity.





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• Satellitesterileprocessingmustconsistoftwo-roomstomaintain“dirtytoclean”workflow.(previouslyallowed1-room)• Decontaminationroom• Cleanworkroom• EXCEPTION:smallcountertopsterilizerswithlimitedworkflow

• Technologydistributionroom- musthave3’clearanceonallsidesofracks(previouslyminimum12’x14’room)

• Mobile/transportablemedicalunits- newguidelinestoensuredesignrequirementsthesameregardlesswhereserviceprovided





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FGI– BeyondFundamentalsResourceLibrary

• Digitalresourcelibraryonlatesthealthcaredesignthinkingregarding:– Bestpractices– Designrecommendations– Evidence-basedresearch– Newapplicationsoftechnology– DraftfundamentalrequirementsbeingconsideredforinclusionintheGuidelines

• Availableonlytosubscribers(www.fgiguidelines.org)

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FGI– BeyondFundamentalsResourceLibrarySamplingofResources

• Guidanceonlow-acuitypatienttreatmentpodsinED• ChecklistforaccommodationsforgeriatricEDpatients• Designofhybridoperatingrooms• Whitepapers,toolsandwebinarsonapplyingtheGuidelines• Designinsightsforpalliativecaresettings• Whitepaperonhowtocreateafunctionalprogram• Whitepaperonpatienthandling&movementassessment


FGI– 2018GuidelinesandBeyondFundamentals

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• AsubscriptiontoBeyondFundamentalsisincludedwithanannualsingle-userlicenseorsitelicenseforall2018 Guidelines documentsthroughMADCADandofferedtootherpurchasersasa$25/yearsubscription,except$65/yearforsubscriberswhopurchaseasitelicensetothe2010or2014edition.

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Questions?WayneKlingelsmith,CHFM,[email protected]

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Documents

Transition to the 2018 Guidelines - MISHE...facilities, mobile/transportable medical units, and dental ... •Residential Healthcare & Support Facilities Guidelines -provides design