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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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