Changing spaces

The Facility Guidelines Institute (FGI) soon will release a draft manuscript of the 2014 edition of the FGI Guidelines for Design and Construction of Health Care Facilities, marking the beginning of an important public comment period that runs from June 1 through Nov. 25.

The Guidelines, which is used by authorities in 42 states and several federal agencies as a code or a reference standard, details baseline standards for all clinical and support areas of hospitals, including critical access and psychiatric hospitals; long-term care facilities, including nursing homes, hospice facilities and assisted living facilities; and outpatient and rehabilitation facilities.

The document includes recommendations on patient handling, infection prevention and architectural details as well as engineering design criteria for mechanical, electrical and plumbing systems.

The committee that creates the Guidelines, the Health Guidelines Revision Committee (HGRC), comprises 130 members from various disciplines, including architects, engineers, physicians, nurses, epidemiologists and other health care professionals as well as authorities having jurisdiction from 19 states and representatives from seven federal agencies, the Joint Commission and numerous health care organizations.

"It's not written by a bunch of architects smoking cigars in a back room," says HGRC Chairman Doug Erickson, FASHE, CHFM, HFDP, CHC. "We really try to mirror the professional makeup you find in a health care organization.

"The goal of the HGRC is to make sure the new requirements are based on research, science and expert opinion," Erickson adds. "We also have a cost-benefit committee that reviews every proposal for change and evaluates each based on clinical need and overall cost."

Counting on participation

The HGRC counts on participation from the public to help propose and review changes to the 2010 edition of the Guidelines. That means gathering public input from all professions working in the field.

Proposals for the Guidelines are submitted through a public process, and more than 2,500 proposals were submitted for the 2014 edition, including suggestions for new chapters on children's hospitals, critical access hospitals and dental facilities. At the HGRC's second meeting of the 2014 revision cycle in February, subcommittees reviewed each proposal and voted on what material should be accepted for inclusion in the draft manuscript.

But just because a proposal has been included in the draft does not mean it will be included in the 2014 edition. Erickson notes that the proposed changes receive greater scrutiny during the comment period evaluation.

The HGRC considers comments from the public as it prepares to vote on which changes should make the final cut. The next step of the guidelines process — the public comment period — provides an opportunity for those in the health care industry to tell the committee what they like about the draft, what they don't like and what should be amended.

The draft 2014 Guidelines document will be available for review in electronic form through the FGI's website at www.fgiguidelines.org by June 1. The draft presents the 2010 text marked to highlight language that has been added, deleted or amended.

The public is invited to submit comments using an online system at the site. Erickson says FGI typically gets about twice as many comments as proposals, so the 2014 HGRC will be busy sorting through public comments at its final meeting.

The HGRC will meet again in April 2013 after the public comment period closes to take action on all public comments and vote on final content for the 2014 edition. The 2014 Guidelines will be available in January 2014.

Chad Beebe, AIA, SASHE, director of codes and standards for the American Society for Healthcare Engineering (ASHE) of the American Hospital Association, urges everyone involved in the health care field to read the draft document closely once it is published and submit comments when appropriate.

"The public input to this document helps shape the Guidelines, which is used in most states around the country," Beebe says. "It's critical to get your comments in now before the 2014 edition is published and the four-year cycle begins again."

Suggested changes

Following is a list of some of the suggested changes that will appear in the draft manuscript for the 2014 Guidelines. Health facilities professionals may want to provide feedback on them.

Part 1: General. Among changes affecting health care facilities of all types, suggested revisions include:

• Risk assessments. The Guidelines draft has combined all risk assessments included in the planning process for health care facility design and construction projects into one Patient and Caregiver Risk Assessment.

This assessment would cover all risk assessments, including those for infection control, patient handling and movement, patient fall prevention, psychiatric injury and suicide prevention. It also would cover two newly proposed risk assessments for security and patient immobility.

• Commissioning. A proposal has recommended adding more aspects of health care commissioning to the Guidelines requirements based on the commissioning guidelines published by ASHE.

The ASHE commissioning process is specifically geared toward the health care physical environment and stresses achieving and sustaining building system performance planned during a new construction or renovation project.

Previously, the FGI Guidelines only recommended the commissioning process for heating, ventilation and air conditioning systems. The draft for the 2014 edition would expand commissioning activities to include other building systems, such as domestic hot water, essential electrical power and building automation.

• Sustainability. Erickson says the HGRC is evaluating whether the Guidelines should take the lead in health care sustainability or leave this aspect of design and construction to another consensus body.

"Some HGRC members strongly believe that FGI should be taking a lead role on this," he says, "while others believe we should reference the work of other org­anizations."

• Furniture. Furniture guidelines will be removed from the main document to a white paper based on a decision that the Guidelines should not be a regulator of movable furniture.=

Part 2: Hospitals. For hospitals specifically, the draft 2014 edition of the Guidelines includes such suggested revisions as:

• Nap rooms. One proposal would require nursing units that have 24/7 patient stay areas to provide a designated nap room for employees to rest.

Material in an appendix could specify details, including recommendations for a restful color palette, sound-absorbing materials, and a light with timer to wake up sleeping staff.

• Bariatric lifts. A proposal would change the amount of weight that patient lifts are required to carry from 600 to 800 pounds.

• Children's hospitals. A new chapter on children's hospitals would highlight some of the differences between acute care hospitals and children's hospitals.

• Critical access hospitals. For the 2010 edition, a task group met to draft a new guidelines chapter for critical access hospitals. A draft was posted online on the FGI website as a white paper, and now is being considered as a new chapter in the 2014 Guidelines.

That draft chapter is available at http://fgiguidelines.org/pdfs/FGI_2.4_CriticalAccess_Hospitals.pdf.

Part 3: Ambulatory care facilities. Suggested changes to the Guidelines regarding ambulatory facilities include:

• Classification of operating rooms. A proposal would replace the outdated American College of Surgeons' "ABC" classifications of operating rooms.

The new language would base the requirements for an outpatient operating room on the need for an aseptic field and the number of people and amount of equipment needed for the types of procedures being performed as well as the type of anesthesia being used.

This would allow for much more flexibility in the sizes of operating rooms in ambulatory surgery centers.

Part 4: Residential long-term care and related facilities. Among suggested changes to the Guidelines for facilities in the residential long-term sphere is:

• Residential care. An important change in 2014 will be separation of the guidelines for acute care and residential care facilities into two volumes.

For the past year, FGI has been working with the organizational leadership of the residential care community to develop text that will reflect the culture shift in residential care to a more social, home-like environment.

Facilities that would be covered under this section include nursing homes, assisted living facilities, hospice facilities, independent living centers and adult day care facilities.

A major influence

Each revision of the FGI Guidelines for Design and Construction of Health Care Facilities is a major influence on those who design, build, operate and maintain the nation's health care facilities.

All health facilities professionals would be wise to read and digest the changes being proposed for the 2014 edition of the Guidelines and constructively respond with any comments they may have.

Deanna Martin is senior communications specialist with the American Society for Healthcare Engineering. She can be reached at dmartin@aha.org.