2022 FGI guidelines have arrived: What do they mean?

FGI Guidelines insights

• The changes outlined in the 2022 FGI guidelines are crucial for planning the design of a facility. The guidelines eventually become enforceable as state laws, codes, rules or regulations when they are adopted by state or federal agencies. The 2022 guidelines emphasize person-centered care and aim to benefit multipurpose patient care.
• Hospitals, outpatient facilities and residential health, care and support facilities face major changes in guidelines. Hospitals will need to increase room sizes and install video surveillance to prevent patients needing immediate attention from being locked out, outpatient facilities are strengthening their spaces risk assessment and requirements and residential facilities were updated to align more with hospital and outpatient guidelines.

For the 2022 edition of its Guidelines for Design and Construction, the Facility Guidelines Institute (FGI) will offer three Guidelines publications for:

• hospitals
• outpatient facilities
• residential health, care and support facilities

Each of the publications are crucial resources for facility planning and design and include program, space, risk assessment, infection prevention, architectural detail and surface and building system requirements. Although the documents are called “guidelines,” they are written as fundamental standards and become enforceable when adopted by federal agencies or states or referenced in state laws, codes, rules or regulations.

Throughout the issuance of the changes for the 2022 FGI guidelines, the repeating theme was person-centered care. Due to the discussion and developments within FGI topic groups requirements and appendices have been added in the Hospital, Outpatient and Residential documents that reflect the role design plays in providing comfort to patients and residents receiving palliative and end-of-life care. Additional requirements within the guidelines provide support for the health spaces to be inclusive for patients, residents, staff and visitors with low or declining vision, hearing, mobility, balance or other physical difficulty. The 2022 guidelines also updated requirements for multipurpose patient care settings, lighting, nurse call systems, telecommunication systems and ligature resistance in areas in behavioral health settings.

Major changes in the hospital guidelines

The guidelines encourage design flexibility and innovation of patient care and staff welfare are not compromised.

Healthcare facilities are often at the forefront of practice and technology, with new spaces continually added and old spaces reconfigured often. To accommodate the ever-changing nature of hospitals, implementing the guidelines does not always align with the scope of a particular project. To address this misalignment, the common chapter of the 2022 hospital guidelines now provides an alternate method of applying requirements: For hospitals where there is a single location with a variety of services provided at a single location, designers are permitted and encouraged to include elements from one or more facility chapters without having to apply the entire chapter. To use this alternate method, designers must identify early in the design which sections of the guidelines are being applied to the project.  (2022 Hospital | 2.1-1.1.3 Non-Traditional Application).

Newborn intensive care unit (NICU) room sizes have increased. Multiple-infant rooms increased from 120 square feet to 150 square feet per patient and single-infant rooms increased from 155 square feet to 180 square feet. A neonatal couplet care room has been added to provide an integrated space where a hospitalized mother and NICU patient can both receive care. As NICU spaces are designed, the design team should coordinate closely with the Architect and Owner to confirm the number of bassinets and locations within each room. (2022 Hospital | 2.2-2.9 Neonatal Intensive Care Unit).

The free-standing emergency care facilities chapter has been removed from the hospital guidelines and will only appear in the outpatient guidelines.

Emergency facilities are required to have video surveillance at public entrances and a duress alarm system where emergency department (ED) entrances may be locked. This change was proposed due to an effort in Massachusetts to pass “Laura’s Law.” Signed in law in January 2021, the law is named after Laura Levis, a 34-year-old woman who suffered an asthma attack and died outside an ED because she could not find an unlocked entrance.

A substantial impact on the plumbing systems is the reduction of permissible non-recirculated fixture branch piping in hospitals from a maximum of 25 feet to 10 feet. This will impact the domestic water design requirements especially in patient care spaces. (2022 Hospital | 2.1-8.42.5 Heated potable water distribution).

Major changes in the outpatient guidelines

The 2022 outpatient guidelines encourage space use flexibility.

• With an eye to behavioral and mental health care, the spaces safety risk assessment requirements are also being strengthened to require the design team to review each space type and associated risk levels. (2022 Outpatient | 1.2-4.6 Behavioral and Mental Health Risk Assessment).
• In the common elements chapter, the single-patient exam/observation room minimum square footage has increased to 100 square feet, meaning the ventilation loads of these spaces will increase in parallel. (2022 Outpatient | 2.1-3.2.2.2 Single-patient exam/observation room).
• Urgent care facilities must now include a minimum of one single-patient exam room. Staff support areas have been added and the nurses’ station is permitted to share space with the reception and information area. In the free-standing emergency facility chapter, the trauma/resuscitation room is now permitted to be subdivided and use of low-acuity patient treatment stations is allowed. This flexibility in design could add capacity for patients during a surge and reserve the private rooms for more severe cases. (2022 Outpatient | 2.5 Specific Requirements for Urgent Care Centers).
• For renal dialysis centers, new requirements are included for fluid disposal sinks in hemodialysis treatment areas. (2022 Outpatient | 2.10 Specific Requirements for Renal Dialysis Centers)
• In the birth centers chapter, the birth room square footage has been reduced. This will reduce the amount of ventilation required for these spaces and potentially increase the number of rooms that are able to fit on a floor plate. (2022 Outpatient | 2.4 Specific Requirements for Birth Centers).
• In the dental facility chapter, dental laboratories are now required to meet the room and pressure requirements of ANSI/ASHRAE/ASHE Standard 170, Ventilation of Health Care Facilities. (2022 Outpatient | 2.14 Specific Requirements for Dental Facilities).

Major changes in the residential guidelines

The 2022 residential guidelines were reorganized to align with the hospital and outpatient guidelines.

• In the new common elements chapter sustainability requirements were updated to refer to existing standards where possible.
• Kitchen and dining area requirements are now included in the common elements chapter.
• There is a focus to improve acoustics in residential dining settings.

Key takeaways

Overall, the 2022 guidelines have been updated to provide for flexible space use. For example, the ED section in the hospital guideline and free-standing emergency facility chapter in the outpatient guideline include requirements for a flexible secure treatment room, capable of serving as either a secure holding room or a single-patient treatment room. The hospital and outpatient guidelines include innovative design guidance for behavioral and mental health spaces for facilities where an intensive outpatient/partial hospitalization program (IOP/PHP) will be provided.

Henderson Engineers is a CFE Media and Technology content partner.

-Edited by Morgan Green, associate editor, CFE Media and Technology, mgreen@cfemedia.com.

Original content can be found at www.hendersonengineers.com.

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