FGI Guidelines Overview 20 September 2019
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FGI Guidelines Overview20 September 2019
Introduction
The Guidelines Process
Chapter 133 Rules Process
Benefits of the Shift
Owners Perspective
Architects Perspective
Significant Changes
01
02
03
04
05
06
07
Content
Introduction
• Employed by HKS for over 18 years• Worked specifically in Healthcare for
over 14 years• Licensed architect, Certified building
official, Accessibility specialist, recently became a member of Academy of College of Healthcare Architects
• 2022 Outpatient Document Group HGRC member
• Raised in Victoria, TX!
Introduction
The views and opinions expressed in this presentation are the opinions of the speaker and not the official position of FGI, the Health Guidelines Revision Committee or the State of Texas
Disclaimer
The Guidelines Process
The Guidelines
The Role of the Guidelines
A consensus-based fundamental standard that promotes a level of building performance that will not detrimentally affect the health and safety of patients and staff when buildings are operated as designed (FGI, 2018).
To provide a baseline of design and construction requirements for health care facilities that recognizes the mission of health care and considers how the built environment supports a safe, effective and efficient health care delivery system (FGI, 2018).
The Guidelines
HGRC Structure
Divided into three document groupsHospitalOutpatientResidential
Topic groups – voluntaryUsually all encompassing
Task groups – temporarySteering committee - balance
The Guidelines
HGRC Multidisciplinary Committee
20% - Architects18% - Medical Professionals16% - State AHJ’s13% - Engineers10% - HC Administrators/HC Organization reps8% - Federal AHJ’s (HIS, CMS, HUD, VA)7% - Infection control experts + NIH/CDC4% - Construction professionals4% - Interior designers
The GuidelinesThe Revision Cycle and Process
(FGI, 2018)
Chapter 133 Hospital Licensing Rules Process
The ‘Rules’
Hospital Rules Forum Structure
Divided into four different groups HospitalAmbulatory Surgical CentersFree Standing Emergency DepartmentsBehavioral Health
The ‘Rules’
Hospital Rules Multidisciplinary Forum
ArchitectsMedical ProfessionalsState AHJ’sEngineersHC Administrators/HC Organization repsInfection control experts
Comparison of Processes
Hospital Rules Forum HGRC
• No set cycle revision policy
• Monthly face to face meeting for
approximately 6 months
• Discussed every chapter in each book
• Discussion was focused on the differences
between the Rules and the Guidelines
• Collaboratively revised text, when needed
• Room consensus for (preliminary) approval
• Four-year cycle
• Weekly meeting for 2 months initially
• Discussed designated chapter(s) in specific
book
• Discussion is focused on reviewing existing
content and its applicability as well as
developing new content
• Collaboratively revised existing and new content
• Official vote on all proposals
Benefits of the Shift
• Nationwide perspective
• Formal interpretation platform
• Chat room available for AHJ’s
• Quality minimum standards that meet today’s needs
• Current Rules are based on the 2001 Guidelines!
Benefits of the Shift
Owners Perspective
• Relevant guidelines for today’s practice• Wider range of applicable precedents
on specialty procedures that may not have been specifically addressed
• Consistent with the Environment of Care guidelines used by The Joint Commission
• Broaden benchmarking data by allowing an ‘apples to apples’ approach
• Additional support and clarity provided by FGI to allow more time for meaningful dialogue with the State
Owners Perspective
Architects Perspective
• Consistency amongst projects across nation
• Easier to maintain code compliance; i.e. one code concept
• Up-to-date standards that provide the best patient and staff care
• Wider range of facilities covered• Removes some of the ambiguity • Beyond Fundamentals can be used
as a resource for new perspectives
Architects Perspective
Significant Changes
The views and opinions expressed in this presentation are the opinions of the speaker and not the official position of FGI, the Health Guidelines Revision Committee or the State of Texas.
Additionally, the information presentation hereto should be verified with final adopted Rules and are subject to change prior to its adoption. The information presented is not all-inclusive regarding changes.
Disclaimer Reminder
133.163(f)(1)(A)(ii)(IX)
Numbering Convention
Current Texas Rules
2.2-3.1.3
2018 Guidelines
Nearly all requirements
specific to a room or
department is included
within each applicable
section
Document Organization
Current Texas Rules
2.1 Includes Common
Elements
2.2 Specific Requirements
Be mindful that the
Outpatient Document is
organized differently
2018 Guidelines
Utilizes CMS’ definition of
surgical or other invasive
procedures
‘operative procedures in
which skin or mucous
membranes and connective
tissue are incised or an
instrument is introduced
through a natural body orifice’ (CMS,2009).
Definitions
Current Texas Rules
Invasive Procedure
2018 Guidelines
Invasive procedures will
specifically include
Biplane and EP labs
Amended Texas Rules
Definitions
Current Texas Rules 2018 Guidelines
Location terminology Location terminology
• In
• Directly accessible
• Adjacent
• Immediately accessible
• Readily accessible
• In the same building
‘Two scrub stations shall be
located in the restricted
corridor within five feet of the
entrance of each operating
room.’
Scrub Facilities
Current Texas Rules
‘At least one hand scrub
position shall be located
next to the entrance to
each cesarean delivery,
operating, and Class 3
imaging room.
2018 Guidelines
At least one hand scrub
position shall be located
within 10’-0” from the edge
of the sink to the frame of
the entrance of each
cesarean delivery,
operating and Class 3
imaging room.
Amended Texas Rules
Imaging Room Classification
Current Texas Rules 2018 Guidelines
CMS definition, special
procedures suite section
and imaging suite section
Surgical suite staff clothing change rooms
Current Texas Rules 2018 Guidelines
‘These areas shall be arranged to provide a
traffic pattern so that personnel entering
from outside the surgical suite can shower,
change, and move directly into the restricted
areas of the surgical suite.’
‘A staff changing area with one or more
private changing rooms or areas shall be
provided for male and female staff working in
the semi-restricted and restricted areas of
the surgery department.’
Aka-no direct connection
needed from locker room
to restricted area!
Post Anesthesia Care Unit ratio
Current Texas Rules 2018 Guidelines
‘A minimum of one and a half patient stations
per operating rooms shall be provided for the
post-anesthesia care or fraction thereof.’
Example: 5 operating rooms would require 8
PACU bays
‘A minimum of one Phase I patient care
station per Class 3 imaging or operating
room shall be provided’
Cross-corridor control
doors shall consist of two
44” leaves which swing in
a direction opposite of
each other and shall be
provided with a view
window
Control Doors
Current Texas Rules
No requirements
2018 Guidelines
Cross-corridor control
doors shall consist of two
44” leaves which swing in
a direction opposite of
each other and shall be
provided with a view
window
Amended Texas Rules
120 sf per bassinet/crib
Neonatal Intensive Care Unit (NICU)
Current Texas Rules
165 sf per bassinet/crib
2018 Guidelines
120 sf per bassinet/crib
Amended Texas Rules
‘The maximum patient
room capacity shall be two
patients.’
Medical/Surgical Patient Care Unit
Current Texas Rules
‘The maximum number of
beds per room in a
medical/surgical patient
care unit shall be one
unless the necessity of a
two-bed arrangement has
been demonstrated. Two
beds per room shall be
permitted when approved
by the authority having
jurisdiction.’
2018 Guidelines
The maximum number of
beds per room in a
medical/surgical patient
care unit shall be two.
Amended Texas Rules
‘Hospitals with 25 or more
maternity beds shall
provide a continuing care
nursery for infants
requiring close
observation.’
Continuing Care Nursery
Current Texas Rules
As required by the
functional program
2018 Guidelines
Elevator Lobby:
• ‘Elevator lobby shall be provided and shall have at least 10’-0” of clear space in front of each elevator door’
Elevator Shaft Opening protection via:
• lobby (not included in egress system)
• smoke exhaust
• swinging hoistway door
• horizontal sliding door
Elevators
Current Texas Rules
No requirements (with regards to
hoistway protection)
Be mindful of the separate
requirements in the International
Building Code and any local
amendments
2018 Guidelines
Referenced frequently as a functional
narrative. Typically includes:
• Description of functions
• Number of beds
Functional Program
Current Texas Rules
Referenced as functional program. Should
include:
• Intent for basis of design
• Executive summary
• Purpose of project
• Project type and size
• Operational requirements
2018 Guidelines
None required
Safety Risk Assessment
Current Texas Rules
Multidisciplinary assessment that is required with the intent to ‘proactively identify hazards and risks and mitigate underlying conditions of the built environment that may contribute to adverse safety events.’ (FGI, 2018)
Can include:• Infection control risk assessment• Patient handling and movement assessment• Fall prevention assessment• Medication safety assessment• Behavioral and mental health risk
assessment• Patient immobility assessment• Security risk assessment
2018 Guidelines
Room for
disturbed
patients not
required but
other behavioral
provisions will
be included,
when applicable
Outstanding or Unresolved Items (at least to me…)
Behavioral Health
Determining the
use of these
rooms, where
they could be
located and
planning ahead
Observation Rooms
Considering the
2018 edition and
if so, how that
will be adopted
LSC Edition
Considering
adopting
ASHRAE 170
without
amendments
Nursery airflow locations
1 2 3 4
In the works as
a ‘Beyond
Fundamentals’
but will not likely
be available
before adoption
ClearanceDiagrams
5
ReferencesThe Facility Guidelines Institute.(2018) Guidelines for Design and
Construction of Hospitals. St. Louis, MO: The Facility Guidelines Institute
The Center for Health Design. (2012-2015). Safety Risk Assessment (SRA) for healthcare facility environments. Concord, California. pg. 9
Texas Department of State Health Services (2007) Title 25 Texas Administrative Code Chapter 133 Hospital Licensing Rules. Austin, Texas
Thank you
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