When a new hospital is constructed, or an existing one is renovated, planners not only must adhere to all applicable buildings codes, they also have to meet strict requirements for patient safety issued by such accrediting agencies as the Joint Commission. Requirements for a healthcare facility's design and layout, as well as its construction process, are outlined in Guidelines for Design and Construction of Health Care Facilities, published by the Facility Guidelines Institute and the American Institute of Architects. As the Guidelines are updated every four years by the Health Guidelines Revision Committee, the 2010 edition is now being distributed for comment until Dec. 15, 2008.
What impact does the Guidelines document have on healthcare facilities? Certainly those involved in the planning phase of a hospital need to be thoroughly familiar with its requirements. Preplanning is key, according to George Mills, senior engineer of the Joint pretations Group. “The focus, before breaking ground, is on any negative impact to patients from a safety and infection point of view,” Mills says, stipulating that two initial meetings should take place. “A first meeting would concern risk assessment and patient safety during construction activities. It should involve a risk manager, infection control manager, construction manager, safety officer, and probably a facilities manager as well. A second meeting would concern interim safety measures and the same people should be involved.” Just as safe removal of patients is crucial, he says, so is the quality of care received in any interim facility. “Occupants of a temporary facility must receive the same amount of care there as they would in the original space,” he says.
Asked if the Joint Commission requirements address so-called “green” building initiatives, Mills says they are to some extent inherent in the process. “We don't embrace green or any specific approach,” he says. “We leave that to the organization, and to states and local agencies. But if you look at our emphasis on maintaining equipment, one of the key elements is proper maintenance of systems and keeping them functional. So by default, we're supportive of energy conservation issues.”
Proposed changes to the Guidelines for Design and Construction of Health Care Facilities are now available for review and public comment. Visit www.fgiguidelines.org for more information.
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Complying with the Guidelines
Daniel Hauer is a senior biomedical technician at Fairbanks Memorial Hospital, a perfect example of a constantly expanding facility that has to keep abreast of current requirements. Situated in the middle of Alaska, with the nearest full-service hospital and imaging center 400 miles away, the facility recently expanded its single magnetic resonance imaging (MRI) unit to three MRIs and an imaging center, “which cut appointment times way down,” Hauer says. “We went from a 12-to a 24-bed emergency room (ER), more than doubling in size and equipment. We went from no cardiologists in this area to three, with a cath lab and plans for a second one, all within the same facility. Now we're remodeling the intensive care unit (ICU) for a stepdown unit. Every step will have to be looked at to ensure that it meets current requirements.”
Architects in particular, Hauer says, require a thorough understanding of the Guidelines. “What we've run into in our facility,” he says, “is that an architect may be up to speed on normal building requirements, but not on the specifics of a hospital.” Others who must have first-hand knowledge include individual department managers, biomedical engineers, and, specifically, project management. “The person handling that at our facility is from the plant operations side—handling HVAC, boilers, electrical outlets, and so forth,” Hauer says, “but isn't quite up on the specific requirements of Joint Commission guidance.”
According to the Facility Guidelines Institute, the following changes to the Guidelines have received particular attention:
New acoustics in healthcare facilities
New facility requirements for safe patient handling and movement
Surfaces and finishes requirements in health-care facilities
Emergency facilities section in general hospitals
Obstetric facilities section in general hospitals
Medical imaging facilities section in general hospitals
Psychiatric hospitals and psych facilities in general hospitals
Information technology requirements in general hospitals
New Cancer treatment centers in general hospitals
New Outpatient cancer treatment facilities
New Outpatient rehabilitation facilities
Birthing centers
Mobile units
Ventilation requirements for hospitals and out-patient facilities
Station outlet requirements for hospitals and outpatient facilities
New table—Electrical receptacle requirements
New table—Nurse call device requirements
Visit www.fgiguidelines.org for more information.
Since patient safety is of primary concern in the planning phase of a construction project, Hauer recommends that precautionary features be built in from the beginning, down to such small details as a conveniently placed button for a nurse call system. “Where it's located, how far it is from the toilet, and other factors would definitely affect patient safety,” he says. “And it's a mixture of making it safer for patients and more efficient for staff as well.”
The biggest difference in the planning and execution of changes at Hauer's facility over time, he says, is that clinical engineering departments are now directly involved in the process. “When I first started here, we weren't asked to be involved,” he says. “Now they see that biomeds have a lot to offer in the construction process. We're there to make sure they do things like put in information technology (IT) ports for biomedical equipment before they put the drywall up. It's much cheaper than to go in later.”
Get Involved
Matt Baretich, owner of Baretich Engineering, Inc., agrees that clinical engineering is not always involved early enough, and says he still finds cases in which medical equipment planning is not well integrated into the process. “Clinical engineering personnel,” he says, “can be very effective in translating the patient care issues, as expressed by clinicians, into technical terms that can be applied in the design and construction process.”
For smaller construction and renovation projects, particularly those managed by in-house staff, large-scale project teams and processes may be unnecessary. In such cases, Baretich says, it is especially important to ensure clinical engineering involvement. “In my experience, the best way to make sure you're included is to develop a good working relationship with the hospital's facility management group. Spend some time learning about the design and construction process. Be willing to contribute your practical knowledge of medical technology.”
“Every clinical engineering program involved in design and construction activities needs to have a copy of the Guidelines,” Baretich advises. “The document does not go into detail about medical equipment, but it does address the utility infrastructure at length. Provision of adequate infrastructure, particularly with regard to electrical power and medical gases, is essential for effective functioning of medical devices.”
Adherence to the requirements has proven successful since the mid-1970s and, according to Mills, that accomplishment speaks for itself. “Those who follow our practice of practical risk assessment and safety measures usually have favorable outcomes,” he says. “Those who don't follow it have situations occur that cause them anguish. If they are showing us they're managing any deficiencies during the life of a project, then most likely they're compliant with our expectations.”