The 2018 edition of the Facility Guidelines Institute’s (FGI) Guidelines for Design and Construction has published the requirements for outpatient facilities separately with the goal of making the requirements flexible to address a variety of projects types, from small clinics or doctor’s offices to tenant improvements in larger buildings to large medical office buildings with multiple clinical services. This session will address the substantively revised text and new language, including applying the guidelines to facility types not included in the document.

Learning Objectives:

• Discuss core differences in the approach to designing hospitals, outpatient facilities, and residential long-term care facilities.
• Apply common element requirements to support the delivery of care in outpatient facilities, such as a provision of imaging facilities and operating and procedure rooms in a doctor’s office as well as in surgery and endoscopy centers.
• Explain how to find and apply design requirements for outpatient facility types that do not have specific requirements in the Outpatient Guidelines document.
• Take advantage of the flexibility provided in the outpatient guidelines when designing very small or tenant improvement project.

Falling reimbursements and the shift away from inpatient care create a challenge for hospitals to balance business, resources, and services provided. As population migrates toward cities, rural health care faces a larger problem in financial sustainability, and an increase in mergers and acquisitions has added pressure on rural hospitals to look at innovative and nontraditional ways to remain viable. Learn how a more community-oriented and sustainable rural health care facility is being created with a facility master plan and non-traditional solutions.

Learning Objectives:

• Recognize current population health issues at play in rural hospitals and potential realignment of services.  
• Identify the key variables used to forecast bed need and determine feasible facility strategies.
  
• Explore consumer-oriented design as a means of community engagement and a resource for population health management.
• Identify effective solutions to repurpose rural health facilities in the era of declining inpatient services and increased specialization.

As a federal health care debate raged in 2015, Boys Town National Research Hospital and LEO A DALY were in the midst of designing a new residential treatment center for at-risk youth. Faced with the uncertainty of funding to sustain the care model, the partnership engineered the space to serve alternative purposes as a backup plan. This session will detail the planning and design strategies used to adapt while meeting the needs of the highly regarded behavioral healthcare model.

Learning Objectives:

• Identify key design and engineering elements that allow a behavioral health facility to also serve as an inpatient facility.
• Frame the current federal health care debate within the context of past historical occurrences and from a bipartisan perspective.
• List specific features for inpatient centers recommended by the Facility Guidelines Institute that can also be used within the behavioral health context, and why they are of benefit.
• Identify specific ways an at-risk youth behavioral health facility can increase safety for its patients, staff, and visitors.

Clinical practice and improved operations are substantially reducing inpatient lengths of stay while increasing services provided in an outpatient setting. What is the appropriate setting for these short-stay patients that promotes the best clinical outcomes and patient and family experience, but doesn’t use the space and resources of an inpatient unit? This presentation will review the clinical, operational, and facility requirements of short-stay units both inside and outside of the hospital.

Learning Objectives:

• Assess why short stay units are the result of ongoing changes in healthcare reimbursement and clinical practice.
• Review code requirements for short stay units and how they may be inadequate for an optimum patient experience.
• Evaluate the types of short-stay settings both inside and outside of the traditional hospital and the key design elements that research says supports best practices and patient experience.
  
• Review a case study of an innovative short stay approach designed to provide care in a welcoming outpatient environment.

In 2006 the Facility Guidelines Institute introduced the requirement that all hospital patient rooms be designed for single-patient use. Ten years later, the requirement is standard practice and other countries have adopted versions of the requirement. With a recent focus on the high cost of construction and limited capital resources in the United States, should FGI revisit this mandate? Researchers will present what they learned from a study of the implementation of the single-patient room as a minimum requirement.

Learning Objectives:

• Discuss how FGI is striving to use research to inform their Guidelines.
• Describe variations in patient outcomes from the use of single-patient rooms across health care settings and countries.
• Recognize what gaps exist across the studies of single-patient rooms.
• Evaluate the advantages and disadvantages of single-patient rooms for patients, staff, and family and visitors.

The defend-in-place strategy used in health care occupancies is a critical function of patient safety. Because of limited mobility, and in some cases immobility, of patients, it is in the best interest of the patient to remain in place during fire emergencies. In rare cases, patients may need to be horizontally relocated away from the fire but not evacuated from the building. For these reasons, fire safety features required for health care occupancies must be properly designed to applicable codes.

Learning Objectives:

• Describe the concept of defend in place.
• Identify the correct type of wall separation.
• Identify the correct fire or smoke door for the type of wall.
• Assess when a fire stop assembly is required.

This session presented case studies of innovations advancing healthcare design, construction, and operations and creating facilities that are flexible for the future. The Healthcare Infrastructure Research Institute and ASHE have been working together to identify innovations in the healthcare field. A jury reviewed more than 70 innovations and selected 16 ideas as best practice. This session will discuss four of the top innovations and will spur attendees to think about innovations for flexibility in their own organizations.

Learning Objectives:

• Describe innovation projects and their benefits on the health, safety, and welfare of your community.
• Discuss whether the innovations can spur additional flexibility in your organization, allowing hospitals to adjust to changing patient needs while adhering to regulatory needs.
• Explain the need for sharing best practices with colleagues and the potential benefits of innovation sharing on health care delivery.
• Describe broad themes in innovation within the field and how they are implemented within current guidelines.

This session will discuss how Joint Commission surveyors prepare for surveys and explain the new agenda process, including details on the agenda if a Life Safety Code surveyor arrives on day one or day two of the survey. Presenters will explain how scoring is completed, the SAFER matrix, and new Project REFRESH pilots, as well as review the new fire drill matrix. Attendees can get answers directly from those overseeing Joint Commission Life Safety Code surveyors.

Learning Objectives:

• Describe how Life Safety Code surveyors prepare for surveys.
• Explain step by step how surveyors conduct surveys.
• Discuss new Joint Commission survey process initiatives.
• Implement tips for a successful Life Safety Code survey

Population health can be affected by modifying behaviors, the physical environment, and proximity of care. To increase and improve access, architects can help navigate from the triple aim (the right care, at the right time, at the right cost) to a quadruple aim: care in the right place. To improve the patient care environment, architects can design spaces that emphasize humanistic care, support the healing process, and improve infection control rates. This session explores how design partnerships with health care providers are significant to improving overall wellness for communities.

Learning Objective:

• Describe the relationship between population health and the importance of place.
• Explain the health determinants of population health and how outcomes are measured and affected by the design process.
• Show how humanistic design contributes to an institution’s image within the community.
• Provide examples of a variety of scaled projects to contribute to a healthier community.

This session identifies the risks in health care settings and how to reduce them by applying fundamental facility design principles related to biocontainment. The presentation will showcase the new Center for Disaster Readiness for Intermountain Healthcare and focus on lessons learned from Emory University and University of Nebraska Medical Center, where Ebola patients have been safely managed. Developing new models for facility design and operations and incorporating fundamental design principles can improve safety for patients, caregivers, maintenance personnel, and the community.

Learning Objectives:

• Identify issues inherent in handling patients with highly pathogenic infectious disease in healthcare settings.
• Describe fundamental design principles for biosafety and biocontainment.
• Identify lessons learned from facilities that have handled patients with Ebola and other highly pathogenic infectious diseases.
• Explain biocontainment design and protocol guidance specifically for patient care facilities