By Charles A. Michelson, AIA, ACHA, LEED AP

The Facility Guidelines Institute (FGI) is a nationally recognized organization dedicated to the planning, design and construction of healthcare facilities. The fundamental standards from which AHCA reviews documents are established by these guidelines. They are published every four years and the 2022 guidelines are available. The guidelines are recognized medical design standards by 43 states including Florida.

There have been significant changes to the recent 2022 guidelines as they have been updated to acknowledge and encourage flexible space use. Medical practice has been at the cutting edge of change and outdated guidelines have often created conflicts between standards and current best practices necessary for patient treatment. The updates strengthen the requirements for the functional program; the document that describes the function, equipment, and process of medical treatment to be performed in a newly designed space. The guidelines are not intended to restrict innovation or design improvements that support clinical objectives; the guidelines are oriented toward person-centered care and not a recipe book of clearances and dos and don’ts.

The FGI Guidelines now include a social aspect to medical facility design as the project narration needs to address the needs of diverse populations and foster accommodation.

The medical design process will create inclusive environments that can be accessed, understood, and used to the greatest extent possible by all people, regardless of age, size or ability. Everyone; patient and employee, must be safe from abuse, harassment, and unfair criticism.

The past two years have opened everyone’s eyes regarding emergency situations and the need of the medical community to respond.

Every construction project for a medical facility includes a safety risk assessment. A major change to the FGI Guidelines is the addition of a Disaster, Emergency and Vulnerability Assessment. This can be the topic of another article in the future. The Safety Risk Assessment has been expanded to include behavioral and mental health accommodations. Now, a review of patient safety concerns shall be considered throughout a facility rather than only in a clinical area where those patients will be seen. Specific risk levels need to be identified and discussed.

Another significant update to the FGI Guidelines is the acknowledgement of multiple patient exam rooms in urgent care and emergency departments for low modality patients. Sizes, clearances and staffing parameters have been estimated for designers. Outpatient facilities such as free-standing ERs have the added requirement of needing to be locked down in an emergency; however, cameras must be utilized so that no one seeking help from an ER is locked out of the facility by virtue of being unseen.

The acoustic requirements in medical facilities have been upgraded as rooms need to be quieter and sound absorption is increased to help ensure privacy and HIPAA regulations.

There is a slew of technical modifications to the FGI Guidelines, from birthing center rooms to hospice unit requirements. As FGI Guidelines continue to change, specific conversations with healthcare providers are imperative to be able to articulate our ever-changing healthcare facility environment.

Charles Michelson is President of Saltz Michelson Architects. For more information, visit