Editor’s Note: This story was originally published on December 12, 2019 and has been updated to reflect the change in implementation of FGI 2018 for Texas healthcare facilities.
The Texas healthcare industry was on pace for a seismic shift this year from Texas Administrative Code Chapter 133 (TX133) Hospital Licensing Rules, to Facility Guidelines Institute (FGI) 2018 requirements. With the unforeseen scheduling challenges, the code shift is now on tap for early 2021.
The good news? TX133 is based on FGI guidelines from 2001, so the new codes should be somewhat familiar to healthcare facility planners and operators. However, there are some key differences between TX133 and FGI 2018 that we need to be aware of to plan and design optimal spaces.
Organization of the Rules and Guidelines
TX133 organizes all the spatial requirements under each individual department. FGI 2018, on the other hand, divides the spatial requirements into a Common Elements section and a Specific Requirement section.
Additionally, the FGI is known for its specific terminology and defining what different locations mean. For example, consider the terms “immediately accessible” and “readily accessible.” Immediately accessible expressly means the space is available either in or adjacent to the identified area or room. Whereas a space that is readily accessible is available on the same floor as the identified area or room.
These changes may take time to adapt for architects and engineers who are used to navigating TX133.
Imaging Room Classifications
While the TX133 code distinguishes between imaging suites and special procedure rooms, sometimes the differences can be murky depending on procedure.
The FGI makes the distinction clearer by creating three classifications for imaging rooms:
- Class 1: Traditional MRI or mammography units.
- Class 2: Diagnostic and therapeutic procedures like peripheral angiography or EP Labs.
- Class 3: Hybrid operating rooms.
As any facility owner knows, saving on square footage often saves money. Under the FGI 2018 guidelines, owners can save costs by reducing the square footage previously needed for specific healthcare footprints.
For example, TX133 mandates an endoscopy room must be at least 250 square feet, but FGI only requires the space to be 180 square feet. And, while TX133 rules required the PACU to have 1.5 stations per operating room, the FGI will reduce that to one station per Class 3 imaging or operating room.
FGI 2018 will also save space in obstetrical departments. Under TX133, hospitals with 25 or more maternity beds are required to offer a Continuing Care Nursery – a significant use of space that is often underutilized. But with FGI 2018, these nurseries are only required by a functional program.
Another benefit is FGI 2018’s guidelines for pre- and post-procedure patient care areas. The FGI now allows healthcare organizations the choice to either provide separate or combined pre-procedure and recovery patient care areas. This includes Phase I (PACU) and Phase II recovery areas, which can now be combined into one space, improving efficiencies.
The goal, according to the FGI, is to facilitate provision of spaces that support the way patient care is provided in the facility. Operators can flex the beds in facilities to accommodate better patient throughput.
However, when the areas are combined, the resulting space must meet the most restrictive design requirements for the combined space types. In addition, a minimum of two patient care stations per procedure, operating, or Class 2 or Class 3 imaging room is required when a combined pre- and post-procedure patient care area is provided. Facilities may still choose to separate services into two or three areas, but the change allows greater flexibility in the delivery of care.
Perhaps the most significant benefit of FGI is its four-year cycle that allows codes to adapt and change with the ever-evolving healthcare environment. Texas is at the forefront of medicine, and dynamic facility guidelines will allow us to meet practitioners on the cutting edge.
While the FGI code is one that most engineers and architects are already familiar with, we should familiarize ourselves with the latest changes. Owners will expect design teams to know the changes on the horizon, to be able to take advantage of them to improve facility design.
What Your Facility Can Do to Prepare
Healthcare facility leaders should have their architects and engineering teams look out in advance to explore the differences between FGI 2018 and TX 133. Healthcare systems like to plan out their capital improvements, so it’s important to ensure that these improvements will be compatible with the new guidelines.
There are three questions to ask of projects still on the drawing board:
- How will FGI 2018 impact this project?
- What changes need to be made if a project planned for TX133 guidelines is delayed until 2021?
- What extra funding may be necessary to prepare these projects for FGI 2018?
There is an opportunity to provide input regarding the shift to FGI 2018 this fall when officials open public commentary. We’ll make sure publish a link to that information when it becomes available.
The information in this article should be re-verified with the final adopted rules. If you’re looking for more insight on the FGI changes coming your way, you can reach me at Jennifer.Youssef@rsandh.com.
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