New Classification System for Imaging Rooms
FGI 2018 has a new classification system for imaging rooms so that the room design and layout can more easily adapt to new technologies and equipment:
- Class 1 (unrestricted area) for services that use a natural orifice entry and do not pierce or penetrate natural protective membranes — such as most diagnostic radiography, fluoroscopy, mammography, CT, MRI, nuclear medicine, and ultrasound procedures.
- Class 2 (semi-restricted area) for diagnostic and therapeutic procedures such as coronary, neurological, neurological, or peripheral angiography and electrophysiology procedures.
- Class 3 (restricted area) for invasive procedures and any Class 2 procedure during which the patient will require physiological monitoring and is anticipated to require life support.
Class 2 and 3 rooms should have a physically separate control room and the sizes of all types of imaging rooms depend on minimum clearances around the equipment to be used in the room and the manufacturer’s recommendations.
Clarification of Procedure and Operating Rooms
The planning of spaces for diagnostic, surgical, and interventional procedures is clarified based on the level of invasiveness (and potential for infection), type of sedation used, number of staff in the room, and minimum clearances for the equipment to be used. This in turn dictates the room size, finishes, and other infrastructure requirements for procedure rooms and operating rooms (ORs).
Operating room sizes. The minimum clear floor area for hospital ORs is still 400 NSF (37.2 NSM) which increases to 600 NSF (55.7 NSM) for image-guided surgery using portable imaging equipment or for surgical procedures that require additional personnel and/or large equipment. However, for outpatient facilities, the clear floor area for an OR has been reduced to 255 NSF (23.7 NSM) if no general anesthesia is administered or 270 NSF (25.1 NSM) with general anesthesia. Where additional staff and equipment are required, an OR in an outpatient facility should have a minimum of 400 NSF (37.2 NSM) as with a hospital OR.
Procedure room sizes. Minimum room sizes and clearances have been revised for procedure rooms to reflect the space required for the anesthesia team and equipment. Two categories of procedure rooms are identified:
- 130 NSF (12.1 NSM) with no anesthesia administration
- 160 NSF (14.9 NSM) with anesthesia administration
Endoscopy room size reduced. The minimum room size for endoscopies has been reduced from 200 NSF (18.6 NSM) to 180 NSF (16.7 NSM).
Restricted area. For surgery and special procedure suites, a designated “restricted” area was added in FGI 2018 in addition to the “semi-restricted” and “unrestricted” areas specified in FGI 2014.
Pre- and Post-Procedure Patient Care Spaces
The guidelines for pre- and post-procedure patient care areas have been revised to allow greater flexibility in how these areas are configured. The spaces have also been standardized and incorporated into the common elements section in both documents. The new requirements for pre- and post-procedure patient care areas in hospitals and outpatient facilities are described below.
Separate areas. As with FGI 2014, the minimum number of patient care spaces are defined for each area:
- Pre-procedure area — one patient care space per OR, procedure, or imaging room.
- Phase I post-anesthetic care unit (PACU) — one patient care space per OR or Class 3 imaging room.
- Phase II recovery area — one patient care space per OR, procedure, or Class 2 or Class 3 imaging room.
Combined area. New to FGI 2018, when these areas are combined, a minimum of two patient care stations are required for each hospital OR, procedure room, and Class 2 or Class 3 imaging room to reflect the flexibility and increased efficiency when all three areas are combined. For outpatient facilities, a minimum of one patient care space for each outpatient OR, procedure room, and Class 2 or Class 3 imaging room is specified.
Class 1 imaging support. In addition to the above requirements, for outpatient imaging facilities, a minimum of one patient care space should be provided for every three Class 1 imaging rooms where patients receive point-of-care lab work or injection preparation with non-radio-pharmaceutical contrast agents.
Other Changes to the Numbers and Sizes of Spaces
Other changes to the FGI Guidelines that impact the required spaces and minimum room sizes in the current edition of the SpaceMed Guide include:
Waiting area seats for outpatient facilities. New to FGI 2018, specific seating ratios for various types of outpatient facilities are provided in an appendix. The number of spaces to be provided for wheelchairs and patients of size is also specified.
Dental operatory. The minimum clear floor area for a dental operatory is now 80 NSF (7.4 NSM) regardless of whether it is a single-patient room or a patient station in an open treatment area.
Sterile processing room. While FGI 2014 allowed a single room for sterile processing, FGI 2018 now specifies the minimum requirement for sterile processing to be a two-room suite to maintain a dirty-to-clean workflow. A one-room sterile processing facility is now permitted only where small countertop sterilizers are used.
Technology distribution room. A three–foot minimum clearance on all sides of equipment racks is now required in lieu of specifying a minimum room size of 12 feet by 14 feet as in FGI 2014.
Additional Design Considerations
Although specific numbers and sizes of these rooms are not mandated, additional design considerations are included in FGI 2018 for the following spaces:
Sexual assault forensic examination (SAFE) room. Although not required for hospital emergency services, detailed design requirements are included in FGI 2018 should a healthcare organization choose to provide a SAFE room.
Accommodation for telemedicine services. To address the expansion of telemedicine services in the U.S., FGI 2018 provides more extensive guidance for designing clinical telemedicine spaces including provisions for privacy, lighting, surfaces, and acoustics.
Mobile/transportable medical units. The chapter on designing mobile/transport¬able medical units was revised in FGI 2018 to support the guiding principle that the physical design requirements for specific medical services should be the same regardless of where those services are provided.
Expanded design guidelines. Although the SpaceMed Guide focuses on predesign planning — identifying the types, numbers, and sizes of spaces required — the FGI Guidelines provides indispensable guidance for the designer on risk assessment, infection prevention, architectural detail, surface, and built-in furnishing requirements. In particular, FGI 2018 provides revised sections on acoustical design, sustainable design, and ventilation requirements.