What's New in the Fourth Edition?

The SpaceMed Guide has undergone a significant update for 2022. The workbook and space planning templates have been reorganized, and some facility components have been realigned to reflect changing technology and medical practice. All the same functional areas found in acute care hospitals, ambulatory care, and specialty facilities are still found in one of the SpaceMed Guide's fifteen new sections. The format and layout of the workbook sections are the same with the addition of new guidance on planning healthcare facilities during times of uncertainty and achieving future flexibility and adaptability.

Alignment with the 2022 FGI Guidelines. The fourth edition of the SpaceMed Guide aligns with the Facilities Guidelines Institute's newest Guidelines for Design and Construction of Hospitals and Guidelines for Design and Construction of Outpatient Facilities — referred to as the FGI Guidelines.

Updated introductory sections. Information on current facility planning issues, the planning process, and developing a functional program has been updated. In addition, new guidance on space planning to support emergency response has been included — particularly for creating surge capacity.

Updated current trends, key planning issues, and space planning templates for all fifteen sections of the SpaceMed Guide. The fourth edition of the SpaceMed Guide incorporates the following themes throughout the workbook — planning during times of uncertainty, the impact of telemedicine on facility capacity, the increasing use of diagnostic and therapeutic imaging across all medical specialties, the rapid evolution of automation and robotics, and the need for flexible, multiuse space.

Most workbook sections have been substantially rewritten to reflect changing technology and medical practice. Some specific changes include:

• Emergency and urgent care services includes new treatment options to improve patient flow and provide more flexibility, including low-acuity treatment stations, a behavioral health crisis unit, and an observation unit. Guidance is also provided on new safety protocols resulting from the global pandemic, such as creating a split-flow model and patient cohorting.
• Surgical and endovascular procedures reflects the melding of interventional radiology and minimally-invasive, image-guided, and traditional open surgical techniques. This new section clarifies the differences between operating, procedure, and imaging rooms and semi-restricted/restricted areas established by the FGI Guidelines. New requirements for patient pre-procedure preparation, post-procedure recovery, clean/sterile storage, and immediate-use steam sterilization are also included.
• Imaging and other diagnostic services has been updated and now includes general radiology, nuclear medicine/molecular imaging, and other diagnostic services — such as noninvasive cardiac diagnostics, pulmonary function testing, sleep disorders testing, and neurodiagnostics.
• Patient care units has been revised to reflect the current planning environment — including bed need forecasting challenges, the emergence of the teleICU, the reengineering of support services, and creating acuity-adaptable patient rooms. The spaces in the care team work area have been updated to reflect new safety protocols, and space planning templates for an intermediate care unit and a hospital-based skilled nursing or rehabilitation unit are new.
• Maternal and infant services includes a revised space planning approach due to increasing cesarian deliveries and induced births and a declining birth rate. Room sizes for birthing rooms and single-infant and multiple-infant neonatal intensive care rooms have been updated, and a neonatal couplet care room and new staff support spaces have been added.
• Behavioral health services has been substantially revised to reflect changing treatments and settings and the rapid growth in telemedicine/telehealth. As a result, the guidance on outpatient behavioral health services has been updated, and space for an intensive outpatient and partial hospitalization program (IOP/PHP) and transcranial magnetic stimulation (TMS) has been added.
• Oncology services addresses new treatments and therapy combinations related to medical oncology/infusion therapy and radiation oncology.
• Cardiovascular services has been reorganized to reflect changing technology and medical practice. Interventional cardiology is now included with Surgical and Endovascular Services and noninvasive cardiac diagnostics has been moved to Imaging and Other Diagnostic Services; cardiac rehabilitation is addressed with Rehabilitation Services.
• Ambulatory care has been revised to reflect new patient care delivery models, particularly the impact of telemedicine and the transformation of primary care with the medical home model. In addition, the scope of services to be provided within the medical procedure unit has been expanded and now includes hyperbaric oxygen therapy. Guidance on planning an ophthalmology/optometry suite, dental suite, and renal dialysis center has also been updated.
• Pharmacy has been substantially updated to reflect the focus on patient safety, new regulations for handling hazardous drugs, and increasing automation and robotics in hospital and outpatient pharmacies.
• Clinical laboratory has been rewritten to address the rapid growth of molecular testing and the impact of new technology and automation on the allocation and configuration of space. Changes in transfusion services and anatomical pathology are also addressed.
• Customer access services has been revised to reflect the rapid transition to electronic communication with new contactless, paperless processes resulting from the COVID-19 pandemic. The guidance on wayfinding has been updated, and parking considerations have been added.
• Other sections have also been revised, including rehabilitation services, central administrative services, building support services, and shared staff support services.