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Below are some of the common design challenges that are unique to critical access hospitals:
- Construction costs can be increased based on scarce resources
- Difficulty finding specialists to provide care
- Lack of patient transportation
- Lack of technology
- Patient population income level distinctions and inability to afford healthcare
- Recruitment efforts are weak due to small labor pool
- Remote location makes getting access to care difficult
An exception is given for renovation of existing space, provided there is a minimum floor area of 150 ft2.
It is up to the facility to make sure that contracted individuals receive the proper training on the facility's emergency plan, important contract information and the facility's expectations for those individuals during an emergency. Additionally, if a surveyor asks one of these Contracted Individuals what their role is during a disaster, or any relevant questions, then the expectation is that the Contracted Individual can describe the emergency plans/their role.
- A new table has been added to help designers and facility owners determine which procedures should be performed in each room type.
- Note: Do not add procedures or services in any existing rooms based on the chart without first checking with DAAC
Source: All information obtained from DOH speaker at the Healthcare Facility Managers Association of Delaware Valley 2019 Spring Conference
It is a good idea to designate a room with chairs for this 15-minute part of the survey as everyone can have an open discussion. The purpose of the Opening Conference is for introductions and to go over every element of the survey agenda.
Airborne infection isolation room doors and doors to the anteroom, if provided, are now permitted to be self-closing or equipped with an audible alarm.
Source: This information was obtained from the Healthcare Facility Managers Association of Delaware Valley in the Spring of 2019.
- Acknowledge and welcome surveyor(s)
- Look at surveyor’s Joint Commission issued ID to ensure identification
- Have a location ready for surveyor(s) to wait while step 4 is executed
- Confirm the validity of survey by having a pre-designated staff member access system’s Joint Commission extranet site
Note that staff members should be aware of these steps and know who is responsible for each one. Having a backup plan is also important in case staff members are on vacation or sick.
If your hospital has or is getting equipment to facilitate the use of Nitrous Oxide as a pain reliever for women giving birth, you must do more than just notify Department of Health (DOH). Currently, DOH is in the process of coming up with standards for Nitrous Oxide equipment. Also, read the manufacturer’s instructions associated with the equipment.
When redesigning aged healthcare facilities, it is important to keep the following tips in mind.
- Find the existing drawings
- Go in with your design team for a very hands-on survey
- Incorporate some restoration of the building if possible
- Have a discussion on phasing conditions
The best ways to reduce water usage are within patient rooms, general bathrooms and employee pantry sinks by specifying low-flow and flush water fixtures where possible. Utilizing non-potable water for mechanical equipment is another way to reduce usage. The energy efficiency of your hospital also plays hand in hand with water consumption.
Clinical-use water fixtures such as surgical scrub and exam sinks are necessary in order to prevent the spread of infection. These types of fixtures are even excluded from LEED due to their value in human health.
The large size of this equipment requires thought in deciding how it will be directed through or around the facility to its desired location. Does it need to be lifted or can a route be deciphered through the hospital? Make sure to discuss this with equipment vendors and have your design team help to make this decision.
The following are tips for designing an efficient operating room:
- User Group Info – get this early
- Plan for Realistic Volume
- Right-Size Room – according to type of surgical procedure
- Infection Prevention
- Technology – have the best and most advanced
- Proper Ventilation
- A Micro-Hospital is a small-scale, inpatient facility with 8-15 short-stay beds.
- The number one benefit in creating one of these facilities is to cut costs.
- Currently, there are about 60 Micro-Hospitals in the US and they are mainly providing patient care in under-served urban locations.
- Note: If you are thinking about creating a Micro-Hospital, any kind of market analysis needs to be followed through with. Due to the small size of these Micro-Hospitals, adding and upgrading within these locations can quickly coincide what you set out to do in the first place. What is meant by this is that the square-footage and bed count can increase quickly, eliminating the cost benefits of a “micro” facility.
Below are some unique tips to consider when designing waiting rooms in a healthcare environment.
- Introduce your facility by providing information on doctors, infrastructure upgrades and innovative or new care that is being provided.
- Seating arrangements should be clustered, so both single patients and patients who brought guests along are accommodated.
- Provide text updates to patients while they are in the waiting room.
- Space should be open but with two sections - one section with a TV and another that is quiet for relaxation.
- Chairs should have high armrests. This helps patients get in and out of chairs easily.
- Natural light should be included as much as possible.
- Sinks for hand washing only (non-patient use)
- Movement sensor start and stop sinks
- Hand drying options should include paper towels only – no hand dryer machines
- Wall hand sanitizer dispensers near all hospital entrances, patient rooms (private and semi-private), nurse stations, hallways and food service areas
- To make hand sanitizer dispensers more visible, try to select a color that contrasts with the wall color
According to Federal Law and Life Safety Code Requirements, new healthcare aisles, corridors and ramps used for exit access in a hospital or nursing home must be at least 8 feet clear and unobstructed.
When planning for construction, demolition, renovation or general maintenance, the healthcare facility undergoes a Preconstruction Risk Assessment for air quality, infection control, utility requirements, vibration, noise and other hazards that affect care, services and treatment. A tip is to designate someone to lead the Preconstruction Risk Assessment by making a plan to show and document information.
Fire extinguishers placed in kitchen grill areas should be Class K extinguishers. Class K extinguishers are specifically used for putting out grease-based fires. These extinguishers must be within 35 feet of all grease-producing appliances.
According to The Joint Commission, the answer is that facility team leaders do not know the location of their smoke compartments. It is advised that Facility Directors document where the facility's smoke compartments are and share this information with the rest of their team.
- Full U (Full Unannounced/Triennial)
- Med Def (Medicare Deficiency) - This survey type has a 50% rate of returned visits
- SSU/OQPS (Special Survey Unit & Office of Quality and Patient Safety)
- ICM 2 or 3 (Intracycle Monitoring)
- Extension Survey (New Building/Services)
No. It is not compliant to have a door between a hospital and non-hospital space for providers to go back and forth. The only time this is acceptable is in the case of a fire escape door. This fire escape door would have to be locked at all times. When the fire alarm is activated, the fire escape door would unlock electronically. A full floor to ceiling wall that meets all LSC requirements is the only acceptable option to separate space between a hospital and non-hospital.
A new table was added to assist designers and facility owners to determine which procedures should be performed in each room type. It should be noted that you should not add procedures or services in existing rooms based upon the chart without first checking with DAAC.
This would be enough power to make a steel fire extinguisher come off the wall. Any room within a hospital that contains an MRI machine should only be using non-ferrous or non-magnetic extinguishers.
- Fire response plan, LIP, copy at operator or security (EC.02.03.01 EP-9)
- Stairwell signage (floor information) tactile (LS.02.01.20 EP-10)
- Kitchen hood extinguishing (FA/Energy/Fans) (EC.02.03.05 EP-13)
- Succession plan and delegation of authority (EM.02.01.01 EP-12)
- Generator EPO remote/not on exterior enclosures (EC.02.05.03 EP-11)
- Corridor/Suite Perimeter Doors (LC.02.01.30 EP-13)
- Triennial 4 hours generator run applies to all HAP/AHC (EC.02.05.07 EP’s 9&10)
- Written surgical fire risk assessment and plan (EC.02.03.01 EP-11)
- Exit sign testing with batteries (EC.02.05.07 EP-1)
- Elevator fire fighter operations monthly test (EC.02.03.05 EP-27)
- LIM’s (EC.02.05.05 EP-7)
Here are some tips for success during your Facility Orientation:
- Make sure you know the location of the electrical panel with the designated breaker for the fire alarm.
- Know the number and types of sprinklers so you can determine the number of spares needed.
The Facility Orientation is the first step of the two day LSCS and should take about an hour.
- 59% Non-Compliant: Manage systems for extinguishing fires including the integrity (nothing supported by sprinkler piping, missing escutcheons)
- 41% Non-Compliant: Sprinkler heads are not damaged; They are free of corrosion, foreign materials, paint and have necessary escutcheon plates installed
- 34% Non-Compliant: Other issues, including blocked access to fire extinguishers (wildcard)
All columns along the perimeter of the wall, any furr-outs along the columns and exterior wall material are all included in exterior wall thickness. Want to learn more healthcare design tips?
According to Section 22.214.171.124.2 of the Life Safety Code, the answer is yes. Bins used for patient records waiting to be disposed of should meet FM Approval Standard 6921 requirements. Other waste bins used for reasons besides recycling clean waste and/or patient records waiting to be disposed of, do not have to meet FM Approval Standard 6921 requirements.
This 2018 edition of the Facility Guidelines Institute Guidelines includes three separate versions specifically for hospitals; outpatient facilities; and residential health, care and support facilities. Until October of 2018, the Department of Health is permitting the implementation of FGI Guidelines from the 2014 edition and 2018 edition for new projects. After that, only the 2018 edition will be valid.
No more Direct and Indirect EP designations
- Consolidate ESC into one 60-day time frame
- No more A or C categories
No more Opportunities for Improvement (OFI's)
- No more Measure of Success (MOS) See it/Cite it Survey Methodology
*Note: This does not apply to Sentinel Events where a MOS is required. At this time, the submittal of a MOS for Sentinel Events is still required.
Although, the requirement for access or direct visibility to the outside environment has been deleted since the LSC 2009 edition, the design of new hospital patient sleeping rooms should still be designed with visibility to the outside world. Many local building codes and state agencies overseeing hospital development require windows in patient sleeping rooms. Plus, there is a significant amount of evidence that human beings have a psychological need to see the outside and that aids in the healing process.
Bedroom: Each bedroom must accommodate no more than four residents each. Facilities that have been approved for construction or facilities certified after November 28, 2016 must accommodate no more than two residents per bedroom.
Bathroom: Each individual resident bedroom must be located near a toilet and bathing facilities or be equipped with such. Facilities that have been approved for construction or facilities certified after November 28, 2016 must equip each residential bedroom with a bathroom. The bathroom must include at least a sink and a toilet.
The label may be removed and doing so is identical to rendering the door as other than a fire protection rated door. Although you may remove the label, covering the label is not allowed. One last thing to note is that the provisions of NFPA 80 do not apply here.
Patients that are too weak to get out of bed are not required to be moved outside or to a safe area during a fire drill. Staff could simulate the relocation of bedridden patients using empty wheelchairs and replicated patients.
- When the facility is undergoing an addition or renovation, dust and contaminants from construction need to be managed.
- Hospital pharmacies need to make sure no contamination of sterile compounds takes place.
- Conscious patient areas need to have correct pressurization and ventilation.
- Utility and portable water systems need to be checked for Legionella growth.
- Change of Use or Occupancy Classification
These six domains come from the Institute of Medicine's definition of quality care in a healthcare setting. Many other organizations use these domains as their general standard such as the U.S. Department of Health and Human Services (HSS).
Out of all the areas including stairs, enclosures, ramps, corridors and exit passageways, which one does not have strict guidelines for the exact location of handrails? The answer is corridors. Even though there is no guidelines on handrails for corridors, there are other codes to consider including complying with ADA requirements.
Yes. Since these offsite locations are usually considered business occupancies, the requirement is once per shift per year, but this also depends on who your facility is accredited by and the entity that is enforcing the Life Safety Code.
This all depends on who the authority is that has jurisdiction. If the storage equipment items qualify as construction, alterations, additions or repair, you may be able to store the items in the unused patient rooms. Of course, alternate life safety standards need to be followed and you should be following in accordance with your own policies as well.
When a play area or breast-feeding room is located near a specific department, they are to be included in the department’s DGSF. The exception is when play areas and breast-feeding rooms are positioned in a lobby or public space then they would be considered public spaces.
If the public can access your building, then you are most likely going to need emergency egress lighting. However, based on the Code, the most general rule is emergency egress lighting is needed when you are required to have two or more paths of egress and/or have delayed egress locking on doors.
This can also be done more frequently if needed.
- Fire escape ladders
- Horizontal exits
- Smokeproof enclosures
- Exit passageways
- Areas of refuge
- Alternating thread devices
Notice that elevators are not on the list.
While Healthcare and Ambulatory Care may be acceptable classifications, an Emergency Department would never be considered a Business Occupancy. This is because not all patients brought to an Emergency Department are able to walk or speak, so that takes Business Occupancy off the table.
If Centers for Medicare and Medicaid Services approved a waiver or equivalency, you should be going through the process repeatedly every three years. This statement is still true even if things have not changed.
A risk assessment is beneficial when deciding if patients should be allowed to bring personal laptops, hairdryers and other electronic equipment into the hospital. Healthcare facilities are expected to develop a course of action to recognize patients' personal equipment that would be included in the medical equipment management plan.
Drawing submissions are required to go to DLS for I-2 and outpatient surgery centers. All hospital based departments, including business occupancies, must submit their narrative in correspondence to DAAC. All additions and alterations are going to be submitted to local code.
All fire-rated door decorating should be looked at as a no-go during festivities.