Keep Your Next Building Project Compliant Consult the FGI Guidelines and hire an architect with ASC experience BY ALEX TAIRA

The main regulatory guid- ance to consult when build- ing or renovating an ASC comes from the Facility Guidelines Institute (FGI),

an independent, not-for-profit organiza- tion dedicated to developing guidance for the planning, design and construction of hospitals, outpatient facilities and res- idential healthcare and support facilities. Beginning in 2006, FGI began pub- lishing updated versions of its guide- lines every four years. It released the latest edition in January 2018. That edition contained several changes that impact ASCs, including for the first time ever, separate guide- lines for outpatient facilities. Taking into account the wide variety of outpatient facilities that may exist, the guidelines provide two different approaches: one that describes a comprehensive facil- ity type (i.e., an ASC) and a second that coalesces guidelines for multiple facility types (i.e., a single building that houses an ASC, imaging center and physician office). In a column that ran in the March 2018 issue of ASC Focus, past ASCA Board chair and FGI board member David Shapiro, MD, states that creating flexible guidelines that could accommo- date multiple facility types was a specific focus for the guideline committee. Those seeking to build or reno-

vate an ASC should consider the new guidelines carefully during the plan- ning and development phase of their project. Because of the spread of out- patient facility types, FGI created a large “common elements” chapter that prescribes minimum requirements for spaces/aspects one might find in many different outpatient facilities. For example, the minimum clear floor area for any operating room in an outpatient facility is 255 square feet. These com-

The FGI guidelines for an operating room in an ASC are different than in a hospital, so an architect’s previous experience planning operating rooms might not translate directly to an ASC project.”

—Alex Taira, ASCA

mon elements may, and often do, differ from guidelines for similar spaces in hospitals and residential care facilities.


FGI traces its lineage back to 1974’s Minimum Requirements of Construc- tion and Equipment for Hospital and Medical Facilities, a document issued by the Department of Health, Edu- cation, and Welfare—precursor to today’s Department of Health and Human Services—that established a set of minimum standards for con- struction and renovation of medical facilities. Although FGI is not a federal regulatory body and the guidelines, themselves, are not federally mandated requirements, the US Department of Health and Human Services (HHS) and the Centers for Medicare & Med- icaid Services (CMS) provide fund- ing for new editions and the guidelines are referenced in a variety of standards and regulations. The guidelines are created using evidence-based research, clinical practice and the rational expe- rience of a multidisciplinary team of architects, engineers, facility and plant managers, physicians, nurses, infec- tion control practitioners and industry leaders who number in the hundreds.


Their goal is to provide a reference for designing a safe, effective and efficient environment of care for patients.

Pick the Right Architect Jamie Oldfather, manager of administra- tive services at Mississippi Valley Health in Davenport, Iowa, advises ASCs to ensure that the architect and engineer are aware that the project is an ASC rather than a hospital and to ensure that those they hire know the difference in require- ments between the two. As mentioned above, the FGI guidelines for an operat- ing room in an ASC are different than in a hospital, so an architect’s previous experi- ence planning operating rooms might not translate directly to an ASC project. Even granular differences, like the number of outlets and the locations of fire refuge areas, are critically important to consider. Building on this, Larry Taylor, ASCA Board president and chief executive offi- cer and president of Practice Partners in Healthcare in Birmingham, Alabama, cautions that even if architects and engi- neers are familiar with ASC/outpatient guidelines, how each one interprets those guidelines might differ significantly. Managing different stakeholders who

have different interpretations of impor- tant guidelines might be as critical as fol- lowing the guidelines themselves, since miscommunication or misinterpretation could result in costly errors and delays. Ultimately, all work should be aligned to maximize the safety of patients and employees and ensure the safe and effi- cient operation of the surgery center. Read the March 2018 Regulatory

Review by Jennifer Butterfield, RN, CASC, former ASCA Board member, on the 2018 FGI Guidelines.

Alex Taira is ASCA’s policy analyst. Write him at

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