In the 2026 revision cycle, the Facility Guidelines Institute made a major structural change by separating enforceable codes from non-mandatory guidance. This article summarizes specific changes related to the the types, numbers, and sizes of spaces included in the SpaceMed Guide.
BACKGROUND
The Facility Guidelines Institute (FGI) is an independent, not-for-profit organization that provides guidance for the planning, design, and construction of hospitals, outpatient facilities, and residential care facilities. Through a consensus process that includes public input, the FGI documents are updated every four years.
The SpaceMed Guide complements the FGI documents by helping healthcare architects and planners develop the functional program, required prior to application of the FGI documents, and the room-by-room space requirements necessary to begin the design process. Although the FGI documents provide indispensable guidance for the designer on risk assessment, infection prevention, architectural details, surfaces, and built-in furnishings, the SpaceMed Guide specifically addresses the types, numbers, and sizes of spaces.
Planning a surgery suite used to be fairly simple. General operating rooms (ORs) were used for a wide range of procedures and dedicated operating rooms were limited to cardiac surgery and orthopedics. At the same time, interventional radiologists and cardiologists created their own workplaces. Today, planning surgical and endovascular suites is complicated by the convergence of diagnostic imaging and surgical procedures, rapidly changing technology, increasing specialization, and strict distinctions between operating rooms and procedure rooms. From a facility planning perspective, the number, size, and specialization of ORs and endovascular procedure rooms is the single most significant factor contributing to the overall footprint of the suite (and project cost). Moreover, the numbers and sizes of related patient care and support spaces are driven by the number and types of operating/procedure rooms. More importantly, the number of operating/procedure rooms drives ongoing staffing and related operational costs.
Every hospital emergency department (ED) is different because it reflects the community’s needs and resources. Some hospitals offer the full continuum of emergency services — including trauma and emergent care, nonurgent care, an observation unit, a chest pain unit, pediatric services, and a behavioral health crisis unit — while others provide only basic services. To estimate the numbers and types of ED treatment spaces, you first need to calculate the number of general treatment spaces (for both the emergent/urgent care area and nonurgent/fast track area). Some of these spaces can then be designed for use by special patient populations. Finally, you need to add other unique and specialty treatment spaces to arrive at the total number of patient care spaces.
Any healthcare organization would be delighted to have a private donor fund a building project. Sometimes, however, the donor has no interest in the organization’s long-range capital investment strategy but wants to construct a building or fund a program that is not even on its radar screen. Most organizations are not in a position to reject such donations, and it is a rare administrator who has the backbone to turn down money rather than compromise the organization’s long-range facility master plan.
Healthcare facilities need to provide a sufficient number of parking spaces for patients, staff, service traffic, and the public. At a minimum, parking standards or requirements developed by local authorities having jurisdiction should be consulted since these will reflect the availability of public transportation, public parking facilities, or other alternatives. This article provides some general rules-of-thumb for estimating the number of parking spaces for patients being admitted/discharged, visitors to inpatient nursing units, hospital staff, outpatients, and emergency patients and their escorts.