Physician offices and outpatient clinics typically consists of a patient intake area with space for reception, check-in/check-out, and waiting; exam/treatment space with a number of identical exam rooms, several office/consultation rooms, and one or more special procedure rooms; and associated clinical and administrative support space. Physician office space may be located in a medical office building (either freestanding or connected to a hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an institute or center organized along a specific service line — such as a Sports Medicine Center, Heart Center, or Cancer Center. Planning space for physician offices (also referred to as physician practice space) and outpatient clinics begins with determining how many exam rooms are needed and two different approaches are commonly used.
The Facility Guidelines Institute (FGI) is a nonprofit organization that works to develop guidelines for designing and building hospitals and other healthcare facilities in the U.S. Through a consensus process that includes public input the FGI Guidelines documents are updated every four years. The SpaceMed Guide complements the FGI Guidelines by helping healthcare architects, planners, and providers to develop the functional program, required prior to application of the FGI Guidelines, and the room-by-room space requirements necessary to begin the design process. Although the 2018 FGI Guidelines documents provide indispensable guidance for the designer on risk assessment, infection prevention, architectural detail, surface, and built-in furnishing requirements, this article identifies changes that specifically impact space planning — including the types, numbers, and minimum sizes of spaces.
The term flexibility has become somewhat overused today. It is repeated as a mantra among healthcare planners and design architects. By definition it means “adaptable” or “adjustable to change.” In reality, achieving flexibility often requires that physicians and department managers and staff relinquish absolute control over their space and equipment for the greater good of the organization. However, with fluctuating workloads, rapidly changing technology, staff shortages and high turnover, and limited access to capital in today’s dynamic healthcare environment, planning flexible space is no longer an option.
Most outpatient pharmacies that are located within a hospital or in an ambulatory care center (on or off-campus) fall into one of four categories ― minimal, small, medium, or large. Assuming that outpatient demand has been established based on the availability and convenience of similar services and potential competition from commercial pharmacies, the primary determinant of an outpatient pharmacy’s size is the average number of daily prescriptions (scripts) that will be filled during the busiest eight-hour shift. This generally determines the numbers and sizes of rooms or areas and overall space.
Prudent Health System planned to construct a new ambulatory care facility on its main hospital campus to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics. The organization needed space to accommodate the following ten-year workload projections and corresponding clinical services:
- Urgent care center with 32,000 annual visits
- Ambulatory surgery center with 4,200 annual surgical cases
- Hospital-sponsored clinics: medicine (23,000 annual visits), surgery (15,000 annual visits), neurosciences (6,000 annual visits), orthopedics (16,000 annual visits)
In addition, Prudent Health planned a small express testing area to consolidate routine, quick-turnaround outpatient testing in a single area—including X-ray, electrocardiogram, and specimen collection — along with a small satellite laboratory.
Imaging and procedure rooms fall into several size categories — small procedure room, typical imaging room, or larger specialty imaging room — and diagnostic equipment has generally become more compact over the last decade. For example, equipment used for chest X-rays, mammography, ultrasound, and pulmonary and neurodiagnostic testing is compact and commonly mobile, requiring only a small procedure room. Most general radiographic and fluoroscopic equipment can be accommodated in a typical imaging room. Computed tomography (CT) units are also becoming more compact but require a contiguous control room. Magnetic resonance imaging (MRI) and interventional procedure suites require a larger footprint including the procedure room, control room, and adjacent space for equipment components. Imaging equipment may also require lead shielding, enhanced floor loading capacity, and other unique design features.