Hospitals and healthcare systems have spent much of the last two years balancing being in a state of emergency readiness while waiting for the next COVID-19 wave and safely delivering routine health services. Many of the challenges that existed before — a shrinking workforce, an aging infrastructure, and narrow operating margins — have worsened during the pandemic. At the onset of the global pandemic, faced with rising COVID admissions, many hospitals canceled elective procedures and redeployed patient care space in new ways to meet the rising demand for beds and new infection control measures. At the same time, U.S. adults delayed or avoided medical care due to their coronavirus-related concerns causing non-COVID admissions to plummet. Starting the third year of the global pandemic, staffing shortages due to burnout are at an all-time high as hospitals still struggle with COVID-19 admissions while treating higher-acuity patients. Concurrently, hospitals and health systems face increasing costs for labor, drugs, personal protective equipment (PPE), and other medical supplies needed to care for higher acuity patients. According to the American Hospital Association, America’s hospitals are experiencing unprecedented financial losses — a net income loss of $54 billion is projected for 2021 that is expected to continue into 2022, according to the American Hospital Association. As a result, healthcare organizations are rethinking their capital investments while existing facilities are being retooled, expanded, and underutilized simultaneously. In this post, you can read about some of the current issues in healthcare facility planning — fluctuating utilization and forecasting challenges, shortage of nurses, new safety protocols, rapid growth in telemedicine, advances in telecommunications technology, and integration of imaging into most medical specialties.
Planning a surgery suite used to be fairly simple. General operating rooms 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.
Imaging and procedure rooms fall into several size categories — small procedure rooms, typical imaging rooms, or larger specialty imaging rooms. Diagnostic equipment has generally become more compact over time. 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 that includes the procedure room, control room, and adjacent space for equipment (or system) components. Imaging equipment may also require lead shielding, enhanced floor loading capacity, and other unique design features. The FGI Guidelines also classify imaging rooms based on different levels of patient acuity and intervention.
A shelf full of outdated facility master plans is a common sight in the facility manager’s office of a large medical center. These are often very thick documents with beautiful graphics that explain in great detail the phased stages of a multi-year building project. There are many reasons why these plans may not have been implemented but the planning process itself is a major factor.
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.
Sometimes a preliminary space estimate is needed to evaluate location alternatives, conduct a feasibility study, or develop a preliminary cost estimate for construction or renovation. Once the number of procedure rooms is determined, an estimate of the total footprint required for the diagnostic imaging suite can be made using the range of DGSF (DGSM) per procedure room shown in this post.