Observation was meant to be a short period of time for healthcare providers to assess patients and decide whether a patient requires admission for inpatient care or can be discharged. Typically this was meant to last less than 24 hours and only rarely spanned longer than 48 hours. Over the past ten years, however, the incidence and duration of observation status stays has increased significantly as a result of changes in Medicare reimbursement.
Cynthia Hayward
Changes to the 2018 FGI Guidelines Impacting Space Planning
The FGI Guidelines were updated in 2022. You can see what’s new in the SpaceMed Guide (fourth edition) on the SpaceMed website.
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.
New Standard for Residential Care Facilities
The Facility Guidelines Institute (FGI) has developed a new standard titled Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. This document provides minimum recommendations for new construction and renovation of nursing homes, hospice facilities, assisted living facilities, independent living settings, adult day care facilities, wellness centers, and outpatient rehabilitation centers. According to the FGI website, the new standard has been developed in response to the widespread adoption of person-centered care and deinstitutionalization in the residential care industry. Based on Part 4 (Residential Care Facilities) of the 2010 edition of the FGI Guidelines for Design and Construction of Health Care Facilities and public proposals submitted on that text in fall 2011, the book is divided into a section on planning and predesign, a section on design and construction elements common to all facility types in the book, and sections grouped by facility type. This document was first published in early in 2014 and was updated in 2018.
This article is an update of a previous post.
Pharmacy Automation Used Throughout the Healthcare Facility
Pharmacy automation is becoming commonplace in many healthcare facilities including point-of-care medication dispensing devices located on nursing units Pyxis Machineand in other acute care areas, controlled substance dispensing and tracking systems, centralized robotic dispensing devices, and similar devices to support ambulatory care.
How Sacramento’s Busiest ED Doubled Capacity Without Expansion
The emergency department (ED) at the Kaiser Permanente South Sacramento Medical Center, one of California’s busiest EDs, has cut patient turnaround times by hours and to far below the national average, through operations improvement, according to Healthcare Informatics. This Level II trauma center saw its workload almost double from 2008 to over 120,000 annual patient visits by 2015. The existing ED space was constrained with only 49 ED bays of which three are dedicated for trauma and four are dedicated to psychiatry. This calculates to 2,500 annual patients per ED bay compared to a recommended 1,500 to 1,800 for a well performing ED. The increasing patient volume and space constraints resulted in long ED wait times with patients waiting five to six hours to see a doctor and every night there were 30 to 40 patients in the waiting room.
After an intensive operations improvement effort using “lean” production principles, South Sacramento Medical Center’s average wait time in the ED was reduced to 19 minutes, less than half the national average of 58 minutes. The average length of stay (LOS) in the ED was reduced to 43 minutes for low-acuity patients compared to a national average of 118 minutes. The LOS for discharged patients was decreased from 4.5 hours to about 2 hours and the LOS for admitted patients dropped from 8 to 6 hours. According to Karen Murrell, M.D., the chair of emergency medicine at Kaiser Permanente Northern California, “Decreasing the length of stay creates capacity, so if we have a patient in a bed for two hours rather than four hours, we can see twice as many patients.”
Source: “How Eliminating Waste and Opening Data Helped Kaiser South Sacramento Create a “No Wait” ER” by Heather Landi, October 23, 2015 [Retrieved online at www.healthcare-informatics.com]
This article is an update of a previous post.
Mercy Opens World’s First Virtual Care Center
Mercy, a not-for-profit Catholic health care organization located in the Midwest, opened a four-story, 125,000 square-foot Virtual Care Center in Chesterfield, Missouri. The facility not only houses the nation’s largest single-hub electronic intensive care unit, but also provides a center for telemedicine innovation and a testing ground for new health care products and services. Using highly sensitive two-way cameras, online-enabled instruments and real-time vital signs, clinicians “see” patients that may be in one of Mercy’s traditional hospitals, a physician office, or in some cases, the patient’s home — 24/7, 365 days per year.