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.
Current Trends
Read about current trends in utilization, medical practice, care delivery, and regulations and their facility impact.
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.
Shared Medical Appointments Are Becoming a New Outpatient Care Option
Most patients wait alone in a cramped exam room for a scheduled appointment as their physician rushes through back-to-back individual patient visits lasting an average of 22 minutes each. With the growing trend of shared medical appointments, a patient and his/her peers spend a full 90 minutes with their personal physician. Shared medical appointments are a small but growing part of primary care as well as for a variety of medical specialties. According to the American Academy of Family Physicians, the percentage of its members offering shared medical appointment more than doubled, to nearly 12 percent, between 2005 and 2012. At the Cleveland Clinic, nearly 10,000 group appointments were logged between 2002 and 2014. Promoted as the wave of the future in outpatient care, group appointments are changing the way physicians and patients view medical treatment.
Community Clinics, ACA Beneficiaries, Worry About Their Future
Community clinics are key providers of primary care services for the poor. Treating people for free or for very little money has been the role of community health centers — a type of community clinic — across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans. With roughly 1,400 community clinics nationwide, they have also expanded in recent years to serve people who gained insurance under the Affordable Care Act (ACA) and these clinics have been the poster child of the positive impact of the landmark ACA.
Micro-Hospitals — A New Healthcare Model
Thinking small allows a healthcare system to test demand or grow its presence in a specific market without the expense of a traditional greenfield full-service campus. Although not all alike, most micro-hospitals focus on treating low-acuity patients and provide ambulatory and emergency services — leaving more complex clinical services and surgeries to the larger, full-service hospitals within their broader healthcare network. They also have a lot fewer beds, often only 8 to 12.