By Annabella Koloskov, Anthony Haas & Gus Blanco
FGI guidelines provide standards and recommendations for the design of healthcare projects, including building codes, space planning, functional layouts and equipment requirements — all meant to ensure safe and efficient healthcare facilities.
But what happens when the FGI guidelines don’t specifically address specialized environments a healthcare design team is charged with planning? Or if the code changes and becomes more stringent halfway through a project?
Our team discovered the best ways to address these situations involve early and ongoing client communication; researching and, in some cases, embracing guidelines from other agencies and design standards; creating a simulation or prototype unit; implementing any code updates sooner rather than later and, perhaps most importantly, building flexibility into the facility for future proofing.
Case in point: tailored specialized project planning
Designed by Page and project partner Cuningham, the new Valleywise Health Medical Center located in Phoenix, Arizona opened in June 2024. The 673,000-square-foot, 10-story acute-care hospital includes a burn center, Level 1 trauma center, 233 patient rooms, 10 operating rooms, two interventional radiology areas and catheterization labs, two helipads and women’s and pediatric programs, as well as additional amenities for patients and families.
The new Diane & Bruce Halle Arizona Burn Center, housed in the hospital, is one of the nation’s largest and busiest academic burn centers serving thousands of patients from across the Southwest each year. Services include not only burn treatment, but also reconstructive and restorative surgeries for healed burns, and treatment for severe skin infections and chronic wound care. Burn care can take months, if not years, of intensive treatment, surgeries and rehabilitation.
The new burn center comprises the entire fourth floor of the new hospital, and contains three dedicated trauma bays, pediatric wing, large physical and occupational therapy room, hyperbaric chamber and space for research and teaching.
Healthcare guidelines + code requirements: beyond the norm
Prior to the 2022 release, the FGI Guidelines didn’t specifically address the burn environment as a distinct unit type. In the absence of clear guidelines, many project teams traditionally relied on CDC recommendations and ICU design standards to inform burn unit planning. Part of the project team’s discovery, in working with Dr. Kevin Foster (director of the burn center) and his team, included identifying the unique requirements needed to treat burn center patients — requirements that a standard hospital environment, even when following ICU and infection control guidance, could not fully accommodate.
For example, severe burns require a debridement process, where dead skin is removed. This requires flushing with water, so the quality of the water is vital since these patients are immunocompromised from the nature of their wounds. Also, there needs to be a dedicated drain or system to capture the runoff. The project team had to go back to the local jurisdiction to figure out how to make this happen. The solution was to place special water filters at the source of the sinks in the burn unit water system.
The burn center not only had to abide by all the regular healthcare guidelines and code requirements, but many times go beyond them; for example, with infection control, patient privacy, space needs and equipment. The team created a prototype unit, which they took to the state to negotiate with authorities.
When change happens mid-way: adopting a newer code
Another challenge was that the building code was updated in the middle of the project. The team started under one code, but over the duration of the project, had the option of adopting a newer code. For documentation and the design process, the project team ended up going to the newer, more stringent code.
The impact was significant in terms of room sizes, so the team wanted to catch that early, while still in early schematic design. To be proactive, the decision was made to build to the newer code.
Also in the newer FGI guidelines were additional requirements for bariatric programs and patients of size, which sometimes created challenges. Patient of size accommodations didn’t work with accessible toilets. For example, in the bed tower, two rooms were needed for patients of size on every floor, while 10% of patient rooms needed to be ADA-compliant. The project team was only responsible for patient rooms and the burn unit, but it trickled down to the whole facility. New code requirements may require a re-examination of the larger project.
Safety, capacity + comfort: adapting to future planning
Other challenges the team encountered under the new code were adaptations made in response to the COVID-19 pandemic, which hit in the midst of the project. The client was interested in enhancing safeguards and increasing flexibility to meet any future patient surges and infectious disease demands.
Considerations such as flow and circulation, isolation/negative air pressure rooms or units, cleaning and disinfection, transformation of waiting areas and separate tracks through the building for contagious and non-contagious patients needed to be considered. An entire level of the hospital was designed to switch to negative air pressure if necessary.
Additionally, the hospital serves a forensic population; consequently, a sally port and a different path through the hospital was required for these patients to get to where they needed to go without mixing with the main patient and visitor population.
Acoustic requirements for exterior walls were more detailed in the new code and required more stringent ratings if a patient area was behind the wall. This applied to the entire wall, not just the window. In several places, thicker glass needed to be used to meet the noise requirements. Additional flexibility was also built in so if there was a future epidemic or mass casualty event, all the observation rooms could function as part of the ER.
Most FGI guidelines and updated code requirements focus on patient and staff comfort and safety. Adherence to the most up-to-date and comprehensive suggestions not only makes good business sense, but it produces a more appealing facility — even if these guidelines and requirements may, at times, require creative maneuvering and a strategic repositioning of resources.
Annabella Koloskov, AIA, LEED AP BD C, is Page lead healthcare planner. Anthony Haas, FAIA, FACHA, and Gus Blanco, AIA, ACHA, are Page project directors.
