Three Significant Changes to FGI Guidelines

Attention healthcare facility planners: New FGI guidelines have been released that may impact your upcoming planning efforts

As the 2014 FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities were recently released, here are three significant changes with implications to physical space requirements.

1. New Hybrid Operating Room Section The new section for Hybrid Operating Rooms stops short of setting minimum clear floor area for the operating rooms but recommends 650 square feet in new construction and may drop to 600 square feet in renovation project. Clear dimensions are specified at 24 feet in new construction and 22 feet in renovation. There is clear recognition that the equipment specification and specific procedures and staffing vary by facility and program. If a control room is required it must be at least 120 square feet clear area and be physically separated from the Operating Room with walls and a door. The section also contains a good deal of content regarding structural support, room shielding, and equipment access to the room.


Butler Hybrid OR // Butler, PA


2. NICU Parent/Infant Rooms Eliminated The NICU Parent/Infant Room has been a long-standing requirement reflecting the historical design of multi-bay NICU’s. This room was intended to provide parents and infants extended private time in preparation to return to the home environment. The new Guidelines eliminate the requirement for this room as long as all NICU rooms are private. If this room is provided, it must have direct access to sink, shower, and toilet facilities as previously published. Interestingly, no guidance is provided on the availability or location of any other family toilet and shower area within the unit. The provision of a private toilet room at each NICU room has been the topic of much discussion recently.

Dublin Methodist Hospital NICU // Columbus, OH


3. Observation Units The observation unit is no longer a subparagraph within the emergency department section but a stand-alone section. The language specifically notes that it may be located in the emergency department or another location within the hospital. Either open bays or private rooms are permitted and all must have 120 square feet clear floor area. Beds must be three feet away from a wall and five feet away from an adjacent bed. Toilet rooms are required at a rate of one per six beds. Typical support facilities such as clean supply, medications, and nourishment are required. A private exam room is required if all beds are not private. Therefore, the observation unit is approaching the same characteristics as an inpatient unit with the exception of the requirement of a patient toilet in each room. The requirement for the Guidelines in the State of Ohio is a bit circuitous. Since the State of Ohio does not have a licensure requirement for most health care facilities, they have not adopted the Guidelines. In the absence of another requirement, a facility accredited by the Joint Commission would use the CMS’s currently-adopted version of the Guidelines which is the 2010 edition for the moment. For information on obtaining a copy of the 2014 Guidelines, please go to If you have further questions, please contact us at


Jane Peters

Jane Peters // Senior Healthcare Planner

Jane earned her Master of Architecture from Harvard University Graduate School of Design and has dedicated over 27 years to providing medical planning and architectural design services for healthcare organizations throughout the country. Jane is a nationally recognized speaker in NICU and pediatric planning and design. Her most recent NICU presentations have included:

  • 5th Annual Developmental Therapists in the NICU Conference (Oct 2010) “Going Green in the NICU: Architecture and Interior Design Elements”
  • 14th Annual Children’s Hospital NICU Leadership Forum/Striving for Excellence (April 2010) “Going Green in the NICU”
  • NACHRI Annual Conference 2009 (Oct 2009) “A Carefully Calibrated NICU”
  • Children’s Hospital Association (previously NACHRI) Creating Connections Conference “Growing Ambulatory Surgery by Reaching Out”