Healthcare Design - April 2016 - 46

A AIA-AAH | 04.16
New front door

Freestanding EDs are growing in popularity as providers find opportunity in
a less costly and more convenient care option that expands reach and helps
drive hospital volume By Robby Aull
One of the newest programs and building types being
developed within the healthcare industry is the freestanding emergency department (FSED). These projects
are growing in popularity as hospitals and healthcare
systems strategize ways to provide improved, responsive
care in the most cost-effective physical environment
possible.
An FSED is not an urgent care center, which is normally based upon primary care models and often utilized
for after-hours, non-emergent care. Rather, an FSED is
an extension of a hospital and provides emergent care
on a 24/7 basis, and many states require that they be
owned and managed by a hospital or healthcare system.
As an extension of a hospital, the FSED is expected to
provide care with direct, on-site access to all services
needed for emergent care that are normally found within
a hospital, such as lab, imaging, and pharmacy. However, access to surgery and inpatient beds aren't provided
at these remote locations. Instead, patients remain within
the department for less than 24 hours, at which point
they're either discharged or transferred to a hospital.
There are several drivers behind the growth of FSEDs,
including hospitals' and health systems' desire to gain
market share. In this age of retail-oriented healthcare,
convenient access to the appropriate service for the
health consumer is an important consideration. FSEDs
can be located in currently underserved areas away from
existing hospitals, allowing a system to either pull new
market share or to consolidate existing customers within
the service area. An FSED can also be located in current
competitive markets, potentially gaining additional market share through the offering of a new choice of service
to consumers. In addition, when emergent care services
are needed, time from event to the first point of care can
be critical to a successful outcome (e.g., heart attack,
stroke, or other critical care needs). Having dispersed
facilities can substantially shorten this timeframe.
Overall, these freestanding facilities are more convenient and easier to access than emergency services
at an existing hospital campus, allowing providers to
adequately serve patients who need emergent care
while giving the public a sense of confidence that that
care is close by and available when needed. Those who
require additional inpatient services, such as specialty
diagnostics, overnight observation and nursing care,
and procedures/surgery are then transferred to the
main hospital-positioning FSEDs to serve as an extended front door and driving hospital volume.
46 HCDmagazine.com 04.16

Building considerations
In order to increase access, FSEDs are generally
located away from existing emergency services. Plus,
when constructed on an open site, these departments
can be significantly less costly than when built at a
main hospital. This remote construction eliminates the
disruption that expansion often creates within existing
emergency departments and on constrained, difficult
sites. In addition, the regulatory and code requirements
for these facilities may allow for staffing models that are
less costly, too.
Because it's a new building type, the codes and
regulations pertaining to these facilities aren't universal
and may vary by location. As a starting point, the International Building Code (IBC) categorizes FSEDs as business occupancy, providing that the patients are at the
facility less than 24 hours. This classification allows for
a relatively simple and cost-effective construction type
without the normal requirements of hospital construction. However, the IBC requirements are augmented by
the National Fire Protection Association (NFPA) 101 Life
Safety Code, which classifies an FSED as an ambulatory
healthcare occupancy. The key added requirements
within this code are the inclusion of a defined separation
between the FSED and other clinical functions within
the same building (such as office space), and also the
requirement for a minimum of two smoke compartments. The Facility Guidelines Institute's 2014 Guidelines
for Design and Construction of Hospitals and Outpatient
Facilities include the FSED within its Hospital Part 2 section, generally based upon the typical, hospital-based
emergency department requirements.
The design regulations become more restrictive
when a code that regulates the engineering building systems, NFPA 99, is considered. Although not
specific to FSEDs, NFPA 99 categorizes building
infrastructure based upon the system's risk to the
safety and well-being of patients in the event of failure.
After assessing risk to the FSED patient populations,
most hospitals choose to spend additional funds on
the various building systems-e.g., back-up power and
increased ventilation systems-and construct FSEDs
to allow for the continuation of operations in the face of
natural or manmade disasters. While the specific code
requirements must be considered based upon local
requirements, in general, an FSED built to business
occupancy and the standards above is less expensive
than typical hospital construction.

Robby Aull

http://www.HCDmagazine.com

Healthcare Design - April 2016

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