Each year ECRI Institute releases an annual list of the top 10 technologies and patient care developments it recommends hospital executives pay attention to. The 2018 list includes at least two items that have implications on how fire and life safety codes, such as NFPA 101, Life Safety Code, and NFPA 99 Health Care Facilities Code, must be applied.
The two trends which building and life safety professionals should be most aware of are a trend toward acuity-adaptable rooms and the construction of microhospitals.
Risks in health care are much more than just fire and life safety issues. Hospital acquired infections, medication errors, and patient falls are just some of these additional risk and those are increased each time a patient must be moved from one unit or area of a hospital to another, such as from an intensive care unit to a step down unit. What some facilities have begun to implement are acuity-adaptable rooms which can allow for hospitals to keep patients in the same room from admission to discharge regardless of their acuity level.
While this approach has several benefits to facilities and is a patient-centered care model it will also introduce many complex challenges that will have to be addressed in order to successfully implement. While many of these relate to staffing, equipment logistics, and clinical issues, we’ll take a look at the NFPA codes and standards impact.
In looking at NFPA codes and standards, the most immediately impacted code application will likely be NFPA 99 in how these rooms will need to be designed in order to meet gas and vacuum system requirements and electrical system requirements.
The application of NFPA 99 is based on risk to patients. Rooms with higher acuity patients, where the risk of a system failure can have significant impacts, require more protection. All rooms designed to accommodate the acuity-adaptable approach will have to meet the requirements for the higher level of risk. This will likely mean a higher number of rooms that need to meet the increased requirements for the higher risk. Some of the impacts this could have would be additional medical gas and vacuum outlets and inlets, increased number of electrical receptacles at patient beds, additional zone valve boxes, and increased loads on the critical branch of essential electrical systems.
Typically designed with 15,000 to 25,000 square feet of space, microhospitals are a concept which has gained a lot of traction over the past couple of years. These buildings are neither urgent care centers nor full-service hospital but act as a way for health care providers to increase community access by distributing care throughout the system’s region without undertaking huge infrastructure projects. There is no definition of what a microhospital is or what services it provides. Many will provide a range of services typically found in traditional hospitals, including inpatient services and emergency care, but generally have a lower acuity patient population.
For some, these facilities, which are a fraction of the size of traditional hospitals, might seem to be buildings which can have a lower level of protection than what is expected in full size hospitals. This is not the case based on the services and patient population expected in these microhospitals.
They will need to be classified as a health care occupancy per NFPA 101 if providing care to 4 or more patients on an inpatient basis who are incapable of self-preservation. This threshold is just 1 or more patients based on Centers for Medicare & Medicaid -CMS- interpretations. The classification as a health care occupancy will require automatic sprinkler protection throughout the building and each story used by inpatients for sleeping or treatment to be subdivided into at least two smoke compartments. This could result in relatively small smoke compartments given the condensed footprint of these building but is necessary to provide the “defend in place” concept needed for building occupants who are in a compromised state.
Medical gas and vacuum systems and electrical system requirements will be based on the risk assessment approach defined in NFPA 99. If failure of these systems are likely to result in major injury or death of patients or caregivers, then the most stringent requirements will need to be followed. A multidisciplinary committee should be brought together to look at the expected services and patient populations to determine the inputs into such a risk assessment.
NFPA Technical Committees and the future of health care
The technical committees for NFPA 101 and NFPA 99 will continue to monitor trends and changes in health care delivery to ensure that the codes are still providing adequate levels of safety to patients and other occupants of health care facilities in a flexible manner that allows improvements in health care delivery models of the future. Both codes are currently accepting public input for their 2021 editions until June 27th.
For more information on NFPA resources for health care facilities see www.nfpa.org/cms.