The Facility Guidelines Institute (FGI) and ASCs (May 21, 2021)




ASCA Public Affairs team member Charlie Leonard interviews David Shapiro, MD, a past president and current Board member of ASCA, in his capacity as a member of the board of directors of the Facility Guidelines Institute (FGI). FGI is widely recognized as the leading source of facility guidelines for the design, construction and remodeling of ASCs and other healthcare facilities. In this short, informative program, listeners can learn more about the role of FGI and its essential ASC-focused publications.

Narrator: 0:06
Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.

Charlie Leonard: 0:37
Hi, I'm Charlie Leonard, a member of the ASCA Public Affairs team. On this episode of the Advancing Surgical Care Podcast, I'm pleased to welcome back Dr. David Shapiro, a member of the ASCA Board of Directors and the Board of Directors of the Facility Guidelines Institute, or FGI. FGI is an independent, not-for-profit organization dedicated to developing guidance for the planning, design and construction of hospitals, outpatient facilities and residential care facilities. A special note to our ASC audience, FGI publishes the Guidelines for Design and Construction of Outpatient Facilities, a manual that is widely regarded as the definitive source of information for designing and constructing ambulatory surgery centers today. FGI's publication is extensively updated every four years, a process that is currently underway for the 2022 edition and the reason we've asked Dr. Shapiro to come back on the ASC Podcast. Dr. Shapiro should be well known to many listeners but for those of you who may have not had the pleasure of meeting him, David is an anesthesiologist with extensive experience in ASC management. In addition to being a current member of the Board of Directors, David is a past president of ASCA. Among his many credentials, he is CASC certified, a Certified Professional in Health Care Risk Management, certified in Health Care Quality & Management and a member of the ASC QC. David, welcome back to the ASC Podcast.

David Shapiro: 2:00
Thank you, Charlie, and greetings to our listeners.

Charlie Leonard: 2:03
David, let's jump in. Before we get into a discussion about the editorial process of updating FGI publications, it might be helpful if you could expand on my introduction and give our listeners a little more foundational information about FGI and your role with them.

David Shapiro: 2:19
Sure. I think the best way to explain it is that the Facility Guidelines Institute is the authoritative source for guidance on health and residential care facility planning, design and construction in the United States. We use a consensus-based, research-informed process to formulate the guidelines, which are then used by regulators, designers, builders and, of course, facility owners around the country to protect public health, safety and welfare. The FGI, Facility Guidelines Institute, publishes three main sets of books or guidelines, and those are titled the FGI Guidelines for Design and Construction of: 1) Hospitals, 2) Outpatient Facilities and 3) Residential Health, Care, and Support Facilities. So while I have the privilege of serving on the FGI board, I'm also a member of the super important Health Guidelines Revision Committee. This is really where most of the work for the organization gets done. The committee is 130 people and it's composed of several different kinds of disciplines. But basically, they are tasked with the job of revising the guidelines every four years. So this committee fully vets all new and revised sections of the guidelines, ensuring that they are fundamentally sound and are in line with current clinical practices. The committee meets usually face-to-face, although of course not these last two cycles, usually yearly during that four-year cycle and between each meeting has numerous, and I do mean numerous, conference calls to discuss and debate and, ultimately, come to a consensus. So as you might gather from the titles of our publications, our work focuses on not just the clinical but also the design and construction of facilities. As such, the committee is not populated only by physicians such as myself. We're also composed not only of healthcare providers representing all disciplines but also architects and builders who specialize in working with healthcare organizations. So, I can tell you, I have learned a ton of stuff that they don't teach you in medical or nursing school. As an anesthesiologist, I try to give guidance on environments where anesthesia is administered, along with informing the committee regarding the latest trends, in an effort to keep the guidelines both current and applicable. Further and more pertinent, really, to this discussion, I always try to give voice to the issues confronting the ASC industry specifically, as we are one of many sites where outpatient care is provided.

Charlie Leonard: 4:55
That's a really, really good background. Let me ask you this—in my introduction and in your comments as well, we both recognized FGI for its leading role in design and construction and remodeling of facilities. Can you explain to our listeners how FGI guidelines also comport with state, local and health department requirements, local building codes, etc.?

David Shapiro: 5:17
Sure, all of those things. Overriding all of those issues, FGI has a strict policy of not competing or conflicting with other codes and standards. So therefore, we don't write life safety, structural or other regulations, which are well covered by organizations such as the International Code Council or the National Fire Protection Association. So our standards address the needs of the clinical environment, and focus on such things as patient and staff safety, infection prevention, sizes of rooms, clearances around the patient stations, access to services and other types of clinical issues which confront all different kinds of healthcare facilities. As for the Department of Health standards, we do supplement their operational and clinical requirements by providing planning and design criteria for the services that are being offered. This removes the burden from state governments for having to write their own regulations, which of course can be both very time-consuming and also very costly.

Charlie Leonard: 6:20
Well, obviously a lot of boxes to check for any ASC looking at a remodel or a construction, but good to hear that there's no conflict there and that there's a close coordination. David, we're going to take a brief pause to hear a message from our podcast sponsor, and we'll be back in just a moment.

Narrator: 6:37
This episode of the Advancing Surgical Care Podcast is brought to you by Somnia Anesthesia, a national perioperative anesthesia management company, bringing advanced anesthesia and pain management techniques to surgery centers for 27 years. Somnia’s anesthesiologists and nurse anesthetists integrate fully with ASC clinical teams to deliver safe, high-quality care. Learn how they do it at

Charlie Leonard: 7:08
Okay, welcome back. David, before the break, we were discussing the need for ASCs to be mindful of FGI guidelines and recommendations as well as their local health department requirements and local building codes. Additionally, ASCs were asked this year to adopt several new protocols to intensify their infection controls to better guard against the spread of COVID-19. Can you tell us what, if any, influence the pandemic may have had on FGI’s updated facility guidelines?

David Shapiro: 7:35
Sure. Infection prevention has always been at the forefront of both providing care and also design and construction of ASCs. And indeed, there have always been infection preventionists as part of that committee that I was speaking of earlier. So that's always been inherent in the guidelines as they’ve been published over the last several cycles. So, most of the revisions for this 2022 cycle were really reworking and updating the existing requirements in a lot of regards because of the COVID pandemic. So some new sections will be added, including hyperbaric facilities, low-acuity pods and freestanding ERs. Again, the need to consider adding airborne infectious isolation rooms to certain ambulatory care facilities, clear floor area in other settings, just to name some of the few changes. But certainly in the forefront of all of our minds during this process over the last year and a half has been COVID-19. But specifically for COVID-19, because so much new material was coming to the forefront and so many new considerations needed to be addressed, FGI actually produced a separate guidance document, which was just released a couple weeks ago. It's got a long title so, wait for it, here it comes, it's Guidance for Designing Health and Residential Care Facilities that Respond and Adapt to Emergency Conditions, or as we call it within the organization, just Emergency Conditions. I know that's a mouthful, but it's also an exceptionally comprehensive document. That publication, which runs over 700 pages, covers recommendations and design considerations for both new construction and also for major renovations. So it's available as of now, free via download, and is posted on our homepage,

Charlie Leonard: 9:28
I think it also bears mentioning that even prior to the pandemic, ASCs have always had very, very robust infection control procedures and protocols in place.

David Shapiro: 9:38
Yes, you are correct. That has always been, as I said, at the forefront of ASC, both design and construction, and certainly at the forefront of the way that we care for our patients while they are in the ASC, and also the way we instruct them to care for themselves after they're discharged from our facilities. It's also one of the things, as most of our listeners know, that we've been benchmarking really closely throughout the years and continue to have a focus, especially during this pandemic times.

Charlie Leonard: 10:08
David, let's talk about the editorial process of actually updating the FGI publications. As I noted in my introduction, this is a process that occurs every four years, and my understanding is that the comment period for the 2022 publications has closed and that you're in the process of evaluating comments and submissions. Can you tell us about the volume of submissions that you've received, the process, and how this all wraps up and when publication would be expected?

David Shapiro: 10:33
Yes, absolutely. So, as you touched on, the revision process begins in the second year of the cycle when we open the document up totally to the public for proposals. So these proposals from the public can take many different forms, from recommending entirely new sections or chapters, or deleting obsolete language, or just revising existing language to keep up with clinical practice, or even sometimes clarifying language that may have been ambiguous in the prior edition. So at that point, we typically receive over 2,000 public proposals across those three documents that I mentioned earlier. And then afterwards, the committee meets and evaluates all the proposals, and we issue a draft document to provide another opportunity for the public but this time to review and comment on the actions taken by the committee. At that time, we usually get over 1,500 comments across, again, all three documents. So just like the public proposals, all of the comments are addressed by the committee for inclusion in the final language. The committee met virtually, of course, a couple of weeks ago for an entire week's duration, and that was a full day meeting over every day of the week in the middle of April. So at this point, we are closing things down as far as getting ready to issue the new guidelines in the next year. And now we're consolidating all of the accepted modifications that were recommended during the public review process. So that takes us to about where we are right now in the current cycle, and folks can expect the 2022 editions of all three documents that I mentioned, including and especially for this audience the outpatient, to be forthcoming in the coming year. So I hope that people will find it both useful and informative, especially if you anticipate building or even remodeling an ASC with which you are involved.

Charlie Leonard: 12:24
Well, David, thank you. That's about all the time we have today. I'm sure I speak for most in the ASCA community when we say, thank you, we're fortunate to have you on the FGI board and looking out for the interests of the ASC community and making sure those voices are heard and those comments are at the forefront. Thank you again for coming on the podcast and hopefully we'll have you back again soon.

David Shapiro: 12:47
Thanks so much, Charlie. I appreciate the opportunity as always.

Charlie Leonard: 12:50
Before closing this podcast, I would again like to acknowledge the support of our ASCA affiliate Somnia Anesthesia, a national anesthesia management company bringing advanced anesthesia and pain management techniques to surgery centers for the past 27 years. Learn more at Until next time, thanks for listening and please continue to follow your local public health guidance.