How increasing smoke compartment size promotes better health and patient satisfaction

ASHE supports the move to 40,000 square feet maximum smoke compartments for a variety of reasons. The change gives designers flexibility and—more importantly—can improve patient health and increase patient satisfaction.

Currently, hospital smoke compartments are limited to 22,500 square feet. In a fairly typical hospital unit today, it is common to find semi-private rooms with two patients in each room. As hospitals expand and change their delivery model, they will likely shift to single bed rooms.  Under current design requirements, hospitals are limited to 20 patients in single bed rooms in a 22,500 square foot smoke compartment.

Hospitals that want to expand the maximum smoke compartment size over 25,000 square feet would be limited to a maximum size of 40,000 square feet and would have to create only private rooms. Hospital planners use design standards that use a grossing factor, which determines how much departmental area is needed per patient. This includes all of the circulation and service areas, such as space for staff to monitor patients, store of equipment off the corridor, and greater clearances inside the room required by other codes. The typical grossing factor of 1.5 is used for general medical or surgical units. Other types of units typically require a larger grossing factor. Even if the maximum smoke compartment size were increased to 40,000 square feet, the actual patient care area would effectively still be limited to just under 27,000 square feet due to the grossing factor in design standards (using a grossing factor of 1.5 of 40,000 gross square feet).

Staffing is a key consideration in these factors, because the number of patients one nurse takes care of during a shift has greatly reduced since the 1970s when the 22,500 square foot maximum smoke compartment size was first introduced. This increased of staff, which is a key element of patient safety, contributes to the additional square footage needed per patient.

Some opponents of this change claim that increasing the smoke compartment size could lead to more patients and more crowded conditions. This is not possible since the change limits the number of patients in the compartment by allowing for single patient rooms. Data from the American Hospital Association and a recent study conducted by Texas A&M University indicates that—at a minimum—2,100 square feet is currently needed for each patient bed. Currently, the national average is higher with a median of 2,500 square feet per bed, according to Texas A&M University’s study. Still, many hospitals are trying to streamline the amount of square footage as much as possible to save costs and improve staff efficiencies. A Kaiser Permanente model has successfully provided 1,500 square feet per patient bed.

Currently, the 22,500 square foot maximum for smoke compartment size does not control the number of patients or bed in a facility. Some hospitals have 4 beds per room, with 15 rooms within a compartment—a total of up to 60 patients. Perhaps more common are facilities with two patients per room—a total of up to 30 patients per compartment.

Under the proposal to move to maximum 40,000 square foot compartments, the number of patients would be controlled by requiring single patient rooms. Even if hospitals using few square feet per bed—1,500 square feet, for example—would only be able to provide 26 rooms per compartment, or 26 patients.

Reducing the number of patients and focusing on single patient rooms helps save lives. The Centers for Disease Control and prevention estimates that about 75,000 people with health care associated infections die each year. Patients sharing a room can spread disease and infection through the air and contact with surfaces. Single bed rooms also improve patient privacy and increase patient satisfaction. Another benefit is that larger smoke compartment sizes mean fewer smoke barriers, which can decrease patient communication from doctors and nurses and lower patient satisfaction.

The International Code Council has already incorporated the 40,000 square foot requirement into their codes and standards. ASHE supports the NFPA’s proposal to move in a similar direction for the reasons stated above and also to decrease conflicts between the overlapping codes and standards that regulate health care facilities.

In summary, some key benefits of moving to 40,000 square feet maximum smoke compartments include:

  • Reduces the number of patients in smoke compartments
  • Promotes single bed rooms that reduce the risks of health care associated infections
  • Increases patient privacy
  • Increases patient satisfaction
  • Increases health care worker to patient communication
  • Reduces conflicts between various codes and standards