The free-standing emergency department (FSED) goes by many colloquialisms – standalone ER, pop-up ER, 24-hour emergency room, etc. The general idea is that an FSED is independently-operated from, and not physically part of, a hospital campus providing inpatient care. FSEDs are smaller, neighborhood healthcare buildings around town that are one step above urgent care and are often combined in one building with a physician practice, imaging (MRI, CT) services, and blood drawing. State + International Building Codes may classify the FSED as an ambulatory care facility, and here is where we are seeing a trend emerge.

Structural risk category II

For quite some time, the free-standing emergency department has been considered by the code as “B (Business) Occupancy,” which results in a Structural Risk Category of II.

Structural Risk Category II can be thought of as any old business; the grocery store, dentist office, coffee shop, and a 24-hour independent emergency room were all considered “normal” risks with typical building design requirements. From our perspective, this kept building costs low, and healthcare systems have been eager to construct FSEDs to serve + treat communities far away from their bustling main hospital campuses.

Introducing new building codes

Now, states that have recently (or are currently) adopting new codes incorporating language from the 2018+ International Building Code are adding “ambulatory care facilities having emergency surgery or emergency treatment facilities” to the buildings assigned to Structural Risk Category IV. The definitions + language surrounding healthcare facilities have left room for interpretation that some healthcare systems have been using to continue classifying their FSEDs as B, Business (examples like whether a facility is open 24 hours, a patient stays to recover for 24+ hours, the surgery is truly life-saving, patients can self-evacuate, the care providers accept the responsibility for emergency care, etc.).

Emerging healthcare trend for free-standing emergency departments

As the IBC codes + specific state codes continue to tweak + evolve their language around such “ambulatory care with surgery” facilities, most healthcare providers we work with are opting to build their FSEDs as Risk Category IV, essential facilities just like a hospital.

It’s a big deal for these buildings to increase to Risk Category IV because, in many areas around the country, this increases the building seismic design to C, D or higher. Why does that matter?

  • The higher seismic design increases the complexity + cost of the structural design
  • Moderate/high seismic requirements kick in for a myriad of non-structural building components like seismic bracing + equipment ratings for:
    • Suspended (lay-in) ceilings
    • HVAC ductwork
    • HVAC + plumbing piping
    • MedGas + more
  • More backup systems + redundancy are required

The seismic requirements greatly affect construction costs, construction schedules + general operating costs to monitor + maintain the necessary redundant systems.

Recent changes in building codes are significantly increasing the construction + infrastructure costs of free-standing emergency department buildings. In 2025, we expect healthcare systems to closely examine the FSED business model, with its ever-rising costs, and consider whether/how it fits into their land acquisition + growth strategy.

Resources

2018 International Building Code
Chapter 16 Structural Design

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