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Descriptions of and/or design criteria for the following shall be provided:
*1.2-5.4.1 Light Seniors and the Low Vision Population
How the use and availability of natural light and illumination are to be considered in the design of the physical environment
A1.2-5.4.1 Light. Provision of natural light should be considered wherever possible in the design of the physical environment.
  1. Access to natural light should be provided no farther than 50 feet from any patient activity area, visitor space, or staff work area. To the extent possible, the source of such natural light should also provide opportunities for exterior views.
  2. Access to natural light should be available without entering private spaces (i.e., staff should not have to enter a patient room to have access to natural light). Examples of such access include windows at the ends of corridors, skylights into deep areas of the building in highly traveled areas, transoms, and door sidelights.
  3. Artificial lighting strategies. The Illuminating Engineering Society (IES) has developed two publications that apply to hospitals. ANSI/IES RP-29: Lighting for Hospitals and Health Care Facilities addresses lighting for the general population and special lighting for medical procedures. ANSI/IES RP-28: Lighting and the Visual Environment for Senior Living addresses the special lighting needs of older adults.
  4. Color rendering properties should be addressed in lamp selection.
  5. Finish selection should address light reflectance values (LRV) in conjunction with lamp selection.
  6. Indirect lighting should be considered to reduce glare.
*1.2-5.4.2 Views of and Access to Nature
How the use and availability of views and other access to nature are to be considered in the design of the physical environment
A1.2-5.4.2 Views of and access to nature. Siting and organization of the building should respond to and prioritize unique natural views and other natural site features.
  1. Ideally, the design for a hospital would include direct physical access to the outdoors as well as views of nature and indoor gardens/atria. When direct access is not possible, suitable alternatives could include indoor gardens with natural light (atria) and visual access to nature, as defined by Green Guide for Health Care Environmental Quality Credit 8.2 and Sustainable Sites Initiative Credit 6.7.
  2. Separate outdoor respite areas for medical and support staff should be provided. For practical guidelines for the percentage of space allocated for these areas, refer to LEED for Health Care and Green Guide for Health Care requirements as well as Sustainable Sites Initiative Credit 9.1.
  3. Hospitals should provide a garden or other controlled exterior space that is accessible to building occupants. Consider specifically designed therapeutic and restorative gardens for patients and/or caregivers, as appropriate. Exterior spaces should be located to accommodate staff observation. Therapeutic and restorative gardens should be designed by landscape architects with knowledge and experience specific to health care design as part of the interdisciplinary design team.
  4. Opportunities for active as well as passive interaction with nature in outdoor space(s) should be provided (e.g., opportunities for exercise and play or other types of physical activity and for physical, occupational, horticultural, or other therapies).
  5. Signage, other wayfinding features, and/or views of outdoor garden(s) and/or atria should be provided to encourage their use.
  6. Access to both sun and shade, with trees and/or built shade structures, should be provided. Shady places are particularly important for patients who are photosensitive.
  7. When access to outdoor space is not restricted, automatic door openers, flat door thresholds, and other physical connections between indoors and outdoors that facilitate easy access should be provided.
  8. Use of harmful and poisonous plants should be avoided, especially in gardens for children, the developmentally disabled, and people with dementia.
*1.2-5.4.3 Wayfinding
How clarity of access will be provided for the entire campus or facility using a wayfinding system. See Section 1.2-6.3 (Wayfinding) for more information.
A1.2-5.4.3 Wayfinding
  1. Hospital entry points should be clearly identified from all major exterior circulation modes (e.g., roadways, bus stops, vehicular parking).
  2. Clearly visible and understandable signage, icons, universal symbols, visual landmarks (including views to the outside), and/or cues for orientation (including views to the outside) should be provided.
  3. Boundaries between public and private areas should be well marked or implied and clearly distinguished.
  4. A system of interior "landmarks" should be developed to aid occupants in cognitive understanding of destinations. To be effective, landmarks should be unique and used only at decision points. Landmarks may include sealed water features, major art, distinctive color, or decorative treatments. These features should attempt to involve tactile, auditory, and language cues as well as visual recognition. When color is used as a wayfinding device, it should support the primary wayfinding system elements and be clearly distinguished from color palette decisions unrelated to wayfinding.
  5. Signage systems should be flexible, expandable, adaptable, and easy to maintain. Signage should be consistent with other patient communications and supporting print, Web, and electronic media.
*1.2-5.4.4 User Control of Environment
How, by what means, and to what extent users of the finished project will be able to control their environment
A1.2-5.4.4 User control of environment. During the functional programming process, opportunities for individual control over as many elements of the environment as possible and reasonable (e.g., temperature, lighting, sound, and privacy) should be evaluated.
  1. Lighting in patient and staff areas should allow for individual control and provide variety in lighting types and levels.
    • -Patients should have control at bedside of over-bed, ceiling, and/or wall sconce lighting.
    • -Patients should have control of varied lighting in patient bathrooms.
    • -Staff should have control of varying lighting levels in corridors outside patient rooms, at caregiver substations, and at central caregiver stations to ensure that patient sleep is not disturbed by general lighting not under the control of patients/visitors.
    • -In single-bed rooms, it is preferable for patients to be able to control access to natural light from the bedside.
  2. Building systems design should address individual control over the thermal environment through carefully considered zoning of mechanical systems that permits control of heating and cooling to achieve thermal comfort for individual patients and for staff in staff areas.
  3. Noise has been proven to be an environmental stressor for patients, families, and staff; therefore, the effects of noise should be a high priority in the design of the physical environment and the selection of operational systems and equipment.
    • -Where feasible and clinically safe to do so, patients should be able to have some control of their acoustic environment. Noisy equipment and systems should be controllable at bedside whenever possible and appropriate. Staff should be able to switch medical alarms and communication equipment such as paging and nurse call systems to staff communication devices and/or to an acoustically protected room or area under caregiver supervision.
    • -Use of personal mobile devices should be considered in place of overhead paging systems.
    • -Patients and staff should be able to activate sound-masking technology to help mask unwanted sounds that affect the patient environment.
    • -Noise-canceling headsets or hearing protection devices should be available for patient use.
    • -In waiting areas with television, alternate listening devices should be available to offer patients a choice of quiet.
  4. Personal storage. When length of stay is extensive, accommodations for patients' personal belongings should be provided. Staff should have a place to secure their personal belongings.
*1.2-5.4.5 Privacy and Confidentiality
How privacy and confidentiality for users of the finished project are to be protected
A1.2-5.4.5 Privacy and confidentiality. Patient privacy is a right that has been established through the Health Insurance Portability and Accountability Act (HIPAA), which is intended to ensure that privacy of patient health care information is maintained in all health care settings.
  1. Public circulation and staff/patient circulation should be separated wherever possible.
  2. Waiting areas for patients on stretchers or in gowns should be located in a private zone within the plan, out of view of the public circulation system.
  3. Private alcoves or rooms should be provided for all communication concerning personal information relative to patient illness, care plans, and insurance and financial matters.
  4. In facilities with multi-bed rooms, family consultation rooms, grieving rooms, and/or private alcoves in addition to family lounges should be provided to permit patients and families to communicate privately.
  5. In multi-bed rooms or other areas where privacy cannot be ensured, patients and/or staff should have smart technology (e.g., tablet or laptop) available as an alternative to verbal communication.
*1.2-5.4.6 Security
How the safety and security of patients, staff, and visitors are to be addressed in the overall planning of the facility
A1.2-5.4.6 Security
  1. Provision of readily accessible and visible external access points to the facility should be balanced with the ability to control and secure all access points in the event of an emergency. Factors such as adequate exterior lighting in parking lots and at entry points to the facility and appropriate reception/security services are essential to ensuring a safe environment.
  2. Since the strict control of access to a hospital is neither possible nor appropriate, safety within the facility also should be addressed through the design of circulation paths and functional relationships.
  3. Provisions should be made for securing the personal belongings of staff, visitors, and patients.
  4. The physical environment should be designed to support the overall safety and security policies and protocols of the institution.
  5. Security monitoring, when provided, should respect patient privacy and dignity.
*1.2-5.4.7 Architectural Details, Surfaces, and Built-in Furnishings
Characteristics and criteria for use in selecting materials and products for architectural details, surfaces, and built-in furnishings
A1.2-5.4.7 Characteristics and criteria for selecting surface materials and products. The effect of surface materials, colors, textures, and patterns on patient, staff, and visitor safety and on maintenance and life cycle performance should be considered in the overall planning and design of hospitals. See appendix sections A2.1-7.2.3 (Characteristics and criteria for selecting surface and furnishing materials and products) and A2.1-7.2.4-a (Characteristics and criteria for selecting furnishing materials and products) for details on selecting surface materials for hospitals.
*1.2-5.4.8 Cultural Responsiveness
How the project addresses and/or responds to local or regional cultural considerations
A1.2-5.4.8 Cultural responsiveness
  1. Organizational culture is defined by the history of the organization, leadership philosophy, management style, and caregivers' dispositions. Also consider the clinical function being served (e.g., pediatrics, geriatrics, oncology, obstetrics).
  2. Regional culture is defined by the physical location and demographics (including age, nationality, religion, and economics) of the communities served. Cultural responsiveness to community-specific issues such as demographic density in urban, suburban, and rural communities should be considered.

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