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Area Calculation Method for Health Care

ASHE Monograph

D. Kirk Hamilton and Sarel Lavy, editors

ASHE Monograph


D. Kirk Hamilton and Sarel Lavy, editors

ASHE Disclaimer

This document is provided by ASHE as a service to its members. The information provided maynot apply to a reader’s specific situation and is not a substitute for application of the reader’s ownindependent judgment or the advice of a competent professional. Neither ASHE nor any authormakes any guaranty or warranty as to the accuracy or completeness of any information containedin this document. ASHE and the authors disclaim liability for personal injury, property damage,or other damages of any kind, whether special, indirect, consequential, or compensatory, that mayresult directly or indirectly from use of or reliance on this document.

© 2017 ASHE

The American Society for Healthcare Engineering (ASHE)of the American Hospital Association155 North Wacker Drive, Suite 400

Chicago, IL 60606312-422-3800

[email protected]

ASHE members can download this monograph from the ASHE website under theResources tab. Paper copies can be purchased from www.ashestore.com.ASHE catalog #: 055590

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Contents

About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Chapter 1How to Use this Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter 2 Method for Consistent Calculation of Hospital Area . . . . . . . . . . 13

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Common Health Care Measurement Models . . . . . . . . . . . . . . . . . . 14

Other Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Area Calculation Method for Health Care . . . . . . . . . . . . . . . . . . . . . 18

Scenario Specific Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

A. Basic Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

B. BGSF Line Items. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

C. Furr-outs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

D. Circulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

E. Exterior Covered Areas and Canopies . . . . . . . . . . . . . . . . . . . 22

F. Columns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

G. Connections to Other Buildings. . . . . . . . . . . . . . . . . . . . . . . . . 25

H. Light Wells and Atriums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

I. Departments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

J. Shell Space. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

K. Parking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

L. Central Utility Plant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

M. Nurse Work Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

N. Non-Departmental Corridor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

O. Entries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

P. Shared Spaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Q. Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

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APPENDIX AArea Calculation Procedures in AutoCAD Architecture . . . . 35

APPENDIX BArea Calculation Procedures in Revit . . . . . . . . . . . . . . . . . . . . . 46

APPENDIX CSuggested List of Departments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54


About the Authors

D. KIRK HAMILTON, FAIA, FACHA, EDAC, is the Julie & Craig Beale Endowed Professor of Health Facility Design and Fellow of the Center for Health Systems & Design at Texas A&M University, where he teaches health care design. His research is on the relationship of evidence-based design to measurable organizational performance. He practiced for 30 years before joining the university, and is a founding principal emeritus of WHR Architects. A past president of the AIA’s Academy of Architecture for Health and American College of Healthcare Architects, Hamilton speaks and writes on health care design and is co-editor of the peer-reviewed, interdisciplinary Health Environments Research & Design journal.

SAREL LAVY, PhD, is an associate professor in the department of construction science at Texas A&M University, and serves as the associate department head. Lavy’s research interests are in the area of facility management, mainly in the health care and education sectors, life cycle cost techniques, performance indicators, and facility management education. Lavy has taught undergraduate and graduate level classes in facility management and construction cost estimating, and introductory classes in construction management. He has authored and co-authored more than 80 papers published in peer-reviewed journals and conference proceedings. Lavy also serves as the co-editor for Facilities, a top international journal in facility management, working with editorial team members from around the world. Lavy earned his doctorate in civil and environmental engineering from the Israeli Institute of Technology (Technion) and joined Texas A&M University in 2005.

AMY KIRCHER, M.Arch, LEED AP BD+C, EDAC, is a user experience designer and strategist in San Francisco, California. She is a past recipient of the Arthur N. Tuttle Jr. Graduate Fellowship in Health Facility Design and Planning, conferred by the AIA Academy of Architecture for Health, and has served as editorial assistant for the peer-reviewed journal Health Environments Research & Design. She worked as a research assistant for the Area Calculation for Hospitals: Method & Results study during and since her graduate work at Texas A&M University, where she received the Certificate in Health Systems and Design. Kircher’s current focus is innovations in health care that merge physical, digital, and business design.

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YIN JIANG, PhD, AIA, is currently a design architect at EYP/Health in Houston, Texas. He has worked on many major health care projects in multiple states, including North Carolina, New Jersey, Colorado, and Texas. Jiang received his Doctor of Philosophy in Architecture from Texas A&M University, with his research focused on the study of people’s perception among different design representational media. He is also the recipient of the Certificate in Health Systems and Design at Texas A&M University. He worked as a research assistant for the area calculation study during his graduate work at Texas A&M University.

MANISH K. DIXIT, PhD, LEED AP, is an assistant professor in the Department of Construction Science at Texas A&M University. Dixit’s research interests include life cycle energy and environmental modeling, green building materials, embodied energy modeling, zero-energy buildings, building information modeling (BIM), and facility performance assessment. He develops application programming interfaces (APIs) to BIM, authoring tools for BIM-based energy and environmental assessments. He has published more than 32 research papers in peer-reviewed journals and conference proceedings. Dixit currently represents the United States as a national participant in Annex 57 of the International Energy Agency (IEA), an international research project focusing on evaluation of embodied energy and carbon dioxide emissions for building construction.


Acknowledgments

Texas A&M University—through the College of Architecture’s Evidence-Based Design Research Lab and principal investigators Professor D. Kirk Hamilton and Associate Professor Sarel Lavy and their graduate students—with the support of Herman Miller Healthcare, the Academy of Architecture for Health Foundation, and Alberta Infrastructure, conducted a study to calculate building and departmental areas in hospitals. The study was also supported by private donations as in the case of Frank Zilm, a board certified health care architect.

The current study follows on the work of David Allison of Clemson University, Kirk Hamilton at Texas A&M, and Frank Zilm, now affiliated with the University of Kansas. The preliminary study, published in 2008, only examined five departments.

Each firm that contributed projects to be measured as the methodology was developed was invited to provide a contact person to manage the interaction between the research team and the individuals responsible for the submitted projects being measured. The contacts will not be identified here to preserve the anonymity of the projects, but the research team is grateful for their important contribution to the study.

Thanks to the generosity of Herman Miller, the research team met at intervals with these representatives and with Peter Bardwell, Roger Call, and Frank Zilm of the Academy of Architecture for Health Foundation. These meetings provided valuable feedback to the study process and the participants were particularly helpful in refining the methodology described in this monograph.

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Foreword

Chad Beebe, AIA, FASHE, ASHE Deputy Executive Director

Every health care facility is unique. Even when health facilities offer similar services or contain similar departments, there are differences: the flow of patients may be slightly different, the staffing model may be different, the systems that support the department may be different, and the staff required to maintain those systems may require a different level of expertise. Although there are differences between facilities, health care organizations all share a goal of wanting to understand how well a particular area or department is performing over time.

To gauge this performance, health care facilities use benchmarking metrics. Regardless of whether we are benchmarking costs, staffing, maintenance costs, or planning, benchmarking figures are based on square footage. Although there are several models for determining square footage, the unique circumstances within health care facilities can make this challenging. In office buildings and similar spaces, for example, square footage measurements are used to help ensure the equitable distribution of the costs of shared spaces such as lobbies or atriums.

Health care spaces need square footage measurements for different reasons. In many instances, we are not looking to lease spaces. Instead, we need to know what a certain department’s square footage is so we can compare how that department performs with other departments nationally or within the hospital or health system. This is especially important as health executives weigh options related to mergers and acquisitions. Square footage measurements are also vital for planning. To accurately estimate the square footage requirements for any health care service, it is important to have information on similar departments to help planners ensure their estimates are on target. When a variation exists, planners are able to analyze the differences and make a qualified judgement of the amount of space needed for a particular program. Square footage information, therefore, helps create more accurate capital investment estimates.


Because of the importance of square footage data, the information on square footage needs to be as accurate and consistent as possible. When looking at square footage data from several different sources, it becomes obvious that there are currently different methods for determining and assigning square footage to departments. These variations can be found among different hospitals within a single health system, and even within firms performing area calculations.

ASHE would like to see the method presented here become the standard for calculating square footage in health care spaces. The use of a single method would provide greater consistency in the field, and would provide more accurate benchmarking comparisons.

The ASHE Board reviewed and approved this document on April 21, 2017. ASHE has also received confirmation from more than 400 health care facilities that they intend on implementing this standard within their facilities. ASHE encourages health care facilities to use this standard method, and it is ASHE’s hope that this becomes the standard method in the field.

In addition to encouraging the use of this method, we will be developing an ongoing study tracking consistent area measurements of multiple facilities. Our hope is to establish consistent data regarding departmental square footages that can be used to establish a number of performance standards. We encourage all users of this method to participate in this anonymous study. Visit www.ashe.org/areacalculation to learn more. Users can also let ASHE know of any items not included in this method by visiting the webpage.

Finally, I would like to give special thanks to all of those that worked very hard to make this document a reality. The acknowledgments page doesn’t convey the hard work that went into creating this method and the years of development and vetting that ultimately created a much-needed standard method for calculating the area of health care spaces.

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Introduction

Cynthia Hayward, AIA

The Area Calculation Method for Health Care represents a significant contribution to the health care planning, design, and construction field by offering a standard methodology for calculating department net and gross areas as well as building gross space allocation. Each of these two components has its own useful role in planning, designing, and managing health care facilities.

Projecting the net and gross space requirements for a new or renovated health care facility plays a key role in assessing facility configuration options and estimating the cost of the project at various stages of the planning process. Calculating and documenting existing space within health care facilities is also necessary for facility management, capital budgeting, financial reimbursement, and post-occupancy evaluation. However, two architects, planners, or facility managers measuring the same building will almost never arrive at the same department net and gross space numbers unless they agree on the method of measurement and a clear definition of what is included and excluded. Also, inconsistent terminology in department names and other facility components creates difficulty when comparing projects to assess the effects of different operational concepts, economies of scale, and design approaches on department net and gross space, building gross space, and the eventual project cost.

Facility planners and programmers have always used information from previous projects to help them estimate the space requirements for new projects. The planning process for a major health care project begins with general concepts, numbers, and conceptual diagrams using preliminary space estimates to develop a facility master plan, test design options, and generate an early project cost estimate. As specific projects are identified and approved, the detailed space programming begins and, when completed, the schematic design and subsequent phases bring more knowledge and details about the project. Nearing the final phases, the concepts and ideas are translated into tangible architectural floor plans, drawings, and construction details—and eventually a three-dimensional building. A post-occupancy evaluation of the completed


project can be used to collect valuable data for yet another project and the cycle starts over again.

Misunderstandings among members of the planning team can occur when there is not a consistent methodology for calculating existing space and estimating future space need. For example, using net to gross space conversion factors that are too low can deem certain facility configuration options feasible when they are not, or result in inaccurate early cost estimates. Using overly generous net to gross space conversion factors may have the opposite effect and a worthwhile project may be deemed unaffordable and put on hold. Physicians and clinical department managers often ask their peers at other institutions for comparative space information and receive “square feet” data with no indication of how it was calculated—and then want their current space expanded. Knowledge of how space allocation is calculated also eliminates surprises when leasing space off-site.

The Area Calculation Method for Health Care also addresses building gross space allocation and prescribes additional factors to be used to estimate the overall size of a floor or building footprint. This is important since the conversion from department gross space to building gross space generally adds 25 to 35 percent. An accurate accounting of the components or subsets of the building gross space—such as mechanical, electrical, communications, non-departmental corridors, stairs, vertical transport, miscellaneous structure, and the thickness of the exterior wall—provides a better understanding of each component’s space impact and results in a more accurate estimate during the early planning stage.

Adoption of the Area Calculation Method for Health Care will allow further evaluation of the major categories of space within a health care facility complex and the specific net and gross space “drivers” in different departments. As shown in this study, department net space to gross space conversion factors generally range from 1.20 to 1.60. Adoption of a consistent method for measuring department net and gross space will facilitate a better understanding of these factors and how they vary based on the department’s function, scope of services, major facility components, and physical constraints. For example, an emergency department or a surgery suite would have a larger factor to account for numerous and variously sized rooms that must be connected by eight-foot-wide corridors to accommodate patient stretchers. On the other hand, large open spaces that do not involve maneuvering patients on stretchers, such as those usually planned for building support services, have a lower factor since they include a limited number of small rooms and minimal access corridors.

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The factor for a specific department or functional area also varies depending on its scope of services and workload, since a department with minimal workload volume needs the same set of fixed support spaces and corridor width as a larger department providing the same service. These factors also vary depending on whether new construction is planned (lower factor) or if the function is to be retrofitted into existing space with specific design constraints (higher factor). Physical constraints—such as the shape of the existing building envelope, minimal bay width and unusual column spacing, and fixed mechanical spaces and shafts—may necessitate a greater departmental gross square feet (DGSF) to accommodate the same amount of net square feet (NSF).

More accurate “apples to apples” comparisons of specific functional components will enable important new research on the effect of different operational concepts, economies of scale, and design approaches on department net and gross space, building gross space, and eventual project cost—research that will contribute to the current body of evidence-based design research.


Chapter 1

How to Use this Document

D. Kirk Hamilton and Sarel Lavy

Calculation of the physical area within health care buildings and departments has long been important for purposes of planning and design, construction estimating, engineering analysis, capital budgeting, facility management, space allocation, and financial reimbursement. For many years, most such calculations in the United States have relied on Methods of Calculating Areas and Volumes of Buildings, the two-page AIA D101-95 document1. In Canada, Area Measurement for Health Care Facilities, the 27-page Z317 11-02 Canadian Standards Association (CSA) document2, is similar, compatible, and somewhat more extensive.

In spite of common usage of these two standard methods, some leeway has been given for individual interpretation, so different individuals and firms have reported statistics that have not been calculated in precisely the same fashion. For some purposes, this has not been a problem as the differences may have been well within acceptable limits. For others, such as when developing a program of space requirements and an accompanying multimillion dollar budget for a large hospital construction project, or for accurately calculating important reimbursements, greater precision and consistency is desired. Design, construction, and facility management elements of the health care field require accuracy and consistency.

The research team documented building and departmental areas for recent hospital projects in North America. With advice from a council of practitioners, the team developed precise methods for making calculations to ensure consistency. This monograph is a record of their model which remains compatible with AIA and CSA.

1 American Institute of Architects (AIA). 1995. Methods of Calculating Areas and Volumes of Buildings. AIA Document D101-1995. Washington, D.C.: American Institute of Architects. Retrieved on 7/7/13 from www.aia.org/groups/aia/documents/pdf/aiab098211.pdf.

2 Canadian Standards Association (CSA). 2002. Area Measurement for Health Care Facilities. CSA Document Z317 11-02. Toronto: Canadian Standards Association.

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The team used calculations of the areas for 36 recent hospital projects to test the methodology and identify the ranges of areas constructed for each major hospital department. Caution should be used when employing the data from these calculations. The study examples may not represent the full range of possibilities in recent hospital construction, or the full range of possibilities for future hospital construction.

This methodology offers accuracy and consistency without varying from compatibility with the most prominent U.S. and Canadian methods for area calculations. Every sector of the health care design, construction, and facility management field is encouraged to use the proposed calculation method.


Chapter 2

Method for Consistent Calculation of Hospital Area

D. Kirk Hamilton, Sarel Lavy, Amy Kircher, Yin Jiang, and Manish K. Dixit

Introduction

The health care field in North America has developed as a design specialty involving great expense and construction that must meet high standards, including attention to accessibility, safety, technological advances, operational complexity, constant energy consumption, and concern for the medical and clinical issues involved in the delivery of care. A hospital, much like a small city, operates around the clock, every day, without pause, and must accommodate all of the varied services from operating rooms and patient rooms to linen service and food service. Hospitals are places where people are born, eat, sleep, work, pray, learn, are cared for, and die.

Planners who provide the basic materials associated with preparing for a major, complex hospital construction project must produce a project briefing document that identifies the services to be provided and how they are expected to operate. Once demographic studies have identified the demand for each service, the planner, or programmer, must prepare a list of the project’s space requirements. This list is fundamental to preparing an accurate project budget.

Planners have always used information from previous projects to help them predict the space requirements for proposed projects. The data collected on these past projects comes from area calculation measurements. An important concern is that different consultants, firms, and individuals have used slightly different methods to calculate area allocated to departments and buildings. Ambiguous situations have been interpreted in different ways. Reporting formats have been inconsistent from one organization to another.

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Common Health Care Measurement Models

The two most common models for measuring area in North American health care projects are the standards of the American Institute of Architects Methods of Calculating Areas and Volumes of Buildings and the Canadian Standards Association Area Measurement for Health Care Facilities. The AIA document is useful only for calculating the gross area of a building. AIA does not address departmental calculations. The CSA document goes into somewhat greater detail without conflicting with the shorter AIA document. The Canadian document introduces calculations for the area allocated to a floor and calculation of net areas.

In the world of health care design, these commonly applied standards have not been sufficient for consistent planning accuracy. Neither standard identifies a method for calculating the gross area associated with a department, which is a critical planning category for the program of space requirements in a hospital, clinic, or medical school. Consultants, designers, and other users, therefore, have adopted personal and idiosyncratic methods to build sophisticated calculation models that include net square footage, departmental gross square footage, net-to-gross factors, and building gross square footage. Without consistent nomenclature for department names and hospital services, programmers have been able to use this kind of data with varying predictive accuracy and success to plan major health care projects. The questions of accuracy and consistency continue to be a concern, especially as the cost of constructed health care space is so expensive.

Neither of the AIA and CSA documents addresses the measurement and reporting for typical building components such as stairs and elevators, or space dedicated to mechanical or electrical services. The information associated with these and other characteristics can provide additional clarity about the historical allocation of area within a health care project. Also excluded from the documents was a consistency associated with departmental measurements and naming of departments (see Appendix C: Suggested List of Departments). In the past, subsets of building gross calculations were rarely called out separately in publicly available documents. Accurate accounting for subsets of building gross space, including mechanical, electrical, communications, non-departmental corridors, stairs, vertical transport, miscellaneous structure, and exterior wall thickness, allow for a more nuanced understanding of the building elements.


Other Standards

The standards or guidelines for measuring building areas are important for facility and property managers, especially when dealing with facility extension, sale, lease, or renovation. To date, there are two organizations that are involved in developing area measurement standards for built facilities:

THE BUILDING OWNERS AND MANAGERS ASSOCIATION (BOMA) publishes Office Buildings: Standard Methods of Measurement3. These standards are appropriate for office buildings only, and cannot be used for area measurements in other types of buildings such as higher education and health care. BOMA has published measurement standards for other types of buildings such as retail, mixed use, industrial, and multi-unit residential. BOMA’s methodology as a standard for floor measurement is accepted and approved methodology by the American National Standards Institute (ANSI).

INTERNATIONAL FACILITY MANAGEMENT ASSOCIATION (IFMA) publishes area measurement guidelines in association with the American Society for Testing and Materials (ASTM). These standards are published as The ASTM Standard Classification for Building Floor Area Measurements for Facility Management. Recently, BOMA and IFMA collectively published Building Floor Area Measurements for Facility Management, which is a document providing common floor area definitions.

The only measurement guide specific to healthcare was published by the Canadian Standards Association (CSA). The standard entitled Area Measurement for Health Care Facilities was published in March 2002.

Definitions

With regard to area measurement, certain relevant important terms need to be emphasized. These terms are defined by the health care design field and various organizations, such as federal or state agencies, universities, and commercial or business associations. The following section lists and defines these terms.

• BUILDING GROSS SQUARE FOOTAGE (BGSF): The total enclosed square footage of a building measured from the surface of the outer face of the constructed walls.

3 American National Standards Institute and Building Owners and Managers Association (ANSI/BOMA). 1996. Standard Method for Measuring Floor Area in Office Buildings. New York: Building Owners and Managers Association International.

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• NET SQUARE FOOTAGE (NSF): The space within an individual room, measured from the inside face of the walls.

• DEPARTMENTAL NET SQUARE FEET (DNSF): The sum of all usable space designated to serve a department, including all of the net spaces assigned to the department or service.

• DEPARTMENTAL GROSS SQUARE FOOTAGE (DGSF): The more common usage for departments identifies the space designated to serve the department, including all of the net space, wall thicknesses between spaces, internal corridors, and incidental space such as structural columns, water fountains, fire extinguisher cabinets, or housekeeping closets. The centerlines of the boundary walls are used to divide between departments.

• NON-DEPARTMENTAL SQUARE FOOTAGE: A subset of building gross space that accounts for corridors and other space not attributable to a department.

• EXTERIOR WALL THICKNESS: That portion of the building attributable to the full thickness of the surrounding walls of the building. It is a component of the building gross area.

• MISCELLANEOUS STRUCTURE: The area of unusual structural elements in the plan that should not be attributed to a department, as in the case of earthquake bracing.

The following definitions are common in commercial and non-medical construction. They are particularly useful for the purpose of rental agreements. Health care organizations may find instances where the use of these terms is expected.

• GROSS BUILDING AREA: The sum of all floor areas of a building measured between outside faces of the building including all horizontal and vertical circulation, service, and mechanical areas. Any architectural features that project out of a building, such as pilasters, awnings, cornices, buttresses, and so forth, are excluded from the measurements.

• NET BUILDING AREA: The sum of all areas enclosed by the walls measured within the inside faces. The sum of all usable area that is either assigned to or currently available for assigning to occupants, or a function or use was defined as net usable square feet.


• ASSIGNABLE BUILDING AREA: The total area assigned to or able to be assigned to occupants or to a specific function. It does not include the wall thickness, but includes any circulation space that is part of the space or a suite of spaces.

• NON-ASSIGNABLE BUILDING AREA: Contrary to the assignable building area, the sum of all areas that are not assigned to or are not available to be assigned to occupants or to a specific function or use is known as non-assignable building area. The sum of assignable and non-assignable areas provides the net building area. When the total net building area is deducted from the total gross building area the remainder is called the total structural area.

The BOMA and CSA standards mentioned above have been used in measuring space areas in a standard manner by a wide range of users such as tenants, building owners, property managers, facility consultants, and asset managers. These standards are being used in space utilization assessments and space management in addition to portfolio marketing by tenants. They are also used as a starting point or a basis for developing standards for other building types within and across the United States. The purpose of these standards was to standardize the process of area measurement in various school and non-school buildings. The BOMA standards were also used as a starting point by the General Service Administration (GSA) Public Buildings Service in developing the National Business Space Assignment Policy4. Interestingly, using BOMA standards, Deru and Torcellini5 developed standard area measurement definitions and metrics for building geometry, to be used for building energy modeling. The purpose was to standardize the buildings’ geometric modeling and area measurement definitions.

GSA surveyed a range of space measurement standards to find out current trends and practices in the field. According to GSA, the federal government is shifting its stand from using strict space standards to developing space need based on organizational goals. Carter and Zhang6 referred to the BOMA, IFMA, and ASHRAE area measurement standards for defining key space area terms for evaluating the indoor volatile organic compound (VOC) concentration in a standard manner.

4 General Service Administration (GSA). 2013. National Business Space Assignment Policy. Washington, D.C.: General Services Administration, Public Buildings Services, Office of Real Property Asset Management.

5 Deru, M. P., and P. A. Torcellini. 2005. “Standard Definitions of Building Geometry for Energy Evaluation.” Boulder, CO: National Renewable Energy Laboratory.

6 Carter, R. D., and J. S. Zhang. 2007. “Definition of Standard Office Environments for Evaluating the Impact of Office Furniture Emissions on Indoor VOC Concentrations.” Transactions-American Society of Heating Refrigerating and Air Conditioning Engineers 113(2):466.

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Portions of North America work with the metric system of measurement rather than the imperial system. The area calculation methodology is the same for square meters as it is for square feet. Thus net square meters (NM2) is the same calculation as NSF, departmental gross square meters (DGM2) is the same calculation as DGSF, and so forth. This document is written in the language of square feet, but one can easily make the translation to square meters.


To test the methodology, the research team used software for computer-aided drafting7 to conduct consistent area takeoffs from drawings of 36 completed projects provided by practitioners. An attempt was made to be completely consistent with prevailing methods, as represented by AIA and CSA. As each project was measured, consistency was maintained with identical sequences of measurement operations. Ambiguous situations were identified, and policy was adopted and documented. The resolutions of ambiguity not addressed by the AIA or CSA documents were reviewed by a council of practitioners, including programming consultants and representatives of the firms providing projects to be measured.

The Area Calculation Method for Health Care is a process with six major steps:

1. Measure the entire building gross square footage (BGSF) of the project, including all area contained by the exterior walls

a. Measure non-departmental line items within the building gross area such as elevators, stairs, and mechanical and electrical space

b. Identify areas calculated at zero, such as interior courtyards or upper levels open to space below

2. Measure the component of BGSF attributable to each floor: total gross floor area

3. Measure the subset of building gross area attributable to the exterior wall thickness

4. Measure departmental gross square footage (DGSF) for each separate department

5. Measure the net square footage (NSF) for each individual room

7 See Appendix A: Area Calculation Procedures in AutoCAD® Architecture for the detailed calculation method using AutoCAD, and see Appendix B: Area Calculation Procedures in Revit® for the same method using Revit software.


6. Check the accuracy of the measurements. The sum of DGSF, exterior wall thickness, and the BGSF line items should equal the total BGSF. If not, a search for the discrepancy is required. Similarly, as another check, the sum of the gross floor areas should equal the total BGSF.

Various combinations of these calculated results allow for reports of departmental net-to-gross ratios (NSF:DGSF) and departmental gross-to-building gross ratios (DGSF:BGSF), as well as line items within the overall building gross. The line item calculations allow greater understanding of allocations of services within a health care building. The percentage of building gross area allocated to stairs and elevators, for example, will be different in one-story, low-rise, or high-rise configurations. While the area calculations are an important record of what was built, the various ratios and percentages are especially important for projecting space needs in future projects.

The Area Calculation Method for Health Care offers a standard compatible with the standards of the AIA and the CSA that goes into greater detail, identifies departmental gross area calculation, calls out subsets of building gross allocations, and offers the potential for higher levels of consistency of area measurements within health care planning, design, and construction. Adoption of this method will benefit the field through greater accuracy and consistency in relevant area calculations.

Scenario Specific Calculations

A. Basic Definitions

A1. Net square footage (NSF) is measured to the inside face of the finished wall.

A2. Departmental gross square footage (DGSF) is measured to the inside face of the exterior wall and the entire thickness of the exterior wall will be allocated to the building gross square footage (BGSF) line item, exterior wall thickness.

A3. Non-departmental corridors are circulation spaces that cannot reasonably be allocated within an individual department. These corridors are required for building circulation and exiting purposes.

A4. Building gross square footage (BGSF) constitutes all of the measured space within the exterior face of the wall of the building being measured.

20 ASHE Monograph

A5. Attached medical office buildings (MOBs) will not be measured or included in the calculations. Hospital-related functions located within the medical office building will not be measured, but will be listed on the first page of the project report. The exterior wall thickness will be measured as it appears in the drawings. No additional exterior wall thickness will be assumed or added to the calculations.

B. BGSF Line Items

B1. Exterior wall thickness includes the exterior wall material, all columns along the perimeter of the wall, and any furr-outs along these columns.

C. Furr-outs

C1. Furr-outs located along columns on the perimeter or along the exterior wall will be included in exterior wall thickness. If furr-outs are along the exterior wall but do not contain columns, the area measured belongs to the department, not to the exterior wall thickness.

C2. Furr-outs located in a department along the perimeter of stairs and elevators will be measured as part of the adjacent department, not as part of the stairs or elevators (Figure C.1).

A1. toftheadjacentdepartment,notaspartofthestairsorelevators(FigureC.1).

FigureC.1Furr-outs

A2. departmentintotwoparts.Examplesmayincludesurgeryorimagingdepartments

(FigureD.1).

FigureD.1Non-departmentalcorridors

FIGURE C.1: FURR-OUTS


C3. Enclosed roof-top mechanical space (e.g., penthouses) will be measured as part of the BGSF; mechanical areas not enclosed will be calculated as zero area.

C4. The BGSF line item, “communication distribution,” is defined as rooms used for data and communications distribution raceways and equipment. Data distribution areas may be identified in floor plans as MDF (main distribution facility), IDF (independent distribution facility), EF (entrance facility), TER (telecommunications equipment room), or TR (telecommunications room).

C5. Miscellaneous structure items include shear walls, cross bracing, and other structural elements not calculated in the department gross or the exterior wall thickness. Each item is assigned its own DGSF and labeled “misc. structure.”

C6. Lobbies for all elevators are included as “non-departmental corridors.”

C7. Revolving doors and vestibules will be designated as “non-departmental corridors.”

D. Circulation

D1. All stairs (except convenience stairs dedicated to a department) are included in BGSF and called out as “stairs.”

D2. All elevators (except those dedicated to a department such as surgery to supply or the helipad to the emergency department) are included in BGSF and called out as “vertical transport.” This also includes dumbwaiters and cart lifts.

D3. Internal departmental corridors are included in DGSF.

D4. All other corridors not in the DGSF are called out as “non-departmental corridors” in a BGSF line item. The boundaries for these corridors are measured from the exterior face of the department boundary wall to the interior face of the exterior wall. Do not split the wall thickness between non-departmental corridors and departments. Public corridors may be split only when major departmental circulation overlaps with the non-departmental corridor, or when a single department is truly split by the non-departmental circulation. Special circumstances may include non-departmental circulation that splits a department into two parts. Examples may include surgery or imaging departments (Figure D.1).

22 ASHE Monograph

E. Exterior Covered Areas and Canopies

E1. Canopies attached to the building are measured as half the area of the canopy and will be listed under “related areas not in calculations.” Ambulance covers have two options: If created by the building overhang they are measured as half the area and included in “exterior covered areas” even if enclosed in the building envelope. If the cover is an attached canopy, then it is measured as a “canopy” and listed below the calculation line. Areas of ambulance drop offs required to be covered by code shall be dedicated to the emergency department. Other covered canopy areas not required by code will be listed in “related areas not in calculations.”

E2. Exterior exit niches (recessed exterior door swing) are calculated as half the area if covered, or zero area if not, and will be listed as “exterior covered areas” (Figure E.1).

A1. toftheadjacentdepartment,notaspartofthestairsorelevators(FigureC.1).

FigureC.1Furr-outs

A2. departmentintotwoparts.Examplesmayincludesurgeryorimagingdepartments

(FigureD.1).

FigureD.1Non-departmentalcorridors

FIGURE D.1: NON-DEPARTMENTAL CORRIDORS


E3. Exterior healing gardens, labyrinth type spaces, roof gardens, and courtyards are measured as a half area if covered, or zero area if not. If these spaces are enclosed and located in the building envelope, the full area is measured. Follow the rules for canopies versus exterior covered areas. If any of these spaces are required specifically by the functional program of a department, then the area shall be dedicated to that department.

F. Columns

F1. Columns located within a department are included in that department’s gross square footage and do not receive a NSF (Figure F.1).

FIGURE E.1: EXTERIOR COVERED AREAS

FIGURE F.1: COLUMNS

A3. Exteriorexitniches(recessedexteriordoorswing)arecalculatedashalftheareaif

covered,orzeroareaifnotandwillbelistedas“exteriorcoveredareas”(FigureE.1).

FigureE.1Exteriorcoveredareas

B. Columns B1. Columnslocatedwithinadepartmentareincludedinthatdepartment’sgross

squarefootageanddonotreceiveaNSF(FigureF.1).

FigureF.1Columns

B2. Columnssupportingexteriorcoveredareaswillbeincludedinthecalculationforthe

exteriorwallthickness.Thesquarefootageofthecolumnswillbesubtractedfrom

theoverhangsquarefootagefortheexteriorcoveredarea(FigureF.2).

24 ASHE Monograph

F2. Columns supporting exterior covered areas will be included in the calculation for the exterior wall thickness. The square footage of the columns will be subtracted from the overhang square footage for the exterior covered area (Figure F.2).

FigureF.2Columnssupportingexteriorcoveredareas

C. Connections to Other Buildings a. centerlineoftheperpendicularwallshouldserveasthejoiningpointforthetwo

centerlines.

FigureI.1Resolvingdifferentwallthicknesses

FIGURE F.2: COLUMNS SUPPORTING EXTERIOR COVERED AREAS

FigureF.2Columnssupportingexteriorcoveredareas

C. Connections to Other Buildings a. centerlineoftheperpendicularwallshouldserveasthejoiningpointforthetwo

centerlines.

FigureI.1Resolvingdifferentwallthicknesses

FIGURE I.1: RESOLVING DIFFERENT WALL THICKNESSES


G. Connections to Other Buildings

G1. Tunnels to power plant or other needed services will be measured if the tunnel is tall enough for a walking space and placed below the calculation line under “related areas not in calculations.” Buried utility lines or crawling tunnels will not be measured.

G2. A bridge or walkway to a building not included in the measurement drawings (e.g., for outbuildings to a facility) is not calculated. The exterior wall of the hospital will be treated as if the bridge or walkway does not exist but no additional exterior wall will be added.

H. Light Wells and Atriums

H1. Atriums or “open to below” areas: the full area of the bottom-most level is measured once if covered, but as zero area if not. If uncovered, proper exterior wall thickness should be assigned. All other floors the atrium passes through are assigned a zero area and subtracted from that floor’s total BGSF floor area. Verify all enclosing exterior walls are properly measured.

H2. Skylights and light wells located in the interior of the building are treated as an atrium. The full area is measured once if covered, or as zero area if not. Verify that all enclosing exterior walls are properly measured.

H3. Skylights and light wells located on the perimeter of the building with an open side are calculated once as half area if covered, or as zero area if open to the sky and called out as “exterior covered areas.” Verify that all exterior walls are properly measured.

I. Departments

I1. The demising wall, which separates two departments from each other, is sometimes composed of varying thicknesses. Departmental boundary measurements have two possible scenarios.

a. The first scenario is when two walls of differing thicknesses abut end to end. For this condition, join the centerlines of each wall.

b. The second condition is when two walls of differing thicknesses join a third wall that is typically at a 90-degree angle to the demising partition as shown in Figure I.1. The centerline of the perpendicular wall should serve as the joining point for the two centerlines.

26 ASHE Monograph

I2. When the “wet wall” of a toilet room falls along a departmental boundary, do not split the overall thickness, which would include the plumbing chase. All of the area that includes the plumbing should belong to the department to which the toilet room belongs.

I3. Satellite conditions, such as labs, pharmacies, material handling spaces, and so forth, are to be called out separately. For example: the main pharmacy department will have its own NSF and DGSF. If there are three satellite pharmacies, the NSF and DGSF for all three will be added together and labeled “satellite pharmacies.” Other spaces that could have satellites are: respiratory therapy, biomedical engineering, and food and nutrition.

I4. The IT department is defined as “where people work and the main computer frame systems are located.” These areas are separate from “communication distribution” areas and will be assigned a NSF and a DGSF and classified as “information technology.”

I5. Folding partitions in rooms: the space allocated for the storage of the partition will not be included in the NSF, but only in the DGSF.

I6. For open telephone and vending areas, calculate the 8’-0” for the adjoining corridor. Anything beyond this measurement will be assigned a NSF and included in the administrative and public spaces DGSF.

I7. Trash chutes will have their own DGSF and will be included in the “vertical transport” BGSF line item. They do not get their own NSF. If the trash chutes are part of the soiled linen room within a department, only the trash chutes will be counted toward the vertical transport BGSF and the soiled linen room will be measured as part of the department and assigned a NSF.

I8. Public toilets located throughout the building will be assigned a NSF and administrative and public spaces DGSF. If the public toilet is part of the program for the department, it will be measured in the department’s DGSF.

I9. Public waiting areas that are not specifically included in a single department will be classified as administrative and public areas spaces. Example: waiting area located directly off elevator but not included within the department boundary.


I10. Large concourse areas will be called out as “concourse” and be assigned an NSF and DGSF. This department is different than an extra wide corridor. Correspondence with the architecture firm may be necessary. Undefined waiting and lobby areas on the ground floor will be calculated as one large public space and assigned a NSF and DGSF.

I11. Cafeterias and bistros are included in the food and nutrition department.

I12. Flex beds between two departments will be included in the department in which the beds are used during the day. Correspondence with the architecture firm may be necessary.

I13. Salons and spas will be designated as “retail.”

I14. Central telemetry monitoring for acute and ICU beds will be given to acute care unless used exclusively in ICU.

I15. The obstetrics department may have spaces that are shared or do not belong to any single department. These spaces will be designated at “shared spaces” under “obstetrics.”

I16. Play areas and breast feeding rooms if near a department will be included in the departmental DGSF. If rooms are located in a public or lobby area they will be designated as public spaces.

J. Shell Space

J1. Shell space will be identified as a department and assigned a NSF and DGSF. The unfinished area should be treated as a large NSF measurement, only extending to the interior finish face of any bounding walls.

J2. When a shell space floor has a main building corridor passing through it, for example to egress stairs, the building corridor will be measured as non-departmental corridors. The corridor will not be included in the shell space area (Figure J.1).

28 ASHE Monograph

J3. Shell space within a department that is allocated as a future space (e.g., future CT room in an emergency department): The future CT room will be assigned a NSF and counted in the emergency department gross, not counted in the shell space calculation.

J4. When adding the shell space to the data sheet, it will be inserted as a separate line item that has been labeled as “storage” on the plans for construction document purposes and will be measured as shell space. Coordination with the architecture firm is necessary to properly differentiate between shell and storage areas.

J5. After the total summation of the NSF and DGSF for the project, a net:gross factor will be calculated. A new grand total number will be produced for NSF and DGSF that includes the shell space. Also, a new net:gross factor will be calculated that includes the shell space (Figure J.2).

C2. Whenthe“wetwall”ofatoiletroomfallsalongadepartmentalboundary,donot

splittheoverallthickness,whichwouldincludetheplumbingchase.Allofthearea

C3. Whenashellspacefloorhasamainbuildingcorridorpassingthroughit,forexample

toegressstairs,thebuildingcorridorwillbemeasuredasnon-departmental

corridors.Thecorridorwillnotbeincludedintheshellspacearea(FigureJ.1).

FigureJ.1Buildingcorridorpassingshellspaces

FigureJ.2Net:grossfactorcalculatedinExcel

D. Parking

FIGURE J.1: BUILDING CORRIDOR PASSING SHELL SPACES

FIGURE J.2: NET:GROSS FACTOR CALCULATED IN EXCEL

C2. Whenthe“wetwall”ofatoiletroomfallsalongadepartmentalboundary,donot

splittheoverallthickness,whichwouldincludetheplumbingchase.Allofthearea

C3. Whenashellspacefloorhasamainbuildingcorridorpassingthroughit,forexample

toegressstairs,thebuildingcorridorwillbemeasuredasnon-departmental

corridors.Thecorridorwillnotbeincludedintheshellspacearea(FigureJ.1).

FigureJ.1Buildingcorridorpassingshellspaces

FigureJ.2Net:grossfactorcalculatedinExcel

D. Parking


K. Parking

K1. Parking spaces enclosed within the building envelope will be assigned a DGSF and placed below the calculation line under “related areas not in calculations.” The DGSF will be measured as all of the usable square footage for parking and vehicular circulation. When the parking space DGSF meets the open air at entrances and exits, the DGSF line is drawn so that it is in line with the outermost edge of the exterior wall.

L. Central Utility Plant

L1. Central utility plants (CUPs) are assigned only a DGSF and listed below the calculation line. Two possible circumstances include:

a. The CUP is a detached piece. The exterior wall for the CUP is not counted in the exterior wall calculation; it is included in the CUP DGSF listed below the calculation line.

b. The CUP is attached to or enclosed within the building envelope. An exterior wall will be created at the wall boundary between the CUP and the remainder of the hospital (Figure L.1).

FIGURE L.1: CENTRAL UTILITY PLANTa. willbecreatedatthewallboundarybetweentheCUPandtheremainderofthe

hospital(FigureL.1).

FigureL.1Centralutilityplant

D2. TheCUPisexcludedfromthetotalfloorareaandtheDGSFwillbeincludedbelow

thecalculationline.

FigureM.1Openworkareasoffacorridor

30 ASHE Monograph

L2. The CUP is excluded from the total floor area and the DGSF will be included below the calculation line.

M. Nurse Work Areas

M1. Pneumatic tube stations are included in the DGSF but do not get their own NSF.

M2. Open work areas and chart areas will be assigned an NSF and be counted in the departmental gross. Respect the 8’-0” minimum requirement for corridors (Figure M.1).

a. willbecreatedatthewallboundarybetweentheCUPandtheremainderofthe

hospital(FigureL.1).

FigureL.1Centralutilityplant

D2. TheCUPisexcludedfromthetotalfloorareaandtheDGSFwillbeincludedbelow

thecalculationline.

FigureM.1Openworkareasoffacorridor

FIGURE M.1 OPEN WORK AREAS OFF A CORRIDOR


M3. Recesses for door swing are part of the non-departmental corridor BGSF, unless the niche is used as an equipment alcove or crash cart storage: then it is included in the departmental gross and the equipment area receives a NSF (Figure M.2).

FIGURE M.2 RECESSES FOR DOOR SWING

M4. If the medication supply station is not adjacent to the nurse station, the circulation that is needed to get from the nurse station to the medication supply station is not included in the NSF, but is factored into the DGSF.

M5. If the boundary of the nurse station is not clearly defined on the floor plans by the architect, the NSF boundary will extend to the edges of counters and exterior face of the walls that define the space. Respect the 8’-0” minimum requirement for corridors. If the nurse station is set back from the line of the corridor, the extra square footage between the edge of the nurse station and the corridor line will be given to the nurse station NSF as if the additional corridor width is being provided to the nurse station as addition circulation space outside of the general corridor movement area.

D3. Recessesfordoorswingarepartofthenon-departmentalcorridorBGSF,unlessthe

nicheisusedasanequipmentalcoveorcrashcartstorage:thenitisincludedinthe

departmentalgrossandtheequipmentareareceivesaNSF(FigureM.2).

FigureM.2Recessesfordoorswing

E. Non-Departmental Corridor

32 ASHE Monograph

N. Non-Departmental Corridor

N1. Open patient care areas, such as PACU stations, prep/recovery areas, and the NICU, that are not clearly defined with partitions will be measured as follows: The NSF for these spaces will not extend beyond the curtain line that defines the space and the corners will be squared off. All circulation between patient beds and nurse stations will be designated as DGSF. Respect the 8'-0" requirement for corridors (Figure N.1).

D3. Recessesfordoorswingarepartofthenon-departmentalcorridorBGSF,unlessthe

nicheisusedasanequipmentalcoveorcrashcartstorage:thenitisincludedinthe

departmentalgrossandtheequipmentareareceivesaNSF(FigureM.2).

FigureM.2Recessesfordoorswing

E. Non-Departmental CorridorFIGURE N.1 PACU STATIONS

N2. Scrub and hand-washing sinks located in an alcove off of a corridor will be counted in the department NSF. Respect the 8'-0" requirement for corridors (Figure N.2).


N3. Equipment alcoves located off of a corridor in the department will be given an NSF. Respect the 8'-0" requirement for corridors (Figure N.3).

FIGURE N.2 SCRUB SINKS IN ALCOVES OFF A CORRIDOR

FIGURE N.3 EQUIPMENT ALCOVES OFF A CORRIDOR

FigureN.1PACUsituation

E1. Scrubandhand-washingsinkslocatedinanalcoveoffofacorridorwillbecounted

inthedepartmentNSF.Respectthe8’-0”requirementforcorridors(FigureN.2).

FigureN.2Scrubsinksinalcovesoffacorridor

E2. EquipmentalcoveslocatedoffofacorridorinthedepartmentwillbegivenanNSF.

Respectthe8’-0”requirementforcorridors(FigureN.3).

FigureN.3Equipmentalcovesoffacorridor

F. Entries

34 ASHE Monograph

O. Entries

O1. Public entry vestibules will be measured as “non-departmental circulation.”

O2. Public entry vestibules into an emergency department will be counted in the NSF and DGSF for that department.

P. Shared Spaces

P1. When two departments located on the same floor share a specific room or space, the dominant department will be designated the NSF for the shared space. If it is not possible to assign a dominant department or the function of the shared space is required by both departments, the shared space NSF will be split between the two departments. The measurements for splitting the space will be conducted in AutoCAD® Architecture and will be kept as simple as possible. Coordination with the architecture firm may be necessary.

Q. Windows

Q1. The NSF boundary for a space with punched windows or curtain wall will be the line for the edge of the window sill.

Q2. When there is not a window sill visible in the floor plan given by the architecture firm, the NSF boundary should follow the outline of the wall and extend no further than the interior face of the window frame visible on the plan.

Q3. When there is only a curtain wall span of windows, the NSF boundary should follow along the interior face of the window frame on the plan.


Appendix A

Area Calculation Procedures in AutoCAD Architecture

Note: The following procedures were creating using AutoCAD® Architecture 2010. AutoDesk Software’s Knowledge Network is recommended for further details and support in using AutoCAD Architecture. Calculations using similar methods can be made in other software.

Conducting Area Takeoffs

This methodology guideline focuses on using AutoCAD® Architecture to conduct area takeoffs. The basic process consists of five major steps:

1. Measure building gross square footage (BGSF) line items, and identify zero area spaces (e.g., open to below, interior courtyards, etc.)

2. Measure BGSF total floor area

3. Measure exterior wall thickness

4. Measure each departmental gross square footage (DGSF)

5. Measure individual room net square footage (NSF)

General Notes

This methodology uses a feature in AutoCAD called a “space” to collect the data on different areas measured. Spaces can be assigned specific identifying attributes and properties. This information can be extracted from AutoCAD and imported into Microsoft® Excel for sorting and calculations. At the end of this appendix, detailed step-by-step instructions are included for reference.

Creating the measurement spaces is a three-step process: 1) create polyline, 2) convert to space, and 3) name the space. This polyline boundary should be along the interior finished face of the surrounding walls. These steps can be used for all areas to be measured: the BGSF total area, BGSF line items, DGSFs, and NSFs. Upon converting the polyline to a space, enter the required information into the appropriate fields.

36 ASHE Monograph

1. BGSF Line Items

Several functions are included in the BGSF that need to be identified. These functions are referred to as “BGSF line items” and include mechanical, electrical, communications, non-departmental corridors, stairs, vertical transport, miscellaneous structure, and exterior wall thickness. These line items will only have a “departmental” boundary; they will not be included in the NSF, even if a function has multiple rooms. Follow the same rules when drawing the boundary for the BGSF line items that are used when drawing a DGSF boundary. For covered areas that are not enclosed in the building envelope such as covered drop-offs, entries, and exit niches, square footage will be measured in the same three-step method and labeled “exterior covered areas.” These spaces will be counted at half area to the total BGSF number and this calculation is completed in the Excel file. For any questions regarding the method to correctly identify the BGSF line items, please refer to the scenario specific calculations list that begins on page 19. Use the process for creating spaces described in the general subsection and enter the required information into the appropriate fields (Appendix Figure 1).

APPENDIX FIGURE 1: BGSF LINE ITEMS

Appendix

A

Area Calculation Procedures in AutoCAD Architecture pagexx.Usetheprocessforcreatingspacesdescribedinthegeneralsubsectionandenterthe

requiredinformationintotheappropriatefields(AppendixFigure1).

AppendixFigure1BGSFlineitems


2. Building Gross Square Footage (BGSF)

The BGSF comprises the total area of each floor in the project. To measure the BGSF total floor area, draw a closed polyline around the exterior face of the exterior wall. Use the process for creating spaces described in the general subsection and enter the required information into the appropriate fields (Appendix Figure 2).

APPENDIX FIGURE 2: BGSF

2.BuildingGrossSquareFootage(BGSF)

TheBGSFcomprisesthetotalareaofeachfloorintheproject.TomeasuretheBGSFtotalfloor

area,drawaclosedpolylinearoundtheexteriorfaceoftheexteriorwall.Usetheprocessfor

creatingspacesdescribedinthegeneralsubsectionandentertherequiredinformationintothe

appropriatefields(AppendixFigure2).

AppendixFigure2BGSF

3.ExteriorWallThickness

38 ASHE Monograph

3. Exterior Wall Thickness

The exterior wall thickness is included as part of the BGSF line items. To measure the BGSF line item “exterior wall thickness,” first make a copy of the entire floor plate (BGSF) drawn in the previous step, then draw a closed polyline of the interior face of the exterior wall. Lastly, subtract this polyline from the copied BGSF to get the exterior wall thickness. Enter the required information into the appropriate fields naming the space: EXT WALL — XX (XX as the floor number) (Appendix Figure 3).

Note: The research team elected to measure the departmental gross to the inside face of the exterior wall, and to allocate the entire thickness of the exterior wall to the building gross calculation. For any questions regarding the method to correctly identify the exterior wall thickness, refer to the scenario specific calculations list.

APPENDIX FIGURE 3: EXTERIOR WALL THICKNESS

Note:Theresearchteamelectedtomeasurethedepartmentalgrosstotheinsidefaceofthe

exteriorwall,andtoallocatetheentirethicknessoftheexteriorwalltothebuildinggross

calculation.Foranyquestionsregardingthemethodtocorrectlyidentifytheexteriorwall

thickness,refertothescenariospecificcalculationslist.

AppendixFigure3Exteriorwallthickness

4.DepartmentalGrossSquareFootage(DGSF)


4. Departmental Gross Square Footage (DGSF)

Draw a polyline around the entire department to create the departmental gross square footage (DGSF) boundary. Included in the DGSF are wall thicknesses between all NSF spaces, departmental circulation, and building structure within the department. If a department is on an exterior wall, the DGSF boundary is drawn along the interior face of the exterior wall and does not include the columns along the perimeter of the exterior wall. When two departments share a common demising partition, the boundary line is drawn down the middle of this partition so that half of the demising partition is equally allocated to the two departments. Every department must be accounted for. For any questions regarding the method to correctly identify the DGSF space, please refer to the scenario specific calculations list. Use the process for creating spaces described in the general subsection, and enter the required information into the appropriate fields (Appendix Figure 4).

APPENDIX FIGURE 4: DGSF

AppendixFigure4DGSF

5.NetSquareFootage(NSF)

ToensurethecorrectidentificationofNSFinadepartment,consultwiththecoloredfloorplans

thathavebeenprovidedbythearchitecturalfirm.Sometimes,departmentidentificationwillbe

partofeachroomtagintheprovidedAutoCADArchitecturefloorplansandcanbeusedtoany

questionsregardingthemethodtocorrectlyidentifytheNSFspace,pleaserefertothescenario

specificcalculationslist.Usetheprocessforcreatingspacesdescribedinthegeneralsubsection

andentertherequiredinformationintotheappropriatefields(AppendixFigure5).

40 ASHE Monograph

5. Net Square Footage (NSF)

To ensure the correct identification of NSF in a department, consult with the colored floor plans that have been provided by the architectural firm. Sometimes, department identification will be part of each room tag in the provided AutoCAD Architecture floor plans and can be used to identify each department’s NSF. Every room that belongs to the department must be measured. Major rooms to be included in the departmental NSF are patient rooms and toilets, nurse stations, operating rooms, soiled and clean linen closets, and housekeeping closets. For any questions regarding the method to correctly identify the NSF space, please refer to the scenario specific calculations list. Use the process for creating spaces described in the general subsection and enter the required information into the appropriate fields (Appendix Figure 5).

APPENDIX FIGURE 5: NSF

Appendix

A

Area Calculation Procedures in AutoCAD Architecture pagexx.Usetheprocessforcreatingspacesdescribedinthegeneralsubsectionandenterthe

requiredinformationintotheappropriatefields(AppendixFigure1).

AppendixFigure1BGSFlineitems


Generating Project Reports

Once the area takeoffs have been completed for each area breakdown in the project, the data that reside within AutoCAD Architecture is ready to be converted, sorted, and organized to generate the necessary reports. This is possible with use of the data extraction feature in AutoCAD Architecture. This feature will extract the data and save the data in a Microsoft Excel spreadsheet. Please refer to the end of this appendix for more detailed step-by-step instructions. The information is sorted according to function: patient beds, obstetrics unit, procedure departments, diagnostic department, centers of excellence, support services, administrative and public areas, BGSF line items, and related areas not in the calculation. After the data have been sorted appropriately, the master project list, project type categories, and ratings should be updated by referencing the information from the individual project spreadsheet. The questionnaire responses from the architecture firm are also listed on the information sheet. When the information sheet is completed, email the information sheet along with PDFs of the final department boundaries to the architecture firm that provided the project. The PDF with departmental boundaries should include all measured and colored floor plans with clearly marked boundaries and department names. The architecture firm’s participation in reviewing the final drawings and report is an important part in the process. Any comments the architecture firm has should be sent to the research team and any necessary adjustments will be made.

Checking Calculations

The research team has also developed methods with which to verify the measurements conducted: the department grand total plus the BGSF line item grand total (including the exterior wall thickness square footage) should equal the BGSF total floor plate area grand total.

A rule of thumb used by the research team to ensure the measurements were conducted accurately is that the BGSF total floor plate area grand total must be within 1 percent of the BGSF total generated in the report by adding the department grand total to the BGSF line item total. This ensures that the accuracy of the measurements does not impact or skew the DGSF:BGSF ratio. If these two numbers are not deemed to be accurate enough, the research assistant must go back to the drawings and double check all measurements until the miscalculations are found. One method the research team uses to further check the accuracy is to extract the data floor by floor. All BGSF line items and DGSFs are added together and compared to the BGSF total floor plate area.

42 ASHE Monograph

These two numbers should fall within the 1 percent rule mentioned above. If they do not, the researcher is able to determine which floor is not calculated accurately before extracting and sorting all data to generate the final project report. This method further verifies the accuracy level of the measurements conducted by the research team.

AutoCAD Architecture Step-by-Step Instructions

Preparing the Measurement Drawing File

1. Setup the file structure for the new project

a. Rename the folder that contains the data sent by the architectural firm: Project “X”(letter will be next in the alphabet)

2. Open AutoCAD Architecture and select the template file “A&M-NTGR-Temp” located in the folder “Setup Template” from the research project folder

3. XREF the AutoCAD Architecture drawing sent from the architectural firm into a new drawing:

a. The XREF should be on the layer named “XREF”

b. Freeze or turn off all layers except for the walls, doors, windows, casework, stairs, elevators, room tags, columns, and other similar/related layers

4. Save the drawing with the following nomenclature:

a. FP-xx (FP =floor plan) (xx = floor number, e.g., 01, 02, 03, 04…)

b. For basement floors, use FP-00

Process for Creating “Spaces”

For NSF:

1. Draw a closed polyline around the room

a. Layer should be “A-Area-PL-NSF”

b. COMMAND: “PL” or “PLINE”

2. Convert PLINE to SPACE

a. COMMAND: “SPACE”i. Type “CO” for “convert”ii. Window will pop up, select OK.

b. **If columns exist within the NSF; draw a closed PLINE around them, right- click, choose AEC MODIFY tools, choose “SUBTRACT” and follow as prompted in the command line


3. Enter information for the room in the PROPERTIES TOOLBAR:

a. Name field: DEPARTMENT-Room Name

b. Description: Additional information about space if needed

c. Style: NSF

4. Repeat this process for all NSFs, DGSFs, BGSF line items, and the total floor plate area:

a. Adjust names as necessary. Example: Name field: DEPARTMENT-DGSF

Alternative Way to Create “Spaces”

1. COMMAND: “Space”

2. Type “A” key to add a new space

3. Trace the boundary of the space to be created

4. Once the boundary is closed, the “space” inside the boundary should be automatically created

5. Repeat step 3

Data Extraction

Once every floor has been completed, use the following instructions to complete the data extraction.

COMMAND: “dataextraction”

– New window opens on the screen

Page 1:

– Create new data extraction

– NEXT – “Save as” window – save in the folder “Data Extraction” within project – name file with the date of extraction in this format: “Project Letter_YYYYMMDD” (YYYY – four digit year; MM – two digit month; DD – two 2 digit day)

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Page 2:

– “Add drawings” button: add all of the drawings that correspond to the project that contain space objects

– Settings: uncheck boxes – “Extract from blocks” & “Extract from XREFs”

– OK and NEXT

Page 3:

– Only check “Space” from the list

– NEXT

Page 4:

– With “Category Filter” on right side, only check the boxes labeled:

– Actual Dimensions

– General

– With “Properties” on the left side, only check the boxes labeled:

– Area

– Description

– Name

Page 5:

– Right click the “count” and “name” columns, one at a time, and select “Hide Column” with “space” as info in the cells below

– Reorder the list by dragging the columns into this order:

1. Name

2. Description

3. Area

– Create new formula column:

– Right click on “Area” column and select “Insert Formula Column”

– Give new name: “Calc Area”

– Double-click area from column name list on the right side

– Click the “/” (divide) button and type “144” in the formula prompt


– OK and Hide “area” column

– Note: Uncheck all 3 options. Make sure to uncheck “Combine Identical Rows”

– NEXT

Page 6:

– Select “Output to external file”

– click the “…” button to choose file destination

– Save the extraction as an .xls file with the name: “Project Letter_YYYYMMDD” in the data extraction folder in the project file

– NEXT and FINISH

– Open the Excel spreadsheet to begin sorting the data

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Appendix B

Area Calculation Procedures in Revit

Conducting Area Takeoffs

Note: The following procedures were creating using Autodesk Revit® 2014. AutoDesk Software’s Knowledge Network is recommended for further details and support in using Revit.

This methodology guideline focuses on using Autodesk Revit software to conduct area takeoffs; the basic process consists of the following major steps:

1. Create area plan for BGSF total floor area

2. Create area plan for BGSF line items and DGSFs

a. Measure building gross square footage (BGSF) line items, and identify zero area spaces (e.g., open to below, interior courtyards)

b. Measure exterior wall thickness

c. Measure each departmental gross square footage (DGSF)

3. Add parameter to rooms to assign a department to each net square footage (NSF)

4. Compare and check area plans with floor plans

General Notes

This Revit procedure will use area plans for capturing BGSF total floor area, BGSF line items, and each department gross square footage (DGSF). Two area plan schemes should be created, one scheme for the BGSF total area and a second scheme for the remaining BGSF line items and DGSFs.

For the net square footages (NSFs), the existing “rooms” in the Revit file will be used. A parameter will be added to the file to ensure each individual room (NSF) is assigned to the appropriate department. At the end of this appendix, detailed step-by-step instructions for the various Revit tools used are included for reference.


This procedure has been written to describe a process for evaluating a project in Revit once it is completed. To set up a new project and start areas calculations earlier on, the steps and process would be slightly modified. For this methodology, the assumption is that the research team has received the Revit files from the architecture firm who designed the project. These files will have multiple layers of information and will likely have departmental boundaries created by the architecture firm for their own work. These guidelines would be used to categorize areas and to understand the project, but new area plans and parameters would need to be created to ensure the calculations abide by the measurement methodology and interpretations discussed earlier in this monograph.

The level of information in the Revit file given by the architecture firm will have to be evaluated to assess what filters can be used during the measurement process. For example, every area of the floor plan is often given a room that is equivalent to the NSF definition in this monograph. However, because every area of the plan is given a room in Revit, this will potentially include corridors and other aspects that would not receive an NSF as part of this study. Since this research study did not capture information on corridors, the spaces that should not be included in the final calculations will have to be filtered out.

1. Create Area Plan for BGSF Total Floor Area

The BGSF comprises the total area of each floor in the project. To measure the BGSF total floor area, create a new area plan called TAMU Study–Building Gross for each level and draw an enclosed area around the exterior face of the exterior wall and add an area (see step-by-step instructions at the end of this appendix). Identify zero area spaces and remove these areas from the BGSF total floor area. In the Properties Palette, label the total floor area by its floor number: BGSF – XX (XX is the floor number).

2. Create Area Plan for BGSF Line Items and DGSFs

To measure the building gross square footage (BGSF) line items, exterior wall thickness, and each departmental gross square footage (DGSF), create a new area plan called TAMU Study–Department Gross. First identify all zero area spaces (e.g., open to below, interior courtyards) and create area boundaries for each. These should not be assigned an area and are excluded from the calculations in this study.

The exterior wall thickness is included as part of the BGSF line items. To measure the BGSF line item “exterior wall thickness,” generate an area that

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includes the entire wall thickness around the perimeter of the floor and enter the required information into the appropriate fields in the Properties Palette and name the space: EXT WALL - XX (XX is the floor number).

Note: For this study, the departmental gross is measured to the inside face of the exterior wall, and the entire thickness of the exterior wall is allocated to the building gross calculation. For any questions regarding the method to correctly identify the exterior wall thickness, refer to the scenario specific calculations list.

Several functions included in the BGSF need to be identified. These functions are referred to as “BGSF line items” and include mechanical, electrical, communications, non-departmental corridors, stairs, vertical transport, miscellaneous structure, and exterior wall thickness. These line items will only have a “departmental” boundary; there will be no NSF, even if a function includes multiple rooms. For covered areas that are not enclosed in the building envelope such as covered drop-offs, entries, and exit niches, measure using the same process as other BGSF line items and DGSFs. These spaces will be counted at half area to the total BGSF number and this calculation is completed in the Excel file. For any questions regarding the method to correctly identify the BGSF line items, refer to the scenario specific calculations list. Upon identifying and giving an area boundary and area to each BGSF line item, enter the required information into the appropriate fields in the Properties Palette.

Next identify departmental boundaries. Draw an area boundary around the entire department and assign it an area to create the departmental gross square footage (DGSF) boundary. Included in the DGSF are wall thicknesses between all NSF spaces, departmental circulation, and building structure within the department. If a department is on an exterior wall, the DGSF boundary is drawn along the interior face of the exterior wall and does not include the columns along the perimeter of the exterior wall. When two departments share a common demising partition, the boundary line is drawn down the middle of this partition so that half of the demising partition is equally allocated to the two departments. Every department must be accounted for. For any questions regarding the method to correctly identify the DGSF space, please refer to the scenario specific calculations list. Upon identifying and giving an area boundary and area to each department, enter the required information into the appropriate fields in the Properties Palette.


3. Add New Text Parameter to Assign Net Square Footages (NSFs) to a Department

Follow the procedures in Revit for adding a new text parameter titled TAMU Study–Department or a name to differentiate the information gathered from any previous departmental naming in the Revit file (see step-by-step instructions at the end of this appendix). Use this new parameter to assign a department to all rooms in the floor plan following the methods described previously in this document. Note any corridors and other circulation in the department and do not assign these areas an NSF. Depending on the information included from the architecture firm in the Revit file, more filters can be used to aid in this process. For example, all of the rooms assigned to the emergency department can be filtered out and then assigned the new parameter for the research study measurements. Using filters can also assist in ensuring corridors or any other areas that should not be given an NSF are excluded from the calculations. Another method that should be used is to select multiple rooms at once and assign the appropriate department in the properties.

To ensure the correct identification of NSF in a department, consult with the colored floor plans that have been provided by the architectural firm and the information included with the Revit file. Sometimes departmental boundaries will be included in the Revit plans provided or department identification will be part of each room tag in the floor plans. This boundary should be along the interior finished face of the surrounding walls. Every room that belongs to the department must be measured. Major rooms to be included in the departmental NSF are: patient rooms and toilets, nurse stations, operating rooms, soiled and clean linen closets, and housekeeping closets. For any questions regarding the method to correctly identify the NSF space, please refer to the scenario specific calculations list. Upon identifying the rooms within the department, enter the required information into the appropriate fields.

4. Compare and Check Area Plans with Floor Plans

Once the above steps are completed, compare the area plans and floor plans to confirm all spaces have been accounted for and that all rooms are assigned to the proper department.

Generating Project Reports

Once the area takeoffs have been completed for each area breakdown in the project, the data that reside within Revit are ready to be extracted, sorted, and organized to generate the necessary reports. This is possible using schedules in

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Revit (see step-by-step instructions at the end of this appendix). A schedule will need to be created for each area plan generated and for the rooms. Create a new schedule with the fields needed for the final data sorting in Excel. The fields should include the name, area, level, and TAMU Study–Department parameter. The schedule can then be used to extract the data to a .txt file that can be opened in a Microsoft Excel spreadsheet. The information should be sorted according to function: patient beds, obstetrics unit, procedure departments, diagnostic department, centers of excellence, support services, administrative and public areas, BGSF line items, and related areas not in calculation. After the data has been sorted appropriately, the master project list, project type categories, and ratings should be updated next by referencing the information from the individual project spreadsheet. The questionnaire responses are also listed on the information sheet. When the information sheet is completed, email the information sheet along with PDFs of the final department boundaries to the architecture firm that provided the project. The PDF with departmental boundaries should include all measured and colored floor plans with clearly marked boundaries and department names. The architecture firm’s participation in reviewing the final drawings and report is an important part in the process. Any comments the architecture firm has should be sent to the research team and any necessary adjustments will be made.

Checking Calculations

The measurements conducted can be verified: the department grand total plus the BGSF line item grand total (including the exterior wall thickness square footage) should equal the BGSF total floor plate area grand total.

A rule of thumb to ensure the measurements were conducted accurately is that the BGSF total floor plate area grand total must be within 1 percent of the BGSF total generated in the report by adding the department grand total to the BGSF line item total. This ensures that the accuracy of the measurements conducted by the research team do not affect or skew the DGSF:BGSF ratio. If these two numbers are not deemed to be accurate enough, the drawings and measurements must be double checked until the miscalculations are found. One method used to further check the accuracy is to extract the data floor by floor. All BGSF line items and DGSFs are added together and compared to the BGSF total floor plate area. These two numbers should fall within the 1 percent rule mentioned above. If they do not, the researcher is able to determine which floor is not calculated accurately before extracting and sorting all data to generate the final project report. This method further verifies the accuracy level of the measurements.


Autodesk Revit Step-by-Step Instructions

Creating Area Schemes

1. Select “Architecture” tab

a. “Room and Area” panel drop-down

b. “Area and Volume Computations”

2. In the “Area and Volume Computations” dialog, select “Area Schemes” tab

3. Select “New”

4. Enter name and description for the new area scheme

5. Select “OK”

Creating Area Plans


a. “Room and Area” panel

b. Area drop-down

c. Area plan

2. In the “New Area Plan” dialog, select an area scheme

3. Select a level for the area plan view

4. Select “OK”

a. Revit will prompt to automatically create boundary lines associated with all external walls. Select “NO” to manually create boundaries based on the methodology.

Creating Area Boundaries and Adding an Area to Area Plans

1. Open an “Area Plan” view



b. Area drop-down

c. Area boundary line

3. Draw or pick area boundaries

a. Clear “apply area rules”

b. Select boundary defining walls

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b. Area drop-down

c. Select “Area”

5. Click in the area plan to add an area to the project

Adding a Room



b. Select “Room”

2. Click in the floor plan to add a room to the project

Adding a Parameter

1. Select “Manage” tab

a. Settings

b. Select “Project Parameters”

2. In the dialog box, select “Add”

3. In Parameter Properties dialog box:

a. “Parameter Type,” select project parameter

b. “Parameter Data,” add name

c. “Type of Parameter,” select “Text”

d. “Group Parameter Under,” Select “Text”

4. Under Categories

a. For room parameter — select “Rooms”

b. For area plans — Select “Areas”

Creating a Schedule

1. Select “View” tab

a. Create panel

b. Schedules drop-down

c. Select schedules and quantities

2. In the “New Schedule” dialog, select R\rooms component from the category list. Change the name of the schedule as necessary.


3. Select “Schedule Building Components”

4. Specify the phase and click “OK”

5. In the “Schedule Properties” dialog, specify and add the desired fields

6. Click “OK”

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Appendix C

Suggested List of Departments

To consistently report the departmental area, the Texas A&M University research team needed to develop consistent terminology for departmental names. A master listing was kept, which grew as more projects were measured.

The value of this list, or any like it, will vary over time. As hybrid facilities blur the boundaries between surgery, imaging, and endoscopy, for example, allocation of space to one or more of these categories, or to a new category, will require a decision from those making the calculations.


Departments Square Footage Other Names and Interpretations

Patient units

Acute care unit

Cardiac

Medical/surgical Use medical/surgical for general acute care beds

Oncology

Orthopedic

Pediatric

Intensive care unit CCU – critical care unit

Cardiac ICU

Coronary CCU

CV ICU

General ICU

Medical ICU

Neuro ICU

Pediatric ICU PICU, peds ICU

Respiratory ICU

Surgical ICU

Trauma ICU

Intermediate care unit IMCU, step down, progressive care, telemetry

Long term acute care LTAC

Psychiatric care

Skilled nursing

Ambulatory care

Obstetrics

Ante partum

C-section

LDR

LDRP

Neonatal ICU Newborn ICU, NICU

Newborn nursery Not included in bed count, special care nursery included

Post partum

Shared support * rooms that do not belong to any one department related to obstetrics care

SRMC

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Procedure departments

Emergency department total

Emergency department

Clinical decision Short stay, 23 hr. stay

Observation

Pediatric ED

Dialysis

Endoscopy Bronchoscopy, gastrointestinal

Hyperbaric suite

IV therapy

PACU

Pheresis

Pre-operative care unit Pre-OP

Pre/recovery unit Combination unit, peri-operative unit

Rehabilitation total

Rehabilitation

Hydrotherapy

Respiratory therapy

Secondary recovery

Surgery department total

Surgery

Ambulatory surgery

Interventional imaging



Diagnostic departments

Cardiac cath.

Cardiology EKG

Imaging

Radiology

Nuclear medicineBreak out separately if substantial or if called out by firm. Don’t measure separately if buried in main department.

Women’s imagingBreak out separately if substantial or if called out by firm. Don’t measure separately if buried in main department.

Neurodiagnostics EEG, epilepsy monitoring

Pathology

Clinical laboratoryMay include blood draw unless blood draw tied to admitting or pre-admission testing

Satellite lab. Could also be decentralized blood draw

Morgue Includes body hold room

Pre-admission testing May include blood draw

Pulmonary function

Urodynamics

Centers of excellence Depts. big enough to have a large dept. boundary or designated exterior entrance; ambulatory like

Cancer center total

Cancer center

Oncology/chemotherapy Treatment and infusion

Radiation therapy

Cardiac/heart center

Clinics

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Support services

Biomedical engineering Equipment maintenance

Building maintenance Electrician, carpenter, maintenance, etc.

Central sterile processing

Engineering/facility management

Operations offices

Environmental services Janitorial and housekeeping services not housed in a dept.

Food and nutrition Watch for elements near loading dock that are kitchen related; includes kitchen and dining

Linen Laundry; break out dept. separate from materials mgmt.

Materials management Includes waste management, biohazard room

Pharmacy total

Pharmacy

Satellite pharmacy

Security

Staff support

Administrative and public

Administrative/medical staff

Business offices

Chapel Includes chaplaincy

Conference/education Patient and staff education

Gift shop

Information technology

Medical records HIM, health information management

On call

Patient admitting May include blood draw

Public spaces

Lobby/reception/public toilets

Concourse/gallery/main street Full NSF and DGSF measured — do not remove circulation

Registration

Resource center Library or patient resource center, typical from Planetree model

Retail

Volunteer services

Total:

Shell space:

Grand total:



BGSF

Mechanical Includes major shafts

Electrical

Communication distribution

Non-departmental corridors

Stairs

Vertical transport Elevators

Misc. structure

Exterior covered areas

Exterior wall thickness

BGSF total:

Dept: building

Related areas not in calculations

Faculty offices Calculate DGSF only — similar to shell

Research areas Calculate DGSF only — similar to shell

Central plant CUP, power plant

Canopies 1/2 area of canopy (not including supports) + full area of canopy supports

Parking Only parking that is determined to be located within the building envelope. Does not include attached or nearby garages.

Tunnels Covered walkway only = 1/2 area; Total enclosed = full area; If no tunnel given = N/A

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