New Guidelines to Require Single-Patient Hospital Rooms

Goal is to reduce nosocomial infections, cut down medication and other errors, increase privacy

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PATIENT SAFETY INITIATIVES are about to trigger another major change to the American healthcare system—a standard for single-room occupancy in hospitals.

On March 22, 2006, The Wall Street Journal (WSJ) reported that the American Institute of Architects (AIA) and the Facility Guidelines Institute (FGI) are preparing to issue new guidelines for hospital construction. Due out in June, the new “Guidelines for Design and Construction of Hospital and Health Care Facilities” will call for single-room occupancy for all patients.

The primary goal is to reduce the risk of nosocomial infections. However, the single room standard is expected to also reduce medication and other types of errors, cut down on the number of patient falls, and increase patient privacy.

Not A Radical Requirement

Guidelines requiring single-patient rooms are not as radical as they might first appear. The WSJ spoke to healthcare architects and construction companies and determined that the hospital industry is expected to spend about $30 billion in scheduled hospital construction projects in 2009. A majority of these construction projects are already planned to include 100% single-patient rooms.

This will trigger a steady evolution away from two-patient rooms toward single occupancy rooms. That’s because healthcare facilities already face competitive pressure to move patients into private rooms.

To attract patients, growing numbers of hospitals have begun to offer single-occupancy rooms, more amenities, and more comfortable accommodations so that family members can stay overnight as well. What’s more, affluent baby boomers prefer the additional privacy and often are willing to pay extra for private rooms.

The new hospital construction guidelines will have teeth. Hospital building authorities in 42 states, the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) in Chicago, and several federal agencies use the guidelines, which are updated every four years, as a standard when reviewing construction designs and plans for health- care facilities.

Laboratory administrators and pathologists should be aware of several factors driving this new development. Obviously the cost to construct single-patient rooms is more than double-occupancy rooms. But a growing number of studies show that inpatients housed in single occupancy rooms have better outcomes—and that the overall cost of care is reduced enough to offset the higher construction costs.

Patients recover faster in private rooms. They get fewer infections and are less likely to get the wrong medication from a hospital staff member confused about which patient in a room gets which medication.

Interestingly, having all single rooms is likely to increase occupancy rates in hospitals. That’s because hospitals would no longer need to pair roommates by sex. Often, about 10% or more beds in hospitals with semiprivate rooms are unoccupied.

Patients in private rooms have fewer falls, which greatly increase hospital costs each year. When a patient stays in a private room, there are often friends and family in attendance to help when the patient has to use the bathroom, for example.

Advocates mince no words about the benefits of private rooms. Because of the additional costs from infections and other risks in semi-private rooms, Craig Zimring, Ph.D., of the Georgia Institute of Technology College of Architecture, stated that “we can’t afford to operate U.S. hospitals that have anything other than private rooms.”

His views are mirrored by Scot Latimer, President of the health architecture group at Kurt Salmon Associates, who stated that “unless there are extenuating circumstances, for most hospitals the semiprivate room will be a thing of the past.” Despite the higher costs of building hospitals with 100% single-patient rooms, Latimer noted that “they pay for themselves very quickly and are much less expensive to operate” in the long run.

THE DARK REPORT considers the recommendation of single-patient rooms to be a significant. It is a powerful example of how patient safety initiatives will reshape the healthcare system as we know it. Efforts to accurately measure outcomes are producing detailed information about a variety of healthcare procedures and processes. This accurate and detailed information is being used to justify far-reaching changes to our healthcare system.

Patients Do Better In Private Rooms

WHEN ISSUING THE RECOMMENDATION for private rooms in hospitals, the American Institute of Architects (AIA) reviewed research on patient preferences.

In its findings, the AIA said that surveys show most patients prefer single rooms because of greater privacy, reduced noise, reduced embarrassment, improved quality of sleep, opportunity for family members to stay, and avoidance of upsetting other patients. Not surprisingly, multiple occupancy rooms are associated with a lack of privacy, more noise, and sleep disturbance.

The AIA referenced research that shows hospitals are a great source of stress for patients. The reasons patients feel stressed in hospitals include a perceived lack of control, lack of privacy, noise, and crowding. Excess noise can lead to increased anxiety and pain perception, loss of sleep, and prolonged convalescence.

In contrast, the AIA’s conclusion is that single rooms often afford more privacy and help reduce noise and crowding levels. Crowding contributes to higher blood pressure among patients, and research shows that private rooms often minimize a patient’s sense of crowding.

In addition, patients in private rooms have more control over certain elements, such as the volume on the television and how much light comes in through the curtains. Researchers say that music can also help reduce stress among patients. In private rooms, patients can listen to music without disturbing other patients.

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