One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs

Abstract

Background and objectivesThere is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs.MethodsMixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms.ResultsTwo-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time.ConclusionsStaff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.

Family members´ experiences of the end-of-life care environments in acute care settings – a photo-elicitation study

“…Numerous efforts have been made to study patient and staff outcomes in relation to specific design characteristics or interventions, including room occupancy (e.g., Maben et al, 2016), the acoustic environment (e.g., Shield, Shiers, & Glanville, 2016), visual contact with nature/landscapes (e.g., Ulrich, 1979), sound and lighting (e.g., Voigt et al, 2017), ergonomic design (e.g., Knibbe & Waaijer, 2012), and the work environment (e.g., Lee & Scott, 2018). Robust research indicates that the design of the care environment has implications for patient safety, communication, coping and experience of stress (Andrade, Lima, Devlin, & Hernandez, 2016; Ulrich et al, 2008).…”

Experiences of Being Hospitalized in a Single Bedroom versus a Four Bedroom: An Interview Study

“…In single bedrooms the staffs is often the patient's main contact given that most patients stay in their room. According to Maben et al patients rarely use dayrooms and therefore interactions with other patients are often absent in wards with only single bedrooms [10]. In conclusion, knowledge about patient's admission in a single bedroom versus a multi bedroom is insufficient and even contradictory.…”

“…Since then, other studies have shown that there seems to be a connection between hospital interior design such as light, music, art on the walls etc and patients' perception of pain, anxiety and length of hospital stay [4][5][6]. Reviews about evidence based health care design conclude that single bedrooms decrease infection rate and promote healing and sleep quality [7][8][9] although conflicting results on infection rate reduction are found by others [3,10].…”

“…Patients enjoy the security of being visible to staff and to each other [10]. On the other hand, being cared for in a single bedroom means that patients can have a feeling of security, because they are able to create a personal environment without disruptive elements.…”

Why evaluate ‘common sense’ quality and safety interventions?

“…Perhaps another apparently common sense intervention is the introduction of single-room accommodation, the impact of which in a hospital based in the English NHS is evaluated by Maben et al 3. By moving staff and patients to a nearby, newly built hospital, the cost and disruption likely to result from converting a hospital from traditional wards and bays to single rooms were avoided, making this intervention relatively straightforward.…”