What’s New in the Patient Safety World


June 2009

Are Single Hospital Rooms Controversial?



Most of you know that the trend in hospital design has been toward providing more single patient rooms. That has largely been driven by the epidemic of hospital-acquired infections such as MRSA, VRE, and C. diff. but there are a variety of other evidence-based concepts suggesting single patient rooms should be the wave of the future.


In the past year we have seen two monographs on evidence-based hospital design, The Joint Commission’s “Guiding Principles for the Development of the Hospital of the Future” and a paper in this year IHI’s Innovation Series entitled “Using Evidence-Based Environmental Design to Enhance Safety and Quality”. And since we are big on John Nance this month, his description of the patient rooms and relationship to nursing presence in his new book (see our June 2, 2009 Patient Safety Tip of the Week “Why Hospitals Should Fly…John Nance Nails It!”) uses heavily the concepts in these works.


But is everyone on board? Of interest, two publications in the lay press last month just days apart but an ocean apart seemed to espouse different views. An article in the New York Times focused on the benefits of single-patient rooms. Benefits include increased privacy, improved sleep, and reduced infections and stress. But an article in The Herald highlighted a new Scottish study that more than half of hospital patients in Scotland would prefer to stay in a ward than a private room. They note that some of the prior studies showing that patients would prefer single private rooms had been done on younger, primarily surgical patients. They feel that their new study, done on older mixed med/surg patients, may be more reflective of the general hospital population. They point out that the Scottish Single Room Provision Steering Group Report, which mandated all new hospitals in Scotland should be built with only single beds, pointed out that the evidence base is, in fact, not terribly strong.


Much of the evidence in the literature comes from two studies (Ulrich et al 2004) and (Chaudhury et al 2005). Read them and decide for yourself the strength and relative merits of the evidence base.


Perhaps the “loneliness” factor cited in The Herald article can be overcome by design features that can still occur with single rooms. Many of the features described in John Nance’s book where patients are kept in proximity not only to other patients but also to their primary nurse are probably important design features.


At any rate, all the above articles are good reading since they get you to think about incorporating patient safety and communication principles into the design of new things.





Guiding Principles for the Development of the Hospital of the Future.

The Joint Commission. 2008




Sadler BL, Joseph A, Keller A, Rostenberg B. Using Evidence-Based Environmental Design to Enhance Safety and Quality. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009




Health Outcomes Driving New Hospital Design


NY Times Published: May 18, 2009




Carolyn Churchill. Hospital patients want wards rather than private rooms. The Herald. Web Edition. May 21 2009




The Scottish Government. Single Room Provision Steering Group Report. December 2008.




Ulrich R, Quan X, Zimring C, Joseph A, Choudhary R. The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity.

September 2004




Chaudhury H, Mahmood A, Valente M. Advantages and disadvantages of single- versus multiple-occupancy rooms in acute care environments: A review and analysis of the literature. Environment and Behavior 2005; 37(6): 760-786












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