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Patient Safety Tip
of the Week
October
25, 2022
Which
Room Do You Want?
If
you are hospitalized, you’d like to think that it doesn’t matter what room you
are put into. But, in reality, your risks may depend
upon a number of features of that room.
Researchers
from the University of Michigan (Mead 2022) studied almost 4000 patients who underwent
13 high-risk surgical procedures at the University of Michigan Hospital. They
looked at clinical outcomes as related to certain features of patient rooms - window
or no window, single occupancy, double occupancy, distance to the nursing
station, and line of sight to clinicians.
Key
findings of that study:
·
Mortality rates for high-risk procedures varied
across room design features and room type.
·
Room features that influenced clinical outcomes
after surgery included distance from a nursing station, single room occupancy,
and having a direct line of sight where clinicians can see into the room.
·
After adjusting for patient comorbidities and
complexity of the operation, mortality rates were 20% higher (odds ratio 1.2)
if patients were admitted to a hospital room without a window than if they were
put in a room with a window.
·
For patients staying in a room without a window,
30-day mortality rates were 10% higher (odds ratio 1.1).
·
Though mortality rates varied across room
design, mortality rates did not vary by room type after accounting for length
of stay, suggesting that length of stay does not account for differences in
mortality.
A
2010 study looking at ICU design (Leaf 2010) compared patient mortality between rooms
that were not visible from the MICU central nursing station (low-visible rooms
or LVR’s) to high-visible rooms (HVR’s). The researchers found that severely
ill patients (those with Acute Physiology and Chronic Health Evaluation II
scores > 30) had significantly higher hospital mortality when admitted to an
LVR than did similarly ill patients admitted to an HVR. ICU mortality showed a
similar pattern.
Most
hospitals have probably already been putting some of their sicker patients in
rooms with these features. The University of Michigan study found that sicker
patients were more likely to get single rooms, closer to a nursing station and
within direct line of sight, and a window view.
The
UM researchers are looking to replicate their study across other hospital
systems.
We do
have one caveat: one unintended consequence is that there is a risk of alarm
fatigue if the rooms are too close to nursing station. We’ve seen instances
where alarm volumes have been lowered in those rooms because the noise in the
nurses’ or physicians’ work areas has been distracting.
Of
course, there have been other studies looking at the impact of room design on
patient outcomes, particularly as related to hospital-acquired infections (HAI’s).
McDonald et al. (McDonald 2019) looked at HAI rates after inpatients in an
older, tertiary care, 417-bed hospital in Montréal, Canada, that consisted of
mainly mixed 3- and 4-person ward-type rooms were moved to a new 350-bed
facility with all private rooms. The new hospital had 100% single-patient rooms
equipped with individual toilets and showers and easy access to sinks for hand
washing. The move appeared to be associated with a sustained decrease in the
rates of new MRSA and VRE colonization and VRE infection. However, the move was
not associated with a reduction in CDI or MRSA infection. Another study (O’Neill 2018) found that patients who stay in private
rooms as opposed to double occupancy rooms have a reduced risk of central line
infections.
And
our many columns on delirium have pointed out the importance of having a window
to the outside to promote normal day/night cycles as one factor combating the
risk of delirium.
We
still have a lot to learn about the impact of patient rooms on clinical outcomes.
The Michigan study has implications for future hospital design, but it also has
important implications for hospital bed triage.
References:
Mead
MJ, et al. Evaluating Mortality and Hospital Room Design after High-Risk Inpatient
Surgery. Scientific Forum. American College of Surgeons Clinical Congress 2022.
As reported by the ACS October 16, 2022
Leaf
DE, Homel P, Factor PH. Relationship between ICU design and mortality. Chest 2010;
137(5): 1022-1027
https://journal.chestnet.org/article/S0012-3692(10)60225-5/fulltext
McDonald
EG, Dendukuri N, Frenette C, et al. Time-Series Analysis of Health
Care–Associated Infections in a New Hospital with All Private Rooms. JAMA
Intern Med 2019; Published online August 19, 2019
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2747870
O’Neill
L, Park S-H, Rosinia F. The role of the built environment and private rooms for
reducing central line-associated bloodstream infections. PLOS One 2018;
Published: July 27, 2018
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201002
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