Private rooms are the trend in hospital planning and design. The advantages of single occupancy rooms are cited as improvements in patient care, a reduction in the risk of cross infection, and greater flexibility in operation. However, it is important to view and interpret the benefits of single-occupancy rooms within the context of patient care issues, other environmental changes and management policy changes in order to bring about desired and sustainable outcomes

First and operating costs

Literature focusing on comparative first costs for single and multi-occupancy rooms is scarce. The limited number of articles exploring the relationship between first costs and operating costs indicates that operating costs are proportionately more than the capital cost of hospitals, and this is true even for cost estimates within the first three years of construction.

Operating costs are reduced in single patient rooms compared with multi occupancy rooms due to reduction in transfer cost, higher bed occupancy rates and reduction in labor cost. However, this cost reduction can be better achieved when conversion to single room is paired with other healing environment design principles. Cost savings because of reduction in transfers is particularly applicable with acuity-adaptable rooms (Hill-Rom, 2002; Ulrich, 2003).

Even with higher first or unit costs of construction, furniture, maintenance, housekeeping, energy (e.g., heating and ventilation) and nursing, single occupancy can match the per diem cost of multi-bed rooms because of the higher occupancy rates (Bobrow & Thomas, 2000; Delon & Smalley, 1970).

A patientís length of stay is associated with hospital costs. Research demonstrates that patientsí length of stay in private rooms is shorter, which in turn reduces costs (Anonymous, 2000; Hill-Rom, 2002).

In comparison to multi-occupancy rooms, medication errors are reduced in single occupancy rooms, resulting in reduced costs (Anonymous, 2000; Bilchik, 2002; Bobrow & Thomas, 2000; Hill-Rom, 2002; Morrissey, 1994).

Infection control and falls prevention

Infected patients or patients highly susceptible to infections need to be isolated in private rooms with proper ventilation systems and barrier protections in order to stop infection from spreading or to reduce the possibility of development of new infections. (Anderson et al., 1985; Muto et al. 2000; OíConnell & Humphreys, 2000; Sehulster & Chinn, 2003).

Prolonged hospitalization is a risk factor for hospital-acquired infections. Additionally, intra-hospital spread of infection may result from patients being transferred to more than one ICU or more than one floor during their hospitalization.

Patientsí length of stay in hospitals and cost is increased due to nosocomial infection (Zhan & Miller, 2003; Press Ganey Associates, 2003; Pittet, Tarara & Wenzel, 1994). Ongoing research is demonstrating that nosocomial infection rates are low in private rooms with proper design and ventilation systems (The Center for Health Design, 2003).

Caution must be used when interpreting results from infection control literature, because the findings and recommendations are often based on retrospective investigations of infection outbreaks in particular settings and are tailored towards those settings. They may or may not be applicable to other settings.

Patient falls

Patients who require constant supervision (as in the case of frail and/or delirious patients) are more likely to fall in hospitals; multi-occupancy patient rooms with increased surveillance may be more appropriate for these patients (Jones & Simpson, 1991; Sutton, 1994; Tutuarima et al., 1997).

Most falls occur in patient rooms, among elderly patients, and when patients are alone or while attempting to go to the bathroom. (Hendrich et al., 1995; Langer, 1996; Pullen, Heikaus, & Fusgen, 1999). However, if provision is made for family members in patient rooms, falls may be reduced due to assistance from family. It is easier to accommodate family in private rooms than in semi-private rooms (Ulrich, 2003).

Mixed results were obtained in studies and surveys of patientsí preferences for room design. The majority of 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 (Douglas, Steele, Todd, & Douglas, 2002; Kirk, 2002; Pease & Finlay, 2002; Reed & Feeley, 1973).

Single-occupancy rooms increase patientsí privacy, which provides patients with control over personal information, an opportunity to rest, and an opportunity to discuss their needs with family members and friends. The number of patients in a room, the presence of visual screening devices, the location of the bathroom, and the placement of the patientís bed all impact privacy (Bobrow & Thomas, 1994; Burden, 1998; Morgan & Stewart, 1999).

The influence of room occupancy on type of pain medication usage is mixed. Some researchers discovered that patients in private rooms were more likely to use narcotics than were similar patients in semi-private rooms. This may be due to decreased environmental stimuli in private rooms. Whereas, others have demonstrated that pain medication intake is less in single occupancy rooms. (Dolce et al., 1985; Lawson & Phiri, 2000).

It is claimed that health care professionals have more private, and in many cases, more thorough consultation with patients in single rooms than with patients in multi-occupancy units (Ulrich, 2003). Research in this area of patient confidentiality and patient consultation is limited.

Patient stress can be reduced if preoperative patients are assigned to rooms with postoperative or non-surgical patients (Kulik, Moore, & Mahler, 1993). Multiple occupancy rooms are associated with lack of privacy, higher noise level and sleep disturbance (Hilton, 1985, Ulrich, 2003).

Universal rooms or acuity adaptable rooms are a current trend in design, especially in hospitals that are promoting patient-centered care and family participation in the patientís healing program. These rooms are all private rooms. Results from a limited number of studies have indicated that medication errors, patient falls and procedural problems may be reduced in acuity adaptable rooms (Bobrow & Thomas, 2000; Gallant & Lanning, 2001; Hill-Rom, 2002; Spear, 1997). However, these results may be specific to the particular institutions studied. More detailed study with examples from multiple hospitals is required before drawing specific conclusions.

Sources of stress for patients are: perceived lack of control, lack of privacy, noise, and crowding (Shumaker & Pequegnat, 1989). Excess noise can lead to increased anxiety and pain perception, loss of sleep, and prolonged convalescence (Baker, Garvin, Kennedy, & Polivka, 1993; Cys, 1999; Hilton, 1985). Single rooms often afford more privacy, reduction of noise and less crowding. Control is greater in private rooms, as patients can adjust settings according to their needs (Shumaker & Reizensten, 1982).

Music can also help reduce patientsí stress. Patients can listen to music in private rooms without disturbing their roommates (Cabrera & Lee, 2000).

Crowding can contribute to higher blood pressure. The use of private rooms often minimizes the patientsí sense of crowding (Baum & Davis, 1980; DíAtri, 1975).

Management, Hospital Design and Therapeutic Impacts

Single - occupancy rooms increase patientsí privacy, which provides patients with control over personal information, an opportunity to rest, and an opportunity to discuss their needs with family members and friends. The number of patients in a room, the presence of visual screening devices, the location of the bathroom, and the placement of the patientís bed all impact privacy (Bobrow & Thomas, 1994; Burden, 1998; Morgan & Stewart, 1999).

The influence of room occupancy on type of pain medication usage is mixed. Some researchers discovered that patients in private rooms were more likely to use narcotics than were similar patients in semi - private rooms. This may be due to decreased environmental stimuli in private rooms. Whereas, others have demonstrated that pain medication intake is less in single occupancy rooms. (Dolce et al., 1985; Lawson & Phiri, 2000).

It is claimed that health care professionals have more private, and in many cases, more thorough consultation with patients in single rooms than with patients in multi-occupancy units (Ulrich, 2003). Research in this area of patient confidentiality and patient consultation is limited.

Mixed results were obtained in studies and surveys of patientsí preferences for room design. The majority of 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 (Douglas, Steele, Todd, & Douglas, 2002; Kirk, 2002; Pease & Finlay, 2002; Reed & Feeley, 1973).

Patient stress can be reduced if preoperative patients are assigned to rooms with postoperative or non - surgical patients (Kulik, Moore, & Mahler, 1993). Multiple occupancy rooms are associated with lack of privacy, higher noise level and sleep disturbance (Hilton, 1985, Ulrich, 2003). - Universal rooms or acuity adaptable rooms are a current trend in design, especially in hospitals that are promoting patient - centered care and family participation in the patientís healing program. These rooms are all private rooms. Results from a limited number of studies have indicated that medication errors, patient falls and procedural problems may be reduced in acuity adaptable rooms (Bobrow & Thomas, 2000; Gallant & Lanning, 2001; Hill-Rom, 2002; Spear, 1997). However, these results may be specific to the particular institutions studied. More detailed study with examples from multiple hospitals is required before drawing specific conclusions.

Sources of stress for patients are: perceived lack of control, lack of privacy, noise, and crowding (Shumaker & Pequegnat, 1989). Excess noise can lead to increased anxiety and pain perception, loss of sleep, and prolonged convalescence (Baker, Garvin, Kennedy, & Polivka, 1993; Cys, 1999; Hilton, 1985). Single rooms often afford more privacy, reduction of noise and less crowding. Control is greater in private rooms, as patients can adjust settings according to their needs (Shumaker & Reizensten, 1982).

Music can also help reduce patientsí stress. Patients can listen to music in private rooms without disturbing their roommates (Cabrera & Lee, 2000). - Crowding can contribute to higher blood pressure. The use of private rooms often minimizes the patientsí sense of crowding (Baum & Davis, 1980; DíAtri, 1975).

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