Elsevier

Health Policy

Volume 84, Issues 2–3, December 2007, Pages 153-161
Health Policy

Review
Do patients in hospitals benefit from single rooms? A literature review

https://doi.org/10.1016/j.healthpol.2007.06.002Get rights and content

Abstract

In the context of growing attention for ‘healing environments’ and ‘evidence based design’ an increasing number of hospitals have decided to provide single-bedded rooms. However it remains unclear to what extent these policy decisions are based on scientific evidence. The aim of this study is to review the literature on benefits of single patient rooms for patients.

The following outcome measures were used: privacy and dignity, patient satisfaction with care, noise and quality of sleep, hospital infection rates, recovery rates, and patient safety issues. We selected 25 studies for review. Randomized controlled trials on this subject were scarce, but other empirical studies have been found. We found that single rooms have a moderate effect on patient satisfaction with care, noise and quality of sleep, and the experience of privacy and dignity. Conflicting results have been found on hospital infection rates. Some studies did not show significant differences, while others concluded that single rooms decrease the risk of hospital infections. Evidence on recovery rates and patient safety was lacking.

Too few sound studies were found to evaluate the effects of single patient rooms thoroughly. Future research should build the body of knowledge on single-bedded rooms in order to explore their impact on well-being and healing on both patients and staff. Also consequences of single rooms to management of care should be explored. Research should support policy making by exploring, indicating and initiating improvements in patient housing and quality of care.

Introduction

Traditionally in post World-War II hospitals the majority of the patients are housed in rooms with one or three roommates. The design of these hospitals is mainly functional: unified units and standardized patient rooms [1]. Nowadays hospital architecture and the configuration of the patient room are changing. In the early 1990s concepts of patient-centered care and ‘healing environments’ emerged [1], [2]. Over the last few years a greater emphasis has been placed on the impact of patients’ physical and psychological comfort on healing and satisfaction. Examples are light and sight, sound, ambiance, (fresh) air, green and nature, ergonomics, and nourishment [2]. Sterile long corridors are painted with soft colors and are decorated with art.

Several studies have shown that healthcare design affects the healing process. Staying on a patient room with a view through a window, for example, may have a positive effect on recovery from surgery [3]. Also physiological measures, for instance blood pressure, seem to react on the hospital environment [4]. A rather new phenomenon in hospital design and construction is the provision of single rooms for patients during hospital stay. Healthcare management is interested in the effects of single rooms in terms of length of stay, the risk of cross-contamination of hospital infections and patient satisfaction with care [5], [6], [7]. Another reason why single rooms are interesting for healthcare organisations is that hospitals are developing a more customer-oriented management approach [8]. Design issues have been applied in order to be responsive to consumers. Being able to deliver personal care may have a positive effect on the market position of the hospital.

Especially in the United States hospitals are increasingly building single rooms [9]. The single patient room is already about to become the standard for the US hospitals [10]. In the UK the NHS has advised that 50–100% of all patient rooms should be single in new hospitals [6], [11]. Also, the Erasmus Medical Center in The Netherlands is now planning to build a hospital with 100% single rooms. At the hospital policy level a growing interest has been noticed regarding the subject of single rooms, even though it is unclear what the effects of these single rooms are. Decisions on building a new hospital and the choice for single rooms have long lasting consequences. Therefore it is important to know the evidence to support these decisions. This study aims at reviewing the existing literature to explore the benefits of single rooms for patients during hospitalisation.

Section snippets

Domains and outcome measures

In this literature review we explore the benefits of single rooms for patients during their hospital stay on the basis of six outcome measures. The outcome measures are all changes that may accompany staying in a single room. Single rooms have been regarded as part of a ‘healing environment’. Since Ulrich et al have conducted a study to link ‘healing’ hospital design to patient outcomes the effects of physical environment have been paradigmatically categorized into general research subjects [12]

Results

During the initial literature search we retrieved a total of 103 articles. Sixty-two have been immediately excluded since they did not refer to single patient rooms in any way. From the remaining articles, it was found that some have not explored effects of the use of single rooms for patients. In the end 25 articles were included in our review-study.

First four (randomized) controlled studies and one systematic review have been found. Second nine articles on either quasi-experimental studies,

Discussion

The aim of this study was to assess the available evidence of the effects of single patient rooms. This literature review shows that research on single rooms is scarce.

Effects of single rooms mostly became apparent by research done on healing environments (effects of light, sound, music and art), while the concept was seldom studied as a separate research subject.

Hardly any controlled trials have been conducted and the methodological quality of the studies retrieved gives insufficient evidence

Conclusion

Addressing the issue of single rooms has become more and more important with regard to the increasing policy decisions that have taken place on the hospital level. We have investigated the effects of single rooms for patients by reviewing the literature. It was been found that evidence is scarce, due to missing research on almost all outcome measures reviewed. Consequently the question ‘do patients benefit from single rooms’ cannot be answered yet. Evidence on the effects of single patient

Acknowledgement

We thank the Research group on Quality (RoQ) for their comments on earlier versions of the manuscript.

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