ReviewDo patients in hospitals benefit from single rooms? A literature review
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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