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Single rooms ‘no safer’ than multi-bed hospital wards

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There is little evidence to suggest that hospitals with only single rooms for patients are any safer than those with more traditional ward structures, according to researchers.

The first NHS acute hospital in the UK to have 100% single in-patient rooms in all wards and high-acuity areas opened at Pembury near Tunbridge Wells in Kent during 2011. 

“These results provide no evidence of either benefit or harm arising from use of 100% single room accommodation”

Study authors

Since then, researchers and clinicians have debated the relative benefits and drawbacks of moving to single room only patient accommodation. For example, nurses have raised concerns that single rooms risk damaging patient safety and team work, but patients generally prefer having their own room.

The latest study, by a team of researchers from the UK and Switzerland, assessed the impact on safety outcomes of the move to the all single room acute Tunbridge Wells Hospital at Pembury when it was newly built.

They looked at levels of falls, pressure ulcers, medication errors and rates of MRSA and C difficile over 36 months across three wards – acute assessment, older people and surgical.

In the older people’s ward, falls, pressure ulcers and C. diff rates increased. However, the case mix of the older people ward also changed substantially in the same period, with the length of stay decreasing from 37 to 20 days and the proportion of orthopaedic trauma patients increasing from 4.6% to 24.8%.

In the acute assessment ward, falls and medication errors increased temporarily but returned to pre-move levels after seven to nine months. In the same period, length of stay also increased from 1.2 to 1.4 days, and some changes in case mix could be observed.

Maidstone and Tunbridge Wells NHS Trust

Single rooms ‘no safer’ than larger hospitals wards

Tunbridge Wells Hospital at Pembury

MRSA infections decreased from 279 cases in the first quarter of 2010 to 92 in the fourth quarter of 2012, but the study authors noted that the overall national trend was similar.

The researchers said they found “plausible” alternative explanations, such as case-mix changes or disruption through the re-organisation of the services after the move to the 100% single room hospital, for variations observed in safety events.

They said: “These results provide no evidence of either benefit or harm arising from use of 100% single room accommodation in terms of these safety-related outcomes.

“While the results of a single observational study with intrinsic limitations cannot conclusively demonstrate no safety effect, the results correspond with the wider literature, which shows a link between single rooms and reduced infection rates in intensive care but not in general medical or surgical populations,” they said in Journal of Health Services Research and Policy.

They added: “The transient rise in falls associated with the move to all single rooms suggests that there is a need to mitigate risk during any transition period.”

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