Building towards single sex hospitals

Some of the solutions UK hospital, community and mental health trusts have found to change the physical environment to meet the target for treating all NHS patients in single-sex accommodation

TRUSTS in England are making great strides in meeting NHS targets for single-sex accommodation, according to figures released by the Department of Health. In September 2011, the number of trusts reporting that they had treated no patients in mixed-sex wards had risen to 117, from a total of 167, from 77 in December 2010.

This increase is the outcome of significant efforts by trusts around the country to reconfigure existing wards, recovery rooms and day surgery facility to meet same-sex requirements and to ensure that newly-built facilities deliver the flexibility to maintain patient dignity. Such is the determination of the Department of Health to ensure this is the case that trusts are fined 250 for every patient they do not treat in same-sex accommodation. The way the penalties work is that, even if there is one woman on a ward with three men, the organisation is fined four times over.

In an ideal world we would have a single-sex day surgery. One day we may build another, but that is something that is still under review

At Colchester General Hospital most of the six-bedded bays in existing wards were open to the corridor with no doors. To enable the rooms to be converted to single-sex accommodation, bespoke sliding doors were designed for the trust in consultation with nurses and other staff. The doors slide into a fixed panel on the wall, where there previously was a staff whiteboard. To compensate for the removal of the whiteboard, explains Denise French, the trust's capital projects manager, the doors were made out of whiteboard material, enabling staff to use them for ward notes. The doors are also fitted with a hands-free sensor to exit the room and a button to press when entering from the corridor.

One of the main considerations in the reconfiguration of the wards is the location of bathrooms and toilets. The trust needed to ensure there was a dedicated bathroom and toilet at the end of each ward. One of the solutions was to convert overly-large assisted bathrooms into two rooms, which allowed the trust to create a new bathroom while keeping one assisted bathroom for the ward.

Flexible signage enables each bed area, and bathrooms, to be easily identified as male or female and these can be changed as demand dictates.

The trust is now working on creating single-sex recovery areas in its endoscopy unit. Until the areas are completed, women are being placed in the adjoining former haematology unit, which requires them to use bottled gas.

Also under review is the surgical day unit. Negotiations about how it will be redeveloped to meet the single-sex requirements are still ongoing. However, in the meantime, sliding screens have been fitted at one end to enable the ward to be segregated as required by the case mix daily.

For Portsmouth Hospitals NHS Trust, its new PFI hospital, which opened in 2009, gave it a headstart in building single-sex accommodation and 88% of patient rooms are en-suite. However, an unexpected issue that arose in the new facility concerned the disabled toilets. A gap down the edge of the door created the risk that passersby might be able to see into the cubicle. The trust remedied this by adding brush edges to cover the gap.

In the retained estate, because wards were designed with either six-bed or four-bed bays, it was relatively straightforward to make them single sex. Toilets were assigned to room bays using a racetrack system. Picture signage clearly depicts which toilet is assigned to which gender and hoists were fitted in each room.

"There is no need for patients to go out of their room unless they are going for treatment," says Julie Sprack, head of nursing for musculoskeletal and trust lead for single-sex accommodation.

One challenge for Portsmouth was the medical admissions ward, where meeting other targets initially took priority and reconfiguring the ward had to wait. "We used to have one bay cut in the middle," Sprack says. "Now the ward has been configured into separate single-sex bays.

Remaining challenges for the trust are in day surgery and recovery areas. "In an ideal world we would have a single-sex day surgery unit," Sprach comments. "One day we may build another, but that is something that is still under review."

Male and female patients in these areas are segregated with the use of semi-permanent screens.

Sherwood Forest Hospitals NHS Foundation Trust found a solution for its 56-bed day surgery recovery unit by reconfiguring its use of recliner chairs and trolleys. Rather than having the unit divided into one area with recliner chairs, for more stable patients, and the other with trolleys for those needing a higher level of care, such as piped oxygen, the unit has been reconfigured so there is a larger side and a smaller side, each fitted with both recliner chairs and trolleys. Which end is male and which is female is determined by the daily case mix.

The trust used 112,000 of its funding from the Privacy and Dignity Challenge Fund to deliver minor building works to enable the changes to the unit, including the installation of medical gas pipes to allow oxygen and suction to be administered at new points in the existing space, new nurse call systems, additional data points and power points, new curtain tracks, 'reversible' male and female signs for toilet doors, and core nurse systems.

At Camden and Islington NHS Foundation Trust, regular feedback and input from both service users and nursing staff was used to determine the redesign of the Nancy Swift Ward, part of the trust's mental healthcare of older people (MHCOP) service. Sub groups were convened to discuss issues such as flooring, furniture, colour and decoration.

In the refurbished facility there are now 14 individual rooms, all with en-suite facilities. Previously, the ward had a number of single rooms and several large double rooms with curtains for privacy, there were five toilets, an assisted bathroom and an assisted shower room, all accessed from the one main corridor.

The redesigned ward is clearly divided into male and female areas and there is controlled access to the female area. The dining room, once open to the corridor, is now a self-contained room with a glass brick wall that allows natural light while maintaining privacy from the corridor.

The nursing station has also been moved and is now located in a more central location and there are more computer terminals on the ward, improving both observation and staff availability to patients.

Trusts have developed a range of innovative solutions to create improved environments for patients. And, in the long run, it is the patients that matter.

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